Pregnant women in and around dhaka city: are their children at risk of developing congenital rubella syndrome?

Informing rubella vaccination strategies in East Java, Indonesia through transmission modelling

An estimated 110,000 babies are born with congenital rubella syndrome (CRS) worldwide annually; a significant proportion of cases occur in Southeast Asia. Rubella vaccine programs have led to successful control of rubella and CRS, and even the elimination of disease in many countries. However, if vaccination is poorly implemented it might increase the number of women reaching childbearing age who remain susceptible to rubella and thereby paradoxically increase CRS. We used an age-structured transmission model to compare seven alternative vaccine strategies for their impact on reducing CRS disease burden in East Java, a setting which is yet to implement a rubella vaccine program. We also investigated the robustness of model predictions to variation in vaccine coverage and other key epidemiological factors. Without rubella vaccination, approximately 700 babies are estimated to be born with CRS in East Java every year at an incidence of 0.77 per 1000live births. This incidence could be reduced to 0.0045 per 1000 live births associated with 99.9% annual reduction in rubella infections after 20 years if the existing two doses of measles vaccine are substituted with two doses of measles plus rubella combination vaccine with the same coverage (87.8% of 9-month-old infants and 80% of 6-year-old children). By comparison a single dose of rubella vaccine will take longer to reduce the burden of rubella and CRS and will be less robust to lower vaccine coverage. While the findings of this study should be informative for settings similar to East Java, the conclusions are dependent on vaccine coverage which would need consideration before applying to all of Indonesia and elsewhere in Asia.

Analysis of Different Prognostic Indicators for Malnutrition and Shigella flexneri Infection Among the Children in Bangladesh

The present study investigates into some socio-economic, demographic, and nutritional features that can predispose Bangladeshi children to malnutrition and Shigella flexneri infection. Significant prognostic indicators associated with malnutrition were mother's illiteracy (unadjusted odds ratio, OR = 2.580; 95% confidence interval, CI = 1.134-5.867 and adjusted odds ratio, ORa, 3.814; 95% CI = 1.124-12.943), low birth weight (OR = 3.143; 95% CI = 1.2-8.232 and ORa = 2.404; 95% CI = 0.870-6.644) and poor socioeconomic status (OR = 2.549; 95% CI = 1.382-4.701 and ORa = 1.808; 95% CI = 0.852-3.838). Age was the strongest predictor for the acquisition of S. flexneri infection in the studied population (OR = 5.472; 95% CI = 2.583-11.592 and ORa = 5.808; 95% CI = 2.420-13.942). The severity of malnutrition was significantly (P = 0.033) related to seroprevalence of S. flexneri infection. To reduce malnutrition emphasis should be given on controlling the incidence of low birth weight, improving the literacy status especially of mothers and narrowing the gap between different socio-economic levels. Malnourished children should be examined for severity and direct intervention therapy should be given when necessary.