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Hefele L, Lai J, Vilivong K, Bounkhoun T, Chanthaluanglath V, Chanthongthip A, Balloch A, Black AP, Hübschen JM, Russell FM, Muller CP. Haemophilus influenzae serotype b seroprevalence in central Lao PDR before and after vaccine introduction. PLoS One 2022; 17:e0274558. [PMID: 36107979 PMCID: PMC9477263 DOI: 10.1371/journal.pone.0274558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 08/31/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Vaccination has dramatically reduced invasive Haemophilus influenzae type b (Hib) disease worldwide. Hib vaccination was introduced in the Lao PDR in 2009, as part of the pentavalent vaccine. To contribute to the understanding of the epidemiology of Hib in Lao PDR and the protection levels before and after the introduction of the vaccination, we tested serum samples from existing cohorts of vaccine age-eligible children and unvaccinated adolescents for antibodies against Hib. METHODS Serum samples from 296 adolescents born before vaccine introduction and from 1017 children under 5 years (vaccinated and unvaccinated) were tested for anti-Hib antibodies by ELISA. Bivariate analyses were performed to investigate factors associated with long-term protection. RESULTS The vast majority of all participants showed evidence of short- (42.7%) or long-term (56.1%) protection against Hib. Almost all of the unvaccinated adolescents had antibody titers indicating short-term protection and almost half (45.6%) were long-term protected. Nearly all children (>99.0%) were at least short-term protected, even those that were unvaccinated or whose vaccination status was unknown. Among vaccinated children, participants vaccinated more than 1 or 2 years ago and with a mid-upper arm circumference z-score < -2 were less likely to be long-term protected. DISCUSSION Nearly all adolescents born before the introduction of Hib vaccination in the Lao PDR had antibody titers corresponding to at least short-term protection, indicating a high burden of Hib disease at that time. After vaccine introduction, all but four children (>99%) showed at least short-term protection. Possible explanations for the proportion of protected, yet apparently unvaccinated children, may be past infections, cross-reacting antibodies or faulty vaccination documentation. Our results highlight the need for robust surveillance and reporting of invasive Hib disease to determine the burden of disease despite vaccination.
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Affiliation(s)
- Lisa Hefele
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand-Duchy of Luxembourg
| | - Jana Lai
- New Vaccines, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- National Centre for Epidemiology and Population Health, Acton, ACT, Australia
| | - Keoudomphone Vilivong
- Lao-Oxford Mahosot Hospital Wellcome Trust Research Unit, Vientiane Capital, Lao PDR
| | - Toukta Bounkhoun
- Lao-Oxford Mahosot Hospital Wellcome Trust Research Unit, Vientiane Capital, Lao PDR
| | | | - Anisone Chanthongthip
- Lao-Oxford Mahosot Hospital Wellcome Trust Research Unit, Vientiane Capital, Lao PDR
| | - Anne Balloch
- New Vaccines, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | | | - Judith M. Hübschen
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand-Duchy of Luxembourg
| | - Fiona M. Russell
- Department of Paediatrics, The University of Melbourne, Victoria, Australia
- Asia-Pacific Health Research, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Claude P. Muller
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand-Duchy of Luxembourg
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Brooks WA, Zaman K, Goswami D, Prosperi C, Endtz HP, Hossain L, Rahman M, Ahmed D, Rahman MZ, Banu S, Shikder AU, Jahan Y, Nahar K, Chisti MJ, Yunus M, Khan MA, Matin FB, Mazumder R, Shahriar Bin Elahi M, Saifullah M, Alam M, Bin Shahid ASMS, Haque F, Sultana S, Higdon MM, Haddix M, Feikin DR, Murdoch DR, Hammitt LL, O’Brien KL, Deloria Knoll M. The Etiology of Childhood Pneumonia in Bangladesh: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study. Pediatr Infect Dis J 2021; 40:S79-S90. [PMID: 34448747 PMCID: PMC8448409 DOI: 10.1097/inf.0000000000002648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pneumonia remains the leading infectious cause of death among children <5 years, but its cause in most children is unknown. We estimated etiology for each child in 2 Bangladesh sites that represent rural and urban South Asian settings with moderate child mortality. METHODS As part of the Pneumonia Etiology Research for Child Health study, we enrolled children 1-59 months of age with World Health Organization-defined severe and very severe pneumonia, plus age-frequency-matched controls, in Matlab and Dhaka, Bangladesh. We applied microbiologic methods to nasopharyngeal/oropharyngeal swabs, blood, induced sputum, gastric and lung aspirates. Etiology was estimated using Bayesian methods that integrated case and control data and accounted for imperfect sensitivity and specificity of the measurements. RESULTS We enrolled 525 cases and 772 controls over 24 months. Of the cases, 9.1% had very severe pneumonia and 42.0% (N = 219) had infiltrates on chest radiograph. Three cases (1.5%) had positive blood cultures (2 Salmonella typhi, 1 Escherichia coli and Klebsiella pneumoniae). All 4 lung aspirates were negative. The etiology among chest radiograph-positive cases was predominantly viral [77.7%, 95% credible interval (CrI): 65.3-88.6], primarily respiratory syncytial virus (31.2%, 95% CrI: 24.7-39.3). Influenza virus had very low estimated etiology (0.6%, 95% CrI: 0.0-2.3). Mycobacterium tuberculosis (3.6%, 95% CrI: 0.5-11.0), Enterobacteriaceae (3.0%, 95% CrI: 0.5-10.0) and Streptococcus pneumoniae (1.8%, 95% CrI: 0.0-5.9) were the only nonviral pathogens in the top 10 etiologies. CONCLUSIONS Childhood severe and very severe pneumonia in young children in Bangladesh is predominantly viral, notably respiratory syncytial virus.
