RESUMEN
BACKGROUND: In yellow fever (YF) endemic areas, measles, mumps, and rubella (MMR), and YF vaccines are often co-administered in childhood vaccination schedules. Because these are live vaccines, we assessed potential immune interference that could result from co-administration. METHODS: We conducted an open-label, randomized non-inferiority trial among healthy 1-year-olds in Misiones Province, Argentina. Children were randomized to one of three groups (1:1:1): Co-administration of MMR and YF vaccines (MMR1YF1), MMR followed by YF vaccine four weeks later (MMR1YF2), or YF followed by MMR vaccine four weeks later (YF1MMR2). Blood samples obtained pre-vaccination and 28 days post-vaccination were tested for immunoglobulin G antibodies against measles, mumps, and rubella, and for YF virus-specific neutralizing antibodies. Non-inferiority in seroconversion was assessed using a -5% non-inferiority margin. Antibody concentrations were compared with Kruskal-Wallis tests. RESULTS: Of 851 randomized children, 738 were correctly vaccinated, had ≥ 1 follow-up sample, and were included in the intention-to-treat population. Non-inferior seroconversion was observed for all antigens (measles seroconversion: 97.9% in the MMR1YF1 group versus 96.3% in the MMR1YF2 group, a difference of 1.6% [90% CI -1.5, 4.7]; rubella: 97.9% MMR1YF1 versus 94.7% MMR1YF2, a difference of 3.3% [-0.1, 6.7]; mumps: 96.7% MMR1YF1 versus 97.9% MMR1YF2, a difference of -1.3% [-4.1, 1.5]; and YF: 96.3% MMR1YF1 versus 97.5% YF1MMR2, a difference of -1.2% [-4.2, 1.7]). Rubella antibody concentrations and YF titers were significantly lower following co-administration; measles and mumps concentrations were not impacted. CONCLUSION: Effective seroconversion was achieved and was not impacted by the co-administration, although antibody levels for two antigens were lower. The impact of lower antibody levels needs to be weighed against missed opportunities for vaccination to determine optimal timing for MMR and YF vaccine administration. TRIAL REGISTRATION: The study was retrospectively registered in ClinicalTrials.gov (NCT03368495) on 11/12/2017.
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Sarampión , Paperas , Rubéola (Sarampión Alemán) , Vacuna contra la Fiebre Amarilla , Fiebre Amarilla , Humanos , Niño , Lactante , Paperas/prevención & control , Argentina , Vacuna contra el Sarampión-Parotiditis-Rubéola , Anticuerpos Antivirales , Rubéola (Sarampión Alemán)/prevención & control , Sarampión/prevención & control , Inmunidad , Vacunas CombinadasRESUMEN
BACKGROUND: Intradermal administration of fractional inactivated poliovirus vaccine (fIPV) is a dose-sparing alternative to the intramuscular full dose. We aimed to compare the immunogenicity of two fIPV doses versus one IPV dose for routine immunisation, and also assessed the immunogenicity of an fIPV booster dose for an outbreak response. METHODS: We did an open-label, randomised, controlled, inequality, non-inferiority trial in two clinics in Dhaka, Bangladesh. Healthy infants were randomly assigned at 6 weeks to one of four groups: group A received IPV at age 14 weeks and IPV booster at age 22 weeks; group B received IPV at age 14 weeks and fIPV booster at age 22 weeks; group C received IPV at age 6 weeks and fIPV booster at age 22 weeks; and group D received fIPV at 6 weeks and 14 weeks and fIPV booster at age 22 weeks. IPV was administered by needle-syringe as an intramuscular full dose (0·5 mL), and fIPV was administered intradermally (0·1 mL of the IPV formulation was administered using the 0·1 mL HelmJect auto-disable syringe with a Helms intradermal adapter). Both IPV and fIPV were administered on the outer, upper right thigh of infants. The primary outcome was vaccine response to poliovirus types 1, 2, and 3 at age 22 weeks (routine immunisation) and age 26 weeks (outbreak response). Vaccine response was defined as seroconversion from seronegative (<1:8) at baseline to seropositive (≥1:8) or four-fold increase in reciprocal antibody titres adjusted for maternal antibody decay and was assessed in the modified intention-to-treat population (infants who received polio vaccines per group assignment and polio antibody titre results to serotypes 1, 2, and 3 at 6, 22, 23, and 26 weeks of age). The non-inferiority margin was 12·5%. This trial is registered with ClinicalTrials.gov, number NCT02847026. FINDINGS: Between Sept 1, 2016 and May 2, 2017, 1076 participants were randomly assigned and included in the modified intention-to-treat analysis: 271 in Group A, 267 in group B, 268 in group C, and 270 in group D. Vaccine response at 22 weeks to two doses of fIPV (group D) was significantly higher (p<0·0001) than to one dose of IPV (groups A and B) for all three poliovirus serotypes: the type 1 response comprised 212 (79% [95% CI 73-83]) versus 305 (57% [53-61]) participants, the type 2 response comprised 173 (64% [58-70]) versus 249 (46% [42-51]) participants, and the type 3 response comprised 196 (73% [67-78]) versus 196 (36% [33-41]) participants. At 26 weeks, the fIPV booster was non-inferior to IPV (group B vs group A) for serotype 1 (-1·12% [90% CI -2·18 to -0·06]), serotype 2 (0·40%, [-2·22 to 1·42]), and serotype 3 (1·51% [-3·23 to -0·21]). Of 129 adverse events, 21 were classified as serious including one death; none were attributed to IPV or fIPV. INTERPRETATION: fIPV appears to be an effective dose-sparing strategy for routine immunisation and outbreak responses. FUNDING: US Centers for Disease Control and Prevention.
