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Chard AN, Machingaidze C, Loayza S, Gharpure R, Nogareda F, González R, Domínguez R, Tinoco YO, Dawood FS, Carreon JD, Lafond KE, Jara J, Azziz-Baumgartner E, Cozza V, Couto P, Rolfes MA, Tempia S. Estimating averted illnesses from influenza vaccination for children and pregnant women - El Salvador, Panama, and Peru, 2011-2018. Vaccine 2024:S0264-410X(24)00419-5. [PMID: 38584055 DOI: 10.1016/j.vaccine.2024.04.007] [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: 12/14/2023] [Revised: 03/15/2024] [Accepted: 04/03/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Estimating the burden of disease averted by vaccination can assist policymakers to implement, adjust, and communicate the value of vaccination programs. Demonstrating the use of a newly available modeling tool, we estimated the burden of influenza illnesses averted by seasonal influenza vaccination in El Salvador, Panama, and Peru during 2011-2017 among two influenza vaccine target populations: children aged 6-23 months and pregnant women. METHODS We derived model inputs, including incidence, vaccine coverage, vaccine effectiveness, and multipliers from publicly available country-level influenza surveillance data and cohort studies. We also estimated changes in illnesses averted when countries' vaccine coverage was achieved using four different vaccine deployment strategies. RESULTS Among children aged 6-23 months, influenza vaccination averted an estimated cumulative 2,161 hospitalizations, 81,907 medically-attended illnesses, and 126,987 overall illnesses during the study period, with a prevented fraction ranging from 0.3 % to 12.5 %. Among pregnant women, influenza vaccination averted an estimated cumulative 173 hospitalizations, 6,122 medically attended illnesses, and 16,412 overall illnesses, with a prevented fraction ranging from 0.2 % to 10.9 %. Compared to an influenza vaccine campaign with equal vaccine distribution during March-June, scenarios in which total cumulative coverage was achieved in March and April consistently resulted in the greatest increase in averted illness (23 %-3,129 % increase among young children and 22 %-3,260 % increase among pregnant women). DISCUSSION Influenza vaccination campaigns in El Salvador, Panama, and Peru conducted between 2011 and 2018 prevented hundreds to thousands of influenza-associated hospitalizations and illnesses in young children and pregnant women. Existing vaccination programs could prevent additional illnesses, using the same number of vaccines, by achieving the highest possible coverage within the first two months of an influenza vaccine campaign.
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Affiliation(s)
- Anna N Chard
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
| | - Chiedza Machingaidze
- Global Influenza Programme, World Health Organization, Av. Appia 20, 1202 Geneva, Switzerland
| | - Sergio Loayza
- Pan American Health Organization, 525 23rd St NW, Washington, DC 20037, United States
| | - Radhika Gharpure
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States
| | - Francisco Nogareda
- Pan American Health Organization, 525 23rd St NW, Washington, DC 20037, United States
| | - Rosalba González
- Gorgas Memorial Institute of Health Studies, Ave. Justo Arosemena, Calle 35, Panama City, Panama
| | - Rhina Domínguez
- National Institute of Health of El Salvador, C. Gabriela Mistral 211, San Salvador, El Salvador
| | - Yeny O Tinoco
- U.S. Naval Medical Research Unit SOUTH, Av. Venezuela. Cuadra 36 s/n. Bellavista. Callao, Lima, Peru
| | - Fatimah S Dawood
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States
| | - Joseph Daniel Carreon
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States
| | - Kathryn E Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States
| | - Jorge Jara
- Pan American Health Organization, 525 23rd St NW, Washington, DC 20037, United States
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States
| | - Vanessa Cozza
- Global Influenza Programme, World Health Organization, Av. Appia 20, 1202 Geneva, Switzerland
| | - Paula Couto
- Pan American Health Organization, 525 23rd St NW, Washington, DC 20037, United States
| | - Melissa A Rolfes
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States; Global Influenza Programme, World Health Organization, Av. Appia 20, 1202 Geneva, Switzerland
| | - Stefano Tempia
- Global Influenza Programme, World Health Organization, Av. Appia 20, 1202 Geneva, Switzerland
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Gharpure R, Chard AN, Cabrera Escobar M, Zhou W, Valleau MM, Yau TS, Bresee JS, Azziz-Baumgartner E, Pallas SW, Lafond KE. Costs and cost-effectiveness of influenza illness and vaccination in low- and middle-income countries: A systematic review from 2012 to 2022. PLoS Med 2024; 21:e1004333. [PMID: 38181066 PMCID: PMC10802964 DOI: 10.1371/journal.pmed.1004333] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 01/22/2024] [Accepted: 12/13/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Historically, lack of data on cost-effectiveness of influenza vaccination has been identified as a barrier to vaccine use in low- and middle-income countries. We conducted a systematic review of economic evaluations describing (1) costs of influenza illness; (2) costs of influenza vaccination programs; and (3) vaccination cost-effectiveness from low- and middle-income countries to assess if gaps persist that could hinder global implementation of influenza vaccination programs. METHODS AND FINDINGS We performed a systematic search in Medline, Embase, Cochrane Library, CINAHL, and Scopus in January 2022 and October 2023 using a combination of the following key words: "influenza" AND "cost" OR "economic." The search included studies with publication years 2012 through 2022. Studies were eligible if they (1) presented original, peer-reviewed findings on cost of illness, cost of vaccination program, or cost-effectiveness of vaccination for seasonal influenza; and (2) included data for at least 1 low- or middle-income country. We abstracted general study characteristics and data specific to each of the 3 study types. Of 54 included studies, 26 presented data on cost-effectiveness, 24 on cost-of-illness, and 5 on program costs. Represented countries were classified as upper-middle income (UMIC; n = 12), lower-middle income (LMIC; n = 7), and low-income (LIC; n = 3). The most evaluated target groups were children (n = 26 studies), older adults (n = 17), and persons with chronic medical conditions (n = 12); fewer studies evaluated pregnant persons (n = 9), healthcare workers (n = 5), and persons in congregate living settings (n = 1). Costs-of-illness were generally higher in UMICs than in LMICs/LICs; however, the highest national economic burden, as a percent of gross domestic product and national health expenditure, was reported from an LIC. Among studies that evaluated the cost-effectiveness of influenza vaccine introduction, most (88%) interpreted at least 1 scenario per target group as either cost-effective or cost-saving, based on thresholds designated in the study. Key limitations of this work included (1) heterogeneity across included studies; (2) restrictiveness of the inclusion criteria used; and (3) potential for missed influenza burden from use of sentinel surveillance systems. CONCLUSIONS The 54 studies identified in this review suggest an increased momentum to generate economic evidence about influenza illness and vaccination from low- and middle-income countries during 2012 to 2022. However, given that we observed substantial heterogeneity, continued evaluation of the economic burden of influenza illness and costs/cost-effectiveness of influenza vaccination, particularly in LICs and among underrepresented target groups (e.g., healthcare workers and pregnant persons), is needed. Use of standardized methodology could facilitate pooling across settings and knowledge sharing to strengthen global influenza vaccination programs.
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Affiliation(s)
- Radhika Gharpure
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna N. Chard
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Weigong Zhou
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Molly M. Valleau
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Tat S. Yau
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Joseph S. Bresee
- Task Force for Global Health, Atlanta, Georgia, United States of America
| | | | - Sarah W. Pallas
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kathryn E. Lafond
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Gharpure R, Akumu AO, Dawa J, Gobin S, Adhikari BB, Lafond KE, Fischer LS, Mirieri H, Mwazighe H, Tabu C, Jalang'o R, Kamau P, Silali C, Kalani R, Oginga P, Jewa I, Njenga V, Ebama MS, Bresee JS, Njenga MK, Osoro E, Meltzer MI, Emukule GO. Costs of seasonal influenza vaccine delivery in a pediatric demonstration project for children aged 6-23 months - Nakuru and Mombasa Counties, Kenya, 2019-2021. Vaccine 2023:S0264-410X(23)01475-5. [PMID: 38154992 DOI: 10.1016/j.vaccine.2023.12.029] [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: 08/28/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND During November 2019-October 2021, a pediatric influenza vaccination demonstration project was conducted in four sub-counties in Kenya. The demonstration piloted two different delivery strategies: year-round vaccination and a four-month vaccination campaign. Our objective was to compare the costs of both delivery strategies. METHODS Cost data were collected using standardized questionnaires and extracted from government and project accounting records. We reported total costs and costs per vaccine dose administered by delivery strategy from the Kenyan government perspective in 2021 US$. Costs were separated into financial costs (monetary expenditures) and economic costs (financial costs plus the value of existing resources). We also separated costs by administrative level (national, regional, county, sub-county, and health facility) and program activity (advocacy and social mobilization; training; distribution, storage, and waste management; service delivery; monitoring; and supervision). RESULTS The total estimated cost of the pediatric influenza demonstration project was US$ 225,269 (financial) and US$ 326,691 (economic) for the year-round delivery strategy (30,397 vaccine doses administered), compared with US$ 214,753 (financial) and US$ 242,385 (economic) for the campaign strategy (25,404 doses administered). Vaccine purchase represented the largest proportion of costs for both strategies. Excluding vaccine purchase, the cost per dose administered was US$ 1.58 (financial) and US$ 5.84 (economic) for the year-round strategy and US$ 2.89 (financial) and US$ 4.56 (economic) for the campaign strategy. CONCLUSIONS The financial cost per dose was 83% higher for the campaign strategy than the year-round strategy due to larger expenditures for advocacy and social mobilization, training, and hiring of surge staff for service delivery. However, the economic cost per dose was more comparable for both strategies (year-round 22% higher than campaign), balanced by higher costs of operating equipment and monitoring activities for the year-round strategy. These delivery cost data provide real-world evidence to inform pediatric influenza vaccine introduction in Kenya.
