1
|
Milazzo A, McMillan M, Giles L, Page K, Flood L, Marshall H. Geographical distribution of invasive meningococcal disease and carriage: A spatial analysis. Epidemiol Infect 2024; 152:e22. [PMID: 38234190 PMCID: PMC10894902 DOI: 10.1017/s0950268824000116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Little information exists concerning the spatial relationship between invasive meningococcal disease (IMD) cases and Neisseria meningitidis (N. meningitidis) carriage. The aim of this study was to examine whether there is a relationship between IMD and asymptomatic oropharyngeal carriage of meningococci by spatial analysis to identify the distribution and patterns of cases and carriage in South Australia (SA). Carriage data geocoded to participants' residential addresses and meningococcal case notifications using Postal Area (POA) centroids were used to analyse spatial distribution by disease- and non-disease-associated genogroups, as well as overall from 2017 to 2020. The majority of IMD cases were genogroup B with the overall highest incidence of cases reported in infants, young children, and adolescents. We found no clear spatial association between N. meningitidis carriage and IMD cases. However, analyses using carriage and case genogroups showed differences in the spatial distribution between metropolitan and regional areas. Regional areas had a higher rate of IMD cases and carriage prevalence. While no clear relationship between cases and carriage was evident in the spatial analysis, the higher rates of both carriage and disease in regional areas highlight the need to maintain high vaccine coverage outside of the well-resourced metropolitan area.
Collapse
Affiliation(s)
- Adriana Milazzo
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Mark McMillan
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Lynne Giles
- School of Public Health, The University of Adelaide, Adelaide, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Kira Page
- Australian Centre for Housing Research, Hugo Centre for Population and Migration Studies, The University of Adelaide, Adelaide, Australia
| | - Louise Flood
- Communicable Disease Control Branch, Department for Health and Wellbeing, Government of South Australia, Adelaide, Australia
| | - Helen Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| |
Collapse
|
2
|
Taha MK, Martinon-Torres F, Köllges R, Bonanni P, Safadi MAP, Booy R, Smith V, Garcia S, Bekkat-Berkani R, Abitbol V. Equity in vaccination policies to overcome social deprivation as a risk factor for invasive meningococcal disease. Expert Rev Vaccines 2022; 21:659-674. [PMID: 35271781 DOI: 10.1080/14760584.2022.2052048] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Social deprivation is associated with poorer healthcare access. Vaccination is among the most effective public health interventions and achieving equity in vaccination access is vitally important. However, vaccines are often reimbursed by public funds only when recommended in national immunization programs (NIPs), which can increase inequity between high and low socioeconomic groups. Invasive meningococcal disease (IMD) is a serious vaccination-preventable disease. This review focuses on vaccination strategies against IMD designed to reduce inequity. AREAS COVERED We reviewed meningococcal epidemiology and current vaccination recommendations worldwide. We also reviewed studies demonstrating an association between social deprivation and risk of meningococcal disease, as well as studies demonstrating an impact of social deprivation on uptake of meningococcal vaccines. We discuss factors influencing inclusion of meningococcal vaccines in NIPs. EXPERT OPINION Incorporating meningococcal vaccines in NIPs is necessary to reduce inequity, but insufficient alone. Inclusion provides clear guidance to healthcare professionals and helps to ensure that vaccines are offered universally to all target groups. Beyond NIPs, cost of vaccination should be reimbursed especially for disadvantaged individuals. These approaches should help to achieve optimal protection against IMD, by increasing access and immunization rates, eventually reducing social inequities, and helping to protect those at greatest risk.
Collapse
Affiliation(s)
- Muhamed-Kheir Taha
- Institut Pasteur, Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus Influenza, Paris, France
| | - Federico Martinon-Torres
- Genetics, Vaccines, Infectious Diseases, Pediatrics Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago and Universidad de Santiago de Compostela, Galicia, Spain.,Translational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.,Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBER-ES), Madrid, Spain
| | - Ralph Köllges
- Praxis für Kinder und Jugendliche, Ralph Köllges und Partner, Mönchengladbach, Germany
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Robert Booy
- Department of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Sydney Institute of Infectious Diseases, University of Sydney, Sydney, NSW, Australia
| | | | | | | | | |
Collapse
|
3
|
Abstract
This article considers what can be learned regarding the ethical acceptability of intrusive interventions intended to halt the spread of infectious disease (‘Infection Control’ measures) from existing ethical discussion of intrusive interventions used to prevent criminal conduct (‘Crime Control’ measures). The main body of the article identifies and briefly describes six objections that have been advanced against Crime Control, and considers how these might apply to Infection Control. The final section then draws out some more general lessons from the foregoing analysis for the ethical acceptability of different kinds of Infection Control.
