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Perera SM, Garbern SC, Mbong EN, Fleming MK, Muhayangabo RF, Ombeni AB, Kulkarni S, Tchoualeu DD, Kallay R, Song E, Powell J, Gainey M, Glenn B, Mutumwa RM, Mustafa SHB, Earle-Richardson G, Fukunaga R, Abad N, Soke GN, Prybylski D, Fitter DL, Levine AC, Doshi RH. Perceptions toward Ebola vaccination and correlates of vaccine uptake among high-risk community members in North Kivu, Democratic Republic of the Congo. PLOS Glob Public Health 2024; 4:e0002566. [PMID: 38236844 PMCID: PMC10796044 DOI: 10.1371/journal.pgph.0002566] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/22/2023] [Indexed: 01/22/2024]
Abstract
The tenth Ebola Virus Disease (EVD) outbreak (2018-2020, North Kivu, Ituri, South Kivu) in the Democratic Republic of the Congo (DRC) was the second-largest EVD outbreak in history. During this outbreak, Ebola vaccination was an integral part of the EVD response. We evaluated community perceptions toward Ebola vaccination and identified correlates of Ebola vaccine uptake among high-risk community members in North Kivu, DRC. In March 2021, a cross-sectional survey among adults was implemented in three health zones. We employed a sampling approach mimicking ring vaccination, targeting EVD survivors, their household members, and their neighbors. Outbreak experiences and perceptions toward the Ebola vaccine were assessed, and modified Poisson regression was used to identify correlates of Ebola vaccine uptake among those offered vaccination. Among the 631 individuals surveyed, most (90.2%) reported a high perceived risk of EVD and 71.6% believed that the vaccine could reduce EVD severity; however, 63.7% believed the vaccine had serious side effects. Among the 474 individuals who had been offered vaccination, 397 (83.8%) received the vaccine, 180 (45.3%) of those vaccinated received the vaccine after two or more offers. Correlates positively associated with vaccine uptake included having heard positive information about the vaccine (RR 1.30, 95% CI 1.06-1.60), the belief that the vaccine could prevent EVD (RR 1.23, 95% CI 1.09-1.39), and reporting that religion influenced all decisions (RR 1.13, 95% CI 1.02-1.25). Ebola vaccine uptake was high in this population, although mixed attitudes and vaccine delays were common. Communicating positive vaccine information, emphasizing the efficacy of the Ebola vaccine, and engaging religious leaders to promote vaccination may aid in increasing Ebola vaccine uptake during future outbreaks.
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Affiliation(s)
- Shiromi M. Perera
- International Medical Corps, Washington, District of Columbia, United States of America
| | - Stephanie Chow Garbern
- Department of Emergency Medicine, Brown University, Providence, Rhode Island, United States of America
| | - Eta Ngole Mbong
- International Medical Corps, Goma, Democratic Republic of the Congo
| | - Monica K. Fleming
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Shibani Kulkarni
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dieula Delissaint Tchoualeu
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ruth Kallay
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elizabeth Song
- Brown University, Providence, Rhode Island, United States of America
| | - Jasmine Powell
- Brown University, Providence, Rhode Island, United States of America
| | - Monique Gainey
- Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Bailey Glenn
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- James A. Ferguson Infectious Disease Program, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | - Giulia Earle-Richardson
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rena Fukunaga
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Neetu Abad
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Gnakub Norbert Soke
- Division of Global Health Protection, Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of the Congo
| | - Dimitri Prybylski
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - David L. Fitter
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Adam C. Levine
- Department of Emergency Medicine, Brown University, Providence, Rhode Island, United States of America
| | - Reena H. Doshi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Doshi RH, Garbern SC, Kulkarni S, Perera SM, Fleming MK, Muhayangabo RF, Ombeni AB, Tchoualeu DD, Kallay R, Song E, Powell J, Gainey M, Glenn B, Mutumwa RM, Hans Bateyi Mustafa S, Earle-Richardson G, Gao H, Abad N, Soke GN, Fitter DL, Hyde TB, Prybylski D, Levine AC, Jalloh MF, Mbong EN. Ebola vaccine uptake and attitudes among healthcare workers in North Kivu, Democratic Republic of the Congo, 2021. Front Public Health 2023; 11:1080700. [PMID: 37559741 PMCID: PMC10408297 DOI: 10.3389/fpubh.2023.1080700] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 06/19/2023] [Indexed: 08/11/2023] Open
Abstract
Introduction During the 2018-2020 Ebola virus disease (EVD) outbreak in the eastern part of the Democratic Republic of the Congo (DRC), prevention and control measures, such as Ebola vaccination were challenging by community mistrust. We aimed to understand perceptions regarding Ebola vaccination and identify determinants of Ebola vaccine uptake among HCWs. Methods In March 2021, we conducted a cross-sectional survey among 438 HCWs from 100 randomly selected health facilities in three health zones (Butembo, Beni, Mabalako) affected by the 10th EVD outbreak in North Kivu, DRC. HCWs were eligible if they were ≥ 18 years and were working in a health facility during the outbreak. We used survey logistic regression to assess correlates of first-offer uptake (i.e., having received the vaccine the first time it was offered vs. after subsequent offers). Results Of the 438 HCWs enrolled in the study, 420 (95.8%) reported that they were eligible and offered an Ebola vaccine. Among those offered vaccination, self-reported uptake of the Ebola vaccine was 99.0% (95% confidence interval (CI) [98.5-99.4]), but first-offer uptake was 70.2% (95% CI [67.1, 73.5]). Nearly all HCWs (94.3%; 95% CI [92.7-95.5]) perceived themselves to be at risk of contracting EVD. The most common concern was that the vaccine would cause side effects (65.7%; 95% CI [61.4-69.7]). In the multivariable analysis, mistrust of the vaccine source or how the vaccine was produced decreased the odds of first-time uptake. Discussion Overall uptake of the Ebola vaccine was high among HCWs, but uptake at the first offer was substantially lower, which was associated with mistrust of the vaccine source. Future Ebola vaccination efforts should plan to make repeated vaccination offers to HCWs and address their underlying mistrust in the vaccines, which can, in turn, improve community uptake.
