1
|
Lata H, Saad Duque NJ, Togami E, Miglietta A, Perkins D, Corpuz A, Kato M, Babu A, Dorji T, Matsui T, Almiron M, Cheng KY, MacDonald LE, Pukkila JT, Williams GS, Andraghetti R, Dolea C, Mahamud A, Morgan O, Olowokure B, Fall IS, Awofisayo-Okuyelu A, Hamblion E. Disseminating information on acute public health events globally: experiences from the WHO's Disease Outbreak News. BMJ Glob Health 2024; 9:e012876. [PMID: 38413101 PMCID: PMC10900317 DOI: 10.1136/bmjgh-2023-012876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 12/20/2023] [Indexed: 02/29/2024] Open
Abstract
WHO works, on a daily basis, with countries globally to detect, prepare for and respond to acute public health events. A vital component of a health response is the dissemination of accurate, reliable and authoritative information. The Disease Outbreak News (DON) reports are a key mechanism through which WHO communicates on acute public health events to the public. The decision to produce a DON report is taken on a case-by-case basis after evaluating key criteria, and the subsequent process of producing a DON report is highly standardised to ensure the robustness of information. DON reports have been published since 1996, and up to 2022 over 3000 reports have been published. Between 2018 and 2022, the most frequently published DON reports relate to Ebola virus disease, Middle East respiratory syndrome, yellow fever, polio and cholera. The DON web page is highly visited with a readership of over 2.6 million visits per year, on average. The DON report structure has evolved over time, from a single paragraph in 1996 to a detailed report with seven sections currently. WHO regularly reviews the DON report process and structure for improvements. In the last 25 years, DON reports have played a unique role in rapidly disseminating information on acute public health events to health actors and the public globally. They have become a key information source for the global public health response to the benefit of individuals and communities.
Collapse
Affiliation(s)
- Harsh Lata
- Health Emergencies, World Health Organization, Geneva, Switzerland
| | | | - Eri Togami
- Health Emergencies, World Health Organization, Geneva, Switzerland
| | | | - Devin Perkins
- Health Emergencies, World Health Organization, Geneva, Switzerland
| | - Aura Corpuz
- Health Emergencies, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Masaya Kato
- World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Amarnath Babu
- World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Tshewang Dorji
- Health Emergencies, World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Tamano Matsui
- World Health Organization Regional Office for the Western Pacific, Manila, The Philippines
| | - Maria Almiron
- Health Emergencies, Pan American Health Organization, Washington, District of Columbia, USA
| | - Ka Yeung Cheng
- Health Emergencies, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Lauren E MacDonald
- Health Emergencies, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Jukka Tapani Pukkila
- Health Emergencies, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - George Sie Williams
- Health Emergencies, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | - Carmen Dolea
- Health Emergencies, World Health Organization, Geneva, Switzerland
| | | | - Oliver Morgan
- Health Emergencies, World Health Organization, Geneva, Switzerland
| | - Babatunde Olowokure
- Health Emergencies, World Health Organization Regional Office for the Western Pacific, Manila, The Philippines
| | | | | | - Esther Hamblion
- Health Emergencies, World Health Organization, Geneva, Switzerland
| |
Collapse
|
2
|
Attar Cohen H, Mesfin S, Ikejezie J, Kassamali Z, Campbell F, Adele S, Guinko N, Idoko F, Mirembe BB, Mitri ME, Nezu I, Shimizu K, Ngongheh AB, Sklenovska N, Gumede N, Mosha FS, Mohamed B, Corpuz A, Pebody R, Marklewitz M, Gresh L, Mendez Rico JA, Hundal K, Kato M, Babu A, Archer BN, le Polain de Waroux O, Van Kerkhove MD, Mahamud A, Subissi L, Pavlin BI. Surveillance for variants of SARS-CoV-2 to inform risk assessments. Bull World Health Organ 2023; 101:707-716. [PMID: 37961054 PMCID: PMC10630725 DOI: 10.2471/blt.23.290093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 11/15/2023] Open
Abstract
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, numerous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants have emerged, some leading to large increases in infections, hospitalizations and deaths globally. The virus's impact on public health depends on many factors, including the emergence of new viral variants and their global spread. Consequently, the early detection and surveillance of variants and characterization of their clinical effects are vital for assessing their health risk. The unprecedented capacity for viral genomic sequencing and data sharing built globally during the pandemic has enabled new variants to be rapidly detected and assessed. This article describes the main variants circulating globally between January 2020 and June 2023, the genetic features driving variant evolution, and the epidemiological impact of these variants across countries and regions. Second, we report how integrating genetic variant surveillance with epidemiological data and event-based surveillance, through a network of World Health Organization partners, supported risk assessment and helped provide guidance on pandemic responses. In addition, given the evolutionary characteristics of circulating variants and the immune status of populations, we propose future directions for the sustainable genomic surveillance of SARS-CoV-2 variants, both nationally and internationally: (i) optimizing variant surveillance by including environmental monitoring; (ii) coordinating laboratory assessment of variant evolution and phenotype; (iii) linking data on circulating variants with clinical data; and (iv) expanding genomic surveillance to additional pathogens. Experience during the COVID-19 pandemic has shown that genomic surveillance of pathogens can provide essential, timely and evidence-based information for public health decision-making.