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Affiliation(s)
- Radhika Gharpure
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Angela Oloo Akumu
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Jeanette Dawa
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Stacie Gobin
- Gobin Global, LLC, Asheville, NC, USA; Partnership for Influenza Vaccine Introduction, Task Force for Global Health, Atlanta, GA, USA
| | | | - Kathryn E Lafond
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Leah S Fischer
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Harriet Mirieri
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Henry Mwazighe
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Collins Tabu
- National Vaccines and Immunization Program, Ministry of Health, Kenya
| | - Rose Jalang'o
- National Vaccines and Immunization Program, Ministry of Health, Kenya
| | - Peter Kamau
- National Vaccines and Immunization Program, Ministry of Health, Kenya
| | - Catherine Silali
- National Vaccines and Immunization Program, Ministry of Health, Kenya
| | - Rosalia Kalani
- Division of Disease Surveillance and Response, Ministry of Health, Kenya
| | | | - Isaac Jewa
- Department of Health, Mombasa County, Kenya
| | | | - Malembe S Ebama
- Partnership for Influenza Vaccine Introduction, Task Force for Global Health, Atlanta, GA, USA
| | - Joseph S Bresee
- Partnership for Influenza Vaccine Introduction, Task Force for Global Health, Atlanta, GA, USA
| | - M Kariuki Njenga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA, USA
| | - Eric Osoro
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA, USA
| | - Martin I Meltzer
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gideon O Emukule
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA; U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
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Dawa J, Jalang'o R, Mirieri H, Kalani R, Marwanga D, Lafond KE, Muriuki MM, Ejoi J, Chiguba F, Patta S, Amoth P, Okunga E, Tabu C, Chaves SS, Ebama MS, Muthoka P, Njenga V, Kiptoo E, Jewa I, Mwanyamawi R, Bresee J, Njenga MK, Osoro E, Mecca L, Emukule GO. Comparing performance of year-round and campaign-mode influenza vaccination strategies among children aged 6-23 months in Kenya: 2019-2021. Vaccine 2023:S0264-410X(23)01380-4. [PMID: 38105140 DOI: 10.1016/j.vaccine.2023.11.036] [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: 06/16/2023] [Revised: 10/03/2023] [Accepted: 11/18/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION In 2016, the Kenya National Immunization Technical Advisory Group requested additional programmatic and cost effectiveness data to inform the choice of strategy for a national influenza vaccination program among children aged 6-23 months of age. In response, we conducted an influenza vaccine demonstration project to compare the performance of a year-round versus campaign-mode vaccination strategy. Findings from this demonstration project will help identify essential learning lessons for a national program. METHODS We compared two vaccine delivery strategies: (i) a year-round vaccination strategy where influenza vaccines were administered throughout the year at health facilities. This strategy was implemented in Njoro sub-county in Nakuru (November 2019 to October 2021) and Jomvu sub-county in Mombasa (December 2019 to October 2021), (ii) a campaign-mode vaccination strategy where vaccines were available at health facilities over four months. This strategy was implemented in Nakuru North sub-county in Nakuru (June to September 2021) and Likoni sub-county in Mombasa (July to October 2021). We assessed differences in coverage, dropout rates, vaccine wastage, and operational needs. RESULTS We observed similar performance between strategies in coverage of the first dose of influenza vaccine (year-round strategy 59.7 %, campaign strategy 63.2 %). The coverage obtained in the year-round sub-counties was similar (Njoro 57.4 %; Jomvu 63.1 %); however, more marked differences between campaign sub-counties were observed (Nakuru North 73.4 %; Likoni 55.2 %). The campaign-mode strategy exceeded the cold chain capacity of participating health facilities, requiring thrice monthly instead of once monthly deliveries, and was associated with a two-fold increase in workload compared to the year-round strategy (168 vaccines administered per day in the campaign strategy versus 83 vaccines administered per day in the year-round strategy). CONCLUSION Although both strategies had similar coverage levels, the campaign-mode strategy was associated with considerable operational needs that could significantly impact the immunization program.
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Affiliation(s)
- Jeanette Dawa
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya.
| | - Rose Jalang'o
- National Vaccines and Immunisation Program, Ministry of Health, Kenya
| | - Harriet Mirieri
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Rosalia Kalani
- Division of Disease Surveillance and Response, Ministry of Health, Kenya
| | - Doris Marwanga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Kathryn E Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Joyce Ejoi
- Department of Health, Nakuru County, Kenya
| | | | - Shem Patta
- Department of Health, Mombasa County, Kenya
| | | | - Emmanuel Okunga
- Division of Disease Surveillance and Response, Ministry of Health, Kenya
| | - Collins Tabu
- National Vaccines and Immunisation Program, Ministry of Health, Kenya
| | - Sandra S Chaves
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA; Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Malembe S Ebama
- Partnership for Influenza Vaccine Introduction, Task Force for Global Health, Atlanta, GA, USA
| | | | | | | | - Isaac Jewa
- Department of Health, Mombasa County, Kenya
| | | | - Joseph Bresee
- Partnership for Influenza Vaccine Introduction, Task Force for Global Health, Atlanta, GA, USA
| | - M Kariuki Njenga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA, USA
| | - Eric Osoro
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA, USA
| | - Lucy Mecca
- National Vaccines and Immunisation Program, Ministry of Health, Kenya
| | - Gideon O Emukule
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA; Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya
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Wangchuk S, Prabhakaran AO, Dhakal GP, Zangmo C, Gharpure R, Dawa T, Phuntsho S, Burkhardsmeier B, Saha S, Wangmo D, Lafond KE. Introducing seasonal influenza vaccine in Bhutan: Country experience and achievements. Vaccine 2023; 41:7259-7264. [PMID: 37866993 DOI: 10.1016/j.vaccine.2023.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 10/24/2023]
Abstract
Bhutan successfully introduced multiple vaccines since the establishment of the Vaccine Preventable Disease Program in 1979. Surveillance and subsequent introduction of influenza vaccination became a public health priority for the Ministry of Health following the influenza A(H1N1)pdm09 pandemic. Sentinel surveillance for influenza in Bhutan began in 2008, and a study of severe acute respiratory infection was conducted in 2017, which found the highest influenza burden in children aged <5 years and adults ≥50 years. Following review of surveillance and burden of disease data, the National Technical Advisory Group presented recommendations to Bhutan's Ministry of Health which approved influenza vaccine introduction for all five high-risk groups in the country. Upon the official launch of the program in June 2018, the Vaccine Preventable Disease Program began planning, budgeting, and procurement processes with technical and financial support from the Partnership for Influenza Vaccine Introduction, the United States Centers for Disease Control and Prevention, the Bhutan Health Trust Fund, and the World Health Organization. Influenza vaccination for high-risk groups was integrated into Bhutan's routine immunization services in all health care facilities beginning in November 2019 and vaccinated all populations in 2020 in response to the COVID-19 pandemic. Coverage levels between 2019 and 2022 were highest in children aged 6-24 months (62.5%-96.9%) and lowest in pregnant women (47.7%-62.5%). Bhutan maintained high coverage levels despite the COVID-19 pandemic by continued provision of influenza vaccine services at health centers during lockdowns, conducting communication and sensitization efforts, and using catch-up campaigns. Bhutan's experience with introducing and scaling up the influenza vaccine program contributed to the country's capacity to rapidly deploy its COVID-19 vaccination program in 2021.