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Affiliation(s)
- Reena H. Doshi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Stephanie C. Garbern
- Department of Emergency Medicine, Brown University, Providence, RI, United States
| | - Shibani Kulkarni
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Monica K. Fleming
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | - Ruth Kallay
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | - Bailey Glenn
- James A. Ferguson Infectious Disease Program, Baltimore, MD, United States
| | | | | | - Giulia Earle-Richardson
- National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Hongjiang Gao
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Neetu Abad
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Gnakub Norbert Soke
- Division of Global Health Protection, Centers for Disease Control and Prevention, Kinshasa, Democratic Republic of Congo
| | - David L. Fitter
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Terri B. Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Dimitri Prybylski
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Adam C. Levine
- International Medical Corps, Washington, DC, United States
- International Medical Corps, Goma, Democratic Republic of Congo
| | - Mohamed F. Jalloh
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Eta Ngole Mbong
- International Medical Corps, Goma, Democratic Republic of Congo
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Soeters HM, Doshi RH, Fleming M, Adegoke OJ, Ajene U, Aksnes BN, Bennett S, Blau EF, Carlton JG, Clements S, Conklin L, Dahlke M, Duca LM, Feldstein LR, Gidudu JF, Grant G, Hercules M, Igboh LS, Ishizumi A, Jacenko S, Kerr Y, Konne NM, Kulkarni S, Kumar A, Lafond KE, Lam E, Longley AT, McCarron M, Namageyo-Funa A, Ortiz N, Patel JC, Perry RT, Prybylski D, Reddi P, Salman O, Sciarratta CN, Shragai T, Siddula A, Sikare E, Tchoualeu DD, Traicoff D, Tuttle A, Victory KR, Wallace A, Ward K, Wong MKA, Zhou W, Schluter WW, Fitter DL, Mounts A, Bresee JS, Hyde TB. CDC's COVID-19 International Vaccine Implementation and Evaluation Program and Lessons from Earlier Vaccine Introductions. Emerg Infect Dis 2022; 28:S208-S216. [PMID: 36502382 DOI: 10.3201/eid2813.212123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The US Centers for Disease Control and Prevention (CDC) supports international partners in introducing vaccines, including those against SARS-CoV-2 virus. CDC contributes to the development of global technical tools, guidance, and policy for COVID-19 vaccination and has established its COVID-19 International Vaccine Implementation and Evaluation (CIVIE) program. CIVIE supports ministries of health and their partner organizations in developing or strengthening their national capacities for the planning, implementation, and evaluation of COVID-19 vaccination programs. CIVIE's 7 priority areas for country-specific technical assistance are vaccine policy development, program planning, vaccine confidence and demand, data management and use, workforce development, vaccine safety, and evaluation. We discuss CDC's work on global COVID-19 vaccine implementation, including priorities, challenges, opportunities, and applicable lessons learned from prior experiences with Ebola, influenza, and meningococcal serogroup A conjugate vaccine introductions.
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Lucien MAB, Esona MD, Pierre M, Joseph G, Rivière C, Leshem E, Aliabadi N, Desormeaux AM, Andre-Alboth J, Fitter DL, Grant-Greene Y, Tate J, Boncy J, Patel R, Burnett E, Juin S, Parashar UD, Bowen MD. Diversity of rotavirus strains circulating in Haiti before and after introduction of monovalent vaccine. IJID Regions 2022; 4:146-151. [PMID: 35923644 PMCID: PMC9340491 DOI: 10.1016/j.ijregi.2022.07.007] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 11/30/2022]
Abstract
Rotaviruses are the most common cause of acute gastroenteritis among children. In Haiti, the most frequent genotype in the pre-vaccine period was G12P[8]. Equine-like G3P[8] strains dominated most years following vaccine introduction.
