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Jimbo Sotomayor R, Toscano CM, Sánchez Choez X, Vilema Ortíz M, Rivas Condo J, Ghisays G, Haneuse S, Weinberger DM, McGee G, de Oliveira LH. Impact of pneumococcal conjugate vaccine on pneumonia hospitalization and mortality in children and elderly in Ecuador: Time series analyses. Vaccine 2020; 38:7033-7039. [PMID: 32981782 DOI: 10.1016/j.vaccine.2020.09.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/31/2020] [Accepted: 09/10/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Pneumococcal conjugate vaccines (PCV) reduce the burden of invasive pneumococcal disease and pneumonia hospitalizations. However, there is limited evidence of the effect of PCVs on pneumonia mortality in children. It is anticipated that indirect effects resulting from PCV use among children might further reduce the remaining burden of adult pneumococcal disease caused by pneumococcal serotypes contained in PCV. Whether this will result in reduced pneumonia mortality in children and adults is still not known. METHODS We investigated the impact of PCV on pneumonia hospitalization and mortality in in Ecuador, where PCV was introduced in 2010, considering national data from secondary data sources from 2005 to 2015. Time series analysis using regression models were used to evaluate the decline in the number of all-cause pneumonia hospitalizations and deaths in the period post-PCV introduction. The target populations were children under 5 years and adults aged 50 years and over. Outcomes of interest were hospitalizations and mortality in which the main cause of hospital admission and death, respectively, were coded as ICD10 codes J12-18 (pneumonia). Three different models were fitted. RESULTS We demonstrate a sizeable impact of PCV in pneumonia hospitalization in children < 1 year (27% reduction, 95%CI 12-42%), and < 5 years of age (33% reduction, 95%CI 11-43%). The estimated impact of PCV in pneumonia mortality was a reduction of 14% in < 1 year (95%CI 0-33%), 10% in < 5 years (95%CI 0-25%), and 22% (95%CI 7-34%) in adults aged 50-64 years. Little evidence of a change was detected in elderly ≥ 65 years. CONCLUSION This study is the first to report on the impact of PCV in pneumonia morbidity and mortality in children and older adults, being relevant to policy makers and global donors. Findings were consistent when using different models. Additional studies on the indirect effect of PCV in older adults are needed.
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Affiliation(s)
- Ruth Jimbo Sotomayor
- Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador; Universidad Alcalá de Henares, Madrid, Spain.
| | - Cristiana M Toscano
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Xavier Sánchez Choez
- Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador; Universidad Alcalá de Henares, Madrid, Spain
| | - Martín Vilema Ortíz
- Estrategia Nacional de Inmunizaciones, Ministerio de Salud Pública del Ecuador, Quito, Ecuador
| | - Jackson Rivas Condo
- Estrategia Nacional de Inmunizaciones, Ministerio de Salud Pública del Ecuador, Quito, Ecuador
| | - Gladys Ghisays
- Pan American Health Organization, PWR-Ecuador, Quito, Ecuador
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT, USA
| | - Glen McGee
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lucia H de Oliveira
- Comprehensive Family Immunization Project, Pan American Health Organization, Washington, DC, USA
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Goodman D, Crocker ME, Pervaiz F, McCollum ED, Steenland K, Simkovich SM, Miele CH, Hammitt LL, Herrera P, Zar HJ, Campbell H, Lanata CF, McCracken JP, Thompson LM, Rosa G, Kirby MA, Garg S, Thangavel G, Thanasekaraan V, Balakrishnan K, King C, Clasen T, Checkley W. Challenges in the diagnosis of paediatric pneumonia in intervention field trials: recommendations from a pneumonia field trial working group. THE LANCET. RESPIRATORY MEDICINE 2019; 7:1068-1083. [PMID: 31591066 PMCID: PMC7164819 DOI: 10.1016/s2213-2600(19)30249-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/27/2019] [Accepted: 07/03/2019] [Indexed: 12/14/2022]
Abstract
Pneumonia is a leading killer of children younger than 5 years despite high vaccination coverage, improved nutrition, and widespread implementation of the Integrated Management of Childhood Illnesses algorithm. Assessing the effect of interventions on childhood pneumonia is challenging because the choice of case definition and surveillance approach can affect the identification of pneumonia substantially. In anticipation of an intervention trial aimed to reduce childhood pneumonia by lowering household air pollution, we created a working group to provide recommendations regarding study design and implementation. We suggest to, first, select a standard case definition that combines acute (≤14 days) respiratory symptoms and signs and general danger signs with ancillary tests (such as chest imaging and pulse oximetry) to improve pneumonia identification; second, to prioritise active hospital-based pneumonia surveillance over passive case finding or home-based surveillance to reduce the risk of non-differential misclassification of pneumonia and, as a result, a reduced effect size in a randomised trial; and, lastly, to consider longitudinal follow-up of children younger than 1 year, as this age group has the highest incidence of severe pneumonia.
