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Sharma AK, Verma H, Estivariz CF, Bajracharaya L, Rai G, Shah G, Sherchand J, Jones KAV, Mainou BA, Chavan S, Jeyaseelan V, Sutter RW, Shrestha LP. Persistence of immunity following a single dose of inactivated poliovirus vaccine: a phase 4, open label, non-randomised clinical trial. Lancet Microbe 2023; 4:e923-e930. [PMID: 37774729 DOI: 10.1016/s2666-5247(23)00215-x] [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: 05/25/2023] [Revised: 06/27/2023] [Accepted: 07/04/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The polio eradication endgame required the withdrawal of Sabin type 2 from the oral poliovirus vaccine and introduction of one or more dose of inactivated poliovirus vaccine (IPV) into routine immunisation schedules. However, the duration of single-dose IPV immunity is unknown. We aimed to address this deficiency. METHODS In this phase 4, open-label, non-randomised clinical trial, we assessed single-dose IPV immunity. Two groups of infants or children were screened: the first group had previously received IPV at 14 weeks of age or older (previous IPV group; age >2 years); the second had not previously received IPV (no previous IPV group; age 7-12 months). At enrolment, all participants received an IPV dose. Children in the no previous IPV group received a second IPV dose at day 30. Blood was collected three times in each group: on days 0, 7, and 30 in the previous IPV group and on days 0, 30, and 37 in the no previous IPV group. Poliovirus antibody was measured by microneutralisation assay. Immunity was defined as the presence of a detectable antibody or a rapid anamnestic response (ie, priming). We used the χ2 to compare proportions and the Mann-Whitney U test to assess continuous variables. To assess safety, vaccinees were observed for 30 min, caregivers for each participating child reported adverse events after each follow-up visit and were questioned during each follow-up visit regarding any adverse events during the intervening period. Adverse events were recorded and graded according to the severity of clinical symptoms. The study is registered with ClinicalTrials.gov, NCT03723837. FINDINGS From Nov 18, 2018, to July 31, 2019, 502 participants enrolled in the study, 458 (255 [65%] boys and 203 [44%] girls) were included in the per protocol analysis: 234 (93%) in the previous IPV group and 224 (90%) in the no previous IPV group. In the previous IPV group, 28 months after one IPV dose 233 (>99%) of 234 children had persistence of poliovirus type 2 immunity (100 [43%] of 234 children were seropositive; 133 [99%] of 134 were seronegative and primed). In the no previous IPV group, 30 days after one IPV dose all 224 (100%) children who were type 2 poliovirus naive had seroconverted (223 [>99%] children) or were primed (one [<1%]). No adverse events were deemed attributable to study interventions. INTERPRETATION A single IPV dose administered at 14 weeks of age or older is highly immunogenic and induces nearly universal type 2 immunity (seroconversion and priming), with immunity persisting for at least 28 months. The polio eradication initiative should prioritise first IPV dose administration to mitigate the paralytic burden caused by poliovirus type 2. FUNDING WHO and Rotary International.
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Affiliation(s)
- Arun K Sharma
- Department of Pediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | | | - Luna Bajracharaya
- Department of Pediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Ganesh Rai
- Department of Pediatric Medicine, Kanti Children's Hospital, Kathmandu, Nepal
| | - Ganesh Shah
- Department of Pediatrics, Patan Hospital, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Jeevan Sherchand
- Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | | | - Smita Chavan
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Laxman P Shrestha
- Department of Pediatrics, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Snider CJ, Zaman K, Wilkinson AL, Binte Aziz A, Yunus M, Haque W, Jones KAV, Wei L, Estivariz CF, Konopka-Anstadt JL, Mainou BA, Patel JC, Lickness JS, Pallansch MA, Wassilak SGF, Steven Oberste M, Anand A. Poliovirus type 1 systemic humoral and intestinal mucosal immunity induced by monovalent oral poliovirus vaccine, fractional inactivated poliovirus vaccine, and bivalent oral poliovirus vaccine: A randomized controlled trial. Vaccine 2023; 41:6083-6092. [PMID: 37652822 PMCID: PMC10895964 DOI: 10.1016/j.vaccine.2023.08.055] [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: 06/20/2023] [Revised: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND To inform response strategies, we examined type 1 humoral and intestinal immunity induced by 1) one fractional inactivated poliovirus vaccine (fIPV) dose given with monovalent oral poliovirus vaccine (mOPV1), and 2) mOPV1 versus bivalent OPV (bOPV). METHODS We conducted a randomized, controlled, open-label trial in Dhaka, Bangladesh. Healthy infants aged 5 weeks were block randomized to one of four arms: mOPV1 at age 6-10-14 weeks/fIPV at 6 weeks (A); mOPV1 at 6-10-14 weeks/fIPV at 10 weeks (B); mOPV1 at 6-10-14 weeks (C); and bOPV at 6-10-14 weeks (D). Immune response at 10 weeks and cumulative response at 14 weeks was assessed among the modified intention-to-treat population, defined as seroconversion from seronegative (<1:8 titers) to seropositive (≥1:8) or a four-fold titer rise among seropositive participants sustained to age 18 weeks. We examined virus shedding after two doses of mOPV1 with and without fIPV, and after the first mOPV1 or bOPV dose. The trial is registered at ClinicalTrials.gov (NCT03722004). FINDINGS During 18 December 2018 - 23 November 2019, 1,192 infants were enrolled (arms A:301; B:295; C:298; D:298). Immune responses at 14 weeks did not differ after two mOPV1 doses alone (94% [95% CI: 91-97%]) versus two mOPV1 doses with fIPV at 6 weeks (96% [93-98%]) or 10 weeks (96% [93-98%]). Participants who received mOPV1 and fIPV at 10 weeks had significantly lower shedding (p < 0·001) one- and two-weeks later compared with mOPV1 alone. Response to one mOPV1 dose was significantly higher than one bOPV dose (79% versus 67%; p < 0·001) and shedding two-weeks later was significantly higher after mOPV1 (76% versus 56%; p < 0·001) indicating improved vaccine replication. Ninety-nine adverse events were reported, 29 serious including two deaths; none were attributed to study vaccines. INTERPRETATION Given with the second mOPV1 dose, fIPV improved intestinal immunity but not humoral immunity. One mOPV1 dose induced higher humoral and intestinal immunity than bOPV. FUNDING U.S. Centers for Disease Control and Prevention.
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Affiliation(s)
- Cynthia J Snider
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Atlanta, GA 30329, USA
| | - Khalequ Zaman
- icddr,b, 68 Shahid Tajuddin Ahmed Sarani, Dhaka 1212, Bangladesh
| | - Amanda L Wilkinson
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Atlanta, GA 30329, USA.
