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Nampota-Nkomba N, Keita AM, Juma J, Sidibe D, Kourouma N, Sissoko S, Haidara FC, Traore CT, Traore CB, Traore A, Gaume B, Sow SO, Kotloff KL, Tapia MD. An Upsurge of Measles Cases in Mali-a Consequence of Pandemic-associated Disruption in Routine Immunization. Open Forum Infect Dis 2024; 11:ofae154. [PMID: 38617075 PMCID: PMC11010308 DOI: 10.1093/ofid/ofae154] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/18/2024] [Indexed: 04/16/2024] Open
Abstract
Measles deaths highlight immunization program gaps. In the Child Health and Mortality Prevention Surveillance study in Mali, we observed a rise in under-5 measles-related deaths in 2022 that corresponded with increased measles cases at the same time and a decline in measles vaccine coverage in Mali in 2020.
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Affiliation(s)
- Nginache Nampota-Nkomba
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Jane Juma
- Centre pour le Développement des Vaccins-Mali, Bamako, Mali
| | | | - Nana Kourouma
- Centre pour le Développement des Vaccins-Mali, Bamako, Mali
| | - Seydou Sissoko
- Centre pour le Développement des Vaccins-Mali, Bamako, Mali
| | | | - Cheick Tidiane Traore
- Direction Générale de la Santé et de l’Hygiène Publique, Ministry of Health and Social Development, Bamako, Mali
| | | | - Awa Traore
- Centre pour le Développement des Vaccins-Mali, Bamako, Mali
| | - Brigitte Gaume
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Milagritos D Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Ogbuanu IU, Otieno K, Varo R, Sow SO, Ojulong J, Duduyemi B, Kowuor D, Cain CJ, Rogena EA, Onyango D, Akelo V, Tippett Barr BA, terKuile F, Kotloff KL, Tapia MD, Keita AM, Juma J, Assefa N, Assegid N, Acham Y, Madrid L, Scott JAG, Arifeen SE, Gurley ES, Mahtab S, Dangor Z, Wadula J, Dutoit J, Madhi SA, Mandomando I, Torres-Fernandez D, Kincardett M, Mabunda R, Mutevedzi P, Madewell ZJ, Blau DM, Whitney CG, Samuels AM, Bassat Q. Burden of child mortality from malaria in high endemic areas: Results from the CHAMPS network using minimally invasive tissue sampling. J Infect 2024; 88:106107. [PMID: 38290664 DOI: 10.1016/j.jinf.2024.01.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/07/2023] [Accepted: 01/17/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Malaria is a leading cause of childhood mortality worldwide. However, accurate estimates of malaria prevalence and causality among patients who die at the country level are lacking due to the limited specificity of diagnostic tools used to attribute etiologies. Accurate estimates are crucial for prioritizing interventions and resources aimed at reducing malaria-related mortality. METHODS Seven Child Health and Mortality Prevention Surveillance (CHAMPS) Network sites collected comprehensive data on stillbirths and children <5 years, using minimally invasive tissue sampling (MITS). A DeCoDe (Determination of Cause of Death) panel employed standardized protocols for assigning underlying, intermediate, and immediate causes of death, integrating sociodemographic, clinical, laboratory (including extensive microbiology, histopathology, and malaria testing), and verbal autopsy data. Analyses were conducted to ascertain the strength of evidence for cause of death (CoD), describe factors associated with malaria-related deaths, estimate malaria-specific mortality, and assess the proportion of preventable deaths. FINDINGS Between December 3, 2016, and December 31, 2022, 2673 deaths underwent MITS and had a CoD attributed from four CHAMPS sites with at least 1 malaria-attributed death. No malaria-attributable deaths were documented among 891 stillbirths or 924 neonatal deaths, therefore this analysis concentrates on the remaining 858 deaths among children aged 1-59 months. Malaria was in the causal chain for 42.9% (126/294) of deaths from Sierra Leone, 31.4% (96/306) in Kenya, 18.2% (36/198) in Mozambique, 6.7% (4/60) in Mali, and 0.3% (1/292) in South Africa. Compared to non-malaria related deaths, malaria-related deaths skewed towards older infants and children (p < 0.001), with 71.0% among ages 12-59 months. Malaria was the sole infecting pathogen in 184 (70.2%) of malaria-attributed deaths, whereas bacterial and viral co-infections were identified in the causal pathway in 24·0% and 12.2% of cases, respectively. Malnutrition was found at a similar level in the causal pathway of both malaria (26.7%) and non-malaria (30.7%, p = 0.256) deaths. Less than two-thirds (164/262; 62.6%) of malaria deaths had received antimalarials prior to death. Nearly all (98·9%) malaria-related deaths were deemed preventable. INTERPRETATION Malaria remains a significant cause of childhood mortality in the CHAMPS malaria-endemic sites. The high bacterial co-infection prevalence among malaria deaths underscores the potential benefits of antibiotics for severe malaria patients. Compared to non-malaria deaths, many of malaria-attributed deaths are preventable through accessible malaria control measures.
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Affiliation(s)
| | - Kephas Otieno
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Rosauro Varo
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Samba O Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | | | - Babatunde Duduyemi
- University of Sierra Leone Teaching Hospital Complex, Freetown, Sierra Leone
| | | | | | - Emily A Rogena
- School of Medicine, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | | | - Victor Akelo
- US Centers for Disease Control and Prevention--Kenya, Kisumu, Kenya
| | | | - Feiko terKuile
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Karen L Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Milagritos D Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Jane Juma
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nardos Assegid
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yenework Acham
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lola Madrid
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research (ICDDR,B), Dhaka, Bangladesh
| | - Emily S Gurley
- International Center for Diarrhoeal Diseases Research (ICDDR,B), Dhaka, Bangladesh; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeannette Wadula
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeanie Dutoit
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Inácio Mandomando
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Moçambique
| | - David Torres-Fernandez
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Milton Kincardett
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Rita Mabunda
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Portia Mutevedzi
- Emory Global Health Institute, Emory University, Atlanta, GA, USA
| | - Zachary J Madewell
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dianna M Blau
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Aaron M Samuels
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, USA; Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Quique Bassat
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique; ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain; Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain; CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.
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3
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Mahtab S, Blau DM, Madewell ZJ, Ogbuanu I, Ojulong J, Lako S, Legesse H, Bangura JS, Bassat Q, Mandomando I, Xerinda E, Fernandes F, Varo R, Sow SO, Kotloff KL, Tapia MD, Keita AM, Sidibe D, Onyango D, Akelo V, Gethi D, Verani JR, Revathi G, Scott JAG, Assefa N, Madrid L, Bizuayehu H, Tirfe TT, El Arifeen S, Gurley ES, Islam KM, Alam M, Zahid Hossain M, Dangor Z, Baillie VL, Hale M, Mutevedzi P, Breiman RF, Whitney CG, Madhi SA. Post-mortem investigation of deaths due to pneumonia in children aged 1-59 months in sub-Saharan Africa and South Asia from 2016 to 2022: an observational study. Lancet Child Adolesc Health 2024; 8:201-213. [PMID: 38281495 PMCID: PMC10864189 DOI: 10.1016/s2352-4642(23)00328-0] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND The Child Health and Mortality Prevention Surveillance (CHAMPS) Network programme undertakes post-mortem minimally invasive tissue sampling (MITS), together with collection of ante-mortem clinical information, to investigate causes of childhood deaths across multiple countries. We aimed to evaluate the overall contribution of pneumonia in the causal pathway to death and the causative pathogens of fatal pneumonia in children aged 1-59 months enrolled in the CHAMPS Network. METHODS In this observational study we analysed deaths occurring between Dec 16, 2016, and Dec 31, 2022, in the CHAMPS Network across six countries in sub-Saharan Africa (Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) and one in South Asia (Bangladesh). A standardised approach of MITS was undertaken on decedents within 24-72 h of death. Diagnostic tests included blood culture, multi-organism targeted nucleic acid amplifications tests (NAATs) of blood and lung tissue, and histopathology examination of various organ tissue samples. An interdisciplinary expert panel at each site reviewed case data to attribute the cause of death and pathogenesis thereof on the basis of WHO-recommended reporting standards. FINDINGS Pneumonia was attributed in the causal pathway of death in 455 (40·6%) of 1120 decedents, with a median age at death of 9 (IQR 4-19) months. Causative pathogens were identified in 377 (82·9%) of 455 pneumonia deaths, and multiple pathogens were implicated in 218 (57·8%) of 377 deaths. 306 (67·3%) of 455 deaths occurred in the community or within 72 h of hospital admission (presumed to be community-acquired pneumonia), with the leading bacterial pathogens being Streptococcus pneumoniae (108 [35·3%]), Klebsiella pneumoniae (78 [25·5%]), and non-typeable Haemophilus influenzae (37 [12·1%]). 149 (32·7%) deaths occurred 72 h or more after hospital admission (presumed to be hospital-acquired pneumonia), with the most common pathogens being K pneumoniae (64 [43·0%]), Acinetobacter baumannii (19 [12·8%]), S pneumoniae (15 [10·1%]), and Pseudomonas aeruginosa (15 [10·1%]). Overall, viruses were implicated in 145 (31·9%) of 455 pneumonia-related deaths, including 54 (11·9%) of 455 attributed to cytomegalovirus and 29 (6·4%) of 455 attributed to respiratory syncytial virus. INTERPRETATION Pneumonia contributed to 40·6% of all childhood deaths in this analysis. The use of post-mortem MITS enabled biological ascertainment of the cause of death in the majority (82·9%) of childhood deaths attributed to pneumonia, with more than one pathogen being commonly implicated in the same case. The prominent role of K pneumoniae, non-typable H influenzae, and S pneumoniae highlight the need to review empirical management guidelines for management of very severe pneumonia in low-income and middle-income settings, and the need for research into new or improved vaccines against these pathogens. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dianna M Blau
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zachary J Madewell
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Sandra Lako
- Aberdeen Women's Centre, Freetown, Sierra Leone
| | | | | | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal - Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain; Institutó Catalana de Recerca I Estudis Avançats, Barcelona, Spain; Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Instituto Nacional de Saúde, Maputo, Mozambique
| | - Elisio Xerinda
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Rosauro Varo
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal - Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
| | - Samba O Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Karen L Kotloff
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Milagritos D Tapia
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Diakaridia Sidibe
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | | | - Victor Akelo
- Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | - Dickson Gethi
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Jennifer R Verani
- National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gunturu Revathi
- Department of Pathology, Aga Khan University, Nairobi, Kenya
| | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lola Madrid
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hiwot Bizuayehu
- Department of Microbiology, Addis Ababa Burn, Emergency and Trauma Hospital, Addis Ababa, Ethiopia
| | | | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Emily S Gurley
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kazi Munisul Islam
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Muntasir Alam
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | | | - Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vicky L Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Martin Hale
- National Health Laboratory Service, Department of Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Portia Mutevedzi
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Robert F Breiman
- Wits Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Cynthia G Whitney
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.
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4
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Morozoff C, Ahmed N, Chinkhumba J, Islam MT, Jallow AF, Ogwel B, Zegarra Paredes LF, Sanogo D, Atlas HE, Badji H, Bar-Zeev N, Conteh B, Güimack Fajardo M, Feutz E, Haidara FC, Karim M, Mamby Keita A, Keita Y, Khanam F, Kosek MN, Kotloff KL, Maguire R, Mbutuka IS, Ndalama M, Ochieng JB, Okello C, Omore R, Perez Garcia KF, Qamar FN, Qudrat-E-Khuda S, Qureshi S, Rajib MNH, Shapiama Lopez WV, Sultana S, Witte D, Yousafzai MT, Awuor AO, Cunliffe NA, Jahangir Hossain M, Paredes Olortegui M, Tapia MD, Zaman K, Means AR. Quantifying the Cost of Shigella Diarrhea in the Enterics for Global Health (EFGH) Shigella Surveillance Study. Open Forum Infect Dis 2024; 11:S41-S47. [PMID: 38532961 PMCID: PMC10962725 DOI: 10.1093/ofid/ofad575] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
Background Comparative costs of public health interventions provide valuable data for decision making. However, the availability of comprehensive and context-specific costs is often limited. The Enterics for Global Health (EFGH) Shigella surveillance study-a facility-based diarrhea surveillance study across 7 countries-aims to generate evidence on health system and household costs associated with medically attended Shigella diarrhea in children. Methods EFGH working groups comprising representatives from each country (Bangladesh, Kenya, Malawi, Mali, Pakistan, Peru, and The Gambia) developed the study methods. Over a 24-month surveillance period, facility-based surveys will collect data on resource use for the medical treatment of an estimated 9800 children aged 6-35 months with diarrhea. Through these surveys, we will describe and quantify medical resources used in the treatment of diarrhea (eg, medication, supplies, and provider salaries), nonmedical resources (eg, travel costs to the facility), and the amount of caregiver time lost from work to care for their sick child. To assign costs to each identified resource, we will use a combination of caregiver interviews, national medical price lists, and databases from the World Health Organization and the International Labor Organization. Our primary outcome will be the estimated cost per inpatient and outpatient episode of medically attended Shigella diarrhea treatment across countries, levels of care, and illness severity. We will conduct sensitivity and scenario analysis to determine how unit costs vary across scenarios. Conclusions Results from this study will contribute to the existing body of literature on diarrhea costing and inform future policy decisions related to investments in preventive strategies for Shigella.
