Voluntary Medical Male Circumcisions for HIV Prevention - 13 Countries in Eastern and Southern Africa, 2017-2021.

In 2007, voluntary medical male circumcision (VMMC) was endorsed by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS after it was found to be associated with approximately a 60% reduction in the risk for female-to-male transmission of HIV (1). As a result of this endorsement, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), through partnerships with U.S. government agencies, including CDC, the U.S. Department of Defense, and the U.S. Agency for International Development, started supporting VMMCs performed in prioritized countries in southern and eastern Africa. During 2010-2016, CDC supported 5,880,372 VMMCs in 12 countries (2,3). During 2017-2021, CDC supported 8,497,297 VMMCs performed in 13 countries. In 2020, the number of VMMCs performed declined 31.8% compared with the number in 2019, primarily because of COVID-19-related disruptions to VMMC service delivery. PEPFAR 2017-2021 Monitoring, Evaluation, and Reporting data were used to provide an update and describe CDC's contribution to the scale-up of the VMMC program, which is important to meeting the 2025 Joint United Nations Programme on HIV/AIDS (UNAIDS) target of 90% of males aged 15-59 years having access to VMMC services in prioritized countries to help end the AIDS epidemic by 2030 (4).

Effects of COVID-19 Pandemic on Voluntary Medical Male Circumcision Services for HIV Prevention, Sub-Saharan Africa, 2020.

Beginning in March 2020, to reduce COVID-19 transmission, the US President's Emergency Plan for AIDS Relief supporting voluntary medical male circumcision (VMMC) services was delayed in 15 sub-Saharan African countries. We reviewed performance indicators to compare the number of VMMCs performed in 2020 with those performed in previous years. In all countries, the annual number of VMMCs performed decreased 32.5% (from 3,898,960 in 2019 to 2,631,951 in 2020). That reduction is largely attributed to national and local COVID-19 mitigation measures instituted by ministries of health. Overall, 66.7% of the VMMC global annual target was met in 2020, compared with 102.0% in 2019. Countries were not uniformly affected; South Africa achieved only 30.7% of its annual target in 2020, but Rwanda achieved 123.0%. Continued disruption to the VMMC program may lead to reduced circumcision coverage and potentially increased HIV-susceptible populations. Strategies for modifying VMMC services provide lessons for adapting healthcare systems during a global pandemic.

Defining the Global Research and Programmatic Agenda and Priority Actions for Voluntary Medical Male Circumcision for HIV Prevention.

PURPOSE OF REVIEW: Since 2007, voluntary medical male circumcision (VMMC) programs have been associated with substantially reduced HIV incidence across 15 prioritized countries in Eastern and Southern Africa. Drawing on the programmatic experience of global VMMC leaders, this report reviews progress made in the first 15 years of the program, describes programmatic and research gaps, and presents considerations to maximize the impact of VMMC. RECENT FINDINGS: Overall, key programmatic and research gaps include a lack of robust male circumcision coverage estimates due to limitations to the data and a lack of standardized approaches across programs; challenges enhancing VMMC uptake include difficulties reaching populations at higher risk for HIV infection and men 30 years and older; limitations to program and procedural quality and safety including variations in approaches used by programs; and lastly, sustainability with limited evidence-based practices. Considerations to address these gaps include the need for global guidance on estimating coverage, conducting additional research on specific sub-populations to improve VMMC uptake, implementation of responsive and comprehensive approaches to adverse event surveillance, and diversifying financing streams to progress towards sustainability. This report's findings may help establish a global VMMC research and programmatic agenda to inform policy, research, and capacity-building activities at the national and global levels.

Global Rotavirus and Pneumococcal Conjugate Vaccine Introductions and the Association With Country Disease Surveillance, 2006-2018.