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Brotes de Enfermedades/prevención & control , Poliomielitis/inmunología , Vacuna Antipolio de Virus Inactivados/administración & dosificación , Poliovirus/inmunología , Anticuerpos Antivirales/metabolismo , Bangladesh , Femenino , Humanos , Inmunización Secundaria , Lactante , Inyecciones Intramusculares/instrumentación , Masculino , Poliomielitis/prevención & control , Vacuna Antipolio de Virus Inactivados/inmunologíaRESUMEN
The genetic characterization of measles viruses is an important tool for measles surveillance. Reverse cold chain requirements for the transportation of samples to reference laboratories are challenging in resource-limited settings. FTA cards facilitate the transport of virologic samples at ambient temperature as noninfectious material; however, the utility of FTA cards for the detection and genotyping of measles virus from clinical samples has not been evaluated. Throat swabs (TS) and oral fluid (OF) samples were collected from suspected measles cases in the Democratic Republic of the Congo. Virus detection (reverse transcription-quantitative real-time PCR [RT-qPCR]) and genotyping (endpoint RT-PCR) were compared for samples from 238 suspected cases; these samples were either transported using the reverse cold chain or at ambient temperature on FTA cards. Virus detection showed excellent positive agreement for OF samples compared to TS (95.3%; confidence interval [CI], 91.6 to 97.4), in contrast to 79.4% (CI, 73.5 to 84.3) for TS on FTA, and 85.5% (CI, 80.2 to 89.6) for OF on FTA compared to OF samples. Genotyping results obtained for a subset of samples indicated that 77.3% of all TS and 71.0% of OF samples would produce genotype information compared to 41.6% of TS and 41.3% of OF on FTA cards. Similar results were found for 16 measles-negative samples that were confirmed as rubella cases. Measles genotype B3 and rubella genotype 2B were detected. FTA cards have limited utility for virologic surveillance of sporadic cases of measles; however, they can be a useful tool for the expansion of virologic surveillance in countries where the reverse cold chain is not available.
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Virus del Sarampión/aislamiento & purificación , Boca/virología , Faringe/virología , Virus de la Rubéola/aislamiento & purificación , Manejo de Especímenes/métodos , República Democrática del Congo , Genotipo , Técnicas de Genotipaje , Humanos , Sarampión/diagnóstico , Sarampión/virología , Virus del Sarampión/genética , Técnicas de Diagnóstico Molecular , ARN Viral/genética , Refrigeración , Rubéola (Sarampión Alemán)/diagnóstico , Rubéola (Sarampión Alemán)/virología , Virus de la Rubéola/genética , Saliva/virología , Manejo de Especímenes/instrumentaciónRESUMEN
Background: In 2015, a large nationwide measles outbreak occurred in Mongolia, with very high incidence in the capital city of Ulaanbaatar and among young adults. Methods: We conducted an outbreak investigation including a matched case-control study of risk factors for laboratory-confirmed measles among young adults living in Ulaanbaatar. Young adults with laboratory-confirmed measles, living in the capital city of Ulaanbaatar, were matched with 2-3 neighborhood controls. Conditional logistic regression was used to estimate adjusted matched odds ratios (aMORs) for risk factors, with 95% confidence intervals. Results: During March 1-September 30, 2015, 20 077 suspected measles cases were reported; 14 010 cases were confirmed. Independent risk factors for measles included being unvaccinated (adjusted matched odds ratio [aMOR] 2.0, P < .01), being a high school graduate without college education (aMOR 2.6, P < .01), remaining in Ulaanbaatar during the outbreak (aMOR 2.5, P < .01), exposure to an inpatient healthcare facility (aMOR 4.5 P < .01), and being born outside of Ulaanbaatar (aMOR 1.8, P = .02). Conclusions: This large, nationwide outbreak shortly after verification of elimination had high incidence among young adults, particularly those born outside the national capital. In addition, findings indicated that nosocomial transmission within health facilities helped amplify the outbreak.
