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Parker AM, Jackson N, Awasthi S, Kim H, Alwan T, Wyllie AL, Kogut K, Holland N, Mora AM, Eskenazi B, Riley LW, Lewnard JA. Upper respiratory Streptococcus pneumoniae colonization among working-age adults with prevalent exposure to overcrowding. Microbiol Spectr 2024:e0087924. [PMID: 39012111 DOI: 10.1128/spectrum.00879-24] [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: 04/18/2024] [Accepted: 06/07/2024] [Indexed: 07/17/2024] Open
Abstract
Most pneumococcal disease occurs among infants and older adults and is thought to be driven by the transmission of Streptococcus pneumoniae from young children to these vulnerable age groups. However, pneumococcal disease outbreaks also affect non-elderly adults living or working in congregate, close-contact settings. Little is known about pneumococcal carriage in such populations. From July to November 2020, we collected saliva from low-income adult farmworkers in Monterey County, California, and tested for pneumococcal carriage following culture enrichment via quantitative PCR assays targeting the pneumococcal lytA and piaB genes. Participants were considered to carry pneumococci if lytA and piaB cycle threshold values were both below 40. Among 1,283 participants enrolled in our study, 117 (9.1%) carried pneumococci. Carriers tended more often than non-carriers to be exposed to children aged <5 years [odds ratio (OR) = 1.45 (0.95-2.20)] and overcrowding [OR = 1.48 (0.96-2.30) and 2.84 (1.20-6.73), respectively, for participants in households with >2-4 and >4 persons per bedroom vs ≤2 persons per bedroom]. Household overcrowding remained associated with increased risk of carriage among participants not exposed to children aged <5 years [OR = 2.05 (1.18-3.59) for participants living in households with >2 vs ≤2 persons per bedroom]. Exposure to children aged <5 years and overcrowding were each associated with increased pneumococcal density among carriers [piaB cT difference of 2.04 (0.36-3.73) and 2.44 (0.80-4.11), respectively]. While exposure to young children was a predictor of pneumococcal carriage, associations of overcrowding with increased prevalence and density of carriage in households without young children suggest that transmission also occurs among adults in close-contact settings.IMPORTANCEAlthough infants and older adults are the groups most commonly affected by pneumococcal disease, outbreaks are known to occur among healthy, working-age populations exposed to overcrowding, including miners, shipyard workers, military recruits, and prisoners. Carriage of Streptococcus pneumoniae is the precursor to pneumococcal disease, and its relation to overcrowding in adult populations is poorly understood. We used molecular methods to characterize pneumococcal carriage in culture-enriched saliva samples from low-income adult farmworkers in Monterey County, CA. While exposure to children in the household was an important risk factor for pneumococcal carriage, living in an overcrowded household without young children was an independent predictor of carriage as well. Moreover, participants exposed to children or overcrowding carried pneumococci at higher density than those without such exposures, suggesting recent transmission. Our findings suggest that, in addition to transmission from young children, pneumococcal transmission may occur independently among adults in overcrowded settings.
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Affiliation(s)
- Anna M Parker
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California, USA
| | - Nicole Jackson
- Division of Infectious Diseases & Vaccinology, School of Public Health, University of California, Berkeley, California, USA
| | - Shevya Awasthi
- Division of Infectious Diseases & Vaccinology, School of Public Health, University of California, Berkeley, California, USA
| | - Hanna Kim
- Division of Infectious Diseases & Vaccinology, School of Public Health, University of California, Berkeley, California, USA
| | - Tess Alwan
- Division of Infectious Diseases & Vaccinology, School of Public Health, University of California, Berkeley, California, USA
| | - Anne L Wyllie
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Katherine Kogut
- Center for Environmental Research & Community Health, School of Public Health, University of California, Berkeley, California, USA
| | - Nina Holland
- Center for Environmental Research & Community Health, School of Public Health, University of California, Berkeley, California, USA
| | - Ana M Mora
- Center for Environmental Research & Community Health, School of Public Health, University of California, Berkeley, California, USA
| | - Brenda Eskenazi
- Center for Environmental Research & Community Health, School of Public Health, University of California, Berkeley, California, USA
| | - Lee W Riley
- Division of Infectious Diseases & Vaccinology, School of Public Health, University of California, Berkeley, California, USA
| | - Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California, USA