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Affiliation(s)
- Chloe Morozoff
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Naveed Ahmed
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jobiba Chinkhumba
- School of Global and Public Health, Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Md Taufiqul Islam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research,Bangladesh Dhaka, Bangladesh
| | - Abdoulie F Jallow
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Billy Ogwel
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | | | - Doh Sanogo
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Hannah E Atlas
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Henry Badji
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Naor Bar-Zeev
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bakary Conteh
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | | | - Erika Feutz
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Fadima C Haidara
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Mehrab Karim
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Youssouf Keita
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Farhana Khanam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research,Bangladesh Dhaka, Bangladesh
| | - Margaret N Kosek
- Division of Infectious Diseases and International Health, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rebecca Maguire
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | - John Benjamin Ochieng
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Collins Okello
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | | | - Farah Naz Qamar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Syed Qudrat-E-Khuda
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research,Bangladesh Dhaka, Bangladesh
| | - Sonia Qureshi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Md Nazmul Hasan Rajib
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research,Bangladesh Dhaka, Bangladesh
| | | | - Shazia Sultana
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Desiree Witte
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | | | - Alex O Awuor
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Nigel A Cunliffe
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - M Jahangir Hossain
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | | | - Milagritos D Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - K Zaman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research,Bangladesh Dhaka, Bangladesh
| | - Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, Washington, USA
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Keita AM, Doh S, Juma J, Nasrin D, Traoré A, Onwuchekwa U, Maguire R, Haidara FC, Sow SO, Kotloff KL, Tapia MD. The Enterics for Global Health (EFGH) Shigella Surveillance Study in Mali. Open Forum Infect Dis 2024; 11:S107-S112. [PMID: 38532954 PMCID: PMC10962726 DOI: 10.1093/ofid/ofae003] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
Background In 2002, the Centre pour le Développement des Vaccins du Mali (CVD-Mali) was established as a partnership between the Mali Ministry of Health and the University of Maryland, Baltimore. Since its creation, CVD-Mali has been dedicated to describing the epidemiology of infectious diseases, supporting the development of vaccines, and training a team of local researchers. CVD-Mali participated in the Global Enteric Multicenter Study from 2007 to 2010 and the Vaccine Impact on Diarrhea in Africa study from 2015 to 2018, where the importance of Shigella as an enteric pathogen was established. Methods In the Enterics for Global Health (EFGH) Shigella surveillance study, CVD-Mali will conduct Shigella surveillance at 4 health centers serving the population currently participating in a demographic surveillance system and will measure the local incidence of Shigella diarrhea and related outcomes in 6- to 35-month-old children. Antibiotic sensitivity patterns and the costs related to these cases will also be measured. Results We anticipate reporting the number of diarrhea episodes that are positive by stool culture, the antibiotic susceptibility of these isolates, and the management and outcomes of these cases. Conclusions In Mali, the EFGH study will contribute valuable information to understanding the burden of Shigella in this population. These data will inform the evaluation of vaccine candidates.
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Affiliation(s)
- Adama Mamby Keita
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Sanogo Doh
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Jane Juma
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Dilruba Nasrin
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Awa Traoré
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Uma Onwuchekwa
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Rebecca Maguire
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Fadima C Haidara
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Samba O Sow
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Milagritos D Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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6
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Atlas HE, Conteh B, Islam MT, Jere KC, Omore R, Sanogo D, Schiaffino F, Yousafzai MT, Ahmed N, Awuor AO, Badji H, Cornick J, Feutz E, Galagan SR, Haidara FC, Horne B, Hossen MI, Hotwani A, Houpt ER, Jallow AF, Karim M, Keita AM, Keita Y, Khanam F, Liu J, Malemia T, Manneh A, McGrath CJ, Nasrin D, Ndalama M, Ochieng JB, Ogwel B, Paredes Olortegui M, Zegarra Paredes LF, Pinedo Vasquez T, Platts-Mills JA, Qudrat-E-Khuda S, Qureshi S, Hasan Rajib MN, Rogawski McQuade ET, Sultana S, Tennant SM, Tickell KD, Witte D, Peñataro Yori P, Cunliffe NA, Hossain MJ, Kosek MN, Kotloff KL, Qadri F, Qamar FN, Tapia MD, Pavlinac PB. Diarrhea Case Surveillance in the Enterics for Global Health Shigella Surveillance Study: Epidemiologic Methods. Open Forum Infect Dis 2024; 11:S6-S16. [PMID: 38532963 PMCID: PMC10962728 DOI: 10.1093/ofid/ofad664] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
Background Shigella is a leading cause of acute watery diarrhea, dysentery, and diarrhea-attributed linear growth faltering, a precursor to stunting and lifelong morbidity. Several promising Shigella vaccines are in development and field efficacy trials will require a consortium of potential vaccine trial sites with up-to-date Shigella diarrhea incidence data. Methods The Enterics for Global Health (EFGH) Shigella surveillance study will employ facility-based enrollment of diarrhea cases aged 6-35 months with 3 months of follow-up to establish incidence rates and document clinical, anthropometric, and financial consequences of Shigella diarrhea at 7 country sites (Mali, Kenya, The Gambia, Malawi, Bangladesh, Pakistan, and Peru). Over a 24-month period between 2022 and 2024, the EFGH study aims to enroll 9800 children (1400 per country site) between 6 and 35 months of age who present to local health facilities with diarrhea. Shigella species (spp.) will be identified and serotyped from rectal swabs by conventional microbiologic methods and quantitative polymerase chain reaction. Shigella spp. isolates will undergo serotyping and antimicrobial susceptibility testing. Incorporating population and healthcare utilization estimates from contemporaneous household sampling in the catchment areas of enrollment facilities, we will estimate Shigella diarrhea incidence rates. Conclusions This multicountry surveillance network will provide key incidence data needed to design Shigella vaccine trials and strengthen readiness for potential trial implementation. Data collected in EFGH will inform policy makers about the relative importance of this vaccine-preventable disease, accelerating the time to vaccine availability and uptake among children in high-burden settings.
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Affiliation(s)
- Hannah E Atlas
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Bakary Conteh
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Md Taufiqul Islam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Khuzwayo C Jere
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Medical Laboratory Sciences, Kamuzu University of Health Sciences, School of Life Sciences and Health Professions, Blantyre, Malawi
| | - Richard Omore
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Doh Sanogo
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | - Francesca Schiaffino
- Faculty of Veterinary Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Infectious Diseases and International Health University of Virginia, School of Medicine, Charlottesville, Virginia, USA
| | | | - Naveed Ahmed
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Alex O Awuor
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Henry Badji
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Jennifer Cornick
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Erika Feutz
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Sean R Galagan
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Bri’Anna Horne
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Md Ismail Hossen
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Eric R Houpt
- Division of Infectious Diseases and International Health University of Virginia, School of Medicine, Charlottesville, Virginia, USA
| | - Abdoulie F Jallow
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Mehrab Karim
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Youssouf Keita
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | - Farhana Khanam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jie Liu
- School of Public Health, Qingdao University, Qingdao, China
| | | | - Alhagie Manneh
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Christine J McGrath
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Dilruba Nasrin
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | - Billy Ogwel
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | | | | | - James A Platts-Mills
- Division of Infectious Diseases and International Health University of Virginia, School of Medicine, Charlottesville, Virginia, USA
| | - Syed Qudrat-E-Khuda
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sonia Qureshi
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Md Nazmul Hasan Rajib
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Shazia Sultana
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Sharon M Tennant
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kirkby D Tickell
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Desiree Witte
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Pablo Peñataro Yori
- Division of Infectious Diseases and International Health University of Virginia, School of Medicine, Charlottesville, Virginia, USA
| | - Nigel A Cunliffe
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - M Jahangir Hossain
- Medical Research Council Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Margaret N Kosek
- Division of Infectious Diseases and International Health University of Virginia, School of Medicine, Charlottesville, Virginia, USA
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Milagritos D Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Patricia B Pavlinac
- Department of Global Health, University of Washington, Seattle, Washington, USA
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7
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Garcia Gomez E, Igunza KA, Madewell ZJ, Akelo V, Onyango D, El Arifeen S, Gurley ES, Hossain MZ, Chowdhury MAI, Islam KM, Assefa N, Scott JAG, Madrid L, Tilahun Y, Orlien S, Kotloff KL, Tapia MD, Keita AM, Mehta A, Magaço A, Torres-Fernandez D, Nhacolo A, Bassat Q, Mandomando I, Ogbuanu I, Cain CJ, Luke R, Kamara SIB, Legesse H, Madhi S, Dangor Z, Mahtab S, Wise A, Adam Y, Whitney CG, Mutevedzi PC, Blau DM, Breiman RF, Tippett Barr BA, Rees CA. Identifying delays in healthcare seeking and provision: The Three Delays-in-Healthcare and mortality among infants and children aged 1-59 months. PLOS Glob Public Health 2024; 4:e0002494. [PMID: 38329969 PMCID: PMC10852234 DOI: 10.1371/journal.pgph.0002494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
Delays in illness recognition, healthcare seeking, and in the provision of appropriate clinical care are common in resource-limited settings. Our objective was to determine the frequency of delays in the "Three Delays-in-Healthcare", and factors associated with delays, among deceased infants and children in seven countries with high childhood mortality. We conducted a retrospective, descriptive study using data from verbal autopsies and medical records for infants and children aged 1-59 months who died between December 2016 and February 2022 in six sites in sub-Saharan Africa and one in South Asia (Bangladesh) and were enrolled in Child Health and Mortality Prevention Surveillance (CHAMPS). Delays in 1) illness recognition in the home/decision to seek care, 2) transportation to healthcare facilities, and 3) the receipt of clinical care in healthcare facilities were categorized according to the "Three Delays-in-Healthcare". Comparisons in factors associated with delays were made using Chi-square testing. Information was available for 1,326 deaths among infants and under 5 children. The majority had at least one identified delay (n = 854, 64%). Waiting >72 hours after illness recognition to seek health care (n = 422, 32%) was the most common delay. Challenges in obtaining transportation occurred infrequently when seeking care (n = 51, 4%). In healthcare facilities, prescribed medications were sometimes unavailable (n = 102, 8%). Deceased children aged 12-59 months experienced more delay than infants aged 1-11 months (68% vs. 61%, P = 0.018). Delays in seeking clinical care were common among deceased infants and children. Additional study to assess the frequency of delays in seeking clinical care and its provision among children who survive is warranted.
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Affiliation(s)
- Elisa Garcia Gomez
- Emory University School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | | | - Zachary J. Madewell
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Victor Akelo
- Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | | | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Emily S. Gurley
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Mohammad Zahid Hossain
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Kazi Munisul Islam
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nega Assefa
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Harar, Ethiopia
| | | | - Lola Madrid
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Harar, Ethiopia
| | - Yenenesh Tilahun
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Harar, Ethiopia
| | - Stian Orlien
- College of Medicine and Health Sciences, University of Hargeisa, Hargeisa, Somaliland
- Department of Paediatrics, Vestfold Hospital Trust, Tønsberg, Norway
| | - Karen L. Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Milagritos D. Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | - Ashka Mehta
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Amilcar Magaço
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - David Torres-Fernandez
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal – Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal – Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institució Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal – Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Moçambique
| | | | | | - Ronita Luke
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Shabir Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Amy Wise
- Department of Obstetrics and Gynaecology, Rahima Mossa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Yasmin Adam
- Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Cynthia G. Whitney
- Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Portia C. Mutevedzi
- Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Dianna M. Blau
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Robert F. Breiman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | | | - Chris A. Rees
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
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8
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Tate JE, Mwenda JM, Keita AM, Tapsoba TW, Ngendahayo E, Kouamé BD, Samateh AL, Aliabadi N, Sissoko S, Traore Y, Bayisenga J, Sounkere-Soro M, Jagne S, Burke RM, Onwuchekwa U, Ouattara M, Bikoroti JB, N'Zue K, Leshem E, Coulibaly O, Ouedraogo I, Uwimana J, Sow S, Parashar UD. Evaluation of Intussusception Following Pentavalent Rotavirus Vaccine (RotaTeq) Administration in 5 African Countries. Clin Infect Dis 2024; 78:210-216. [PMID: 37596934 DOI: 10.1093/cid/ciad492] [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: 06/15/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND A low-level risk of intussusception following rotavirus vaccination has been observed in some settings and may vary by vaccine type. We examined the association between RotaTeq vaccination and intussusception in low-income settings in a pooled analysis from 5 African countries that introduced RotaTeq into their national immunization program. METHODS Active surveillance was conducted at 20 hospitals to identify intussusception cases. A standard case report form was completed for each enrolled child, and vaccination status was determined by review of the child's vaccination card. The pseudo-likelihood adaptation of self-controlled case-series method was used to assess the association between RotaTeq administration and intussusception in the 1-7, 8-21, and 1-21 day periods after each vaccine dose in infants aged 28-245 days. RESULTS Data from 318 infants with confirmed rotavirus vaccination status were analyzed. No clustering of cases occurred in any of the risk windows after any of the vaccine doses. Compared with the background risk of naturally occurring intussusception, no increased risk was observed after dose 1 in the 1-7 day (relative incidence = 2.71; 95% confidence interval [CI] = 0.47-8.03) or the 8-21 day window (relative incidence = 0.77; 95%CI = 0.0-2.69). Similarly, no increased risk of intussusception was observed in any risk window after dose 2 or 3. CONCLUSIONS RotaTeq vaccination was not associated with increased risk of intussusception in this analysis from 5 African countries. This finding mirrors results from similar analyses with other rotavirus vaccines in low-income settings and highlights the need for vaccine-specific and setting-specific risk monitoring.
