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Mahazabin M, Swarna SN, Naime J, Rahman A, Islam MA. Factors influencing the first dose of measles vaccination uptake in 42 low- and middle-income countries. Public Health 2024; 237:85-93. [PMID: 39341152 DOI: 10.1016/j.puhe.2024.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 09/16/2024] [Accepted: 09/18/2024] [Indexed: 09/30/2024]
Abstract
OBJECTIVES Vaccination against measles still stands as a highly impactful public health strategy for mitigating childhood morbidity and mortality. Relatively poor immunization coverage among children has been observed in low and middle-income countries (LMICs). Our study intended to determine socio-demographic factors associated with the 1st dose of measles vaccination among South Asian (SA) and SubSaharan African (SSA) countries children. STUDY DESIGN This was a cross-sectional study. METHODS This study utilized demographic and health survey data from 42 low-and middle-income countries (LMICs) in SA and SSA. The children's dataset yielded 255,775 children between the ages of 12 and 59 months. The independent predictors were determined by using crude and adjusted odds ratios with 95% confidence intervals (CI). RESULTS The prevalence of first-dose measles-immunized children was 55.5% for the selected LMICs. The multivariable analysis for combined regions (SA and SSA) showed that parents with a higher level of education, rich wealth quintile, mothers with media access, mothers with more than four antenatal care (ANC) visits and baby postnatal check-up (PNC) within two months were significantly associated with the first dose of measles vaccination among children. CONCLUSION The first dose measles immunization coverage in the selected LMICs was considerably low. To boost the uptake of childhood measles vaccination, public health interventions particularly need to focus on children born to uneducated parents, poor families, and those who have not used health services (ANC and PNC). Financial funding is crucial for establishing mobile vaccination clinics to improve immunization rates among the impoverished.
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Affiliation(s)
- Maliha Mahazabin
- Statistics Discipline, Science, Engineering and Technology School, Khulna University, Khulna, 9208, Bangladesh
| | - Shangita Nandi Swarna
- Statistics Discipline, Science, Engineering and Technology School, Khulna University, Khulna, 9208, Bangladesh
| | - Jannatul Naime
- Statistics Discipline, Science, Engineering and Technology School, Khulna University, Khulna, 9208, Bangladesh
| | - Abdur Rahman
- Statistics Discipline, Science, Engineering and Technology School, Khulna University, Khulna, 9208, Bangladesh.
| | - Md Akhtarul Islam
- Statistics Discipline, Science, Engineering and Technology School, Khulna University, Khulna, 9208, Bangladesh
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2
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Mahazabin M, Tabassum N, Syfullah SK, Majumder UK, Islam MA. Socio-demographic factors affecting the first and second dose of measles vaccination status among under-five children: Perspectives from South Asian countries. Prev Med Rep 2024; 45:102839. [PMID: 39188972 PMCID: PMC11345404 DOI: 10.1016/j.pmedr.2024.102839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/28/2024] Open
Abstract
Background The measles vaccine is crucial in preventing fatalities and reducing widespread childhood infections worldwide, yet achieving the desired immunization rates remains a challenge in developing countries. Our study aims to identify the impact of socio-demographic factors on measles vaccination among children in South Asian countries. Methods Participants (89513) were taken from the most recent Demographic and Health Survey (DHS) datasets of South Asian countries between 2015 and 2021. Descriptive statistics and multivariable analyses were employed to find out the factors associated with measles vaccination among South Asian countries. Results Our study found that the first dose of vaccinated children was 51.7 % in Afghanistan which is the lowest among South Asian countries. The key determinants related to two doses of measles vaccination include parental characteristics, media access, and antenatal care (ANC). Mothers who had done baby postnatal checkups (AOR = 1.22, CI = 1.17-1.26) and made more than four ANC (AOR = 1.77, CI: 1.65-1.89) were more likely to fully immunize their child than mothers with no postnatal and antenatal checkups. Conclusion The complete dose of measles vaccination rate in South Asia is still low compared to the first dose of measles vaccination among children. The government and stakeholders should organize frequent awareness programs through media and health personnel to inform people about routine vaccinations to eliminate measles.
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Affiliation(s)
- Maliha Mahazabin
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna 9208, Bangladesh
| | - Nazia Tabassum
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna 9208, Bangladesh
| | - S.M. Khalid Syfullah
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna 9208, Bangladesh
| | - Uttam Kumar Majumder
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna 9208, Bangladesh
| | - Md. Akhtarul Islam
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna 9208, Bangladesh
- Collaborative Biostatistics Program, School of Public Health, University of Saskatchewan, Saskatoon, Canada
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Rachlin A, Hampton LM, Rota PA, Mulders MN, Papania M, Goodson JL, Krause LK, Hanson M, Osborn J, Kelly-Cirino C, Evans B, Sinha A, Warrener L, Featherstone D, Brown D. Use of Measles and Rubella Rapid Diagnostic Tests to Improve Case Detection and Targeting of Vaccinations. Vaccines (Basel) 2024; 12:823. [PMID: 39203949 PMCID: PMC11360261 DOI: 10.3390/vaccines12080823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/17/2024] [Accepted: 07/18/2024] [Indexed: 09/03/2024] Open
Abstract
Efforts to control and eliminate measles and rubella are aided by high-quality surveillance data-supported by laboratory confirmation-to guide decision-making on routine immunization strategies and locations for conducting preventive supplementary immunization activities (SIAs) and outbreak response. Important developments in rapid diagnostic tests (RDTs) for measles and rubella present new opportunities for the global measles and rubella surveillance program to greatly improve the ability to rapidly detect and respond to outbreaks. Here, we review the status of RDTs for measles and rubella Immunoglobulin M (IgM) testing, as well as ongoing questions and challenges regarding the operational use and deployment of RDTs as part of global measles and rubella surveillance. Efforts to develop IgM RDTs that can be produced at scale are underway. Once validated RDTs are available, clear information on the benefits, challenges, and costs of their implementation will be critical for shaping deployment guidance and informing country plans for sustainably deploying such tests. The wide availability of RDTs could provide new programmatic options for measles and rubella elimination efforts, potentially enabling improvements and flexibility for testing, surveillance, and vaccination.
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Affiliation(s)
- Audrey Rachlin
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Lee M. Hampton
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Paul A. Rota
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Mick N. Mulders
- Department of Immunization, Vaccines and Biologicals, World Health Organization, 1211 Geneva, Switzerland
| | - Mark Papania
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - James L. Goodson
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | | | - Matt Hanson
- Sound Global Health Consulting, LLC, Seattle, WA 98199, USA
| | - Jennifer Osborn
- Foundation for Innovative New Diagnostics (FIND), 1218 Geneva, Switzerland
| | | | - Beth Evans
- Gavi, the Vaccine Alliance, Global Health Campus, 1218 Geneva, Switzerland
- Institute of Global Health, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland
| | - Antara Sinha
- Gavi, the Vaccine Alliance, Global Health Campus, 1218 Geneva, Switzerland
| | - Lenesha Warrener
- Public Health Microbiology Division, UK Health Security Agency (UKHSA), London NW9 5EQ, UK
| | | | - David Brown
- Public Health Microbiology Division, UK Health Security Agency (UKHSA), London NW9 5EQ, UK
- Laboratory of Respiratory Viruses, Exanthematics, Enteroviruses and Viral Emergencies (LVRE), Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro 21040-900, Brazil
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Mak J, Patenaude BN, Mutembo S, Pilewskie ME, Winter AK, Moss WJ, Carcelen AC. Modeling the Cost of Vaccinating a Measles Zero-Dose Child in Zambia Using Three Vaccination Strategies. Am J Trop Med Hyg 2024; 111:121-128. [PMID: 38772386 PMCID: PMC11229634 DOI: 10.4269/ajtmh.23-0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 02/10/2024] [Indexed: 05/23/2024] Open
Abstract
Countries with moderate to high measles-containing vaccine coverage face challenges in reaching the remaining measles zero-dose children. There is growing interest in targeted vaccination activities to reach these children. We developed a framework for prioritizing districts for targeted measles and rubella supplementary immunization activities (SIAs) for Zambia in 2020, incorporating the use of the WHO's Measles Risk Assessment Tool (MRAT) and serosurveys. This framework was used to build a model comparing the cost of vaccinating one zero-dose child under three vaccination scenarios: standard nationwide SIA, targeted subnational SIA informed by MRAT, and targeted subnational SIA informed by both MRAT and measles seroprevalence data. In the last scenario, measles seroprevalence data are acquired via either a community-based serosurvey, residual blood samples from health facilities, or community-based IgG point-of-contact rapid diagnostic testing. The deterministic model found that the standard nationwide SIA is the least cost-efficient strategy at 13.75 USD per zero-dose child vaccinated. Targeted SIA informed by MRAT was the most cost-efficient at 7.63 USD per zero-dose child, assuming that routine immunization is just as effective as subnational SIA in reaching zero-dose children. Under similar conditions, a targeted subnational SIA informed by both MRAT and seroprevalence data resulted in 8.17-8.35 USD per zero-dose child vaccinated, suggesting that use of seroprevalence to inform SIA planning may not be as cost prohibitive as previously thought. Further refinement to the decision framework incorporating additional data may yield strategies to better target the zero-dose population in a financially feasible manner.