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Affiliation(s)
- W. Abdullah Brooks
- From the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Khalequ Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Doli Goswami
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Hubert P. Endtz
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
- Department of Clinical Microbiology & Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
- Fondation Mérieux, Lyon, France
| | - Lokman Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Mustafizur Rahman
- Virology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dilruba Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Mohammed Ziaur Rahman
- Virology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sayera Banu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Arif Uddin Shikder
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Yasmin Jahan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kamrun Nahar
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | | | - Mohammed Yunus
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | | | | | - Razib Mazumder
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | | | - Muhammad Saifullah
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Muntasir Alam
- Virology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Fahim Haque
- Virology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sabiha Sultana
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Melissa M. Higdon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Meredith Haddix
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel R. Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David R. Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Laura L. Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Saha S, Saha SK. Invasive Bacterial Vaccine-Preventable Disease Surveillance: Successes and Lessons Learned in Bangladesh for a Sustainable Path Forward. J Infect Dis 2021; 224:S293-S298. [PMID: 34469550 PMCID: PMC8409528 DOI: 10.1093/infdis/jiab129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We have made considerable progress in setting and scaling up surveillance systems to drive evidence-based policy decisions, but the recent epidemics highlight that current systems are not optimally designed. Good surveillance systems should be coordinated, comprehensive, and adaptive. They should generate data in real time for immediate analysis and intervention, whether for endemic diseases or potential epidemics. Such systems are especially needed in low-resource settings where disease burden is the highest, but tracking systems are the weakest here due to competing priorities and constraints on available resources. In this article, using the examples of 3 large, and mostly successful, infectious disease surveillance studies in Bangladesh, we identify 2 core limitations—the pathogen bias and the vaccine bias—in the way current surveillance programs are designed for low-resource settings. We highlight the strengths of the current Global Invasive Bacterial Vaccine Preventable Disease Surveillance Network of the World Health Organization and present case studies from Bangladesh to illustrate how this surveillance platform can be leveraged to overcome its limitations. Finally, we propose a set of criteria for building a comprehensive infectious disease surveillance system with the hope of encouraging current systems to use the limited resources as optimally as possible to generate the maximum amount of knowledge.
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Affiliation(s)
- Senjuti Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh.,Dhaka Shishu Hospital, Dhaka, Bangladesh.,Bangladesh Institute of Child Health, Dhaka, Bangladesh
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Saha S, Tanmoy AM, Tanni AA, Goswami S, Sium SMA, Saha S, Islam S, Hooda Y, Malaker AR, Anik AM, Haq MS, Jabin T, Hossain MM, Tabassum N, Rahman H, Hossain MJ, Islam MS, Saha SK. New waves, new variants, old inequity: a continuing COVID-19 crisis. BMJ Glob Health 2021; 6:e007031. [PMID: 34385165 PMCID: PMC8361706 DOI: 10.1136/bmjgh-2021-007031] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 01/07/2023] Open
Affiliation(s)
- Senjuti Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | | | | | - Sudipta Saha
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - Yogesh Hooda
- Child Health Research Foundation, Dhaka, Bangladesh
- Division of Cell Biology, Laboratory of Molecular Biology - MRC, Cambridge, UK
| | | | | | | | - Tasnim Jabin
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | | | | | | | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
- Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
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Hossain MZ, Tong S, Bambrick H, Khan AF, Hore SK, Hu W. Weather factors, PCV intervention and childhood pneumonia in rural Bangladesh. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:561-569. [PMID: 31848699 DOI: 10.1007/s00484-019-01842-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/18/2019] [Accepted: 12/03/2019] [Indexed: 06/10/2023]
Abstract
Available evidence is limited on the association between weather factors and childhood pneumonia, especially in developing countries. This study examined the effects of weather variability on childhood pneumonia after the introduction of pneumococcal conjugate vaccines (PCV) intervention in rural Bangladesh. Data on pneumonia cases and weather variables (temperature and relative humidity) between the 1st January 2012 and the 31st December 2016 were collected from Matlab Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh, and Bangladesh Meteorological Department, respectively. Time series cross-correlation functions were applied to identify the time lags of the effect of each weather factor on pneumonia. Generalized linear regression model with Poisson link was used to quantify the association between weather factors and childhood pneumonia after adjustment of PCV intervention. The annual incidence rate of pneumonia reduced from 5691/100,000 to 2000/100,000 after PCV intervention. Generalized linear regression model suggested that temperature had a negative association with childhood pneumonia (relative risk, 0.985; 95% confidence interval (CI), 0.974-0.997), and PCV intervention was a protective factor with the relative risk estimate of 0.489 (95% CI, 0.435-0.551). However, no substantial association was found with relative humidity. PCV intervention appeared protective against childhood pneumonia, and temperature might be associated with this disease in children. Our findings may help inform public health policy, including the potential of development of early warning systems based on weather factors and PCV for the control and prevention of pneumonia in lower middle-income country like Bangladesh.