Collapse
|
4
|
Taha MK, Weil-Olivier C, Bouée S, Emery C, Nachbaur G, Pribil C, Loncle-Provot V. Risk factors for invasive meningococcal disease: a retrospective analysis of the French national public health insurance database. Hum Vaccin Immunother 2021; 17:1858-1866. [PMID: 33449835 PMCID: PMC8115611 DOI: 10.1080/21645515.2020.1849518] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Vaccination of at-risk populations against Neisseria meningitidis is an important strategy to prevent invasive meningococcal disease (IMD). The objective of this study was to characterize preexisting risk factors in patients with IMD and to compare their relative importance. This case-control analysis was performed in the French national public health insurance database (SNDS). Cases consisted of all people hospitalized for IMD in France over a six-year period (2012–2017). Controls were matched by age, gender, and district of residence. Medical risk factors were identified from ICD-10 codes in the SNDS. Socioeconomic risk factors studied were low household income and social deprivation of the municipality of residence. Associations of these risk factors with hospitalization for IMD were quantified as odds ratios (ORs) between cases and controls with their 95% confidence intervals (95%CI). The medical risk factors showing the most robust associations were congenital immunodeficiency (OR: 39.1 [95%CI: 5.1–299], acquired immunodeficiency (10.3 [4.5–24.0]) and asplenia/hyposplenia (6.7 [3.7–14.7]). In addition, certain chronic medical conditions, such as autoimmune disorders (5.4 [2.5–11.8]), hemophilia (4.7 [1.8–12.2]) and severe chronic respiratory disorders (4.3 [3.1–6.2]) were also strongly associated, as was low household income (1.68 [1.49–1.80]). In conclusion, this study has documented potential risk factors associated with hospitalization for IMD in a large and comprehensive sample of individuals with IMD in France. Several of the risk factors identified may help identify groups who could benefit from targeted prevention measures (such as vaccination) in order to reduce the burden of IMD.
Collapse
Affiliation(s)
| | | | | | | | | | - Céline Pribil
- Vaccine Medical Department, GSK, Rueil-Malmaison, France
| | | |
Collapse
|
5
|
Fletcher R, Wilkinson E, Cleary P, Blagden S, Farmer S. Did school characteristics affect the uptake of meningococcal quadrivalent vaccine in Greater Manchester, United Kingdom? Public Health 2019; 171:24-30. [PMID: 31082757 DOI: 10.1016/j.puhe.2019.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/27/2019] [Accepted: 03/29/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The objective of this study was to assess if school characteristics were associated with the uptake of the meningococcal ACWY (MenACWY) vaccine in Greater Manchester in 2017/18. STUDY DESIGN This is an ecological cross-sectional study. METHODS We analysed data on all 129 schools in seven local authorities in Greater Manchester from the Department for Education and from local child health information systems to determine whether school characteristics, including school type and Ofsted effectiveness score, were associated with vaccine uptake. Schools with no eligible pupils were excluded. We undertook single-variable and multivariable analysis and considered key interactions. RESULTS The overall uptake rate was 80.7%, with a median uptake per school of 80.6% (interquartile range, 69.0%-87.4%). Lower vaccination rates were associated with lower overall effectiveness scores (odds ratio [OR]: 3.54, 95% confidence interval [CI]: 3.00-4.19) and lower numbers of pupils eligible for vaccination (OR: 1.39, 95% CI: 1.28-1.51). Schools with a lower percentage of pupils for whom English is a second language and high deprivation were associated with lower uptake (OR: 1.58, 95% CI: 1.41-1.78). In addition, community schools (the schools with the most local authority oversight) had lower vaccination rates than other categories of schools. CONCLUSIONS In this study, uptake rates of the MenACWY vaccine were associated with all five school characteristics considered. Effectiveness scores for schools had the largest association with vaccine uptake, with poorer schools having lower uptake. These characteristics should be used by vaccination providers to prioritise their interventions to increase immunisation rates.