Background Haiti introduced a monovalent human group A rotavirus (RVA) vaccine (Rotarix) into its routine infant immunization program in April 2014. The goal of the surveillance program was to characterize RVA strains circulating in Haiti before and after RVA vaccine introduction. Methods Stool samples were collected from children <5 years old presenting with acute gastroenteritis at 16 hospitals in Haiti. RVA antigen enzyme immunoassay (EIA) testing was performed, and G and P genotypes were determined for positive specimens. In this study, genotype data for samples collected from May 2012 through April 2014 (the pre-vaccine introduction era) and May 2014 through July 2019 (post-vaccine introduction era) were analyzed. Results A total of 809 specimens were tested by the Centers for Disease Control and Prevention. During the pre-vaccine introduction era (May 2012 through April 2014), G12P[8] was the predominant genotype, detected in 88–94% of specimens. There was a high prevalence of the equine-like G3P[8] genotype among Haitian children with RVA after vaccine introduction. Conclusions The predominance of equine-like G3P[8] in three of five RVA seasons post-vaccine introduction suggests possible vaccine-specific selection pressure in Haiti. These temporal variations in RVA genotype predominance will require continued monitoring in Haiti as the vaccination program continues.
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Affiliation(s)
- Mentor Ali Ber Lucien
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
- Corresponding author: Mentor Ali Ber Lucien, Laboratoire National de Santé Publique, Port-au-Prince, Haiti.
| | - Mathew D. Esona
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (NCIRD), CDC, Atlanta, Georgia, USA
| | | | - Gerard Joseph
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | | | - Eyal Leshem
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (NCIRD), CDC, Atlanta, Georgia, USA
| | - Negar Aliabadi
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (NCIRD), CDC, Atlanta, Georgia, USA
| | | | | | | | | | - Jacqueline Tate
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (NCIRD), CDC, Atlanta, Georgia, USA
| | - Jacques Boncy
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | | | - Eleanor Burnett
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (NCIRD), CDC, Atlanta, Georgia, USA
| | | | - Umesh D. Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (NCIRD), CDC, Atlanta, Georgia, USA
| | - Michael D. Bowen
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (NCIRD), CDC, Atlanta, Georgia, USA
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Dismer AM, Charles M, Dear N, Louis-Jean JM, Barthelemy N, Richard M, Morose W, Fitter DL. Identification of TB space-time clusters and hotspots in Ouest département, Haiti, 2011-2016. Public Health Action 2021; 11:101-107. [PMID: 34159071 DOI: 10.5588/pha.20.0085] [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: 12/19/2020] [Accepted: 03/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Haiti has the highest incidence rate of TB in the Western Hemisphere, with an estimated 170 cases per 100,000 in 2019. Since 2010, control efforts have focused on targeted case-finding activities in urban areas, implementation of rapid molecular diagnostics at high-volume TB centers, and improved reporting. TB analyses are rarely focused on lower geographic units; thus, the major goal was to determine if there were focal areas of TB transmission from 2011 to 2016 at operational geographic levels useful for the National TB Control Program (PNLT). METHODS We created a geocoder to locate TB cases at the smallest geographic level. Kulldorff's space-time permutation scan, Anselin Moran's I, and Getis-Ord Gi* statistics were used to determine the spatial distribution and clusters of TB. RESULTS With 91% of cases linked using the geocoder, TB clusters were identified each year. Getis-Ord Gi* analysis revealed 14 distinct spatial clusters of high incidences in the Port-au-Prince metropolitan area. One hundred retrospective space-time clusters were detected. CONCLUSION Our study confirms the presence of TB hotspots in the Ouest département, with most clusters in the Port-au-Prince metropolitan area. Results will help the PNLT and its partners better design case-finding strategies for these areas.
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Affiliation(s)
- A M Dismer
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - N Dear
- CDC, Port-au-Prince, Haiti
| | - J M Louis-Jean
- Programme National de Lutte contre la Tuberculose, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - N Barthelemy
- Directorate of Epidemiology, Laboratory, and Research, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - M Richard
- Programme National de Lutte contre la Tuberculose, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - W Morose
- Programme National de Lutte contre la Tuberculose, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
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Kriss JL, Reynolds LE, Wang A, Stokley S, Cole MM, Harris LQ, Shaw LK, Black CL, Singleton JA, Fitter DL, Rose DA, Ritchey MD, Toblin RL. COVID-19 Vaccine Second-Dose Completion and Interval Between First and Second Doses Among Vaccinated Persons - United States, December 14, 2020-February 14, 2021. MMWR Morb Mortal Wkly Rep 2021; 70:389-395. [PMID: 33735162 PMCID: PMC7976616 DOI: 10.15585/mmwr.mm7011e2] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Charles M, Richard M, Reichler MR, Koama JB, Morose W, Fitter DL. Treatment success for patients with tuberculosis receiving care in areas severely affected by Hurricane Matthew - Haiti, 2016. PLoS One 2021; 16:e0247750. [PMID: 33730043 PMCID: PMC7968710 DOI: 10.1371/journal.pone.0247750] [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] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 02/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND On October 4, 2016, Hurricane Matthew struck southwest Haiti as a category 4 storm. The goal of this study was to evaluate the impact of the hurricane on tuberculosis (TB) services and patient outcomes in the three severely affected departments-Sud, Grand'Anse, and Nippes-of southwest Haiti. METHODS We developed a standard questionnaire to assess a convenience sample of health facilities in the affected areas, a patient tracking form, and a line list for tracking all patients with drug-susceptible TB registered in care six months before the hurricane. We analyzed data from the national TB electronic surveillance system to determine outcomes for all patients receiving anti-TB treatment in the affected areas. We used logistic regression analysis to determine factors associated with treatment success. RESULTS Of the 66 health facilities in the three affected departments, we assessed 31, accounting for 536 (45.7%) of 1,174 TB patients registered in care when Hurricane Matthew made landfall in Haiti. Three (9.7%) health facilities sustained moderate to severe damage, whereas 18 (58.1%) were closed for <1 week, and five (16.1%) for ≥1 week. Four weeks after the hurricane, 398 (73.1%) of the 536 patients in the assessed facilities were located. Treatment success in the affected departments one year after the hurricane was 81.4%. Receiving care outside the municipality of residence (adjusted odds ratio [aOR]: 0.46, 95% confidence interval [CI]: 0.27-0.80) and HIV positivity (aOR: 0.31, 95% CI: 0.19-0.51) or unknown HIV status (aOR: 0.49, 95% CI: 0.33-0.74) were associated with significantly lower rates of treatment success. CONCLUSIONS Despite major challenges, a high percentage of patients receiving anti-TB treatment before the hurricane were located and successfully treated in southwest Haiti. The lessons learned and results presented here may help inform policies and guidelines in similar settings for effective TB control after a natural disaster.
