Characterization of Monoclonal Antibodies to Measure Cell Surface Protein Levels of Human Interferon-Lambda Receptor 1.

Type III interferons (IFN-lambdas, IFN-λs) are important antiviral cytokines that can also modulate immune responses by acting through a heterodimeric receptor composed of the specific and limited expressed IFN-λR1 chain and the ubiquitous IL-10R2 chain, which is shared with IL-10 family cytokines. Conflicting data have been reported regarding which cells express the IFN-λR1 subunit and directly respond to IFN-λs. This is, in part, owing to transcript levels of the IFN-λR1 gene, IFNLR1, not always correlating with cell surface protein levels. In this study, we tested a panel of novel monoclonal antibodies (mAbs) that specifically recognize human IFN-λR1. Initially, antigen specificity was confirmed by enzyme-linked immunosorbent assay (ELISA), from which a subset of antibodies was selected for additional flow cytometry and neutralization assays. We further characterized two antibodies based on their strong ELISA binding activity (HLR1 and HLR14) and found only HLR14 could reliably detect cell surface IFN-λR1 protein on a variety of cell lines by flow cytometry. HLR14 could also detect IFN-λR1 protein on certain primary human blood cells, including plasmacytoid dendritic cells and B cells from peripheral blood. Availability of the HLR14 mAb will enable the quantification of IFN-λR1 protein levels on cells and better characterization of the cell specificity of the IFN-λ response.

Growth Response in Oryctolagus cuniculus to Selenium Toxicity Exposure Ameliorated with Vitamin E.

The adverse impacts of high temperature during the summer season on the rabbit industry have gained increased global attention. In this study, the comparative effects of biological (BIO) and chemical (CH) nanoselenium (nano-Se) combined with vitamin E on the growth and immune performances of rabbits were observed. A total of 200 white male rabbits of similar age (90 days) were divided into five treatment groups (T0, T1, T2, T3, and T4), 40 animals in each treatment. The rabbits in the first treatment group (T0) was fed basal diet; (T1) basal diet supplemented with 35 mg biological synthesized nanoselenium/kg diet; (T2) basal diet with 35 mg biological nanoselenium/kg diet+150 mg Vit. E/kg; (T3) basal diet+35 m chemically synthesized nanoselenium/kg diet; and (T4) basal diet+35 mg of chemical nanoselenium/kg diet+150 mg Vit. E/kg. The duration of this experiment was 63 days. The body weight of each rabbit was recorded weekly. Results revealed a significant (P < 0.05) increase in live body weight (LBW), total body gain (TBG), and feed conversion ratio (FCR) of rabbits treated with BIO-Se+Vit. E (T2) compared to the other groups. Selenium concentrations in the kidneys and liver were significantly higher (P < 0.05) in animals fed with BIO-Se+Vit. E (T2). The concentrations of serum urea, glutamyl transferase (GGT), and triglycerides (TG) were lower in untreated (T0) and treated groups (T1, T2, T3, and T4). From the results of this study, it can be concluded that biological nano-Se gave maximum improvement for the parameters under study compared to the chemically synthesized nanoselenium by playing a role in alleviating heat stress, increasing the growth performance, and enhancing the immunity of growing white male rabbits. Further addition of Vit. E is an alternative method to maximize productivity with no adverse effects during the fattening period of growing white male rabbits.

Surveillance Review System to Track Progress Towards Polio Eradication in the Horn of Africa.