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Affiliation(s)
- Mohammad Zahid Hossain
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Shilu Tong
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Public Health, Institute of Environment and Population Health, Anhui Medical University, Hefei, China
| | - Hilary Bambrick
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Al Fazal Khan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Samar Kumar Hore
- Organization for Population Health Environment & Nutrition, Abhaynagar, Jashore, Bangladesh
| | - Wenbiao Hu
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
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Horng L, Kakoly NS, Abedin J, Luby SP. Effect of household relocation on child vaccination and health service utilisation in Dhaka, Bangladesh: a cross-sectional community survey. BMJ Open 2019; 9:e026176. [PMID: 30878989 PMCID: PMC6429946 DOI: 10.1136/bmjopen-2018-026176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To explore the relationship between household relocation and use of vaccination and health services for severe acute respiratory illness (ARI) among children in Dhaka, Bangladesh. DESIGN Analysis of cross-sectional community survey data from a prior study examining the impact of Haemophilus influenzae type b vaccine introduction in 2009 on meningitis incidence in Bangladesh. SETTING Communities surrounding two large paediatric hospitals in Dhaka, Bangladesh. PARTICIPANTS Households with children under 5 years old who either recently relocated <12 months or who were residentially stable living >24 months in their current residence (total n=10 020) were selected for this study. PRIMARY OUTCOME MEASURES Full vaccination coverage among children aged 9-59 months and visits to a qualified medical provider for severe ARI among children under 5 years old. RESULTS Using vaccination cards with maternal recall, full vaccination was 80% among recently relocated children (n=3795) and 85% among residentially stable children (n=4713; χ2=37.2, p<0.001). Among children with ARI in the prior year, 69% of recently relocated children (n=695) had visited a qualified medical provider compared with 82% of residentially stable children (n=763; χ2=31.9, p<0.001). After adjusting for demographic and socioeconomic characteristics, recently relocated children were less likely to be fully vaccinated (prevalence ratio [PR] 0.97; 95% CI 0.95 to 0.99; p=0.016) and to have visited a qualified medical provider for ARI (PR 0.88; 95% CI 0.84 to 0.93; p<0.001). CONCLUSIONS Children in recently relocated households in Dhaka, Bangladesh, have decreased use of vaccination and qualified health services for severe ARI.
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Affiliation(s)
- Lily Horng
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Nadira Sultana Kakoly
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jaynal Abedin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Stephen P Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Fitzwater SP, Ramachandran P, Kahn GD, Nedunchelian K, Suresh S, Santosham M, Chandran A. Impact of the introduction of the Haemophilus influenzae type b conjugate vaccine in an urban setting in southern India. Vaccine 2019; 37:1608-1613. [PMID: 30772069 DOI: 10.1016/j.vaccine.2019.01.080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 01/22/2019] [Accepted: 01/29/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Haemophilus influenzae type b was the leading cause of bacterial meningitis in infants and children below the age of two years prior to the introduction of H. influenzae type b conjugate vaccines. In December 2011, the Indian government introduced H. influenzae b vaccine in the state of Tamilnadu. A prospective surveillance for bacterial meningitis was established at the Institute of Child Health in Chennai to evaluate the etiology of meningitis and impact of the vaccine. MATERIAL AND METHODS Infants aged one to 23 months who were admitted to the hospital with symptoms of suspected bacterial meningitis were enrolled and lumbar puncture was performed. Cerebrospinal fluid samples were analyzed for white blood cells, protein, and glucose. Bacterial culture and a latex agglutination test for common bacterial pathogens were performed. RESULTS Between January 2009 and March 2014, 4,770 children with suspected bacterial meningitis were enrolled. Prior to the introduction of the vaccine, an average of 11.7 cases of H. influenzae b meningitis and 31.1 cases of probable meningitis with no etiology were identified each year. After introduction, the number of cases were reduced by 79% and 44% respectively. The average H. influenzae b vaccine coverage after introduction was 69% among all children with clinically suspected meningitis. In contrast, the mean number of aseptic meningitis and pneumococcal meningitis cases remained stable throughout the pre and post vaccination period; 28.2 and 4.8 per year, respectively. CONCLUSIONS H. influenzae b conjugate vaccine reduced the number of cases of H. influenzae b meningitis and probable meningitis within the first two years of its introduction. The impact against meningitis was higher than the vaccination rate, indicating indirect effects of the vaccine. India has recently scaled up the use of Hib conjugate vaccine throughout the country which should substantially reduce childhood meningitis rates further in the country.