Collapse
Affiliation(s)
- R Fletcher
- Health Education England (North West), UK.
| | - E Wilkinson
- Institute of Medicine, University of Chester, UK
| | | | - S Blagden
- Health Education England (North West), UK
| | | |
Collapse
|
6
|
Blagden S, Hungerford D, Limmer M. Meningococcal vaccination in primary care amongst adolescents in North West England: an ecological study investigating associations with general practice characteristics. J Public Health (Oxf) 2019; 41:149-157. [PMID: 29385512 DOI: 10.1093/pubmed/fdy010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/01/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In 2015 the meningococcal ACWY (MenACWY) vaccination was introduced amongst adolescents in England following increased incidence and mortality associated with meningococcal group W. METHODS MenACWY vaccination uptake data for 17-18 years old and students delivered in primary care were obtained for 20 National Health Service clinical commissioning groups (CCGs) via the ImmForm vaccination system. Data on general practice characteristics, encompassing demographics and patient satisfaction variables, were extracted from the National General Practice Profiles resource. Univariable analysis of the associations between practice characteristics and vaccination was performed, followed by multivariable negative binomial regression. RESULTS Data were utilized from 587 general practices, accounting for ~8% of all general practices in England. MenACWY vaccination uptake varied from 20.8% to 46.8% across the CCGs evaluated. Upon multivariable regression, vaccination uptake increased with increasing percentage of patients from ethnic minorities, increasing percentage of patients aged 15-24 years, increasing percentage of patients that would recommend their practice and total Quality and Outcomes Framework achievement for the practice. Conversely, vaccination uptake decreased with increasing deprivation. CONCLUSIONS This study has identified several factors independently associated with MenACWY vaccination in primary care. These findings will enable a targeted approach to improve general practice-level vaccination uptake.
Collapse
Affiliation(s)
- Sarah Blagden
- Lancashire County Council, County Hall, Fishergate, Preston, UK.,Health Education North West, Regatta Place, Brunswick Business Park, Summers Road, Liverpool, UK.,Division of Health Research, Furness Building, Lancaster University, Lancaster, UK
| | - Daniel Hungerford
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, The Ronald Ross Building, University of Liverpool, Liverpool, UK.,Field Epidemiology Service, Public Health England North West, Suite 3b, Cunard Building, Water Street, Liverpool, UK
| | - Mark Limmer
- Division of Health Research, Furness Building, Lancaster University, Lancaster, UK
| |
Collapse
|
7
|
Blagden S, Seddon D, Hungerford D, Stanistreet D. Uptake of a new meningitis vaccination programme amongst first-year undergraduate students in the United Kingdom: A cross-sectional study. PLoS One 2017; 12:e0181817. [PMID: 28767667 PMCID: PMC5540503 DOI: 10.1371/journal.pone.0181817] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 07/07/2017] [Indexed: 12/02/2022] Open
Abstract
Background In 2015 meningococcal group W was declared endemic in the UK, with the meningococcal ACWY vaccination (MenACWY) subsequently introduced amongst adolescents and first-year university students. This study aimed to determine MenACWY uptake amongst students and to evaluate how this was influenced by demographics and via the Health Belief Model (HBM). Methods This was a cross-sectional study conducted at a British university amongst first-year undergraduate students aged 18–25 years. Data collection was via an electronic questionnaire encompassing demographics, the HBM and vaccination status. Univariable analysis of the associations between demographics, health beliefs and vaccination was performed, followed by multiple logistic regression. Results 401 participants were included in analysis. Vaccine uptake was 68.1%. Variables independently associated with vaccination upon multiple regression were age, gap-year, perceived effectiveness of the vaccine and knowledge about risk of meningitis. Compared to 18 year-olds, the odds of vaccination were reduced for 19 year-olds (aOR = 0.087, 95% CI = 0.010–0.729), 20 year-olds (aOR = 0.019, 95% CI = 0.002–0.161) and 21–25 year-olds (aOR = 0.003, 95% CI = <0.001–0.027). In contrast, taking a gap year (aOR = 2.939, 95% CI = 1.329–6.501), higher perceived vaccine effectiveness (aOR = 3.555, 95% CI = 1.787–7.073) and knowledge about meningitis risk (aOR = 2.481, 95% CI = 1.165–5.287) were independently associated with increased uptake. Conclusions MenACWY uptake amongst students in this study and in other sources is above the national coverage for all adolescents (35.3%), indicating that this vaccination programme may be increasing health inequalities. Older students are less likely to become vaccinated due to differing vaccination policy in this age-group. In future, strategies that focus on specific student cohorts and that highlight vaccine effectiveness and the risk of meningitis should be considered. National evaluation of this vaccination programme is recommended to clarify its impact on health inequalities.