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Affiliation(s)
- Dina Goodman
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Mary E Crocker
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA; Division of Pediatric Pulmonology, School of Medicine, University of Washington, Seattle, WA, USA
| | - Farhan Pervaiz
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Eric D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA; School of Medicine, and Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kyle Steenland
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Suzanne M Simkovich
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Catherine H Miele
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Laura L Hammitt
- School of Medicine, and Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Phabiola Herrera
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA
| | - Heather J Zar
- Department of Pediatrics and Child Health, SA-MRC Unit on Child & Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Harry Campbell
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Claudio F Lanata
- Instituto de Investigación Nutricional, Lima, Peru; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - John P McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Lisa M Thompson
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Ghislaine Rosa
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Miles A Kirby
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sarada Garg
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Medical College & Research Institute (Deemed University), Chennai, India
| | - Gurusamy Thangavel
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Medical College & Research Institute (Deemed University), Chennai, India
| | - Vijayalakshmi Thanasekaraan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Medical College & Research Institute (Deemed University), Chennai, India
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Medical College & Research Institute (Deemed University), Chennai, India
| | - Carina King
- Institute for Global Health, University College London, London, UK
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA; School of Medicine, and Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
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Comparison of two schedules of two-dose priming with the ten-valent pneumococcal conjugate vaccine in Nepalese children: an open-label, randomised non-inferiority controlled trial. THE LANCET. INFECTIOUS DISEASES 2019; 19:156-164. [DOI: 10.1016/s1473-3099(18)30568-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/24/2018] [Accepted: 09/11/2018] [Indexed: 11/19/2022]
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Megiddo I, Klein E, Laxminarayan R. Potential impact of introducing the pneumococcal conjugate vaccine into national immunisation programmes: an economic-epidemiological analysis using data from India. BMJ Glob Health 2018; 3:e000636. [PMID: 29765775 PMCID: PMC5950640 DOI: 10.1136/bmjgh-2017-000636] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/16/2018] [Accepted: 03/29/2018] [Indexed: 11/03/2022] Open
Abstract
Pneumococcal pneumonia causes an estimated 105 000 child deaths in India annually. The planned introduction of the serotype-based pneumococcal conjugate vaccine (PCV) is expected to avert child deaths, but the high cost of PCV relative to current vaccines provided under the Universal Immunization Programme has been a concern. Cost-effectiveness studies from high-income countries are not readily comparable because of differences in the distribution of prevalent serotypes, population and health systems. We extended IndiaSim, our agent-based simulation model representative of the Indian population and health system, to model the dynamics of Streptococcus pneumoniae. This enabled us to evaluate serotype and overall disease dynamics in the context of the local population and health system, an aspect that is missing in prospective evaluations of the vaccine. We estimate that PCV13 introduction would cost approximately US$240 million and avert US$48.7 million in out-of-pocket expenditures and 34 800 (95% CI 29 600 to 40 800) deaths annually assuming coverage levels and distribution similar to DPT (diphtheria, pertussis and tetanus) vaccination (~77%). Introducing the vaccine protects the population, especially the poorest wealth quintile, from potentially catastrophic expenditure. The net-present value of predicted money-metric value of insurance for 20 years of vaccination is US$160 000 (95% CI US$151 000 to US$168 000) per 100 000 under-fives, and almost half of this protection is for the bottom wealth quintile (US$78 000; 95% CI 70 800 to 84 400). Extending vaccination to 90% coverage averts additional lives and provides additional financial risk protection. Our estimates are sensitive to immunity parameters in our model; however, our assumptions are conservative, and if willingness to pay per years of life lost averted is US$228 or greater, then introducing the vaccine is more cost-effective than our baseline (no vaccination) in more than 95% of simulations.