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Affiliation(s)
- Sean Patrick Fitzwater
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21218, USA.
| | | | - Geoffrey D Kahn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21218, USA
| | | | - Saradha Suresh
- Institute of Child Health and Hospital for Children, Halls Road, Egmore, Chennai, India
| | - Mathuram Santosham
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21218, USA
| | - Aruna Chandran
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21218, USA
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Sultana M, Sarker AR, Sheikh N, Akram R, Ali N, Mahumud RA, Alam NH. Prevalence, determinants and health care-seeking behavior of childhood acute respiratory tract infections in Bangladesh. PLoS One 2019; 14:e0210433. [PMID: 30629689 PMCID: PMC6328134 DOI: 10.1371/journal.pone.0210433] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 12/22/2018] [Indexed: 11/18/2022] Open
Abstract
Background Acute respiratory infections (ARIs) are one of the leading causes of child mortality worldwide and contribute significant health burden for developing nations such as Bangladesh. Seeking care and prompt management is crucial to reduce disease severity and to prevent associated morbidity and mortality. Objective This study investigated the prevalence and care-seeking behaviors among under-five children in Bangladesh and identified factors associated with ARI prevalence and subsequent care-seeking behaviors. Method The present study analyzed cross-sectional data from the 2014 Bangladesh Demographic Health Survey. Bivariate analysis was performed to estimate the prevalence of ARIs and associated care-seeking. Logistic regression analysis was used to determine the influencing socio-economic and demographic predictors. A p-value of <0.05 was considered as the level of significance. Result Among 6,566 under-five children, 5.42% had experienced ARI symptoms, care being sought for 90% of affected children. Prevalence was significantly higher among children < 2 years old, and among males. Children from poorer and the poorest quintiles of households were 2.40 (95% CI = 1.12, 5.15) and 2.36 (95% CI = 1.06, 5.24) times more likely to suffer from ARIs compared to the wealthiest group. Seeking care was significantly higher among female children (AOR = 2.19, 95% CI = 0.94, 5.12). The likelihood of seeking care was less for children belonging to the poorest quintile compared to the richest (AOR = 0.03, 95% CI = 0.01, 0.55). Seeking care from untrained providers was 3.74 more likely among rural residents compared to urban (RRR = 3.74, 95% CI = 1.10, 12.77). Conclusion ARIs continue to contribute high disease burden among under-five children in Bangladesh lacking of appropriate care-seeking behavior. Various factors, such as age and sex of the children, wealth index, the education of the mother, and household lifestyle factors were significantly associated with ARI prevalence and care-seeking behaviors. In addition to public-private actions to increase service accessibility for poorer households, equitable and efficient service distribution and interventions targeting households with low socio-economic status and lower education level, are recommended.
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Affiliation(s)
- Marufa Sultana
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- School of Health and Social Development, Deakin University, Burwood, Melbourne, Australia
- * E-mail:
| | - Abdur Razzaque Sarker
- Health Systems and Population Studies Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- University of Strathclyde, Glasgow, United Kingdom
| | - Nurnabi Sheikh
- Health Systems and Population Studies Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Raisul Akram
- Health Systems and Population Studies Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nausad Ali
- Health Systems and Population Studies Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Nur Haque Alam
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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9
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Ali M, Chang BA, Johnson KW, Morris SK. Incidence and aetiology of bacterial meningitis among children aged 1-59 months in South Asia: systematic review and meta-analysis. Vaccine 2018; 36:5846-5857. [PMID: 30145101 DOI: 10.1016/j.vaccine.2018.07.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/22/2018] [Accepted: 07/15/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Bacterial meningitis is a significant cause of morbidity and mortality worldwide among children aged 1-59 months. We aimed to describe its burden in South Asia, focusing on vaccine-preventable aetiologies. METHODS We searched five databases for studies published from January 1, 1990, to April 25, 2017. We estimated incidence and aetiology-specific proportions using random-effects meta-analysis. In secondary analyses, we described vaccine impact and pneumococcal meningitis serotypes. RESULTS We included 48 articles cumulatively reporting 20,707 cases from 1987 to 2013. Mean annual incidence was 105 (95% confidence interval [CI], 53-173) cases per 100,000 children. On average, Haemophilus influenzae type b (Hib) accounted for 13% (95% CI, 8-19%) of cases, pneumococcus for 10% (95% CI, 6-15%), and meningococcus for 1% (95% CI, 0-2%). These meta-analyses had substantial between-study heterogeneity (I2 > 78%, P < 0.0001). Among studies reporting only confirmed cases, these three bacteria caused a median of 78% cases (IQR, 50-87%). Hib meningitis incidence declined by 72-83% at sentinel hospitals in Pakistan and Bangladesh, respectively, within two years of implementing nationwide vaccination. On average, PCV10 covered 49% (95% CI, 39-58%), PCV13 covered 51% (95% CI, 40-61%), and PPSV23 covered 74% (95% CI, 67-80%) of pneumococcal meningitis serotypes. Lower PCV10 and PCV13 serotype coverage in Bangladesh was associated with higher prevalence of serotype 2, compared to India and Pakistan. CONCLUSIONS South Asia has relatively high incidence of bacterial meningitis among children aged 1-59 months, with vaccine-preventable bacteria causing a substantial proportion. These estimates are likely underestimates due to multiple epidemiological and microbiological factors. Further research on vaccine impact and distribution of pneumococcal serotypes will inform vaccine policymaking and implementation.