BACKGROUND: The risk for importation and reintroduction wild poliovirus in areas that have been cleared of the wild poliovirus in the Horn of Africa will remain if the surveillance systems are weak and porous. METHODS: Consequently, the Horn of Africa Polio Coordinating Office in Nairobi, together with partners conducted surveillance reviews for some of the countries in the Horn of Africa, especially Ethiopia, Kenya and Somalia to identify gaps in the polio surveillance and provided recommendations for improved surveillance. Structured questionnaires collected information about acute flaccid paralysis (AFP) surveillance resources, training, data monitoring, and supervision at provincial, district, and health facility levels. Other information collected included resource availability, management and monitoring of AFP surveillance. RESULTS: The result revealed that although AFP surveillance systems were well established in these countries, a number of gaps and constraints existed. Widespread deficiencies and inefficient resource flow systems were observed and reported at all levels. There were also deficiencies related to provider knowledge, funding, training, and supervision, and were particularly evident at the health facility level. These weaknesses were corroborated with the sustained transmission of polioviruses in the region, where the surveillance systems were not sensitive enough to pick the viruses. CONCLUSION: The review teams made useful recommendations that led to strengthening of the surveillance systems in these countries, including the formation and use of village polio volunteers in the south and central zones of Somalia, where security was heavily compromised and surveillance officers lacked regular access to the communities.

Reasons why children miss vaccinations in Western Kenya; A step in a five-point plan to improve routine immunization.

Global childhood vaccination coverage has stagnated over the past decade and raising coverage will require a collection of approaches since no single approach has been suitable for all countries or situations. The American Red Cross has developed a 5-Point Plana to geolocate under-vaccinated children and determine the reasons why they miss vaccination by capitalizing on the Red Cross Movement's large cadres of trusted community volunteers. The Plan was piloted in Bobasi sub-county in Western Kenya, with volunteers seeking to conduct a face-to-face interview in all households, visiting over 60,000 over 7 days. Six pockets of 233 children without a home-based vaccination record or missing an age-appropriate dose of Penta1, Penta3 or measles-containing vaccine were identified. Three activities were carried out to learn why these children were not vaccinated: 1) one-on-one interviews and 2) focus group discussions with the caregivers of the under-vaccinated children and 3) interviews with healthcare workers who vaccinate in Bobasi. Complacency was commonly reported by caregivers during one-on-one interviews while bad staff attitude or practice was most frequently reported in focus group discussions; health staff reported caregiver hesitency, not knowing vaccination due date and vaccine stock-outs as the most common reasons for caregivers to not have their child vaccinated. As reasons varied across the three different activities, the different perspectives and approaches helped characterize vaccination barriers. Civil society organizations working together with the Ministry of Health can provide valuable information for immunization managers to act on.

Micro-planning in a wide age range measles rubella (MR) campaign using mobile phone app, a case of Kenya, 2016.

INTRODUCTION: A Measles rubella campaign that targeted 9 months to 14 year old children was conducted in all the 47 counties in Kenya between 16th and 24th of May 2016. Micro-planning using an android phone-based app was undertaken to map out the target population and logistics in all the counties 4 weeks to the campaign implementation instead of 6 months as per the WHO recommendation. The outcomes of the micro-planning exercise were a detailed micro-plan that served as a guide in ensuring that every eligible individual in the population was vaccinated with potent vaccine. A national Trainer of Trainers training was done to equip key officers with new knowledge and skills in developing micro-plans at all levels. The micro planning was done using a mobile phone app, the doforms that enabled data to be transmitted real time to the national level. The objective of the study was to establish whether use of mobile phone app would contribute to quality of sub national micro plans that can be used for national level planning and implementation of the campaign. METHODS: There were 9 data collection forms but only forms 1-7 were to be uploaded onto the app. Forms 8A and 9A were to be filled but were to remain at the implementation level for use intra campaign. The forms were coded; Form 1A&B, 2A, 3A, 4A, 5A, 6A, 7A, 8A and 9A The Village form (form 1A&B) captured information by household which included village names, name of head of household, cell phone contact of head of household, number of children aged 9 months to 14years in the household, possible barriers to reaching the children, appropriate vaccination strategy based on barriers identified and estimated or proposed number of teams and type. This was the main form and from this every other form picked the population figures to estimate other supplies and logistics. On advocacy, communication and social mobilization the information collected included mobile network coverage, public amenities such as churches, mosques and key partners at the local level. On human resource and cold chain supplies the information collected included number of health facilities by type, number of health workers by cadre in facilities within the village, number of vaccine carriers and icepacks by size, refrigerators and freezers. All these forms were to be uploaded onto the phone app. except form 8A, the individual team plan, which was to be used during implementation at the local level. Android phone application, doforms, was used to capture data. Training on micro planning, data entry and doforms app was conducted at National, County, Sub-county and ward levels using standardized guidelines. An interactive case study was used in all the trainings to facilitate understanding. The App was also available on Laptops through its provided web-application. The app allowed multiple users to log in concurrently. Feedback on all the variables were obtained from the team at the Ward level. The ward level team included education officers or teachers, village elders, community health workers and other community stakeholders. Only the Ward level was allowed to collect information on paper and that information was subsequently transferred to the phone-based app, doforms, by health information officers. The national, county and sub county were able to access their data from the app using a password provided by the administrator. RESULTS: Real time data was received from 46 of 47 counties. One county (Marsabit) did not participate in the micro plan process. Over 97% (283/290) of the sub counties responded and shared various information via the app. Different data forms had different completion rates. There was 100% completion rate for the data on villages and target population. Much valuable information was shared but there was no time for the national and county level to interrogate and harmonize for proper implementation. The information captured during the campaign can be used for routine immunization and other community based interventions. Electronic data collection not only provided the number of children but provided the locations also where these children could be found. CONCLUSION: Despite the limitations of time to harmonize the micro plans with the national plan, the micro planning process was a great success with 46/47 counties responding through the mobile phone app. Not only did it provide the numbers of the target children, it further provided the places where these children could be found. There was timely data transfer, data integrity, tracking, real time data visualization reporting and analysis. The app enabled real time feedback to national focal point by data entry clerks as well as enabling trouble shooting by the administrator. This ensured campaign planning was done from the lowest level to the national level.