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Affiliation(s)
- Jacqueline E Tate
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jason M Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | | | | | | | | | - Negar Aliabadi
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Yacouba Traore
- Centre Hospitalier Universitaire Sourou SANOU de Bobo Dioulasso, Bobo Dioulasso, Burkina Faso
| | | | | | - Sheriffo Jagne
- National Public Health Reference Laboratory, Ministry of Health, Banjul, The Gambia
| | - Rachel M Burke
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Ma Ouattara
- World Health Organization Country Office, Ouagadougou, Burkina Faso
| | | | - Kofi N'Zue
- World Health Organization Country Office, Abidjan, Cote d'Ivoire
| | - Eyal Leshem
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Oumar Coulibaly
- Centre Hospitalier Universitaire Gabriel Touré, Bamako, Mali
| | - Issa Ouedraogo
- Ministry of Health, Expanded Program on Immunizations, Ouagadougou, Burkina Faso
| | | | - Samba Sow
- Center for Vaccine Development, Bamako, Mali
| | - Umesh D Parashar
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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9
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Rees CA, Igunza KA, Madewell ZJ, Akelo V, Onyango D, El Arifeen S, Gurley ES, Hossain MZ, Rahman A, Alam M, Scott JAG, Assefa N, Madrid L, Belachew A, Leulseged H, Kotloff KL, Sow SO, Tapia MD, Keita AM, Sidibe D, Sitoe A, Varo R, Ajanovic S, Bassat Q, Mandomando I, Tippett Barr BA, Ogbuanu I, Cain CJ, Bassey IA, Luke R, Gassama K, Madhi S, Dangor Z, Mahtab S, Velaphi S, du Toit J, Mutevedzi PC, Blau DM, Breiman RF, Whitney CG. Provider adherence to clinical care recommendations for infants and children who died in seven low- and middle-income countries in the Child Health and Mortality Prevention Surveillance (CHAMPS) network. EClinicalMedicine 2023; 63:102198. [PMID: 37692079 PMCID: PMC10484959 DOI: 10.1016/j.eclinm.2023.102198] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023] Open
Abstract
Background Most childhood deaths globally are considered preventable through high-quality clinical care, which includes adherence to clinical care recommendations. Our objective was to describe adherence to World Health Organization recommendations for the management of leading causes of death among children. Methods We conducted a retrospective, descriptive study examining clinical data for children aged 1-59 months who were hospitalized and died in a Child Health and Mortality Prevention Surveillance (CHAMPS) catchment, December 2016-June 2021. Catchment areas included: Baliakandi and Faridpur, Bangladesh; Kersa, Haramaya, and Harar, Ethiopia; Kisumu and Siaya, Kenya; Bamako, Mali; Manhiça and Quelimane, Mozambique; Makeni, Sierra Leone; Soweto, South Africa. We reviewed medical records of those who died from lower respiratory tract infections, sepsis, malnutrition, malaria, and diarrheal diseases to determine the proportion who received recommended treatments and compared adherence by hospitalization duration. Findings CHAMPS enrolled 460 hospitalized children who died from the leading causes (median age 12 months, 53.0% male). Median hospital admission was 31 h. There were 51.0% (n = 127/249) of children who died from lower respiratory tract infections received supplemental oxygen. Administration of intravenous fluids for sepsis (15.9%, n = 36/226) and supplemental feeds for malnutrition (14.0%, n = 18/129) were uncommon. There were 51.4% (n = 55/107) of those who died from malaria received antimalarials. Of the 80 children who died from diarrheal diseases, 76.2% received intravenous fluids. Those admitted for ≥24 h more commonly received antibiotics for lower respiratory tract infections and sepsis, supplemental feeds for malnutrition, and intravenous fluids for sepsis than those admitted <24 h. Interpretation Provision of recommended clinical care for leading causes of death among young children was suboptimal. Further studies are needed to understand the reasons for deficits in clinical care recommendation adherence. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- Chris A. Rees
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
- Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | | | - Zachary J. Madewell
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Victor Akelo
- Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | | | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Emily S. Gurley
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Mohammad Zahid Hossain
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Afruna Rahman
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Muntasir Alam
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Nega Assefa
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lola Madrid
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Anteneh Belachew
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Ethiopia
| | - Haleluya Leulseged
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Ethiopia
| | - Karen L. Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Samba O. Sow
- Centre pour le Développement des Vaccins-Mali, Bamako, Mali
| | - Milagritos D. Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | | | | | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Rosauro Varo
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Sara Ajanovic
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Moçambique
| | | | | | | | | | - Ronita Luke
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Shabir Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sithembiso Velaphi
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeanie du Toit
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Portia C. Mutevedzi
- Global Health Institute, Emory University, Atlanta, GA, United States of America
| | - Dianna M. Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Robert F. Breiman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Cynthia G. Whitney
- Global Health Institute, Emory University, Atlanta, GA, United States of America
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10
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Mahtab S, Madewell ZJ, Madhi SA, Wise A, Swart PJ, Velaphi S, Mandomando I, Bramugy J, Mabunda R, Xerinda E, Scott AG, Assefa N, Madrid L, Bweihun M, Temesgen F, Onyango D, Akelo V, Oliech R, Otieno P, Verani JR, Arifeen SE, Gurley ES, Alam M, Rahman A, Hossain MZ, Sow S, Kotloff K, Tapia M, Keita AM, Sanogo D, Ogbuanu I, Ojulong J, Lako S, Ita O, Kaluma E, Wilson T, Mutevedzi P, Barr BAT, Whitney CG, Blau DM, Bassat Q. Stillbirths and Neonatal Deaths Caused by Group B Streptococcus in Africa and South Asia Identified Through Child Health and Mortality Prevention Surveillance (CHAMPS). Open Forum Infect Dis 2023; 10:ofad356. [PMID: 37674633 PMCID: PMC10478157 DOI: 10.1093/ofid/ofad356] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/10/2023] [Indexed: 09/08/2023] Open
Abstract
Background Invasive Group B Streptococcus (GBS) is a common cause of early-onset neonatal sepsis and is also associated with stillbirth. This study aimed to determine the proportion of stillborn infants and infants who died between 0 and 90 days attributable to GBS using postmortem minimally invasive tissue sampling (MITS) in 7 low- and middle-income countries (LMICs) participating in Child Health and Mortality Prevention Surveillance (CHAMPS). Methods Deaths that occurred between December 2016 and December 2021 were investigated with MITS, including culture for bacteria of blood and cerebrospinal fluid (CSF), multipathogen polymerase chain reaction on blood, CSF, and lung tissue and histopathology of lung, liver, and brain. Data collection included clinical record review and verbal autopsy. Expert panels reviewed all information and assigned causes of death. Results We evaluated 2966 deaths, including stillborn infants (n = 1322), infants who died during first day of life (0 to <24 hours, n = 597), early neonatal deaths (END) (1 day to <7 days; END; n = 593), and deaths from 7 to 90 days (n = 454). Group B Streptococcus was determined to be in the causal pathway of death for 2.7% of infants (79 of 2, 966; range, 0.3% in Sierra Leone to 7.2% in South Africa), including 2.3% (31 of 1322) of stillbirths, 4.7% (28 of 597) 0 to <24 hours, 1.9% (11 of 593) END, and 2.0% (9 of 454) of deaths from 7 to 90 days of age. Among deaths attributed to GBS with birth weight data available, 61.9% (39 of 63) of decedents weighed <2500 grams at birth. Group B Streptococcus sepsis was the postmortem diagnosis for 100% (31 of 31) of stillbirths. For deaths <90 days, postmortem diagnoses included GBS sepsis (83.3%, 40 of 48), GBS meningitis (4.2%, 2 of 48), and GBS pneumonia (2.1%, 1 of 48). Conclusions Our study reveals significant heterogeneity in the contribution of invasive GBS disease to infant mortality across different countries, emphasizing the need for tailored prevention strategies. Moreover, our findings highlight the substantial impact of GBS on stillbirths, shedding light on a previously underestimated aspect in LMICs.
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Affiliation(s)
- Sana Mahtab
- South African Medical Research Council, Vaccines Infectious Diseases and Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zachary J Madewell
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shabir A Madhi
- South African Medical Research Council, Vaccines Infectious Diseases and Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amy Wise
- National Health for Laboratory Service in South Africa, Johannesburg, South Africa
| | - Peter J Swart
- Department of Obstetrics and Gynecology, Rahima Mossa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Sithembiso Velaphi
- Department of Pediatrics, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Instituto Nacional de Saúde (INS), Maputo, Mozambique
| | - Justina Bramugy
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Rita Mabunda
- ISGlobal—Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
| | - Elisio Xerinda
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lola Madrid
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | | | | | - Dickens Onyango
- Kisumu County Department of Health, Ministry of Health, Kisumu, Kenya
| | - Victor Akelo
- US Centers for Disease Control and Prevention–Kenya, Kisumu, Kenya
| | - Richard Oliech
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Peter Otieno
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Jennifer R Verani
- National Center for Immunization and Respiratory Disease, Centers for Disease Control, Atlanta, Georgia, USA
| | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research (icddr, b), Dhaka, Bangladesh
| | - Emily S Gurley
- International Center for Diarrhoeal Diseases Research (icddr, b), Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Muntasir Alam
- International Center for Diarrhoeal Diseases Research (icddr, b), Dhaka, Bangladesh
| | - Afruna Rahman
- International Center for Diarrhoeal Diseases Research (icddr, b), Dhaka, Bangladesh
| | | | - Samba Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Karen Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Milagritos Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Doh Sanogo
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | | | | | - Sandra Lako
- Aberdeen Women's Centre in Freetown, Sierra Leone
| | | | | | - Tais Wilson
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Portia Mutevedzi
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Beth A Tippett Barr
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Cynthia G Whitney
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Dianna M Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal—Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
- Institutó Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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11
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Bassat Q, Blau DM, Ogbuanu IU, Samura S, Kaluma E, Bassey IA, Sow S, Keita AM, Tapia MD, Mehta A, Kotloff KL, Rahman A, Islam KM, Alam M, El Arifeen S, Gurley ES, Baillie V, Mutevedzi P, Mahtab S, Thwala BN, Tippett Barr BA, Onyango D, Akelo V, Rogena E, Onyango P, Omore R, Mandomando I, Ajanovic S, Varo R, Sitoe A, Duran-Frigola M, Assefa N, Scott JAG, Madrid L, Tesfaye T, Dessie Y, Madewell ZJ, Breiman RF, Whitney CG, Madhi SA. Causes of Death Among Infants and Children in the Child Health and Mortality Prevention Surveillance (CHAMPS) Network. JAMA Netw Open 2023; 6:e2322494. [PMID: 37494044 PMCID: PMC10372710 DOI: 10.1001/jamanetworkopen.2023.22494] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
Importance The number of deaths of children younger than 5 years has been steadily decreasing worldwide, from more than 17 million annual deaths in the 1970s to an estimated 5.3 million in 2019 (with 2.8 million deaths occurring in those aged 1-59 months [53% of all deaths in children aged <5 years]). More detailed characterization of childhood deaths could inform interventions to improve child survival. Objective To describe causes of postneonatal child deaths across 7 mortality surveillance sentinel sites in Africa and Asia. Design, Setting, and Participants The Child Health and Mortality Prevention Surveillance (CHAMPS) Network conducts childhood mortality surveillance in sub-Saharan Africa and South Asia using innovative postmortem minimally invasive tissue sampling (MITS). In this cross-sectional study, MITS was conducted in deceased children aged 1 to 59 months at 7 sites in sub-Saharan Africa and South Asia from December 3, 2016, to December 3, 2020. Data analysis was conducted between October and November 2021. Main Outcomes and Measures The expert panel attributed underlying, intermediate, and immediate conditions in the chain of events leading to death, based on histopathologic analysis, microbiological diagnostics, clinical data, and verbal autopsies. Results In this study, MITS was performed in 632 deceased children (mean [SD] age at death, 1.3 [0.3] years; 342 [54.1%] male). The 6 most common underlying causes of death were malnutrition (104 [16.5%]), HIV (75 [11.9%]), malaria (71 [11.2%]), congenital birth defects (64 [10.1%]), lower respiratory tract infections (LRTIs; 53 [8.4%]), and diarrheal diseases (46 [7.2%]). When considering immediate causes only, sepsis (191 [36.7%]) and LRTI (129 [24.8%]) were the 2 dominant causes. An infection was present in the causal chain in 549 of 632 deaths (86.9%); pathogens most frequently contributing to infectious deaths included Klebsiella pneumoniae (155 of 549 infectious deaths [28.2%]; 127 [81.9%] considered nosocomial), Plasmodium falciparum (122 of 549 [22.2%]), and Streptococcus pneumoniae (109 of 549 [19.9%]). Other organisms, such as cytomegalovirus (57 [10.4%]) and Acinetobacter baumannii (39 [7.1%]; 35 of 39 [89.7%] considered nosocomial), also played important roles. For the top underlying causes of death, the median number of conditions in the chain of events leading to death was 3 for malnutrition, 3 for HIV, 1 for malaria, 3 for congenital birth defects, and 1 for LRTI. Expert panels considered 494 of 632 deaths (78.2%) preventable and 26 of 632 deaths (4.1%) preventable under certain conditions. Conclusions and Relevance In this cross-sectional study investigating causes of child mortality in the CHAMPS Network, results indicate that, in these high-mortality settings, infectious diseases continue to cause most deaths in infants and children, often in conjunction with malnutrition. These results also highlight opportunities for action to prevent deaths and reveal common interaction of various causes in the path toward death.
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Affiliation(s)
- Quique Bassat
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça-CISM, Maputo, Mozambique
- ICREA, Pg. Lluís Companys 23, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública-CIBERESP, Madrid, Spain
| | - Dianna M Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Samba Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Milagritos D Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Ashka Mehta
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Karen L Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Afruna Rahman
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Kazi Munisul Islam
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Muntasir Alam
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Emily S Gurley
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Vicky Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Portia Mutevedzi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bukiwe Nana Thwala
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Victor Akelo
- Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | - Emily Rogena
- Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | - Peter Onyango
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Inacio Mandomando
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça-CISM, Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Moçambique
| | - Sara Ajanovic
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça-CISM, Maputo, Mozambique
| | - Rosauro Varo
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça-CISM, Maputo, Mozambique
| | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça-CISM, Maputo, Mozambique
| | | | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Lola Madrid
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Tseyon Tesfaye
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Yadeta Dessie
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Zachary J Madewell
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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12
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Omore R, Powell H, Sow SO, Jahangir Hossain M, Ogwel B, Doh S, Ochieng JB, Jones JCM, Zaman SMA, Awuor AO, Juma J, Kasumba IN, Roose A, Jamka LP, Nasrin D, Liu J, Keita AM, Traoré A, Onwuchekwa U, Badji H, Sarwar G, Antonio M, Sugerman CE, Mintz ED, Houpt ER, Verani JR, Widdowson MA, Tennant SM, Platts-Mills JA, Tate JE, Parashar UD, Kotloff KL. Norovirus Disease Among Children <5 Years in 3 Sub-Saharan African Countries: Findings From the Vaccine Impact on Diarrhea in Africa (VIDA) Study, 2015-2018. Clin Infect Dis 2023; 76:S114-S122. [PMID: 37074441 PMCID: PMC10116553 DOI: 10.1093/cid/ciac967] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND To address a paucity of data from sub-Saharan Africa, we examined the prevalence, severity, and seasonality of norovirus genogroup II (NVII) among children <5 years old in The Gambia, Kenya, and Mali following rotavirus vaccine introduction. METHODS Population-based surveillance was conducted to capture medically-attended moderate-to-severe diarrhea (MSD) cases, defined as a child 0-59 months old passing ≥3 loose stools in a 24-hour period with ≥1 of the following: sunken eyes, poor skin turgor, dysentery, intravenous rehydration, or hospitalization within 7 days of diarrhea onset. Diarrhea-free matched controls randomly selected from a censused population were enrolled at home. Stools from cases and controls were tested for enteropathogens, including norovirus and rotavirus, by TaqMan quantitative polymerase chain reaction (PCR) and conventional reverse transcription PCR. We used multiple logistic regression to derive adjusted attributable fractions (AFe) for each pathogen causing MSD, which takes into consideration the prevalence in both cases and controls, for each site and age. A pathogen was considered etiologic if AFe was ≥0.5. In further analyses focusing on the predominant NVII strains, we compared rotavirus and NVII severity using a 20-point modified Vesikari score and examined seasonal fluctuations. RESULTS From May 2015 to July 2018, we enrolled 4840 MSD cases and 6213 controls. NVI was attributed to only 1 MSD episode. NVII was attributed to 185 (3.8%) of all MSD episodes and was the sole attributable pathogen in 139 (2.9%); peaking (36.0%) at age 6-8 months with majority (61.2%) aged 6-11 months. MSD cases whose episodes were attributed to NVII alone compared with rotavirus alone were younger (median age, 8 vs 12 months, P < .0001) and had less severe illness (median Vesikari severity score, 9 vs 11, P = .0003) but equally likely to be dehydrated. NVII occurred year-round at all study sites. CONCLUSIONS Infants aged 6-11 months bear the greatest burden of norovirus disease, with NVII predominating. An early infant vaccine schedule and rigorous adherence to guidelines recommended for management of dehydrating diarrhea may offer substantial benefit in these African settings.