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Affiliation(s)
- Mohsin Ali
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Brian A Chang
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kipp W Johnson
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA; Institute for Next Generation Healthcare, Icahn Institute for Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Shaun K Morris
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Canada; Centre for Global Child Health, Hospital for Sick Children Research Institute, Toronto, Canada; Department of Paediatrics, University of Toronto, Toronto, Canada.
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Epidemiology of Otitis Media With Otorrhea Among Bangladeshi Children: Baseline Study for Future Assessment of Pneumococcal Conjugate Vaccine Impact. Pediatr Infect Dis J 2018; 37:715-721. [PMID: 29634626 DOI: 10.1097/inf.0000000000002077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Otitis media (OM) poses a high disease burden on Bangladeshi children, but little is known about its etiologies. We conducted a surveillance study in the largest pediatric hospital to characterize pathogens responsible for OM. METHODS In the outpatient ear-nose-throat department of Dhaka Shishu Hospital, which serves 0 to 18-year-old children, we collected ear swabs from OM children with otorrhea from April 2014 to March 2015. We cultured all specimens for bacterial pathogens and assessed serotype and antimicrobial susceptibility of Streptococcus pneumoniae (Spn) and Haemophilus influenzae (Hi) isolates. RESULTS We recorded 1111 OM episodes; 88% (981/1111) involved otorrhea, and we collected samples from 91% (891/981) of these children. Fifty-one percent (452/891) were culture positive (contaminants excluded), with Hi (21%, 187/891) and Spn (18%, 164/891) most commonly detected. Overall, 45 distinct single and mixed pathogens were revealed. Dominant pneumococcal serotypes were 19A, 19F, 3 and 14; 98% of Hi isolates were nontypeable. Pneumococcal conjugate vaccine (PCV)10 and PCV10 + 6A serotypes accounted for 8% and 9% of all OM and 46% and 49% of pneumococcus-positive cases, respectively, and were more likely to be nonsusceptible to at least 1 antibiotic (erythromycin and/or trimethoprim-sulfamethoxazole) than nonvaccine serotypes (91% vs. 77%). Staphylococcus aureus (9%, 83/891) and Pseudomonas aeruginosa (4%, 38/891) were also found. CONCLUSIONS Nontypeable Hi (NTHi) and Spn are predominant causes of OM in Bangladesh. PCV10, introduced in March 2015, is likely to reduce pneumococcal and overall OM burden. Data collected post-PCV10 will provide comprehensive insight into the effects of this vaccine on these pathogens.
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Hasan AZ, Saha S, Saha SK, Sahakyan G, Grigoryan S, Mwenda JM, Antonio M, Knoll MD, Serhan F, Cohen AL. Using pneumococcal and rotavirus surveillance in vaccine decision-making: A series of case studies in Bangladesh, Armenia and the Gambia. Vaccine 2018; 36:4939-4943. [PMID: 30037484 DOI: 10.1016/j.vaccine.2018.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 11/19/2022]
Abstract
Pneumonia and diarrhea are the leading causes of child morbidity and mortality globally and are vaccine preventable. The WHO-coordinated Global Rotavirus and Invasive Bacterial Vaccine-Preventable Disease Surveillance Networks support surveillance systems across WHO regions to provide burden of disease data for countries to make evidence-based decisions about introducing vaccines and to demonstrate the impact of vaccines on disease burden. These surveillance networks help fill the gaps in data in low and middle-income countries where disease burden and risk are high but support to sustain surveillance activities and generate data is low. Through a series of country case studies, this paper reviews the successful use of surveillance data for disease caused by pneumococcus and rotavirus in informing national vaccine policy in Bangladesh, Armenia and The Gambia. The case studies delve into ways in which countries are leveraging and building capacity in existing surveillance infrastructure to monitor other diseases of concern in the country. Local institutions have been identified to play a critical role in making surveillance data available to policymakers. We recommend that countries review local or regional surveillance data in making vaccine policy decisions. Documenting use of surveillance activities can be used as advocacy tools to convince governments and external funders to invest in surveillance and make it a priority immunization activity.