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Affiliation(s)
- Joshua Mak
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Bryan N Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Simon Mutembo
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Monica E Pilewskie
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Amy K Winter
- Department of Epidemiology & Biostatistics, University of Georgia College of Public Health, Athens, Georgia
| | - William J Moss
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrea C Carcelen
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Stepovic M, Dragojevic Simic V, Zivanovic Macuzic I, Simic R, Vekic S, Sekulic M, Radovanovic S, Maricic M, Sorak M, Suljagic V, Vojinovic R, Rancic N. The last 3 decade of vaccination coverage in the Balkan and Eastern Europe countries with reference to the impact of the COVID-19 pandemic. Front Pharmacol 2024; 15:1278771. [PMID: 38903986 PMCID: PMC11187251 DOI: 10.3389/fphar.2024.1278771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 05/14/2024] [Indexed: 06/22/2024] Open
Affiliation(s)
- Milos Stepovic
- Department of Anatomy, Faculty of Medical Science, University of Kragujevac, Kragujevac, Serbia
| | - Viktorija Dragojevic Simic
- Centre for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia
- Medical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Ivana Zivanovic Macuzic
- Department of Anatomy, Faculty of Medical Science, University of Kragujevac, Kragujevac, Serbia
| | - Radoje Simic
- Department for Plastic Surgery, Institute for Mother and Child Healthcare of Serbia Dr. Vukan Cupic, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Stefan Vekic
- Faculty of Economics, University of Belgrade, Belgrade, Serbia
| | - Marija Sekulic
- Department of Hygiene and Ecology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Snezana Radovanovic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Milena Maricic
- The College of Health Sciences, Academy of Applied Studies Belgrade, Belgrade, Serbia
| | - Marija Sorak
- Department of Gynecology and Obstetrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Vesna Suljagic
- Medical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia
- Department of Healthcare-Associated Infection Prevention and Control, Military Medical Academy, Belgrade, Serbia
| | - Radisa Vojinovic
- Department of Radiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Nemanja Rancic
- Centre for Clinical Pharmacology, Military Medical Academy, Belgrade, Serbia
- Medical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia
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Moturi AK, Jalang'o R, Cherono A, Muchiri SK, Snow RW, Okiro EA. Malaria vaccine coverage estimation using age-eligible populations and service user denominators in Kenya. Malar J 2023; 22:287. [PMID: 37759277 PMCID: PMC10523632 DOI: 10.1186/s12936-023-04721-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/21/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The World Health Organization approved the RTS,S/AS01 malaria vaccine for wider rollout, and Kenya participated in a phased pilot implementation from 2019 to understand its impact under routine conditions. Vaccine delivery requires coverage measures at national and sub-national levels to evaluate progress over time. This study aimed to estimate the coverage of the RTS,S/AS01 vaccine during the first 36 months of the Kenyan pilot implementation. METHODS Monthly dose-specific immunization data for 23 sub-counties were obtained from routine health information systems at the facility level for 2019-2022. Coverage of each RTS,S/AS01 dose was determined using reported doses as a numerator and service-based (Penta 1 and Measles) or population (projected infant populations from WorldPop) as denominators. Descriptive statistics of vaccine delivery, dropout rates and coverage estimates were computed across the 36-month implementation period. RESULTS Over 36 months, 818,648 RTSS/AS01 doses were administered. Facilities managed by the Ministry of Health and faith-based organizations accounted for over 88% of all vaccines delivered. Overall, service-based malaria vaccine coverage was 96%, 87%, 78%, and 39% for doses 1-4 respectively. Using a population-derived denominator for age-eligible children, vaccine coverage was 78%, 68%, 57%, and 24% for doses 1-4, respectively. Of the children that received measles dose 1 vaccines delivered at 9 months (coverage: 95%), 82% received RTSS/AS01 dose 3, only 66% of children who received measles dose 2 at 18 months (coverage: 59%) also received dose 4. CONCLUSION The implementation programme successfully maintained high levels of coverage for the first three doses of RTSS/AS01 among children defined as EPI service users up to 9 months of age but had much lower coverage within the community with up to 1 in 5 children not receiving the vaccine. Consistent with vaccines delivered over the age of 1 year, coverage of the fourth malaria dose was low. Vaccine uptake, service access and dropout rates for malaria vaccines require constant monitoring and intervention to ensure maximum protection is conferred.
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Affiliation(s)
- Angela K Moturi
- Population & Health Impact Surveillance Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
| | - Rose Jalang'o
- National Vaccines & Immunization Programme, Ministry of Health, Nairobi, Kenya
| | - Anitah Cherono
- Population & Health Impact Surveillance Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Samuel K Muchiri
- Population & Health Impact Surveillance Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Robert W Snow
- Population & Health Impact Surveillance Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Emelda A Okiro
- Population & Health Impact Surveillance Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Kulkarni S, Ishizumi A, Eleeza O, Patel P, Feika M, Kamara S, Bangura J, Jalloh U, Koroma M, Sankoh Z, Sandy H, Toure M, Igbu TU, Sesay T, Fayorsey RN, Abad N. Using photovoice methodology to uncover individual-level, health systems, and contextual barriers to uptake of second dose of measles containing vaccine in Western Area Urban, Sierra Leone, 2020. Vaccine X 2023; 14:100338. [PMID: 37577263 PMCID: PMC10422676 DOI: 10.1016/j.jvacx.2023.100338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/30/2023] [Accepted: 06/23/2023] [Indexed: 08/15/2023] Open
Abstract
Background Vaccination coverage for the second dose of the measles-containing vaccine (MCV2) among children has remained stagnant in Sierra Leone at nearly 67% since its introduction in 2015. Identifying community-specific barriers faced by caregivers in accessing MCV2 services for their children and by health workers in delivering MCV2 is key to informing strategies to improve vaccination coverage. Methods We used Photovoice, a participatory method using photographs and narratives to understand community barriers to MCV2 uptake from March- September 2020. Six female and five male caregivers of MCV2-eligible children (15-24 months of age), and six health care workers (HCWs) in Freetown, Sierra Leone participated. After having an orientation to photovoice, they photographed barriers related to general immunization and MCV2 uptake in their community. This was followed by facilitated discussions where participants elaborated on the barriers captured in the photos. Transcripts from the six immunization-related discussions were analyzed to deduce themes through open-ended coding. A photo exhibition was held for participants to discuss the barriers and suggested solutions with decision-makers, such as the ministry of health. Results We identified and categorized nine themes into three groups: 1) individual or caregiver level barriers (e.g., caregivers' lack of knowledge on MCV2, concerns about vaccine side effects, and gender-related barriers); 2) health system barriers, such as HCWs' focus on children below one year and usage of old child health cards; and 3) contextual barriers, such as poverty, poor infrastructure, and the COVID-19 pandemic. Participants suggested the decision-makers to enhance community engagement with caregivers and HCW capacity including, increasing accountability of their work using performance-based approaches, among different strategies to improve MCV2 uptake. Conclusion Photovoice can provide nuanced understanding of community issues affecting MCV2. As a methodology, it should be integrated in broader intervention planning activities to facilitate the translation of community-suggested strategies into action.