Collapse
Affiliation(s)
- Sarah Blagden
- Department of Public Health and Policy, Institute of Psychology Health and Society, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Daniel Seddon
- NHS England, Regatta Place, Brunswick Business Park, Liverpool, United Kingdom
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Daniel Hungerford
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Public Health England North West, Liverpool, United Kingdom
| | - Debbi Stanistreet
- Department of Public Health and Policy, Institute of Psychology Health and Society, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
8
|
Cleary PR, Calvert N, Gee S, Graham C, Gray S, Kaczmarski E, Morphet J, Murphy L, Verlander N, Wood T, Borrow R. Variations in Neisseria meningitidis carriage by socioeconomic status: a cross-sectional study. J Public Health (Oxf) 2015; 38:61-70. [PMID: 25742719 DOI: 10.1093/pubmed/fdv015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Deprivation is associated with an increased risk of invasive Neisseria meningitidis disease, but little is known about the relationship between deprivation and asymptomatic carriage of N. meningitidis. This analysis was conducted to examine the relationship between meningococcal carriage and deprivation. METHODS As part of a rapid meningococcal carriage prevalence study conducted in West Cumbria to investigate an apparent cluster of invasive meningococcal disease, data were collected on lifestyle and social factors, including area-level indicators of socioeconomic status, to identify factors associated with meningococcal carriage. RESULTS In a multivariable log binomial regression model adjusted for age, lower socioeconomic status was significantly associated with higher prevalence of meningococcal carriage. A 1-unit increase in Index of Multiple Deprivation (2010) score was associated with a 1.7% increase in meningococcal carriage prevalence (95% confidence interval 0.3-3.0%). Age was the only significant predictor of carriage of Neisseria lactamica. CONCLUSIONS Living in a deprived area is associated with increased carriage of Group B meningococcus. Deprivation is an important factor to consider in the evaluation of the effectiveness and cost-effectiveness of the introduction of new meningococcal B vaccines and the development and implementation of immunization policies. Further work is required to understand whether deprivation has an effect on meningococcal carriage through other factors such as smoking.
Collapse
Affiliation(s)
- P R Cleary
- PHE Field Epidemiology Service, Liverpool L1 1JF, UK
| | - N Calvert
- NHS Cumbria, Penrith, Cumbria CA11 8HX, UK
| | - S Gee
- Cumbria and Lancashire Public Health England Centre, Chorley PR7 1NY, UK
| | - C Graham
- North Cumbria University Hospitals Whitehaven, Cumbria CA28 8JG, UK
| | - S Gray
- PHE Meningococcal Reference Unit, Public Health England (PHE), Manchester M13 9WL, UK
| | - E Kaczmarski
- PHE Meningococcal Reference Unit, Public Health England (PHE), Manchester M13 9WL, UK
| | - J Morphet
- NHS Cumbria, Penrith, Cumbria CA11 8HX, UK
| | - L Murphy
- NHS Cumbria, Penrith, Cumbria CA11 8HX, UK
| | - N Verlander
- Public Health England Centre for Infection Disease Surveillance and Control, London NW9 5EQ, UK
| | - T Wood
- Cumbria and Lancashire Public Health England Centre, Chorley PR7 1NY, UK
| | - R Borrow
- PHE Meningococcal Reference Unit, Public Health England (PHE), Manchester M13 9WL, UK
| |
Collapse
|
9
|
Martin NG, Sadarangani M, Pollard AJ, Goldacre MJ. Hospital admission rates for meningitis and septicaemia caused by Haemophilus influenzae, Neisseria meningitidis, and Streptococcus pneumoniae in children in England over five decades: a population-based observational study. THE LANCET. INFECTIOUS DISEASES 2014; 14:397-405. [DOI: 10.1016/s1473-3099(14)70027-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
10
|
Inequalities in the incidence of infectious disease in the North East of England: a population-based study. Epidemiol Infect 2014; 143:189-201. [DOI: 10.1017/s0950268814000533] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
SUMMARYThe objective of this study was to measure the association between deprivation and incidence of 21 infectious diseases in the North East of England (2007–2011). We used count regression models with the Index of Multiple Deprivation and population/landscape data for small areas (~1500 persons). Deprivation significantly predicted incidence (P < 0·05) for 17 infectious diseases. The direction of association was broadly consistent within groups: increased incidence with increased deprivation for all three bloodborne viruses, 2/3 invasive bacterial diseases, 4/5 sexually transmitted infections (STI) and tuberculosis (TB); decreased incidence with increased deprivation for 5/6 infectious intestinal diseases (IID) and 2/3 vaccine-preventable diseases. Associations were removed for all but one IID (E. coliO157 infection) after accounting for recent foreign travel. Hepatitis C virus, TB and STI are priority infections for reduction of inequalities associated with deprivation in the North East of England.
