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Sbarra AN, Jit M, Mosser JF, Ferrari M, Cutts F, Papania M, Kretsinger K, McCarthy KA, Thakkar N, Gaythorpe KAM, Gamage D, Krause LK, Dansereau E, Crowcroft N, Portnoy A. Population-Level Risk Factors Related to Measles Case Fatality: A Conceptual Framework Based on Expert Consultation and Literature Review. Vaccines (Basel) 2023; 11:1389. [PMID: 37631957 PMCID: PMC10458804 DOI: 10.3390/vaccines11081389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/29/2023] Open
Abstract
A better understanding of population-level factors related to measles case fatality is needed to estimate measles mortality burden and impact of interventions such as vaccination. This study aimed to develop a conceptual framework of mechanisms associated with measles case fatality ratios (CFRs) and assess the scope of evidence available for related indicators. Using expert consultation, we developed a conceptual framework of mechanisms associated with measles CFR and identified population-level indicators potentially associated with each mechanism. We conducted a literature review by searching PubMed on 31 October 2021 to determine the scope of evidence for the expert-identified indicators. Studies were included if they contained evidence of an association between an indicator and CFR and were excluded if they were from non-human studies or reported non-original data. Included studies were assessed for study quality. Expert consultation identified five mechanisms in a conceptual framework of factors related to measles CFR. We identified 3772 studies for review and found 49 studies showing at least one significant association with CFR for 15 indicators (average household size, educational attainment, first- and second-dose coverage of measles-containing vaccine, human immunodeficiency virus prevalence, level of health care available, stunting prevalence, surrounding conflict, travel time to major city or settlement, travel time to nearest health care facility, under-five mortality rate, underweight prevalence, vitamin A deficiency prevalence, vitamin A treatment, and general malnutrition) and only non-significant associations for five indicators (antibiotic use for measles-related pneumonia, malaria prevalence, percent living in urban settings, pneumococcal conjugate vaccination coverage, vitamin A supplementation). Our study used expert consultation and a literature review to provide additional insights and a summary of the available evidence of these underlying mechanisms and indicators that could inform future measles CFR estimations.
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Affiliation(s)
- Alyssa N. Sbarra
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Jonathan F. Mosser
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, WA 98195, USA
| | - Matthew Ferrari
- Department of Biology, Pennsylvania State University, State College, PA 16801, USA
| | - Felicity Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Mark Papania
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Katrina Kretsinger
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Kevin A. McCarthy
- Institute for Disease Modeling, Global Health Division, Bill & Melinda Gates Foundation, Seattle, WA 98109, USA
| | - Niket Thakkar
- Institute for Disease Modeling, Global Health Division, Bill & Melinda Gates Foundation, Seattle, WA 98109, USA
| | - Katy A. M. Gaythorpe
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London SW7 2BX, UK
| | - Deepa Gamage
- Epidemiology Unit, Ministry of Health, Colombo 01000, Sri Lanka
| | - L. Kendall Krause
- Global Development Division, Bill & Melinda Gates Foundation, Seattle, WA 98109, USA
| | - Emily Dansereau
- Global Development Division, Bill & Melinda Gates Foundation, Seattle, WA 98109, USA
| | - Natasha Crowcroft
- Department of Immunization, Vaccines and Biologicals, World Health Organization, 1202 Geneva, Switzerland
| | - Allison Portnoy
- Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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Sodjinou VD, Mengouo MN, Douba A, Tanifum P, Yapi MD, Kuzanwa KR, Otomba JS, Masresha B. Epidemiological characteristics of a protracted and widespread measles outbreak in the Democratic Republic of Congo, 2018 - 2020. Pan Afr Med J 2022; 42:282. [PMID: 36405650 PMCID: PMC9636736 DOI: 10.11604/pamj.2022.42.282.34410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/06/2022] [Indexed: 12/26/2022] Open
Abstract
Introduction measles is a highly contagious viral disease. Since 2011, the Democratic Republic of Congo (DR Congo) has had the first dose measles vaccination coverage of less than 80% according to the World Health Organization - United Nations International Children's Emergency Fund (WHO-UNICEF) coverage estimates, and measles mass vaccination coverage of less than the required coverage level of 95% by survey. Starting in August 2018, the country experienced an increase in measles case reports which continued through to early 2020. Epidemiological aspects of the outbreak are described in this article. Methods we analysed aggregate weekly passive surveillance data from the DR Congo for the years 2018 - 2020 to understand the trends of occurrence of suspected measles cases. We also analysed the measles case-based surveillance database to understand the epidemiological characteristics of confirmed cases of measles and rubella during the same period of time. Results a total of 458,156 suspected measles cases and 8,127 deaths were reported between 1st January 2018 and 31st December 2020, with the majority of cases and deaths reported in 2019. Only 2.9% of these cases were reported through the case-based surveillance system, with 31,639 cases being confirmed as measles by the laboratory, by epidemiological linkage and on clinical compatibility. Children less than 5 years of age were most affected with a cumulative incidence of 960 cases per 1,000,000 inhabitants. Only 41% of the confirmed cases were vaccinated. Maindombe and Tshopo provinces had the highest cumulative incidence levels. There was a distinct geographic progression of the outbreak between provinces during the course of the three years. A total of 1760 lab confirmed rubella cases were confirmed in various provinces among the cases investigated with blood specimens, 93% of whom were less than 15 years of age. Conclusion the recent gaps in vaccination coverage, the age pattern of confirmed cases and the lack of vaccination history in the majority of cases is suggestive of failure to vaccinate as the likely cause of this large and protracted outbreak. Efforts to improve vaccination coverage and the measles surveillance system are needed in order to prevent the occurrence of future outbreaks and to avert measles-related deaths.