BACKGROUND: To inform the introduction of pneumococcal conjugate vaccine (PCV) and rotavirus vaccine, the World Health Organization (WHO) established the Global Invasive Bacterial Vaccine-Preventable Disease Surveillance Network (GISN) and the Global Rotavirus Surveillance Network (GRSN) in 2008. We investigated whether participation in these networks or other surveillance was associated with vaccine introduction. METHODS: Between 2006 and 2018, among all WHO member states, we used multivariable models adjusting for economic status to assess (1) the association between surveillance for pneumococcal disease or rotavirus disease, including participation in GISN or GRSN and the introduction of the PCV or the rotavirus vaccine, respectively, and (2) the association between the rotavirus disease burden and the rotavirus vaccine introduction among 56 countries participating in GRSN from 2008 to 2018. RESULTS: Countries that participated in or conducted surveillance for invasive pneumococcal disease or rotavirus disease were 3.5 (95% confidence interval [CI], 1.7-7.1) and 4.2 (95% CI, 2.1-8.6) times more likely to introduce PCV or rotavirus respectively, compared to those without surveillance. Among countries participating in GRSN, there was insufficient evidence to demonstrate an association between countries with higher rotavirus positivity and vaccine introduction. CONCLUSIONS: Surveillance should be incorporated into advocacy strategies to encourage the introduction of vaccines, with countries benefiting from data from, support for, and coordination of international disease surveillance networks.

Global Routine Vaccination Coverage, 2018.

Endorsed by the World Health Assembly in 2012, the Global Vaccine Action Plan 2011-2020 (GVAP) (1) calls on all countries to reach ≥90% national coverage with all vaccines in the country's national immunization schedule by 2020. Building on previous analyses (2) and using the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) global vaccination coverage estimates as of 2018, this report presents global, regional, and national vaccination coverage estimates and trends, including vaccination dropout rates. According to these estimates, global coverage with the first dose of diphtheria and tetanus toxoids and pertussis-containing vaccine (DTP1) remained relatively unchanged from 2010 (89%) to 2018 (90%). Global coverage with the third DTP dose (DTP3) followed a similar global trend to that of DTP1, remaining relatively consistent from 2010 (84%) to 2018 (86%) (3). Globally, 19.4 million children (14%) were not fully vaccinated in 2018, and among them, 13.5 million (70%) did not receive any DTP doses. Overall, dropout rates from DTP1 to DTP3 decreased globally from 6% in 2010 to 4% in 2018. Global coverage with the first dose of measles-containing vaccine (MCV1) remained between 84% and 86% during 2010-2018. Among countries that offer a second MCV dose (MCV2) during the second year of life, coverage increased from 19% in 2007 to 54% in 2018; among countries offering MCV2 to older age groups (children aged 3-14 years), coverage also increased, from 36% in 2007 to 69% in 2018 (3). Globally, the estimated difference in coverage with MCV1 and MCV2 in 2018 was 17%. However, among new and underused vaccines, global coverage increased from 2007 to 2018 for completed series of rotavirus vaccine, pneumococcal conjugate vaccine (PCV), rubella vaccine, Haemophilus influenzae type b vaccine (Hib), and hepatitis B vaccine (HepB). To reach global vaccination coverage goals for vaccines recommended during childhood, adolescence, and adulthood, tailored strategies that address local determinants for incomplete vaccination are needed, including targeting hard-to-reach and hard-to-vaccinate populations.

Nationwide Measles and Rubella Outbreaks in South Sudan, 2019.

Background: South Sudan confirmed a measles outbreak in December 2018. An investigation was conducted to assess underlying causes of the outbreak. Methods: Vaccination coverage and measles surveillance data were analyzed. A suspected measles case had fever, maculopapular rash, and cough or conjunctivitis. A confirmed measles case had generalized maculopapular rash lasting >3 days, a temperature >38°C, and cough or conjunctivitis; or serologic confirmation (anti-measles immunoglobin M [IgM] antibody detection) in serum samples collected ≤30 days from rash onset. A confirmed rubella case tested measles IgM-negative and rubella IgM-positive. Results: Nationwide, 3727 suspected measles cases were reported in 2019. Seventy-five percent of all suspected measles cases were in children aged <5 years. Thirty-six percent of patients with suspected measles were admitted to the hospital, and 36 measles-related deaths were reported. Among cases, 922 (25%) were tested for measles; of these, 317 (34%) were measles IgM-positive. Among cases that tested measles IgM-negative, 149 (33%) were rubella IgM-positive. Immunization coverage for 1 dose of measles-containing vaccine (MCV) varied by state, ranging from 6% to 67%. Conclusions: Measles and rubella remain public health problems in South Sudan. To reduce measles incidence, South Sudan needs to achieve >95% coverage with 2 doses of MCV.