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Affiliation(s)
- Sonam Wangchuk
- Royal Centers for Disease Control, Ministry of Health, Thimphu, Bhutan.
| | - Aslesh O Prabhakaran
- Influenza Program, US Centers for Disease Control and Prevention, New Delhi, India
| | - Guru Prasad Dhakal
- Department of Medicine, Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
| | - Cheten Zangmo
- Vaccine Preventable Disease Program, Department of Public Health, Ministry of Health, Bhutan
| | - Radhika Gharpure
- Influenza Division, United States Centers for Disease Control and Prevention, Atlanta, USA
| | - Tashi Dawa
- Vaccine Preventable Disease Program, Department of Public Health, Ministry of Health, Bhutan
| | - Sangay Phuntsho
- Vaccine Preventable Disease Program, Department of Public Health, Ministry of Health, Bhutan
| | | | - Siddhartha Saha
- Influenza Program, US Centers for Disease Control and Prevention, New Delhi, India
| | | | - Kathryn E Lafond
- Influenza Division, United States Centers for Disease Control and Prevention, Atlanta, USA
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Krishnan A, Shekhawat K, Ortega-Sanchez IR, Kanungo S, Rajkumar P, Bhardwaj SD, Kumar R, Prabhakaran AO, Gopal G, Chakrabarti AK, Purushothaman GKC, Potdar V, Manna B, Gharpure R, Amarchand R, Choudekar A, Lafond KE, Dar L, Bhattacharjee U, Azziz-Baumgartner E, Saha S. Cost of acute respiratory illness episode and its determinants among community-dwelling older adults: a four-site cohort study from India. BMJ Public Health 2023; 1:e000103. [PMID: 38116390 PMCID: PMC10728158 DOI: 10.1136/bmjph-2023-000103] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Introduction Advocacy for the provision of public health resources, including vaccine for the prevention of acute respiratory illnesses (ARIs) among older adults in India, needs evidence on costs and benefits. Using a cohort of community-dwelling adults aged 60 years and older in India, we estimated the cost of ARI episode and its determinants. Methods We enrolled 6016 participants in Ballabgarh, Chennai, Kolkata and Pune from July 2018 to March 2020. They were followed up weekly to identify ARI and classified them as acute upper respiratory illness (AURI) or pneumonia based on clinical features based on British Thoracic Society guidelines. All pneumonia and 20% of AURI cases were asked about the cost incurred on medical consultation, investigation, medications, transportation, food and lodging. The cost of services at public facilities was supplemented by WHO-Choosing Interventions that are Cost-Effective(CHOICE) estimates for 2019. Indirect costs incurred by the affected participant and their caregivers were estimated using human capital approach. We used generalised linear model with log link and gamma family to identify the average marginal effect of key determinants of the total cost of ARI. Results We included 2648 AURI and 1081 pneumonia episodes. Only 47% (range 36%-60%) of the participants with pneumonia sought care. The mean cost of AURI episode was US$13.9, while that of pneumonia episode was US$25.6, with indirect costs comprising three-fourths of the total. The cost was higher among older men by US$3.4 (95% CI: 1.4 to 5.3), those with comorbidities by US$4.3 (95% CI: 2.8 to 5.7) and those who sought care by US$17.2 (95% CI: 15.1 to 19.2) but not by influenza status. The mean per capita annual cost of respiratory illness was US$29.5. Conclusion Given the high community disease and cost burden of ARI, intensifying public health interventions to prevent and mitigate ARI among this fast-growing older adult population in India is warranted.
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Affiliation(s)
- Anand Krishnan
- Center For Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kusum Shekhawat
- Center For Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ismael R Ortega-Sanchez
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Suman Kanungo
- Indian Council of Medical Research,National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Prabu Rajkumar
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Sumit Dutt Bhardwaj
- Indian Council of Medical Research,National Institute of Virology, Pune, India
| | - Rakesh Kumar
- Center For Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Giridara Gopal
- Center For Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Kumar Chakrabarti
- Virology, Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | | | - Varsha Potdar
- Indian Council of Medical Research,National Institute of Virology, Pune, India
| | - Byomkesh Manna
- Indian Council of Medical Research,National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Radhika Gharpure
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ritvik Amarchand
- Center For Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Avinash Choudekar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kathryn E Lafond
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lalit Dar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Uttaran Bhattacharjee
- Indian Council of Medical Research,National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Eduardo Azziz-Baumgartner
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Siddhartha Saha
- Influenza Program, Centers for Disease Control and Prevention, New Delhi, Delhi, India
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Finci I, Rojas Castro MY, Hasibra I, Sulo J, Fico A, Daja R, Vasili A, Kota M, Preza I, Mühlemann B, Drosten C, Pebody R, Lafond KE, Kissling E, Katz MA, Bino S. Primary Series and Booster Coronavirus Disease 2019 Vaccine Effectiveness in a Cohort of Healthcare Workers in Albania During a BA.1 and BA.2 Variant Period, January-May 2022. Open Forum Infect Dis 2023; 10:ofad479. [PMID: 37885795 PMCID: PMC10599317 DOI: 10.1093/ofid/ofad479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/19/2023] [Indexed: 10/28/2023] Open
Abstract
Background Healthcare workers (HCWs) have experienced high rates of coronavirus disease 2019 (COVID-19) morbidity and mortality. We estimated COVID-19 2-dose primary series and monovalent booster vaccine effectiveness (VE) against symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron (BA.1 and BA.2) infection among HCWs in 3 Albanian hospitals during January-May 2022. Methods Study participants completed weekly symptom questionnaires, underwent polymerase chain reaction (PCR) testing when symptomatic, and provided quarterly blood samples for serology. We estimated VE using Cox regression models (1 - hazard ratio), with vaccination status as the time-varying exposure and unvaccinated HCWs as the reference group, adjusting for potential confounders: age, sex, prior SARS-CoV-2 infection (detected by PCR, rapid antigen test, or serology), and household size. Results At the start of the analysis period, 76% of 1462 HCWs had received a primary series, 10% had received a booster dose, and 9% were unvaccinated; 1307 (89%) HCWs had evidence of prior infection. Overall, 86% of primary series and 98% of booster doses received were BNT162b2. The median time interval from the second dose and the booster dose to the start of the analysis period was 289 (interquartile range [IQR], 210-292) days and 30 (IQR, 22-46) days, respectively. VE against symptomatic PCR-confirmed infection was 34% (95% confidence interval [CI], -36% to 68%) for the primary series and 88% (95% CI, 39%-98%) for the booster. Conclusions Among Albanian HCWs, most of whom had been previously infected, COVID-19 booster dose offered improved VE during a period of Omicron BA.1 and BA.2 circulation. Our findings support promoting booster dose uptake among Albanian HCWs, which, as of January 2023, was only 20%. Clinical Trials Registration. NCT04811391.