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Affiliation(s)
- Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Helen Powell
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Samba O Sow
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - M Jahangir Hossain
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Billy Ogwel
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Sanogo Doh
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - John B Ochieng
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Joquina Chiquita M Jones
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Syed M A Zaman
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Alex O Awuor
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Jane Juma
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Irene N Kasumba
- Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Anna Roose
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Leslie P Jamka
- Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Dilruba Nasrin
- Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jie Liu
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Awa Traoré
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Uma Onwuchekwa
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Henry Badji
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Golam Sarwar
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Martin Antonio
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Ciara E Sugerman
- Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric D Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jennifer R Verani
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Marc-Alain Widdowson
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Sharon M Tennant
- Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jacqueline E Tate
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Umesh D Parashar
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karen L Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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13
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Buchwald AG, Verani JR, Keita AM, Jahangir Hossain M, Roose A, Sow SO, Omore R, Doh S, Jones JCM, Nasrin D, Zaman SMA, Okoi C, Antonio M, Ochieng JB, Juma J, Onwuchekwa U, Powell H, Platts-Mills JA, Tennant SM, Kotloff KL. Etiology, Presentation, and Risk Factors for Diarrheal Syndromes in 3 Sub-Saharan African Countries After the Introduction of Rotavirus Vaccines From the Vaccine Impact on Diarrhea in Africa (VIDA) Study. Clin Infect Dis 2023; 76:S12-S22. [PMID: 37074436 PMCID: PMC10116565 DOI: 10.1093/cid/ciad022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Diarrheal disease is heterogeneous, including watery diarrhea (WD) and dysentery, some cases of which become persistent diarrhea (PD). Changes in risk over time necessitate updated knowledge of these syndromes in sub-Saharan Africa. METHODS The Vaccine Impact on Diarrhea in Africa (VIDA) study was an age-stratified, case-control study of moderate-to-severe diarrhea among children <5 years old in The Gambia, Mali, and Kenya (2015-2018). We analyzed cases with follow-up of about 60 days after enrollment to detect PD (lasting ≥14 days), examined the features of WD and dysentery, and examined determinants for progression to and sequelae from PD. Data were compared with those from the Global Enteric Multicenter Study (GEMS) to detect temporal changes. Etiology was assessed from stool samples using pathogen attributable fractions (AFs), and predictors were assessed using χ2 tests or multivariate regression, where appropriate. RESULTS Among 4606 children with moderate-to-severe diarrhea, 3895 (84.6%) had WD and 711 (15.4%) had dysentery. PD was more frequent among infants (11.3%) than in children 12-23 months (9.9%) or 24-59 months (7.3%), P = .001 and higher in Kenya (15.5%) than in The Gambia (9.3%) or Mali (4.3%), P < .001; the frequencies were similar among children with WD (9.7%) and those with dysentery (9.4%). Compared to children not treated with antibiotics, those who received antibiotics had a lower frequency of PD overall (7.4% vs 10.1%, P = .01), and particularly among those with WD (6.3% vs 10.0%; P = .01) but not among children with dysentery (8.5% vs 11.0%; P = .27). For those with watery PD, Cryptosporidium and norovirus had the highest AFs among infants (0.16 and 0.12, respectively), while Shigella had the highest AF (0.25) in older children. The odds of PD decreased significantly over time in Mali and Kenya while increasing significantly in The Gambia. CONCLUSIONS The burden of PD endures in sub-Saharan Africa, with nearly 10% of episodes of WD and dysentery becoming persistent.
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Affiliation(s)
- Andrea G Buchwald
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jennifer R Verani
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - M Jahangir Hossain
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Anna Roose
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Samba O Sow
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Sanogo Doh
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Joquina Chiquita M Jones
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Dilruba Nasrin
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Syed M A Zaman
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Catherine Okoi
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Martin Antonio
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - John B Ochieng
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Jane Juma
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Uma Onwuchekwa
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Helen Powell
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Sharon M Tennant
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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14
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Ochieng JB, Powell H, Sugerman CE, Omore R, Ogwel B, Juma J, Awuor AO, Sow SO, Sanogo D, Onwuchekwa U, Keita AM, Traoré A, Badji H, Hossain MJ, Jones JCM, Kasumba IN, Nasrin D, Roose A, Liang Y, Jamka LP, Antonio M, Platts-Mills JA, Liu J, Houpt ER, Mintz ED, Hunsperger E, Onyango CO, Strockbine N, Widdowson MA, Verani JR, Tennant SM, Kotloff KL. Epidemiology of Enteroaggregative, Enteropathogenic, and Shiga Toxin-Producing Escherichia coli Among Children Aged <5 Years in 3 Countries in Africa, 2015-2018: Vaccine Impact on Diarrhea in Africa (VIDA) Study. Clin Infect Dis 2023; 76:S77-S86. [PMID: 37074433 PMCID: PMC10116530 DOI: 10.1093/cid/ciad035] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND To address knowledge gaps regarding diarrheagenic Escherichia coli (DEC) in Africa, we assessed the clinical and epidemiological features of enteroaggregative E. coli (EAEC), enteropathogenic E. coli (EPEC), and Shiga toxin-producing E. coli (STEC) positive children with moderate-to-severe diarrhea (MSD) in Mali, The Gambia, and Kenya. METHODS Between May 2015 and July 2018, children aged 0-59 months with medically attended MSD and matched controls without diarrhea were enrolled. Stools were tested conventionally using culture and multiplex polymerase chain reaction (PCR), and by quantitative PCR (qPCR). We assessed DEC detection by site, age, clinical characteristics, and enteric coinfection. RESULTS Among 4840 children with MSD and 6213 matched controls enrolled, 4836 cases and 1 control per case were tested using qPCR. Of the DEC detected with TAC, 61.1% were EAEC, 25.3% atypical EPEC (aEPEC), 22.4% typical EPEC (tEPEC), and 7.2% STEC. Detection was higher in controls than in MSD cases for EAEC (63.9% vs 58.3%, P < .01), aEPEC (27.3% vs 23.3%, P < .01), and STEC (9.3% vs 5.1%, P < .01). EAEC and tEPEC were more frequent in children aged <23 months, aEPEC was similar across age strata, and STEC increased with age. No association between nutritional status at follow-up and DEC pathotypes was found. DEC coinfection with Shigella/enteroinvasive E. coli was more common among cases (P < .01). CONCLUSIONS No significant association was detected between EAEC, tEPEC, aEPEC, or STEC and MSD using either conventional assay or TAC. Genomic analysis may provide a better definition of the virulence factors associated with diarrheal disease.
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Affiliation(s)
- John B Ochieng
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Helen Powell
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ciara E Sugerman
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Billy Ogwel
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Jane Juma
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Alex O Awuor
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Samba O Sow
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | - Doh Sanogo
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | - Uma Onwuchekwa
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | | | - Awa Traoré
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | - Henry Badji
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - M Jahangir Hossain
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Joquina Chiquita M Jones
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Irene N Kasumba
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Dilruba Nasrin
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Anna Roose
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Yuanyuan Liang
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Leslie P Jamka
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Martin Antonio
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jie Liu
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
- Department of Microbial Surveillance and Biosafety, School of Public Health, Qingdao University, Qingdao, China
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Eric D Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth Hunsperger
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Clayton O Onyango
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Nancy Strockbine
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marc-Alain Widdowson
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Jennifer R Verani
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Sharon M Tennant
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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15
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Keita AM, Doh S, Sow SO, Powell H, Omore R, Jahangir Hossain M, Ogwel B, Ochieng JB, Jones JCM, Zaman SMA, Awuor AO, Juma J, Nasrin D, Liu J, Traoré A, Onwuchekwa U, Badji H, Sarwar G, Antonio M, Houpt ER, Tennant SM, Kasumba IN, Jamka LP, Roose A, Platts-Mills JA, Verani JR, Tate JE, Parashar UD, Neuzil KM, Kotloff KL. Prevalence, Clinical Severity, and Seasonality of Adenovirus 40/41, Astrovirus, Sapovirus, and Rotavirus Among Young Children With Moderate-to-Severe Diarrhea: Results From the Vaccine Impact on Diarrhea in Africa (VIDA) Study. Clin Infect Dis 2023; 76:S123-S131. [PMID: 37074439 PMCID: PMC10116545 DOI: 10.1093/cid/ciad060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND While rotavirus causes severe diarrheal disease in children aged <5 years, data on other viral causes in sub-Saharan Africa are limited. METHODS In the Vaccine Impact on Diarrhea in Africa study (2015-2018), we analyzed stool from children aged 0-59 months with moderate-to-severe diarrhea (MSD) and without diarrhea (controls) in Kenya, Mali, and The Gambia using quantitative polymerase chain reaction. We derived the attributable fraction (AFe) based on the association between MSD and the pathogen, accounting for other pathogens, site, and age. A pathogen was attributable if the AFe was ≥0.5.The severity of attributable MSD was defined by a modified Vesikari score (mVS). Monthly cases were plotted against temperature and rainfall to assess seasonality. RESULTS Among 4840 MSD cases, proportions attributed to rotavirus, adenovirus 40/41, astrovirus, and sapovirus were 12.6%, 2.7%, 2.9%, and 1.9%, respectively. Attributable rotavirus, adenovirus 40/41, and astrovirus MSD cases occurred at all sites, with mVS of 11, 10, and 7, respectively. MSD cases attributable to sapovirus occurred in Kenya, with mVS of 9. Astrovirus and adenovirus 40/41 peaked during the rainy season in The Gambia, while rotavirus peaked during the dry season in Mali and The Gambia. CONCLUSIONS In sub-Saharan Africa, rotavirus was the most common cause of MSD; adenovirus 40/41, astrovirus, and sapovirus contributed to a lesser extent among children aged <5 years. Rotavirus- and adenovirus 40/41-attributable MSD were most severe. Seasonality varied by pathogen and location. Efforts to increase the coverage of rotavirus vaccines and to improve prevention and treatment for childhood diarrhea should continue.
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Affiliation(s)
- Adama Mamby Keita
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Sanogo Doh
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Samba O Sow
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Helen Powell
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - M Jahangir Hossain
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Billy Ogwel
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - John B Ochieng
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Joquina Chiquita M Jones
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Syed M A Zaman
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Alex O Awuor
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Jane Juma
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Dilruba Nasrin
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jie Liu
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Awa Traoré
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Uma Onwuchekwa
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Henry Badji
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Golam Sarwar
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Martin Antonio
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Sharon M Tennant
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Irene N Kasumba
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Leslie P Jamka
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Anna Roose
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jennifer R Verani
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Jacqueline E Tate
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Umesh D Parashar
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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16
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Deichsel EL, Keita AM, Verani JR, Powell H, Jamka LP, Hossain MJ, Jones JCM, Omore R, Awuor AO, Sow SO, Sanogo D, Tapia MD, Neuzil KM, Kotloff KL. Management of Diarrhea in Young Children in Sub-Saharan Africa: Adherence to World Health Organization Recommendations During the Global Enteric Multisite Study (2007-2011) and the Vaccine Impact of Diarrhea in Africa (VIDA) Study (2015-2018). Clin Infect Dis 2023; 76:S23-S31. [PMID: 37074440 PMCID: PMC10116557 DOI: 10.1093/cid/ciac926] [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] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Reducing diarrhea-related morbidity and mortality is a global priority, particularly in low-resource settings. We assessed adherence to diarrhea case management indicators in the Global Enteric Multisite Study (GEMS) and Vaccine Impact of Diarrhea in Africa (VIDA) study. METHODS GEMS (2007-2010) and VIDA (2015-2018) were age-stratified case-control studies of moderate-to-severe diarrhea (MSD) in children aged <5 years. In this case-only analysis, we included children enrolled in The Gambia, Kenya, and Mali. A case with no dehydration received adherent care at home if they were offered more than usual fluids and at least the same as usual to eat. Children with diarrhea and some dehydration are to receive oral rehydration salts (ORS) in the facility. The recommendation for severe dehydration is to receive ORS and intravenous fluids in the facility. Adherent care in the facility included a zinc prescription independent of dehydration severity. RESULTS For home-based management of children with MSD and no signs of dehydration, 16.6% in GEMS and 15.6% in VIDA were adherent to guidelines. Adherence to guidelines in the facility was likewise low during GEMS (some dehydration, 18.5%; severe dehydration, 5.5%). The adherence to facility-based rehydration and zinc guidelines improved during VIDA to 37.9% of those with some dehydration and 8.0% of children with severe dehydration. CONCLUSIONS At research sites in The Gambia, Kenya, and Mali, suboptimal adherence to diarrhea case management guidelines for children aged <5 years was observed. Opportunities exist for improvement in case management for children with diarrhea in low-resource settings.