Collapse
Affiliation(s)
- Homa Attar Cohen
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Samuel Mesfin
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Juniorcaius Ikejezie
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Zyleen Kassamali
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Finlay Campbell
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Sandra Adele
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Noe Guinko
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Friday Idoko
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Bernadette Basuta Mirembe
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Maria Elizabeth Mitri
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Ingrid Nezu
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Kazuki Shimizu
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Ajong Brian Ngongheh
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Nikola Sklenovska
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | | | | | - Basant Mohamed
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Aura Corpuz
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | | | | | - Lionel Gresh
- Pan American Health Organization, WashingtonD.C., United States of America
| | | | - Kareena Hundal
- WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Masaya Kato
- WHO Regional Office for South-East Asia, New Delhi, India
| | - Amarnath Babu
- WHO Regional Office for South-East Asia, New Delhi, India
| | - Brett N Archer
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | | | - Maria D Van Kerkhove
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Abdirahman Mahamud
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Lorenzo Subissi
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Boris I Pavlin
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| |
Collapse
|
3
|
Molodecky NA, Jafari H, Safdar RM, Ahmed JA, Mahamud A, Bandyopadhyay AS, Shukla H, Quddus A, Zaffran M, Sutter RW, Grassly NC, Blake IM. Modelling the spread of serotype-2 vaccine derived-poliovirus outbreak in Pakistan and Afghanistan to inform outbreak control strategies in the context of the COVID-19 pandemic. Vaccine 2021; 41 Suppl 1:A93-A104. [PMID: 34629206 PMCID: PMC8463303 DOI: 10.1016/j.vaccine.2021.09.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 08/31/2021] [Accepted: 09/13/2021] [Indexed: 11/27/2022]
Abstract
Background Since July 2019, Pakistan and Afghanistan have been facing an outbreak of serotype-2 circulating vaccine derived poliovirus (cVDPV2) in addition to continued transmission of serotype-1 wild poliovirus (WPV1) and SARS-CoV-2 in 2020. Understanding the risks of cVDPV2 transmission due to pause of global vaccination efforts and the impact of potential vaccination response strategies in the current context of COVID-19 mitigation measures is critical. Methods We developed a stochastic, geographically structured mathematical model of cVDPV2 transmission which captures both mucosal and humoral immunity separately and allows for reversion of serotype-2 oral polio vaccine (OPV2) virus to cVDPV2 following vaccine administration. The model includes geographic heterogeneities in vaccination coverage, population immunity and population movement. The model was fitted to historic cVDPV2 cases in Pakistan and Afghanistan between January 2010-April 2016 and July 2019-March 2020 using iterated particle filtering. The model was used to simulate spread of cVDPV2 infection from July 2019 to explore impact of various proposed vaccination responses on stopping transmission and risk of spread of reverted Sabin-2 under varying assumptions of impacts from COVID-19 lockdown measures on movement patterns as well as declines in vaccination coverage. Results Simulated monthly incidence of cVDPV2 from the best-fit model demonstrated general spatio-temporal alignment with observed cVDPV2 cases. The model predicted substantial spread of cVDPV2 infection, with widespread transmission through 2020 in the absence of any vaccination activities. Vaccination responses were predicted to substantially reduce transmission and case burden, with a greater impact from earlier responses and those with larger geographic scope. While the greatest risk of seeding reverted Sabin-2 was predicted in areas targeted with OPV2, subsequent spread was greatest in areas with no or delayed response. The proposed vaccination strategy demonstrated ability to stop the cVDPV2 outbreak (with low risk of reverted Sabin-2 spread) by February 2021. Conclusion Outbreak response vaccination campaigns against cVDPV2 will be challenging throughout the COVID-19 pandemic but must be implemented urgently when feasible to stop transmission of cVDPV2.
Collapse
Affiliation(s)
- Natalia A Molodecky
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, UK; World Health Organization (WHO), Islamabad, Pakistan; National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan; World Health Organization (WHO), Geneva, Switzerland.
| | - Hamid Jafari
- World Health Organization (WHO), EMRO, Amman, Jordan
| | - Rana M Safdar
- National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan; Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
| | - Jamal A Ahmed
- World Health Organization (WHO), Islamabad, Pakistan; National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan; World Health Organization (WHO), Geneva, Switzerland
| | - Abdirahman Mahamud
- World Health Organization (WHO), Islamabad, Pakistan; National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan; World Health Organization (WHO), Geneva, Switzerland
| | | | - Hemant Shukla
- World Health Organization (WHO), EMRO, Amman, Jordan
| | - Arshad Quddus
- World Health Organization (WHO), Geneva, Switzerland
| | | | | | - Nicholas C Grassly
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, UK
| | - Isobel M Blake
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, UK
| |
Collapse
|
4
|
Pratt R, Ojo-Fati O, DuBois D, Okuyemi K, Graham AL, Mohamed S, Janowiec M, Kahin A, Mahamud A, Tessier KM, Busch AM, Joseph AM. Testing the Feasibility and Acceptability of a Religiously-Tailored Text Messaging Intervention to Reduce Smoking Among Somali Muslim Men During Ramadan. Nicotine Tob Res 2021; 23:1283-1290. [PMID: 33277991 PMCID: PMC8496498 DOI: 10.1093/ntr/ntaa260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 12/02/2020] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The prevalence of smoking among Somali Muslim male immigrants residing in Minnesota is estimated at 44%, however smoking reduction is common during the month of Ramadan. This study evaluated the feasibility and impact of a religiously tailored text message intervention delivered during Ramadan to encourage smoking reduction among Somali Muslim men who smoke. METHODS Fifty Somali men were recruited. Participants received two text messages per day starting 1 week prior to and throughout the month of Ramadan. Approximately half were religiously tailored and half were about the risks of smoking and benefits of quitting. Smoking behavior was assessed at baseline, and at weeks 4 (end of Ramadan), 8, and 16. Outcomes included feasibility, acceptability, and preliminary impact of the text message intervention on smoking reduction and bioverified abstinence. RESULTS The average age was 41 years. Average time to first cigarette was 1.8 hours at baseline, and 46% of participants smoked menthol cigarettes. Eighteen of 50 participants selected English and 32 selected Somali text messages. Subjects significantly reduced self-reported cigarettes per day (CPD) from 12.4 CPD at baseline to 5.8 CPD at week 16 (p < 0.001). Seven subjects reported quitting at week 16, five completed CO testing, confirming self-reported abstinence. The majority of participants found the cultural and religious references encouraging at the end of the week 16 survey. CONCLUSIONS Religiously tailored text messages to decrease smoking are feasible and acceptable to Somali Muslim men who smoke during Ramadan. This intervention for addressing smoking disparities is worthy of further study. IMPLICATIONS Recruitment of Somali Muslim men who smoke is feasible and supports the idea that further studies targeting smoking during Ramadan are practical. Ramadan presents a window of opportunity upon which to build smoking cessation interventions for smokers who identify as Muslim. These preliminary findings suggest that text messaging is a feasible and acceptable intervention strategy, and that religious tailoring was well received. Such an approach may offer potential for addressing smoking disparities among Somali Muslim male smokers. TRIAL REGISTRATION ClinicalTrial.gov: NCT03379142.
Collapse
Affiliation(s)
- Rebekah Pratt
- Department of Family Medicine and Community Health, University of
Minnesota, Minneapolis, MN
| | | | | | - Kolawole Okuyemi
- Department of Family and Preventive Medicine, University of Utah
School of Medicine, Salt Lake City, UT
| | - Amanda L Graham
- Innovations Center, Truth Initiative, Washington,
DC
- Department of Medicine, Mayo Clinic College of Medicine and
Science, Rochester, MN
| | - Sharif Mohamed
- Islamic Civic Society of America (ICSA), Minneapolis,
MN
| | | | - Abdillahi Kahin
- Department of Medicine, Hennepin Healthcare,
Minneapolis, MN
| | | | - Katelyn M Tessier
- Masonic Cancer Center, Biostatistics Core, University of
Minnesota, Minneapolis, MN
| | - Andrew M Busch
- Department of Medicine, Hennepin Healthcare,
Minneapolis, MN
- Department of Medicine, University of Minnesota,
Minneapolis, MN
| | - Anne M Joseph
- Department of Medicine, University of Minnesota,
Minneapolis, MN
| |
Collapse
|
5
|
Molodecky NA, Usman A, Javaid A, Wahdan A, Parker EPK, Ahmed JA, Shah N, Agbor J, Mahamud A, Safdar RM. Quantifying movement patterns and vaccination status of high risk mobile populations in Pakistan and Afghanistan to inform poliovirus risk and vaccination strategy. Vaccine 2021; 39:2124-2132. [PMID: 33736917 DOI: 10.1016/j.vaccine.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Stopping serotype 1 wild poliovirus transmission in Pakistan and Afghanistan requires ensuring all children <5 years of age are repeatedly vaccinated, including the large proportion living in mobile groups. Vaccinating children living in high-risk mobile populations (HRMPs) remains a priority for the polio programme. METHODS In 2017-2018, group-level censuses were conducted in 43 districts of Pakistan, gathering information for all HRMP children <5 years of age residing in settlements. Demographic and mobility information was collected, including HRMP type, ethnicity, language, mode of transportation and movement patterns. Vaccination status was recorded for the most recent polio campaign. Proportion of HRMP children by demographic factors and mode of transportation was determined and the magnitude of movement was quantified based on the origin, previous and next locations. Magnitude of cross-border movement with Afghanistan was evaluated, as was primary crossing point. Vaccination status was evaluated for each district by demographic and mode of transportation information. RESULTS In total, 188,130 HRMP children <5 years of age were assessed. The predominant HRMP type, ethnic group, language and mode of transport was Afghan refugees (27%), Pashtun (69%), Pashto (69%) and bus (52%). Overall, 84% of children originated outside of their current district, including 29% from Afghanistan. Previous and next locations, were reported outside of current location by 34% and 77% of children. Afghanistan was previous and next location for 5% and 11% of children, with 5.5% and 3% of children crossing the Afghanistan border in the past 6-months and next 3-months. Primary crossing route was Torkham (79%). Overall vaccination coverage was 98% (IQR: 96%-99%) and consistently >90% across HRMP type, ethnic group, language and mobility means. CONCLUSION Large numbers of HRMPs were found across Pakistan, with substantial links throughout the country and with Afghanistan. While vaccination coverage of HRMPs was high, ensuring these populations are consistently vaccinated remains a priority.
