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Righolt CH, Pabla G, Donelle J, Brna P, Deeks SL, Wilson SE, Smith B, Wilson K, Mahmud SM, Top KA, Hawken S. Vaccine coverage among children with epilepsy in two Canadian provinces: A Canadian immunization research network study. Vaccine 2021; 39:2117-2123. [PMID: 33722410 DOI: 10.1016/j.vaccine.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Children with epilepsy are at increased risk of complications from vaccine-preventable infections, yet information on vaccine coverage in these children is scarce. We aimed to compare vaccine coverage among children with epilepsy to children without epilepsy. STUDY DESIGN We conducted a retrospective cohort study including all 2005-2013 births in Manitoba and Ontario, Canada, creating two cohorts: 2-year-olds and 7-year-olds (followed to age 2 and 7 years). We split each cohort into epilepsy and non-epilepsy subcohorts. We assessed vaccination coverage based on provincial schedules and determined timeliness of MMR (measles, mumps, rubella) dose 1 (recommended at 12 months) and DTaP (diphtheria, tetanus, pertussis) dose 4 (recommended at 18 months). We used logistic regression to calculate adjusted odds ratios (aORs) of the association between epilepsy and vaccination, combining both provincial estimates using random effects meta-analysis. RESULTS We included 16,558 2-year-olds (Manitoba, 653; Ontario, 15,905) and 13,004 7-year-olds (Manitoba, 483; Ontario, 12,521) with epilepsy. At age 2 years, the aOR for up-to-date vaccination among children with versus without epilepsy was 0.9 (95% confidence interval 0.8-1.1); at age 7 years it was 1.0 (0.9-1.1). Infants diagnosed with epilepsy before age 6 months were less likely to be up-to-date at age 2 years (0.9; 0.8-0.9), although this difference disappeared by age 7 years. Vaccine timeliness was similar between children with and without epilepsy for MMR dose 1 and DTaP dose 4. CONCLUSIONS Overall, this study suggests that children with epilepsy are not significantly under-vaccinated compared to their peers without epilepsy. As children with epilepsy are at a higher risk of complications from vaccine-preventable diseases, vaccination in children with epilepsy should be optimized, especially early in life, as these children may not be able to rely on herd protection.
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Affiliation(s)
- Christiaan H Righolt
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Gurpreet Pabla
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jessy Donelle
- Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Paula Brna
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Shelley L Deeks
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Public Health Ontario, Toronto, ON, Canada
| | | | - Bruce Smith
- Department of Mathematics and Statistics, Dalhousie University, Halifax, NS, Canada
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Karina A Top
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada; Department of Community Health & Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Steven Hawken
- Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
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Wilck MB, Xu ZJ, Stek JE, Lee AW. Safety and immunogenicity of a fully-liquid DTaP-IPV-Hib-HepB vaccine (Vaxelis™) in premature infants. Hum Vaccin Immunother 2020; 17:191-196. [PMID: 32750261 PMCID: PMC7872088 DOI: 10.1080/21645515.2020.1756668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Immune immaturity may put premature infants at increased risk for infections. DTaP-IPV-Hib-HepB vaccine (Vaxelis™), a hexavalent vaccine studied in >6,800 children, has acceptable safety and immunogenicity profiles generally similar to control vaccines. Here we evaluate safety and immunogenicity of DTaP-IPV-Hib-HepB vaccine in premature infants. Methods: Premature infants were identified using prior medical conditions terms "premature baby/delivery" and/or "low birth weight baby". Immunogenicity and safety data were summarized across one Phase II and four Phase III randomized, active-comparator-controlled clinical trials (Protocol 004 in Canada [Control: PENTACEL™]; Protocols 005 and 006 in the US [Control: PENTACEL™]; and Protocols 007 and 008 in the EU [Control: INFANRIX™ hexa]) and one Phase III clinical trial in the UK (PRI01C); no formal statistical comparisons were performed. Results: Overall, 160 infants were considered premature (DTaP-IPV-Hib-HepB = 111 Control = 49). The incidence of adverse events (AEs) for DTaP-IPV-Hib-HepB was comparable between overall and premature populations for all AEs days 1-15 postvaccination (Overall = 96.3%; Premature = 97.3%;), solicited injection-site AEs days 1-5 postvaccination (Overall = 84.1%; Premature = 75.5%), and solicited systemic AEs days 1-5 postvaccination (Overall = 93.7%; Premature = 94.5%). A high percentage of premature infants mounted protective immune responses to antigens contained in DTaP-IPV-Hib-HepB vaccine. Response rates in preterm infants for all antigens (80-99%) were in a similar range to all infants (80-99%) for both DTaP-IPV-Hib-HepB and control vaccines. Conclusions: DTaP-IPV-Hib-HepB vaccine has a low incidence of AEs, an acceptable safety profile, and elicited satisfactory immune responses in premature infants comparable to the overall study population. These findings support vaccination with DTaP-IPV-Hib-HepB vaccine in healthy premature infants.