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Brotes de Enfermedades , Virus del Sarampión/inmunología , Sarampión/epidemiología , Adolescente , Adulto , Factores de Edad , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Historia del Siglo XXI , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Sarampión/historia , Sarampión/prevención & control , Sarampión/virología , Vacuna Antisarampión/inmunología , Mongolia/epidemiología , Oportunidad Relativa , Vigilancia de la Población , Factores de Riesgo , Estaciones del Año , Vacunación/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: Vaccination Week in the Americas (VWA) is an annual initiative in countries and territories of the Americas every April to highlight the work of national expanded programs on immunization (EPI) and increase access to vaccination services for high-risk population groups. In 2011, as part of VWA, Venezuela targeted children aged less than 6 years in 25 priority border municipalities using social mobilization to increase institution-based vaccination. Implementation of social communication activities was decentralized to the local level. We conducted a survey in one border municipality of Venezuela to evaluate the outcome of VWA 2011 and provide a snapshot of the overall performance of the routine EPI at that level. METHODS: We conducted a coverage survey, using stratified cluster sampling, in the Venezuelan municipality of Bolivar (bordering Colombia) in August 2011. We collected information for children aged <6 years through caregiver interviews and transcription of vaccination card data. We estimated each child's eligibility to receive a specific vaccine dose during VWA 2011 and whether or not they were actually vaccinated during VWA activities. We also estimated baseline vaccination coverage, timeliness and 95% confidence intervals (CI), and used chi-square tests to compare coverage across age cohorts, taking into account the sampling design. RESULTS: We surveyed 839 children from 698 households; 93% of children had a vaccination card. Among households surveyed, 216 (31%) caregivers reported having heard about a vaccination activity during April or May 2011. Of the 528 children eligible to receive a vaccine during VWA, 24% received at least one dose, while 13% received all doses due. Overall, baseline coverage with routine vaccines, as measured by the survey, was >85%, with a few exceptions. CONCLUSION: Low levels of VWA awareness among caregivers probably contributed to the limited vaccination of eligible children during the VWA activities in Bolivar in 2011. However, vaccine coverage for most EPI vaccines was high. Additionally, high vaccination card availability and high participation in VWA among those caregivers aware of it in 2011 suggest public trust in the EPI program in the municipality. Health authorities have used survey findings to inform changes to the routine EPI and better VWA implementation in subsequent years.
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Programas de Inmunización/estadística & datos numéricos , Vacunas/administración & dosificación , Preescolar , Femenino , Humanos , Lactante , Masculino , Encuestas y Cuestionarios , VenezuelaRESUMEN
INTRODUCTION: The objectives of this survey were to assess the seroprevalence of antibodies to poliovirus types 1 and 3 and the impact of bivalent (types 1 and 3) oral poliovirus vaccine (bOPV) use in immunization campaigns in northern India. METHODS: In August 2010, a 2-stage stratified cluster sampling method identified infants aged 6-7 months in high-risk blocks for wild poliovirus infection. Vaccination history, weight and length, and serum were collected to test for neutralizing antibodies to poliovirus types 1, 2, and 3. RESULTS: Seroprevalences of antibodies to poliovirus types 1, 2, and 3 were 98% (95% confidence interval [CI], 97%-99%), 66% (95% CI, 62%-69%), and 77% (95% CI, 75%-79%), respectively, among 664 infants from Bihar and 616 infants from Uttar Pradesh. Infants had received a median of 3 bOPV doses and 2 monovalent type 1 OPV (mOPV1) doses through campaigns and 3 trivalent OPV (tOPV) doses through routine immunization. Among subjects with 0 tOPV doses, the seroprevalences of antibodies to type 3 were 50%, 77%, and 82% after 2, 3, and 4 bOPV doses, respectively. In multivariable analysis, malnutrition was associated with a lower seroprevalence of type 3 antibodies. CONCLUSIONS: This study confirmed that replacing mOPV1 with bOPV in campaigns was successful in maintaining very high population immunity to type 1 poliovirus and substantially decreasing the immunity gap to type 3 poliovirus.
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Anticuerpos Antivirales/sangre , Poliomielitis/epidemiología , Poliomielitis/prevención & control , Poliovirus/inmunología , Anticuerpos Neutralizantes/sangre , Estudios Transversales , Femenino , Humanos , India/epidemiología , Lactante , Recién Nacido , Masculino , Vacunas contra Poliovirus/administración & dosificación , Vacunas contra Poliovirus/inmunología , Estudios Seroepidemiológicos , Vacunación/métodosRESUMEN
BACKGROUND: The Democratic Republic of the Congo (DRC) experienced atypical outbreaks of wild poliovirus type 1 (WPV1) infection during 2010-2011 in that they affected persons aged ≥15 years in 4 (Bandundu, Bas Congo, Kasaï Occidental, and Kinshasa provinces) of the 6 provinces with outbreaks. METHODS: Analyses of cases of WPV1 infection with onset during 2010-2011 by province, age, polio vaccination status, and sex were conducted. The prevalence of antibodies to poliovirus (PV) types 1, 2, and 3 was assessed in sera collected before the outbreaks from women attending antenatal clinics in 3 of the 4 above-mentioned provinces. RESULTS: Of 193 cases of WPV1 infection during 2010-2011, 32 (17%) occurred in individuals aged ≥15 years. Of these 32 cases, 31 (97%) occurred in individuals aged 16-29 years; 9 (28%) were notified in Bandundu, 17 (53%) were notified in Kinshasa, and 22 (69%) had an unknown polio vaccination status. In the seroprevalence assessment, PV type 1 and 3 seroprevalence was lower among women aged 15-29 years in Bandundu and Kinshasa, compared with those in Kasaï Occidental. Seropositivity to PVs was associated with increasing age, more pregnancies, and a younger age at first pregnancy. CONCLUSIONS: This spatiotemporal analysis strongly suggests that the 2010-2011 outbreaks of WPV1 infection affecting young adults were caused by a PV type 1 immunity gap in Kinshasa and Bandundu due to insufficient exposure to PV type 1 through natural infection or vaccination. Poliovirus immunity gaps in this age group likely persist in DRC.