Intussusception Cases Among Children Admitted to Referral Hospitals in Kenya, 2002-2013: Implications for Monitoring Postlicensure Safety of Rotavirus Vaccines in Africa.

To describe the epidemiology of intussusception before introduction of the rotavirus vaccine, we reviewed the records of 280 patients younger than 5 years who were hospitalized in Kenya between 2002 and 2013. The patients who died (18 [6.4%]) had sought care later after symptom onset than the patients who survived (median, 5 vs 3 days, respectively; P = .04). Seeking prompt care may improve therapeutic outcomes.

Forewarning of poliovirus outbreaks in the Horn of Africa: an assessment of acute flaccid paralysis surveillance and routine immunization systems in Kenya.

BACKGROUND: Although the Horn of Africa region has successfully eliminated endemic poliovirus circulation, it remains at risk for reintroduction. International partners assisted Kenya in identifying gaps in the polio surveillance and routine immunization programs, and provided recommendations for improved surveillance and routine immunization during the health system decentralization process. METHODS: Structured questionnaires collected information about acute flaccid paralysis (AFP) surveillance resources, training, data monitoring, and supervision at provincial, district, and health facility levels. The routine immunization program information collected included questions about vaccine and resource availability, cold chain, logistics, health-care services and access, outreach coverage data, microplanning, and management and monitoring of AFP surveillance. RESULTS: Although AFP surveillance met national performance standards, widespread deficiencies and limited resources were observed and reported at all levels. Deficiencies were related to provider knowledge, funding, training, and supervision, and were particularly evident at the health facility level. CONCLUSIONS: Gap analysis assists in maximizing resources and capacity building in countries where surveillance and routine immunization lag behind other health priorities. Limited resources for surveillance and routine immunization systems in the region indicate a risk for additional outbreaks of wild poliovirus and other vaccine-preventable illnesses. Monitoring and evaluation of program strengthening activities are needed.

High burden of rotavirus gastroenteritis in young children in rural western Kenya, 2010-2011.