Preventing HIV Among Adolescent Boys and Young Men Through PEPFAR-Supported Voluntary Medical Male Circumcision in 15 Sub-Saharan African Countries, 2018-2021.

Voluntary medical male circumcision (VMMC) is an HIV prevention intervention that has predominantly targeted adolescent and young men, aged 10-24 years. In 2020, the age eligibility for VMMC shifted from 10 to 15 years of age. This report describes the VMMC client age distribution from 2018 to 2021, at the site, national, and regional levels, among 15 countries in southern and eastern Africa. Overall, in 2018 and 2019, the highest proportion of VMMCs were performed among 10-14-year-olds (45.6% and 41.2%, respectively). In 2020 and 2021, the 15-19-year age group accounted for the highest proportion (37.2% and 50.4%, respectively) of VMMCs performed across all age groups. Similarly, in 2021 at the site level, 68.1% of VMMC sites conducted the majority of circumcisions among men aged 15-24 years. This analysis highlights that adolescent boys and young men are the primary recipients of VMMC receiving an important lifetime reduction in HIV risk.

HIV, syphilis, and hepatitis B virus infection and male circumcision in five Sub-Saharan African countries: Findings from the Population-based HIV Impact Assessment surveys, 2015-2019.

Voluntary medical male circumcision (VMMC) has primarily been promoted for HIV prevention. Evidence also supports that male circumcision offers protection against other sexually transmitted infections. This analysis assessed the effect of circumcision on syphilis, hepatitis B virus (HBV) infection and HIV. Data from the 2015 to 2019 Population-based HIV Impact Assessments (PHIAs) surveys from Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe were used for the analysis. The PHIA surveys are cross-sectional, nationally representative household surveys that include biomarking testing for HIV, syphilis and HBV infection. This is a secondary data analysis using publicly available PHIA data. Univariate and multivariable logistic regression models were created using pooled PHIA data across the five countries to assess the effect of male circumcision on HIV, active and ever syphilis, and HBV infection among sexually active males aged 15-59 years. Circumcised men had lower odds of syphilis infection, ever or active infection, and HIV, compared to uncircumcised men, after adjusting for covariates (active syphilis infection = 0.67 adjusted odds ratio (aOR), 95% confidence interval (CI), 0.52-0.87, ever having had a syphilis infection = 0.85 aOR, 95% CI, 0.73-0.98, and HIV = 0.53 aOR, 95% CI, 0.47-0.61). No difference between circumcised and uncircumcised men was identified for HBV infection (P = 0.75). Circumcised men have a reduced likelihood for syphilis and HIV compared to uncircumcised men. However, we found no statistically significant difference between circumcised and uncircumcised men for HBV infection.

Deliberative Q-method: A combined method for understanding the ecological value of urban ecosystem services and disservices.

There is a need, in the ecosystem valuation literature to compliment the economic methods with sociocultural valuation methods that capture and facilitate a better understanding nuanced social and cultural values that are difficult to measure. Yet, sociocultural valuation methods are often critiqued for their lack of structured and replicable procedures and for often maintaining limited internal research validity. Accordingly, this paper demonstrates the development and application of a mixed-methods valuation approach to better recognize non-use social and cultural values by integrating the triad of deliberation, local ecological knowledge, and value quantification. We operationalized this method in Amman, Jordan where we analyzed how local experts value, based on their local ecological knowledge, the ecosystem services supplied by the City's urban water features (fountains, ponds, and streams).•We combine the conventional Q-method and focus group to yield a group deliberative Q-method.•The deliberative Q-method facilitates a structured valuation framework.•The deliberative Q-method method produces rich qualitative data.•The rigorous statistical analysis of deliberative Q-method improves internal validity and streamlines qualitative data coding.•The rigorous statistical analysis of deliberative Q-method weighs competing values to better understand polarized and consensus views.