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Anticuerpos Antivirales/sangre , Brotes de Enfermedades , Poliomielitis/epidemiología , Poliomielitis/inmunología , Poliovirus/inmunología , Poliovirus/aislamiento & purificación , Adolescente , Adulto , Factores de Edad , República Democrática del Congo/epidemiología , Erradicación de la Enfermedad , Femenino , Humanos , Persona de Mediana Edad , Poliomielitis/prevención & control , Poliomielitis/virología , Embarazo , Topografía Médica , Adulto JovenRESUMEN
CONTEXT: The effect of testosterone on depressive symptoms in men with hypogonadism remains incompletely understood. OBJECTIVE: We assessed the effects of testosterone-replacement therapy (TRT) in improving depressive symptoms in hypogonadal men with and without depressive symptoms enrolled in the TRAVERSE cardiovascular safety trial. METHODS: A randomized, placebo-controlled, double-blind study was conducted at 316 trial sites. Participants included men, aged 45 to 80 years, with 2 fasting testosterone levels less than 300 ng/dL, 1 or more hypogonadal symptoms, cardiovascular disease (CVD), or increased risk of CVD. We evaluated 3 subgroups of participants: (1) men with rigorously defined, late-life-onset, low-grade persistent depressive disorder (LG-PDD, previously "dysthymia"); (2) all men with significant depressive symptoms (Patient Health Questionnaire-9 Score >4); and (3) all randomly assigned men. Intervention included 1.62% transdermal testosterone or placebo gel. Outcome measures included the proportions of participants (1) meeting criteria for LG-PDD or (2) with significant depressive symptoms; and changes in depressive symptoms, energy, sleep quality, and cognition in testosterone-treated vs placebo-treated men in the 3 subgroups. RESULTS: Of 5204 randomly assigned participants, 2643 (50.8%) had significant depressive symptoms, but only 49 (1.5%) met rigorous criteria for LG-PDD. Among those with LG-PDD, there was no significant difference in any outcome measure between the TRT and placebo groups, possibly reflecting low statistical power. In men with significant depressive symptoms (n = 2643) and in all randomly assigned participants (n = 5204), TRT was associated with modest but significantly greater improvements in mood and energy but not cognition or sleep quality. CONCLUSION: Depressive symptoms are common in middle-aged and older men with hypogonadism but LG-PDD is uncommon. TRT is associated with small improvements in mood and energy in hypogonadal men with and without significant depressive symptoms.
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Depresión , Terapia de Reemplazo de Hormonas , Hipogonadismo , Testosterona , Humanos , Masculino , Testosterona/administración & dosificación , Testosterona/uso terapéutico , Persona de Mediana Edad , Terapia de Reemplazo de Hormonas/métodos , Hipogonadismo/tratamiento farmacológico , Hipogonadismo/psicología , Método Doble Ciego , Anciano , Depresión/tratamiento farmacológico , Anciano de 80 o más Años , Trastorno Depresivo/tratamiento farmacológico , Resultado del TratamientoRESUMEN
Integration of immunizations with hygiene interventions may improve use of both interventions. We interviewed 1361 intervention and 1139 comparison caregivers about hygiene practices and vaccination history, distributed water treatment and hygiene kits to caregivers during infant vaccination sessions in intervention clinics for 12 months, and conducted a followup survey of 2361 intervention and 1033 comparison caregivers. We observed significant increases in reported household water treatment (30% vs 44%, P < .0001) and correct handwashing technique (25% vs 51%, P < .0001) in intervention households and no changes in comparison households. Immunization coverage improved in both intervention and comparison infants (57% vs 66%, P = .04; 37% vs 53%, P < .0001, respectively). Hygiene kit distribution during routine immunizations positively impacted household water treatment and hygiene without a negative impact on vaccination coverage. Further study is needed to assess hygiene incentives, implement alternative water quality indicators, and evaluate the impact of this intervention in other settings.