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Affiliation(s)
- Shibani Kulkarni
- U.S. Centers for Disease Control and Prevention, Atlanta GA, USA
| | | | | | - Palak Patel
- U.S. Centers for Disease Control and Prevention, Atlanta GA, USA
| | | | | | | | | | | | | | | | - Mame Toure
- ICAP Sierra Leone, Freetown, Sierra Leone
| | | | - Tom Sesay
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Neetu Abad
- U.S. Centers for Disease Control and Prevention, Atlanta GA, USA
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Auzenbergs M, Fu H, Abbas K, Procter SR, Cutts FT, Jit M. Health effects of routine measles vaccination and supplementary immunisation activities in 14 high-burden countries: a Dynamic Measles Immunization Calculation Engine (DynaMICE) modelling study. Lancet Glob Health 2023; 11:e1194-e1204. [PMID: 37474227 PMCID: PMC10369016 DOI: 10.1016/s2214-109x(23)00220-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND WHO recommends at least 95% population coverage with two doses of measles-containing vaccine (MCV). Most countries worldwide use routine services to offer a first dose of measles-containing vaccine (MCV1) and later, a second dose of measles-containing vaccine (MCV2). Many countries worldwide conduct supplementary immunisation activities (SIAs), offering vaccination to all people in a specific age range irrespective of previous vaccination history. We aimed to estimate the relative effects of each dose and delivery route in 14 countries with high measles burden. METHODS We used an age-structured compartmental dynamic model, the Dynamic Measles Immunization Calculation Engine (DynaMICE), to assess the effects of different vaccination strategies on measles susceptibility and burden during 2000-20 in 14 countries with high measles incidence (containing 53% of the global birth cohort and 78% of the global measles burden). Country-specific routine MCV1 and MCV2 coverage data during 1980-2020 were obtained from the WHO and UNICEF Estimates of National Immunization Coverage database for all modelled countries and SIA data were obtained from the WHO summary of measles and rubella SIAs. We estimated the incremental health effects of different vaccination strategies using prevented cases of measles and deaths from measles and their efficiency using the incremental number needed to vaccinate (NNV) to prevent an additional measles case. FINDINGS Compared with no vaccination, MCV1 implementation was estimated to have prevented 824 million cases of measles and 9·6 million deaths from measles, with a median NNV of 1·41 (IQR 1·35-1·44). Adding routine MCV2 to MCV1 was estimated to have prevented 108 million cases and 404 270 deaths, whereas adding SIAs to MCV1 was estimated to have prevented 256 million cases and 4·4 million deaths. Despite larger incremental effects, adding SIAs to MCV1 (median incremental NNV 6·02, 5·30-7·68) showed reduced efficiency compared with adding routine MCV2 (5·41, 4·76-6·11). INTERPRETATION Vaccination strategies, including non-selective SIAs, reach a greater proportion of children who are unvaccinated and reduce measles burden more than MCV2 alone, but efficiency is lower because of the wide age range targeted by SIAs. This analysis provides information to help improve the health effects and efficiency of measles vaccination strategies. The interplay between MCV1, MCV2, and SIAs should be considered when planning future measles vaccination strategies. FUNDING Gavi, the Vaccine Alliance and the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Megan Auzenbergs
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Han Fu
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Kaja Abbas
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Public Health Foundation of India, New Delhi, India
| | - Simon R Procter
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Felicity T Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; School of Public Health, University of Hong Kong, Hong Kong Special Administrative Region, China
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Ramírez MA, Fernádez Santisteban MT, Galange MM, Carralero RR, Júlio G, Samutondo C, Gaston C, Manuel E, Pedro AM, Paixão J, Freitas H, Morais J, Francisco NM. Epidemiology of measles in Angola: Results from routine surveillance from 2015 to 2021. IJID REGIONS 2023; 7:256-261. [PMID: 37223088 PMCID: PMC10200832 DOI: 10.1016/j.ijregi.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 05/25/2023]
Abstract
Background Measles, an acute infectious disease of extremely contagious viral aetiology, has been eliminated in some parts of the world. To the best of the authors' knowledge, this is the first study on the epidemiological pattern of the measles virus in Angola, and it was carried out through a review of 7 years of observational retrospective data from the national measles laboratory surveillance programme. Methods A retrospective study using national databases on the laboratory surveillance of measles was performed. Patients of all ages with suspected measles from all provinces of Angola were included. Serum samples were used to detect IgM-type measles-virus-specific antibodies by enzyme-linked immunosorbent assay. Findings In total, 3690 suspected measles samples were sent to the Instituto Nacional de Investigação em Saúde. There were 962 (26.1%) laboratory-confirmed cases, and the most affected age group was children aged 1-4 years. The highest incidence rate per 100,000 population was found in Benguela (17.9%), followed by Huambo (16.7%) and Cuanza Sul (13.6%). Of the study years, the incidence rate per 1,000,000 population was highest in 2020 (11.9%). The most common complication was diarrhoea (n=406, 42.2%). Of the confirmed cases, 209 (21.7%) were vaccinated, 633 (65.8%) were unvaccinated, and 120 (12.5%) had unknown vaccination status. For all study years, vaccination coverage was <70%. Interpretation Measles continues to be a serious problem in Angola, and more efforts are needed to increase measles surveillance and achieve a high percentage of vaccination coverage.
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Affiliation(s)
- Mabel A. Ramírez
- Grupo de Investigação Microbiana e Imunológica, Instituto Nacional de Investigação em Saúde, Luanda, Angola
| | | | - Maria M. Galange
- Grupo de Investigação Microbiana e Imunológica, Instituto Nacional de Investigação em Saúde, Luanda, Angola
| | - Raisa R. Carralero
- Grupo de Investigação Microbiana e Imunológica, Instituto Nacional de Investigação em Saúde, Luanda, Angola
| | - Graciete Júlio
- Grupo de Investigação Microbiana e Imunológica, Instituto Nacional de Investigação em Saúde, Luanda, Angola
| | | | - Celestina Gaston
- Grupo de Investigação Microbiana e Imunológica, Instituto Nacional de Investigação em Saúde, Luanda, Angola
| | - Eusebio Manuel
- Direcção Nacional de Saúde Pública, Ministério da Saúde, Luanda, Angola
| | - Alda M. Pedro
- Direcção Nacional de Saúde Pública, Ministério da Saúde, Luanda, Angola
| | - Joana Paixão
- Grupo de Investigação Microbiana e Imunológica, Instituto Nacional de Investigação em Saúde, Luanda, Angola
| | - Helga Freitas
- Direcção Nacional de Saúde Pública, Ministério da Saúde, Luanda, Angola
| | - Joana Morais
- Grupo de Investigação Microbiana e Imunológica, Instituto Nacional de Investigação em Saúde, Luanda, Angola
- Faculdade de Medicina, Universidade Agostinho Neto, Luanda, Angola
| | - Ngiambudulu M. Francisco
- Grupo de Investigação Microbiana e Imunológica, Instituto Nacional de Investigação em Saúde, Luanda, Angola
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Ario AR, Aliddeki DM, Kadobera D, Bulage L, Kayiwa J, Wetaka MM, Kyazze S, Ocom F, Makumbi I, Mbaka P, Behumbiize P, Ayebazibwe I, Balinandi SK, Lutwama JJ, Crawley A, Divi N, Lule JR, Ojwang JC, Harris JR, Boore AL, Nelson LJ, Borchert J, Jarvis D. Uganda's experience in establishing an electronic compendium for public health emergencies. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001402. [PMID: 36962840 PMCID: PMC10021891 DOI: 10.1371/journal.pgph.0001402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/28/2022] [Indexed: 02/12/2023]
Abstract
Uganda has implemented several interventions that have contributed to prevention, early detection, and effective response to Public Health Emergencies (PHEs). However, there are gaps in collecting and documenting data on the overall response to these PHEs. We set out to establish a comprehensive electronic database of PHEs that occurred in Uganda since 2000. We constituted a core development team, developed a data dictionary, and worked with Health Information Systems Program (HISP)-Uganda to develop and customize a compendium of PHEs using the electronic Integrated Disease Surveillance and Response (eIDSR) module on the District Health Information Software version 2 (DHIS2) platform. We reviewed literature for retrospective data on PHEs for the compendium. Working with the Uganda Public Health Emergency Operations Center (PHEOC), we prospectively updated the compendium with real-time data on reported PHEs. We developed a user's guide to support future data entry teams. An operational compendium was developed within the eIDSR module of the DHIS2 platform. The variables for PHEs data collection include those that identify the type, location, nature and time to response of each PHE. The compendium has been updated with retrospective PHE data and real-time prospective data collection is ongoing. Data within this compendium is being used to generate information that can guide future outbreak response and management. The compendium development highlights the importance of documenting outbreak detection and response data in a central location for future reference. This data provides an opportunity to evaluate and inform improvements in PHEs response.