Collapse
Affiliation(s)
- Natalia A Molodecky
- World Health Organization (WHO), Islamabad, Pakistan; National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan; Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
| | - Asma Usman
- World Health Organization (WHO), Islamabad, Pakistan; National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan
| | - Asif Javaid
- World Health Organization (WHO), Islamabad, Pakistan; National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan
| | - Ashraf Wahdan
- World Health Organization (WHO), Islamabad, Pakistan; National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan; World Health Organization (WHO), EMRO, Amman, Jordan
| | - Edward P K Parker
- The Vaccine Centre, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Jamal A Ahmed
- World Health Organization (WHO), Islamabad, Pakistan; National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan; World Health Organization (WHO), Geneva, Switzerland
| | - Nadeem Shah
- National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan
| | - John Agbor
- National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan; UNICEF, Islamabad, Pakistan
| | - Abdirahman Mahamud
- World Health Organization (WHO), Islamabad, Pakistan; National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan; World Health Organization (WHO), Geneva, Switzerland
| | - Rana M Safdar
- National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan; Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
| |
Collapse
|
6
|
Wong J, Abdul Aziz ABZ, Chaw L, Mahamud A, Griffith MM, Lo YR, Naing L. High proportion of asymptomatic and presymptomatic COVID-19 infections in air passengers to Brunei. J Travel Med 2020; 27:5828924. [PMID: 32365178 PMCID: PMC7239182 DOI: 10.1093/jtm/taaa066] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 01/12/2023]
Abstract
We report early findings from COVID-19 cases in Brunei suggesting a remarkably high proportion of asymptomatic (12%) and presymptomatic (30%) cases. This proportion was even higher in imported cases. These have implications for measures to prevent onward local transmission and should prompt reconsideration of current testing protocols and safe de-escalation of social distancing measures.
Collapse
Affiliation(s)
- Justin Wong
- Disease Control Division, Ministry of Health, Bandar Seri Begawan, Brunei
| | | | - Liling Chaw
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Abdirahman Mahamud
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Matthew M Griffith
- Western Pacific Regional Office, World Health Organization Philippines, Manila, Philippines
| | - Ying-Ru Lo
- Representative Office to Malaysia, Brunei Darussalam and Singapore, World Health Organization, Kuala Lumpur, Malaysia
| | - Lin Naing
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| |
Collapse
|
7
|
Daly C, Molodecky NA, Sreevatsava M, Belayneh AD, Chandio SA, Partridge J, Shaikh A, Laghari M, Agbor J, Safdar RM, Bullo UF, Malik SM, Mahamud A. Needle-free injectors for mass administration of fractional dose inactivated poliovirus vaccine in Karachi, Pakistan: A survey of caregiver and vaccinator acceptability. Vaccine 2020; 38:1893-1898. [PMID: 31983581 DOI: 10.1016/j.vaccine.2019.12.059] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/22/2019] [Accepted: 12/25/2019] [Indexed: 11/19/2022]
Abstract
The first large-scale vaccination campaign using needle-free jet injectors to administer fractional doses of inactivated poliovirus vaccine (fIPV) was conducted in Karachi, Pakistan, in February 2019. Data on acceptability of jet injectors were collected from 610 vaccinators and 4898 caregivers during the first four days of the campaign. Of those with prior needle and syringe experience, both vaccinators and caregivers expressed a strong preference for jet injectors (578/592 [97.6%] and 4792/4813 [99.6%], respectively), citing ease of use, appearance, and child's response to vaccination. Among caregivers, 4638 (94.7%) stated they would be more likely to bring their child for vaccination in a future campaign that used jet injectors. Mean vaccine coverage among towns administering fIPV was 98.7% - an increase by 18.4% over the preceding campaign involving full-dose IPV. Our findings demonstrate the strong acceptability of fIPV jet injectors and highlight the potential value of this method in future mass campaigns.
Collapse
Affiliation(s)
| | - Natalia A Molodecky
- World Health Organization (WHO), Islamabad, Pakistan; National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan
| | | | | | | | | | - Ahmed Shaikh
- Bill & Melinda Gates Foundation, Sindh, Pakistan
| | - Mumtaz Laghari
- National Stop Transmission of Polio (N-STOP) Program, Pakistan
| | - John Agbor
- United Nations Children's Fund (UNICEF), Islamabad, Pakistan
| | - Rana M Safdar
- Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
| | - Umar Farooq Bullo
- Ministry of National Health Services, Regulations and Coordination, Sindh, Pakistan
| | - Safi M Malik
- Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
| | - Abdirahman Mahamud
- World Health Organization (WHO), Islamabad, Pakistan; National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan
| |
Collapse
|
8
|
Hsu CH, Kader M, Mahamud A, Bullard K, Jorba J, Agbor J, Safi MM, Jafari HS, Ehrhardt D. Progress Toward Poliomyelitis Eradication - Pakistan, January 2018-September 2019. MMWR Morb Mortal Wkly Rep 2019; 68:1029-1033. [PMID: 31725710 PMCID: PMC6855509 DOI: 10.15585/mmwr.mm6845a5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
9
|
Pratt R, Ojo-Fati O, Adam A, Sharif H, Kahin A, Mahamud A, Dubois D, Mohamed S, Okuyemi K, Graham AL, Joseph A. Text Message Support for Smoking Cessation During Ramadan: A Focus Group Study With Somali Immigrant Muslim Men. Nicotine Tob Res 2019; 22:1636-1639. [DOI: 10.1093/ntr/ntz187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/25/2019] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Somali Muslim male immigrants in Minnesota have a high prevalence of smoking, estimated at 44%, compared with the average smoking rate for adults in the United States (14%). However, the literature has reported spontaneous reductions of smoking during Ramadan. This study sought to gather the views of Somali Muslim men on how faith impacts their smoking, and determine what messaging to incorporate into a tailored text messages intervention that draws on the Muslim faith beliefs and practices during Ramadan to promote smoking cessation.
