The impact of hepatitis B vaccination in the United States, 1999-2018.

BACKGROUND AND AIMS: Hepatitis B vaccine has been included in the infant immunization schedule since 1991 in the United States. We aimed to assess its effectiveness against HBV infection and its impact on mortality. APPROACH AND RESULTS: The study population was participants aged 6+ years with an HBV vaccination history and an HBV serologic test from the National Health and Nutrition Examination Survey, 1999-2018. Participants aged 18+ years with linked mortality records from 1999-2014 were followed for mortality analysis. Multivariable logistic regression was used to compute vaccine effectiveness (VE) overall, by year of birth, and by age. Cox regression was used to estimate HRs for all-cause, cancer-related, and cardiovascular disease-related mortality. A total of 64,107 participants were included in the main analysis, with 29,600 (40.7%) having completed HBV vaccination (three or more doses, vaccinated). The highest vaccination uptake was found among those born after 1991, at 86.5%. Vaccinated participants had higher prevalence of vaccine-induced immunity than the unvaccinated (47.2% vs. 7.4%). Among those born after 1991, VE was found at 58% (95% CI, 18%-79%) overall and 85% for those aged ≥20 years (mean age, 22), whereas no effect was found among those born prior to 1990. HBV vaccination was associated with reduced risk of all-cause mortality (HR, 0.78; 95% CI, 0.68-0.90) and cancer-related mortality (HR, 0.76; 95% CI, 0.58-1.00) but not for cardiovascular disease-related mortality. CONCLUSIONS: In the universal infant vaccination era, the HBV vaccine has shown substantial effectiveness against HBV infection and maintained strong protection for 20 years. It was also associated with reduced risk of all-cause and cancer-related mortality.

Toolkits for implementing and evaluating digital health: A systematic review of rigor and reporting.

OBJECTIVE: Toolkits are an important knowledge translation strategy for implementing digital health. We studied how toolkits for the implementation and evaluation of digital health were developed, tested, and reported. MATERIALS AND METHODS: We conducted a systematic review of toolkits that had been used, field tested or evaluated in practice, and published in the English language from 2009 to July 2019. We searched several electronic literature sources to identify both peer-reviewed and gray literature, and records were screened as per systematic review conventions. RESULTS: Thirteen toolkits were eventually identified, all of which were developed in North America, Europe, or Australia. All reported their intended purpose, as well as their development process. Eight of the 13 toolkits involved a literature review, 3 did not, and 2 were unclear. Twelve reported an underlying conceptual framework, theory, or model: 3 cited the normalization process theory and 3 others cited the World Health Organization and International Telecommunication Union eHealth Strategy. Seven toolkits were reportedly evaluated, but details were unavailable. Forty-three toolkits were excluded for lack of field-testing. DISCUSSION: Despite a plethora of published toolkits, few were tested, and even fewer were evaluated. Methodological rigor was of concern, as several did not include an underlying conceptual framework, literature review, or evaluation and refinement in real-world settings. Reporting was often inconsistent and unclear, and toolkits rarely reported being evaluated. CONCLUSION: Greater attention needs to be paid to rigor and reporting when developing, evaluating, and reporting toolkits for implementing and evaluating digital health so that they can effectively function as a knowledge translation strategy.

Paenibacillus marchantiophytorum sp. nov., isolated from the liverwort Herbertus sendtneri.

A Gram-stain-positive, aerobic, motile, rod-shaped, endospore-forming bacterium, designated strain R55T, was isolated from the liverwort Herbertus sendtneri growing at Gawalong glacier, Tibet, and characterized by using a polyphasic taxonomic approach. The major fatty acids of strain R55T were anteiso-C15 : 0, C16 : 0 and iso-C16 : 0. Diphosphatidylglycerol, phosphatidylethanolamine and phosphatidylglycerol were the predominant polar lipids and occurred along with two unidentified aminophospholipids, one unidentified phospholipid and one unidentified aminolipid. Strain R55T contained MK-7 as the dominant menaquinone and meso-diaminopimelic acid as the major diagnostic diamino acid in the cell-wall peptidoglycan. The G+C content of the genomic DNA was 36.9 mol%. Phylogenetic analysis based on 16S rRNA gene sequences showed that strain R55T was affiliated to species of the genus Paenibacillus, and was related most closely to Paenibacillus ferrarius CY1T (97.1 % similarity). However, the DNA-DNA relatedness between this strain and strain R55T was only 44.1 %. Based on phenotypic, chemotaxonomic and phylogenetic properties, strain R55T is considered to represent a novel species of the genus Paenibacillus, for which the name Paenibacillus marchantiophytorum sp. nov. is proposed. The type strain is R55T ( = CGMCC 1.15043T = DSM 29850T).

Paenibacillus herberti sp. nov., an endophyte isolated from Herbertus sendtneri.

Strain R33(T), an endophyte recovered from Herbertus sendtneri, was identified as representing a novel species of the genus Paenibacillus by using a polyphasic taxonomic approach. The novel strain was observed to be a Gram-stain positive, aerobic, rod-shaped, motile and endospore-forming bacterium. The major polar lipids of strain R33(T) were identified as diphosphatidylglycerol, phosphatidylethanolamine, along with lesser amounts of phosphatidylglycerol, three unidentified aminophospholipids, two unidentified phospholipids and two unidentified lipids. The predominant isoprenoid quinone was identified as MK-7. The major fatty acids (>8.0 %) were found to be anteiso-C15:0 (40.0 %), C16:1 ω11c (9.4 %), C16:1 ω7c alcohol (8.5 %) and C16:0 (8.2 %). The diamino acid found in the cell-wall peptidoglycan was meso-diaminopimelic acid. The G+C content of genomic DNA was determined to be 56.9 mol%. The 16S rRNA gene sequence similarities of strain R33(T) to other Paenibacillus species ranged from 91.6 to 97.2 %, with high similarities to Paenibacillus humicus PC-147(T) and Paenibacillus pasadenensis SAFN-007(T). The phylogenetic analyses based on 16S rRNA gene sequences and the partial rpoB gene confirmed that strain R33(T) belongs to the genus Paenibacillus. However, strain R33(T) shows differential molecular characteristics compared to other related Paenibacillus species based on 16S rDNA-RFLP analyses; the DNA-DNA relatedness values between strain R33(T) and P. humicus PC-147(T), and that between strain R33(T) and P. pasadenensis SAFN-007(T), were 35.0 ± 2.0 and 41.4 ± 0.9 %, respectively. Based on its phenotypic, chemotaxonomic and phylogenetic properties, strain R33(T) is considered to represent a novel species of the genus Paenibacillus, for which the name Paenibacillus herberti is proposed (type strain R33(T) = CGMCC 1.15042(T) = DSM 29849(T)).