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Affiliation(s)
- Emily L Deichsel
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Jennifer R Verani
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Helen Powell
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Leslie P Jamka
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - M Jahangir Hossain
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Joquina Chiquita M Jones
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Alex O Awuor
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Samba O Sow
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | - Doh Sanogo
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | - Milagritos D Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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17
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Awuor AO, Ogwel B, Powell H, Verani JR, Sow SO, Hossain MJ, Ochieng JB, Juma J, Jamka LP, Roose A, Doh S, Deichsel EL, Onwuchekwa U, Keita AM, Antonio M, Jones JCM, Zaman SMA, Badji H, Kasumba IN, Nasrin D, Platts-Mills JA, Houpt ER, Berendes DM, Sugerman CE, Widdowson MA, Tennant SM, Mintz ED, Omore R, Kotloff KL. Antibiotic-Prescribing Practices for Management of Childhood Diarrhea in 3 Sub-Saharan African Countries: Findings From the Vaccine Impact on Diarrhea in Africa (VIDA) Study, 2015-2018. Clin Infect Dis 2023; 76:S32-S40. [PMID: 37074427 PMCID: PMC10116514 DOI: 10.1093/cid/ciac980] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Despite antibiotic prescription being recommended for dysentery and suspected cholera only, diarrhea still triggers unwarranted antibiotic prescription. We evaluated antibiotic-prescribing practices and their predictors among children aged 2-59 months in the Vaccine Impact on Diarrhea in Africa (VIDA) Study performed in The Gambia, Mali, and Kenya. METHODS VIDA was a prospective case-control study (May 2015-July 2018) among children presenting for care with moderate-to-severe diarrhea (MSD). We defined inappropriate antibiotic use as prescription or use of antibiotics when not indicated by World Health Organization (WHO) guidelines. We used logistic regression to assess factors associated with antibiotic prescription for MSD cases who had no indication for an antibiotic, at each site. RESULTS VIDA enrolled 4840 cases. Among 1757 (36.3%) who had no apparent indication for antibiotic treatment, 1358 (77.3%) were prescribed antibiotics. In The Gambia, children who presented with a cough (adjusted odds ratio [aOR]: 2.05; 95% confidence interval [95% CI]: 1.21-3.48) were more likely to be prescribed an antibiotic. In Mali, those who presented with dry mouth (aOR: 3.16; 95% CI: 1.02-9.73) were more likely to be prescribed antibiotics. In Kenya, those who presented with a cough (aOR: 2.18; 95% CI: 1.01-4.70), decreased skin turgor (aOR: 2.06; 95% CI: 1.02-4.16), and were very thirsty (aOR: 4.15; 95% CI: 1.78-9.68) were more likely to be prescribed antibiotics. CONCLUSIONS Antibiotic prescription was associated with signs and symptoms inconsistent with WHO guidelines, suggesting the need for antibiotic stewardship and clinician awareness of diarrhea case-management recommendations in these settings.
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Affiliation(s)
- Alex O Awuor
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Billy Ogwel
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Helen Powell
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jennifer R Verani
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Samba O Sow
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - M Jahangir Hossain
- Medical Research Council Unit-The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - John B Ochieng
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Jane Juma
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Leslie P Jamka
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Anna Roose
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sanogo Doh
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Emily L Deichsel
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Uma Onwuchekwa
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Martin Antonio
- Medical Research Council Unit-The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Joquina Chiquita M Jones
- Medical Research Council Unit-The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Syed M A Zaman
- Medical Research Council Unit-The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Henry Badji
- Medical Research Council Unit-The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Irene N Kasumba
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Dilruba Nasrin
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - David M Berendes
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ciara E Sugerman
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marc-Alain Widdowson
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Sharon M Tennant
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Eric D Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Schwartz LM, Oshinsky J, Reymann M, Esona MD, Bowen MD, Jahangir Hossain M, Zaman SMA, Jones JCM, Antonio M, Badji H, Sarwar G, Sow SO, Sanogo D, Keita AM, Tamboura B, Traoré A, Onwuchekwa U, Omore R, Verani JR, Awuor AO, Ochieng JB, Juma J, Ogwel B, Parashar UD, Tate JE, Kasumba IN, Tennant SM, Neuzil KM, Rowhani-Rahbar A, Elizabeth Halloran M, Atmar RL, Pasetti MF, Kotloff KL. Histo-Blood Group Antigen Null Phenotypes Associated With a Decreased Risk of Clinical Rotavirus Vaccine Failure Among Children <2 Years of Age Participating in the Vaccine Impact on Diarrhea in Africa (VIDA) Study in Kenya, Mali, and the Gambia. Clin Infect Dis 2023; 76:S153-S161. [PMID: 37074435 PMCID: PMC10116560 DOI: 10.1093/cid/ciac910] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Previously studied risk factors for rotavirus vaccine failure have not fully explained reduced rotavirus vaccine effectiveness in low-income settings. We assessed the relationship between histo-blood group antigen (HBGA) phenotypes and clinical rotavirus vaccine failure among children <2 years of age participating in the Vaccine Impact on Diarrhea in Africa Study in 3 sub-Saharan African countries. METHODS Saliva was collected and tested for HBGA phenotype in children who received rotavirus vaccine. The association between secretor and Lewis phenotypes and rotavirus vaccine failure was examined overall and by infecting rotavirus genotype using conditional logistic regression in 218 rotavirus-positive cases with moderate-to-severe diarrhea and 297 matched healthy controls. RESULTS Both nonsecretor and Lewis-negative phenotypes (null phenotypes) were associated with decreased rotavirus vaccine failure across all sites (matched odds ratio, 0.30 [95% confidence interval: 0.16-0.56] or 0.39 [0.25-0.62], respectively]. A similar decrease in risk against rotavirus vaccine failure among null HBGA phenotypes was observed for cases with P[8] and P[4] infection and their matched controls. While we found no statistically significant association between null HBGA phenotypes and vaccine failure among P[6] infections, the matched odds ratio point estimate for Lewis-negative individuals was >4. CONCLUSIONS Our study demonstrated a significant relationship between null HBGA phenotypes and decreased rotavirus vaccine failure in a population with P[8] as the most common infecting genotype. Further studies are needed in populations with a large burden of P[6] rotavirus diarrhea to understand the role of host genetics in reduced rotavirus vaccine effectiveness.
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Affiliation(s)
- Lauren M Schwartz
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jennifer Oshinsky
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mardi Reymann
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mathew D Esona
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael D Bowen
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - M Jahangir Hossain
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Syed M A Zaman
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Joquina Chiquita M Jones
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Martin Antonio
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Henry Badji
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Golam Sarwar
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Samba O Sow
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | - Doh Sanogo
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | | | - Boubou Tamboura
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | - Awa Traoré
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | - Uma Onwuchekwa
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Jennifer R Verani
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Alex O Awuor
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - John B Ochieng
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Jane Juma
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Billy Ogwel
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Umesh D Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jacqueline E Tate
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Irene N Kasumba
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sharon M Tennant
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - M Elizabeth Halloran
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington, USA
- Center for Inference and Dynamics of Infectious Diseases, Seattle, Washington, USA
| | - Robert L Atmar
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Marcela F Pasetti
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Nelson EJ, Khan AI, Keita AM, Brintz BJ, Keita Y, Sanogo D, Islam MT, Khan ZH, Rashid MM, Nasrin D, Watt MH, Ahmed SM, Haaland B, Pavia AT, Levine AC, Chao DL, Kotloff KL, Qadri F, Sow SO, Leung DT. Improving Antibiotic Stewardship for Diarrheal Disease With Probability-Based Electronic Clinical Decision Support: A Randomized Crossover Trial. JAMA Pediatr 2022; 176:973-979. [PMID: 36036920 PMCID: PMC9425282 DOI: 10.1001/jamapediatrics.2022.2535] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Inappropriate use of antibiotics for diarrheal illness can result in adverse effects and increase in antimicrobial resistance. OBJECTIVE To determine whether the diarrheal etiology prediction (DEP) algorithm, which uses patient-specific and location-specific features to estimate the probability that diarrhea etiology is exclusively viral, impacts antibiotic prescriptions in patients with acute diarrhea. DESIGN, SETTING, AND PARTICIPANTS A randomized crossover study was conducted to evaluate the DEP incorporated into a smartphone-based electronic clinical decision-support (eCDS) tool. The DEP calculated the probability of viral etiology of diarrhea, based on dynamic patient-specific and location-specific features. Physicians were randomized in the first 4-week study period to the intervention arm (eCDS with the DEP) or control arm (eCDS without the DEP), followed by a 1-week washout period before a subsequent 4-week crossover period. The study was conducted at 3 sites in Bangladesh from November 17, 2021, to January 21, 2021, and at 4 sites in Mali from January 6, 2021, to March 5, 2021. Eligible physicians were those who treated children with diarrhea. Eligible patients were children between ages 2 and 59 months with acute diarrhea and household access to a cell phone for follow-up. INTERVENTIONS Use of the eCDS with the DEP (intervention arm) vs use of the eCDS without the DEP (control arm). MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of children prescribed an antibiotic. RESULTS A total of 30 physician participants and 941 patient participants (57.1% male; median [IQR] age, 12 [8-18] months) were enrolled. There was no evidence of a difference in the proportion of children prescribed antibiotics by physicians using the DEP (risk difference [RD], -4.2%; 95% CI, -10.7% to 1.0%). In a post hoc analysis that accounted for the predicted probability of a viral-only etiology, there was a statistically significant difference in risk of antibiotic prescription between the DEP and control arms (RD, -0.056; 95% CI, -0.128 to -0.01). No known adverse effects of the DEP were detected at 10-day postdischarge. CONCLUSIONS AND RELEVANCE Use of a tool that provides an estimate of etiological likelihood did not result in a significant change in overall antibiotic prescriptions. Post hoc analysis suggests that a higher predicted probability of viral etiology was linked to reductions in antibiotic use. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT04602676.
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Affiliation(s)
- Eric J. Nelson
- Departments of Pediatrics and Environmental and Global Health, Emerging Pathogens Institute, University of Florida, Gainesville
| | - Ashraful I. Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Ben J. Brintz
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City
| | | | - Doh Sanogo
- Center for Vaccine Development—Mali, Bamako, Mali
| | - Md Taufiqul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Zahid Hasan Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md Mahbubur Rashid
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Dilruba Nasrin
- Center for Vaccine Development and the Department of Pediatrics, University of Maryland, Baltimore
| | - Melissa H. Watt
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Sharia M. Ahmed
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City
| | - Ben Haaland
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Andrew T. Pavia
- Division of Pediatrics Infectious Diseases, University of Utah School of Medicine, Salt Lake City
| | - Adam C. Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Dennis L. Chao
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle, Washington
| | - Karen L. Kotloff
- Center for Vaccine Development and the Department of Pediatrics, University of Maryland, Baltimore
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Samba O. Sow
- Center for Vaccine Development—Mali, Bamako, Mali
| | - Daniel T. Leung
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City
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20
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Quincer E, Philipsborn R, Morof D, Salzberg NT, Vitorino P, Ajanovic S, Onyango D, Ogbuanu I, Assefa N, Sow SO, Mutevedzi P, El Arifeen S, Tippet Barr BA, Scott JAG, Mandomando I, Kotloff KL, Jambai A, Akelo V, Cain CJ, Chowdhury AI, Gure T, Igunza KA, Islam F, Keita AM, Madrid L, Mahtab S, Mehta A, Mitei PK, Ntuli C, Ojulong J, Rahman A, Samura S, Sidibe D, Thwala BN, Varo R, Madhi SA, Bassat Q, Gurley ES, Blau DM, Whitney CG. Insights on the differentiation of stillbirths and early neonatal deaths: A study from the Child Health and Mortality Prevention Surveillance (CHAMPS) network. PLoS One 2022; 17:e0271662. [PMID: 35862419 PMCID: PMC9302850 DOI: 10.1371/journal.pone.0271662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/14/2021] [Accepted: 07/05/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction The high burden of stillbirths and neonatal deaths is driving global initiatives to improve birth outcomes. Discerning stillbirths from neonatal deaths can be difficult in some settings, yet this distinction is critical for understanding causes of perinatal deaths and improving resuscitation practices for live born babies. Methods We evaluated data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network to compare the accuracy of determining stillbirths versus neonatal deaths from different data sources and to evaluate evidence of resuscitation at delivery in accordance with World Health Organization (WHO) guidelines. CHAMPS works to identify causes of stillbirth and death in children <5 years of age in Bangladesh and 6 countries in sub-Saharan Africa. Using CHAMPS data, we compared the final classification of a case as a stillbirth or neonatal death as certified by the CHAMPS Determining Cause of Death (DeCoDe) panel to both the initial report of the case by the family member or healthcare worker at CHAMPS enrollment and the birth outcome as stillbirth or livebirth documented in the maternal health record. Results Of 1967 deaths ultimately classified as stillbirth, only 28 (1.4%) were initially reported as livebirths. Of 845 cases classified as very early neonatal death, 33 (4%) were initially reported as stillbirth. Of 367 cases with post-mortem examination showing delivery weight >1000g and no maceration, the maternal clinical record documented that resuscitation was not performed in 161 cases (44%), performed in 14 (3%), and unknown or data missing for 192 (52%). Conclusion This analysis found that CHAMPS cases assigned as stillbirth or neonatal death after DeCoDe expert panel review were generally consistent with the initial report of the case as a stillbirth or neonatal death. Our findings suggest that more frequent use of resuscitation at delivery and improvements in documentation around events at birth could help improve perinatal outcomes.