Methods
Thirty-seven Somali adult male smokers were recruited from community settings to participate in one of five focus groups in Minneapolis and Saint Paul, Minnesota. The research study team developed a semi-structured focus group guide that explored: (1) the experience of Muslim immigrants quitting smoking during Ramadan, (2) views on text messaging interventions to reduce smoking focusing on health and faith, and (3) views on the relationship between faith and smoking. A thematic analysis was conducted.
Results
Participants reported reductions in smoking during Ramadan, which was mostly achieved without formal treatment (ie, willpower). There was interest in text messaging interventions that incorporated faith and health-related messages, and that would be delivered around the time of Ramadan. Participants described concerns about the adverse health effects of smoking, including the risk of chronic health issues, cancer, and death.
Conclusion
Combining faith and health-related text-based messaging, and tailoring interventions around and beyond Ramadan, maybe a valuable approach to help address smoking disparities in the Somali immigrant community.
Implications
Ramadan offers a unique window of opportunity to intervene upon smoking for Somali Muslim immigrant men, for whom rates of smoking are high. Combining faith and health-related text-based messaging, and tailoring interventions around and beyond Ramadan, maybe a valuable approach to help address these serious smoking disparities.
Collapse
Affiliation(s)
- Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | | | - Asma Adam
- School of Medicine, University of Minnesota, Minneapolis, MN
| | - Hiba Sharif
- School of Nursing, University of Minnesota, Minneapolis, MN
| | | | | | | | | | - Kola Okuyemi
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
| | | | - Anne Joseph
- Department of Medicine, University of Minnesota, Minneapolis MN
| |
Collapse
|
10
|
Kroiss SJ, Ahmadzai M, Ahmed J, Alam MM, Chabot-Couture G, Famulare M, Mahamud A, McCarthy KA, Mercer LD, Muhammad S, Safdar RM, Sharif S, Shaukat S, Shukla H, Lyons H. Assessing the sensitivity of the polio environmental surveillance system. PLoS One 2018; 13:e0208336. [PMID: 30592720 PMCID: PMC6310268 DOI: 10.1371/journal.pone.0208336] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 11/15/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The polio environmental surveillance (ES) system has been an incredible tool for advancing polio eradication efforts because of its ability to highlight the spatial and temporal extent of poliovirus circulation. While ES often outperforms, or is more sensitive than AFP surveillance, the sensitivity of the ES system has not been well characterized. Fundamental uncertainty of ES site sensitivity makes it difficult to interpret results from ES, particularly negative results. METHODS AND FINDINGS To study ES sensitivity, we used data from Afghanistan and Pakistan to examine the probability that each ES site detected the Sabin 1, 2, or 3 components of the oral polio vaccine (OPV) as a function of virus prevalence within the same district (estimated from AFP data). Accounting for virus prevalence is essential for estimating site sensitivity because Sabin detection rates should vary with prevalence-high immediately after supplemental immunization activities (SIAs), but low in subsequent months. We found that most ES sites in Pakistan and Afghanistan are highly sensitive for detecting poliovirus relative to AFP surveillance in the same districts. For example, even when Sabin poliovirus is at low prevalence of ~0.5-3% in AFP surveillance, most ES sites have ~34-50% probability of detecting Sabin. However, there was considerable variation in ES site sensitivity and we flagged several sites for re-evaluation based on low sensitivity rankings and low wild polio virus detection rates. In these areas, adding new sites or modifying collection methods in current sites could improve sensitivity of environmental surveillance. CONCLUSIONS Relating ES detections to virus prevalence significantly improved our ability to evaluate site sensitivity compared to evaluations based solely on ES detection rates. To extend our approach to new sites and regions, we provide a preliminary framework for relating ES and AFP detection rates, and descriptions of how detection rates might relate to SIAs and natural seasonality.
Collapse
Affiliation(s)
- Steve J. Kroiss
- Institute for Disease Modeling, Bellevue, WA, United States of America
| | - Maiwand Ahmadzai
- National Emergency Operations Centre for Polio Eradication, Kabul, Afghanistan
| | - Jamal Ahmed
- World Health Organization, Geneva, Switzerland
| | - Muhammad Masroor Alam
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
- World Health Organization, Islamabad, Pakistan
| | | | - Michael Famulare
- Institute for Disease Modeling, Bellevue, WA, United States of America
| | - Abdirahman Mahamud
- World Health Organization, Islamabad, Pakistan
- National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan
| | - Kevin A. McCarthy
- Institute for Disease Modeling, Bellevue, WA, United States of America
| | - Laina D. Mercer
- Institute for Disease Modeling, Bellevue, WA, United States of America
| | - Salman Muhammad
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
| | - Rana M. Safdar
- National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan
| | - Salmaan Sharif
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
- World Health Organization, Islamabad, Pakistan
| | - Shahzad Shaukat
- Department of Virology, National Institute of Health, Chak Shahzad, Islamabad, Pakistan
- World Health Organization, Islamabad, Pakistan
| | - Hemant Shukla
- National Emergency Operations Centre for Polio Eradication, Kabul, Afghanistan
| | - Hil Lyons
- Institute for Disease Modeling, Bellevue, WA, United States of America
| |
Collapse
|
11
|
Hsu C, Mahamud A, Safdar M, Nikulin J, Jorba J, Bullard K, Agbor J, Kader M, Sharif S, Ahmed J, Ehrhardt D. Progress Toward Poliomyelitis Eradication - Pakistan, January 2017-September 2018. MMWR Morb Mortal Wkly Rep 2018; 67:1242-1245. [PMID: 30408024 PMCID: PMC6223954 DOI: 10.15585/mmwr.mm6744a5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Among the three wild poliovirus (WPV) serotypes, only WPV type 1 (WPV1) has been reported in polio cases or detected from environmental surveillance globally since 2012. Pakistan remains one of only three countries worldwide (the others are Afghanistan and Nigeria) that has never had interrupted WPV1 transmission. This report documents Pakistan's activities and progress toward polio eradication during January 2017-September 2018 and updates previous reports (1,2). In 2017, Pakistan reported eight WPV1 cases, a 60% decrease from 20 cases in 2016. As of September 18, 2018, four cases had been reported, compared with five cases at that time in 2017. Nonetheless, in 2018, WPV1 continues to be isolated regularly from environmental surveillance sites, primarily in the core reservoir areas of Karachi, Quetta, and Peshawar, signifying persistent transmission. Strategies to increase childhood immunity have included an intense schedule of supplemental immunization activities (SIAs), expanding and refining deployment of community-based vaccination implemented by community health workers recruited from the local community in reservoir areas, and strategic placement of permanent transit points where vaccination is provided to mobile populations. Interruption of WPV1 transmission will require further programmatic improvements throughout the country with a focus on specific underperforming subdistricts in reservoir areas.