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Affiliation(s)
- Macarthur Charles
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
- * E-mail:
| | - Milo Richard
- Programme National de Lutte contre la Tuberculose (PNLT), Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Mary R. Reichler
- National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | - Willy Morose
- Programme National de Lutte contre la Tuberculose (PNLT), Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - David L. Fitter
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
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8
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Doshi RH, Fleming M, Mukoka AK, Carter RJ, Hyde TB, Choi M, Nzaji MK, Bateyi SH, Christie A, Nichol ST, Damon IK, Beach M, Musenga EM, Fitter DL. Vaccination of contacts of Ebola virus disease survivors to prevent further transmission. Lancet Glob Health 2020; 8:e1455-e1456. [PMID: 33220205 PMCID: PMC10662388 DOI: 10.1016/s2214-109x(20)30454-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/06/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Reena H Doshi
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| | - Monica Fleming
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | | | - Rosalind J Carter
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Mary Choi
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Athalia Christie
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Stuart T Nichol
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Inger K Damon
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael Beach
- Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - David L Fitter
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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Schnaubelt ER, Charles M, Richard M, Fitter DL, Morose W, Cegielski JP. Loss to follow-up among patients receiving anti-tuberculosis treatment, Haiti, 2011-2015. Public Health Action 2018; 8:154-161. [PMID: 30775274 DOI: 10.5588/pha.18.0043] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 08/23/2018] [Indexed: 11/10/2022] Open
Abstract
Setting: Tuberculosis (TB) treatment facilities in Haiti. Objective: To assess factors associated with loss to follow-up (LTFU) among patients receiving treatment for tuberculosis (TB) in Haiti. Design: We analyzed Haiti's national surveillance data for patients started on anti-tuberculosis treatment from 2011 to 2015 to determine factors associated with LTFU using multivariable logistic regression and describe LTFU in terms of subnational units to target future intervention strategies. We also conducted a survival analysis to estimate hazard ratios of factors associated with time to LTFU. Results: Of 81 490 TB cases reported, 7423 (9.1%) were LTFU during anti-tuberculosis treatment, increasing from 7.1% in 2011 to 10.3% in 2015. Six high-volume facilities had significantly higher rates of LTFU (14.3-31.9%) than the rest of the country, accounting for 18.8% of all TB cases reported, but 41.7% of all LTFU patients. Male sex, previous treatment history, and human immunodeficiency virus infection were associated with higher rates of LTFU. The median time to LTFU was 94 days. Conclusion: A small number of facilities accounted for disproportionately high rates of LTFU. These results identify characteristics of facilities and individuals leading to concentrated interventions to reduce LTFU and improve treatment success.
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Affiliation(s)
- E R Schnaubelt
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service Program, Atlanta, Georgia, USA
| | - M Charles
- Division for Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - M Richard
- Programme National de Lutte contre la Tuberculose, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - D L Fitter
- Division for Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - W Morose
- Programme National de Lutte contre la Tuberculose, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - J P Cegielski
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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10
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Charles M, Richard M, Joseph P, Bury MR, Perrin G, Louis FJ, Fitter DL, Marston BJ, Deyde V, Boncy J, Morose W, Pape JW, Lowrance DW. Trends in Tuberculosis Case Notification and Treatment Success, Haiti, 2010-2015. Am J Trop Med Hyg 2017; 97:49-56. [PMID: 29064365 PMCID: PMC5676628 DOI: 10.4269/ajtmh.16-0863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 11/17/2022] Open
Abstract
Since the 2010 earthquake, tuberculosis (TB) control has been a major priority for health sector response and recovery efforts in Haiti. The goal of this study was to analyze trends in TB case notification in Haiti from the aggregate data reported by the National TB Control Program to understand the effects of such efforts. A total of 95,745 TB patients were registered for treatment in Haiti between 2010 and 2015. Three regions, the West, Artibonite, and North departments accounted for 68% of the TB cases notified during the period. Patients in the 15–34 age groups represented 53% (50,560) of all cases. Case notification rates of all forms of TB increased from 142.7/100,000 in 2010 to 153.4 in 2015, peaking at 163.4 cases/100,000 in 2013. Case notification for smear-positive pulmonary TB increased from 85.5 cases/100,000 to 105.7 cases/100,000, whereas treatment success rates remained stable at 79–80% during the period. Active TB case finding efforts in high-risk communities and the introduction of new diagnostics have contributed to increasing TB case notification trends in Haiti from 2010 to 2015. Targeted interventions and novel strategies are being implemented to reach high-risk populations and underserved communities.