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Affiliation(s)
- Iris Finci
- Regional Office for Europe, World Health Organization,Copenhagen, Denmark
| | | | - Iris Hasibra
- Department for the Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Jonilda Sulo
- Southeast European Center for Surveillance and Control of Infectious Diseases,Tirana, Albania
- Mediterranean and Black Sea Programme in Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Albana Fico
- Department for the Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
- Tirana University Hospital Centre, Tirana, Albania
| | - Rovena Daja
- Department for the Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Adela Vasili
- Department for the Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Majlinda Kota
- Department for the Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
| | - Iria Preza
- Country Office Albania, World Health Organization, Tirana, Albania
| | - Barbara Mühlemann
- Institute of Virology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health,Berlin, Germany
- German Centre for Infection Research, partner site Charité, Berlin, Germany
| | - Christian Drosten
- Institute of Virology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health,Berlin, Germany
- German Centre for Infection Research, partner site Charité, Berlin, Germany
| | - Richard Pebody
- Regional Office for Europe, World Health Organization,Copenhagen, Denmark
| | - Kathryn E Lafond
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Mark A Katz
- Regional Office for Europe, World Health Organization,Copenhagen, Denmark
| | - Silvia Bino
- Department for the Control of Infectious Diseases, Institute of Public Health, Tirana, Albania
- Southeast European Center for Surveillance and Control of Infectious Diseases,Tirana, Albania
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8
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Rubin-Smith JE, Castro MYR, Preza I, Hasibra I, Sulo J, Fico A, Daja R, Vasili A, Kota M, Schmid A, Sridhar S, Guseinova A, Boshevska G, Bejtja G, Mühlemann B, Drosten C, Jorgensen P, Pebody R, Kissling E, Lafond KE, Katz MA, Bino S. Primary series COVID-19 vaccine effectiveness among healthcare workers in Albania, February-December 2021. IJID Reg 2023; 8:19-27. [PMID: 37317681 PMCID: PMC10106115 DOI: 10.1016/j.ijregi.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 06/16/2023]
Abstract
Background Healthcare workers have experienced high rates of morbidity and mortality from coronavirus disease 2019 (COVID-19). Methods A prospective cohort study was conducted in three Albanian hospitals between 19 February and 14 December 2021. All participants underwent polymerase chain reaction (PCR) and serological testing at enrolment, regular serology throughout, and PCR testing when symptomatic.Vaccine effectiveness (VE) against COVID-19 and against all severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections (symptomatic or asymptomatic) was estimated. VE was estimated using a Cox regression model, with vaccination status as a time-varying variable. Findings In total, 1504 HCWs were enrolled in this study; 70% had evidence of prior SARS-CoV-2 infection. VE was 65.1% [95% confidence interval (CI) 37.7-80.5] against COVID-19, 58.2% (95% CI 15.7-79.3) among participants without prior SARS-CoV-2 infection, and 73.6% (95% CI 24.3-90.8) among participants with prior SARS-CoV-2 infection. For BNT162b2 alone, VE was 69.5% (95% CI 44.5-83.2). During the period when the Delta variant was predominant, VE was 67.1% (95% CI 38.3-82.5). VE against SARS-CoV-2 infection for the full study period was 36.9% (95% CI 15.8-52.7). Interpretation This study found moderate primary series VE against COVID-19 among healthcare workers in Albania. These results support the continued promotion of COVID-19 vaccination in Albania, and highlight the benefits of vaccination in populations with high levels of prior infection.
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Affiliation(s)
- Julia E. Rubin-Smith
- Global Health Program, Boston Children's Hospital, Boston, MA, USA
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | | | - Iria Preza
- Institute of Public Health, Tirana, Albania
| | | | - Jonilda Sulo
- Southeast European Centre for Surveillance and Control of Infectious Disease, Tirana, Albania
| | | | | | | | | | - Alexis Schmid
- Global Health Program, Boston Children's Hospital, Boston, MA, USA
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Shela Sridhar
- Global Health Program, Boston Children's Hospital, Boston, MA, USA
- Department of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Alina Guseinova
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | | | - Gazmend Bejtja
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Barbara Mühlemann
- Institute of Virology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt – Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- German Centre for Infection Research, Partner Site Charité, Berlin, Germany
| | - Christian Drosten
- Institute of Virology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt – Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- German Centre for Infection Research, Partner Site Charité, Berlin, Germany
| | - Pernille Jorgensen
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Richard Pebody
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | | | - Kathryn E. Lafond
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark A. Katz
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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9
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Lafond KE, Gharpure R, Dugan VG, Azziz-Baumgartner E. Estimating the full health and economic benefits of current and future influenza vaccines. BMC Med 2023; 21:273. [PMID: 37501176 PMCID: PMC10373290 DOI: 10.1186/s12916-023-02995-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023] Open
Abstract
In the dynamic landscape of respiratory virus vaccines, it is crucial to assess the value of novel mRNA and combination influenza/COVID-19 vaccines in low- and middle-income countries. Modeling studies, such as the one conducted by Waterlow et al., provide vital information about the cost-benefit potential of these products compared to currently licensed vaccines. However, this approach only accounts for directly measured medically attended influenza-associated illnesses and has two major limitations. First, this method fails to capture the full disease burden of influenza (including non-respiratory and non-medically attended influenza illnesses), which are particularly important drivers of disease burden in infants and older adults. Second, the model does not describe the ancillary benefits of influenza vaccination such as the attenuation of severe disease, prevention of severe non-respiratory outcomes (e.g., myocardial infarctions), or reduced antibiotic use. To obtain a comprehensive understanding of the benefits of influenza vaccines, we must strive to improve the inputs for future modeling-based evaluations.
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Affiliation(s)
- K E Lafond
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, 30307, USA.
| | - R Gharpure
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, 30307, USA
| | - V G Dugan
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, 30307, USA
| | - E Azziz-Baumgartner
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, 30307, USA
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10
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Dar L, Krishnan A, Kumar R, Dhakad S, Choudekar A, Bagga S, Sharma A, Kumar A, Jethani J, Saha S, Amarchand R, Kumar R, Choudhary A, Narayan VV, Gopal G, Lafond KE, Lindstrom S. Nasal shedding of vaccine viruses after immunization with a Russian-backbone live attenuated influenza vaccine in India. Influenza Other Respir Viruses 2023; 17:e13149. [PMID: 37380175 DOI: 10.1111/irv.13149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/24/2023] [Accepted: 05/07/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND We present post-vaccination nasal shedding findings from the phase IV, community-based, triple-blinded RCT conducted to assess efficacy of trivalent LAIV and inactivated influenza vaccines in rural north India. METHODS Children aged 2-10 years received LAIV or intranasal placebo across 2015 and 2016, as per initial allocation. On days 2 and 4 post-vaccination, trained study nurses collected nasal swabs from randomly selected subset of trial participants based on operational feasibility, accounting for 10.0% and 11.4% of enrolled participants in 2015 and 2016, respectively. Swabs were collected in viral transport medium and transported under cold chain to laboratory for testing by reverse transcriptase real-time polymerase chain reaction. RESULTS In year 1, on day 2 post-vaccination, 71.2% (74/104) of LAIV recipients shed at least one of vaccine virus strains compared to 42.3% (44/104) on day 4. During year 1, on day 2 post-vaccination, LAIV-A(H1N1)pdm09 was detected in nasal swabs of 12% LAIV recipients, LAIV-A(H3N2) in 41%, and LAIV-B in 59%. In year 2, virus shedding was substantially lower; 29.6% (32/108) of LAIV recipients shed one of the vaccine virus strains on day 2 compared to 21.3% on day 4 (23/108). CONCLUSION At day 2 post-vaccination in year 1, two-thirds of LAIV recipients were shedding vaccine viruses. Shedding of vaccine viruses varied between strains and was lower in year 2. More research is needed to determine the reason for lower virus shedding and vaccine efficacy for LAIV-A(H1N1)pdm09.
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Affiliation(s)
- Lalit Dar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Kumar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shivram Dhakad
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Avinash Choudekar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sumedha Bagga
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Amrit Sharma
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Kumar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Jyoti Jethani
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Siddhartha Saha
- Influenza Division, US Centers for Disease Control and Prevention, New Delhi, India
| | - Ritvik Amarchand
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Aashish Choudhary
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Giridara Gopal
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kathryn E Lafond
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephen Lindstrom
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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11
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Warmath CR, Ortega-Sanchez IR, Duca LM, Porter RM, Usher MG, Bresee JS, Lafond KE, Davis WW. Comparisons in the Health and Economic Assessments of Using Quadrivalent Versus Trivalent Influenza Vaccines: A Systematic Literature Review. Value Health 2023; 26:768-779. [PMID: 36436790 DOI: 10.1016/j.jval.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/05/2022] [Accepted: 11/16/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Seasonal influenza vaccines protect against 3 (trivalent influenza vaccine [IIV3]) or 4 (quadrivalent influenza vaccine [IIV4]) viruses. IIV4 costs more than IIV3, and there is a trade-off between incremental cost and protection. This is especially the case in low- and middle-income countries (LMICs) with limited budgets; previous reviews have not identified studies of IIV4-IIV3 comparisons in LMICs. We summarized the literature that compared health and economic outcomes of IIV4 and IIV3, focused on LMICs. METHODS We systematically searched 5 databases for articles published before October 6, 2021, that modeled health or economic effects of IIV4 versus IIV3. We abstracted data and compared findings among countries and models. RESULTS Thirty-eight studies fit our selection criteria; 10 included LMICs. Most studies (N = 31) reported that IIV4 was cost-saving or cost-effective compared with IIV3; we observed no difference in health or economic outcomes between LMICs and other countries. Based on cost differences of influenza vaccines, only one study compared coverage of IIV3 with IIV4 and reported that the maximum IIV4 price that would still yield greater public health impact than IIV3 was 13% to 22% higher than IIV3. CONCLUSIONS When vaccination coverage with IIV4 and IIV3 is the same, IIV4 tends to be not only more effective but more cost-effective than IIV3, even with relatively high price differences between vaccine types. Alternatively, where funding is limited as in most LMICs, higher vaccine coverage can be achieved with IIV3 than IIV4, which could result in more favorable health and economic outcomes.