Collapse
|
11
|
The changing epidemiology of meningococcal disease in Quebec, Canada, 1991-2011: potential implications of emergence of new strains. PLoS One 2012; 7:e50659. [PMID: 23209803 PMCID: PMC3510192 DOI: 10.1371/journal.pone.0050659] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 10/26/2012] [Indexed: 12/12/2022] Open
Abstract
Background In order to inform meningococcal disease prevention strategies, we analysed the epidemiology of invasive meningococcal disease (IMD) in the province of Quebec, Canada, 10 years before and 10 years after the introduction of serogroup C conjugate vaccination. Methodology IMD cases reported to the provincial notifiable disease registry in 1991–2011 and isolates submitted for laboratory surveillance in 1997–2011 were analysed. Serogrouping, PCR testing and assignment of isolates to sequence types (ST) by using multilocus sequence typing (MLST) were performed. Results Yearly overall IMD incidence rates ranged from 2.2–2.3/100,000 in 1991–1992 to 0.49/100,000 in 1999–2000, increasing to 1.04/100,000 in 2011. Among the 945 IMD cases identified by laboratory surveillance in 1997–2011, 68%, 20%, 8%, and 3% were due to serogroups B, C, Y, and W135, respectively. Serogroup C IMD almost disappeared following the implementation of universal childhood immunization with monovalent C conjugate vaccines in 2002. Serogroup B has been responsible for 88% of all IMD cases and 61% of all IMD deaths over the last 3 years. The number and proportion of ST-269 clonal complex has been steadily increasing among the identified clonal complexes of serogroup B IMD since its first identification in 2003, representing 65% of serogroup B IMD in 2011. This clonal complex was first introduced in adolescent and young adults, then spread to other age groups. Conclusion Important changes in the epidemiology of IMD have been observed in Quebec during the last two decades. Serogroup C has been virtually eliminated. In recent years, most cases have been caused by the serogroup B ST-269 clonal complex. Although overall burden of IMD is low, the use of a vaccine with potential broad-spectrum coverage could further reduce the burden of disease. Acceptability, feasibility and cost-effectiveness studies coupled with ongoing clinical and molecular surveillance are necessary in guiding public policy decisions.
Collapse
|
12
|
Diggle PJ, Guan Y, Hart AC, Paize F, Stanton M. Estimating Individual-Level Risk in Spatial Epidemiology Using Spatially Aggregated Information on the Population at Risk. J Am Stat Assoc 2012; 105:1394-1402. [PMID: 22798701 PMCID: PMC3395722 DOI: 10.1198/jasa.2010.ap09323] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We propose a novel alternative to case-control sampling for the estimation of individual-level risk in spatial epidemiology. Our approach uses weighted estimating equations to estimate regression parameters in the intensity function of an inhomogeneous spatial point process, when information on risk-factors is available at the individual level for cases, but only at a spatially aggregated level for the population at risk. We develop data-driven methods to select the weights used in the estimating equations and show through simulation that the choice of weights can have a major impact on efficiency of estimation. We develop a formal test to detect non-Poisson behavior in the underlying point process and assess the performance of the test using simulations of Poisson and Poisson cluster point processes. We apply our methods to data on the spatial distribution of childhood meningococcal disease cases in Merseyside, U.K. between 1981 and 2007.