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Affiliation(s)
- Itamar Megiddo
- Department of Management Science, University of Strathclyde, Glasgow, UK.,Center for Disease Dynamics Economics and Policy, Washington, District of Columbia, USA
| | - Eili Klein
- Center for Disease Dynamics Economics and Policy, Washington, District of Columbia, USA.,Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ramanan Laxminarayan
- Department of Management Science, University of Strathclyde, Glasgow, UK.,Center for Disease Dynamics Economics and Policy, Washington, District of Columbia, USA.,Princeton Environmental Institute, Princeton University, Princeton, New Jersey, USA
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Steenland K, Pillarisetti A, Kirby M, Peel J, Clark M, Checkley W, Chang HH, Clasen T. Modeling the potential health benefits of lower household air pollution after a hypothetical liquified petroleum gas (LPG) cookstove intervention. ENVIRONMENT INTERNATIONAL 2018; 111:71-79. [PMID: 29182949 PMCID: PMC5801118 DOI: 10.1016/j.envint.2017.11.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/01/2017] [Accepted: 11/22/2017] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Improved biomass and advanced fuel cookstoves can lower household air pollution (HAP), but levels of fine particulate matter (PM2.5) often remain above the World Health Organization (WHO) recommended interim target of 35μg/m3. METHODS Based on existing literature, we first estimate a range of likely levels of personal PM2.5 before and after a liquefied petroleum gas (LPG) intervention. Using simulations reflecting uncertainty in both the exposure estimates and exposure-response coefficients, we estimate corresponding expected health benefits for systolic blood pressure (SBP) in adults, birthweight, and pneumonia incidence among children <2years old. We also estimate potential avoided premature mortality among those exposed. RESULTS Our best estimate is that an LPG stove intervention would decrease personal PM2.5 exposure from approximately 270μg/m3 to approximately 70μg/m3, due to likely continued use of traditional open-fire stoves. We estimate that this decrease would lead to a 5.5mmHg lower SBP among women over age 50, a 338g higher birthweight, and a 37% lower incidence of severe childhood pneumonia. We estimate that decreased SBP, if sustained, would result in a 5%-10% decrease in mortality for women over age 50. We estimate that higher birthweight would reduce infant mortality by 4 to 11 deaths per 1000 births; for comparison, the current global infant mortality rate is 32/1000 live births. Reduced exposure is estimated to prevent approximately 29 cases of severe pneumonia per year per 1000 children under 2, avoiding approximately 2-3 deaths/1000 per year. However, there are large uncertainties around all these estimates due to uncertainty in both exposure estimates and in exposure-response coefficients; all health effect estimates include the null value of no benefit. CONCLUSIONS An LPG stove intervention, while not likely to lower exposure to the WHO interim target level, is still likely to offer important health benefits.
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Affiliation(s)
- Kyle Steenland
- Rollins School of Public Health, Emory U., Atlanta, Georgia.
| | - Ajay Pillarisetti
- Environmental Health Sciences, University of California, Berkeley, United States
| | - Miles Kirby
- Rollins School of Public Health, Emory U., Atlanta, Georgia
| | - Jennifer Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - Maggie Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - Will Checkley
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Howard H Chang
- Rollins School of Public Health, Emory U., Atlanta, Georgia
| | - Thomas Clasen
- Rollins School of Public Health, Emory U., Atlanta, Georgia
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Madhi SA, Nunes MC. The potential impact of pneumococcal conjugate vaccine in Africa: Considerations and early lessons learned from the South African experience. Hum Vaccin Immunother 2016; 12:314-25. [PMID: 26317537 DOI: 10.1080/21645515.2015.1084450] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The introduction of pneumococcal conjugate vaccine (PCV) into the South African public immunization program since 2009 adopted a novel vaccination schedule of 3 doses at 6, 14 and 40 weeks of age. Over the past 5 y it has been shown that infant PCV immunization in South Africa is effective in reducing the burden of invasive pneumococcal disease (IPD) among HIV-infected and HIV-uninfected children. Furthermore, indirect protection of unvaccinated age-groups (including high risk groups such as HIV-infected adults) against IPD was demonstrated despite the absence of any substantial catch-up campaign of older children. This indirect effect against IPD is corroborated by the temporal reduction in vaccine-serotype colonization among age-groups targeted for PCV immunization as well as unvaccinated HIV-infected and HIV-uninfected adults, which was evident within 2 y of PCV introduction into the immunization program. Vaccine effectiveness has also been demonstrated in children against presumed bacterial pneumonia. The evaluation of the impact of PCV in South Africa, however, remains incomplete. The knowledge gaps remaining include the evaluation of PCV on the incidence of all-cause pneumonia hospitalization among vaccinated and unvaccinated age-groups. Furthermore, ongoing surveillance is required to determine whether there is ongoing replacement disease by non-vaccine serotypes, which could offset the early gains associated with the immunization program in the country.