| | - Asma Binte Aziz
- icddr,b, 68 Shahid Tajuddin Ahmed Sarani, Dhaka 1212, Bangladesh
| | - Mohammad Yunus
- icddr,b, 68 Shahid Tajuddin Ahmed Sarani, Dhaka 1212, Bangladesh
| | - Warda Haque
- icddr,b, 68 Shahid Tajuddin Ahmed Sarani, Dhaka 1212, Bangladesh
| | - Kathryn A V Jones
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Atlanta, GA 30329, USA
| | - Ling Wei
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Atlanta, GA 30329, USA
| | - Concepcion F Estivariz
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Atlanta, GA 30329, USA
| | | | - Bernardo A Mainou
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Atlanta, GA 30329, USA
| | - Jaymin C Patel
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Atlanta, GA 30329, USA
| | - Jacquelyn S Lickness
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Atlanta, GA 30329, USA
| | - Mark A Pallansch
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Atlanta, GA 30329, USA
| | - Steven G F Wassilak
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Atlanta, GA 30329, USA
| | - M Steven Oberste
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Atlanta, GA 30329, USA
| | - Abhijeet Anand
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Road Northeast, Atlanta, GA 30329, USA
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3
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Sharma AK, Verma H, Estivariz CF, Bajracharaya L, Rai G, Shah G, Sherchand J, Jones KAV, Mainou BA, Chavan S, Jeyaseelan V, Sutter RW, Shrestha LP. Persistence of immunity following a single dose of inactivated poliovirus vaccine: a phase 4, open label, non-randomised clinical trial. The Lancet Microbe 2023. [DOI: org/10.1016/s2666-5247(23)00215-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2023] Open
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4
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Wilkinson AL, Zaman K, Hoque M, Estivariz CF, Burns CC, Konopka-Anstadt JL, Mainou BA, Kovacs SD, An Q, Lickness JS, Yunus M, Snider CJ, Zhang Y, Coffee E, Abid T, Wassilak SGF, Pallansch MA, Oberste MS, Vertefeuille JF, Anand A. Immunogenicity of novel oral poliovirus vaccine type 2 administered concomitantly with bivalent oral poliovirus vaccine: an open-label, non-inferiority, randomised, controlled trial. Lancet Infect Dis 2023; 23:1062-1071. [PMID: 37178706 PMCID: PMC10503264 DOI: 10.1016/s1473-3099(23)00139-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Novel oral poliovirus vaccine type 2 (nOPV2) was developed by modifying the Sabin strain to increase genetic stability and reduce risk of seeding new circulating vaccine-derived poliovirus type 2 outbreaks. Bivalent oral poliovirus vaccine (bOPV; containing Sabin types 1 and 3) is the vaccine of choice for type 1 and type 3 outbreak responses. We aimed to assess immunological interference between nOPV2 and bOPV when administered concomitantly. METHODS We conducted an open-label, non-inferiority, randomised, controlled trial at two clinical trial sites in Dhaka, Bangladesh. Healthy infants aged 6 weeks were randomly assigned (1:1:1) using block randomisation, stratified by site, to receive nOPV2 only, nOPV2 plus bOPV, or bOPV only, at the ages of 6 weeks, 10 weeks, and 14 weeks. Eligibility criteria included singleton and full term (≥37 weeks' gestation) birth and parents intending to remain in the study area for the duration of study follow-up activities. Poliovirus neutralising antibody titres were measured at the ages of 6 weeks, 10 weeks, 14 weeks, and 18 weeks. The primary outcome was cumulative immune response for all three poliovirus types at the age of 14 weeks (after two doses) and was assessed in the modified intention-to-treat population, which was restricted to participants with adequate blood specimens from all study visits. Safety was assessed in all participants who received at least one dose of study product. A non-inferiority margin of 10% was used to compare single and concomitant administration. This trial is registered with ClinicalTrials.gov, NCT04579510. FINDINGS Between Feb 8 and Sept 26, 2021, 736 participants (244 in the nOPV2 only group, 246 in the nOPV2 plus bOPV group, and 246 in the bOPV only group) were enrolled and included in the modified intention-to-treat analysis. After two doses, 209 (86%; 95% CI 81-90) participants in the nOPV2 only group and 159 (65%; 58-70) participants in the nOPV2 plus bOPV group had a type 2 poliovirus immune response; 227 (92%; 88-95) participants in the nOPV2 plus bOPV group and 229 (93%; 89-96) participants in the bOPV only group had a type 1 response; and 216 (88%; 83-91) participants in the nOPV2 plus bOPV group and 212 (86%; 81-90) participants in the bOPV only group had a type 3 response. Co-administration was non-inferior to single administration for types 1 and 3, but not for type 2. There were 15 serious adverse events (including three deaths, one in each group, all attributable to sudden infant death syndrome); none were attributed to vaccination. INTERPRETATION Co-administration of nOPV2 and bOPV interfered with immunogenicity for poliovirus type 2, but not for types 1 and 3. The blunted nOPV2 immunogenicity we observed would be a major drawback of using co-administration as a vaccination strategy. FUNDING The US Centers for Disease Control and Prevention.
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Affiliation(s)
| | - Khalequ Zaman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Masuma Hoque
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Cara C Burns
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Qian An
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Mohammad Yunus
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Yiting Zhang
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Talha Abid
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | - Abhijeet Anand
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
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Kalkowska DA, Wassilak SGF, Wiesen E, F Estivariz C, Burns CC, Badizadegan K, Thompson KM. Complexity of options related to restarting oral poliovirus vaccine (OPV) in national immunization programs after OPV cessation. Gates Open Res 2023; 7:55. [PMID: 37547300 PMCID: PMC10403636 DOI: 10.12688/gatesopenres.14511.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Accepted: 03/09/2023] [Indexed: 08/08/2023] Open
Abstract
Background: The polio eradication endgame continues to increase in complexity. With polio cases caused by wild poliovirus type 1 and circulating vaccine-derived polioviruses of all three types (1, 2 and 3) reported in 2022, the number, formulation, and use of poliovirus vaccines poses challenges for national immunization programs and vaccine suppliers. Prior poliovirus transmission modeling of globally-coordinated type-specific cessation of oral poliovirus vaccine (OPV) assumed creation of Sabin monovalent OPV (mOPV) stockpiles for emergencies and explored the potential need to restart OPV if the world reached a specified cumulative threshold number of cases after OPV cessation. Methods: We document the actual experience of type 2 OPV (OPV2) cessation and reconsider prior modeling assumptions related to OPV restart. We develop updated decision trees of national immunization options for poliovirus vaccines considering different possibilities for OPV restart. Results: While OPV restart represented a hypothetical situation for risk management and contingency planning to support the 2013-2018 Global Polio Eradication Initiative (GPEI) Strategic Plan, the actual epidemiological experience since OPV2 cessation raises questions about what, if any, trigger(s) could lead to restarting the use of OPV2 in routine immunization and/or plans for potential future restart of type 1 and 3 OPV after their respective cessation. The emergency use listing of a genetically stabilized novel type 2 OPV (nOPV2) and continued evaluation of nOPV for types 1 and/or 3 add further complexity by increasing the combinations of possible OPV formulations for OPV restart. Conclusions: Expanding on a 2019 discussion of the logistical challenges and implications of restarting OPV, we find a complex structure of the many options and many issues related to OPV restart decisions and policies as of early 2023. We anticipate many challenges for forecasting prospective vaccine supply needs during the polio endgame due to increasing potential combinations of poliovirus vaccine choices.
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Affiliation(s)
| | - Steven GF Wassilak
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eric Wiesen
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Concepcion F Estivariz
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cara C Burns
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, USA, Atlanta, GA, USA
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Estivariz CF, Kovacs SD, Mach O. Review of use of inactivated poliovirus vaccine in campaigns to control type 2 circulating vaccine derived poliovirus (cVDPV) outbreaks. Vaccine 2022; 41 Suppl 1:A113-A121. [PMID: 35365341 PMCID: PMC10389290 DOI: 10.1016/j.vaccine.2022.03.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/16/2021] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
Abstract
Delivering inactivated poliovirus vaccine (IPV) with oral poliovirus vaccine (OPV) in campaigns has been explored to accelerate the control of type 2 circulating vaccine-derived poliovirus (cVDPV) outbreaks. A review of scientific literature suggests that among populations with high prevalence of OPV failure, a booster with IPV after at least two doses of OPV may close remaining humoral and mucosal immunity gaps more effectively than an additional dose of trivalent OPV. However, IPV alone demonstrates minimal advantage on humoral immunity compared with monovalent and bivalent OPV, and cannot provide the intestinal immunity that prevents infection and spread to those individuals not previously exposed to live poliovirus of the same serotype (i.e. type 2 for children born after the switch from trivalent to bivalent OPV in April 2016). A review of operational data from polio campaigns shows that addition of IPV increases the cost and logistic complexity of campaigns. As a result, campaigns in response to an outbreak often target small areas. Large campaigns require a delay to ensure logistics are in place for IPV delivery, and may need implementation in phases that last several weeks. Challenges to delivery of injectable vaccines through house-to-house visits also increases the risk of missing the children who are more likely to benefit from IPV: those with difficult access to routine immunization and other health services. Based upon this information, the Strategic Advisory Group of Experts in immunization (SAGE) recommended in October 2020 the following strategies: provision of a second dose of IPV in routine immunization to reduce the risk and number of paralytic cases in countries at risk of importation or new emergences; and use of type 2 OPV in high-quality campaigns to interrupt transmission and avoid seeding new type 2 cVDPV outbreaks.