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Affiliation(s)
- Alvira Z Hasan
- Expanded Programme on Immunization (EPI), Department of Immunizations, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland.
| | - Senjuti Saha
- Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Samir K Saha
- Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh; Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Gayane Sahakyan
- National Immunization Program, Armenia National Center of Disease Control and Prevention, Armenia & Ministry of Health of the Republic of Armenia, Yerevan, Armenia
| | - Svetlana Grigoryan
- National Center of Disease Control and Prevention, Armenia Ministry of Health of the Republic of Armenia & Immunization and Epidemiology of Vaccine-Preventable Diseases, Yerevan, Armenia
| | - Jason M Mwenda
- The World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Martin Antonio
- Vaccines and Immunity Theme, Medical Research Council Unit, Fajara, Gambia
| | - Maria D Knoll
- Department of International Health, Johns Hopkins University, Baltimore, MD, United States
| | - Fatima Serhan
- Expanded Programme on Immunization (EPI), Department of Immunizations, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Adam L Cohen
- Expanded Programme on Immunization (EPI), Department of Immunizations, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
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Saha S, Santosham M, Hussain M, Black RE, Saha SK. Rotavirus Vaccine will Improve Child Survival by More than Just Preventing Diarrhea: Evidence from Bangladesh. Am J Trop Med Hyg 2017; 98:360-363. [PMID: 29210350 DOI: 10.4269/ajtmh.17-0586] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Despite the high burden of rotavirus diarrhea, uptake of rotavirus vaccines in Asia remains low. This primarily stems from a perception of rotavirus as a non-life-threatening pathogen amidst a background of competing health priorities and limited resources. In the largest pediatric hospital of Bangladesh, where there is a fierce competition for beds, we found that between November 2015 and October 2016, 12% of 23,064 admissions were due to gastrointestinal infections, 54% of which were caused by rotavirus. One in four cases requiring hospitalization, or 5,879 cases, was refused because of unavailability of beds. Most refused cases were of pneumonia (22%), severe perinatal asphyxia (17%), preterm birth complications (7%), and meningitis (2%), all of which bear high risks of death or disability, if not treated timely. When determining vaccine policies and conducting vaccine impact studies, it would be shortsighted to not consider the impact on morbidity and mortality of cases that are refused admission because of the hospitalization of children with a preventable disease as rotavirus diarrhea. In our hospital, routine use of a rotavirus vaccine with 41% efficacy will release 629 beds per year to accommodate previously refused cases. Based on evidence, we make the case that introduction of this vaccine in Bangladesh and the surrounding region will prevent morbidity and mortality, both directly and indirectly, and help us ensure survival and well-being of all children.
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Affiliation(s)
- Senjuti Saha
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Mathuram Santosham
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Manzoor Hussain
- Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Samir K Saha
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh.,Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
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Saha S, Hasan M, Kim L, Farrar JL, Hossain B, Islam M, Ahmed ANU, Amin MR, Hanif M, Hussain M, El-Arifeen S, Whitney CG, Saha SK. Epidemiology and risk factors for pneumonia severity and mortality in Bangladeshi children <5 years of age before 10-valent pneumococcal conjugate vaccine introduction. BMC Public Health 2016; 16:1233. [PMID: 27927201 PMCID: PMC5142317 DOI: 10.1186/s12889-016-3897-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 12/01/2016] [Indexed: 02/03/2023] Open
Abstract
Background Pneumonia is the leading infectious cause of morbidity and mortality in young children in Bangladesh. We present the epidemiology of pneumonia in Bangladeshi children <5 years before 10-valent pneumococcal conjugate vaccine introduction and investigate factors associated with disease severity and mortality. Methods Children aged 2–59 months admitted to three Bangladeshi hospitals with pneumonia (i.e., cough or difficulty breathing and age-specific tachypnea without danger signs) or severe pneumonia (i.e., cough or difficulty breathing and ≥1 danger signs) were included. Demographic, clinical, laboratory, and vaccine history data were collected. We assessed associations between characteristics and pneumonia severity and mortality using multivariable logistic regression. Results Among 3639 Bangladeshi children with pneumonia, 61% had severe disease, and 2% died. Factors independently associated with severe pneumonia included ages 2–5 months (adjusted odds ratio [aOR] 1.60 [95% CI: 1.26–2.01]) and 6–11 months (aOR 1.31 [1.10–1.56]) relative to 12–59 months, low weight for age (aOR 1.22 [1.04–1.42]), unsafe drinking water source (aOR 2.00 [1.50–2.69]), higher paternal education (aOR 1.34 [1.15–1.57]), higher maternal education (aOR 0.74 [0.64–0.87]), and being fully vaccinated for age with pentavalent vaccination (aOR 0.64 [0.51–0.82]). Increased risk of pneumonia mortality was associated with age <12 months, low weight for age, unsafe drinking water source, lower paternal education, disease severity, and having ≥1 co-morbid condition. Conclusions Modifiable factors for severe pneumonia and mortality included low weight for age and access to safe drinking water. Improving vaccination status could decrease disease severity.