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Affiliation(s)
- Shabir A Madhi
- a Medical Research Council; Respiratory and Meningeal Pathogens Research Unit; University of the Witwatersrand ; Johannesburg , South Africa.,b Department of Science and Technology/National Research Foundation ; Vaccine Preventable Diseases; University of the Witwatersrand ; Johannesburg , South Africa.,c National Institute for Communicable Diseases; National Health Laboratory Service; Center for Vaccines and Immunology ; Johannesburg , South Africa
| | - Marta C Nunes
- a Medical Research Council; Respiratory and Meningeal Pathogens Research Unit; University of the Witwatersrand ; Johannesburg , South Africa.,b Department of Science and Technology/National Research Foundation ; Vaccine Preventable Diseases; University of the Witwatersrand ; Johannesburg , South Africa
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7
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King C, Beard J, Crampin AC, Costello A, Mwansambo C, Cunliffe NA, Heyderman RS, French N, Bar-Zeev N. Methodological challenges in measuring vaccine effectiveness using population cohorts in low resource settings. Vaccine 2015; 33:4748-55. [PMID: 26235370 PMCID: PMC4570930 DOI: 10.1016/j.vaccine.2015.07.062] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/07/2015] [Accepted: 07/21/2015] [Indexed: 11/20/2022]
Abstract
We discuss methodological challenges for evaluating vaccine effectiveness using cohorts. No single set of definitions or analytical approach can address all possible biases. Careful consideration of denominator, exposure and outcome definitions is needed. Sensitivity analyses are crucial to examine assumptions and explore subtle relationships.
Post-licensure real world evaluation of vaccine implementation is important for establishing evidence of vaccine effectiveness (VE) and programme impact, including indirect effects. Large cohort studies offer an important epidemiological approach for evaluating VE, but have inherent methodological challenges. Since March 2012, we have conducted an open prospective cohort study in two sites in rural Malawi to evaluate the post-introduction effectiveness of 13-valent pneumococcal conjugate vaccine (PCV13) against all-cause post-neonatal infant mortality and monovalent rotavirus vaccine (RV1) against diarrhoea-related post-neonatal infant mortality. Our study sites cover a population of 500,000, with a baseline post-neonatal infant mortality of 25 per 1000 live births. We conducted a methodological review of cohort studies for vaccine effectiveness in a developing country setting, applied to our study context. Based on published literature, we outline key considerations when defining the denominator (study population), exposure (vaccination status) and outcome ascertainment (mortality and cause of death) of such studies. We assess various definitions in these three domains, in terms of their impact on power, effect size and potential biases and their direction, using our cohort study for illustration. Based on this iterative process, we discuss the pros and cons of our final per-protocol analysis plan. Since no single set of definitions or analytical approach accounts for all possible biases, we propose sensitivity analyses to interrogate our assumptions and methodological decisions. In the poorest regions of the world where routine vital birth and death surveillance are frequently unavailable and the burden of disease and death is greatest We conclude that provided the balance between definitions and their overall assumed impact on estimated VE are acknowledged, such large scale real-world cohort studies can provide crucial information to policymakers by providing robust and compelling evidence of total benefits of newly introduced vaccines on reducing child mortality.