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Affiliation(s)
| | - Stephanie D Kovacs
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
| | - Ondrej Mach
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
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7
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Zaman K, Kovacs SD, Vanderende K, Aziz A, Yunus M, Khan S, Snider CJ, An Q, Estivariz CF, Oberste MS, Pallansch MA, Anand A. Assessing the immunogenicity of three different inactivated polio vaccine schedules for use after oral polio vaccine cessation, an open label, phase IV, randomized controlled trial. Vaccine 2021; 39:5814-5821. [PMID: 34481702 DOI: 10.1016/j.vaccine.2021.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND After global oral poliovirus vaccine (OPV) cessation, the Strategic Advisory Group of Experts on Immunization (SAGE) currently recommends a two-dose schedule of inactivated poliovirus vaccine (IPV) beginning ≥14-weeks of age to achieve at least 90% immune response. We aimed to compare the immunogenicity of three different two-dose IPV schedules started before or at 14-weeks of age. METHODS We conducted a randomized, controlled, open-label, inequality trial at two sites in Dhaka, Bangladesh. Healthy infants at 6-weeks of age were randomized into one of five arms to receive two-dose IPV schedules at different ages with and without OPV. The three IPV-only arms are presented: Arm C received IPV at 14-weeks and 9-months; Arm D received IPV at 6-weeks and 9-months; and Arm E received IPV at 6 and 14-weeks. The primary outcome was immune response defined as seroconversion from seronegative (<1:8) to seropositive (≥1:8) after vaccination, or a four-fold rise in antibody titers and median reciprocal antibody titers to all three poliovirus types measured at 10-months of age. FINDINGS Of the 987 children randomized to Arms C, D, and E, 936 were included in the intention-to-treat analysis. At 10-months, participants in Arm C (IPV at 14-weeks and 9-months) had ≥99% cumulative immune response to all three poliovirus types which was significantly higher than the 77-81% observed in Arm E (IPV at 6 and 14-weeks). Participants in Arm D (IPV at 6-weeks and 9-months) had cumulative immune responses of 98-99% which was significantly higher than that of Arm E (p value < 0.0001) but not different from Arm C. INTERPRETATION Results support current SAGE recommendations for IPV following OPV cessation and provide evidence that the schedule of two full IPV doses could begin as early as 6-weeks.
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Affiliation(s)
- Khalequ Zaman
- International Centre for Diarrheal Disease, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Stephanie D Kovacs
- Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
| | - Kristin Vanderende
- Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | - Asma Aziz
- International Centre for Diarrheal Disease, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Mohammed Yunus
- International Centre for Diarrheal Disease, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh
| | - Sara Khan
- Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | - Cynthia J Snider
- Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | - Qian An
- Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | - Concepcion F Estivariz
- Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | - M Steven Oberste
- Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | - Mark A Pallansch
- Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | - Abhijeet Anand
- Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA
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Cooley GM, Feldstein LR, Bennett SD, Estivariz CF, Weil L, Bohara R, Vandenent M, Mainul Hasan A, Akhtar MS, Uzzaman MS, Billah MM, Conklin L, Ehlman DC, Asiedu K, Solomon AW, Alamgir A, Flora MS, Martin DL. No Serological Evidence of Trachoma or Yaws Among Residents of Registered Camps and Makeshift Settlements in Cox's Bazar, Bangladesh. Am J Trop Med Hyg 2021; 104:2031-2037. [PMID: 33939630 PMCID: PMC8176462 DOI: 10.4269/ajtmh.21-0124] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/16/2021] [Indexed: 12/03/2022] Open
Abstract
Successful achievement of global targets for elimination of trachoma as a public health problem and eradication of yaws will require control efforts to reach marginalized populations, including refugees. Testing for serologic evidence of transmission of trachoma and yaws in residents of registered camps and a Makeshift Settlement in Cox’s Bazar District, Bangladesh, was added to a serosurvey for vaccine-preventable diseases (VPDs) conducted April–May 2018. The survey was primarily designed to estimate remaining immunity gaps for VPDs, including diphtheria, measles, rubella, and polio. Blood specimens from 1- to 14-year-olds from selected households were collected and tested for antibody responses against antigens from Treponema pallidum and Chlamydia trachomatis using a multiplex bead assay to evaluate for serologic evidence of the neglected tropical diseases (NTDs) yaws and trachoma, respectively. The prevalence of antibodies against two C. trachomatis antigens in children ranged from 1.4% to 1.5% for Pgp3 and 2.8% to 7.0% for CT694. The prevalence of antibody responses against both of two treponemal antigens (recombinant protein17 and treponemal membrane protein A) tested was 0% to 0.15% in two camps. The data are suggestive of very low or no transmission of trachoma and yaws, currently or previously, in children resident in these communities. This study illustrates how integrated serologic testing can provide needed data to help NTD programs prioritize limited resources.
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Affiliation(s)
- Gretchen M Cooley
- 1Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leora R Feldstein
- 2Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.,3Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah D Bennett
- 3Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Concepcion F Estivariz
- 3Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lauren Weil
- 4National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - M Salim Uzzaman
- 8Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | | | - Laura Conklin
- 3Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel C Ehlman
- 3Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Asm Alamgir
- 8Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | | | - Diana L Martin
- 1Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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9
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de Deus N, Capitine IPU, Bauhofer AFL, Marques S, Cassocera M, Chissaque A, Bero DM, Langa JP, Padama FM, Jeyaseelan V, Oberste MS, Estivariz CF, Verma H, Jani I, Mach O, Sutter RW. Immunogenicity of reduced-dose monovalent type 2 oral poliovirus vaccine in Mocuba, Mozambique. J Infect Dis 2020; 226:292-298. [PMID: 33180924 PMCID: PMC9400415 DOI: 10.1093/infdis/jiaa704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/05/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Monovalent type 2 oral poliovirus vaccine (mOPV2) stockpile is low. One potential strategy to stretch the existing mOPV2 supply is to administer a reduced dose: one-drop instead of two-drops. METHODS We conducted a randomized, controlled, open-label, non-inferiority trial (10% margin) to compared immunogenicity following administration of one versus two-drops of mOPV2. We enrolled 9-22-months old infants from Mocuba district of Mozambique. Poliovirus neutralizing antibodies were measured in sera collected before and one month after mOPV2 administration. Immune response was defined as seroconversion from seronegative (<1:8) at baseline to seropositive (>1:8) after vaccination or boosting titers by >4-fold for those with titers between 1:8 and 1:362 at baseline. The trial was registered at anzctr.org.au (number ACTRN12619000184178p). RESULTS We enrolled 378 children and 262 (69%) completed per-protocol requirements. Immune response of mOPV2 was 53.6% (95% confidence interval [CI]: 44.9%-62.1%) and 60.6% (95% CI: 52.2%-68.4%) in 1-drop and 2-drops recipients, respectively. The non-inferiority margin of the 10% was not reached (difference=7.0%; 95%CI= -5.0-19.0). CONCLUSION A small loss of immunogenicity of reduced mOPV2 was observed. Although the non-inferiority target was not achieved, the Strategic Advisory Group of Experts on Immunization, recommended the 1-drop strategy as a dose-sparing measure if mOPV2 supplies deteriorate further.