BACKGROUND: Diarrhea is a leading cause of hospitalization and death in children <5 years of age. OBJECTIVES: To facilitate evaluation of the impact of rotavirus vaccine introduction in western Kenya, we estimated baseline rates of rotavirus-associated hospitalization and mortality among children <5 years of age. METHODS: From January 2010 to December 2011, we collected demographic, clinical and laboratory data for children <5 years of age seeking care at the district hospital and 2 outpatient facilities within a Health and Demographic Surveillance System (HDSS). Children with acute gastroenteritis (AGE), defined as ≥3 loose stools and/or ≥1 episode of unexplained vomiting followed by loose stool within a 24-hour period, were asked to provide a stool sample for rotavirus ELISA testing. Rates of rotavirus-associated hospitalization and mortality were estimated using time of residence in the HDSS to calculate person-years of observation. To estimate the rotavirus-associated mortality rate, we applied the percentage positive for rotavirus among AGE hospitalizations to verbal autopsy estimates of diarrhea deaths in the HDSS. RESULTS: There were 4991 hospitalizations of children <5 years of age; 1134 (23%) were for AGE and stool specimens were obtained from 790 (70%). Rotavirus was detected in 211 (27%) specimens. Among 4951 <5 outpatient sick visits, 608 (12%) were for AGE; 320 (51%) provided specimens and 62 (20%) were positive for rotavirus. Rotavirus AGE accounted for 501 <5 hospitalizations per 100,000 person-years of observation. Rotavirus-associated <5 mortality was 136 deaths per 100,000 person-years of observation. CONCLUSIONS: Continued surveillance of rotavirus AGE will provide timely data on the population-level impact of rotavirus vaccine following its likely introduction in 2014.

Menstrual patterns and gynecologic morbidity among university students in Kano, Nigeria.

OBJECTIVE: To examine menstrual patterns and effects of menstrual disorders on social and academic lives of undergraduate students in Kano, Nigeria. PARTICIPANTS: Students attending Bayero University Kano, Nigeria (n = 383). INTERVENTION: Self-administered questionnaires. MAIN OUTCOME MEASURES: Sociodemographic characteristics, menstrual patterns, and associated symptoms were elicited. Treatment-seeking behavior and effects of symptoms on academic and social activities were ascertained. RESULTS: The mean age at menarche was 13.7 ± 1.68 years. Menstrual bleeding lasted an average of 5.2 ± 1.6 days. Cycle length was 21-35 days in 92% of cases (n = 353). Approximately 72% of respondents reported dysmenorrhea. After adjusting for confounding, age at menarche, menstrual cycle length, duration of menstrual bleeding and use of contraceptive pills remained significant predictors of dysmenorrhea. Menstrual disorders interfered with social and academic life of 91% and 84% of respondents respectively. CONCLUSIONS: Gynecologic morbidity related to menstruation is common among adolescent Nigerians and is associated with detrimental effects on academic and social activities. Student health services should prioritize measures to mitigate the social and physical impact of menstrual disorders in young women.

A cost effectiveness and capacity analysis for the introduction of universal rotavirus vaccination in Kenya: comparison between Rotarix and RotaTeq vaccines.

BACKGROUND: Diarrhoea is an important cause of death in the developing world, and rotavirus is the single most important cause of diarrhoea associated mortality. Two vaccines (Rotarix and RotaTeq) are available to prevent rotavirus disease. This analysis was undertaken to aid the decision in Kenya as to which vaccine to choose when introducing rotavirus vaccination. METHODS: Cost-effectiveness modelling, using national and sentinel surveillance data, and an impact assessment on the cold chain. RESULTS: The median estimated incidence of rotavirus disease in Kenya was 3015 outpatient visits, 279 hospitalisations and 65 deaths per 100,000 children under five years of age per year. Cumulated over the first five years of life vaccination was predicted to prevent 34% of the outpatient visits, 31% of the hospitalizations and 42% of the deaths. The estimated prevented costs accumulated over five years totalled US$1,782,761 (direct and indirect costs) with an associated 48,585 DALYs. From a societal perspective Rotarix had a cost-effectiveness ratio of US$142 per DALY (US$5 for the full course of two doses) and RotaTeq US$288 per DALY ($10.5 for the full course of three doses). RotaTeq will have a bigger impact on the cold chain compared to Rotarix. CONCLUSION: Vaccination against rotavirus disease is cost-effective for Kenya irrespective of the vaccine. Of the two vaccines Rotarix was the preferred choice due to a better cost-effectiveness ratio, the presence of a vaccine vial monitor, the requirement of fewer doses and less storage space, and proven thermo-stability.