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Affiliation(s)
| | - Marcellin Nimpa Mengouo
- World Health Organization Country Office for Democratic Republic of Congo, Kinshasa, the Democratic Republic of the Congo
| | - Alfred Douba
- Public Health Department, Felix Houphouet Boigny University, Abidjan-Cocody, Cote d'Ivoire
| | - Patricia Tanifum
- World Health Organization Intercountry Team for Central Africa, Libreville, Gabon
| | - Moise Desire Yapi
- World Health Organization Country Office for Democratic Republic of Congo, Kinshasa, the Democratic Republic of the Congo
| | - Kanyiga Robert Kuzanwa
- World Health Organization Country Office for Democratic Republic of Congo, Kinshasa, the Democratic Republic of the Congo
| | - John Samuel Otomba
- World Health Organization Country Office for Democratic Republic of Congo, Kinshasa, the Democratic Republic of the Congo
| | - Balcha Masresha
- World Health Organization Regional Office for Africa, Brazzaville, Congo,,Corresponding author: Balcha Masresha, World Health Organization Regional Office for Africa, Brazzaville, Congo.
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Tsegaye G, Gezahegn Y, Tesfaye A, Mulatu G, Bulcha GG, Berhanu N. Measles Outbreak Investigation in Guradamole District of Bale Zone, South Eastern Ethiopia, 2021. Infect Drug Resist 2022; 15:669-683. [PMID: 35250282 PMCID: PMC8893148 DOI: 10.2147/idr.s343270] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Method Results Conclusion
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Affiliation(s)
- Geremew Tsegaye
- Ethiopian Field Epidemiology and Laboratory Training Program, Faculty of Public Health, Jimma University, Jimma, Ethiopia
- Correspondence: Geremew Tsegaye, Ethiopian Field Epidemiology and Laboratory Training Program, Faculty of Public Health, Jimma University, Jimma, Ethiopia, Email
| | - Yenealem Gezahegn
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Assegid Tesfaye
- Ethiopian Field Epidemiology and Laboratory Training Program, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Gadissa Mulatu
- Disease Control and Prevention Department, Bale Zone Health Office, Robe, Ethiopia
| | - Gemechu Gudina Bulcha
- Public Health Emergency Management Department, Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Naod Berhanu
- Field Epidemiology, Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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Louart S, Bonnet E, Ridde V. Is patient navigation a solution to the problem of "leaving no one behind"? A scoping review of evidence from low-income countries. Health Policy Plan 2021; 36:101-116. [PMID: 33212491 PMCID: PMC7938515 DOI: 10.1093/heapol/czaa093] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2020] [Indexed: 12/25/2022] Open
Abstract
Patient navigation interventions, which are designed to enable patients excluded from health systems to overcome the barriers they face in accessing care, have multiplied in high-income countries since the 1990s. However, in low-income countries (LICs), indigents are generally excluded from health policies despite the international paradigm of universal health coverage (UHC). Fee exemption interventions have demonstrated their limits and it is now necessary to act on other dimensions of access to healthcare. However, there is a lack of knowledge about the interventions implemented in LICs to support the indigents throughout their care pathway. The aim of this paper is to synthesize what is known about patient navigation interventions to facilitate access to modern health systems for vulnerable populations in LICs. We therefore conducted a scoping review to identify all patient navigation interventions in LICs. We found 60 articles employing a total of 48 interventions. Most of these interventions targeted traditional beneficiaries such as people living with HIV, pregnant women and children. We utilized the framework developed by Levesque et al. (Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 2013;12:18) to analyse the interventions. All acted on the ability to perceive, 34 interventions on the ability to reach, 30 on the ability to engage, 8 on the ability to pay and 6 on the ability to seek. Evaluations of these interventions were encouraging, as they often appeared to lead to improved health indicators and service utilization rates and reduced attrition in care. However, no intervention specifically targeted indigents and very few evaluations differentiated the impact of the intervention on the poorest populations. It is therefore necessary to test navigation interventions to enable those who are worst off to overcome the barriers they face. It is a major ethical issue that health policies leave no one behind and that UHC does not benefit everyone except the poorest.