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Affiliation(s)
- Clara R Warmath
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Ismael R Ortega-Sanchez
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lindsey M Duca
- Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachael M Porter
- Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Molly G Usher
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Joseph S Bresee
- Partnership for Influenza Vaccine Introduction, The Task Force for Global Health, Decatur, GA, USA
| | - Kathryn E Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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12
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Jorgensen P, Schmid A, Sulo J, Preza I, Hasibra I, Kissling E, Fico A, Sridhar S, Rubin-Smith JE, Kota M, Vasili A, Daja R, Nika M, Pebody R, Lafond KE, Katz MA, Bino S. Factors associated with receipt of COVID-19 vaccination and SARS-CoV-2 seropositivity among healthcare workers in Albania (February 2021-June 2022): secondary analysis of a prospective cohort study. Lancet Reg Health Eur 2023; 27:100584. [PMID: 37013112 PMCID: PMC9969343 DOI: 10.1016/j.lanepe.2023.100584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 03/02/2023]
Abstract
Background Healthcare workers (HCWs) have been disproportionally affected by COVID-19. We investigated factors associated with two- and three-dose COVID-19 vaccine uptake and SARS-CoV-2 seropositivity among 1504 HCWs enrolled (19 February-7 May 2021) in a prospective COVID-19 vaccine effectiveness cohort in Albania through a secondary analysis. Methods We collected sociodemographic, occupational, health, prior SARS-CoV-2 infection, and COVID-19 vaccination data from all HCWs at enrollment. Vaccination status was assessed weekly through June 2022. A serum sample was collected from all participants at enrollment and tested for anti-spike SARS-CoV-2 antibodies. We analyzed HCWs characteristics and outcomes using multivariable logistic regression. Findings By 11 June 2022, 1337 (88.9%) HCWs had received two COVID-19 vaccine doses, of whom 255 (19.1%) received a booster. Factors significantly associated with receiving three doses (adjusted odds ratio (aOR), 95% CIs) were being ≥35 years (35-44 years: 1.76 (1.05-2.97); 45-54 years: 3.11 (1.92-5.05); ≥55 years: 3.38 (2.04-5.59)) and vaccinated against influenza (1.78; 1.20-2.64). Booster dose receipt was lower among females (0.58; 0.41-0.81), previously infected (0.67; 0.48-0.93), nurses and midwives (0.31; 0.22-0.45), and support staff (0.19; 0.11-0.32). Overall 1076 (72%) were SARS-CoV-2 seropositive at enrollment. Nurses and midwifes (1.45; 1.05-2.02), support staff (1.57; 1.03-2.41), and HCWs performing aerosol-generating procedures (AGPs) (1.40; 1.01-1.94) had higher odds of being seropositive, while smokers had reduced odds (0.55; 0.40-0.75). Interpretation In a large cohort of Albanian HCWs, COVID-19 vaccine booster dose uptake was very low, particularly among younger, female, and non-physician HCWs, despite evidence demonstrating the added benefit of boosters in preventing infection and severe disease. Reasons behind these disparities should be explored to develop targeted strategies in order to promote uptake in this critical population. SARS-CoV-2 seroprevalence was higher among non-physicians and HCWs performing APGs. A better understanding of the factors contributing to these differences is needed to inform interventions that could reduce infections in the future. Funding This study was funded by the Task Force for Global Health (US Centers for Disease Control (CDC) cooperative agreement # NU51IP000873) and the World Health Organization, Regional Office for Europe.
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Affiliation(s)
- Pernille Jorgensen
- World Health Organization, Regional Office for Europe, Marmorvej 51, 2100, Copenhagen, Denmark
| | - Alexis Schmid
- Boston Children's Hospital Global Health Program, Boston, MA, USA
| | - Jonilda Sulo
- Southeast European Center for Surveillance and Control of Infectious Diseases, Alexander Moisiut Street N.80, 1001, Tirana, Albania
| | - Iria Preza
- Institute of Public Health, Alexander Moisiut Street N.80, 1001, Tirana, Albania
| | - Iris Hasibra
- Institute of Public Health, Alexander Moisiut Street N.80, 1001, Tirana, Albania
| | | | - Albana Fico
- Institute of Public Health, Alexander Moisiut Street N.80, 1001, Tirana, Albania
| | - Shela Sridhar
- Boston Children's Hospital Global Health Program, Boston, MA, USA
- Brigham and Women's Hospital, Department of Global Health Equity, 651 Huntington Avenue FXB, Building, 7th Floor, Boston, MA, USA
| | | | - Majlinda Kota
- Institute of Public Health, Alexander Moisiut Street N.80, 1001, Tirana, Albania
| | - Adela Vasili
- Institute of Public Health, Alexander Moisiut Street N.80, 1001, Tirana, Albania
| | - Rovena Daja
- Institute of Public Health, Alexander Moisiut Street N.80, 1001, Tirana, Albania
| | - Miljana Nika
- Tirana University Hospital “Mother Theresa”, Dibra Street N.372, 1001, Tirana, Albania
| | - Richard Pebody
- World Health Organization, Regional Office for Europe, Marmorvej 51, 2100, Copenhagen, Denmark
| | - Kathryn E. Lafond
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark A. Katz
- World Health Organization, Regional Office for Europe, Marmorvej 51, 2100, Copenhagen, Denmark
| | - Silvia Bino
- Institute of Public Health, Alexander Moisiut Street N.80, 1001, Tirana, Albania
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Marcenac P, McCarron M, Davis W, Igboh LS, Mott JA, Lafond KE, Zhou W, Sorrells M, Charles MD, Gould P, Arriola CS, Veguilla V, Guthrie E, Dugan VG, Kondor R, Gogstad E, Uyeki TM, Olsen SJ, Emukule GO, Saha S, Greene C, Bresee JS, Barnes J, Wentworth DE, Fry AM, Jernigan DB, Azziz-Baumgartner E. Leveraging International Influenza Surveillance Systems and Programs during the COVID-19 Pandemic. Emerg Infect Dis 2022; 28:S26-S33. [PMID: 36502434 DOI: 10.3201/eid2813.212248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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
A network of global respiratory disease surveillance systems and partnerships has been built over decades as a direct response to the persistent threat of seasonal, zoonotic, and pandemic influenza. These efforts have been spearheaded by the World Health Organization, country ministries of health, the US Centers for Disease Control and Prevention, nongovernmental organizations, academic groups, and others. During the COVID-19 pandemic, the US Centers for Disease Control and Prevention worked closely with ministries of health in partner countries and the World Health Organization to leverage influenza surveillance systems and programs to respond to SARS-CoV-2 transmission. Countries used existing surveillance systems for severe acute respiratory infection and influenza-like illness, respiratory virus laboratory resources, pandemic influenza preparedness plans, and ongoing population-based influenza studies to track, study, and respond to SARS-CoV-2 infections. The incorporation of COVID-19 surveillance into existing influenza sentinel surveillance systems can support continued global surveillance for respiratory viruses with pandemic potential.
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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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Koul PA, Saha S, Kaul KA, Mir H, Potdar V, Chadha M, Iuliano D, Lafond KE, Lal RB, Krishnan A. Respiratory syncytial virus among children hospitalized with severe acute respiratory infection in Kashmir, a temperate region in northern India. J Glob Health 2022; 12:04050. [PMID: 35976005 PMCID: PMC9288648 DOI: 10.7189/jogh.12.04050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Severe acute respiratory infections (SARI) are a leading cause of hospitalizations in children, especially due to viral pathogens. We studied the prevalence of respiratory viruses among children aged <5 years hospitalized with severe acute respiratory infections (SARI) in Kashmir, India. Methods We conducted a prospective observational study in two tertiary care hospitals from October 2013 to September 2014, systematically enrolling two children aged <5 years with SARI per day. We defined SARI as history of fever or measured fever (≥38°C) and cough with onset in the last 7 days requiring hospitalization for children aged 3-59 months and as physician-diagnosed acute lower respiratory infection for children aged <3 months. Trained study staff screened children within 24 hours of hospitalization for SARI and collected clinical data and nasopharyngeal swabs from enrolled participants. We tested for respiratory syncytial virus (RSV) A and B, influenza viruses, rhinoviruses (HRV)/enteroviruses, adenovirus (AdV), bocavirus (BoV), human metapneumovirus (hMPV) A and B, coronaviruses (OC43, NL65, C229E), and parainfluenza viruses (PIV) 1, 2, 3 and 4 using standardized duplex real-time polymerase chain reaction. Results Among 4548 respiratory illness admissions screened from October 2013 to September 2014, 1026 met the SARI case definition, and 412 were enrolled (ages = 5 days to 58 months; median = 12 months). Among enrolees, 256 (62%) were positive for any virus; RSV was the most commonly detected (n = 118, 29%) followed by HRV/enteroviruses (n = 88, 21%), PIVs (n = 31, 8%), influenza viruses (n = 18, 4%), BoV (n = 15, 4%), coronaviruses (n = 16, 4%), AdV (n = 14, 3%), and hMPV (n = 9, 2%). Fifty-four children had evidence of virus co-detection. Influenza-associated SARI was more common among children aged 1-5 years (14/18, 78%) while most RSV detections occurred in children <12 months (83/118, 70%). Of the RSV viruses typed (n = 116), the majority were type B (94, 80%). Phylogenetic analysis of G gene of RSV showed circulation of the BA9 genotype with 60bp nucleotide duplication. Conclusions Respiratory viruses, especially RSV, contributed to a substantial proportion of SARI hospitalizations among children <5 years in north India. These data can help guide clinicians on appropriate treatment and prevention strategies.