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Affiliation(s)
- Nilsa de Deus
- Instituto Nacional de Saúde (INS) - Mozambique, Maputo, Mozambique
| | | | - Adilson Fernando Loforte Bauhofer
- Instituto Nacional de Saúde (INS) - Mozambique, Maputo, Mozambique.,Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, Lisboa, Portugal
| | - Selma Marques
- Instituto Nacional de Saúde (INS) - Mozambique, Maputo, Mozambique
| | - Marta Cassocera
- Instituto Nacional de Saúde (INS) - Mozambique, Maputo, Mozambique.,Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, Lisboa, Portugal
| | - Assucênio Chissaque
- Instituto Nacional de Saúde (INS) - Mozambique, Maputo, Mozambique.,Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, Lisboa, Portugal
| | | | - José Paulo Langa
- Instituto Nacional de Saúde (INS) - Mozambique, Maputo, Mozambique
| | | | | | | | | | - Harish Verma
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
| | - Ilesh Jani
- Instituto Nacional de Saúde (INS) - Mozambique, Maputo, Mozambique
| | - Ondrej Mach
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
| | - Roland W Sutter
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
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10
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Estivariz CF, Bennett SD, Lickness JS, Feldstein LR, Weldon WC, Leidman E, Ehlman DC, Khan MFH, Adhikari JM, Hasan M, Billah MM, Oberste MS, Alamgir ASM, Flora MD. Assessment of immunity to polio among Rohingya children in Cox's Bazar, Bangladesh, 2018: A cross-sectional survey. PLoS Med 2020; 17:e1003070. [PMID: 32231366 PMCID: PMC7108688 DOI: 10.1371/journal.pmed.1003070] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 02/27/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We performed a cross-sectional survey in April-May 2018 among Rohingya in Cox's Bazar, Bangladesh, to assess polio immunity and inform vaccination strategies. METHODS AND FINDINGS Rohingya children aged 1-6 years (younger group) and 7-14 years (older group) were selected using multi-stage cluster sampling in makeshift settlements and simple random sampling in Nayapara registered camp. Surveyors asked parents/caregivers if the child received any oral poliovirus vaccine (OPV) in Myanmar and, for younger children, if the child received vaccine in any of the 5 campaigns delivering bivalent OPV (serotypes 1 and 3) conducted during September 2017-April 2018 in Cox's Bazar. Dried blood spot (DBS) specimens were tested for neutralizing antibodies to poliovirus types 1, 2, and 3 in 580 younger and 297 older children. Titers ≥ 1:8 were considered protective. Among 632 children (335 aged 1-6 years, 297 aged 7-14 years) enrolled in the study in makeshift settlements, 51% were male and 89% had arrived after August 9, 2017. Among 245 children (all aged 1-6 years) enrolled in the study in Nayapara, 54% were male and 10% had arrived after August 9, 2017. Among younger children, 74% in makeshift settlements and 92% in Nayapara received >3 bivalent OPV doses in campaigns. Type 1 seroprevalence was 85% (95% CI 80%-89%) among younger children and 91% (95% CI 86%-95%) among older children in makeshift settlements, and 92% (88%-95%) among younger children in Nayapara. Type 2 seroprevalence was lower among younger children than older children in makeshift settlements (74% [95% CI 68%-79%] versus 97% [95% CI 94%-99%], p < 0.001), and was 69% (95% CI 63%-74%) among younger children in Nayapara. Type 3 seroprevalence was below 75% for both age groups and areas. The limitations of this study are unknown routine immunization history and poor retention of vaccination cards. CONCLUSIONS Younger Rohingya children had immunity gaps to all 3 polio serotypes and should be targeted by future campaigns and catch-up routine immunization. DBS collection can enhance the reliability of assessments of outbreak risk and vaccination strategy impact in emergency settings.
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Affiliation(s)
- Concepcion F. Estivariz
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sarah D. Bennett
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jacquelyn S. Lickness
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Leora R. Feldstein
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - William C. Weldon
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eva Leidman
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Daniel C. Ehlman
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Mainul Hasan
- United Nations Children’s Fund, Dhaka, Bangladesh
| | - Mallick M. Billah
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - M. Steven Oberste
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - A. S. M. Alamgir
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Meerjady D. Flora
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
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11
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Carter RJ, Idriss A, Widdowson MA, Samai M, Schrag SJ, Legardy-Williams JK, Estivariz CF, Callis A, Carr W, Webber W, Fischer ME, Hadler S, Sahr F, Thompson M, Greby SM, Edem-Hotah J, Momoh RM, McDonald W, Gee JM, Kallon AF, Spencer-Walters D, Bresee JS, Cohn A, Hersey S, Gibson L, Schuchat A, Seward JF. Implementing a Multisite Clinical Trial in the Midst of an Ebola Outbreak: Lessons Learned From the Sierra Leone Trial to Introduce a Vaccine Against Ebola. J Infect Dis 2019; 217:S16-S23. [PMID: 29788343 DOI: 10.1093/infdis/jix657] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The Sierra Leone Trial to Introduce a Vaccine against Ebola (STRIVE), a phase 2/3 trial of investigational rVSV∆G-ZEBOV-GP vaccine, was conducted during an unprecedented Ebola epidemic. More than 8600 eligible healthcare and frontline response workers were individually randomized to immediate (within 7 days) or deferred (within 18-24 weeks) vaccination and followed for 6 months after vaccination for serious adverse events and Ebola virus infection. Key challenges included limited infrastructure to support trial activities, unreliable electricity, and staff with limited clinical trial experience. Study staff made substantial infrastructure investments, including renovation of enrollment sites, laboratories, and government cold chain facilities, and imported equipment to store and transport vaccine at ≤-60oC. STRIVE built capacity by providing didactic and practical research training to >350 staff, which was reinforced with daily review and feedback meetings. The operational challenges of safety follow-up were addressed by issuing mobile telephones to participants, making home visits, and establishing a nurse triage hotline. Before the Ebola outbreak, Sierra Leone had limited infrastructure and staff to conduct clinical trials. Without interfering with the outbreak response, STRIVE responded to an urgent need and helped build this capacity. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov [NCT02378753] and Pan African Clinical Trials Registry [PACTR201502001037220].
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Affiliation(s)
| | - Ayesha Idriss
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | - Mohamed Samai
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | | | - Amy Callis
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wendy Carr
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Winston Webber
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Marc E Fischer
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephen Hadler
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Foday Sahr
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Melvina Thompson
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Stacie M Greby
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph Edem-Hotah
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Roselyn M'baindu Momoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Wendi McDonald
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julianne M Gee
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ahamed Flagbata Kallon
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | - Joseph S Bresee
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amanda Cohn
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sara Hersey
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Anne Schuchat
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jane F Seward
- Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Snider CJ, Zaman K, Estivariz CF, Yunus M, Weldon WC, Wannemuehler KA, Oberste MS, Pallansch MA, Wassilak SG, Bari TIA, Anand A. Immunogenicity of full and fractional dose of inactivated poliovirus vaccine for use in routine immunisation and outbreak response: an open-label, randomised controlled trial. Lancet 2019; 393:2624-2634. [PMID: 31104832 PMCID: PMC7069654 DOI: 10.1016/s0140-6736(19)30503-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/13/2019] [Accepted: 02/25/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intradermal administration of fractional inactivated poliovirus vaccine (fIPV) is a dose-sparing alternative to the intramuscular full dose. We aimed to compare the immunogenicity of two fIPV doses versus one IPV dose for routine immunisation, and also assessed the immunogenicity of an fIPV booster dose for an outbreak response. METHODS We did an open-label, randomised, controlled, inequality, non-inferiority trial in two clinics in Dhaka, Bangladesh. Healthy infants were randomly assigned at 6 weeks to one of four groups: group A received IPV at age 14 weeks and IPV booster at age 22 weeks; group B received IPV at age 14 weeks and fIPV booster at age 22 weeks; group C received IPV at age 6 weeks and fIPV booster at age 22 weeks; and group D received fIPV at 6 weeks and 14 weeks and fIPV booster at age 22 weeks. IPV was administered by needle-syringe as an intramuscular full dose (0·5 mL), and fIPV was administered intradermally (0·1 mL of the IPV formulation was administered using the 0·1 mL HelmJect auto-disable syringe with a Helms intradermal adapter). Both IPV and fIPV were administered on the outer, upper right thigh of infants. The primary outcome was vaccine response to poliovirus types 1, 2, and 3 at age 22 weeks (routine immunisation) and age 26 weeks (outbreak response). Vaccine response was defined as seroconversion from seronegative (<1:8) at baseline to seropositive (≥1:8) or four-fold increase in reciprocal antibody titres adjusted for maternal antibody decay and was assessed in the modified intention-to-treat population (infants who received polio vaccines per group assignment and polio antibody titre results to serotypes 1, 2, and 3 at 6, 22, 23, and 26 weeks of age). The non-inferiority margin was 12·5%. This trial is registered with ClinicalTrials.gov, number NCT02847026. FINDINGS Between Sept 1, 2016 and May 2, 2017, 1076 participants were randomly assigned and included in the modified intention-to-treat analysis: 271 in Group A, 267 in group B, 268 in group C, and 270 in group D. Vaccine response at 22 weeks to two doses of fIPV (group D) was significantly higher (p<0·0001) than to one dose of IPV (groups A and B) for all three poliovirus serotypes: the type 1 response comprised 212 (79% [95% CI 73-83]) versus 305 (57% [53-61]) participants, the type 2 response comprised 173 (64% [58-70]) versus 249 (46% [42-51]) participants, and the type 3 response comprised 196 (73% [67-78]) versus 196 (36% [33-41]) participants. At 26 weeks, the fIPV booster was non-inferior to IPV (group B vs group A) for serotype 1 (-1·12% [90% CI -2·18 to -0·06]), serotype 2 (0·40%, [-2·22 to 1·42]), and serotype 3 (1·51% [-3·23 to -0·21]). Of 129 adverse events, 21 were classified as serious including one death; none were attributed to IPV or fIPV. INTERPRETATION fIPV appears to be an effective dose-sparing strategy for routine immunisation and outbreak responses. FUNDING US Centers for Disease Control and Prevention.