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Affiliation(s)
- Alex Riolexus Ario
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Daniel Kadobera
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Joshua Kayiwa
- Uganda National Institute of Public Health, Kampala, Uganda
- Uganda Public Health Emergency Operations Center, Kampala, Uganda
| | - Milton M. Wetaka
- Uganda National Institute of Public Health, Kampala, Uganda
- Uganda Public Health Emergency Operations Center, Kampala, Uganda
| | - Simon Kyazze
- Uganda National Institute of Public Health, Kampala, Uganda
- Uganda Public Health Emergency Operations Center, Kampala, Uganda
| | - Felix Ocom
- Uganda National Institute of Public Health, Kampala, Uganda
- Uganda Public Health Emergency Operations Center, Kampala, Uganda
| | - Issa Makumbi
- Uganda National Institute of Public Health, Kampala, Uganda
- Uganda Public Health Emergency Operations Center, Kampala, Uganda
| | - Paul Mbaka
- Uganda National Institute of Public Health, Kampala, Uganda
- Division of Health Information, Ministry of Health, Kampala, Uganda
| | | | | | | | | | - Adam Crawley
- Ending Pandemics, San Francisco, California, United States of America
| | - Nomita Divi
- Ending Pandemics, San Francisco, California, United States of America
| | - John R. Lule
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | | | - Julie R. Harris
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Amy L. Boore
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Lisa J. Nelson
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Jeff Borchert
- Division of Vector-Borne Diseases, National Center for Emerging, Zoonotic, Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Dennis Jarvis
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Prosperi C, Thangaraj J, Hasan A, Kumar M, Truelove S, Kumar V, Winter A, Bansal A, Chauhan S, Grover G, Jain A, Kulkarni R, Sharma S, Soman B, Chaaithanya I, Kharwal S, Mishra S, Salvi N, Sharma N, Sharma S, Varghese A, Sabarinathan R, Duraiswamy A, Rani D, Kanagasabai K, Lachyan A, Gawali P, Kapoor M, Chonker S, Cutts F, Sangal L, Mehendale S, Sapkal G, Gupta N, Hayford K, Moss W, Murhekar M. Added value of the measles-rubella supplementary immunization activity in reaching unvaccinated and under-vaccinated children, a cross-sectional study in five Indian districts, 2018-20. Vaccine 2023; 41:486-495. [PMID: 36481106 PMCID: PMC9831119 DOI: 10.1016/j.vaccine.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/29/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Supplementary immunization activities (SIAs) aim to interrupt measles transmission by reaching susceptible children, including children who have not received the recommended two routine doses of MCV before the SIA. However, both strategies may miss the same children if vaccine doses are highly correlated. How well SIAs reach children missed by routine immunization is a key metric in assessing the added value of SIAs. METHODS Children aged 9 months to younger than 5 years were enrolled in cross-sectional household serosurveys conducted in five districts in India following the 2017-2019 measles-rubella (MR) SIA. History of measles containing vaccine (MCV) through routine services or SIA was obtained from documents and verbal recall. Receipt of a first or second MCV dose during the SIA was categorized as "added value" of the SIA in reaching un- and under-vaccinated children. RESULTS A total of 1,675 children were enrolled in these post-SIA surveys. The percentage of children receiving a 1st or 2nd dose through the SIA ranged from 12.8% in Thiruvananthapuram District to 48.6% in Dibrugarh District. Although the number of zero-dose children prior to the SIA was small in most sites, the proportion reached by the SIA ranged from 45.8% in Thiruvananthapuram District to 94.9% in Dibrugarh District. Fewer than 7% of children remained measles zero-dose after the MR SIA (range: 1.1-6.4%) compared to up to 28% before the SIA (range: 7.3-28.1%). DISCUSSION We demonstrated the MR SIA provided considerable added value in terms of measles vaccination coverage, although there was variability across districts due to differences in routine and SIA coverage, and which children were reached by the SIA. Metrics evaluating the added value of an SIA can help to inform the design of vaccination strategies to better reach zero-dose or undervaccinated children.
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Affiliation(s)
- C. Prosperi
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J.W.V. Thangaraj
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - A.Z. Hasan
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M.S. Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - S. Truelove
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - V.S. Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - A.K. Winter
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A.K. Bansal
- ICMR-National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, India
| | - S.L. Chauhan
- ICMR- National Institute for Research in Reproductive and Child Health (NIRRCH), Mumbai, India
| | - G.S. Grover
- Directorate of Health Services, Government of Punjab, Chandigarh, India
| | - A.K. Jain
- ICMR-National Institute of Pathology, New Delhi, India
| | - R.N. Kulkarni
- ICMR- National Institute for Research in Reproductive and Child Health (NIRRCH), Mumbai, India
| | - S.K. Sharma
- ICMR-Regional Medical Research Centre, NE Region, Dibrugarh, India
| | - B. Soman
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - I.K. Chaaithanya
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - S. Kharwal
- Department of Health Research, Model Rural Health Research Unit-Hoshiarpur, Punjab, India
| | - S.K. Mishra
- Department of Health Research, Model Rural Health Research Unit-Hoshiarpur, Punjab, India
| | - N.R. Salvi
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - N.P. Sharma
- Department of Health Research, Model Rural Health Research Unit-Chabua, Assam, India
| | - S. Sharma
- Department of Health Research, Model Rural Health Research Unit-Kanpur, Uttar Pradesh, India
| | - A. Varghese
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - R. Sabarinathan
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - A. Duraiswamy
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - D.S. Rani
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - K. Kanagasabai
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - A. Lachyan
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - P. Gawali
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - M. Kapoor
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - S.K. Chonker
- Department of Health Research, Model Rural Health Research Unit-Kanpur, Uttar Pradesh, India
| | - F.T. Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - L. Sangal
- World Health Organization, Southeast Asia Region Office, New Delhi, India
| | - S.M. Mehendale
- PD Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - G.N. Sapkal
- ICMR-National Institute of Virology, Pune, India
| | - N. Gupta
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - K. Hayford
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - W.J. Moss
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Corresponding author at: International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - M.V. Murhekar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
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12
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Mebrate M, Hailu C, Alemu S. Measles outbreak investigation in Kasoshekumer kebele, Sinana district, South-Eastern Oromia, Ethiopia: A case-control study. SAGE Open Med 2023; 11:20503121231169182. [PMID: 37152839 PMCID: PMC10161311 DOI: 10.1177/20503121231169182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/24/2023] [Indexed: 05/09/2023] Open
Abstract
Objective This study aimed at verifying the outbreak, preventing further transmission, and identifying the risk factors for the outbreak. Method A case-control study design was conducted from March 4, 2020 to April 30, 2020, in Kasoshekumer kebele of Sinana district. Thirty-seven carer-patient pairs and 74 controls were recruited in a 1:2 case-control ratio. Patients were selected using a national standard case definition of the Ministry of Health. Controls were selected from neighbors of patients and interviewed after the second incubation period from the last patient of the outbreak by a structured questionnaire similar to patients. All cases were included while controls were selected purposively for their exposure status. Vaccine efficacy, attack rate, and case fatality rate were conducted as a descriptive epidemiology. Multivariate analysis was used to identify associated factors. Result Out of 109 study participants, there were 37 cases and 72 controls. The mean age was 58.8 months with ±54 standard deviation. Thirty-one (83.8%) of the cases had a known contact history and 23 (62.2%) were unvaccinated. The age-specific attack rate was 36/1000 in <5 years and 53/100,000 in >15 years. The estimated vaccine efficacy was 73.7%. Having any type of socialization behavior (adjusted odds ratio = 6.8, confidence interval: 4.25, 11.4), maternal poor knowledge of measles prevention (adjusted odds ratio = 4.152, confidence interval: 1.226, 8.058), and being unvaccinated (adjusted odds ratio = 7.79, confidence interval: 2.281, 12.63) were associated factors for measles infection. Conclusion Poor knowledge of the parents on vaccination and the less effort taken to deliver good attitude toward vaccination are resulting in measles outbreak. However, herd immunity can prevent the outbreak; if not, the community will continue to suffer from mortality and morbidity. A resilient immunization program with sustainable and equitable supply, delivery, monitoring, and evaluation is a fundamental action in prevention of measles outbreak. Increased awareness of vaccination and other prevention measures are also crucial to end the outbreaks.
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Affiliation(s)
- Milkessa Mebrate
- Field Epidemiology Training Program, Department of Epidemiology, Jimma University, Jimma, Ethiopia
| | - Cherinet Hailu
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Soresa Alemu
- Mettu Health Science College, Mettu, Ethiopia
- Soresa Alemu, Mettu Health Science College, Mettu, Oromia, Ethiopia.