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Affiliation(s)
- Parvaiz A Koul
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Siddhartha Saha
- Influenza Program, US Centers for Disease Control and Prevention – Delhi office, India
| | | | - Hyder Mir
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | | | | | - Danielle Iuliano
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathryn E Lafond
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Renu B Lal
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anand Krishnan
- All India Institute of Medical Sciences, New Delhi, India
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Richardson VL, Franco MAC, Márquez AB, Valdez LM, Ceronio LEC, Cruz VC, Gharpure R, Lafond KE, Yau TS, Azziz-Baumgartner E, Ávila MH. Vaccine Effectiveness of CanSino (Adv5-nCoV) Coronavirus Disease 2019 (COVID-19) Vaccine Among Childcare Workers-Mexico, March-December 2021. Clin Infect Dis 2022; 75:S167-S173. [PMID: 35717650 PMCID: PMC9214173 DOI: 10.1093/cid/ciac488] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Beginning in March 2021, Mexico vaccinated childcare workers with a single-dose CanSino Biologics (Adv5-nCoV) coronavirus disease 2019 (COVID-19) vaccine. Although CanSino is currently approved for use in 10 Latin American, Asian, and European countries, little information is available about its vaccine effectiveness (VE). METHODS We evaluated CanSino VE within a childcare worker cohort that included 1408 childcare facilities. Participants were followed during March-December 2021 and tested through severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse-transcription polymerase chain reaction or rapid antigen test if they developed any symptom compatible with COVID-19. Vaccination status was obtained through worker registries. VE was calculated as 100% × (1 - hazard ratio for SARS-CoV-2 infection in fully vaccinated vs unvaccinated participants), using an Andersen-Gill model adjusted for age, sex, state, and local viral circulation. RESULTS The cohort included 43 925 persons who were mostly (96%) female with a median age of 32 years; 37 646 (86%) were vaccinated with CanSino. During March-December 2021, 2250 (5%) participants had laboratory-confirmed COVID-19, of whom 25 were hospitalized and 6 died. Adjusted VE was 20% (95% confidence interval [CI], 10%-29%) against illness, 76% (95% CI, 42%-90%) against hospitalization, and 94% (95% CI, 66%-99%) against death. VE against illness declined from 48% (95% CI, 33%-61%) after 14-60 days following full vaccination to 20% (95% CI, 9%-31%) after 61-120 days. CONCLUSIONS CanSino vaccine was effective at preventing COVID-19 illness and highly effective at preventing hospitalization and death. It will be useful to further evaluate duration of protection and assess the value of booster doses to prevent COVID-19 and severe outcomes.
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Affiliation(s)
- Vesta L Richardson
- Post-Acceptance Corresponding author: Vesta L. Richardson. Coordinación del Servicio de Guardería para el Desarrollo Integral Infantil. Paseo de la Reforma No. 476, Pórtico Planta Alta, Col. Juárez, Alcaldía Cuauhtémoc, C. P. 06600, CDMX.
| | | | - Aurora Bautista Márquez
- Dirección de Prestaciones Económicas y Sociales del Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Libny Martínez Valdez
- Dirección de Prestaciones Económicas y Sociales del Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Luis Enrique Castro Ceronio
- Dirección de Prestaciones Económicas y Sociales del Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Vicente Cruz Cruz
- Dirección de Prestaciones Económicas y Sociales del Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Radhika Gharpure
- Corresponding author: Radhika Gharpure, US Centers for Disease Control and Prevention. 1600 Clifton Rd NE, Atlanta GA, 30329.
| | | | - Tat S Yau
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Mauricio Hernández Ávila
- Dirección de Prestaciones Económicas y Sociales del Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Sridhar S, Fico A, Preza I, Hatibi I, Sulo J, Kissling E, Daja R, Ibrahim R, Lemos D, Rubin-Smith J, Schmid A, Vasili A, Valenciano M, Jorgensen P, Pebody R, Lafond KE, Katz MA, Bino S. COVID-19 vaccine effectiveness among healthcare workers in Albania (COVE-AL): protocol for a prospective cohort study and cohort baseline data. BMJ Open 2022; 12:e057741. [PMID: 35321895 PMCID: PMC8943479 DOI: 10.1136/bmjopen-2021-057741] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Critical questions remain about COVID-19 vaccine effectiveness (VE) in real-world settings, particularly in middle-income countries. We describe a study protocol to evaluate COVID-19 VE in preventing laboratory-confirmed SARS-CoV-2 infection in health workers (HWs) in Albania, an upper-middle-income country. METHODS AND ANALYSIS In this 12-month prospective cohort study, we enrolled HWs at three hospitals in Albania. HWs are vaccinated through the routine COVID-19 vaccine campaign. Participants completed a baseline survey about demographics, clinical comorbidities, and infection risk behaviours. Baseline serology samples were also collected and tested against the SARS-CoV-2 spike protein, and respiratory swabs were collected and tested for SARS-CoV-2 by RT-PCR. Participants complete weekly symptom questionnaires and symptomatic participants have a respiratory swab collected, which is tested for SARS-CoV-2. At 3, 6, 9 months and 12 months of the study, serology will be collected and tested for antibodies against the SARS-CoV-2 nucleocapsid protein and spike protein. VE will be estimated using a piecewise proportional hazards model (VE=1-HR). BASELINE DATA From February to May 2021, 1504 HWs were enrolled. The median age was 44 (range: 22-71) and 78% were female. At enrolment, 72% of participants were seropositive for SARS-CoV-2. 56% of participants were vaccinated with one dose, of whom 98% received their first shot within 4 days of enrolment. All HWs received the Pfizer BNT162b2 mRNA COVID-19 vaccine. ETHICS AND DISSEMINATION The study protocol and procedures were reviewed and approved by the WHO Ethical Review Board, reference number CERC.0097A, and the Albanian Institute of Public Health Ethical Review Board, reference number 156. All participants have provided written informed consent to participate in this study. The primary results of this study will be published in a peer-reviewed journal at the time of completion. TRIAL REGISTRATION NUMBER NCT04811391.