Collapse
Affiliation(s)
- Peter J. Diggle
- School of Health and Medicine, Lancaster University, Lancaster, U.K. and Adjunct Professor, Department of Biostatistics, Johns Hopkins University School of Public Health, Baltimore
| | - Yongtao Guan
- Division of Biostatistics, Yale University, New Haven, CT 06520-8034
| | - Anthony C. Hart
- Division of Medical Microbiology, University of Liverpool, Liverpool, U.K. (deceased September 2007)
| | - Fauzia Paize
- Institute of Child Health, University of Liverpool, Alder Hey Children’s NHS Foundation Trust, Liverpool, U.K
| | - Michelle Stanton
- School of Health and Medicine, Lancaster University, Lancaster, U.K
| |
Collapse
|
13
|
Meningococcal disease in children in Merseyside, England: a 31 year descriptive study. PLoS One 2011; 6:e25957. [PMID: 22016791 PMCID: PMC3189236 DOI: 10.1371/journal.pone.0025957] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 09/14/2011] [Indexed: 11/19/2022] Open
Abstract
Meningococcal disease (MCD) is the leading infectious cause of death in early childhood in the United Kingdom, making it a public health priority. MCD most commonly presents as meningococcal meningitis (MM), septicaemia (MS), or as a combination of the two syndromes (MM/MS). We describe the changing epidemiology and clinical presentation of MCD, and explore associations with socioeconomic status and other risk factors. A hospital-based study of children admitted to a tertiary children's centre, Alder Hey Children's Foundation Trust, with MCD, was undertaken between 1977 to 2007 (n = 1157). Demographics, clinical presentations, microbiological confirmation and measures of deprivation were described. The majority of cases occurred in the 1–4 year age group and there was a dramatic fall in serogroup C cases observed with the introduction of the meningococcal C conjugate (MCC) vaccine. The proportion of MS cases increased over the study period, from 11% in the first quarter to 35% in the final quarter. Presentation with MS (compared to MM) and serogroup C disease (compared to serogroup B) were demonstrated to be independent risk factors for mortality, with odds ratios of 3.5 (95% CI 1.18 to 10.08) and 2.18 (95% CI 1.26 to 3.80) respectively. Cases admitted to Alder Hey were from a relatively more deprived population (mean Townsend score 1.25, 95% CI 1.09 to 1.41) than the Merseyside reference population. Our findings represent one of the largest single-centre studies of MCD. The presentation of MS is confirmed to be a risk factor of mortality from MCD. Our study supports the association between social deprivation and MCD.
Collapse
|
14
|
Chin RFM, Neville BGR, Peckham C, Wade A, Bedford H, Scott RC. Socioeconomic deprivation independent of ethnicity increases status epilepticus risk. Epilepsia 2008; 50:1022-9. [PMID: 19178565 DOI: 10.1111/j.1528-1167.2008.01796.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND A higher incidence of convulsive status epilepticus (CSE) has been reported in nonwhite compared to white populations. Socioeconomic factors can be intricately involved in observed ethnic "effects," and the importance of socioeconomic status on health conditions is widely recognized. Understanding the effect of socioeconomic factors on CSE would provide insights into etiology and management, leading to the development of novel prevention strategies. METHODS From a population-based UK study on childhood CSE, we tested the hypothesis that socioeconomic deprivation independent of ethnicity increases the risk of childhood CSE. Home postal codes were used to measure the socioeconomic status of the neighborhood in which patients lived relative to that of the borough in which the neighborhood was located. The child's ethnicity was reported by parent(s). Relationships between socioeconomic status, ethnicity, and incidence were investigated using Poisson regression analysis. RESULTS A total of 176 children were enrolled. The incidence of CSE in nonwhite children [18.5, 95% confidence interval (CI) 13.7-23.3/100,000/year] was 1.8 (95% CI 1.3-2.4) times greater than for white children (10.5, 95% CI 7.9-13.1/100,000/year) (p < 0.0005). Socioeconomic deprivation and Asian ethnicity were independently associated with increased incidence. For each point increase in Index of Multiple Deprivation (IMD) 2004, there was a 1.03 cumulative increased relative risk (95% CI 1.01-1.06, p = 0.007). Asian children were 5.7 times (95% CI 1.7-18.9) more likely than white children to have a first-ever episode of CSE (p = 0.004). Socioeconomic and ethnicity effects were related to etiology of CSE. INTERPRETATION Ethnic and socioeconomic factors independently affect risk for prolonged febrile seizures and acute symptomatic CSE, but not for other types of childhood CSE.