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Affiliation(s)
- Elizabeth Quincer
- Department of Pediatrics and Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia, United States of America
| | - Rebecca Philipsborn
- Department of Pediatrics and Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia, United States of America
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Diane Morof
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Durban, South Africa
| | - Navit T. Salzberg
- Public Health Informatics, The Task Force for Global Health, Atlanta, Georgia, United States of America
| | - Pio Vitorino
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
| | - Sara Ajanovic
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
| | | | | | - Nega Assefa
- College of Health Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Samba O. Sow
- Centre pour le Développement des Vaccines (CVD-Mali), Bamako, Mali
| | - Portia Mutevedzi
- MRC Vaccines and Infectious Diseases Analytics (VIDA) Research Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Beth A. Tippet Barr
- Center for Global Health, Centers for Disease Control and Prevention, Kisumu, Kenya
| | - J. Anthony G. Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
- Instituto Nacional de Saúde [INS], Maputo, Mozambique
| | - Karen L. Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Amara Jambai
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Victor Akelo
- Center for Global Health, Centers for Disease Control and Prevention, Kisumu, Kenya
| | | | | | - Tadesse Gure
- College of Health Medical Sciences, Haramaya University, Harar, Ethiopia
| | | | - Farzana Islam
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | | | - Lola Madrid
- College of Health Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sana Mahtab
- MRC Vaccines and Infectious Diseases Analytics (VIDA) Research Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Ashka Mehta
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | - Constance Ntuli
- MRC Vaccines and Infectious Diseases Analytics (VIDA) Research Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | | | - Afruna Rahman
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | | | | | - Bukiwe Nana Thwala
- Wits Health Consortium, University of Witwatersrand, Johannesburg, South Africa
| | - Rosauro Varo
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
- ISGlobal- Hospital Clinic—Universitat de Barcelona, Barcelona, Spain
| | - Shabir A. Madhi
- MRC Vaccines and Infectious Diseases Analytics (VIDA) Research Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
- ISGlobal- Hospital Clinic—Universitat de Barcelona, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital de Sant Joan de Deu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigacion Biomedica en Red de Epidemiologia y Salud, Madrid, Spain
| | - Emily S. Gurley
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Dianna M. Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Cynthia G. Whitney
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
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21
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Roose A, Keita AM, Tapia MD, Sow SO, Mast TC, Kotloff KL. Incidence of Intussusception in Bamako, Mali, Before and After the Introduction of Rotavirus Vaccine. J Pediatric Infect Dis Soc 2022; 11:404-407. [PMID: 35713304 PMCID: PMC9520282 DOI: 10.1093/jpids/piac044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 06/01/2022] [Indexed: 12/04/2022]
Abstract
Pentavalent rotavirus vaccine has been associated with a small increase in intussusception, but pre- and post-introduction data are lacking in many low-resource settings. Using chart review and prospective surveillance data, intussusception incidence was estimated in Bamako, Mali. The mean annual intussusception incidence post-introduction was not significantly different from that of pre-introduction.
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Affiliation(s)
| | | | - Milagritos D Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA,Department of Pediatrics and Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Samba O Sow
- Centre for Vaccine Development, Bamako, Mali
| | | | - Karen L Kotloff
- Corresponding Author: Karen L. Kotloff, MD, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W. Baltimore Street, HSF 480, Baltimore, MD 21201, USA. E-mail:
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22
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Garbern SC, Nelson EJ, Nasrin S, Keita AM, Brintz BJ, Gainey M, Badji H, Nasrin D, Howard J, Taniuchi M, Platts-Mills JA, Kotloff KL, Haque R, Levine AC, Sow SO, Alam NH, Leung DT. External validation of a mobile clinical decision support system for diarrhea etiology prediction in children: a multicenter study in Bangladesh and Mali. eLife 2022; 11:72294. [PMID: 35137684 PMCID: PMC8903833 DOI: 10.7554/elife.72294] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 02/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Diarrheal illness is a leading cause of antibiotic use for children in low- and middle-income countries. Determination of diarrhea etiology at the point-of-care without reliance on laboratory testing has the potential to reduce inappropriate antibiotic use. Methods: This prospective observational study aimed to develop and externally validate the accuracy of a mobile software application ('App') for the prediction of viral-only etiology of acute diarrhea in children 0-59 months in Bangladesh and Mali. The App used a previously derived and internally validated model consisting of patient-specific ('present patient') clinical variables (age, blood in stool, vomiting, breastfeeding status, and mid-upper arm circumference) as well as location-specific viral diarrhea seasonality curves. The performance of additional models using the 'present patient' data combined with other external data sources including location-specific climate, data, recent patient data, and historical population-based prevalence were also evaluated in secondary analysis. Diarrhea etiology was determined with TaqMan Array Card using episode-specific attributable fraction (AFe) >0.5. Results: Of 302 children with acute diarrhea enrolled, 199 had etiologies above the AFe threshold. Viral-only pathogens were detected in 22% of patients in Mali and 63% in Bangladesh. Rotavirus was the most common pathogen detected (16% Mali; 60% Bangladesh). The present patient + viral seasonality model had an AUC of 0.754 (0.665-0.843) for the sites combined, with calibration-in-the-large α=-0.393 (-0.455 - -0.331) and calibration slope β=1.287 (1.207 - 1.367). By site, the present patient + recent patient model performed best in Mali with an AUC of 0.783 (0.705 - 0.86); the present patient + viral seasonality model performed best in Bangladesh with AUC 0.710 (0.595 - 0.825). Conclusion: The App accurately identified children with high likelihood of viral-only diarrhea etiology. Further studies to evaluate the App's potential use in diagnostic and antimicrobial stewardship are underway. Funding: Funding for this study was provided through grants from the Bill and Melinda Gates Foundation (OPP1198876) and the National Institute of Allergy and Infectious Diseases (R01AI135114). Several investigators were also partially supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK116163). This investigation was also supported by the University of Utah Population Health Research (PHR) Foundation, with funding in part from the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002538. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in the study design, data collection, data analysis, interpretation of data, or in the writing or decision to submit the manuscript for publication.
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Affiliation(s)
| | - Eric J Nelson
- Department of Pediatrics, University of Florida, Gainesville, United States
| | - Sabiha Nasrin
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Ben J Brintz
- Department of Internal Medicine, University of Utah, Salt Lake City, United States
| | - Monique Gainey
- Department of Emergency Medicine, Rhode Island Hospital, Providence, United States
| | - Henry Badji
- Center for Vaccine Development, Bamako, Mali
| | - Dilruba Nasrin
- Center for Vaccine Development and Global Healt, University of Maryland School of Medicine, Baltimore, United States
| | - Joel Howard
- Department of Pediatrics, University of Kentucky, Lexington, United States
| | - Mami Taniuchi
- Department of Medicine, University of Virginia, Charlottesville, United States
| | | | - Karen L Kotloff
- Department of Pediatrics, University of Maryland, Baltimore, United States
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Adam C Levine
- Department of Emergency Medicine, Brown University, Providence, United States
| | - Samba O Sow
- Center for Vaccine Development, Bamako, Mali
| | - Nur Haque Alam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Daniel T Leung
- Internal Medicine (Infectious Diseases), University of Utah, Salt Lake City, United States
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23
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Blau DM, Baillie VL, Els T, Mahtab S, Mutevedzi P, Keita AM, Kotloff KL, Mehta A, Sow SO, Tapia MD, Tippett Barr BA, Oluoch BO, Onyango C, Revathi G, Verani JR, Abayneh M, Assefa N, Madrid L, Oundo JO, Scott JAG, Bassat Q, Mandomando I, Sitoe A, Valente M, Varo R, Bassey IA, Cain CJ, Jambai A, Ogbuanu I, Ojulong J, Alam M, El Arifeen S, Gurley ES, Rahman A, Rahman M, Waller JL, Dewey B, Breiman RF, Whitney CG, Madhi SA. Deaths Attributed to Respiratory Syncytial Virus in Young Children in High-Mortality Rate Settings: Report from Child Health and Mortality Prevention Surveillance (CHAMPS). Clin Infect Dis 2021; 73:S218-S228. [PMID: 34472577 PMCID: PMC8411256 DOI: 10.1093/cid/ciab509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Lower respiratory tract infections are a leading cause of death in young children, but few studies have collected the specimens needed to define the role of specific causes. The Child Health and Mortality Prevention Surveillance (CHAMPS) platform aims to investigate causes of death in children aged <5 years in high–mortality rate settings, using postmortem minimally invasive tissue sampling and other advanced diagnostic techniques. We examined findings for deaths identified in CHAMPS sites in 7 countries in sub-Saharan Africa and south Asia to evaluate the role of respiratory syncytial virus (RSV). Methods We included deaths that occurred between December 2016 and December 2019. Panels determined causes of deaths by reviewing all available data including pathological results from minimally invasive tissue sampling, polymerase chain reaction screening for multiple infectious pathogens in lung tissue, nasopharyngeal swab, blood, and cerebrospinal fluid samples, clinical information from medical records, and verbal autopsies. Results We evaluated 1213 deaths, including 695 in neonates (aged <28 days), 283 in infants (28 days to <12 months), and 235 in children (12–59 months). RSV was detected in postmortem specimens in 67 of 1213 deaths (5.5%); in 24 deaths (2.0% of total), RSV was determined to be a cause of death, and it contributed to 5 other deaths. Younger infants (28 days to <6 months of age) accounted for half of all deaths attributed to RSV; 6.5% of all deaths in younger infants were attributed to RSV. RSV was the underlying and only cause in 4 deaths; the remainder (n = 20) had a median of 2 (range, 1–5) other conditions in the causal chain. Birth defects (n = 8) and infections with other pathogens (n = 17) were common comorbid conditions. Conclusions RSV is an important cause of child deaths, particularly in young infants. These findings add to the substantial body of literature calling for better treatment and prevention options for RSV in high–mortality rate settings.
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Affiliation(s)
- Dianna M Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Vicky L Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Toyah Els
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Portia Mutevedzi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ashka Mehta
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Samba O Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Milagritos D Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | - Clayton Onyango
- Centers for Disease Control and Prevention, Kenya, Kisumu, Kenya
| | - Gunturu Revathi
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Jennifer R Verani
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mahlet Abayneh
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nega Assefa
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Lola Madrid
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.,College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Joseph O Oundo
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - J Anthony G Scott
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Quique Bassat
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom.,ISGlobal-Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Institutó Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
| | - Inacio Mandomando
- ISGlobal-Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Antonio Sitoe
- ISGlobal-Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
| | - Marta Valente
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Rosauro Varo
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom.,ISGlobal-Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | - Emily S Gurley
- Crown Agents, Freetown, Sierra Leone.,International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | | | | | - Jessica L Waller
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Betsy Dewey
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Cynthia G Whitney
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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24
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Breiman RF, Blau DM, Mutevedzi P, Akelo V, Mandomando I, Ogbuanu IU, Sow SO, Madrid L, El Arifeen S, Garel M, Thwala NB, Onyango D, Sitoe A, Bassey IA, Keita AM, Alemu A, Alam M, Mahtab S, Gethi D, Varo R, Ojulong J, Samura S, Mehta A, Ibrahim AM, Rahman A, Vitorino P, Baillie VL, Agaya J, Tapia MD, Assefa N, Chowdhury AI, Scott JAG, Gurley ES, Kotloff KL, Jambai A, Bassat Q, Tippett-Barr BA, Madhi SA, Whitney CG. Postmortem investigations and identification of multiple causes of child deaths: An analysis of findings from the Child Health and Mortality Prevention Surveillance (CHAMPS) network. PLoS Med 2021; 18:e1003814. [PMID: 34591862 PMCID: PMC8516282 DOI: 10.1371/journal.pmed.1003814] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 10/14/2021] [Accepted: 09/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The current burden of >5 million deaths yearly is the focus of the Sustainable Development Goal (SDG) to end preventable deaths of newborns and children under 5 years old by 2030. To accelerate progression toward this goal, data are needed that accurately quantify the leading causes of death, so that interventions can target the common causes. By adding postmortem pathology and microbiology studies to other available data, the Child Health and Mortality Prevention Surveillance (CHAMPS) network provides comprehensive evaluations of conditions leading to death, in contrast to standard methods that rely on data from medical records and verbal autopsy and report only a single underlying condition. We analyzed CHAMPS data to characterize the value of considering multiple causes of death. METHODS AND FINDINGS We examined deaths identified from December 2016 through November 2020 from 7 CHAMPS sites (in Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa), including 741 neonatal, 278 infant, and 241 child <5 years deaths for which results from Determination of Cause of Death (DeCoDe) panels were complete. DeCoDe panelists included all conditions in the causal chain according to the ICD-10 guidelines and assessed if prevention or effective management of the condition would have prevented the death. We analyzed the distribution of all conditions listed as causal, including underlying, antecedent, and immediate causes of death. Among 1,232 deaths with an underlying condition determined, we found a range of 0 to 6 (mean 1.5, IQR 0 to 2) additional conditions in the causal chain leading to death. While pathology provides very helpful clues, we cannot always be certain that conditions identified led to death or occurred in an agonal stage of death. For neonates, preterm birth complications (most commonly respiratory distress syndrome) were the most common underlying condition (n = 282, 38%); among those with preterm birth complications, 256 (91%) had additional conditions in causal chains, including 184 (65%) with a different preterm birth complication, 128 (45%) with neonatal sepsis, 69 (24%) with lower respiratory infection (LRI), 60 (21%) with meningitis, and 25 (9%) with perinatal asphyxia/hypoxia. Of the 278 infant deaths, 212 (79%) had ≥1 additional cause of death (CoD) beyond the underlying cause. The 2 most common underlying conditions in infants were malnutrition and congenital birth defects; LRI and sepsis were the most common additional conditions in causal chains, each accounting for approximately half of deaths with either underlying condition. Of the 241 child deaths, 178 (75%) had ≥1 additional condition. Among 46 child deaths with malnutrition as the underlying condition, all had ≥1 other condition in the causal chain, most commonly sepsis, followed by LRI, malaria, and diarrheal disease. Including all positions in the causal chain for neonatal deaths resulted in 19-fold and 11-fold increases in attributable roles for meningitis and LRI, respectively. For infant deaths, the proportion caused by meningitis and sepsis increased by 16-fold and 11-fold, respectively; for child deaths, sepsis and LRI are increased 12-fold and 10-fold, respectively. While comprehensive CoD determinations were done for a substantial number of deaths, there is potential for bias regarding which deaths in surveillance areas underwent minimally invasive tissue sampling (MITS), potentially reducing representativeness of findings. CONCLUSIONS Including conditions that appear anywhere in the causal chain, rather than considering underlying condition alone, markedly changed the proportion of deaths attributed to various diagnoses, especially LRI, sepsis, and meningitis. While CHAMPS methods cannot determine when 2 conditions cause death independently or may be synergistic, our findings suggest that considering the chain of events leading to death can better guide research and prevention priorities aimed at reducing child deaths.