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Affiliation(s)
- Shela Sridhar
- Global Health Program, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Iria Preza
- Institute of Public Health, Tirana, Albania
| | | | - Jonilda Sulo
- Southeast European Center for Surveillance and Control of Infectious Disease, Tirana, Albania
| | | | | | - Rawi Ibrahim
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Diogo Lemos
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Julia Rubin-Smith
- Global Health Program, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alexis Schmid
- Global Health Program, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | | | - Pernille Jorgensen
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Richard Pebody
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | | | - Mark A Katz
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Silvia Bino
- Institute of Public Health, Southern European Centre for Surveillance and Control of Infectious Diseases (SECID), Tirana, Albania
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Krishnan A, Dar L, Amarchand R, Prabhakaran AO, Kumar R, Rajkumar P, Kanungo S, Bhardwaj SD, Choudekar A, Potdar V, Chakrabarti AK, Kumar CG, Parameswaran GG, Dhakad S, Manna B, Choudhary A, Lafond KE, Azziz-Baumgartner E, Saha S. Cohort profile: Indian Network of Population-Based Surveillance Platforms for Influenza and Other Respiratory Viruses among the Elderly (INSPIRE). BMJ Open 2021; 11:e052473. [PMID: 34620665 PMCID: PMC8499317 DOI: 10.1136/bmjopen-2021-052473] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE We describe here a multicentric community-dwelling cohort of older adults (>60 years of age) established to estimate incidence, study risk factors, healthcare utilisation and economic burden associated with influenza and respiratory syncytial virus (RSV) in India. PARTICIPANTS The four sites of this cohort are in northern (Ballabgarh), southern (Chennai), eastern (Kolkata) and western (Pune) parts of India. We enrolled 5336 participants across 4220 households and began surveillance in July 2018 for viral respiratory infections with additional participants enrolled annually. Trained field workers collected data about individual-level and household-level risk factors at enrolment and quarterly assessed frailty and grip strength. Trained nurses surveilled weekly to identify acute respiratory infections (ARI) and clinically assessed individuals to diagnose acute lower respiratory infection (ALRI) as per protocol. Nasal and oropharyngeal swabs are collected from all ALRI cases and one-fifth of the other ARI cases for laboratory testing. Cost data of the episode are collected using the WHO approach for estimating the economic burden of seasonal influenza. Handheld tablets with Open Data Kit platform were used for data collection. FINDINGS TO DATE The attrition of 352 participants due to migration and deaths was offset by enrolling 680 new entrants in the second year. All four sites reported negligible influenza vaccination uptake (0.1%-0.4%), low health insurance coverage (0.4%-22%) and high tobacco use (19%-52%). Ballabgarh had the highest proportion (54.4%) of households in the richest wealth quintile, but reported high solid fuel use (92%). Frailty levels were highest in Kolkata (11.3%) and lowest in Pune (6.8%). The Chennai cohort had highest self-reported morbidity (90.1%). FUTURE PLANS The findings of this cohort will be used to inform prioritisation of strategies for influenza and RSV control for older adults in India. We also plan to conduct epidemiological studies of SARS-CoV-2 using this platform.
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Affiliation(s)
- Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Dar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ritvik Amarchand
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rakesh Kumar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Suman Kanungo
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Avinash Choudekar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | - Shivram Dhakad
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Byomkesh Manna
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Ashish Choudhary
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kathryn E Lafond
- Influenza division, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Siddhartha Saha
- Influenza program, US Centers for Disease Control and Prevention, New Delhi, India
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19
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Roguski KM, Rolfes MA, Reich JS, Owens Z, Patel N, Fitzner J, Cozza V, Lafond KE, Azziz-Baumgartner E, Iuliano AD. Variability in published rates of influenza-associated hospitalizations: A systematic review, 2007-2018. J Glob Health 2021; 10:020430. [PMID: 33274066 PMCID: PMC7699004 DOI: 10.7189/jogh.10.020430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/22/2022] Open
Abstract
Background Influenza burden estimates help provide evidence to support influenza prevention and control programs at local and international levels. Methods Through a systematic review, we aimed to identify all published articles estimating rates of influenza-associated hospitalizations, describe methods and data sources used, and identify regions of the world where estimates are still lacking. We evaluated study heterogeneity to determine if we could pool published rates to generate global estimates of influenza-associated hospitalization. Results We identified 98 published articles estimating influenza-associated hospitalization rates from 2007-2018. Most articles (65%) identified were from high-income countries, with 34 of those (53%) presenting estimates from the United States. While we identified fewer publications (18%) from low- and lower-middle-income countries, 50% of those were published from 2015-2018, suggesting an increase in publications from lower-income countries in recent years. Eighty percent (n = 78) used a multiplier approach. Regression modelling techniques were only used with data from upper-middle or high-income countries where hospital administrative data was available. We identified variability in the methods, case definitions, and data sources used, including 91 different age groups and 11 different categories of case definitions. Due to the high observed heterogeneity across articles (I2>99%), we were unable to pool published estimates. Conclusions The variety of methods, data sources, and case definitions adapted locally suggests that the current literature cannot be synthesized to generate global estimates of influenza-associated hospitalization burden.
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Affiliation(s)
| | - Melissa A Rolfes
- US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Jeremy S Reich
- US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Zachary Owens
- Emory University, Rollins School of Public Health, Department of Epidemiology, Atlanta, Georgia, USA
| | - Neha Patel
- US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Julia Fitzner
- World Health Organization, Global Influenza Programme, Geneva, Switzerland
| | - Vanessa Cozza
- World Health Organization, Global Influenza Programme, Geneva, Switzerland
| | - Kathryn E Lafond
- US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | | | - A Danielle Iuliano
- US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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20
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Niang MN, Sugimoto JD, Diallo A, Diarra B, Ortiz JR, Lewis KDC, Lafond KE, Halloran ME, Widdowson MA, Neuzil KM, Victor JC. Estimates of Inactivated Influenza Vaccine Effectiveness Among Children in Senegal: Results From 2 Consecutive Cluster-Randomized Controlled Trials in 2010 and 2011. Clin Infect Dis 2021; 72:e959-e969. [PMID: 33165566 DOI: 10.1093/cid/ciaa1689] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/30/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We report results of years 2 and 3 of consecutive cluster-randomized controlled trials of trivalent inactivated influenza vaccine (IIV3) in Senegal. METHODS We cluster-randomized (1:1) 20 villages to annual vaccination with IIV3 or inactivated poliovirus vaccine (IPV) of age-eligible residents (6 months-10 years). The primary outcome was total vaccine effectiveness against laboratory-confirmed influenza illness (LCI) among age-eligible children (modified intention-to-treat population [mITT]). Secondary outcomes were indirect (herd protection) and population (overall community) vaccine effectiveness. RESULTS We vaccinated 74% of 12 408 age-eligible children in year 2 (June 2010-April 11) and 74% of 11 988 age-eligible children in year 3 (April 2011-December 2011) with study vaccines. Annual cumulative incidence of LCI was 4.7 (year 2) and 4.2 (year 3) per 100 mITT child vaccinees of IPV villages. In year 2, IIV3 matched circulating influenza strains. The total effectiveness was 52.8% (95% confidence interval [CI], 32.3-67.0), and the population effectiveness was 36.0% (95% CI, 10.2-54.4) against LCI caused by any influenza strain. The indirect effectiveness against LCI by A/H3N2 was 56.4% (95% CI, 39.0-68.9). In year 3, 74% of influenza detections were vaccine-mismatched to circulating B/Yamagata and 24% were vaccine-matched to circulating A/H3N2. The year 3 total effectiveness against LCI was -14.5% (95% CI, -81.2-27.6). Vaccine effectiveness varied by type/subtype of influenza in both years. CONCLUSIONS IIV3 was variably effective against influenza illness in Senegalese children, with total and indirect vaccine effectiveness present during the year when all circulating strains matched the IIV3 formulation. CLINICAL TRIALS REGISTRATION NCT00893906.
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Affiliation(s)
| | - Jonathan D Sugimoto
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Aldiouma Diallo
- VITROME, Institut de Recherche Pour le Développement, Dakar, Senegal
| | - Bou Diarra
- VITROME, Institut de Recherche Pour le Développement, Dakar, Senegal
| | - Justin R Ortiz
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Kathryn E Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - M Elizabeth Halloran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Marc-Alain Widdowson
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Institute of Tropical Medicine, Antwerp, Belgium
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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21
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Lutz CS, Biggerstaff M, Rolfes MA, Lafond KE, Azziz-Baumgartner E, Porter RM, Reed C, Bresee JS. Estimating the number of averted illnesses and deaths as a result of vaccination against an influenza pandemic in nine low- and middle-income countries. Vaccine 2021; 39:4219-4230. [PMID: 34119348 DOI: 10.1016/j.vaccine.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND During the 2009 influenza A(H1N1)pdm09 pandemic, 77 countries received donated monovalent A(H1N1)pdm09 vaccine through the WHO Pandemic Influenza A(H1N1) Vaccine Deployment Initiative. However, 47% did not receive their first shipment until after the first wave of virus circulation, and 8% did not receive their first shipment until after the WHO declared the end of the pandemic. Arguably, these shipments were too late into the pandemic to have a substantial effect on virus transmission or disease burden during the first waves of the pandemic. OBJECTIVES In order to evaluate the potential benefits of earlier vaccine availability, we estimated the number of illnesses and deaths that could be averted during a 2009-like influenza pandemic under five different vaccine-availability timing scenarios. METHODS We adapted a model originally developed to estimate annual influenza morbidity and mortality burden averted through US seasonal vaccination and ran it for five vaccine availability timing scenarios in nine low- and middle-income countries that received donated vaccine. RESULTS Among nine study countries, we estimated that the number of averted cases was 61-216,197 for actual vaccine receipt, increasing to 2,914-283,916 had vaccine been available simultaneously with the United States. CONCLUSIONS Earlier delivery of vaccines can reduce influenza case counts during a simulated 2009-like pandemic in some low- and middle-income countries. For others, increasing the number of cases and deaths prevented through vaccination may be dependent on factors other than timely initiation of vaccine administration, such as distribution and administration capacity.