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Prestación Integrada de Atención de Salud , Desinfección de las Manos , Higiene , Inmunización , Madres , Calidad del Agua , Adulto , Femenino , Desinfección de las Manos/normas , Instituciones de Salud , Humanos , Lactante , Kenia , Masculino , Adulto JovenRESUMEN
BACKGROUND: Hygiene interventions reduce child mortality from diarrhea. Vaccination visits provide a platform for delivery of other health services but may overburden nurses. We compared 2 strategies to integrate hygiene interventions with vaccinations in Kenya's Homa Bay district, 1 using community workers to support nurses and 1 using nurses. METHODS: Homa Bay was divided into 2 geographical areas, each with 9 clinics. Each area was randomly assigned to either the nurse or community-assisted strategy. At infant vaccination visits hygiene kits were distributed by the nurse or community member. Surveys pre- and post-intervention, measured hygiene indicators and vaccination coverage. Interviews and focus groups assessed acceptability. RESULTS: Between April 2009 and March 2010, 39 158 hygiene kits were distributed. Both nurse and community-assisted strategies were well-accepted. Hygiene indicators improved similarly in nurse and community sites. However, residual chlorine in water changed in neither group. Vaccination coverage increased in urban areas. In rural areas coverage either remained unchanged or increased with 1 exception (13% third dose poliovirus vaccine decrease). CONCLUSIONS: Distribution of hygiene products and education during vaccination visits was found to be feasible using both delivery strategies. Additional studies should consider assessing the use of community members to support integrated service delivery.
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Prestación Integrada de Atención de Salud , Higiene , Vacunación , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Servicios de Salud Comunitaria , Prestación Integrada de Atención de Salud/economía , Humanos , Kenia , Calidad de la Atención de Salud , Calidad del AguaRESUMEN
BACKGROUND: Diarrhea is a leading cause of childhood morbidity and mortality in sub-Saharan Africa. Data on risk factors for mortality are limited. We conducted hospital-based surveillance to characterize the etiology of diarrhea and identify risk factors for death among children hospitalized with diarrhea in rural western Kenya. METHODS AND FINDINGS: We enrolled all children <5 years old, hospitalized with diarrhea (≥3 loose stools in 24 hours) at two district hospitals in Nyanza Province, western Kenya. Clinical and demographic information was collected. Stool specimens were tested for bacterial and viral pathogens. Bivariate and multivariable logistic regression analyses were carried out to identify risk factors for death. From May 23, 2005 to May 22, 2007, 1,146 children <5 years old were enrolled; 107 (9%) children died during hospitalization. Nontyphoidal Salmonella were identified in 10% (118), Campylobacter in 5% (57), and Shigella in 4% (42) of 1,137 stool samples; rotavirus was detected in 19% (196) of 1,021 stool samples. Among stools from children who died, nontyphoidal Salmonella were detected in 22%, Shigella in 11%, rotavirus in 9%, Campylobacter in 5%, and S. Typhi in <1%. In multivariable analysis, infants who died were more likely to have nontyphoidal Salmonella (adjusted odds ratio [aOR]â=â6·8; 95% CI 3·1-14·9), and children <5 years to have Shigella (aORâ=â5·5; 95% CI 2·2-14·0) identified than children who survived. Children who died were less likely to be infected with rotavirus (ORâ=â0·4; 95% CI 0·2-0·8). Further risk factors for death included being malnourished (aORâ=â4·2; 95% CI 2·1-8·7); having oral thrush on physical exam (aORâ=â2·3; 95% CI 1·4-3·8); having previously sought care at a hospital for the illness (aORâ=â2·2; 95% CI 1·2-3·8); and being dehydrated as diagnosed at discharge/death (aORâ=â2·5; 95% CI 1·5-4·1). A clinical diagnosis of malaria, and malaria parasites seen on blood smear, were not associated with increased risk of death. This study only captured in-hospital childhood deaths, and likely missed a substantial number of additional deaths that occurred at home. CONCLUSION: Nontyphoidal Salmonella and Shigella are associated with mortality among rural Kenyan children with diarrhea who access a hospital. Improved prevention and treatment of diarrheal disease is necessary. Enhanced surveillance and simplified laboratory diagnostics in Africa may assist clinicians in appropriately treating potentially fatal diarrheal illness.