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Affiliation(s)
- Cynthia J Snider
- US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Khalequ Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Mohammad Yunus
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | | | | | | | - Tajul Islam A Bari
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abhijeet Anand
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
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13
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Billah MM, Zaman K, Estivariz CF, Snider CJ, Anand A, Hampton LM, Bari TIA, Russell KL, Chai SJ. Cold-Chain Adaptability During Introduction of Inactivated Polio Vaccine in Bangladesh, 2015. J Infect Dis 2017; 216:S114-S121. [PMID: 28838173 PMCID: PMC5853344 DOI: 10.1093/infdis/jiw591] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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] [Indexed: 11/23/2022] Open
Abstract
Background. Introduction of inactivated polio vaccine creates challenges in maintaining the cold chain for vaccine storage and distribution. Methods. We evaluated the cold chain in 23 health facilities and 36 outreach vaccination sessions in 8 districts and cities of Bangladesh, using purposive sampling during August–October 2015. We interviewed immunization and cold-chain staff, assessed equipment, and recorded temperatures during vaccine storage and transportation. Results. All health facilities had functioning refrigerators, and 96% had freezers. Temperature monitors were observed in all refrigerators and freezers but in only 14 of 66 vaccine transporters (21%). Recorders detected temperatures >8°C for >60 minutes in 5 of 23 refrigerators (22%), 3 of 6 cold boxes (50%) transporting vaccines from national to subnational depots, and 8 of 48 vaccine carriers (17%) used in outreach vaccination sites. Temperatures <2°C were detected in 4 of 19 cold boxes (21%) transporting vaccine from subnational depots to health facilities and 14 of 48 vaccine carriers (29%). Conclusions. Bangladesh has substantial cold-chain storage and transportation capacity after inactivated polio vaccine introduction, but temperature fluctuations during vaccine transport could cause vaccine potency loss that could go undetected. Bangladesh and other countries should strive to ensure consistent and sufficient cold-chain storage and monitor the cold chain during vaccine transportation at all levels.
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Affiliation(s)
- Mallick M Billah
- Field Epidemiology Training Program Bangladesh, Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - K Zaman
- icddr,b (formerly International Centre for Diarrhoeal Diseases Research, Bangladesh), Dhaka, Bangladesh
| | | | | | | | | | - Tajul I A Bari
- Expanded Program for Immunization, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Kevin L Russell
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shua J Chai
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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14
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Cardemil CV, Sherchand JB, Shrestha L, Sharma A, Gary HE, Estivariz CF, Diez-Valcarce M, Ward ML, Bowen MD, Vinjé J, Parashar U, Chu SY. Pathogen-Specific Burden of Outpatient Diarrhea in Infants in Nepal: A Multisite Prospective Case-Control Study. J Pediatric Infect Dis Soc 2017; 6:e75-e85. [PMID: 28472489 PMCID: PMC10389588 DOI: 10.1093/jpids/pix009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 01/09/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Nonsevere diarrheal disease in Nepal represents a large burden of illness. Identification of the specific disease-causing pathogens will help target the appropriate control measures. METHODS Infants aged 6 weeks to 12 months were recruited from 5 health facilities in eastern, central, and western Nepal between August 2012 and August 2013. The diarrhea arm included infants with mild or moderate diarrhea treatable in an outpatient setting; the nondiarrhea arm included healthy infants who presented for immunization visits or had a mild nondiarrheal illness. Stool samples were tested for 15 pathogens with a multiplex polymerase chain reaction (PCR) assay and real-time reverse-transcription (RT)-PCR assays for rotavirus and norovirus. Rotavirus- and norovirus-positive specimens were genotyped. We calculated attributable fractions (AFs) to estimate the pathogen-specific burden of diarrhea and adjusted for facility, age, stunting, wasting, and presence of other pathogens. RESULTS We tested 307 diarrheal and 358 nondiarrheal specimens. Pathogens were detected more commonly in diarrheal specimens (164 of 307 [53.4%]) than in nondiarrheal specimens (113 of 358 [31.6%]) (P < .001). Rotavirus (AF, 23.9% [95% confidence interval (CI), 14.9%-32.8%]), Salmonella (AF, 12.4% [95% CI, 6.6%-17.8%]), and Campylobacter (AF, 5.6% [95% CI, 1.3%-9.8%]) contributed most to the burden of disease. In these diarrheal specimens, the most common genotypes for rotavirus were G12P[6] (27 of 82 [32.9%]) and G1P[8] (16 of 82 [19.5%]) and for norovirus were GII.4 Sydney (9 of 26 [34.6%]) and GII.7 (5 of 26 [19.2%]). CONCLUSIONS The results of this study indicate that the introduction of a rotavirus vaccine in Nepal will likely decrease outpatient diarrheal disease burden in infants younger than 1 year, but interventions to detect and target other pathogens, such as Salmonella and Campylobacter spp, should also be considered.
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Affiliation(s)
- Cristina V Cardemil
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Laxman Shrestha
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Arun Sharma
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Howard E Gary
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Concepcion F Estivariz
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marta Diez-Valcarce
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - M Leanne Ward
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael D Bowen
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jan Vinjé
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Umesh Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan Y Chu
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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15
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Estivariz CF, Snider CJ, Anand A, Hampton LM, Bari TI, Billah MM, Chai SJ, Wassilak SG, Heffelfinger JD, Zaman K. Lessons Learned From the Introduction of Inactivated Poliovirus Vaccine in Bangladesh. J Infect Dis 2017; 216:S122-S129. [PMID: 28838154 PMCID: PMC5853666 DOI: 10.1093/infdis/jiw510] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background We assessed programmatic adaptations and infants' uptake of inactivated poliovirus vaccine (IPV) after its introduction into the routine immunization schedule in Bangladesh. Methods Using convenience and probability sampling, we selected 23 health facilities, 36 vaccinators, and 336 caregivers, within 5 districts and 3 city corporations. We collected data during August-October 2015 by conducting interviews, reviewing vaccination records, and observing activities. Results Knowledge about IPV was high among vaccinators (94%). No problems with IPV storage, transport, or waste disposal were detected, but shortages were reported in 20 health facilities (87%). Wastage per 5-dose vaccine vial was above the recommended 30% in 20 health facilities (87%); all were related to providing <5 doses per open vial. Among eligible infants, 87% and 86% received the third dose of pentavalent and oral poliovirus vaccine, respectively, but only 65% received IPV at the same visit. Among 73 infants not vaccinated with IPV, 58% of caregivers reported that vaccine was unavailable. Conclusions Bangladesh successfully introduced IPV, but shortages related to insufficient global supply and high vaccine wastage in small outreach immunization sessions might reduce its impact on population immunity. Minimizing wastage and use of a 2-dose fractional-IPV schedule could extend IPV immunization to more children.