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Affiliation(s)
| | - Milo Richard
- Programme National de Lutte contre la Tuberculose, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | | | - Margarette R Bury
- Pan American Health Organization/World Health Organization, Port-au-Prince, Haiti
| | - Georges Perrin
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | | | - David L Fitter
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | | | - Varough Deyde
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Jacques Boncy
- Laboratoire National de Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Willy Morose
- Programme National de Lutte contre la Tuberculose, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | | | - David W Lowrance
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
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Fitter DL, Delson DB, Guillaume FD, Schaad AW, Moffett DB, Poncelet JL, Lowrance D, Gelting R. Applying a New Framework for Public Health Systems Recovery following Emergencies and Disasters: The Example of Haiti following a Major Earthquake and Cholera Outbreak. Am J Trop Med Hyg 2017; 97:4-11. [PMID: 29064359 PMCID: PMC5676637 DOI: 10.4269/ajtmh.16-0862] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 06/09/2017] [Indexed: 11/25/2022] Open
Abstract
Emergencies can often directly impact health systems of an affected region or country, especially in resource-constrained areas. Health system recovery following an emergency is a complex and dynamic process. Health system recovery efforts have often been structured around the World Health Organization's health systems building blocks as demonstrated by the Post-Disaster Needs Assessment. Although this structure is valuable and well known, it can overlook the intricacies of public health systems. We retrospectively examine public health systems recovery, a subset of the larger health system, following the 2010 Haiti earthquake and cholera outbreak, through the lens of the 10 essential public health services. This framework illustrates the comprehensive nature of and helps categorize the activities necessary for a well-functioning public health system and can complement other assessments. Outlining the features of a public health system for recovery in structured manner can also help lay the foundation for sustainable long-term development leading to a more robust and resilient health system.
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Affiliation(s)
- David L. Fitter
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | | | | | | | | | | | - David Lowrance
- Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - Richard Gelting
- Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Juin S, Schaad N, Lafontant D, Joseph GA, Barzilay E, Boncy J, Barrais R, Louis FJ, Jean Charles NL, Corvil S, Barthelemy N, Dismer A, Pierre JS, Archer RW, Antoine M, Marston B, Katz M, Dely P, Adrien P, Fitter DL, Lowrance D, Patel R. Strengthening National Disease Surveillance and Response-Haiti, 2010-2015. Am J Trop Med Hyg 2017; 97:12-20. [PMID: 29064361 PMCID: PMC5676630 DOI: 10.4269/ajtmh.16-0948] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 05/01/2017] [Indexed: 11/13/2022] Open
Abstract
Haiti's health system has faced many challenges over the years, with competing health priorities in the context of chronic financial and human resource limitations. As a result, the existing notifiable disease surveillance system was unable to provide the most basic epidemiologic data for public health decision-making and action. In the wake of the January 2010 earthquake, the Haitian Ministry of Public Health and Population collaborated with the U.S. Centers for Disease Control and Prevention, the Pan American Health Organization, and other local and international partners to implement a functional national surveillance system. More than 7 years later, it is important to take the opportunity to reflect on progress made on surveillance and response in Haiti, including disease detection, reporting, outbreak investigation, and response. The national epidemiologic surveillance network that started with 51 sites in 2010 has been expanded to 357 sites as of December 2015. Disease outbreaks identified via the surveillance system, or other surveillance approaches, are investigated by epidemiologists trained by the Ministry of Health's Field Epidemiology Training Program. Other related surveillance modules have been developed on the same model and electronic platform, allowing the country to document the impact of interventions, track progress, and monitor health problems. Sustainability remains the greatest challenge since most of the funding for surveillance come from external sources.