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13
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Sievers BL, Sievers RE, Sievers EL. Incentivized self-vaccination for global measles eradication. J Virus Erad 2022; 8:100310. [PMID: 36578361 PMCID: PMC9791812 DOI: 10.1016/j.jve.2022.100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Measles-we've become inured to its cruel, insidious impact as it kills over 100,000 children yearly because of suboptimal vaccination coverage. It does not have to be this way. A familiar, safe, exceptionally effective measles vaccine saves lives and permanent, global measles eradication is within reach. But now we need to be clever and courageously explore new strategies to save lives. Firstly, let us enable people to vaccinate themselves, not with a needle and syringe, but with a quick inhaled puff of dry powder vaccine. Secondly, let us provide micro-payments using digital currency to incentivize those who vaccinate themselves. Thirdly, let us leverage learnings from how our social networks guide our behaviors to further encourage self-vaccination. Fourthly, let us inspire friendly regional competition among communities vying for the highest proportion of citizens who show measles neutralizing antibodies in spot saliva samples. With global cooperation and relentless determination, we eradicated smallpox. Next up? Measles.
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Affiliation(s)
| | - Robert E. Sievers
- Department of Chemistry and Biochemistry, University of Colorado Boulder, Boulder, CO, 80309, USA
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14
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Rana MS, Usman M, Alam MM, Ikram A, Salman M, Umair M. The world's largest measles-Rubella vaccination campaign in Pakistan: Time to invest in routine immunization. Hum Vaccin Immunother 2022; 18:2080444. [PMID: 35802459 PMCID: PMC9621063 DOI: 10.1080/21645515.2022.2080444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/18/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Muhammad Usman
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | | | - Aamer Ikram
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Muhammad Salman
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Massab Umair
- Department of Virology, National Institute of Health, Islamabad, Pakistan
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15
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Exploring the subnational inequality and heterogeneity of the impact of routine measles immunisation in Africa. Vaccine 2022; 40:6806-6817. [PMID: 36244882 DOI: 10.1016/j.vaccine.2022.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/07/2022]
Abstract
Despite vaccination being one of the most effective public health interventions, there are persisting inequalities and inequities in immunisation. Understanding the differences in subnational vaccine impact can help improve delivery mechanisms and policy. We analyse subnational vaccination coverage of measles first-dose (MCV1) and estimate patterns of inequalities in impact, represented as deaths averted, across 45 countries in Africa. We also evaluate how much this impact would improve under more equitable vaccination coverage scenarios. Using coverage data for MCV1 from 2000-2019, we estimate the number of deaths averted at the first administrative level. We use the ratio of deaths averted per vaccination from two mathematical models to extrapolate the impact at a subnational level. Next, we calculate inequality for each country, measuring the spread of deaths averted across its regions, accounting for differences in population. Finally, using three more equitable vaccination coverage scenarios, we evaluate how much impact of MCV1 immunisation could improve by (1) assuming all regions in a country have at least national coverage, (2) assuming all regions have the observed maximum coverage; and (3) assuming all regions have at least 80% coverage. Our results show that progress in coverage and reducing inequality has slowed in the last decade in many African countries. Under the three scenarios, a significant number of additional deaths in children could be prevented each year; for example, under the observed maximum coverage scenario, global MCV1 coverage would improve from 76% to 90%, resulting in a further 363(95%CrI:299-482) deaths averted per 100,000 live births. This paper illustrates that estimates of the impact of MCV1 immunisation at a national level can mask subnational heterogeneity. We further show that a considerable number of deaths could be prevented by maximising equitable access in countries with high inequality when increasing the global coverage of MCV1 vaccination.
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16
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Wigley A, Lorin J, Hogan D, Utazi CE, Hagedorn B, Dansereau E, Tatem AJ, Tejedor-Garavito N. Estimates of the number and distribution of zero-dose and under-immunised children across remote-rural, urban, and conflict-affected settings in low and middle-income countries. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001126. [PMID: 36962682 PMCID: PMC10021885 DOI: 10.1371/journal.pgph.0001126] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/05/2022] [Indexed: 02/11/2023]
Abstract
While there has been great success in increasing the coverage of new childhood vaccines globally, expanding routine immunization to reliably reach all children and communities has proven more challenging in many low- and middle-income countries. Achieving this requires vaccination strategies and interventions that identify and target those unvaccinated, guided by the most current and detailed data regarding their size and spatial distribution. Through the integration and harmonisation of a range of geospatial data sets, including population, vaccination coverage, travel-time, settlement type, and conflict locations. We estimated the numbers of children un- or under-vaccinated for measles and diphtheria-tetanus-pertussis, within remote-rural, urban, and conflict-affected locations. We explored how these numbers vary both nationally and sub-nationally, and assessed what proportions of children these categories captured, for 99 lower- and middle-income countries, for which data was available. We found that substantial heterogeneities exist both between and within countries. Of the total 14,030,486 children unvaccinated for DTP1, over 11% (1,656,757) of un- or under-vaccinated children were in remote-rural areas, more than 28% (2,849,671 and 1,129,915) in urban and peri-urban areas, and up to 60% in other settings, with nearly 40% found to be within 1-hour of the nearest town or city (though outside of urban/peri-urban areas). Of the total number of those unvaccinated, we estimated between 6% and 15% (826,976 to 2,068,785) to be in conflict-affected locations, based on either broad or narrow definitions of conflict. Our estimates provide insights into the inequalities in vaccination coverage, with the distributions of those unvaccinated varying significantly by country, region, and district. We demonstrate the need for further inquiry and characterisation of those unvaccinated, the thresholds used to define these, and for more country-specific and targeted approaches to defining such populations in the strategies and interventions used to reach them.
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Affiliation(s)
- Adelle Wigley
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, United Kingdom
| | - Josh Lorin
- Gavi, The Vaccine Alliance, Geneva, Switzerland
| | - Dan Hogan
- Gavi, The Vaccine Alliance, Geneva, Switzerland
| | - C Edson Utazi
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, United Kingdom
| | - Brittany Hagedorn
- Institute for Disease Modelling, Bill & Melinda Gates Foundation, Seattle, Washington, WA, United States of America
| | - Emily Dansereau
- Institute for Disease Modelling, Bill & Melinda Gates Foundation, Seattle, Washington, WA, United States of America
| | - Andrew J Tatem
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, United Kingdom
| | - Natalia Tejedor-Garavito
- WorldPop, Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, United Kingdom
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17
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How accurate are WorldPop-Global-Unconstrained gridded population data at the cell-level?: A simulation analysis in urban Namibia. PLoS One 2022; 17:e0271504. [PMID: 35862480 PMCID: PMC9302737 DOI: 10.1371/journal.pone.0271504] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/04/2022] [Indexed: 11/19/2022] Open
Abstract
Disaggregated population counts are needed to calculate health, economic, and development indicators in Low- and Middle-Income Countries (LMICs), especially in settings of rapid urbanisation. Censuses are often outdated and inaccurate in LMIC settings, and rarely disaggregated at fine geographic scale. Modelled gridded population datasets derived from census data have become widely used by development researchers and practitioners; however, accuracy in these datasets are evaluated at the spatial scale of model input data which is generally courser than the neighbourhood or cell-level scale of many applications. We simulate a realistic synthetic 2016 population in Khomas, Namibia, a majority urban region, and introduce several realistic levels of outdatedness (over 15 years) and inaccuracy in slum, non-slum, and rural areas. We aggregate the synthetic populations by census and administrative boundaries (to mimic census data), resulting in 32 gridded population datasets that are typical of LMIC settings using the WorldPop-Global-Unconstrained gridded population approach. We evaluate the cell-level accuracy of these gridded population datasets using the original synthetic population as a reference. In our simulation, we found large cell-level errors, particularly in slum cells. These were driven by the averaging of population densities in large areal units before model training. Age, accuracy, and aggregation of the input data also played a role in these errors. We suggest incorporating finer-scale training data into gridded population models generally, and WorldPop-Global-Unconstrained in particular (e.g., from routine household surveys or slum community population counts), and use of new building footprint datasets as a covariate to improve cell-level accuracy (as done in some new WorldPop-Global-Constrained datasets). It is important to measure accuracy of gridded population datasets at spatial scales more consistent with how the data are being applied, especially if they are to be used for monitoring key development indicators at neighbourhood scales within cities.