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Affiliation(s)
| | | | | | | | - Tajul I Bari
- Expanded Programme on Immunization, Dhaka, Bangladesh
| | - Mallick M Billah
- Field Epidemiology Training Program Bangladesh, Institute of Epidemiology, Disease Control and Research, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Shua J Chai
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - James D Heffelfinger
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - K Zaman
- International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
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16
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Alraddadi BM, Al-Salmi HS, Jacobs-Slifka K, Slayton RB, Estivariz CF, Geller AI, Al-Turkistani HH, Al-Rehily SS, Alserehi HA, Wali GY, Alshukairi AN, Azhar EI, Haynes L, Swerdlow DL, Jernigan JA, Madani TA. Risk Factors for Middle East Respiratory Syndrome Coronavirus Infection among Healthcare Personnel. Emerg Infect Dis 2016; 22:1915-1920. [PMID: 27767011 PMCID: PMC5088034 DOI: 10.3201/eid2211.160920] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Healthcare settings can amplify transmission of Middle East respiratory syndrome coronavirus (MERS-CoV), but knowledge gaps about the epidemiology of transmission remain. We conducted a retrospective cohort study among healthcare personnel in hospital units that treated MERS-CoV patients. Participants were interviewed about exposures to MERS-CoV patients, use of personal protective equipment, and signs and symptoms of illness after exposure. Infection status was determined by the presence of antibodies against MERS-CoV. To assess risk factors, we compared infected and uninfected participants. Healthcare personnel caring for MERS-CoV patients were at high risk for infection, but infection most often resulted in a relatively mild illness that might be unrecognized. In the healthcare personnel cohort reported here, infections occurred exclusively among those who had close contact with MERS-CoV patients.
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Affiliation(s)
- Basem M. Alraddadi
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia (B.M. Alraddadi, H.S. Al-Salmi, H.H. Al-Turkistani, S.S. Al-Rehily, H.A. Alserehi, G.Y. Wali, A.N. Alshukairi)
- Ministry of Health, Jeddah (B.M. Alraddadi, E.I. Azhar, T.A. Madani)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K. Jacobs-Slifka, R.B. Slayton, C.F. Estivariz, A.I. Geller, L. Haynes, D.L. Swerdlow, J.A. Jernigan)
- King Abdulaziz University, Jeddah (E.I. Azhar, T.A. Madani)
| | - Hanadi S. Al-Salmi
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia (B.M. Alraddadi, H.S. Al-Salmi, H.H. Al-Turkistani, S.S. Al-Rehily, H.A. Alserehi, G.Y. Wali, A.N. Alshukairi)
- Ministry of Health, Jeddah (B.M. Alraddadi, E.I. Azhar, T.A. Madani)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K. Jacobs-Slifka, R.B. Slayton, C.F. Estivariz, A.I. Geller, L. Haynes, D.L. Swerdlow, J.A. Jernigan)
- King Abdulaziz University, Jeddah (E.I. Azhar, T.A. Madani)
| | - Kara Jacobs-Slifka
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia (B.M. Alraddadi, H.S. Al-Salmi, H.H. Al-Turkistani, S.S. Al-Rehily, H.A. Alserehi, G.Y. Wali, A.N. Alshukairi)
- Ministry of Health, Jeddah (B.M. Alraddadi, E.I. Azhar, T.A. Madani)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K. Jacobs-Slifka, R.B. Slayton, C.F. Estivariz, A.I. Geller, L. Haynes, D.L. Swerdlow, J.A. Jernigan)
- King Abdulaziz University, Jeddah (E.I. Azhar, T.A. Madani)
| | - Rachel B. Slayton
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia (B.M. Alraddadi, H.S. Al-Salmi, H.H. Al-Turkistani, S.S. Al-Rehily, H.A. Alserehi, G.Y. Wali, A.N. Alshukairi)
- Ministry of Health, Jeddah (B.M. Alraddadi, E.I. Azhar, T.A. Madani)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K. Jacobs-Slifka, R.B. Slayton, C.F. Estivariz, A.I. Geller, L. Haynes, D.L. Swerdlow, J.A. Jernigan)
- King Abdulaziz University, Jeddah (E.I. Azhar, T.A. Madani)
| | - Concepcion F. Estivariz
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia (B.M. Alraddadi, H.S. Al-Salmi, H.H. Al-Turkistani, S.S. Al-Rehily, H.A. Alserehi, G.Y. Wali, A.N. Alshukairi)
- Ministry of Health, Jeddah (B.M. Alraddadi, E.I. Azhar, T.A. Madani)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K. Jacobs-Slifka, R.B. Slayton, C.F. Estivariz, A.I. Geller, L. Haynes, D.L. Swerdlow, J.A. Jernigan)
- King Abdulaziz University, Jeddah (E.I. Azhar, T.A. Madani)
| | - Andrew I. Geller
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia (B.M. Alraddadi, H.S. Al-Salmi, H.H. Al-Turkistani, S.S. Al-Rehily, H.A. Alserehi, G.Y. Wali, A.N. Alshukairi)
- Ministry of Health, Jeddah (B.M. Alraddadi, E.I. Azhar, T.A. Madani)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K. Jacobs-Slifka, R.B. Slayton, C.F. Estivariz, A.I. Geller, L. Haynes, D.L. Swerdlow, J.A. Jernigan)
- King Abdulaziz University, Jeddah (E.I. Azhar, T.A. Madani)
| | - Hanan H. Al-Turkistani
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia (B.M. Alraddadi, H.S. Al-Salmi, H.H. Al-Turkistani, S.S. Al-Rehily, H.A. Alserehi, G.Y. Wali, A.N. Alshukairi)
- Ministry of Health, Jeddah (B.M. Alraddadi, E.I. Azhar, T.A. Madani)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K. Jacobs-Slifka, R.B. Slayton, C.F. Estivariz, A.I. Geller, L. Haynes, D.L. Swerdlow, J.A. Jernigan)
- King Abdulaziz University, Jeddah (E.I. Azhar, T.A. Madani)
| | - Sanaa S. Al-Rehily
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia (B.M. Alraddadi, H.S. Al-Salmi, H.H. Al-Turkistani, S.S. Al-Rehily, H.A. Alserehi, G.Y. Wali, A.N. Alshukairi)
- Ministry of Health, Jeddah (B.M. Alraddadi, E.I. Azhar, T.A. Madani)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K. Jacobs-Slifka, R.B. Slayton, C.F. Estivariz, A.I. Geller, L. Haynes, D.L. Swerdlow, J.A. Jernigan)
- King Abdulaziz University, Jeddah (E.I. Azhar, T.A. Madani)
| | - Haleema A. Alserehi
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia (B.M. Alraddadi, H.S. Al-Salmi, H.H. Al-Turkistani, S.S. Al-Rehily, H.A. Alserehi, G.Y. Wali, A.N. Alshukairi)
- Ministry of Health, Jeddah (B.M. Alraddadi, E.I. Azhar, T.A. Madani)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K. Jacobs-Slifka, R.B. Slayton, C.F. Estivariz, A.I. Geller, L. Haynes, D.L. Swerdlow, J.A. Jernigan)
- King Abdulaziz University, Jeddah (E.I. Azhar, T.A. Madani)
| | - Ghassan Y. Wali