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Affiliation(s)
- Robert F. Breiman
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Dianna M. Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Portia Mutevedzi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Innovation/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Victor Akelo
- US Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
- Instituto Nacional de Saúde [INS], Manhiça, Mozambique
| | | | - Samba O. Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Lola Madrid
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Mischka Garel
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Nana Bukiwe Thwala
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Innovation/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | | | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
| | | | - Adama Mamby Keita
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Addisu Alemu
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Muntasir Alam
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Innovation/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Dickson Gethi
- Kenya Medical Research Institute (KEMRI) Center for Global Health Research, Kisumu, Kenya
| | - Rosauro Varo
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
- Universitat de Barcelona, Barcelona, Spain
| | | | | | - Ashka Mehta
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | - Afruna Rahman
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Pio Vitorino
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
| | - Vicky L. Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Janet Agaya
- Kenya Medical Research Institute (KEMRI) Center for Global Health Research, Kisumu, Kenya
| | - Milagritos D. Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | | | - J. Anthony G. Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Emily S. Gurley
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Karen L. Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Amara Jambai
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital de Sant Joan de Deu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigacion Biomedica en Red de Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
| | | | - Shabir A. Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Innovation/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Cynthia G. Whitney
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
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25
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Brintz BJ, Haaland B, Howard J, Chao DL, Proctor JL, Khan AI, Ahmed SM, Keegan LT, Greene T, Keita AM, Kotloff KL, Platts-Mills JA, Nelson EJ, Levine AC, Pavia AT, Leung DT. A modular approach to integrating multiple data sources into real-time clinical prediction for pediatric diarrhea. eLife 2021; 10:63009. [PMID: 33527894 PMCID: PMC7853717 DOI: 10.7554/elife.63009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/17/2021] [Indexed: 11/13/2022] Open
Abstract
Traditional clinical prediction models focus on parameters of the individual patient. For infectious diseases, sources external to the patient, including characteristics of prior patients and seasonal factors, may improve predictive performance. We describe the development of a predictive model that integrates multiple sources of data in a principled statistical framework using a post-test odds formulation. Our method enables electronic real-time updating and flexibility, such that components can be included or excluded according to data availability. We apply this method to the prediction of etiology of pediatric diarrhea, where 'pre-test’ epidemiologic data may be highly informative. Diarrhea has a high burden in low-resource settings, and antibiotics are often over-prescribed. We demonstrate that our integrative method outperforms traditional prediction in accurately identifying cases with a viral etiology, and show that its clinical application, especially when used with an additional diagnostic test, could result in a 61% reduction in inappropriately prescribed antibiotics.
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Affiliation(s)
- Ben J Brintz
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, United States.,Division of Infectious Diseases, Department of Internal Medicine, University of Utah, Salt Lake City, United States
| | - Benjamin Haaland
- Population Health Sciences, University of Utah, Salt Lake City, United States
| | - Joel Howard
- Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, United States
| | - Dennis L Chao
- Institute of Disease Modeling, Bill and Melinda Gates Foundation, Seattle, United States
| | - Joshua L Proctor
- Institute of Disease Modeling, Bill and Melinda Gates Foundation, Seattle, United States
| | - Ashraful I Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sharia M Ahmed
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah, Salt Lake City, United States
| | - Lindsay T Keegan
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, United States
| | - Tom Greene
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, United States
| | | | - Karen L Kotloff
- Division of Infectious Disease and Tropical Pediatrics, University of Maryland, Baltimore, United States
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, United States
| | - Eric J Nelson
- Departments of Pediatrics, University of Florida, Gainesville, United States.,Departments of Environmental and Global Health, University of Florida, Gainesville, United States
| | - Adam C Levine
- Department of Emergency Medicine, Brown University, Providence, United States
| | - Andrew T Pavia
- Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, United States
| | - Daniel T Leung
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah, Salt Lake City, United States.,Division of Microbiology and Immunology, Department of Internal Medicine, University of Utah, Salt Lake City, United States
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26
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Cuttin K, Dupont E, Keita AM, Sow S, Kotloff K. 767. Identification and Management of Diarrhea in Children Under Five in Bamako, Mali. Open Forum Infect Dis 2020. [PMCID: PMC7777678 DOI: 10.1093/ofid/ofaa439.957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Diarrhea is a leading cause of death for Children Under Five Years Old (CUFYO) worldwide, and Mali has the second highest diarrhea-related case fatality rate among African countries. The World Health Organization’s Integrated Management for Childhood Illness (IMCI) handbook provides recommendations for management of acute watery diarrhea (AWD), including: increased fluids, continued feeding, and zinc supplementation. It restricts antibiotics to dysentery. The 2018 Malian Demographic and Health Survey noted low rates of rehydration and zinc use. This study aimed to evaluate how provider knowledge, beliefs, and practices (KBPs) align with IMCI recommendations for diagnosis and management of diarrhea in Mali. Methods This qualitative cross-sectional study interviewed 136 providers who manage diarrhea in CUFYO in Bamako, Mali from July - August 2017. Providers included: doctors (D), pharmacists (P), market vendors of allopathic medications (MV), traditional healers (TH), and vendors of traditional medicines (TV). Participants were randomly selected and presented with scenarios depicting diarrheal syndromes. They provided a diagnosis, etiology of illness, and management recommendations. Providers were surveyed on KBPs regarding IMCI recommendations. Results Only 43% of providers provided the IMCI definition of AWD. Participant-IMCI concordant diagnosis varied by provider group for AWD (D-73%, P-67%, MV-31%, TH-18%, TV-40%), Dysentery (D-38%, P-75%, MV-38%, TH-61%, TV-40%), and Some Dehydration (D-31%, P-4%, MV-4%, TH-7%, TV-40%). Only 41% of all providers identified dehydration as a sequela of AWD; 18% noted mortality. Etiologies of AWD cited included: infection, teething, diet, hygiene, and many others. Participants volunteered treatment of AWD with fluids (D-52%, P-8%, MV-0%, TH-0%, TV-0%), but not zinc (0%). MK alone offered inappropriate use of antibiotics for AWD (23%). Conclusion Provider identification and management of diarrheal syndromes in CUFYO remain largely inconsistent with IMCI recommendations across all sectors of providers interviewed, specifically for rehydration therapy and zinc supplementation. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Karen Cuttin
- Boston University School of Medicine, Brookline, Massachusetts
| | | | | | - Samba Sow
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Karen Kotloff
- University of Maryland School of Medicine, Baltimore, Maryland
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27
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Still WL, Tapia MD, Tennant SM, Sylla M, Touré A, Badji H, Keita AM, Sow SO, Levine MM, Kotloff KL. Surveillance for Invasive Salmonella Disease in Bamako, Mali, From 2002 to 2018. Clin Infect Dis 2020; 71:S130-S140. [PMID: 32725229 PMCID: PMC7388721 DOI: 10.1093/cid/ciaa482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Salmonella enterica bloodstream infections are an important cause of childhood morbidity and mortality, including in Mali. We report 17 years of surveillance for nontyphoidal and typhoidal S. enterica infections among inpatients and outpatients at l'Hôpital Gabriel Touré, the main source of pediatric tertiary care in Bamako, Mali. METHODS Between June 2002 and December 2018, a blood culture was collected from 54 748 children aged ≤15 years with fever and/or suspected invasive bacterial infection who provided consent (38 152 inpatients, 16 596 outpatients). Bacterial pathogens were identified using standard microbiological techniques and serovars of S. enterica were determined by PCR and/or agglutination with antisera. RESULTS Nontyphoidal Salmonella (NTS) was identified in 671 enrolled inpatients (1.8% of all enrolled inpatients, 13.8% of enrolled inpatients with a positive culture). S. Enteritidis, the most common NTS serovar, accounted for 38.5% of all NTS isolates (n = 258), followed by S. Typhimurium (31.7%, n = 213). The median (SD) age of children with a culture positive for NTS was 1.8 (3) years. Overall case fatality was 20.9%. An additional 138 inpatients (0.4%) had a positive culture for typhoidal Salmonella. NTS was identified in 11 outpatients (0.07%), while typhoidal Salmonella was found in 49 outpatients (0.3%). The annual incidence of invasive NTS disease decreased over the study period, but case fatality remained high. CONCLUSIONS Although incidence decreased, NTS remained a major cause of invasive bacterial infection and mortality among hospitalized children in Bamako, while typhoidal Salmonella was uncommon. Because 87% of NTS belonged to only 4 serovars, a multivalent vaccine may be an effective strategy to reduce the burden and mortality of invasive NTS.
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Affiliation(s)
- William L Still
- Department of Epidemiology and Public Health, University of Maryland Graduate School, Baltimore, Maryland, USA
| | - Milagritos D Tapia
- Department of Pediatrics and Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sharon M Tennant
- Department of Pediatrics and Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mamadou Sylla
- Centre Pour le Développement des Vaccins–Mali, Bamako, Mali
| | - Aliou Touré
- Centre Pour le Développement des Vaccins–Mali, Bamako, Mali
| | - Henry Badji
- Centre Pour le Développement des Vaccins–Mali, Bamako, Mali
| | | | - Samba O Sow
- Centre Pour le Développement des Vaccins–Mali, Bamako, Mali
| | - Myron M Levine
- Centre Pour le Développement des Vaccins–Mali, Bamako, Mali
| | - Karen L Kotloff
- Department of Pediatrics and Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Correspondence: K. L. Kotloff, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 West Baltimore Street, Room 480, Baltimore, MD 21201–1509 ()
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28
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Taylor AW, Blau DM, Bassat Q, Onyango D, Kotloff KL, Arifeen SE, Mandomando I, Chawana R, Baillie VL, Akelo V, Tapia MD, Salzberg NT, Keita AM, Morris T, Nair S, Assefa N, Seale AC, Scott JAG, Kaiser R, Jambai A, Barr BAT, Gurley ES, Ordi J, Zaki SR, Sow SO, Islam F, Rahman A, Dowell SF, Koplan JP, Raghunathan PL, Madhi SA, Breiman RF. Initial findings from a novel population-based child mortality surveillance approach: a descriptive study. Lancet Glob Health 2020; 8:e909-e919. [PMID: 32562647 PMCID: PMC7303945 DOI: 10.1016/s2214-109x(20)30205-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/12/2020] [Accepted: 04/14/2020] [Indexed: 10/28/2022]
Abstract
BACKGROUND Sub-Saharan Africa and south Asia contributed 81% of 5·9 million under-5 deaths and 77% of 2·6 million stillbirths worldwide in 2015. Vital registration and verbal autopsy data are mainstays for the estimation of leading causes of death, but both are non-specific and focus on a single underlying cause. We aimed to provide granular data on the contributory causes of death in stillborn fetuses and in deceased neonates and children younger than 5 years, to inform child mortality prevention efforts. METHODS The Child Health and Mortality Prevention Surveillance (CHAMPS) Network was established at sites in seven countries (Baliakandi, Bangladesh; Harar and Kersa, Ethiopia; Siaya and Kisumu, Kenya; Bamako, Mali; Manhiça, Mozambique; Bombali, Sierra Leone; and Soweto, South Africa) to collect standardised, population-based, longitudinal data on under-5 mortality and stillbirths in sub-Saharan Africa and south Asia, to improve the accuracy of determining causes of death. Here, we analysed data obtained in the first 2 years after the implementation of CHAMPS at the first five operational sites, during which surveillance and post-mortem diagnostics, including minimally invasive tissue sampling (MITS), were used. Data were abstracted from all available clinical records of deceased children, and relevant maternal health records were also extracted for stillbirths and neonatal deaths, to incorporate reported pregnancy or delivery complications. Expert panels followed standardised procedures to characterise causal chains leading to death, including underlying, intermediate (comorbid or antecedent causes), and immediate causes of death for stillbirths, neonatal deaths, and child (age 1-59 months) deaths. FINDINGS Between Dec 10, 2016, and Dec 31, 2018, MITS procedures were implemented at five sites in Mozambique, South Africa, Kenya, Mali, and Bangladesh. We screened 2385 death notifications for inclusion eligibility, following which 1295 families were approached for consent; consent was provided for MITS by 963 (74%) of 1295 eligible cases approached. At least one cause of death was identified in 912 (98%) of 933 cases (180 stillbirths, 449 neonatal deaths, and 304 child deaths); two or more conditions were identified in the causal chain for 585 (63%) of 933 cases. The most common underlying causes of stillbirth were perinatal asphyxia or hypoxia (130 [72%] of 180 stillbirths) and congenital infection or sepsis (27 [15%]). The most common underlying causes of neonatal death were preterm birth complications (187 [42%] of 449 neonatal deaths), perinatal asphyxia or hypoxia (98 [22%]), and neonatal sepsis (50 [11%]). The most common underlying causes of child deaths were congenital birth defects (39 [13%] of 304 deaths), lower respiratory infection (37 [12%]), and HIV (35 [12%]). In 503 (54%) of 933 cases, at least one contributory pathogen was identified. Cytomegalovirus, Escherichia coli, group B Streptococcus, and other infections contributed to 30 (17%) of 180 stillbirths. Among neonatal deaths with underlying prematurity, 60% were precipitated by other infectious causes. Of the 275 child deaths with infectious causes, the most common contributory pathogens were Klebsiella pneumoniae (86 [31%]), Streptococcus pneumoniae (54 [20%]), HIV (40 [15%]), and cytomegalovirus (34 [12%]), and multiple infections were common. Lower respiratory tract infection contributed to 174 (57%) of 304 child deaths. INTERPRETATION Cause of death determination using MITS enabled detailed characterisation of contributing conditions. Global estimates of child mortality aetiologies, which are currently based on a single syndromic cause for each death, will be strengthened by findings from CHAMPS. This approach adds specificity and provides a more complete overview of the chain of events leading to death, highlighting multiple potential interventions to prevent under-5 mortality and stillbirths. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Allan W Taylor
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dianna M Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Quique Bassat
- ISGlobal, Hospital Clínic, University of Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain; Pediatrics Department, Pediatric Infectious Diseases Unit, Hospital Sant Joan de Déu, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Karen L Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health and Division of Infectious Disease and Tropical Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Richard Chawana
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, School of Pathology and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vicky L Baillie
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, School of Pathology and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Milagritos D Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health and Division of Infectious Disease and Tropical Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Navit T Salzberg
- Emory Global Health Institute, Emory University, Atlanta, GA, USA
| | | | - Timothy Morris
- Emory Global Health Institute, Emory University, Atlanta, GA, USA; Public Health Informatics Institute, Task Force for Global Health, Atlanta, GA, USA
| | - Shailesh Nair
- Emory Global Health Institute, Emory University, Atlanta, GA, USA; Public Health Informatics Institute, Task Force for Global Health, Atlanta, GA, USA
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Anna C Seale
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Amara Jambai
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Beth A Tippet Barr
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily S Gurley
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jaume Ordi
- ISGlobal, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Sherif R Zaki
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Samba O Sow
- Centre for Vaccine Development, Bamako, Mali
| | - Farzana Islam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Afruna Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Jeffrey P Koplan
- Emory Global Health Institute, Emory University, Atlanta, GA, USA
| | - Pratima L Raghunathan
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, School of Pathology and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, GA, USA.