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18
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Ndondo AP, Eley B, Wilmshurst JM, Kakooza-Mwesige A, Giannoccaro MP, Willison HJ, Cruz PMR, Heckmann JM, Bateman K, Vincent A. Post-Infectious Autoimmunity in the Central (CNS) and Peripheral (PNS) Nervous Systems: An African Perspective. Front Immunol 2022; 13:833548. [PMID: 35356001 PMCID: PMC8959857 DOI: 10.3389/fimmu.2022.833548] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
The direct impact and sequelae of infections in children and adults result in significant morbidity and mortality especially when they involve the central (CNS) or peripheral nervous system (PNS). The historical understanding of the pathophysiology has been mostly focused on the direct impact of the various pathogens through neural tissue invasion. However, with the better understanding of neuroimmunology, there is a rapidly growing realization of the contribution of the innate and adaptive host immune responses in the pathogenesis of many CNS and PNS diseases. The balance between the protective and pathologic sequelae of immunity is fragile and can easily be tipped towards harm for the host. The matter of immune privilege and surveillance of the CNS/PNS compartments and the role of the blood-brain barrier (BBB) and blood nerve barrier (BNB) makes this even more complex. Our understanding of the pathogenesis of many post-infectious manifestations of various microbial agents remains elusive, especially in the diverse African setting. Our exploration and better understanding of the neuroimmunology of some of the infectious diseases that we encounter in the continent will go a long way into helping us to improve their management and therefore lessen the burden. Africa is diverse and uniquely poised because of the mix of the classic, well described, autoimmune disease entities and the specifically "tropical" conditions. This review explores the current understanding of some of the para- and post-infectious autoimmune manifestations of CNS and PNS diseases in the African context. We highlight the clinical presentations, diagnosis and treatment of these neurological disorders and underscore the knowledge gaps and perspectives for future research using disease models of conditions that we see in the continent, some of which are not uniquely African and, where relevant, include discussion of the proposed mechanisms underlying pathogen-induced autoimmunity. This review covers the following conditions as models and highlight those in which a relationship with COVID-19 infection has been reported: a) Acute Necrotizing Encephalopathy; b) Measles-associated encephalopathies; c) Human Immunodeficiency Virus (HIV) neuroimmune disorders, and particularly the difficulties associated with classical post-infectious autoimmune disorders such as the Guillain-Barré syndrome in the context of HIV and other infections. Finally, we describe NMDA-R encephalitis, which can be post-HSV encephalitis, summarise other antibody-mediated CNS diseases and describe myasthenia gravis as the classic antibody-mediated disease but with special features in Africa.
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Affiliation(s)
- Alvin Pumelele Ndondo
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Brian Eley
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.,Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Jo Madeleine Wilmshurst
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.,Department of Paediatric Neurology, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Angelina Kakooza-Mwesige
- Department of Pediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Maria Pia Giannoccaro
- Laboratory of Neuromuscular Pathology and Neuroimmunology, Istituto di Ricovero e Cura a CarattereScientifico (IRCCS) Instiuto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Hugh J Willison
- Institute of Infection, Immunity and Inflammation (3I), University of Glasgow, Glasgow, United Kingdom
| | - Pedro M Rodríguez Cruz
- Centro Nacional de Analisis Genomico - Centre for Genomic Regulation (CNAG-CRG ), Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain.,Department of Neuromuscular Disease, University College London (UCL) Queen Square Institute of Neurology, London, United Kingdom.,Faculté de Médecine, de Pharmacie et d'Odontologie, Université Cheikh Anta Diop, Dakar, Senegal
| | - Jeannine M Heckmann
- Neurology Division, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa.,The University of Cape Town (UCT) Neurosciences Institute, University of Cape Town, Cape Town, South Africa
| | - Kathleen Bateman
- Neurology Division, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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19
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Abstract
Measles is a highly contagious, potentially fatal, but vaccine-preventable disease caused by measles virus. Symptoms include fever, maculopapular rash, and at least one of cough, coryza, or conjunctivitis, although vaccinated individuals can have milder or even no symptoms. Laboratory diagnosis relies largely on the detection of specific IgM antibodies in serum, dried blood spots, or oral fluid, or the detection of viral RNA in throat or nasopharyngeal swabs, urine, or oral fluid. Complications can affect many organs and often include otitis media, laryngotracheobronchitis, pneumonia, stomatitis, and diarrhoea. Neurological complications are uncommon but serious, and can occur during or soon after the acute disease (eg, acute disseminated encephalomyelitis) or months or even years later (eg, measles inclusion body encephalitis and subacute sclerosing panencephalitis). Patient management mainly involves supportive therapy, such as vitamin A supplementation, monitoring for and treatment of secondary bacterial infections with antibiotics, and rehydration in the case of severe diarrhoea. There is no specific antiviral therapy for the treatment of measles, and disease control largely depends on prevention. However, despite the availability of a safe and effective vaccine, measles is still endemic in many countries and causes considerable morbidity and mortality, especially among children in resource-poor settings. The low case numbers reported in 2020, after a worldwide resurgence of measles between 2017 and 2019, have to be interpreted cautiously, owing to the effect of the COVID-19 pandemic on disease surveillance. Disrupted vaccination activities during the pandemic increase the potential for another resurgence of measles in the near future, and effective, timely catch-up vaccination campaigns, strong commitment and leadership, and sufficient resources will be required to mitigate this threat.
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Affiliation(s)
- Judith M Hübschen
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.
| | - Ionela Gouandjika-Vasilache
- Laboratoire des Virus Entériques et de la Rougeole, Institut Pasteur de Bangui, Bangui, Central African Republic
| | - Julia Dina
- Virology Department, Normandie University, UNICAEN, INSERM U1311 DynaMicURe, Caen University Hospital, Caen, France
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20
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Ding M, Wennberg A, Ek S, Santoni G, Gigante B, Walldius G, Hammar N, Modig K. The association of apolipoproteins with later-life all-cause and cardiovascular mortality: a population-based study stratified by age. Sci Rep 2021; 11:24440. [PMID: 34952923 PMCID: PMC8709841 DOI: 10.1038/s41598-021-03959-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
Midlife lipid levels are important predictors of cardiovascular diseases, yet their association with mortality in older adults is less clear. We aimed to (1) identify lipid profiles based on cholesterol, triglycerides, and apolipoproteins using cluster analysis, and (2) investigate how lipid profiles and lipid levels at different ages are associated with later-life all-cause and cardiovascular mortality. We used data from 98,270 individuals in the Swedish AMORIS cohort who had blood measurements between 1985-1996 and were followed until 2012. Over the follow-up (mean 18.0 years), 30,730 (31.3%) individuals died. Three lipid profiles were identified. Compared with reference profile, a high lipid profile (low ApoA-I and high total cholesterol (TC), triglycerides, ApoB, and ApoB/ApoA-I ratio) at ages 39-59 or 60-79 was associated with higher all-cause mortality. A high lipid profile at ≥ 80 years, however, did not confer higher mortality. For the specific markers, high TC (≥ 7.25 mmol/L) was associated with higher all-cause mortality in ages 39-59 but lower mortality in ages 60-79 and ≥ 80. Low ApoA-I (< 1.28 g/L) and high ApoB/ApoA-I ratio (≥ 1.18), on the other hand, were associated with higher cardiovascular mortality regardless of age at lipid measurement, highlighting their potential relevance for survival in both young and older individuals.
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Affiliation(s)
- Mozhu Ding
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, 17177, Stockholm, Sweden.
| | - Alexandra Wennberg
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, 17177, Stockholm, Sweden
| | - Stina Ek
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, 17177, Stockholm, Sweden
| | - Giola Santoni
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Bruna Gigante
- Division of Cardiovascular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Division of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Göran Walldius
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, 17177, Stockholm, Sweden
| | - Niklas Hammar
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, 17177, Stockholm, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobelsväg 13, 17177, Stockholm, Sweden
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21
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Ota MOC, Badur S, Romano-Mazzotti L, Friedland LR. Impact of COVID-19 pandemic on routine immunization. Ann Med 2021; 53:2286-2297. [PMID: 34854789 PMCID: PMC8648038 DOI: 10.1080/07853890.2021.2009128] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/16/2021] [Indexed: 11/04/2022] Open
Abstract
The current COVID-19 global pandemic continues to impact healthcare services beyond those directly related to the management of SARS-CoV-2 transmission and disease. We reviewed the published literature to assess the pandemic impact on existing global immunization activities and how the impact may be addressed. Widespread global disruption in routine childhood immunization has impacted a majority of regions and countries, especially in the initial pandemic phases. While data indicate subsequent recovery in immunization rates, a substantial number of vulnerable people remain unvaccinated. The downstream impact may be even greater in resource-limited settings and economically poorer populations, and consequently there are growing concerns around the resurgence of vaccine-preventable diseases, particularly measles. Guidance on how to address immunization deficits are available and continue to evolve, emphasizing the importance of maintaining and restoring routine immunization and necessary mass vaccination campaigns during and after pandemics. In this, collaboration between a broad range of stakeholders (governments, industry, healthcare decision-makers and frontline healthcare professionals) and clear communication and engagement with the public can help achieve these goals.Key messagesThe COVID-19 pandemic has a substantial impact on essential immunization activities.Disruption to mass vaccination campaigns increase risk of VPD resurgence.Catch-up campaigns are necessary to limit existing shortfalls in vaccine uptake.Guidance to mitigate these effects continues to evolve.