Effectiveness of Haemophilus influenzae type b Conjugate vaccine introduction into routine childhood immunization in Kenya.

CONTEXT: Haemophilus influenzae type b (Hib) conjugate vaccine is not perceived as a public health priority in Africa because data on Hib disease burden and vaccine effectiveness are scarce. Hib immunization was introduced in Kenyan infants in 2001. OBJECTIVE: To define invasive Hib disease incidence and Hib vaccine program effectiveness in Kenya. DESIGN, SETTING, AND PATIENTS: Culture-based surveillance for invasive Hib disease at Kilifi District Hospital from 2000 through 2005 was linked to demographic surveillance of 38,000 children younger than 5 years in Kilifi District, Kenya. Human immunodeficiency virus (HIV) infection and Hib vaccination status were determined for children with Hib disease admitted 2002-2005. INTERVENTIONS: Introduction of conjugate Hib vaccine within the routine childhood immunization program at ages 6, 10, and 14 weeks beginning November 2001. MAIN OUTCOME MEASURES: Incidence of culture-proven Hib invasive disease before and after vaccine introduction and vaccine program effectiveness. RESULTS: Prior to vaccine introduction, the median age of children with Hib was 8 months; case fatality was 23%. Among children younger than 5 years, the annual incidence of invasive Hib disease 1 year before and 1 and 3 years after vaccine introduction was 66, 47, and 7.6 per 100,000, respectively. For children younger than 2 years, incidence was 119, 82, and 16 per 100,000, respectively. In 2004-2005, vaccine effectiveness was 88% (95% confidence interval, 73%-96%) among children younger than 5 years and 87% (95% confidence interval, 66%-96%) among children younger than 2 years. Of 53 children with Hib admitted during 2002-2005, 29 (55%) were age-ineligible to have received vaccine, 12 (23%) had not been vaccinated despite being eligible, and 12 (23%) had received 2 or more doses of vaccine (2 were HIV positive). CONCLUSIONS: In Kenya, introduction of Hib vaccine into the routine childhood immunization program reduced Hib disease incidence among children younger than 5 years to 12% of its baseline level. This impact was not observed until the third year after vaccine introduction.

Immunization coverage and risk factors for failure to immunize within the Expanded Programme on Immunization in Kenya after introduction of new Haemophilus influenzae type b and hepatitis b virus antigens.

BACKGROUND: Kenya introduced a pentavalent vaccine including the DTP, Haemophilus influenzae type b and hepatitis b virus antigens in Nov 2001 and strengthened immunization services. We estimated immunization coverage before and after introduction, timeliness of vaccination and risk factors for failure to immunize in Kilifi district, Kenya. METHODS: In Nov 2002 we performed WHO cluster-sample surveys of >200 children scheduled for vaccination before or after introduction of pentavalent vaccine. In Mar 2004 we conducted a simple random sample (SRS) survey of 204 children aged 9-23 months. Coverage was estimated by inverse Kaplan-Meier survival analysis of vaccine-card and mothers' recall data and corroborated by reviewing administrative records from national and provincial vaccine stores. The contribution to timely immunization of distance from clinic, seasonal rainfall, mother's age, and family size was estimated by a proportional hazards model. RESULTS: Immunization coverage for three DTP and pentavalent doses was 100% before and 91% after pentavalent vaccine introduction, respectively. By SRS survey, coverage was 88% for three pentavalent doses. The median age at first, second and third vaccine dose was 8, 13 and 18 weeks. Vials dispatched to Kilifi District during 2001-2003 would provide three immunizations for 92% of the birth cohort. Immunization rate ratios were reduced with every kilometre of distance from home to vaccine clinic (HR 0.95, CI 0.91-1.00), rainy seasons (HR 0.73, 95% CI 0.61-0.89) and family size, increasing progressively up to 4 children (HR 0.55, 95% CI 0.41-0.73). CONCLUSION: Vaccine coverage was high before and after introduction of pentavalent vaccine, but most doses were given late. Coverage is limited by seasonal factors and family size.