Systematic content analysis: A combined method to analyze the literature on the daylighting (de-culverting) of urban streams.

In this era of climate change, novel nature-based solutions, like the daylighting (de-culverting) of streams, that enhance the socio-ecological resilience are gaining prominence. Yet, the growing body of literature on stream daylighting spreads over an array of seemingly disconnected disciplines and lacks consistency in the terminology and the definitions of the practice. Moreover, nearly all the literature review studies on stream daylighting (mostly produced since 2000) underscore, as their point of departure, the daylighting projects rather than a review of the literature's content per se. Therefore, this study reassesses the literature on stream daylighting with a particular focus on its role, as a nature-based solution, for climate change mitigation and adaptation and for socio-environmental justice. We combine the systematic literature review (an all-encompassing review of the available literature on stream daylighting) with the inductive content analysis (an in-depth analysis of this literature's nature). Accordingly, we investigate all the relevant English-language publications since the first peer reviewed article on stream daylighting was published in 1992 until the end of 2018 to analyze four themes: the disciplines and sub-disciplines of the literature; the terminologies and synonyms of stream daylighting; the definitions of stream daylighting; and the case studies tackled in the literature.•We develop a method that combines a systematic review of the stream daylighting literature and inductive content analysis.•The method provides insights on the stream daylighting's literature's disciplines, terminologies, synonyms and case studies.•The method is adaptable particularly, to nascent areas of study where sources' numbers range between 100-200.

Dataset for assessing the scope and nature of global stream daylighting practices.

This paper presents five publicly available datasets (I through V) of which two are interactive and visual tools (a Tableau Dashboard and an Interactive Map). These five datasets were extracted from 115 literature sources on the daylighting of streams that were published between 1992 and 2018. Dataset I consist of 19 variables that combine two types of data extracted from these sources: ten manifest variables (indisputable, obvious, factual) and nine variables extracted from the sources' latent content (indirect, hence, based on careful reading of the sources' contents). Manifest variables include, among others, authors' names and affiliations, authorship location, and publication year. Latent variables include primarily the literature sources' underlying themes and their sub-themes (sub-categories), the daylighting case studies/projects discussed, and the geographic coverage or scope addressed in the literature sources. Datasets II identifies 16 literature sources that delve into the climate change adaptation and/or mitigation theme and reveal how it was tackled vis-à-vis the other themes/sub-themes. Dataset III identifies and provides detailed information on the 145 different stream daylighting case studies/projects mentioned in the literature's sources, such as each project's location, daylighted length, completion date, cost, and type of treatment. Dataset IV is a Tableau Dashboard that offers interactive analytical querying in the form of relational analyses and data visualization while Dataset V is an Interactive Map created in Google My Map that maps the 145 stream daylighting case studies/projects mentioned in the literature sources over and provides a synopsis on each based on the literature's contents. The combination of these five datasets and their diversity in type and presentation yields a comprehensive, global, and unique repository of information on the daylighting of urban streams for all types of audiences (academic, professional, and laypeople).

Knowledge, Attitudes and Practices Associated with Brucellosis among Small-Scale Goat Farmers in Thailand.