Collapse
Affiliation(s)
- Richard F M Chin
- Neurosciences Unit, Institute of Child Health, University College London, and Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom.
| | | | | | | | | | | | | |
Collapse
|
15
|
Reinhardt M, Elias J, Albert J, Frosch M, Harmsen D, Vogel U. EpiScanGIS: an online geographic surveillance system for meningococcal disease. Int J Health Geogr 2008; 7:33. [PMID: 18593474 PMCID: PMC2483700 DOI: 10.1186/1476-072x-7-33] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Accepted: 07/01/2008] [Indexed: 11/10/2022] Open
Abstract
Background Surveillance of infectious diseases increasingly relies on Geographic Information Systems (GIS). The integration of pathogen fine typing data in dynamic systems and visualization of spatio-temporal clusters are a technical challenge for system development. Results An online geographic information system (EpiScanGIS) based on open source components has been launched in Germany in May 2006 for real time provision of meningococcal typing data in conjunction with demographic information (age, incidence, population density). Spatio-temporal clusters of disease detected by computer assisted cluster analysis (SaTScan™) are visualized on maps. EpiScanGIS enables dynamic generation of animated maps. The system is based on open source components; its architecture is open for other infectious agents and geographic regions. EpiScanGIS is available at , and currently has 80 registered users, mostly from the public health service in Germany. At present more than 2,900 cases of invasive meningococcal disease are stored in the database (data as of June 3, 2008). Conclusion EpiScanGIS exemplifies GIS applications and early-warning systems in laboratory surveillance of infectious diseases.
Collapse
|
16
|
Semenza JC, Giesecke J. Intervening to reduce inequalities in infections in Europe. Am J Public Health 2008; 98:787-92. [PMID: 18381991 PMCID: PMC2374832 DOI: 10.2105/ajph.2007.120329] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2007] [Indexed: 12/20/2022]
Abstract
The European Centre for Disease Prevention and Control was founded in response to newly emerging infections such as severe acute respiratory syndrome and avian influenza. However, Europe faces other communicable disease challenges that have proven to be remarkably resilient to public health interventions. We present examples of communicable diseases with inequitable distribution among those with poor educational attainment, low income, or other socioeconomic factors in every European country. Because these findings are incompatible with social justice and fairness, we examine strategic interventions targeting upstream causes of communicable disease transmission keeping in mind 10 indispensable public health functions essential to reach marginalized groups. These interventions have to be tailored to the socio-political context and rely on community-based decision-making and intersectorial collaboration.
Collapse
Affiliation(s)
- Jan C Semenza
- Unit of Scientific Advice, European Centre for Disease Prevention and Control (ECDC), Tomtebodavägen 11A, S-17183 Stockholm, Sweden.
| | | |
Collapse
|
17
|
Stein-Zamir C, Abramson N, Zentner G, Shoob H, Valinsky L, Block C. Invasive meningococcal disease in children in Jerusalem. Epidemiol Infect 2007; 136:782-9. [PMID: 17662169 PMCID: PMC2870872 DOI: 10.1017/s0950268807009259] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Neisseria meningitidis is an important cause of childhood meningitis and septicaemia. Between 1999 and 2005, 133 invasive meningococcal disease (IMD) cases occurred in Jerusalem, 112 (84.2%) of them in children aged 0-14 years. The annual incidence rate in Jerusalem was higher than the national average (2.45+/-0.6 vs. 1.13+/-0.16/100 000 population, P=0.002). Most of the children (82.1%) were from low socio-economic Arab and Jewish ultra-orthodox communities; mortality was higher among Arab than Jewish children (1.3 vs. 0.22/100 000 person-years, P=0.004). A cluster of 10 children with severe meningococcal sepsis (three fatalities) emerged in the winter of 2003-2004. Compared to the other 102 cases in 1999-2005 both meningococcaemia (100% vs. 51%, P=0.003) and mortality (30% vs. 6.9%, P=0.014) rates were higher. Serogroup B comprised 77.6% of the bacterial isolates. Pulsed-field gel electrophoresis showed considerable variability among cluster isolates, but significant resemblance in Arab cases throughout 1999-2005. The increased susceptibility of specific sub-populations to IMD necessitates further evaluation.
Collapse
Affiliation(s)
- C Stein-Zamir
- Jerusalem District Health Office, Ministry of Health, Israel.
| | | | | | | | | | | |
Collapse
|
18
|
|