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia (B.M. Alraddadi, H.S. Al-Salmi, H.H. Al-Turkistani, S.S. Al-Rehily, H.A. Alserehi, G.Y. Wali, A.N. Alshukairi)
- Ministry of Health, Jeddah (B.M. Alraddadi, E.I. Azhar, T.A. Madani)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K. Jacobs-Slifka, R.B. Slayton, C.F. Estivariz, A.I. Geller, L. Haynes, D.L. Swerdlow, J.A. Jernigan)
- King Abdulaziz University, Jeddah (E.I. Azhar, T.A. Madani)
| | - Abeer N. Alshukairi
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia (B.M. Alraddadi, H.S. Al-Salmi, H.H. Al-Turkistani, S.S. Al-Rehily, H.A. Alserehi, G.Y. Wali, A.N. Alshukairi)
- Ministry of Health, Jeddah (B.M. Alraddadi, E.I. Azhar, T.A. Madani)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K. Jacobs-Slifka, R.B. Slayton, C.F. Estivariz, A.I. Geller, L. Haynes, D.L. Swerdlow, J.A. Jernigan)
- King Abdulaziz University, Jeddah (E.I. Azhar, T.A. Madani)
| | - Esam I. Azhar
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia (B.M. Alraddadi, H.S. Al-Salmi, H.H. Al-Turkistani, S.S. Al-Rehily, H.A. Alserehi, G.Y. Wali, A.N. Alshukairi)
- Ministry of Health, Jeddah (B.M. Alraddadi, E.I. Azhar, T.A. Madani)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K. Jacobs-Slifka, R.B. Slayton, C.F. Estivariz, A.I. Geller, L. Haynes, D.L. Swerdlow, J.A. Jernigan)
- King Abdulaziz University, Jeddah (E.I. Azhar, T.A. Madani)
| | - Lia Haynes
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia (B.M. Alraddadi, H.S. Al-Salmi, H.H. Al-Turkistani, S.S. Al-Rehily, H.A. Alserehi, G.Y. Wali, A.N. Alshukairi)
- Ministry of Health, Jeddah (B.M. Alraddadi, E.I. Azhar, T.A. Madani)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K. Jacobs-Slifka, R.B. Slayton, C.F. Estivariz, A.I. Geller, L. Haynes, D.L. Swerdlow, J.A. Jernigan)
- King Abdulaziz University, Jeddah (E.I. Azhar, T.A. Madani)
| | - David L. Swerdlow
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia (B.M. Alraddadi, H.S. Al-Salmi, H.H. Al-Turkistani, S.S. Al-Rehily, H.A. Alserehi, G.Y. Wali, A.N. Alshukairi)
- Ministry of Health, Jeddah (B.M. Alraddadi, E.I. Azhar, T.A. Madani)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (K. Jacobs-Slifka, R.B. Slayton, C.F. Estivariz, A.I. Geller, L. Haynes, D.L. Swerdlow, J.A. Jernigan)
- King Abdulaziz University, Jeddah (E.I. Azhar, T.A. Madani)
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Bahl S, Verma H, Bhatnagar P, Haldar P, Satapathy A, Kumar KNA, Horton J, Estivariz CF, Anand A, Sutter R. Fractional-Dose Inactivated Poliovirus Vaccine Immunization Campaign - Telangana State, India, June 2016. MMWR Morb Mortal Wkly Rep 2016; 65:859-63. [PMID: 27559683 DOI: 10.15585/mmwr.mm6533a5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Wild poliovirus type 2 was declared eradicated in September 2015 (1). In April 2016, India, switched from use of trivalent oral poliovirus vaccine (tOPV; containing types 1, 2, and 3 polio vaccine viruses), to bivalent OPV (bOPV; containing types 1 and 3), as part of a globally synchronized initiative to withdraw Sabin poliovirus type 2 vaccine. Concurrently, inactivated poliovirus vaccine (IPV) was introduced into India's routine immunization program to maintain an immunity base that would mitigate the number of paralytic cases in the event of epidemic transmission of poliovirus type 2 (2,3). After cessation of use of type 2 Sabin vaccine, any reported isolation of vaccine-derived poliovirus type 2 (VDPV2) would be treated as a public health emergency and might need outbreak response with monovalent type 2 oral vaccine, IPV, or both (4). In response to identification of a VDPV2 isolate from a sewage sample collected in the southern state of Telangana in May 2016, India conducted a mass vaccination campaign in June 2016 using an intradermal fractional dose (0.1 ml) of IPV (fIPV). Because of a global IPV supply shortage, fIPV, which uses one fifth of regular intramuscular (IM) dose administered intradermally, has been recommended as a response strategy for VDPV2 (5). Clinical trials have demonstrated that fIPV is highly immunogenic (6,7). During the 6-day campaign, 311,064 children aged 6 weeks-3 years were vaccinated, achieving an estimated coverage of 94%. With appropriate preparation, an emergency fIPV response can be promptly and successfully implemented. Lessons learned from this campaign can be applied to successful implementation of future outbreak responses using fIPV.
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Emperador DM, Velasquez DE, Estivariz CF, Lopman B, Jiang B, Parashar U, Anand A, Zaman K. Interference of Monovalent, Bivalent, and Trivalent Oral Poliovirus Vaccines on Monovalent Rotavirus Vaccine Immunogenicity in Rural Bangladesh. Clin Infect Dis 2015; 62:150-6. [PMID: 26349548 DOI: 10.1093/cid/civ807] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 08/28/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Trivalent oral poliovirus vaccine (OPV) is known to interfere with monovalent rotavirus vaccine (RV1) immunogenicity. The interference caused by bivalent and monovalent OPV formulations, which will be increasingly used globally in coming years, has not been examined. We conducted a post hoc analysis to assess the effect of coadministration of different OPV formulations on RV1 immunogenicity. METHODS Healthy infants in Matlab, Bangladesh, were randomized to receive 3 doses of monovalent OPV type 1 or bivalent OPV types 1 and 3 at either 6, 8, and 10 or 6, 10, and 14 weeks of age or trivalent OPV at 6, 10, and 14 weeks of age. All infants received 2 doses of RV1 at about 6 and 10 weeks of age. Concomitant administration was defined as RV1 and OPV given on the same day; staggered administration as RV1 and OPV given ≥1 day apart. Rotavirus seroconversion was defined as a 4-fold rise in immunoglobulin A titer from before the first RV1 dose to ≥3 weeks after the second RV1 dose. RESULTS There were no significant differences in baseline RV1 immunogenicity among the 409 infants included in the final analysis. Infants who received RV1 and OPV concomitantly, regardless of OPV formulation, were less likely to seroconvert (47%; 95% confidence interval, 39%-54%) than those who received both vaccines staggered ≥1 day (63%; 57%-70%; P < .001). For staggered administration, we found no evidence that the interval between RV1 and OPV administration affected RV1 immunogenicity. CONCLUSIONS Coadministration of monovalent, bivalent, or trivalent OPV seems to lower RV1 immunogenicity. CLINICAL TRIALS REGISTRATION NCT01633216.