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Affiliation(s)
- Shampa Saha
- Child Health research Foundation, Dhaka Shishu Hospital, Sher-E Bangla Nagar, Dhaka, 1207, Bangladesh
| | - Md Hasan
- Child Health research Foundation, Dhaka Shishu Hospital, Sher-E Bangla Nagar, Dhaka, 1207, Bangladesh
| | - Lindsay Kim
- , 1600 Clifton Road, NE, MS A34, Atlanta, GA, 30329, USA
| | | | - Belal Hossain
- Child Health research Foundation, Dhaka Shishu Hospital, Sher-E Bangla Nagar, Dhaka, 1207, Bangladesh
| | - Maksuda Islam
- Child Health research Foundation, Dhaka Shishu Hospital, Sher-E Bangla Nagar, Dhaka, 1207, Bangladesh
| | - Asm Nawshad Uddin Ahmed
- Child Health research Foundation, Dhaka Shishu Hospital, Sher-E Bangla Nagar, Dhaka, 1207, Bangladesh
| | - M Ruhul Amin
- Child Health research Foundation, Dhaka Shishu Hospital, Sher-E Bangla Nagar, Dhaka, 1207, Bangladesh
| | - Mohammed Hanif
- Child Health research Foundation, Dhaka Shishu Hospital, Sher-E Bangla Nagar, Dhaka, 1207, Bangladesh
| | - Manzoor Hussain
- Child Health research Foundation, Dhaka Shishu Hospital, Sher-E Bangla Nagar, Dhaka, 1207, Bangladesh
| | - Shams El-Arifeen
- Child Health research Foundation, Dhaka Shishu Hospital, Sher-E Bangla Nagar, Dhaka, 1207, Bangladesh.,International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, 1212, Bangladesh
| | | | - Samir K Saha
- Child Health research Foundation, Dhaka Shishu Hospital, Sher-E Bangla Nagar, Dhaka, 1207, Bangladesh. .,Department of Microbiology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, 1207, Bangladesh.
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Le P, Nghiem VT, Swint JM. Post-GAVI sustainability of the Haemophilus influenzae type b vaccine program: The potential role of economic evaluation. Hum Vaccin Immunother 2016; 12:2403-5. [PMID: 27135964 PMCID: PMC5027728 DOI: 10.1080/21645515.2016.1175695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Haemophilus influenzae type b (Hib) can cause severe invasive diseases which are, however, preventable by vaccination. To increase access to Hib vaccine, GAVI – the Vaccine Alliance – has provided financial support for 73 lower income countries worldwide. At the same time, GAVI has been implementing its co-financing policy, requiring recipient countries to pay a portion of vaccine costs and to increase this amount over time. Starting in 2016, 5 countries will stop receiving GAVI funding and procure the vaccine themselves. Although the graduating countries have access to the UNICEF/GAVI tendered vaccine price for 5 more years, the uncertainty in market vaccine price may hamper the post-GAVI program sustainability. A possible increase in vaccine price would cause a significant burden on governmental budgets, discouraging countries to continue the program. As a special tool, economic evaluation (EE) can assist decision makers by identifying the maximum affordable vaccine price for countries to pay. Given that only 6 GAVI-eligible countries have such analyses published, more EEs are necessary to strengthen countries' commitment during this transition period. The information will also be useful for manufacturers to determine their pricing policy.
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Affiliation(s)
- Phuc Le
- a Center for Value-based Care Research , Medicine Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Van T Nghiem
- b Department of Management , Policy and Community Health, The University of Texas School of Public Health , Houston , TX , USA
| | - J Michael Swint
- b Department of Management , Policy and Community Health, The University of Texas School of Public Health , Houston , TX , USA.,c Center for Clinical Research and Evidence-Based Medicine , The University of Texas School of Medicine , Houston , TX , USA
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Luby SP, Saha S, Andrews JR. Towards sustainable public health surveillance for enteric fever. Vaccine 2015; 33 Suppl 3:C3-7. [PMID: 25912287 DOI: 10.1016/j.vaccine.2015.02.054] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/09/2015] [Accepted: 02/12/2015] [Indexed: 10/23/2022]
Abstract
Enteric fever that results from infection by the typhoidal Salmonellas (Salmonella Typhi and Salmonella Paratyphi A, B and C) is a life-threatening preventable illness. Surveillance of enteric fever is important to understand current burden of disease, to track changes in human health burden from increasing antimicrobial resistance and to assess the impact of efforts to reduce disease burden. Since enteric fever occurs predominantly in low income communities, expensive surveillance is not sustainable. Traditional hospital-based surveillance does not estimate population burden and intensive community-based cohort studies do not capture the severe disease that is crucial to policy decisions. While cohort studies have been considered the gold standard for incidence estimates, the resources required to conduct them are great; as a consequence, estimates of enteric fever burden have been highly geographically and temporally restricted. A hybrid approach combining laboratory diagnosis that is already being conducted in healthcare centers with community-based surveillance of health care facility use offers a low-cost, sustainable approach to generate policy relevant data.