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Mortalidad del Niño , Diarrea/epidemiología , Hospitalización/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Distribución por Edad , Preescolar , Técnicas de Laboratorio Clínico , Diarrea/diagnóstico , Diarrea/microbiología , Femenino , Humanos , Lactante , Kenia/epidemiología , Modelos Logísticos , Masculino , Análisis Multivariante , Vigilancia de la Población , Factores de RiesgoRESUMEN
OBJECTIVE: To evaluate the effect of integrating ITN distribution on measles vaccination campaign coverage in Madagascar. METHODS: Nationwide cross-sectional survey to estimate measles vaccination coverage, nationally, and in districts with and without ITN integration. To evaluate the effect of ITN integration, propensity score matching was used to create comparable samples in ITN and non-ITN districts. Relative risks (RR) and 95% confidence intervals (CI) were estimated via log-binomial models. Equity ratios, defined as the coverage ratio between the lowest and highest household wealth quintile (Q), were used to assess equity in measles vaccination coverage. RESULTS: National measles vaccination coverage during the campaign was 66.9% (95% CI 63.0-70.7). Among the propensity score subset, vaccination campaign coverage was higher in ITN districts (70.8%) than non-ITN districts (59.1%) (RR=1.3, 95% CI 1.1-1.6). Among children in the poorest wealth quintile, vaccination coverage was higher in ITN than in non-ITN districts (Q1; RR=2.4, 95% CI 1.2-4.8) and equity for measles vaccination was greater in ITN districts (equity ratio=1.0, 95% CI 0.8-1.3) than in non-ITN districts (equity ratio=0.4, 95% CI 0.2-0.8). CONCLUSION: Integration of ITN distribution with a vaccination campaign might improve measles vaccination coverage among the poor, thus providing protection for the most vulnerable and difficult to reach children.
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Prestación Integrada de Atención de Salud/métodos , Mosquiteros Tratados con Insecticida/estadística & datos numéricos , Malaria/prevención & control , Vacuna Antisarampión/administración & dosificación , Sarampión/prevención & control , Control de Mosquitos/métodos , Ropa de Cama y Ropa Blanca , Niño , Protección a la Infancia/estadística & datos numéricos , Preescolar , Estudios Transversales , Femenino , Promoción de la Salud/métodos , Estado de Salud , Humanos , Lactante , Madagascar/epidemiología , Malaria/epidemiología , Masculino , Vacunación Masiva/estadística & datos numéricos , Sarampión/epidemiología , Pobreza/estadística & datos numéricos , Servicios Preventivos de Salud/organización & administración , Factores SocioeconómicosRESUMEN
BACKGROUND: All Member States of the World Health Organization (WHO) European Region have endorsed rubella elimination and congenital rubella syndrome (CRS) prevention. However, Poland has continued high levels of reported rubella. METHODS: We reviewed rubella incidence in Poland since 1966 and analyzed national aggregated surveillance data from the period 2003-2008 and case-based data from 4 provinces from the period 2006-2008. We described CRS cases since 1997 and assessed maternal receipt of vaccine. We reviewed national vaccination coverage from 1992 through 2008. RESULTS: Since 1966, rubella outbreaks have occurred every 4-6 years in Poland. Aggregate and case-based data from the period 2003-2008 indicate that rubella virus transmission has occurred across wide age ranges (from <1 year to 60 years), with disproportionately higher percentage of cases among adolescent boys. Of 18 children with reported CRS cases from 1997 through 2008, 15 (83%) of their mothers had not been vaccinated. Measles-mumps-rubella dose 1 vaccination coverage ranged from 97% to 99%. CONCLUSIONS: Poland had the highest incidence of rubella in the WHO European Region in 2007 and 2008. Rubella occurs predominantly in age and sex cohorts historically not included in vaccination recommendations. The risk for CRS continues. To achieve rubella elimination, supplemental immunization activities among adolescent boys are needed, as is integration with measles elimination efforts.
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Sarampión/prevención & control , Vigilancia de la Población , Vacuna contra la Rubéola/administración & dosificación , Rubéola (Sarampión Alemán)/prevención & control , Adolescente , Adulto , Niño , Preescolar , Brotes de Enfermedades , Femenino , Humanos , Programas de Inmunización , Incidencia , Lactante , Masculino , Sarampión/epidemiología , Vacuna contra el Sarampión-Parotiditis-Rubéola/administración & dosificación , Persona de Mediana Edad , Polonia/epidemiología , Rubéola (Sarampión Alemán)/epidemiología , Síndrome de Rubéola Congénita/epidemiología , Síndrome de Rubéola Congénita/prevención & control , Vacunación , Adulto JovenRESUMEN
Recent reports describe increasing incidence of non-Aspergillus mold infections in hematopoietic cell transplant (HCT) and solid organ transplant (SOT) recipients. To investigate the epidemiology of infections with Mucorales, Fusarium spp., and Scedosporium spp. molds, we analyzed data from the Transplant-Associated Infection Surveillance Network, 23 transplant centers that conducted prospective surveillance for invasive fungal infections during 2001-2006. We identified 169 infections (105 Mucorales, 37 Fusarium spp., and 27 Scedosporium spp.) in 169 patients; 124 (73.4%) were in HCT recipients, and 45 (26.6%) were in SOT recipients. The crude 90-day mortality rate was 56.6%. The 12-month mucormycosis cumulative incidence was 0.29% for HCT and 0.07% for SOT. Mucormycosis incidence among HCT recipients varied widely, from 0.08% to 0.69%, with higher incidence in cohorts receiving transplants during 2003 and 2004. Non-Aspergillus mold infections continue to be associated with high mortality rates. The incidence of mucormycosis in HCT recipients increased substantially during the surveillance period.