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Affiliation(s)
- Stanley Juin
- U.S. Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Nicolas Schaad
- U.S. Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Donald Lafontant
- Directorate of Epidemiology, Laboratory and Research, Port-au-Prince, Haiti
| | | | - Ezra Barzilay
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jacques Boncy
- National Laboratory of Public Health, Port-au-Prince, Haiti
| | - Robert Barrais
- Directorate of Epidemiology, Laboratory and Research, Port-au-Prince, Haiti
| | - Frantz Jean Louis
- U.S. Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | | | - Salomon Corvil
- Directorate of Epidemiology, Laboratory and Research, Port-au-Prince, Haiti
| | | | - Amber Dismer
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jean Samuel Pierre
- Directorate of Epidemiology, Laboratory and Research, Port-au-Prince, Haiti
| | - Roodly W. Archer
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mayer Antoine
- U.S. Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Barbara Marston
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark Katz
- U.S. Centers for Disease Control and Prevention, Port-au-Prince, Haiti
- Ben Gurion University of the Negev, Beersheva, Israel
| | - Patrick Dely
- Directorate of Epidemiology, Laboratory and Research, Port-au-Prince, Haiti
| | - Paul Adrien
- Directorate of Epidemiology, Laboratory and Research, Port-au-Prince, Haiti
| | - David L. Fitter
- U.S. Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - David Lowrance
- U.S. Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Roopal Patel
- U.S. Centers for Disease Control and Prevention, Port-au-Prince, Haiti
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13
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Sissoko D, Keïta M, Diallo B, Aliabadi N, Fitter DL, Dahl BA, Akoi Bore J, Raymond Koundouno F, Singethan K, Meisel S, Enkirch T, Mazzarelli A, Amburgey V, Faye O, Alpha Sall A, Magassouba N, Carroll MW, Anglaret X, Malvy D, Formenty P, Bruce Aylward R, Keïta S, Harouna Djingarey M, Loman NJ, Günther S, Duraffour S. Ebola Virus Persistence in Breast Milk After No Reported Illness: A Likely Source of Virus Transmission From Mother to Child. Clin Infect Dis 2017; 64:513-516. [PMID: 27940938 PMCID: PMC5404930 DOI: 10.1093/cid/ciw793] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 07/05/2016] [Accepted: 11/30/2016] [Indexed: 12/03/2022] Open
Abstract
A 9-month-old infant died from Ebola virus (EBOV) disease with unknown epidemiological link. While her parents did not report previous illness, laboratory investigations revealed persisting EBOV RNA in the mother’s breast milk and the father’s seminal fluid. Genomic analysis strongly suggests EBOV transmission to the child through breastfeeding.
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Affiliation(s)
- Daouda Sissoko
- INSERM U1219, Bordeaux University, Bordeaux, France.,Bordeaux University Hospital, Bordeaux, France
| | - Mory Keïta
- World Health Organization, Conakry, Guinea
| | | | - Negar Aliabadi
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David L Fitter
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Benjamin A Dahl
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph Akoi Bore
- European Mobile Laboratory Consortium, Hamburg, Germany.,Ministry of Health, Conakry, Guinea
| | - Fara Raymond Koundouno
- European Mobile Laboratory Consortium, Hamburg, Germany.,Ministry of Health, Conakry, Guinea
| | - Katrin Singethan
- European Mobile Laboratory Consortium, Hamburg, Germany.,Institute of Virology, Technische Universität München/Helmholtz Zentrum München, Munich
| | - Sarah Meisel
- European Mobile Laboratory Consortium, Hamburg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Theresa Enkirch
- European Mobile Laboratory Consortium, Hamburg, Germany.,Paul-Ehrlich-Institut, Division of Veterinary Medicine, Langen, Germany
| | - Antonio Mazzarelli
- European Mobile Laboratory Consortium, Hamburg, Germany.,National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Victoria Amburgey
- Sandia National Laboratories, Albuquerque, New Mexico.,Ratoma Ebola Diagnostic Center, Conakry, Guinea
| | | | | | - N'Faly Magassouba
- Université Gamal Abdel Nasser de Conakry, Laboratoire des Fièvres Hémorragiques en Guinée, Conakry, Guinea
| | - Miles W Carroll
- European Mobile Laboratory Consortium, Hamburg, Germany.,Public Health England, Porton Down, Salisbury.,University of Southampton, South General Hospital, Southampton, United Kingdom
| | - Xavier Anglaret
- INSERM U1219, Bordeaux University, Bordeaux, France.,PAC-CI, ANRS Research Site, Treichville University Hospital, Abidjan, Côte d'Ivoire
| | - Denis Malvy
- INSERM U1219, Bordeaux University, Bordeaux, France.,Bordeaux University Hospital, Bordeaux, France
| | | | | | | | | | - Nicholas J Loman
- Institute of Microbiology and Infection, University of Birmingham, United Kingdom
| | - Stephan Günther
- European Mobile Laboratory Consortium, Hamburg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Sophie Duraffour
- European Mobile Laboratory Consortium, Hamburg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
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14
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Jean Louis F, Huang JY, Nebie YK, Koivogui L, Jayaraman G, Abiola N, Vansteelandt A, Worrel MC, Shang J, Murphy LB, Fitter DL, Marston BJ, Martel L. Implementation of broad screening with Ebola rapid diagnostic tests in Forécariah, Guinea. Afr J Lab Med 2017; 6:484. [PMID: 28879148 PMCID: PMC5523918 DOI: 10.4102/ajlm.v6i1.484] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 05/04/2016] [Accepted: 11/15/2016] [Indexed: 11/06/2022] Open
Abstract
Background Laboratory-enhanced surveillance is critical for rapidly detecting the potential re-emergence of Ebola virus disease. Rapid diagnostic tests (RDT) for Ebola antigens could expand diagnostic capacity for Ebola virus disease. Objectives The Guinean National Coordination for Ebola Response conducted a pilot implementation to determine the feasibility of broad screening of patients and corpses with the OraQuick® Ebola RDT. Methods The implementation team developed protocols and trained healthcare workers to screen patients and corpses in Forécariah prefecture, Guinea, from 15 October to 30 November 2015. Data collected included number of consultations, number of fevers reported or measured, number of tests performed for patients or corpses and results of confirmatory RT-PCR testing. Data on malaria RDT results were collected for comparison. Feedback from Ebola RDT users was collected informally during supervision visits and forums. Results There were 3738 consultations at the 15 selected healthcare facilities; 74.6% of consultations were for febrile illness. Among 2787 eligible febrile patients, 2633 were tested for malaria and 1628 OraQuick® Ebola RDTs were performed. A total of 322 OraQuick® Ebola RDTs were conducted on corpses. All Ebola tests on eligible patients were negative. Conclusions Access to Ebola testing was expanded by the implementation of RDTs in an emergency situation. Feedback from Ebola RDT users and lessons learned will contribute to improving quality for RDT expansion.