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Affiliation(s)
| | - Z Jin Xu
- Merck & Co., Inc ., Kenilworth, NJ, USA
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Nakatudde I, Rujumba J, Namiiro F, Sam A, Mugalu J, Musoke P. Vaccination timeliness and associated factors among preterm infants at a tertiary hospital in Uganda. PLoS One 2019; 14:e0221902. [PMID: 31490987 PMCID: PMC6730875 DOI: 10.1371/journal.pone.0221902] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/16/2019] [Indexed: 11/25/2022] Open
Abstract
Background Preterm infants are at increased risk of infections including vaccine preventable diseases. Therefore, timely vaccination is crucial to ensure adequate disease protection. Information on whether preterm infants are vaccinated according to chronological age as recommended is limited in low-income countries. Objectives We evaluated the timeliness of vaccination and associated factors among preterm infants at Mulago hospital, Uganda. Methods We conducted a mixed methods study between July 2016 and April 2017. Vaccination dates of preterm infants aged 6–24 months were obtained from child health cards. Additional data were collected using a questionnaire. Five key informant interviews with health workers and two focus group discussions with caregivers were conducted. Cox regression analysis was used to identify factors associated with vaccination timeliness. Qualitative data was transcribed and analysed manually using content thematic approach. Results We enrolled 350 preterm infants, with a median age of 8.4 months (IQR 6.8–10.8). Less than half, 149/350 (42.6%) of infants received all vaccines within the recommended time range. Timely vaccination was highest for BCG (92%) and lowest for OPV (45.4%). Untimely vaccination was highest for vaccines administered at 6 weeks (DPT 1, PCV 1 and OPV 1) compared to other vaccines in the EPI schedule. Delivering from home or private clinics and vaccine stock-out were significantly associated with untimely BCG and OPV 0 vaccination. Low maternal education level and being very preterm were associated with untimely DPT 1 and DPT 3 receipt. Admission and long stay in the neonatal unit were associated with untimely DPT 1 receipt while extreme low birth weight was associated with untimely DPT 3 vaccination. Increasing parity was associated with untimely measles vaccination. Qualitative findings revealed that lack of knowledge and poor attitudes of health workers and caregivers, gaps in documentation of vaccination status and inadequate communication by health workers hindered timely vaccination. Conclusion More than half of preterm infants attending a specialised clinic at Mulago National Referral hospital in Uganda did not receive vaccines within the recommended time range. Specific strategies to improve vaccination timeliness in preterm infants are needed especially among the extremely low birth weight, very preterm and those with prolonged hospitalisation.