Collapse
|
12
|
Zhou NA, Fagnant-Sperati CS, Shirai JH, Sharif S, Zaidi SZ, Rehman L, Hussain J, Agha R, Shaukat S, Alam M, Khurshid A, Mujtaba G, Salman M, Safdar RM, Mahamud A, Ahmed J, Khan S, Kossik AL, Beck NK, Matrajt G, Asghar H, Bandyopadhyay AS, Boyle DS, Meschke JS. Evaluation of the bag-mediated filtration system as a novel tool for poliovirus environmental surveillance: Results from a comparative field study in Pakistan. PLoS One 2018; 13:e0200551. [PMID: 30011304 PMCID: PMC6047795 DOI: 10.1371/journal.pone.0200551] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/28/2018] [Indexed: 01/06/2023] Open
Abstract
Poliovirus (PV) environmental surveillance (ES) plays an important role in the global eradication program and is crucial for monitoring silent PV circulation especially as clinical cases decrease. This study compared ES results using the novel bag-mediated filtration system (BMFS) with the current two-phase separation method. From February to November 2016, BMFS and two-phase samples were collected concurrently from twelve sites in Pakistan (n = 117). Detection was higher in BMFS than two-phase samples for each Sabin-like (SL) PV serotype (p<0.001) and wild PV type 1 (WPV1) (p = 0.065). Seventeen sampling events were positive for WPV1, with eight discordant in favor of BMFS and two in favor of two-phase. A vaccine-derived PV type 2 was detected in one BMFS sample but not the matched two-phase. After the removal of SL PV type 2 (SL2) from the oral polio vaccine in April 2016, BMFS samples detected SL2 more frequently than two-phase (p = 0.016), with the last detection by either method occurring June 12, 2016. More frequent PV detection in BMFS compared to two-phase samples is likely due to the greater effective volume assayed (1620 mL vs. 150 mL). This study demonstrated that the BMFS achieves enhanced ES for all PV serotypes in an endemic country.
Collapse
Affiliation(s)
- Nicolette Angela Zhou
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - Christine Susan Fagnant-Sperati
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - Jeffry Hiroshi Shirai
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
| | | | | | - Lubna Rehman
- National Institute of Health, Islamabad, Pakistan
| | | | - Rahim Agha
- World Health Organization, Islamabad, Pakistan
- National Emergency Operations Center, Islamabad, Pakistan
| | | | - Masroor Alam
- National Institute of Health, Islamabad, Pakistan
| | | | | | | | - Rana Muhammed Safdar
- National Institute of Health, Islamabad, Pakistan
- National Emergency Operations Center, Islamabad, Pakistan
| | - Abdirahman Mahamud
- World Health Organization, Islamabad, Pakistan
- National Emergency Operations Center, Islamabad, Pakistan
| | - Jamal Ahmed
- World Health Organization, Islamabad, Pakistan
- National Emergency Operations Center, Islamabad, Pakistan
| | - Sadaf Khan
- PATH, Seattle, WA, United States of America
| | - Alexandra Lynn Kossik
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - Nicola Koren Beck
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
| | - Graciela Matrajt
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
| | | | | | | | - John Scott Meschke
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, United States of America
| |
Collapse
|
13
|
Pervaiz A, Mbaeyi C, Baig MA, Burman A, Ahmed JA, Akter S, Jatoi FA, Mahamud A, Asghar RJ, Azam N, Shah MN, Laghari MA, Soomro K, Wadood MZ, Ehrhardt D, Safdar RM, Farag N. Fractional-Dose Inactivated Poliovirus Vaccine Campaign - Sindh Province, Pakistan, 2016. MMWR Morb Mortal Wkly Rep 2017; 66:1295-1299. [PMID: 29190264 PMCID: PMC5708687 DOI: 10.15585/mmwr.mm6647a4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
14
|
Elhamidi Y, Mahamud A, Safdar M, Al Tamimi W, Jorba J, Mbaeyi C, Hsu CH, Wadood Z, Sharif S, Ehrhardt D. Progress Toward Poliomyelitis Eradication - Pakistan, January 2016-September 2017. MMWR Morb Mortal Wkly Rep 2017; 66:1276-1280. [PMID: 29166363 PMCID: PMC5769788 DOI: 10.15585/mmwr.mm6646a4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
In 1988, the World Health Assembly launched the Global Polio Eradication Initiative. Among the three wild poliovirus serotypes, only wild poliovirus (WPV) type 1 (WPV1) has been detected since 2012. Since 2014, Pakistan, Afghanistan, and Nigeria remain the only countries with continuing endemic WPV1 transmission. This report describes activities conducted and progress made toward the eradication of poliovirus in Pakistan during January 2016-July 2017 and provides an update to previous reports (1,2). In 2016, Pakistan reported 20 WPV1 cases, a 63% decrease compared with 54 cases in 2015 (3). As of September 25, 2017, five WPV1 cases have been reported in 2017, representing a 69% decline compared with 16 cases reported during the same period in 2016 (Figure 1). During January-September 2017, WPV1 was detected in 72 of 468 (15%) environmental samples collected, compared with 36 of 348 (9%) samples collected during the same period in 2016. WPV1 was detected in environmental samples in areas where no polio cases are being reported, which indicates that WPV1 transmission is continuing in some high-risk areas. Interruption of WPV transmission in Pakistan requires maintaining focus on reaching missed children (particularly among mobile populations), continuing community-based vaccination, implementing the 2017-2018 National Emergency Action Plan (4), and improving routine immunization services.
Collapse
|
15
|
Mercer LD, Safdar RM, Ahmed J, Mahamud A, Khan MM, Gerber S, O’Leary A, Ryan M, Salet F, Kroiss SJ, Lyons H, Upfill-Brown A, Chabot-Couture G. Spatial model for risk prediction and sub-national prioritization to aid poliovirus eradication in Pakistan. BMC Med 2017; 15:180. [PMID: 29017491 PMCID: PMC5635525 DOI: 10.1186/s12916-017-0941-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 09/06/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pakistan is one of only three countries where poliovirus circulation remains endemic. For the Pakistan Polio Eradication Program, identifying high risk districts is essential to target interventions and allocate limited resources. METHODS Using a hierarchical Bayesian framework we developed a spatial Poisson hurdle model to jointly model the probability of one or more paralytic polio cases, and the number of cases that would be detected in the event of an outbreak. Rates of underimmunization, routine immunization, and population immunity, as well as seasonality and a history of cases were used to project future risk of cases. RESULTS The expected number of cases in each district in a 6-month period was predicted using indicators from the previous 6-months and the estimated coefficients from the model. The model achieves an average of 90% predictive accuracy as measured by area under the receiver operating characteristic (ROC) curve, for the past 3 years of cases. CONCLUSIONS The risk of poliovirus has decreased dramatically in many of the key reservoir areas in Pakistan. The results of this model have been used to prioritize sub-national areas in Pakistan to receive additional immunization activities, additional monitoring, or other special interventions.