OBJECTIVES: This study aimed to identify occupational risk factors for brucellosis among small scale goat farmers in Thailand. METHODS: To better understand farmers' knowledge, attitudes and practices associated with brucellosis we interviewed 51 farmers and tested 314 goats for Brucella melitensis. RESULTS: All serological samples tested negative for Brucella infection. Based on previous research and estimates provided from the Thai national brucellosis surveillance system, zero seropositivity was less than expected. Findings from interviews with farmers demonstrate that most respondents were relatively new to goat farming with just over half (53%) reporting owning goats for five or fewer years. The majority of respondents demonstrated important gaps in knowledge on disease transmission in animals and knowledge of human brucellosis was particularly limited with just over half (54%) reporting that humans could become infected. Participants had a very low perceived risk of infection with the majority (91.7%) reporting that they or a member of their household were not at risk of the disease. CONCLUSION: Overall findings from this study support that brucellosis poses an occupational risk to goat farmers with specific areas of concern including weak awareness of disease transmission to humans and lack of knowledge on specific safe farm practices such as quarantine practices. Findings from this study contribute to a more comprehensive understanding of brucellosis in Thailand by identifying specific occupational risk factors and describing areas where farmer education and training should be strengthened.

Insights into the immune transcriptome of the shrimp Litopenaeus vannamei: tissue-specific expression profiles and transcriptomic responses to immune challenge.

Infectious disease constitutes a major obstacle to the sustainability of shrimp aquaculture worldwide and a significant threat to natural populations of shrimp and other crustacea. The study of the shrimp immune system, including the response to viral infection, has been hampered by a relative lack of molecular genetic information and of tools suitable for high-throughput assessment of gene expression. In this report, the generation of a cDNA microarray encompassing 2,469 putative unigenes expressed in gills, circulating hemocytes, and hepatopancreas of Litopenaeus vannamei is described. The unigenes printed on the microarray were derived from the analyses of 7,021 expressed sequence tags obtained from standard cDNA libraries as well as from libraries generated by suppression subtractive hybridization, after challenging shrimp with a variety of immune stimuli. The general utility of the cDNA microarray was demonstrated by interrogating the array with labeled RNA from four different shrimp tissues (gills, hemocytes, hepatopancreas, and muscle) and by analyzing the transcriptomic response of shrimp to a lethal challenge with white spot syndrome virus. Our results indicate that white spot syndrome virus infection upregulates (in the hepatopancreas) genes encoding known and potential antimicrobial effectors, while some genes involved in protection from oxidative stress were found to be downregulated by the virus.

Improving Team Performance for Public Health Preparedness.

OBJECTIVE: Between May 2010 and September 2011, the University of Minnesota School of Public Health partnered with the Minnesota Department of Health (MDH) to assess the effect of exercises on team performance during public health emergency response. METHODS: Participants were divided into 3 research teams exposed to various levels of intervention. Groups consisted of a control group that was given standard MDH training exercises, a didactic group exposed to team dynamics and communication training, and a treatment group that received the didactic training in addition to a post-exercise facilitated debriefing. To assess differences in team performance, teams engaged in 15 functional exercises. RESULTS: Differences in team performance across the 3 groups were identified, although there was no trend in team performance over time for any of the groups. Groups demonstrated fluctuation in team performance during the study period. Attitudinal surveys demonstrated an increase in workplace satisfaction and confidence in training among all groups throughout the study period. CONCLUSIONS: Findings from this research support that a critical link exists between training type and team performance during public health emergency response. This research supports that intentional teamwork training for emergency response workers is essential for effective public health emergency response. (Disaster Med Public Health Preparedness. 2017;11:7-10).

Disaster behavioral health capacity: Findings from a multistate preparedness assessment.

PURPOSE: To identify gaps in disaster behavioral health, the Preparedness and Emergency Response Learning Center (PERL) at the University of Minnesota's School of Public Health supported the development and implementation of a multistate disaster behavioral health preparedness assessment. Information was gathered regarding worker knowledge of current disaster behavioral health capacity at the state and local level, and perceived disaster behavioral health training needs and preferences. METHODS: Between May and July 2015, 143 participants completed a 31-item uniform questionnaire over the telephone by a trained interviewer. Trained interviewers were given uniform instructions on administering the questionnaire. Participants included county and city-level public health leaders and directors from Minnesota, Wisconsin, and North Dakota. FINDINGS: Findings demonstrate that across the three states there is a need for improved disaster behavioral health training and response plans for before, during, and after public health emergencies. This study identified perceived gaps in plans and procedures for meeting the disaster behavioral health needs of different atrisk populations, including children, youth, and those with mental illness. There was consistent agreement among participants about the lack of behavioral health coordination between agencies during emergency events. VALUE: Findings can be used to inform policy and the development of trainings for those involved in disaster behavioral health. Effectively attending to interagency coordination and mutual aid agreements, planning for effective response and care for vulnerable populations, and targeted training will contribute to a more successful public health response to emergency events.