- Division of Infectious Diseases & Vaccinology, School of Public Health, University of California, Berkeley, California, USA
- Center for Computational Biology, College of Engineering, University of California, Berkeley, California, USA
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Shiferie F, Gebremedhin S, Andargie G, Tsegaye DA, Alemayehu WA, Fenta TG. Decomposition Analysis of Socioeconomic Inequalities in Vaccination Dropout in Remote and Underserved Settings in Ethiopia. Am J Trop Med Hyg 2024; 111:196-204. [PMID: 38834055 PMCID: PMC11229642 DOI: 10.4269/ajtmh.23-0816] [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: 11/18/2023] [Accepted: 03/07/2024] [Indexed: 06/06/2024] Open
Abstract
Despite increments in immunization coverage over the past decades, substantial inequality due to wealth status has persisted in Ethiopia. This study aimed to decompose the concentration index into the contributions of individual factors to socioeconomic inequalities of childhood vaccination dropout in remote and underserved settings in Ethiopia by using a decomposition approach. A wealth index was developed by reducing 41 variables related to women's household living standards into nine factors by using principal component analysis. The components were further totaled into a composite score and divided into five quintiles (poorest, poorer, middle, richer, and richest). Vaccination dropout was calculated as the proportion of children who did not get the pentavalent-3 vaccine among those who received the pentavalent-1 vaccine. The concentration index was used to estimate socioeconomic inequalities in childhood vaccination dropout, which was then decomposed to examine the factors contributing to socioeconomic inequalities in vaccination dropout. The overall concentration index was -0.179 (P <0.01), confirming the concentration of vaccination dropout among the lowest wealth strata. The decomposition analyses showed that wealth index significantly contributed to inequalities in vaccination dropout (49.7%). Place of residence also explained -16.2% of the inequality. Skilled birth attendance and availability of a health facility in the kebele (the lowest administrative government structure) also significantly contributed (33.6% and 12.6%, respectively) to inequalities in vaccination dropout. Wealth index, place of residence, skilled birth attendance, and availability of a health facility in the kebele largely contributed to the concentration of vaccination dropout among the lowest wealth strata. Policymakers should address vaccination inequality by designing more effective strategies.
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Affiliation(s)
- Fisseha Shiferie
- Project HOPE Ethiopia Country Office, Addis Ababa, Ethiopia
- School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
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Rocha-Ortega M, Nava-Bolaños A, Córdoba-Aguilar A. Merging socioecological variables to predict risk of Chagas disease. Acta Trop 2024; 251:107098. [PMID: 38215899 DOI: 10.1016/j.actatropica.2023.107098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 01/14/2024]
Abstract
How far are we from predicting the occurrence of zoonotic diseases? In this paper we have made use of both socioecological and ecological variables to predict Chagas disease occurrence. Chagas disease involves, Trypanosoma cruzi, a complex life-cycle parasite which requires two hosts: blood-feeding triatomine insects and vertebrate hosts including humans. We have used a common risk assessment method combined with datasets that imply critical environmental and socioeconomic drivers of Chagas dynamics to predict the occurrence of this disease. We also carried out a network analysis to assess the interactions among triatomines and mammal host species given their human contact via whether hunted, domesticated or associated with anthropogenic landscapes in Mexico. We found that social backwardness variation, lack of health services and altitude had the largest relative influence Chagas events. Triatoma pallidipennis made use of the largest host diversity. Host species shared by the highest number of different triatomines were a woodrat, the highly appreciated bushmeat, and racoon. These results indicate both the predominance of socio-economic factors over ecological ones, and how close we are from predicting zoonotic diseases.
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Affiliation(s)
- Maya Rocha-Ortega
- Departamento de Ecología Evolutiva, Instituto de Ecología, Universidad Nacional Autónoma de México, Apdo. P. 70-275, Circuito Exterior, Ciudad Universitaria, 04510, Coyoacán, Distrito Federal, Mexico
| | - Angela Nava-Bolaños
- Unidad Multidisciplinaria de Docencia e Investigación, Facultad de Ciencias Campus Juriquilla, Universidad Nacional Autónoma de México, 76230, Juriquilla, Mexico
| | - Alex Córdoba-Aguilar
- Departamento de Ecología Evolutiva, Instituto de Ecología, Universidad Nacional Autónoma de México, Apdo. P. 70-275, Circuito Exterior, Ciudad Universitaria, 04510, Coyoacán, Distrito Federal, Mexico.
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