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22
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Holroyd TA, Schiaffino F, Chang RH, Wanyiri JW, Saldanha IJ, Gross M, Moss WJ, Hayford K. Diagnostic accuracy of dried blood spots for serology of vaccine-preventable diseases: a systematic review. Expert Rev Vaccines 2021; 21:185-200. [PMID: 34852211 DOI: 10.1080/14760584.2022.2013821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Venous serum and plasma are optimal specimens for serological testing but may be logistically infeasible. Dried blood spots (DBS) are a feasible alternative, provided results are adequately sensitive and specific. We aimed to assess the diagnostic accuracy of DBS to measure IgG and IgM antibodies for vaccine-preventable diseases and compare test validity of DBS with venous blood. AREAS COVERED In October 2020, we searched seven databases for peer-reviewed studies assessing the diagnostic accuracy of DBS specimens compared with serum in detecting antibodies to VPDs in humans. We extracted data and assessed risk of bias in all included studies. We calculated sensitivity and specificity with 95% confidence intervals for each index-reference test comparison. We narratively synthesized the identified evidence on diagnostic accuracy and blood collection and processing methods for DBS. Studies on measles and rubella IgG and IgM were the most frequently identified and reported generally high sensitivity and specificity. EXPERT OPINION Lack of standardization in collection, storage, and testing methods limited systematic comparison across studies. Our findings indicate a need for additional validation studies on the diagnostic accuracy of DBS to expand their use in serological surveillance. We recommend practical considerations to improve standardized reporting for DBS validation studies.
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Affiliation(s)
- Taylor A Holroyd
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Francesca Schiaffino
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rachel H Chang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jane W Wanyiri
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ian J Saldanha
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Margaret Gross
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - William J Moss
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kyla Hayford
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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23
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Decouttere C, Banzimana S, Davidsen P, Van Riet C, Vandermeulen C, Mason E, Jalali MS, Vandaele N. Insights into vaccine hesitancy from systems thinking, Rwanda. Bull World Health Organ 2021; 99:783-794D. [PMID: 34737471 PMCID: PMC8542260 DOI: 10.2471/blt.20.285258] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To investigate vaccine hesitancy leading to underimmunization and a measles outbreak in Rwanda and to develop a conceptual, community-level model of behavioural factors. METHODS Local immunization systems in two Rwandan communities (one recently experienced a measles outbreak) were explored using systems thinking, human-centred design and behavioural frameworks. Data were collected between 2018 and 2020 from: discussions with 11 vaccination service providers (i.e. hospital and health centre staff); interviews with 161 children's caregivers at health centres; and nine validation interviews with health centre staff. Factors influencing vaccine hesitancy were categorized using the 3Cs framework: confidence, complacency and convenience. A conceptual model of vaccine hesitancy mechanisms with feedback loops was developed. FINDINGS A comparison of service providers' and caregivers' perspectives in both rural and peri-urban settings showed that similar factors strengthened vaccine uptake: (i) high trust in vaccines and service providers based on personal relationships with health centre staff; (ii) the connecting role of community health workers; and (iii) a strong sense of community. Factors identified as increasing vaccine hesitancy (e.g. service accessibility and inadequate follow-up) differed between service providers and caregivers and between settings. The conceptual model could be used to explain drivers of the recent measles outbreak and to guide interventions designed to increase vaccine uptake. CONCLUSION The application of behavioural frameworks and systems thinking revealed vaccine hesitancy mechanisms in Rwandan communities that demonstrate the interrelationship between immunization services and caregivers' vaccination behaviour. Confidence-building social structures and context-dependent challenges that affect vaccine uptake were also identified.
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Affiliation(s)
| | - Stany Banzimana
- East African Community Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, University of Rwanda, Kigali, Rwanda
| | - Pål Davidsen
- System Dynamics Group, University of Bergen, Bergen, Norway
| | - Carla Van Riet
- Research Center for Access-to-Medicines, Naamsestraat 69, 3000 Leuven, Belgium
| | | | - Elizabeth Mason
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Cambridge, United States of America
| | - Mohammad S Jalali
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Cambridge, United States of America
| | - Nico Vandaele
- Research Center for Access-to-Medicines, Naamsestraat 69, 3000 Leuven, Belgium
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24
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Campbell JD, Pasetti MF, Oot L, Adam Z, Tefera M, Beyane B, Mulholland N, Steinglass R, Krey R, Chen WH, Blackwelder WC, Levine MM. Linked vaccination coverage surveys plus serosurveys among Ethiopian toddlers undertaken three years apart to compare coverage and serologic evidence of protection in districts implementing the RED-QI approach. Vaccine 2021; 39:5802-5813. [PMID: 34465472 PMCID: PMC8494116 DOI: 10.1016/j.vaccine.2021.08.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 08/15/2021] [Accepted: 08/18/2021] [Indexed: 11/19/2022]
Abstract
A seroprotective tetanus titer indicates a toddler has received pentavalent vaccine. Serosurveys document increased seroprevalence post-measles vaccination campaigns. Vaccination coverage/serosurveys can assess interventions to improve immunizations.
In low and middle-income countries, estimating the proportion of vaccinated toddlers in a population is important for controlling vaccine-preventable diseases by identifying districts where immunization services need strengthening. Estimates measured before and several years after specific interventions can assess program performance. However, employing different methods to derive vaccination coverage estimates often yield differing results. Methods Linked vaccination coverage surveys and seroprotection surveys performed among ~300 toddlers 12–23 months of age in districts (woredas), one per region, of Ethiopia (total, ~900 toddlers) in 2013 to estimate the proportion vaccinated with tetanus toxoid (a proxy for pentavalent vaccine) and measles vaccine. The surveys were followed by implementation of the Reaching Every District using Quality Improvement (RED-QI) approach to strengthen the immunization system. Linked coverage/serosurveys were repeated in 2016 to assess effects of the interventions on vaccination coverage. Indicators included “documented coverage” (vaccination card and/or health facility register records) and “crude coverage” (documented plus parent/caretaker recall for children without cards). Seroprotection thresholds were IgG-ELISA tetanus antitoxin ≥0.05 IU/ml and plaque reduction neutralization (PRN) measles titers ≥120 mIU/ml. Findings Improved markers in 2016 over 2013 include coverage of pentavalent vaccination, vaccination timeliness, and fewer missed opportunities to vaccinate. In parallel, tetanus seroprotection increased in the 3 woredas from 59.6% to 79.1%, 72.9% to 83.7%, and 94.3 to 99.3%. In 2015, the Ethiopian government conducted supplemental measles mass vaccination campaigns in several regions including one that involved a project woreda and the campaign overlapped with the RED-QI intervention timeframe; protective measles PRN titers there rose from 31.0% to 50.0%. Interpretation The prevalence of seroprotective titers of tetanus antitoxin (stimulated by tetanus toxoid components within pentavalent vaccine) provides a reliable biomarker to identify children who received pentavalent vaccine. In the three study woredas, the RED-QI intervention appeared to improve immunization service delivery, as documented by enhanced pentavalent vaccine coverage, vaccination timeliness, and fewer missed vaccination opportunities. A measles mass vaccination campaign was followed by a markedly increased prevalence of measles PRN antibodies. Collectively, these observations suggest that wider implementation of RED-QI can strengthen immunization, and periodic linked vaccination surveys/serosurveys can monitor changes.