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Micosis/epidemiología , Infecciones Oportunistas/epidemiología , Trasplante , Adulto , Antifúngicos/uso terapéutico , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Micosis/tratamiento farmacológico , Micosis/microbiología , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/microbiología , Trasplante/efectos adversos , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Invasive fungal infections (IFIs) are a major cause of morbidity and mortality among organ transplant recipients. Multicenter prospective surveillance data to determine disease burden and secular trends are lacking. METHODS: The Transplant-Associated Infection Surveillance Network (TRANSNET) is a consortium of 23 US transplant centers, including 15 that contributed to the organ transplant recipient dataset. We prospectively identified IFIs among organ transplant recipients from March, 2001 through March, 2006 at these sites. To explore trends, we calculated the 12-month cumulative incidence among 9 sequential cohorts. RESULTS: During the surveillance period, 1208 IFIs were identified among 1063 organ transplant recipients. The most common IFIs were invasive candidiasis (53%), invasive aspergillosis (19%), cryptococcosis (8%), non-Aspergillus molds (8%), endemic fungi (5%), and zygomycosis (2%). Median time to onset of candidiasis, aspergillosis, and cryptococcosis was 103, 184, and 575 days, respectively. Among a cohort of 16,808 patients who underwent transplantation between March 2001 and September 2005 and were followed through March 2006, a total of 729 IFIs were reported among 633 persons. One-year cumulative incidences of the first IFI were 11.6%, 8.6%, 4.7%, 4.0%, 3.4%, and 1.3% for small bowel, lung, liver, heart, pancreas, and kidney transplant recipients, respectively. One-year incidence was highest for invasive candidiasis (1.95%) and aspergillosis (0.65%). Trend analysis showed a slight increase in cumulative incidence from 2002 to 2005. CONCLUSIONS: We detected a slight increase in IFIs during the surveillance period. These data provide important insights into the timing and incidence of IFIs among organ transplant recipients, which can help to focus effective prevention and treatment strategies.
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Huésped Inmunocomprometido , Micosis/epidemiología , Vigilancia de Guardia , Trasplantes/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estados Unidos/epidemiología , Adulto JovenRESUMEN
BACKGROUND: The incidence and epidemiology of invasive fungal infections (IFIs), a leading cause of death among hematopoeitic stem cell transplant (HSCT) recipients, are derived mainly from single-institution retrospective studies. METHODS: The Transplant Associated Infections Surveillance Network, a network of 23 US transplant centers, prospectively enrolled HSCT recipients with proven and probable IFIs occurring between March 2001 and March 2006. We collected denominator data on all HSCTs preformed at each site and clinical, diagnostic, and outcome information for each IFI case. To estimate trends in IFI, we calculated the 12-month cumulative incidence among 9 sequential subcohorts. RESULTS: We identified 983 IFIs among 875 HSCT recipients. The median age of the patients was 49 years; 60% were male. Invasive aspergillosis (43%), invasive candidiasis (28%), and zygomycosis (8%) were the most common IFIs. Fifty-nine percent and 61% of IFIs were recognized within 60 days of neutropenia and graft-versus-host disease, respectively. Median onset of candidiasis and aspergillosis after HSCT was 61 days and 99 days, respectively. Within a cohort of 16,200 HSCT recipients who received their first transplants between March 2001 and September 2005 and were followed up through March 2006, we identified 718 IFIs in 639 persons. Twelve-month cumulative incidences, based on the first IFI, were 7.7 cases per 100 transplants for matched unrelated allogeneic, 8.1 cases per 100 transplants for mismatched-related allogeneic, 5.8 cases per 100 transplants for matched-related allogeneic, and 1.2 cases per 100 transplants for autologous HSCT. CONCLUSIONS: In this national prospective surveillance study of IFIs in HSCT recipients, the cumulative incidence was highest for aspergillosis, followed by candidiasis. Understanding the epidemiologic trends and burden of IFIs may lead to improved management strategies and study design.
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Trasplante de Células Madre Hematopoyéticas/efectos adversos , Huésped Inmunocomprometido , Control de Infecciones/organización & administración , Micosis/epidemiología , Vigilancia de Guardia , Adolescente , Adulto , Anciano , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estados Unidos/epidemiología , Adulto JovenRESUMEN
The Michigan Female Health Study (MFHS) conducted research focusing on reproductive health outcomes among women exposed to polybrominated biphenyls (PBBs). In the work presented here, the available longitudinal serum PBB exposure measurements are used to obtain predictions of PBB exposure for specific time points of interest via random effects models. In a two-stage approach, a prediction of the PBB exposure is obtained and then used in a second-stage health outcome model. This paper illustrates how a unified approach, which links the exposure and outcome in a joint model, provides an efficient adjustment for covariate measurement error. We compare the use of empirical Bayes predictions in the two-stage approach with results from a joint modeling approach, with and without an adjustment for left- and interval-censored data. The unified approach with the adjustment for left- and interval-censored data resulted in little bias and near-nominal confidence interval coverage in both the logistic and linear model setting.