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Affiliation(s)
| | - Jennifer Y Huang
- Centers for Diseases Control and Prevention, Atlanta, Georgia, United States
| | | | | | | | - Nadine Abiola
- Centers for Diseases Control and Prevention, Kinshasa, Congo
| | - Amanda Vansteelandt
- Centers for Diseases Control and Prevention, Atlanta, Georgia, United States
| | - Mary C Worrel
- Centers for Diseases Control and Prevention, Atlanta, Georgia, United States
| | - Judith Shang
- Centers for Diseases Control and Prevention, Yaoundé, Cameroon
| | - Louise B Murphy
- Centers for Diseases Control and Prevention, Atlanta, Georgia, United States
| | - David L Fitter
- Centers for Diseases Control and Prevention, Atlanta, Georgia, United States
| | - Barbara J Marston
- Centers for Diseases Control and Prevention, Atlanta, Georgia, United States
| | - Lise Martel
- Centers for Diseases Control and Prevention, Conakry, Guinea
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15
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Journel I, Andrécy LL, Metellus D, Pierre JS, Faublas RM, Juin S, Dismer AM, Fitter DL, Neptune D, Laraque MJ, Corvil S, Pierre M, Buteau J, Lafontant D, Patel R, Lemoine JF, Lowrance DW, Charles M, Boncy J, Adrien P. Transmission of Zika Virus - Haiti, October 12, 2015-September 10, 2016. MMWR Morb Mortal Wkly Rep 2017; 66:172-176. [PMID: 28207688 PMCID: PMC5657860 DOI: 10.15585/mmwr.mm6606a4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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16
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Tohme RA, François J, Wannemuehler K, Magloire R, Danovaro-Holliday MC, Flannery B, Cavallaro KF, Fitter DL, Purcell N, Dismer A, Tappero JW, Vertefeuille JF, Hyde TB. Measles and rubella vaccination coverage in Haiti, 2012: progress towards verifying and challenges to maintaining measles and rubella elimination. Trop Med Int Health 2014; 19:1105-15. [PMID: 25041586 DOI: 10.1111/tmi.12335] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We conducted a nationwide survey to assess measles containing vaccine (MCV) coverage among children aged 1-9 years in Haiti and identify factors associated with vaccination before and during the 2012 nationwide supplementary immunisation activities (SIA). METHODS Haiti was stratified into five geographic regions (Metropolitan Port-au-Prince, North, Centre, South and West), 40 clusters were randomly selected in each region, and 35 households were selected per cluster. RESULTS Among the 7000 visited households, 75.8% had at least one child aged 1-9 years; of these, 5279 (99.5%) households consented to participate in the survey. Of 9883 children enrolled, 91% received MCV before and/or during the SIA; 31% received MR for the first time during the SIA, and 50.7% received two doses of MCV (one before and one during the 2012 SIA). Among the 1685 unvaccinated children during the SIA, the primary reason of non-vaccination was caregivers not being aware of the SIA (31.0%). Children aged 1-4 years had significantly lower MR SIA coverage than those aged 5-9 years (79.5% vs. 84.8%) (P < 0.0001). A higher proportion of children living in the West (12.3%) and Centre (11.2%) regions had never been vaccinated than in other regions (4.8-9.1%). Awareness, educational level of the mother and region were significantly associated with MR vaccination during and before the SIA (P < 0.001). CONCLUSIONS The 2012 SIA successfully increased MR coverage; however, to maintain measles and rubella elimination, coverage needs to be further increased among children aged 1-4 years and in regions with lower coverage.