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Affiliation(s)
- Stephen P Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, United States.
| | - Samir Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Jason R Andrews
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, United States
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Flasche S, Takahashi K, Vu DT, Suzuki M, Nguyen THA, Le H, Hashizume M, Dang DA, Edmond K, Ariyoshi K, Mulholland EK, Edmunds WJ, Yoshida LM. Early indication for a reduced burden of radiologically confirmed pneumonia in children following the introduction of routine vaccination against Haemophilus influenzae type b in Nha Trang, Vietnam. Vaccine 2014; 32:6963-6970. [PMID: 25444823 PMCID: PMC7125610 DOI: 10.1016/j.vaccine.2014.10.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 10/06/2014] [Accepted: 10/20/2014] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Despite the global success of Hib vaccination in reducing disease and mortality, uncertainty about the disease burden and the potential impact of Hib vaccination in Southeast Asia has delayed the introduction of vaccination in some countries in the region. Hib vaccination was introduced throughout Vietnam in July 2010 without catch-up. In an observational, population based surveillance study we estimated the impact of routine Hib vaccination on all cause radiologically confirmed childhood pneumonia in Nha Trang, Vietnam. MATERIALS AND METHODS In 2007 active hospital based surveillance was established in Khanh Hoa General Hospital, the only hospital in Nha Trang, Khanh Hoa province. Nasopharyngeal samples and chest radiographs are taken routinely from all children diagnosed with acute respiratory illness on admission. For admissions between 02/2007 and 03/2012 chest radiographs were interpreted for the presence of WHO primary endpoint pneumonia and nasopharyngeal swabs were analysed by PCR for the presence of Influenza A or B, RSV and rhinovirus. We employed Poisson regression to estimate the impact of Hib vaccination on radiologically confirmed pneumonia (RCP) while statistically accounting for potential differences in viral circulation in the post vaccination era which could have biased the estimate. RESULTS Of 3151 cases admitted during the study period, 166 had RCP and major viruses were detected in 1601. The adjusted annual incidence of RCP in children younger than 5 years declined by 39% (12-58%) after introduction of Hib vaccination. This decline was most pronounced in children less than 2 years old, adjusted IRR: 0.52 (0.33-0.81), and no significant impact was observed in the 2-4 years old who were not eligible for vaccination, adjusted IRR: 0.96 (0.52-1.72). DISCUSSION We present early evidence that the burden of Hib associated RCP in Nha Trang before vaccination was substantial and that shortly after introduction to the routine childhood immunisation scheme vaccination has substantially reduced that burden.
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Affiliation(s)
- Stefan Flasche
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Kensuke Takahashi
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Dinh Thiem Vu
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | - Motoi Suzuki
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | | | - HuuTho Le
- Khanh Hoa Health Service Department, Nha Trang, Viet Nam
| | | | - Duc Anh Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | - Karen Edmond
- Menzies School of Health Research, Darwin, Australia
| | - Koya Ariyoshi
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - E Kim Mulholland
- London School of Hygiene and Tropical Medicine, London, UK; Menzies School of Health Research, Darwin, Australia
| | - W John Edmunds
- London School of Hygiene and Tropical Medicine, London, UK
| | - Lay-Myint Yoshida
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
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Ahmed ASMNU, Khan NZ, Hussain M, Amin MR, Hanif M, Mahbub M, El-Arifeen S, Baqui AH, Qazi SA, Saha SK. Follow-up of cases of Haemophilus influenzae type b meningitis to determine its long-term sequelae. J Pediatr 2013; 163:S44-9. [PMID: 23773594 DOI: 10.1016/j.jpeds.2013.03.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To measure physical and neurologic impact of Haemophilus influenzae type b (Hib) meningitis on surviving children through short- and long-term follow-up. STUDY DESIGN Cases of Hib meningitis, diagnosed at a tertiary level pediatric hospital, were subjected to short- and long-term follow-up and compared with age, sex, and area of residence matched healthy controls. Follow-up assessments included thorough physical and neurodevelopmental assessments using a standardized protocol by a multidisciplinary team. RESULTS Assessments of short-term follow-up cohort (n = 64) revealed hearing, vision, mental, and psychomotor deficits in 7.8%, 3%, 20%, and 25% of the cases, respectively. Deficits were 10%, 1.4%, 21%, and 25% in long-term follow-up cohort (n = 71), in that order. Mental and psychomotor deficits were found in 2% of the controls, none of whom had vision or hearing deficits. CONCLUSIONS In addition to risk of death, Hib meningitis in children causes severe disabilities in survivors. These data facilitated a comprehensive understanding of the burden of Hib meningitis, specifically in developing countries where disabled children remain incapacitated because of lack of resources and facilities. The evidence generated from this study is expected to provide a compelling argument in favor of introduction and continuation of Hib conjugate vaccine in the national immunization program for children.
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Affiliation(s)
- A S M Nawshad Uddin Ahmed
- Department of Pediatrics, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
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