Collapse
Affiliation(s)
- Laina D. Mercer
- Institute for Disease Modeling, 3150 138th Ave SE, Bellevue, WA 98005 USA
| | - Rana M. Safdar
- National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan
| | - Jamal Ahmed
- National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan
- World Health Organization, Islamabad, Pakistan
| | - Abdirahman Mahamud
- National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan
- World Health Organization, Islamabad, Pakistan
| | - M. Muzaffar Khan
- National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan
- World Health Organization, Islamabad, Pakistan
| | - Sue Gerber
- Bill and Melinda Gates Foundation, Seattle, WA USA
| | - Aiden O’Leary
- National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan
- United Nations Children’s Fund (UNICEF), Islamabad, Pakistan
| | - Mike Ryan
- National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan
| | - Frank Salet
- National Emergency Operations Centre for Polio Eradication, Islamabad, Pakistan
| | - Steve J. Kroiss
- Institute for Disease Modeling, 3150 138th Ave SE, Bellevue, WA 98005 USA
| | - Hil Lyons
- Institute for Disease Modeling, 3150 138th Ave SE, Bellevue, WA 98005 USA
| | | | | |
Collapse
|
16
|
Mbaeyi C, Ryan MJ, Smith P, Mahamud A, Farag N, Haithami S, Sharaf M, Jorba JC, Ehrhardt D. Response to a Large Polio Outbreak in a Setting of Conflict - Middle East, 2013-2015. MMWR Morb Mortal Wkly Rep 2017; 66:227-231. [PMID: 28253229 PMCID: PMC5657899 DOI: 10.15585/mmwr.mm6608a6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
17
|
Hsu CH, Mahamud A, Safdar RM, Ahmed J, Jorba J, Sharif S, Farag N, Martinez M, Tangermann RH, Ehrhardt D. Progress Toward Poliomyelitis Eradication - Pakistan, January 2015-September 2016. MMWR Morb Mortal Wkly Rep 2016; 65:1295-1299. [PMID: 27880752 DOI: 10.15585/mmwr.mm6546a4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Pakistan, Afghanistan, and Nigeria remain the only countries where endemic wild poliovirus type 1 (WPV1) transmission continues. This report describes the activities, challenges, and progress toward polio eradication in Pakistan during January 2015-September 2016 and updates previous reports (1,2). In 2015, a total of 54 WPV1 cases were reported in Pakistan, an 82% decrease from 2014. In 2016, 15 WPV1 cases had been reported as of November 1, representing a 61% decrease compared with the 38 cases reported during the same period in 2015 (Figure 1). Among the 15 WPV1 cases reported in 2016, children aged <36 months accounted for 13 cases; four of those children had received only a single dose of oral poliovirus vaccine (OPV). Seven of the 15 WPV1 cases occurred in the province of Khyber Pakhtunkhwa (KP), five in Sindh, two in the Federally Administered Tribal Areas (FATA), and one in Balochistan (3). During January-September 2016, WPV1 was detected in 9% (36 of 384) of environmental samples collected, compared with 19% (69 of 354) of samples collected during the same period in 2015. Rigorous implementation of the 2015-2016 National Emergency Action Plan (NEAP) (4), coordinated by the National Emergency Operations Center (EOC), has resulted in a substantial decrease in overall WPV1 circulation compared with the previous year. However, detection of WPV1 cases in high-risk areas and the detection of WPV1 in environmental samples from geographic areas where no polio cases are identified highlight the need to continue to improve the quality of supplemental immunization activities (SIAs),* immunization campaigns focused on vaccinating children with OPV outside of routine immunization services, and surveillance for acute flaccid paralysis (AFP). Continuation and refinement of successful program strategies, as outlined in the new 2016-2017 NEAP (5), with particular focus on identifying children missed by vaccination, community-based vaccination, and rapid response to virus identification are needed to stop WPV transmission.
Collapse
|
18
|
Abstract
Since the 1988 resolution of the World Health Assembly to eradicate polio, significant progress has been made toward achieving this goal, with the result that only Afghanistan, Nigeria, and Pakistan have never successfully interrupted endemic transmission of wild poliovirus. However, one of the greatest challenges of the Global Polio Eradication Initiative has been that of maintaining the polio-free status of countries in unstable regions with weak healthcare infrastructure, a challenge exemplified by Somalia, a country in the Horn of Africa region. Somalia interrupted indigenous transmission of wild poliovirus in 2002, 4 years after the country established its national polio eradication program. But political instability and protracted armed conflict, with significant disruption of the healthcare system, have left Somalia vulnerable to 2 imported outbreaks of wild poliovirus. The first occurred during 2005-2007, resulting in >200 cases of paralytic polio, whereas the second, which began in 2013, is currently ongoing. Despite immense challenges, the country has a sensitive surveillance system that has facilitated prompt detection of outbreaks, but its weak routine immunization system means that supplementary immunization activities constitute the primary strategy for reaching children with polio vaccines. Conducting vaccination campaigns in a setting of conflict has been at times hazardous, but the country's polio program has demonstrated resilience in overcoming many obstacles to ensure that children receive lifesaving polio vaccines. Regaining and maintaining Somalia's polio-free status will depend on finding innovative and lasting solutions to the challenge of administering vaccines in a setting of ongoing conflict and instability.
Collapse
Affiliation(s)
- Chukwuma Mbaeyi
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Raoul Kamadjeu
- Centers for Disease Control and Prevention, Atlanta, Georgia World Health Organization, Somalia Liaison Office, Nairobi, Kenya
| | | | - Jenna Webeck
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Derek Ehrhardt
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Abraham Mulugeta
- World Health Organization, Somalia Liaison Office, Nairobi, Kenya
| |
Collapse
|
19
|
Mahamud A, Kamadjeu R, Webeck J, Mbaeyi C, Baranyikwa MT, Birungi J, Nurbile Y, Ehrhardt D, Shukla H, Chatterjee A, Mulugeta A. Effectiveness of oral polio vaccination against paralytic poliomyelitis: a matched case-control study in Somalia. J Infect Dis 2014; 210 Suppl 1:S187-93. [PMID: 25316835 DOI: 10.1093/infdis/jiu261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND After the last case of type 1 wild poliovirus (WPV1) was reported in 2007, Somalia experienced another outbreak of WPV1 (189 cases) in 2013. METHODS We conducted a retrospective, matched case-control study to evaluate the vaccine effectiveness (VE) of oral polio vaccine (OPV). We retrieved information from the Somalia Surveillance Database. A case was defined as any case of acute flaccid paralysis (AFP) with virological confirmation of WPV1. We selected two groups of controls for each case: non-polio AFP cases ("NPAFP controls") matched to WPV1 cases by age, date of onset of paralysis and region; and asymptomatic "neighborhood controls," matched by age. Using conditional logistic regression, we estimated the VE of OPV as (1-odds ratio)×100. RESULT We matched 99 WPV cases with 99 NPAFP controls and 134 WPV1 cases with 268 neighborhood controls. Using NPAFP controls, the overall VE was 70% (95% confidence interval [CI], 37-86), 59% (2-83) among 1-3 dose recipients, 77% (95% CI, 46-91) among ≥4 dose recipients. In neighborhood controls, the overall VE was 95% (95% CI, 84-98), 92% (72-98) among 1-3 dose recipients, and 97% (89-99) among ≥4 dose recipients. When the analysis was limited to cases and controls ≤24 months old, the overall VE in NPAFP and neighborhood controls was 95% (95% CI, 65-99) and 97% (95% CI, 76-100), respectively. CONCLUSIONS Among individuals who were fully vaccinated with OPV, vaccination was effective at preventing WPV1 in Somalia.