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Affiliation(s)
- Rania A Tohme
- Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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17
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Fitter DL, Anselme R, Paluku G, Rey G, Flannery B, Tohme RA, Marston BJ, Griswold M, Boncy J, Vertefeuille JF. Seroprevalence of measles and rubella antibodies in pregnant women Haiti, 2012. Vaccine 2013; 32:69-73. [PMID: 24188751 DOI: 10.1016/j.vaccine.2013.10.071] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/17/2013] [Accepted: 10/22/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Haiti had set a national goal to eliminate measles and rubella, as well as congenital rubella syndrome (CRS) by 2010. A 2007-2008 nationwide measles and rubella vaccination campaign targeting 1-19 years, however, reached only 79% of the target population. To assess whether population immunity was adequate to support elimination, we conducted a national serosurvey. METHODS We systematically selected 740 serum specimens collected from pregnant women in a 2012 national antenatal HIV sentinel serosurvey across four age strata: 15-19, 20-24, 25-29 and 30-39 years. Sera were tested for measles and rubella specific immunoglobulin G antibodies (IgG) using commercial immunoassays. We classified sera as seropositive, seronegative or indeterminate per manufacturer's instructions, and analyzed seroprevalence according to age strata, and rural or urban residence. We assessed immunity by estimating antibody concentrations in international units per milliliter (IU/mL) for seropositive and indeterminate sera. Measles IgG concentrations >0.12 IU/mL and rubella IgG concentrations >10 IU/mL were considered clinically protective. RESULTS Of 740 sera, 696 (94.1%) were seropositive and 20 (2.7%) were indeterminate for measles IgG; overall 716 (96.8%) sera had IgG concentrations >0.12 IU/mL. For rubella IgG, 691 (93.4%) sera were seropositive and 1 (0.1%) was indeterminate; a total of 687 (92.8%) had IgG concentrations >10 IU/mL. Measles seropositivity varied across age strata (p=0.003); seropositivity increased from 88.6% among 15-19 year olds to 98.4% among 30-39 year olds (Cochran-Armitage trend tes t ≤ 0.0001). Rubella seropositivity did not differ across age strata. There were no statistically significant differences in measles or rubella seropositivity by urban versus rural residence. CONCLUSION Despite previous low vaccination coverage for measles, results from this serosurvey indicate high levels of measles and rubella seropositivity in pregnant women, and contribute to the evidence for measles, rubella and CRS elimination from Haiti by the target date.
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Affiliation(s)
- David L Fitter
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service program, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Renette Anselme
- National Public Health Laboratory, Ministry of Public Health and Population, Haiti
| | - Gilson Paluku
- Comprehensive Family Immunization, Pan American Health Organization, Port-au-Prince, Haiti
| | - Gloria Rey
- Comprehensive Family Immunization, Pan American Health Organization, San Jose, Costa Rica
| | - Brendan Flannery
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rania A Tohme
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Barbara J Marston
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark Griswold
- Global Program, National Alliance of State and Territorial AIDS Directors, Washington, DC, USA
| | - Jacques Boncy
- National Public Health Laboratory, Ministry of Public Health and Population, Haiti
| | - John F Vertefeuille
- Haiti Country Office, US Centers for Disease Control and Prevention, Port-au-Prince, Haiti
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18
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Chun-Hai Fung I, Fitter DL, Borse RH, Meltzer MI, Tappero JW. Modeling the effect of water, sanitation, and hygiene and oral cholera vaccine implementation in Haiti. Am J Trop Med Hyg 2013; 89:633-640. [PMID: 24106189 PMCID: PMC3795092 DOI: 10.4269/ajtmh.13-0201] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 07/31/2013] [Indexed: 11/07/2022] Open
Abstract
In 2010, toxigenic Vibrio cholerae was newly introduced to Haiti. Because resources are limited, decision-makers need to understand the effect of different preventive interventions. We built a static model to estimate the potential number of cholera cases averted through improvements in coverage in water, sanitation and hygiene (WASH) (i.e., latrines, point-of-use chlorination, and piped water), oral cholera vaccine (OCV), or a combination of both. We allowed indirect effects and non-linear relationships between effect and population coverage. Because there are limited incidence data for endemic cholera in Haiti, we estimated the incidence of cholera over 20 years in Haiti by using data from Malawi. Over the next two decades, scalable WASH interventions could avert 57,949-78,567 cholera cases, OCV could avert 38,569-77,636 cases, and interventions that combined WASH and OCV could avert 71,586-88,974 cases. Rate of implementation is the most influential variable, and combined approaches maximized the effect.
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Affiliation(s)
- Isaac Chun-Hai Fung
- National Center for Emerging and Zoonotic Infectious Diseases, and Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David L. Fitter
- National Center for Emerging and Zoonotic Infectious Diseases, and Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Jordan W. Tappero
- National Center for Emerging and Zoonotic Infectious Diseases, and Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Fitter DL, Freeman NM, Buteau J, Magloire R, Sessions WM, Guo L, Katz MA, Boncy J. Pandemic H1N1 influenza surveillance in Haiti, July-December 2009. Influenza Other Respir Viruses 2012. [PMID: 23199103 PMCID: PMC5781211 DOI: 10.1111/irv.12060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/28/2022] Open
Abstract
Please cite this paper as: Fitter et al. (2012) Pandemic H1N1 influenza surveillance in Haiti, July–December 2009. Influenza and Other Respiratory Viruses DOI: 10.1111/irv.12060. From June 2009 through December 2009, Haiti conducted sentinel surveillance for influenza. 499 samples were collected and tested using real‐time RT‐PCR. 197 (39.5%) were positive for influenza, including 95 (48%) pandemic (H1N1) 2009, 57 (29%) seasonal influenza A and 45 (23%) influenza B. The median age of pandemic (H1N1) 2009 cases was 21.7; two‐thirds of pandemic (H1N1) 2009 cases were in patients aged 6 years – 35 years. Pandemic activity peaked in September and co‐circulated with other influenza subtypes. The age distribution and seasonality of pandemic (H1N1) 2009 in Haiti were similar to other countries in the Caribbean region.
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Affiliation(s)
- David L Fitter
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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