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Affiliation(s)
- James D Campbell
- Center for Vaccine Development and Global Health, Baltimore, MD 21201, USA; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Marcela F Pasetti
- Center for Vaccine Development and Global Health, Baltimore, MD 21201, USA; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Lisa Oot
- JSI Research & Training Institute Inc., Arlington, VA, USA
| | - Zenaw Adam
- JSI Research & Training Institute Inc., Arlington, VA, USA
| | - Mesfin Tefera
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Berhane Beyane
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Nigisti Mulholland
- Family & Reproductive Rights Education Program (FARREP), The Royal Women's Hospital, Parkville, VIC 3052, Australia
| | | | - Rebecca Krey
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Wilbur H Chen
- Center for Vaccine Development and Global Health, Baltimore, MD 21201, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - William C Blackwelder
- Center for Vaccine Development and Global Health, Baltimore, MD 21201, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Myron M Levine
- Center for Vaccine Development and Global Health, Baltimore, MD 21201, USA; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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25
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Decouttere C, De Boeck K, Vandaele N. Advancing sustainable development goals through immunization: a literature review. Global Health 2021; 17:95. [PMID: 34446050 PMCID: PMC8390056 DOI: 10.1186/s12992-021-00745-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Immunization directly impacts health (SDG3) and brings a contribution to 14 out of the 17 Sustainable Development Goals (SDGs), such as ending poverty, reducing hunger, and reducing inequalities. Therefore, immunization is recognized to play a central role in reaching the SDGs, especially in low- and middle-income countries (LMICs). Despite continuous interventions to strengthen immunization systems and to adequately respond to emergency immunization during epidemics, the immunization-related indicators for SDG3 lag behind in sub-Saharan Africa. Especially taking into account the current Covid19 pandemic, the current performance on the connected SDGs is both a cause and a result of this. METHODS We conduct a literature review through a keyword search strategy complemented with handpicking and snowballing from earlier reviews. After title and abstract screening, we conducted a qualitative analysis of key insights and categorized them according to showing the impact of immunization on SDGs, sustainability challenges, and model-based solutions to these challenges. RESULTS We reveal the leveraging mechanisms triggered by immunization and position them vis-à-vis the SDGs, within the framework of Public Health and Planetary Health. Several challenges for sustainable control of vaccine-preventable diseases are identified: access to immunization services, global vaccine availability to LMICs, context-dependent vaccine effectiveness, safe and affordable vaccines, local/regional vaccine production, public-private partnerships, and immunization capacity/capability building. Model-based approaches that support SDG-promoting interventions concerning immunization systems are analyzed in light of the strategic priorities of the Immunization Agenda 2030. CONCLUSIONS In general terms, it can be concluded that relevant future research requires (i) design for system resilience, (ii) transdisciplinary modeling, (iii) connecting interventions in immunization with SDG outcomes, (iv) designing interventions and their implementation simultaneously, (v) offering tailored solutions, and (vi) model coordination and integration of services and partnerships. The research and health community is called upon to join forces to activate existing knowledge, generate new insights and develop decision-supporting tools for Low-and Middle-Income Countries' health authorities and communities to leverage immunization in its transformational role toward successfully meeting the SDGs in 2030.
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Affiliation(s)
- Catherine Decouttere
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
| | - Kim De Boeck
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
| | - Nico Vandaele
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
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26
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Chang SY, Bisht A, Faysman K, Schiller GJ, Uslan DZ, Multani A. Vaccine-Associated Measles in a Hematopoietic Cell Transplant Recipient: Case Report and Comprehensive Review of the Literature. Open Forum Infect Dis 2021; 8:ofab326. [PMID: 34377725 PMCID: PMC8339276 DOI: 10.1093/ofid/ofab326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/18/2021] [Indexed: 01/04/2023] Open
Abstract
Measles is a worldwide viral disease that can cause fatal complications in immunocompromised hosts such as hematopoietic cell transplant (HCT) recipients. The live attenuated measles, mumps, and rubella (MMR) vaccine is generally contraindicated post-HCT due to the risk for vaccine-associated measles. This, combined with decreasing vaccination rates due to vaccine hesitancy and the coronavirus disease 2019 pandemic, raises significant concerns for a measles resurgence that could portend devastating consequences for immunocompromised hosts. Multiple guidelines have included criteria to determine which HCT recipients can safely receive the MMR vaccine. Here, we report a case of vaccine-associated measles in a HCT recipient who met guideline-recommended criteria for MMR vaccination. The objective of this article is to query these criteria, highlight the importance of MMR vaccination, and comprehensively review the literature.
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Affiliation(s)
- Sandy Y Chang
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Anjali Bisht
- Clinical Epidemiology and Infection Prevention, UCLA Health, Los Angeles, California, USA
| | - Karolina Faysman
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Gary J Schiller
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Daniel Z Uslan
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
- Clinical Epidemiology and Infection Prevention, UCLA Health, Los Angeles, California, USA
| | - Ashrit Multani
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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27
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Uwishema O, Adriano LF, Torbati T, Onyeaka H. Measles crisis in Africa amidst the COVID-19 pandemic: Delayed measles vaccine administration may cause a measles outbreak in Africa. J Med Virol 2021; 93:5697-5699. [PMID: 34181289 DOI: 10.1002/jmv.27150] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Olivier Uwishema
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda.,Department of Research, Project and Education, Clinton Global Initiative University, New York, USA.,Department of General Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Lubanga F Adriano
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda.,Department of General Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Tania Torbati
- Department of Neurosurgery, Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, California, USA
| | - Helen Onyeaka
- Department of Chemical Engineering, School of Chemical Engineering, University of Birmingham, Birmingham, UK
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28
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Gaythorpe KAM, Abbas K, Huber J, Karachaliou A, Thakkar N, Woodruff K, Li X, Echeverria-Londono S, Ferrari M, Jackson ML, McCarthy K, Perkins TA, Trotter C, Jit M. Impact of COVID-19-related disruptions to measles, meningococcal A, and yellow fever vaccination in 10 countries. eLife 2021; 10:e67023. [PMID: 34165077 PMCID: PMC8263060 DOI: 10.7554/elife.67023] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/23/2021] [Indexed: 12/30/2022] Open
Abstract
Background Childhood immunisation services have been disrupted by the COVID-19 pandemic. WHO recommends considering outbreak risk using epidemiological criteria when deciding whether to conduct preventive vaccination campaigns during the pandemic. Methods We used two to three models per infection to estimate the health impact of 50% reduced routine vaccination coverage in 2020 and delay of campaign vaccination from 2020 to 2021 for measles vaccination in Bangladesh, Chad, Ethiopia, Kenya, Nigeria, and South Sudan, for meningococcal A vaccination in Burkina Faso, Chad, Niger, and Nigeria, and for yellow fever vaccination in the Democratic Republic of Congo, Ghana, and Nigeria. Our counterfactual comparative scenario was sustaining immunisation services at coverage projections made prior to COVID-19 (i.e. without any disruption). Results Reduced routine vaccination coverage in 2020 without catch-up vaccination may lead to an increase in measles and yellow fever disease burden in the modelled countries. Delaying planned campaigns in Ethiopia and Nigeria by a year may significantly increase the risk of measles outbreaks (both countries did complete their supplementary immunisation activities (SIAs) planned for 2020). For yellow fever vaccination, delay in campaigns leads to a potential disease burden rise of >1 death per 100,000 people per year until the campaigns are implemented. For meningococcal A vaccination, short-term disruptions in 2020 are unlikely to have a significant impact due to the persistence of direct and indirect benefits from past introductory campaigns of the 1- to 29-year-old population, bolstered by inclusion of the vaccine into the routine immunisation schedule accompanied by further catch-up campaigns. Conclusions The impact of COVID-19-related disruption to vaccination programs varies between infections and countries. Planning and implementation of campaigns should consider country and infection-specific epidemiological factors and local immunity gaps worsened by the COVID-19 pandemic when prioritising vaccines and strategies for catch-up vaccination. Funding Bill and Melinda Gates Foundation and Gavi, the Vaccine Alliance.
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Affiliation(s)
- Katy AM Gaythorpe
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College LondonLondonUnited Kingdom
| | - Kaja Abbas
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | - John Huber
- Department of Biological Sciences, University of Notre DameSouth BendUnited States
| | | | - Niket Thakkar
- Institute for Disease Modeling, Bill & Melinda Gates FoundationSeattleUnited States
| | - Kim Woodruff
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College LondonLondonUnited Kingdom
| | - Xiang Li
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College LondonLondonUnited Kingdom
| | - Susy Echeverria-Londono
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), School of Public Health, Imperial College LondonLondonUnited Kingdom
| | | | | | - Kevin McCarthy
- Institute for Disease Modeling, Bill & Melinda Gates FoundationSeattleUnited States
| | - T Alex Perkins
- Department of Biological Sciences, University of Notre DameSouth BendUnited States
| | - Caroline Trotter
- Department of Veterinary Medicine, University of CambridgeCambridgeUnited Kingdom
| | - Mark Jit
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical MedicineLondonUnited Kingdom
- School of Public Health, University of Hong KongHong Kong SARChina
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29
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Cutts FT, Danovaro-Holliday MC, Rhoda DA. Challenges in measuring supplemental immunization activity coverage among measles zero-dose children. Vaccine 2021; 39:1359-1363. [PMID: 33551302 PMCID: PMC7903240 DOI: 10.1016/j.vaccine.2020.11.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/14/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
•Measles Supplemental Immunization Activities (SIAs) are resource intensive. •SIAs importantly reach some previously unvaccinated (so-called measles zero-dose) children. •We highlight difficulties in measuring how many measles zero-dose children the SIA reaches. •We also suggest some other methods to improve estimation of SIA impact.
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Affiliation(s)
- Felicity T Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | | | - Dale A Rhoda
- Biostat Global Consulting, Worthington, OH, USA.
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