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Affiliation(s)
- Irene Nakatudde
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
- * E-mail:
| | - Joseph Rujumba
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Ali Sam
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jamir Mugalu
- Mulago National Referral Hospital, Kampala, Uganda
| | - Philippa Musoke
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Makerere University-John Hopkins University Research Collaboration, Kampala, Uganda
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Walker EJ, MacDonald NE, Islam N, Le Saux N, Top KA, Fell DB. Completeness and timeliness of diphtheria-tetanus-pertussis, measles-mumps-rubella, and polio vaccines in young children with chronic health conditions: A systematic review. Vaccine 2019; 37:1725-1735. [PMID: 30814030 DOI: 10.1016/j.vaccine.2019.02.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/23/2019] [Accepted: 02/06/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To systematically review literature on uptake and timeliness of diphtheria-tetanus-pertussis, measles-mumps-rubella, and/or polio-containing vaccines ininfants who were born preterm, with a low birth weight, and/or with chronic health conditions that were diagnosed within the first 6 months of life. METHODS Using a standardized search strategy developed by a medical librarian, records were extracted from MEDLINE, Embase, Database of Abstracts of Reviews of Effects, and CINAHL up to May 8, 2018. RESULTS Out of the 1997 records that were screened, we identified 21 studies that met inclusion criteria. Eleven studies assessed vaccine coverage and/or timeliness in preterm infants, 6 in low birth weight infants, and 7 in children with chronic health conditions. Estimates of coverage in these populations were highly variable, ranging from 40% to 100% across the vaccines and population groups. CONCLUSIONS There is a lack of studies reporting coverage and timeliness of routine immunizations in special populations of children. POLICY IMPLICATIONS Our review suggests a need for improved surveillance of immunization status in special populations of infants, as wellas aneed for standardization of reporting practices.
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Affiliation(s)
| | - Noni E MacDonald
- Dalhousie University, Halifax, NS, Canada; Canadian Centre for Vaccinology, Halifax, NS, Canada
| | | | - Nicole Le Saux
- Division of Infectious Diseases, University of Ottawa, Ottawa, ON, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Karina A Top
- Dalhousie University, Halifax, NS, Canada; Canadian Centre for Vaccinology, Halifax, NS, Canada
| | - Deshayne B Fell
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
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Omeñaca F, Vázquez L, Garcia-Corbeira P, Mesaros N, Hanssens L, Dolhain J, Gómez IP, Liese J, Knuf M. Immunization of preterm infants with GSK's hexavalent combined diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliovirus-Haemophilus influenzae type b conjugate vaccine: A review of safety and immunogenicity. Vaccine 2018; 36:986-996. [PMID: 29336924 DOI: 10.1016/j.vaccine.2018.01.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 11/20/2017] [Accepted: 01/04/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Infants with history of prematurity (<37 weeks gestation) and low birth weight (LBW, <2500 g) are at high risk of infection due to functional immaturity of normal physical and immunological defense mechanisms. Despite current recommendations that infants with history of prematurity/LBW should receive routine immunization according to the same schedule and chronological age as full-term infants, immunization is often delayed. METHODS Here we summarize 10 clinical studies and 15 years of post-marketing safety surveillance of GSK's hexavalent vaccine (DTPa-HBV-IPV/Hib), a combined diphtheria-tetanus-acellular-pertussis-hepatitis-B-inactivated-poliovirus-Haemophilus influenzae-type-b (Hib) conjugate vaccine, when administered alone, or co-administered with pneumococcal conjugate, rotavirus, and meningococcal vaccines and respiratory syncytial virus IgG to infants with history of prematurity/LBW in clinical trials. RESULTS At least 92.5% of infants with history of prematurity/LBW as young as 24 weeks gestation in clinical studies were seropositive to all vaccine antigens after 3-dose primary vaccination with GSK's hexavalent DTPa-HBV-IPV/Hib vaccine, with robust immune responses to booster vaccination. Seropositivity rates and antibody concentrations to hepatitis B and Hib appeared lower in infants with history of prematurity/LBW than term infants. Between 13-30% of medically stable infants with history of prematurity developed apnea after vaccination with GSK's hexavalent DTPa-HBV-IPV/Hib vaccine; usually after dose 1. The occurrence of post-immunization cardiorespiratory events appears to be influenced by the severity of any underlying neonatal condition. Most cardiorespiratory events resolve spontaneously or require minimal intervention. GSK's hexavalent DTPa-HBV-IPV/Hib vaccine was well tolerated in co-administration regimens. CONCLUSION GSK's hexavalent DTPa-HBV-IPV/Hib vaccine alone or co-administered with other pediatric vaccines has a clinically acceptable safety and immunogenicity profile when used in infants with history of prematurity/LBW for primary and booster vaccination. Additional studies are needed in very premature and very LBW infants. However, currently available data support using GSK's hexavalent DTPa-HBV-IPV/Hib vaccine to immunize infants with history of prematurity/LBW according to chronological age.