Collapse
Affiliation(s)
- Abdirahman Mahamud
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Jenna Webeck
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chukwuma Mbaeyi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Julianne Birungi
- United Nations Children's Fund (UNICEF), Somalia Support Centre, Nairobi, Kenya
| | - Yassin Nurbile
- Somalia Ministry of Human Development and Public Services, Health Directorate, Mogadishu
| | - Derek Ehrhardt
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hemant Shukla
- Global Polio Eradication Initiative, WHO, Geneva, Switzerland
| | - Anirban Chatterjee
- United Nations Children's Fund (UNICEF), Somalia Support Centre, Nairobi, Kenya
| | | |
Collapse
|
20
|
Kamadjeu R, Mahamud A, Webeck J, Baranyikwa MT, Chatterjee A, Bile YN, Birungi J, Mbaeyi C, Mulugeta A. Polio outbreak investigation and response in Somalia, 2013. J Infect Dis 2014; 210 Suppl 1:S181-6. [PMID: 25316834 PMCID: PMC10548859 DOI: 10.1093/infdis/jiu453] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND For >2 decades, conflicts and recurrent natural disasters have maintained Somalia in a chronic humanitarian crisis. For nearly 5 years, 1 million children <10 years have not had access to lifesaving health services, including vaccination, resulting in the accumulation by 2012 of the largest geographically concentrated cohort of unvaccinated children in the world. This article reviews the epidemiology, risk, and program response to what is now known as the 2013 wild poliovirus (WPV) outbreak in Somalia and highlights the challenges that the program will face in making Somalia free of polio once again. METHODS A case of acute flaccid paralysis (AFP) was defined as a child <15 years of age with sudden onset of fever and paralysis. Polio cases were defined as AFP cases with stool specimens positive for WPV. RESULTS From 9 May to 31 December 2013, 189 cases of WPV type 1 (WPV1) were reported from 46 districts of Somalia; 42% were from Banadir region (Mogadishu), 60% were males, and 93% were <5 years of age. All Somalian polio cases belonged to cluster N5A, which is known to have been circulating in northern Nigeria since 2011. In response to the outbreak, 8 supplementary immunization activities were conducted with oral polio vaccine (OPV; trivalent OPV was used initially, followed subsequently by bivalent OPV) targeting various age groups, including children aged <5 years, children aged <10 years, and individuals of any age. CONCLUSIONS The current polio outbreak erupted after a polio-free period of >6 years (the last case was reported in March 2007). Somalia interrupted indigenous WPV transmission in 2002, was removed from the list of polio-endemic countries a year later, and has since demonstrated its ability to control polio outbreaks resulting from importation. This outbreak reiterates that the threat of large polio outbreaks resulting from WPV importation will remain constant unless polio transmission is interrupted in the remaining polio-endemic countries.
Collapse
Affiliation(s)
- Raoul Kamadjeu
- Somalia Liaison, World Health Organization, Nairobi, Kenya
| | - Abdirahman Mahamud
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jenna Webeck
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Yassin Nur Bile
- Health Directorate, Somalia Ministry of Human Development and Public Services, Mogadishu
| | - Julianne Birungi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chukwuma Mbaeyi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | |
Collapse
|
21
|
Navarro-Colorado C, Mahamud A, Burton A, Haskew C, Maina GK, Wagacha JB, Ahmed JA, Shetty S, Cookson S, Goodson JL, Schilperoord M, Spiegel P. Measles outbreak response among adolescent and adult Somali refugees displaced by famine in Kenya and Ethiopia, 2011. J Infect Dis 2014; 210:1863-70. [PMID: 25117754 DOI: 10.1093/infdis/jiu395] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The refugee complexes of Dadaab, Kenya, and Dollo-Ado, Ethiopia, experienced measles outbreaks during June-November 2011, following a large influx of refugees from Somalia. METHODS Line-lists from health facilities were used to describe the outbreak in terms of age, sex, vaccination status, arrival date, attack rates (ARs), and case fatality ratios (CFRs) for each camp. Vaccination data and coverage surveys were reviewed. RESULTS In Dadaab, 1370 measles cases and 32 deaths (CFR, 2.3%) were reported. A total of 821 cases (60.1%) were aged ≥15 years, 906 (82.1%) arrived to the camps in 2011, and 1027 (79.6%) were unvaccinated. Camp-specific ARs ranged from 212 to 506 cases per 100 000 people. In Dollo-Ado, 407 cases and 23 deaths (CFR, 5.7%) were reported. Adults aged ≥15 years represented 178 cases (43.7%) and 6 deaths (26.0%). Camp-specific ARs ranged from 21 to 1100 cases per 100 000 people. Immunization activities that were part of the outbreak responses initially targeted children aged 6 months to 14 years and were later expanded to include individuals up to 30 years of age. CONCLUSIONS The target age group for outbreak response-associated immunization activities at the start of the outbreaks was inconsistent with the numbers of cases among unvaccinated adolescents and adults in the new population. In displacement of populations from areas affected by measles outbreaks, health authorities should consider vaccinating adults in routine and outbreak response activities.