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Affiliation(s)
- C King
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom.
| | - J Beard
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - A C Crampin
- London School of Hygiene and Tropical Medicine, London, United Kingdom; Karonga Prevention Study, Karonga, Malawi
| | - A Costello
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - C Mwansambo
- MaiMwana Project Mchinji, Parent and Child Health Initiative, Lilongwe, Malawi; Ministry of Health, Lilongwe, Malawi
| | - N A Cunliffe
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - R S Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Division of Infection & Immunity, University College London, London, United Kingdom
| | - N French
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - N Bar-Zeev
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
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8
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Gordon SB, Bruce NG, Grigg J, Hibberd PL, Kurmi OP, Lam KBH, Mortimer K, Asante KP, Balakrishnan K, Balmes J, Bar-Zeev N, Bates MN, Breysse PN, Buist S, Chen Z, Havens D, Jack D, Jindal S, Kan H, Mehta S, Moschovis P, Naeher L, Patel A, Perez-Padilla R, Pope D, Rylance J, Semple S, Martin WJ. Respiratory risks from household air pollution in low and middle income countries. THE LANCET RESPIRATORY MEDICINE 2014; 2:823-60. [PMID: 25193349 DOI: 10.1016/s2213-2600(14)70168-7] [Citation(s) in RCA: 518] [Impact Index Per Article: 51.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A third of the world's population uses solid fuel derived from plant material (biomass) or coal for cooking, heating, or lighting. These fuels are smoky, often used in an open fire or simple stove with incomplete combustion, and result in a large amount of household air pollution when smoke is poorly vented. Air pollution is the biggest environmental cause of death worldwide, with household air pollution accounting for about 3·5-4 million deaths every year. Women and children living in severe poverty have the greatest exposures to household air pollution. In this Commission, we review evidence for the association between household air pollution and respiratory infections, respiratory tract cancers, and chronic lung diseases. Respiratory infections (comprising both upper and lower respiratory tract infections with viruses, bacteria, and mycobacteria) have all been associated with exposure to household air pollution. Respiratory tract cancers, including both nasopharyngeal cancer and lung cancer, are strongly associated with pollution from coal burning and further data are needed about other solid fuels. Chronic lung diseases, including chronic obstructive pulmonary disease and bronchiectasis in women, are associated with solid fuel use for cooking, and the damaging effects of exposure to household air pollution in early life on lung development are yet to be fully described. We also review appropriate ways to measure exposure to household air pollution, as well as study design issues and potential effective interventions to prevent these disease burdens. Measurement of household air pollution needs individual, rather than fixed in place, monitoring because exposure varies by age, gender, location, and household role. Women and children are particularly susceptible to the toxic effects of pollution and are exposed to the highest concentrations. Interventions should target these high-risk groups and be of sufficient quality to make the air clean. To make clean energy available to all people is the long-term goal, with an intermediate solution being to make available energy that is clean enough to have a health impact.
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Affiliation(s)
- Stephen B Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Nigel G Bruce
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Jonathan Grigg
- Centre for Paediatrics, Blizard Institute, Queen Mary, University of London, London, UK
| | - Patricia L Hibberd
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - Om P Kurmi
- Clinical Trials Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kin-bong Hubert Lam
- Institute of Occupational and Environmental Medicine, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Kevin Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kwaku Poku Asante
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, Sri Ramachandra University, Chennai, India
| | - John Balmes
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Naor Bar-Zeev
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Michael N Bates
- Divisions of Epidemiology and Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Patrick N Breysse
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sonia Buist
- Oregon Health and Science University, Portland, OR, USA
| | - Zhengming Chen
- Clinical Trials Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Deborah Havens
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Darby Jack
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Haidong Kan
- School of Public Health, Fudan University, Shanghai, China
| | - Sumi Mehta
- Health Effects Institute, Boston, MA, USA
| | - Peter Moschovis
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - Luke Naeher
- The University of Georgia, College of Public Health, Department of Environmental Health Science, Athens, GA, USA
| | | | | | - Daniel Pope
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Jamie Rylance
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Sean Semple
- University of Aberdeen, Scottish Centre for Indoor Air, Division of Applied Health Sciences, Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - William J Martin
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA.
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