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Affiliation(s)
| | | | - Concepcion F Estivariz
- Global Immunization Division, Centers for Diseases Control and Prevention, Atlanta, Georgia
| | | | | | | | - Abhijeet Anand
- Global Immunization Division, Centers for Diseases Control and Prevention, Atlanta, Georgia
| | - Khalequ Zaman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Sheikh MA, Makokha F, Hussein MA, Mohamed G, Mach O, Humayun K, Okiror S, Abrar L, Nasibov O, Burton J, Unshur A, Wannemuehler K, Estivariz CF. Combined use of inactivated and oral poliovirus vaccines in refugee camps and surrounding communities - Kenya, December 2013. MMWR Morb Mortal Wkly Rep 2014; 63:237-41. [PMID: 24647400 PMCID: PMC4584634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Since the launch of the Global Polio Eradication Initiative (GPEI) in 1988, circulation of indigenous wild poliovirus (WPV) has continued without interruption in only three countries: Afghanistan, Nigeria, and Pakistan. During April-December 2013, a polio outbreak caused by WPV type 1 (WPV1) of Nigerian origin resulted in 217 cases in or near the Horn of Africa, including 194 cases in Somalia, 14 cases in Kenya, and nine cases in Ethiopia (all cases were reported as of March 10, 2014). During December 14-18, 2013, Kenya conducted the first-ever campaign providing inactivated poliovirus vaccine (IPV) together with oral poliovirus vaccine (OPV) as part of its outbreak response. The campaign targeted 126,000 children aged ≤59 months who resided in Somali refugee camps and surrounding communities near the Kenya-Somalia border, where most WPV1 cases had been reported, with the aim of increasing population immunity levels to ensure interruption of any residual WPV transmission and prevent spread from potential new importations. A campaign evaluation and vaccination coverage survey demonstrated that combined administration of IPV and OPV in a mass campaign is feasible and can achieve coverage >90%, although combined IPV and OPV campaigns come at a higher cost than OPV-only campaigns and require particular attention to vaccinator training and supervision. Future operational studies could assess the impact on population immunity and the cost-effectiveness of combined IPV and OPV campaigns to accelerate interruption of poliovirus transmission during polio outbreaks and in certain areas in which WPV circulation is endemic.
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Affiliation(s)
| | - Frederick Makokha
- Field Epidemiology and Laboratory Training, Ministry of Health, Kenya
| | | | - Gedi Mohamed
- World Health Organization (WHO) Country Office, Nairobi, Kenya
| | | | | | | | | | | | - John Burton
- United Nations High Commissioner for Refugees, Kenya
| | - Ahmed Unshur
- Refugee Health Program, CDC/Kenya Medical Research Institute
| | | | - Concepcion F. Estivariz
- Global Immunization Division, Center for Global Health, CDC,Corresponding author: Concepcion F. Estivariz, , 404-639-8499
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Rainey JJ, Bhatnagar P, Estivariz CF, Durrani S, Galway M, Sandhu H, Bahl S, Jafari H, Wenger J. Providing monovalent oral polio vaccine type 1 to newborns: findings from a pilot birth-dose project in Moradabad district, India. Bull World Health Organ 2009; 87:955-9. [PMID: 20454487 PMCID: PMC2789365 DOI: 10.2471/blt.08.061556] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 03/10/2009] [Accepted: 03/11/2009] [Indexed: 11/27/2022] Open
Abstract
PROBLEM Poliovirus transmission remained a public health challenge in western Uttar Pradesh, India in late 2005 and early 2006. In 2006, the India Expert Advisory Group for Polio Eradication concluded that, given the peak incidence of polio among children 6 to 12 months of age, a targeted birth dose of oral polio vaccine may be necessary to interrupt intense poliovirus transmission in high risk areas. APPROACH The Government of Uttar Pradesh, the National Polio Surveillance Project and the United Nations Children's Fund (UNICEF) implemented a pilot birth-dose project aimed at identifying and vaccinating all newborns with a dose of oral polio vaccine within 72 hours of birth in an effort to evaluate operational feasibility and potential impact on population immunity. LOCAL SETTING The project was piloted in Moradabad district: zone 7 in Moradabad City (urban setting), Kunderki block (rural setting) and in select birthing hospitals. RELEVANT CHANGES Between July 2006 and February 2007, 9740 newborns were identified, of which 6369 (65%) were vaccinated by project personnel within 72 hours of birth. Project coverage (for total newborns vaccinated) ranged from 39% (in zone 7) to 76% (in Kunderki block) of the estimated number of newborns vaccinated during previous supplemental immunization activities. LESSONS LEARNED Birth-dose coverage among newborns was lower than expected. Expansion costs were estimated to be high, with marginal impact. The project, however, provided opportunities to strengthen newborn tracking systems which have increased the number of newborns and young infants vaccinated during supplemental immunization activities and enrolled in routine programmes.
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Affiliation(s)
- J J Rainey
- US Centers for Disease Control and Prevention, Global Immunization Division,1600 Clifton Road (MS E-05), Atlanta, GA 30333, United States of America.
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Estivariz CF, Bhatti LI, Pati R, Jensen B, Arduino MJ, Jernigan D, Lipuma JJ, Srinivasan A. An Outbreak of Burkholderia cepacia Associated With Contamination of Albuterol and Nasal Spray. Chest 2006; 130:1346-53. [PMID: 17099009 DOI: 10.1378/chest.130.5.1346] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Species within the Burkholderia cepacia complex (Bcc) can contaminate medications and disinfectants and cause severe pneumonia in critically ill patients or persons with cystic fibrosis. In March 2004, we investigated a hospital outbreak of Bcc possibly associated with a contaminated nasal spray. METHODS We conducted a matched case-control study, environmental sampling, and observations of infection control practices. Case patients had infection or colonization with Bcc, and control patients had sputum culture not yielding Bcc. Isolates from patients and environmental samples were compared by pulsed-field gel electrophoresis (PFGE). RESULTS Bcc was recovered from sputum in 18 patients. Compared with matched control patients (n = 18), case patients were more likely to be receiving mechanical ventilation (p = 0.01), to have been hospitalized > 6 days (p = 0.01), and to have received antimicrobial treatment within 7 days before sputum collection (p = 0.03). Bcc was cultured from opened, but not unopened, multidose albuterol bottles, a nebulizer attached to a ventilator, and opened and unopened nasal spray bottles from contaminated lots. PFGE showed that isolates from albuterol samples and from patients were indistinguishable but unrelated to the nasal spray strain. Observations revealed improper aseptic techniques during respiratory therapy procedures and inadequate nebulizer cleaning. CONCLUSIONS Despite a temporal association with use of a contaminated nasal spray, this outbreak was caused by extrinsic contamination of multidose albuterol used for nebulization treatments and lack of adherence to infection control precautions. Implementation and re-enforcement of infection control measures successfully terminated the outbreak.
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Affiliation(s)
- Concepcion F Estivariz
- Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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López del Val T, Estivariz CF, Martínez de Icaya P, Jaunsolo MA, del Olmo D, Vázquez Martínez C. [Consumption of sweets and snacks by a population of school children in the Autonomous Community of Madrid. The CAENPE Group]. Med Clin (Barc) 1997; 109:88-91. [PMID: 9289520] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND In our society advertising compaigns promote consumption of superfluous foods, such as sweets and snacks, displacing the intake of other basic nutrients. The aim of this study is to assess the intake of these foods by children, their relative contribution to overall macronutrient intake and their effects on health. SUBJECTS AND METHODS A dietary assessment was performed on a representative sample of scholar children from the Autonomous Community of Madrid. It reflects food consumption for a 4-days period (3 week-days and 1 weekend day) in 2,698 boys and girls aged 6 to 15 years. The intake is expressed as grams per 1,000 kcal to standardize nutrient consumption in boys and girls. Lipid profile and several markers of nutritional status are also determined. RESULTS The consumption of sweets and snacks items per 1,000 kcal is higher in boys than in girls (35.8 +/- 20.0 and 34.2 +/- 19.6 g/1,000 kcal, respectively; p = 0.01) and increases during adolescence (12 and 13 years) in both sexes. Sweets and snacks provide 16.1% of dietary total caloric intake, 7.1% of saturated fatty acids, 10.7% of monounsaturated fatty acids, 10.4% of polyunsaturated fatty acids and 11.3% of cholesterol. Children of ages 6, 7, 8 and 9 years with high calculated LDL-cholesterol levels (> or = 120 mg/dl) consume significative higher amounts of sweet foods than children with low calculated LDL-cholesterol levels (< or = 90 mg/dl). CONCLUSIONS Children from the Autonomous Community of Madrid, Spain consume excessive sweets, which could be responsible for a higher prevalence of diseases related to this intake, such as caries, obesity and obesity-related associate diseases.
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Affiliation(s)
- T López del Val
- Sección de Endocrinología y Nutrición, Hospital Severo Ochoa, Madrid
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