Collapse
Affiliation(s)
| | | | - Ann Burton
- United Nations High Commissioner for Refugees (UNHCR), Nairobi, Kenya
| | | | | | - John B Wagacha
- United Nations High Commissioner for Refugees (UNHCR), Nairobi, Kenya
| | | | - Sharmila Shetty
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Susan Cookson
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - James L Goodson
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | | | | |
Collapse
|
22
|
Mahamud A, Masunu-Faleafaga Y, Walls L, Williams N, Garcia P, Teshale E, Williams R, Dulski T, Bellini WJ, Kutty PK. Seroprevalence of measles, mumps and rubella among children in American Samoa, 2011, and progress towards West Pacific Region goals of elimination. Vaccine 2013; 31:3683-7. [DOI: 10.1016/j.vaccine.2013.05.102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 05/15/2013] [Accepted: 05/30/2013] [Indexed: 11/27/2022]
|
23
|
Mahamud A, Burton A, Hassan M, Ahmed JA, Wagacha JB, Spiegel P, Haskew C, Eidex RB, Shetty S, Cookson S, Navarro-Colorado C, Goodson JL. Risk factors for measles mortality among hospitalized Somali refugees displaced by famine, Kenya, 2011. Clin Infect Dis 2013; 57:e160-6. [PMID: 23821730 DOI: 10.1093/cid/cit442] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Measles among displaced, malnourished populations can result in a high case fatality ratio. In 2011, a large measles outbreak occurred in Dadaab, Kenya, among refugees fleeing famine and conflict in Somalia. The aim of this study was to identify predictors of measles deaths among hospitalized patients during the outbreak. METHODS A retrospective cohort study design was used to investigate measles mortality among hospitalized measles patients with a date of rash onset during 6 June-10 September 2011. Data were abstracted from medical records and a measles case was defined as an illness with fever, maculopapular rash, and either cough, coryza or conjunctivitis. Vaccination status was determined by patient or parental recall. Independent predictors of mortality were identified using logistic regression analysis. RESULTS Of 388 hospitalized measles patients, 188 (49%) were from hospital X, 70 (18%) from hospital Y, and 130 (34%) from hospital Z; median age was 22 years, 192 (50%) were 15-29 years of age, and 22 (6%) were vaccinated. The mean number of days from rash onset to hospitalization varied by hospital (hospital X = 5, hospital Y = 3, hospital Z = 6; P < .0001). Independent risk factors for measles mortality were neurological complications (odds ratio [OR], 12.8; 95% confidence interval [CI], 3.1-52.4), acute malnutrition (OR, 7.6; 95% CI, 1.3-44.3), and admission to hospital Z (OR, 4.2; 95% CI, 1.3-13.2). CONCLUSIONS Among Somali refugees, in addition to timely vaccination at border crossing points, early detection and treatment of acute malnutrition and proper management of measles cases may reduce measles mortality.
Collapse
|
24
|
Mahamud A, Fiebelkorn AP, Nelson G, Aguon A, McKenna J, Villarruel G, Gallagher K, Ortega-Sánchez IR. Economic impact of the 2009-2010 Guam mumps outbreak on the public health sector and affected families. Vaccine 2012; 30:6444-8. [PMID: 22902678 DOI: 10.1016/j.vaccine.2012.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 07/30/2012] [Accepted: 08/01/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The United States Territory of Guam reported a large mumps outbreak of 505 cases during 2009-2010. We assessed the economic impact of the outbreak from the perspectives of the local public health sector and affected families. METHODS Using standard cost analysis methods, we retrospectively identified all public health personnel involved in the outbreak response and surveyed them about their outbreak-related activities. We then estimated the costs of outbreak-related personnel hours and materials. We also assessed out-of-pocket costs and costs incurred for work-time missed for persons with mumps and their families. We defined the analysis period as February 25-October 22, 2010. RESULTS Seventy-six public health personnel were involved in outbreak response activities. Overall, the response required approximately 8264 person-hours, 2380 miles driven, and 3000 doses of measles-mumps-rubella vaccine ordered. The cost to the public health sector was 256,785 U.S. dollars (USD). Families of 102 persons with mumps were interviewed. An estimated 761 USD per person with mumps was spent by families; 88% of this cost was due to missed days of work. The estimated total cost to families of the 470 persons with mumps during the analysis period was 357,670 USD. Total outbreak-related costs were 614,455 USD. CONCLUSIONS The costs reported underscore the impact of mumps outbreaks in highly vaccinated populations and the need for effective mumps prevention and control strategies.
Collapse
Affiliation(s)
- Abdirahman Mahamud
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, United States.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Mahamud A, Wiseman R, Grytdal S, Basham C, Asghar J, Dang T, Leung J, Lopez A, Schmid DS, Bialek SR. Challenges in confirming a varicella outbreak in the two-dose vaccine era. Vaccine 2012; 30:6935-9. [PMID: 22884663 DOI: 10.1016/j.vaccine.2012.07.076] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 07/12/2012] [Accepted: 07/27/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND A second dose of varicella vaccine was recommended for U.S. children in 2006. We investigated a suspected varicella outbreak in School District X, Texas to determine 2-dose varicella vaccine effectiveness (VE). METHODS A varicella case was defined as an illness with maculopapulovesicular rash without other explanation with onset during April 1-June 10, 2011, in a School District X student. We conducted a retrospective cohort in the two schools with the majority of cases. Lesion, saliva, and environmental specimens were collected for varicella-zoster virus (VZV) PCR testing. VE was calculated using historic attack rates among unvaccinated. RESULTS In School District X, 82 varicella cases were reported, including 60 from Schools A and B. All cases were mild, with a median of 14 lesions. All 10 clinical specimens and 58 environmental samples tested negative for VZV. Two-dose varicella vaccination coverage was 66.4% in Schools A and B. Varicella VE in affected classrooms was 80.9% (95% CI: 67.2-88.9) among 1-dose vaccinees and 94.7% (95% CI: 89.2-97.4) among 2-dose vaccinees in School A, with a second dose incremental VE of 72.1% (95% CI: 39.0-87.3). Varicella VE among School B students did not differ significantly by dose (80.1% vs. 84.2% among 1-dose and 2-dose vaccinees, respectively). CONCLUSION Laboratory testing could not confirm varicella as the etiology of this outbreak; clinical and epidemiologic data suggests varicella as the likely cause. Better diagnostics are needed for diagnosis of varicella in vaccinated individuals so that appropriate outbreak control measures can be implemented.
Collapse
Affiliation(s)
- Abdirahman Mahamud
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Mahamud A, Marin M, Nickell SP, Shoemaker T, Zhang JX, Bialek SR. Herpes zoster-related deaths in the United States: validity of death certificates and mortality rates, 1979-2007. Clin Infect Dis 2012; 55:960-6. [PMID: 22715169 DOI: 10.1093/cid/cis575] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Herpes zoster (HZ) vaccine was recommended in the United States to reduce HZ-associated morbidity. Vaccination may reduce HZ-associated mortality, but no strategy exists to monitor mortality trends. METHODS We validated HZ coding on death certificates from California, using hospital records as the gold standard, and applied the results to national-level data to estimate HZ mortality. RESULTS In the validation phase of the study, among 40 available hospital records listing HZ as the underlying cause of death, HZ was the underlying cause for 21 (52.5%) and a contributing cause for 5 (12.5%). Among the 21 hospital records listing HZ as the underlying cause of death, the median age of decedents was 84 years (range, 50-99); 60% had no contraindications for HZ vaccination. Of the 37 available records listing HZ as a contributing cause of death, HZ was a contributing cause for 2 (5.4%) and the underlying cause for 6 (16.2%). Nationally, in the 7 years preceding the HZ vaccination program, the average annual number of deaths in which HZ was reported as the underlying cause of death was 149; however, based on our validation study, we estimate the true number was 78 (range, 31-118). CONCLUSIONS National death certificate data greatly overestimate deaths in which HZ is the underlying or contributing cause of death. The HZ vaccination program could prevent some HZ-related deaths, but the impact will be difficult to assess using national mortality data.
Collapse
Affiliation(s)
- Abdirahman Mahamud
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | | | | | | | | |
Collapse
|
27
|
Wallace C, Mahamud A, Paliwal B, Tolakanahalli R. SU-FF-T-634: Dosimetric Impact of Imaging Artifacts From KVCT and MVCT in the Presence of Metallic Prostheses. Med Phys 2009. [DOI: 10.1118/1.3182132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|