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Affiliation(s)
- Felix Omeñaca
- Hospital Infantil La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain.
| | - Liliana Vázquez
- Fundación Centro de Estudios Infectológicos, C1425AWK Buenos Aires, Argentina.
| | - Pilar Garcia-Corbeira
- GSK, Parque Tecnológico de Madrid, Calle de Severo Ochoa, 2, 28760 Tres Cantos, Madrid, Spain.
| | | | | | | | | | - Johannes Liese
- Department of Paediatrics, Paediatric Infectious Diseases and Immunology, University of Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany.
| | - Markus Knuf
- HELIOS Dr. Horst Schmidt Kliniken, Children's Hospital, Ludwig-Erhard-Str. 100, 65199 Wiesbaden, Germany.
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Sisson H, Gardiner E, Watson R. Vaccination timeliness in preterm infants: An integrative review of the literature. J Clin Nurs 2017; 26:4094-4104. [PMID: 28618109 DOI: 10.1111/jocn.13916] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2017] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To take a systematic approach to reviewing the scientific literature examining the timeliness of vaccination in preterm infants and to identify any factors associated with timeliness. BACKGROUND Preterm infants are vulnerable to infection and guidance advocates they are vaccinated in accordance with their full-term peers. Vaccination is well tolerated and protective immune responses are observed, yet some early enquiries suggest that preterm infants experience unwarranted delays. The recent surge in pertussis cases and the increase in vaccinations administered make this a topic requiring further exploration. DESIGN An integrative review of the empirical literature. METHODS Studies were identified following a search of Medline, Academic Search Premier, Cochrane Database of Systematic Reviews and the Cumulative Index to Nursing and Allied Health Literature. The review methods used were influenced by a narrative synthesis approach. The retrieval of papers adhered to recognised reporting standards. RESULTS Fourteen studies were identified, which indicated that infants with the lowest gestational ages and birthweights experience the greatest delays. Vaccination timeliness is influenced by hospitalisation and increased postdischarge follow-up. There was a lack of consensus to indicate that parental socio-economic status and level of education were indicators for a delay. The studies propose that many delays are unjustified and not according to genuine contraindications. CONCLUSION This review indicates that preterm infants are not vaccinated in a timely manner. Those involved in vaccinating preterm infants must be informed of the genuine contraindications to avoid unnecessary delays putting preterm infants at an increased risk of infection. RELEVANCE TO CLINICAL PRACTICE Care providers should acknowledge the risk of a delay in preterm infants and actively promote vaccination in this population. Regular training should help to negate the occurrence of inappropriate delays, and careful discharge planning is needed to ensure that preterm infants are vaccinated on time.