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Affiliation(s)
- Sarah Louart
- Univ. Lille, CNRS, UMR 8019 - CLERSE - Centre Lillois d’Études et de Recherches sociologiques et Économiques, F-59000 Lille, France
| | - Emmanuel Bonnet
- Institute for Research on Sustainable Development, UMI Résiliences 236, Bondy, France
| | - Valéry Ridde
- Institute for Research on Sustainable Development, CEPED (IRD-Université de Paris), Université de Paris, ERL INSERM SAGESUD, 45 Rue des Saints-Pères, Paris 75006, France
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Polonsky JA, Baidjoe A, Kamvar ZN, Cori A, Durski K, Edmunds WJ, Eggo RM, Funk S, Kaiser L, Keating P, de Waroux OLP, Marks M, Moraga P, Morgan O, Nouvellet P, Ratnayake R, Roberts CH, Whitworth J, Jombart T. Outbreak analytics: a developing data science for informing the response to emerging pathogens. Philos Trans R Soc Lond B Biol Sci 2019; 374:20180276. [PMID: 31104603 PMCID: PMC6558557 DOI: 10.1098/rstb.2018.0276] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2018] [Indexed: 12/16/2022] Open
Abstract
Despite continued efforts to improve health systems worldwide, emerging pathogen epidemics remain a major public health concern. Effective response to such outbreaks relies on timely intervention, ideally informed by all available sources of data. The collection, visualization and analysis of outbreak data are becoming increasingly complex, owing to the diversity in types of data, questions and available methods to address them. Recent advances have led to the rise of outbreak analytics, an emerging data science focused on the technological and methodological aspects of the outbreak data pipeline, from collection to analysis, modelling and reporting to inform outbreak response. In this article, we assess the current state of the field. After laying out the context of outbreak response, we critically review the most common analytics components, their inter-dependencies, data requirements and the type of information they can provide to inform operations in real time. We discuss some challenges and opportunities and conclude on the potential role of outbreak analytics for improving our understanding of, and response to outbreaks of emerging pathogens. This article is part of the theme issue 'Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control'. This theme issue is linked with the earlier issue 'Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes'.
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Affiliation(s)
- Jonathan A. Polonsky
- Department of Health Emergency Information and Risk Assessment, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
- Faculty of Medicine, University of Geneva, 1 rue Michel-Servet, 1211 Geneva, Switzerland
| | - Amrish Baidjoe
- Department of Infectious Disease Epidemiology, School of Public Health, MRC Centre for Global Infectious Disease Analysis, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place London W2 1PG, UK
| | - Zhian N. Kamvar
- Department of Infectious Disease Epidemiology, School of Public Health, MRC Centre for Global Infectious Disease Analysis, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place London W2 1PG, UK
| | - Anne Cori
- Department of Infectious Disease Epidemiology, School of Public Health, MRC Centre for Global Infectious Disease Analysis, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place London W2 1PG, UK
| | - Kara Durski
- Department of Infectious Hazard Management, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - W. John Edmunds
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Rosalind M. Eggo
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Sebastian Funk
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Laurent Kaiser
- Faculty of Medicine, University of Geneva, 1 rue Michel-Servet, 1211 Geneva, Switzerland
| | - Patrick Keating
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
- UK Public Health Rapid Support Team, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Olivier le Polain de Waroux
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
- UK Public Health Rapid Support Team, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
- Public Health England, Wellington House, 133–155 Waterloo Road, London SE1 8UG, UK
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Paula Moraga
- Centre for Health Informatics, Computing and Statistics (CHICAS), Lancaster Medical School, Lancaster University, Lancaster LA1 4YW, UK
| | - Oliver Morgan
- Department of Health Emergency Information and Risk Assessment, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Pierre Nouvellet
- Department of Infectious Disease Epidemiology, School of Public Health, MRC Centre for Global Infectious Disease Analysis, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place London W2 1PG, UK
- School of Life Sciences, University of Sussex, Sussex House, Brighton BN1 9RH, UK
| | - Ruwan Ratnayake
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Chrissy H. Roberts
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Jimmy Whitworth
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
- UK Public Health Rapid Support Team, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Thibaut Jombart
- Department of Infectious Disease Epidemiology, School of Public Health, MRC Centre for Global Infectious Disease Analysis, Imperial College London, Medical School Building, St Mary's Campus, Norfolk Place London W2 1PG, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
- UK Public Health Rapid Support Team, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
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