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Findlow H, Tapia MD, Sow SO, Haidara FC, Coulibaly F, Keita AM, Diallo F, Doumbia M, Traore A, Schluterman N, Clark DA, Borrow R, Levine MM. Kinetics of maternally-derived serogroup A, C, Y and W-specific meningococcal immunoglobulin G in Malian women and infants. Vaccine 2019; 37:2477-2481. [PMID: 30952500 PMCID: PMC6990398 DOI: 10.1016/j.vaccine.2019.03.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 03/05/2019] [Accepted: 03/21/2019] [Indexed: 11/08/2022]
Abstract
Immunisation with MCV during pregnancy resulted in an antibody response. Maternal immunization with MCV conveyed protective levels of MenA IgG at birth. Infant antibody levels declined over the first 3 months of life.
A prospective, randomised, controlled observer-blind trial measuring the efficacy and immunogenicity of trivalent influenza vaccine (TIV) and the immunogenicity of quadrivalent meningococcal conjugate vaccine (MCV) in pregnant women and their infants up to 6 months of age was conducted in Mali. Here we reported the immunogenicity of MCV, which was used as a comparator vaccine to TIV, in this population. Third-trimester pregnant Malian women were randomized to receive TIV or MCV. Blood samples were collected from women prior to vaccination, 28 days post-vaccination, at delivery and 3 and 6 months post-delivery and from infants at birth and 3 and 6 months of age. Meningococcal-specific serogroup (Men) A, C, Y and W-specific antibodies were measured by enzyme linked immunosorbent assay in a randomly selected subset of 50 mother-infant pairs where the mother had received MCV. At birth, 94.0% (47/50) of infants had MenA specific IgG levels ≥ 2 µg/mL decreasing to 72.9% and 30.4% at 3 and 6 months of age. For MenC, 81.3% (39/48) of infants had MenC specific IgG levels ≥ 2 µg/mL at birth decreasing to 29.4% and 17.8% at 3 and 6 months of age. For MenY, 89.6% (43/48) of infants had MenY specific IgG levels ≥ 2 µg/mL at birth decreasing to 64.6% and 62.5% at 3 and 6 months of age. For MenW, 89.6% (43/48) of infants had MenW specific IgG levels ≥ 2 μg/ml at birth decreasing to 62.5% and 41.7% at 3 and 6 months of age. Maternal immunization with MCV conveyed protective levels of IgG at birth through to 3 months of age in the majority of infants.
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Affiliation(s)
- H Findlow
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK.
| | - M D Tapia
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S O Sow
- Centre pour le Développement des Vaccins, Bamako, Mali
| | - F C Haidara
- Centre pour le Développement des Vaccins, Bamako, Mali
| | - F Coulibaly
- Centre pour le Développement des Vaccins, Bamako, Mali
| | - A M Keita
- Centre pour le Développement des Vaccins, Bamako, Mali
| | - F Diallo
- Centre pour le Développement des Vaccins, Bamako, Mali
| | - M Doumbia
- Centre pour le Développement des Vaccins, Bamako, Mali
| | - A Traore
- Centre pour le Développement des Vaccins, Bamako, Mali
| | - N Schluterman
- Department of Epidemiology, University of Maryland, Baltimore, MD, USA
| | - D A Clark
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - R Borrow
- Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - M M Levine
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
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Talla Nzussouo N, Duque J, Adedeji AA, Coulibaly D, Sow S, Tarnagda Z, Maman I, Lagare A, Makaya S, Elkory MB, Kadjo Adje H, Shilo PA, Tamboura B, Cisse A, Badziklou K, Maïnassara HB, Bara AO, Keita AM, Williams T, Moen A, Widdowson MA, McMorrow M. Epidemiology of influenza in West Africa after the 2009 influenza A(H1N1) pandemic, 2010-2012. BMC Infect Dis 2017; 17:745. [PMID: 29202715 PMCID: PMC5716025 DOI: 10.1186/s12879-017-2839-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/16/2017] [Indexed: 01/20/2023] Open
Abstract
Background Over the last decade, capacity for influenza surveillance and research in West Africa has strengthened. Data from these surveillance systems showed influenza A(H1N1)pdm09 circulated in West Africa later than in other regions of the continent. Methods We contacted 11 West African countries to collect information about their influenza surveillance systems (number of sites, type of surveillance, sampling strategy, populations sampled, case definitions used, number of specimens collected and number of specimens positive for influenza viruses) for the time period January 2010 through December 2012. Results Of the 11 countries contacted, 8 responded: Burkina Faso, Cote d’Ivoire, Mali, Mauritania, Niger, Nigeria, Sierra Leone and Togo. Countries used standard World Health Organization (WHO) case definitions for influenza-like illness (ILI) and severe acute respiratory illness (SARI) or slight variations thereof. There were 70 surveillance sites: 26 SARI and 44 ILI. Seven countries conducted SARI surveillance and collected 3114 specimens of which 209 (7%) were positive for influenza viruses. Among influenza-positive SARI patients, 132 (63%) were influenza A [68 influenza A(H1N1)pdm09, 64 influenza A(H3N2)] and 77 (37%) were influenza B. All eight countries conducted ILI surveillance and collected 20,375 specimens, of which 2278 (11%) were positive for influenza viruses. Among influenza-positive ILI patients, 1431 (63%) were influenza A [820 influenza A(H1N1)pdm09, 611 influenza A(H3N2)] and 847 (37%) were influenza B. A majority of SARI and ILI case-patients who tested positive for influenza (72% SARI and 59% ILI) were children aged 0–4 years, as were a majority of those enrolled in surveillance. The seasonality of influenza and the predominant influenza type or subtype varied by country and year. Conclusions Influenza A(H1N1)pdm09 continued to circulate in West Africa along with influenza A(H3N2) and influenza B during 2010–2012. Although ILI surveillance systems produced a robust number of samples during the study period, more could be done to strengthen surveillance among hospitalized SARI case-patients. Surveillance systems captured young children but lacked data on adults and the elderly. More data on risk groups for severe influenza in West Africa are needed to help shape influenza prevention and clinical management policies and guidelines. Electronic supplementary material The online version of this article (10.1186/s12879-017-2839-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ndahwouh Talla Nzussouo
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. .,CTS Global Inc., California, El Segundo, USA. .,Noguchi Memorial Institute for Medical Research, P.O. Box LG 481, Legon, Accra, Ghana.
| | - Jazmin Duque
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Battelle Atlanta, Atlanta, GA, USA
| | - Adebayo Abel Adedeji
- National Influenza Reference Laboratory, Federal Ministry of Health, Abuja, Nigeria
| | - Daouda Coulibaly
- Institut National d'Hygiene Publique (INHP), Abidjan, Côte d'Ivoire
| | - Samba Sow
- Centre National d'Appui à la Lutte Contre la Maladie (CNAM), Centre pour le Développement des Vaccins du Mali (CVD), Bamako, Mali
| | - Zekiba Tarnagda
- Institut de Recherche en Sciences de Santé (IRSS), Bobo-Dioulasso, Burkina Faso
| | | | - Adamou Lagare
- Centre de Recherche Médicale et Sanitaire (CERMES), Niamey, Niger
| | - Sonia Makaya
- Influenza National Reference Laboratory Lakka, Freetown, Sierra Leone
| | | | | | - Paul Alhassan Shilo
- National Influenza Reference Laboratory, Federal Ministry of Health, Abuja, Nigeria
| | - Boubou Tamboura
- Centre National d'Appui à la Lutte Contre la Maladie (CNAM), Centre pour le Développement des Vaccins du Mali (CVD), Bamako, Mali
| | - Assana Cisse
- Institut de Recherche en Sciences de Santé (IRSS), Bobo-Dioulasso, Burkina Faso
| | | | | | - Ahmed Ould Bara
- Institut National Recherche en Sante Publique (INRSP), Nouakchott, Mauritanie
| | - Adama Mamby Keita
- Centre National d'Appui à la Lutte Contre la Maladie (CNAM), Centre pour le Développement des Vaccins du Mali (CVD), Bamako, Mali
| | - Thelma Williams
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ann Moen
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marc-Alain Widdowson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Meredith McMorrow
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,U.S. Public Health Service, Rockville, MD, USA
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Tapia MD, Sow SO, Tamboura B, Tégueté I, Pasetti MF, Kodio M, Onwuchekwa U, Tennant SM, Blackwelder WC, Coulibaly F, Traoré A, Keita AM, Haidara FC, Diallo F, Doumbia M, Sanogo D, DeMatt E, Schluterman NH, Buchwald A, Kotloff KL, Chen WH, Orenstein EW, Orenstein LAV, Villanueva J, Bresee J, Treanor J, Levine MM. Maternal immunisation with trivalent inactivated influenza vaccine for prevention of influenza in infants in Mali: a prospective, active-controlled, observer-blind, randomised phase 4 trial. Lancet Infect Dis 2016; 16:1026-1035. [PMID: 27261067 PMCID: PMC4985566 DOI: 10.1016/s1473-3099(16)30054-8] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/13/2016] [Accepted: 04/15/2016] [Indexed: 12/16/2022]
Abstract
Background Despite the heightened risk of serious influenza during infancy, vaccination is not recommended in infants younger than 6 months. We aimed to assess the safety, immunogenicity, and efficacy of maternal immunisation with trivalent inactivated influenza vaccine for protection of infants against a first episode of laboratory-confirmed influenza. Methods We did this prospective, active-controlled, observer-blind, randomised phase 4 trial at six referral centres and community health centres in Bamako, Mali. Third-trimester pregnant women (≥28 weeks' gestation) were randomly assigned (1:1), via a computer-generated, centre-specific list with alternate block sizes of six or 12, to receive either trivalent inactivated influenza vaccine or quadrivalent meningococcal vaccine. Study personnel administering vaccines were not masked to treatment allocation, but allocation was concealed from clinicians, laboratory personnel, and participants. Infants were visited weekly until age 6 months to detect influenza-like illness; laboratory-confirmed influenza diagnosed with RT-PCR. We assessed two coprimary objectives: vaccine efficacy against laboratory-confirmed influenza in infants born to women immunised any time prepartum (intention-to-treat population), and vaccine efficacy in infants born to women immunised at least 14 days prepartum (per-protocol population). The primary outcome was the occurrence of a first case of laboratory-confirmed influenza by age 6 months. This trial is registered with ClinicalTrials.gov, number NCT01430689. Findings We did this trial from Sept 12, 2011, to Jan 28, 2014. Between Sept 12, 2011, and April 18, 2013, we randomly assigned 4193 women to receive trivalent inactivated influenza vaccine (n=2108) or quadrivalent meningococcal vaccine (n=2085). There were 4105 livebirths; 1797 (87%) of 2064 infants in the trivalent inactivated influenza vaccine group and 1793 (88%) of 2041 infants in the quadrivalent meningococcal vaccine group were followed up until age 6 months. We recorded 5279 influenza-like illness episodes in 2789 (68%) infants, of which 131 (2%) episodes were laboratory-confirmed influenza. 129 (98%) cases of laboratory-confirmed influenza were first episodes (n=77 in the quadrivalent meningococcal vaccine group vs n=52 in the trivalent inactivated influenza vaccine group). In the intention-to-treat population, overall infant vaccine efficacy was 33·1% (95% CI 3·7–53·9); in the per-protocol population, vaccine efficacy was 37·3% (7·6–57·8). Vaccine efficacy remained robust during the first 4 months of follow-up (67·9% [95% CI 35·1–85·3] by intention to treat and 70·2% [35·7–87·6] by per protocol), before diminishing during the fifth month (57·3% [30·6–74·4] and 60·7 [33·8–77·5], respectively). Adverse event rates in women and infants were similar among groups. Pain at the injection site was more common in women given quadrivalent meningococcal vaccine than in those given trivalent inactivated influenza vaccine (n=253 vs n=132; p<0·0001), although 354 [92%] reactions were mild. Obstetrical and non-obstetrical serious adverse events were reported in 60 (3%) women in the quadrivalent meningococcal vaccine group and 61 (3%) women in the trivalent inactivated influenza vaccine group. Presumed neonatal infection was more common in infants in the trivalent inactivated influenza vaccine group than in those in the quadrivalent meningococcal vaccine group (n=60 vs n=37; p=0·02). No serious adverse events were related to vaccination. Interpretation Vaccination of pregnant women with trivalent inactivated influenza vaccine in Mali—a poorly resourced country with high infant mortality—was technically and logistically feasible and protected infants from laboratory-confirmed influenza for 4 months. With adequate financing to procure the vaccine, implementation will parallel the access to antenatal care and immunisation coverage of pregnant women with tetanus toxoid. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- Milagritos D Tapia
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Samba O Sow
- Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Boubou Tamboura
- Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Ibrahima Tégueté
- Department of Obstetrics and Gynecology, Hôpital Gabriel Touré, Bamako, Mali
| | - Marcela F Pasetti
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mamoudou Kodio
- Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Uma Onwuchekwa
- Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Sharon M Tennant
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
| | - William C Blackwelder
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Flanon Coulibaly
- Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Awa Traoré
- Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Adama Mamby Keita
- Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | | | - Fatoumata Diallo
- Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Moussa Doumbia
- Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Doh Sanogo
- Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Ellen DeMatt
- Cooperative Studies Program Coordinating Center, Department of Veterans Affairs, Perry Point, MD, USA
| | | | - Andrea Buchwald
- Department of Epidemiology, University of Maryland, Baltimore, MD, USA
| | - Karen L Kotloff
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Wilbur H Chen
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Evan W Orenstein
- Emory University School of Medicine, Atlanta, GA, USA; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia PA, USA
| | - Lauren A V Orenstein
- Emory University School of Medicine, Atlanta, GA, USA; Department of Dermatology, University of Pennsylvania Hospital, Philadelphia PA, USA
| | - Julie Villanueva
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joseph Bresee
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Treanor
- Division of Infectious Diseases, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Myron M Levine
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA.
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