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Bell CA, Simmonds KA, MacDonald SE. Exploring the heterogeneity among partially vaccinated children in a population-based cohort. Vaccine 2015; 33:4572-8. [DOI: 10.1016/j.vaccine.2015.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 06/30/2015] [Accepted: 07/02/2015] [Indexed: 11/16/2022]
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Retrospective review of administration of childhood primary vaccination schedule in an Irish tertiary neonatal intensive care unit. Public Health 2015; 129:896-8. [PMID: 26112125 DOI: 10.1016/j.puhe.2015.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/21/2015] [Accepted: 05/12/2015] [Indexed: 11/22/2022]
Abstract
AIMS Quantify and evaluate administration of the routine childhood primary vaccination schedule in a tertiary neonatal intensive care unit (NICU). STUDY DESIGN Retrospective review of paper record of vaccinations administered to inpatients in the NICU from 01/01/2001-30/11/2013. METHODS Data were extracted from hospital records and institutional databases and analysed using SPSS for Mac version 21. Analysis was made based on gestational age, chronological age at time of administration of vaccine, corrected gestational age at time of vaccine administration and type of vaccine received. RESULTS For all preterm (gestation < 37 weeks) babies that received the first '6in1' vaccination while an inpatient (n = 344): mean gestational age = 27.3 weeks (sd = 2.6 weeks); mean chronological age at time of vaccination = 9.4 weeks. For all preterm patients that received the second '6in1' vaccination while an inpatient (n = 19): mean gestational age = 25.6 weeks (sd = 1.63); mean chronological age at time of vaccination = 18.4 weeks. For all term (gestation ≥ 37 weeks) patients that received the first '6in1' vaccination while an inpatient (n = 9): mean gestational age = 40.1 weeks (sd = 1.9); mean chronological age at time of vaccination = 9.8 weeks. There were no reported adverse events to any of the vaccinations administered. CONCLUSION It is safe for premature infants to receive the routine vaccination schedule in a NICU setting.
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Ochoa TJ, Zea-Vera A, Bautista R, Davila C, Salazar JA, Bazán C, López L, Ecker L. Vaccine schedule compliance among very low birth weight infants in Lima, Peru. Vaccine 2014; 33:354-8. [PMID: 25448091 DOI: 10.1016/j.vaccine.2014.11.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 11/02/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE There is little information about vaccine schedule compliance in very-low-birth-weight infants in developing countries. The aim of the study was to describe the compliance with the vaccine schedule among this population in Lima, Peru. PATIENTS AND METHODS We conducted a prospective cohort study in four hospitals in Lima in infants with a birth-weight of less than 1500 g, followed from birth up to 12 months of age every 2 weeks. The date and age at administration of each vaccine was recorded RESULTS 222 infants were enrolled. The median birth-weight was 1250 g (range 550-1499 g) and the median gestational age was 30.0 weeks (range 23-37 weeks). The mean age for the first pentavalent (DPT, Hib, HepB) and oral polio vaccine administration was 4.3 ± 1.4 months in infants with a birth-weight of < 1000 g vs. 3.1 ± 1.0 in infants with a birth-weight 1000-1500 g (p < 0.001); 4.1 ± 0.9 vs. 3.3 ± 1.1 for rotavirus (p < 0.05); and 5.1 ± 2.1 vs. 4.3 ± 1.8 for the 7-valent pneumococcal conjugated vaccine. Only 35% had received the three doses of oral polio and pentavalent vaccine by seven months, although by nine months 81% had received these vaccines. CONCLUSIONS Vaccination of very-low-birth-weight infants in Peru is significantly delayed, especially in infants with a birth-weight of < 1000 g and lower gestational age. Urgent educational interventions targeting physicians and nurses should be implemented in order to improve vaccination rates and timing in these high risk populations.
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Affiliation(s)
- Theresa J Ochoa
- Universidad Peruana Cayetano Heredia, Lima, Lima, Peru; University of Texas School of Public Health, Houston, TX, United States.
| | | | | | - Carmen Davila
- Instituto de Nacional Materno Perinatal, Lima, Lima, Peru
| | | | - Carlos Bazán
- Hospital Nacional Madre Niño San Bartolome, Lima, Lima, Peru
| | - Luis López
- Instituto de Nacional Materno Perinatal, Lima, Lima, Peru
| | - Lucie Ecker
- Instituto de Investigación Nutricional, Lima, Lima, Peru
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