Mobile phone use among Medical Reserve Corps coordinators and volunteers: an exploratory study.

OBJECTIVE: To better understand how mobile phones can be used during emergency response, this study identifies a) current mobile phone use among Medical Reserve Corps (MRC) volunteers and coordinators in their daily lives and during response; b) challenges for mobile phone use during response; and c) areas for capacity building. DESIGN: In 2012, 459 MRC volunteers and coordinators responded to a 35-question survey conducted online through SurveyMonkey. Respondents were asked how they use their mobile phones in their daily lives and during response, and how they would like to use them during response. Frequencies were calculated using SurveyMonkey and Excel. MAIN OUTCOME MEASURES: Respondents reported frequent and varied mobile phone use in their daily lives, with 99 percent of respondents owning a phone, 82 percent texting, and 87 percent of smartphone owners using apps. Although 80 percent of respondents who had been deployed used mobile phones during response, use of sophisticated mobile phone features was low; only 10 percent accessed emergency preparedness apps and 23 percent browsed the Internet for emergency response information. Respondents indicated a desire to use more features during response, such as emergency preparedness apps (72 percent) and e-mail to send or receive response instructions (80 percent). CONCLUSION: Results indicate that given access to mobile technology and training, emergency responders would like to increase their mobile phone use during response. Implications of these findings show a need for organizations to improve their support of mobile phone use.

Games, simulations, and learning in emergency preparedness: a review of the literature.

Between 2007 and 2011, a comprehensive review of the literature was conducted to identify the usefulness of educational games and simulations in developing and evaluating the competency of public health professionals to prepare for, respond to, and recover from emergencies. This article presents an overview of the literature related to the use of games and simulations in education and training, summarizes key findings, identifies key features of gaming simulation design for educational effectiveness, and suggests that use of these emerging teaching and learning strategies be considered in the development of a comprehensive approach for creating and evaluating competency.

Analysis of multiple tissue-specific cDNA libraries from the Pacific whiteleg shrimp, Litopenaeus vannamei.

Multiple small-scale transcriptome studies have been undertaken for various members of the Penaeidae. Penaeid shrimp are important both as members of diverse ecosystems around the world and for their importance as commercial commodities. Of the many shrimps, the most important from this family is the Pacific whiteleg shrimp, Litopenaeus vannamei, as it is the primary shrimp used in worldwide aquaculture. The sequencing and analysis of 13 656 expressed sequence tags (ESTs) from this species is presented. ESTs were derived from multiple tissue-specific cDNA libraries with an emphasis being placed on those tissues with predicted immune function. Assembly of the sequences into non-overlapping clusters yielded 7466 putative unigenes (1981 contigs and 5485 singletons). Multiple approaches were taken to assign putative function to each transcript; sequence homology searches using BLASTX (Basic Local Alignment Search Tool: Translated query versus protein database) of the National Center for Biotechnology Information's (NCBI) GenBank Database and Gene Ontology annotation, and still a significant portion of the shrimp ESTs (62%) had no homology with known proteins in the public databases. The sequence and complete annotation of all ESTs is available at www.marinegenomics.org, a publicly accessible database. In addition to providing the basic resources for microarray construction, transcript profiling, and novel gene discovery, this study constitutes the largest combined analysis of ESTs from any shrimp species and is a prelude to an even larger effort aimed at identifying and depleting highly redundant genes from shrimp cDNA libraries toward the goal of sequencing 100 000 shrimp ESTs.