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Enfermedad/etiología , Exposición a Riesgos Ambientales/estadística & datos numéricos , Contaminantes Ambientales/efectos adversos , Epidemiología , Estudios Longitudinales , Modelos Estadísticos , Adolescente , Adulto , Algoritmos , Teorema de Bayes , Niño , Preescolar , Simulación por Computador , Exposición a Riesgos Ambientales/efectos adversos , Contaminantes Ambientales/sangre , Femenino , Humanos , Análisis de los Mínimos Cuadrados , Funciones de Verosimilitud , Modelos Lineales , Modelos Logísticos , Trastornos de la Menstruación/inducido químicamente , Trastornos de la Menstruación/epidemiología , Michigan/epidemiología , Persona de Mediana Edad , Modelos Biológicos , Bifenilos Polibrominados/efectos adversos , Bifenilos Polibrominados/sangre , Adulto JovenRESUMEN
INTRODUCTION: Endemic measles persists in China, despite >95% reported coverage of two measles-containing vaccine doses and nationwide campaign that vaccinated >100 million children in 2010. An increasing proportion of infections now occur among adults and there is concern that persistent susceptibility in adults is an obstacle to measles elimination in China. We performed a case-control study in six Chinese provinces between January 2012 to June 2013 to identify risk factors for measles virus infection and susceptibility among adults. METHODS: Persons ≥15 years old with laboratory-confirmed measles were age and neighborhood matched with three controls. Controls had blood specimens collected to determine their measles IgG serostatus. We interviewed case-patients and controls about potential risk factors for measles virus infection and susceptibility. Unadjusted and adjusted matched odds ratios and 95% confidence intervals (CIs) were calculated via conditional logistic regression. We calculated attributable fractions for infection for risk factors that could be interpreted as causal. RESULTS: 899 cases and 2498 controls were enrolled. Among controls, 165 (6.6%) were seronegative for measles IgG indicating persistent susceptibility to infection. In multivariable analysis, hospital visit and travel outside the prefecture in the prior 1-3 weeks were significant risk factors for measles virus infection. Occupation and reluctance to accept measles vaccination were significant risk factors for measles susceptibility. The calculated attributable fraction of measles cases from hospital visitation was 28.6% (95% CI: 20.6-38.8%). CONCLUSIONS: Exposure to a healthcare facility was the largest risk factor for measles virus infection in adults in China. Improved adherence to hospital infection control practices could reduce risk of ongoing measles virus transmission and increase the likelihood of achieving and sustaining measles elimination in China. The use of control groups stratified by serological status identified distinct risk factors for measles virus infection and susceptibility among adults.
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Virus del Sarampión , Sarampión , Adolescente , Adulto , Estudios de Casos y Controles , Niño , China/epidemiología , Brotes de Enfermedades , Humanos , Lactante , Sarampión/epidemiología , Sarampión/prevención & control , Vacuna Antisarampión , Factores de Riesgo , VacunaciónRESUMEN
BACKGROUND: Treatment of pulmonary coccidioidomycosis is typically limited to patients with severe disease or those with increased risk of dissemination. In response to an increase of coccidioidomycosis at a correctional institution in an endemic area, physicians initiated an enhanced diagnosis and treatment program. METHODS: Case patients were inmates with laboratory-confirmed coccidioidomycosis during January 1, 2003, through October 31, 2004. We abstracted medical record data, including demographics, IgG complement fixation (CF) titers, treatment, and clinical outcome for initial and follow-up visits. Case patients receiving antifungal treatment were categorized into early (
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Antifúngicos/uso terapéutico , Coccidioidomicosis/tratamiento farmacológico , Coccidioidomicosis/epidemiología , Brotes de Enfermedades , Prisioneros , Adulto , Anciano , California , Fluconazol/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenRESUMEN
Our research focuses on the association between exposure to an airborne pollutant and counts of emergency department visits attributed to a specific chronic illness. The motivating example for this analysis of measurement error in time series studies of air pollution and acute health outcomes was a study of emergency department visits from a 20-county Atlanta metropolitan statistical area from 1993-1999. The research presented illustrates the impact of using various surrogates for unobserved measurements of ambient concentrations at the zip code level. Simulation results indicate that the impact of measurement error on the association between pollutant exposure and a health outcome can be substantial. The proposed conditional expectation approach provided reliable estimates of the association and exhibited good confidence interval coverage for a variety of magnitudes of association. Use of a single-centrally located monitor, the arithmetic average, the nearest-neighbor monitor, and the inverse-distance weighted average surrogates resulted in biased estimates and poor coverage rates, especially for larger magnitudes of the association. A focus on obtaining reasonable exposure measurements within clearly defined subregions is important when the pollutant exposure of interest exhibits strong spatial variability.