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Affiliation(s)
- Chelsea S Lutz
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, United States; Oak Ridge Institute for Science and Education, United States Department of Energy, 100 ORAU Way, Oak Ridge, TN 37830, United States; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States.
| | - Matthew Biggerstaff
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, United States
| | - Melissa A Rolfes
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, United States
| | - Kathryn E Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, United States
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, United States
| | - Rachael M Porter
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, United States
| | - Carrie Reed
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, United States
| | - Joseph S Bresee
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, United States
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22
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Kumar R, Dar L, Amarchand R, Saha S, Lafond KE, Purakayastha DR, Kumar R, Choudekar A, Gopal G, Dhakad S, Narayan VV, Wahi A, Chhokar R, Lindstrom S, Whitaker B, Choudhary A, Dey AB, Krishnan A. Incidence, risk factors, and viral etiology of community-acquired acute lower respiratory tract infection among older adults in rural north India. J Glob Health 2021; 11:04027. [PMID: 33880179 PMCID: PMC8035979 DOI: 10.7189/jogh.11.04027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There are limited data on incidence, risk factors and etiology of acute lower respiratory tract infection (LRTI) among older adults in low- and middle-income countries. METHODS We established a cohort of community dwelling older adults ≥60 years and conducted weekly follow-up for acute respiratory infections (ARI) during 2015-2017. Nurses assessed ARI cases for LRTI, collecting combined nasal/throat swabs from all LRTI cases and an equal number of age- and sex-matched asymptomatic neighbourhood controls. Swabs were tested for influenza viruses, respiratory syncytial virus (RSV), human metapneumovirus (hMPV), and parainfluenza viruses (PIV) using polymerase chain reaction. LRTI and virus-specific LRTI incidence was calculated per 1000 person-years. We estimated adjusted incidence rate ratios (IRR) for risk factors using Poisson regression and calculated etiologic fractions (EF) using adjusted odds ratios for detection of viral pathogens in LRTI cases vs controls. RESULTS We followed 1403 older adults for 2441 person-years. LRTI and LRTI-associated hospitalization incidences were 248.3 (95% confidence interval (CI) = 229.3-268.8) and 12.7 (95% CI = 8.9-18.1) per 1000 person-years. Persons with pre-existing chronic bronchitis as compared to those without (incidence rate ratio (IRR) = 4.7, 95% CI = 3.9-5.6); aged 65-74 years (IRR = 1.6, 95% CI = 1.3-2.0) and ≥75 years (IRR = 1.8, 95% CI = 1.4-2.4) as compared to 60-64 years; and persons in poorest wealth quintile (IRR = 1.4, 95% CI = 1.1-1.8); as compared to those in wealthiest quintile were at higher risk for LRTI. Virus was detected in 10.1% of LRTI cases, most commonly influenza (3.8%) and RSV (3.0%). EF for RSV and influenza virus was 83.9% and 83.6%, respectively. CONCLUSION In this rural cohort of older adults, the incidence of LRTI was substantial. Chronic bronchitis was an important risk factor; influenza virus and RSV were major viral pathogens.
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Affiliation(s)
- Rakesh Kumar
- All India Institute of Medical Sciences, New Delhi
| | - Lalit Dar
- All India Institute of Medical Sciences, New Delhi
| | | | - Siddhartha Saha
- Influenza Division, Centers for Disease Control and Prevention- India Country Office, New Delhi, India
| | - Kathryn E Lafond
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Ramesh Kumar
- All India Institute of Medical Sciences, New Delhi
| | | | | | | | - Venkatesh Vinayak Narayan
- Influenza Division, Centers for Disease Control and Prevention- India Country Office, New Delhi, India
| | | | | | | | - Brett Whitaker
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - A B Dey
- All India Institute of Medical Sciences, New Delhi
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Krishnan A, Dar L, Saha S, Narayan VV, Kumar R, Kumar R, Amarchand R, Dhakad S, Chokker R, Choudekar A, Gopal G, Choudhary A, Potdar V, Chadha M, Lafond KE, Lindstrom S, Widdowson MA, Jain S. Efficacy of live attenuated and inactivated influenza vaccines among children in rural India: A 2-year, randomized, triple-blind, placebo-controlled trial. PLoS Med 2021; 18:e1003609. [PMID: 33914729 PMCID: PMC8118535 DOI: 10.1371/journal.pmed.1003609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 05/13/2021] [Accepted: 04/04/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Influenza is a cause of febrile acute respiratory infection (FARI) in India; however, few influenza vaccine trials have been conducted in India. We assessed absolute and relative efficacy of live attenuated influenza vaccine (LAIV) and inactivated influenza vaccine (IIV) among children aged 2 to 10 years in rural India through a randomized, triple-blind, placebo-controlled trial conducted over 2 years. METHODS AND FINDINGS In June 2015, children were randomly allocated to LAIV, IIV, intranasal placebo, or inactivated polio vaccine (IPV) in a 2:2:1:1 ratio. In June 2016, vaccination was repeated per original allocation. Overall, 3,041 children received LAIV (n = 1,015), IIV (n = 1,010), nasal placebo (n = 507), or IPV (n = 509). Mean age of children was 6.5 years with 20% aged 9 to 10 years. Through weekly home visits, nasal and throat swabs were collected from children with FARI and tested for influenza virus by polymerase chain reaction. The primary outcome was laboratory-confirmed influenza-associated FARI; vaccine efficacy (VE) was calculated using modified intention-to-treat (mITT) analysis by Cox proportional hazards model (PH) for each year. In Year 1, VE was 40.0% (95% confidence interval (CI) 25.2 to 51.9) for LAIV and 59.0% (95% CI 47.8 to 67.9) for IIV compared with controls; relative efficacy of LAIV compared with IIV was -46.2% (95% CI -88.9 to -13.1). In Year 2, VE was 51.9% (95% CI 42.0 to 60.1) for LAIV and 49.9% (95% CI 39.2 to 58.7) for IIV; relative efficacy of LAIV compared with IIV was 4.2% (95% CI -19.9 to 23.5). No serious adverse vaccine-attributable events were reported. Study limitations include differing dosage requirements for children between nasal and injectable vaccines (single dose of LAIV versus 2 doses of IIV) in Year 1 and the fact that immunogenicity studies were not conducted. CONCLUSIONS In this study, we found that LAIV and IIV vaccines were safe and moderately efficacious against influenza virus infection among Indian children. TRIAL REGISTRATION Clinical Trials Registry of India CTRI/2015/06/005902.
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Affiliation(s)
- Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, Delhi, India
- * E-mail:
| | - Lalit Dar
- Microbiology Department, All India Institute of Medical Sciences, Delhi, India
| | - Siddhartha Saha
- Influenza Program, Centers for Disease Control and Prevention, New Delhi, India
| | | | - Rakesh Kumar
- Centre for Community Medicine, All India Institute of Medical Sciences, Delhi, India
| | - Ramesh Kumar
- Microbiology Department, All India Institute of Medical Sciences, Delhi, India
| | - Ritvik Amarchand
- Centre for Community Medicine, All India Institute of Medical Sciences, Delhi, India
| | - Shivram Dhakad
- Microbiology Department, All India Institute of Medical Sciences, Delhi, India
| | - Reshmi Chokker
- Centre for Community Medicine, All India Institute of Medical Sciences, Delhi, India
| | - Avinash Choudekar
- Microbiology Department, All India Institute of Medical Sciences, Delhi, India
| | - Giridara Gopal
- Centre for Community Medicine, All India Institute of Medical Sciences, Delhi, India
| | - Aashish Choudhary
- Microbiology Department, All India Institute of Medical Sciences, Delhi, India
| | | | | | - Kathryn E. Lafond
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Stephen Lindstrom
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Marc-Alain Widdowson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Seema Jain
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Lafond KE, Porter RM, Whaley MJ, Suizan Z, Ran Z, Aleem MA, Thapa B, Sar B, Proschle VS, Peng Z, Feng L, Coulibaly D, Nkwembe E, Olmedo A, Ampofo W, Saha S, Chadha M, Mangiri A, Setiawaty V, Ali SS, Chaves SS, Otorbaeva D, Keosavanh O, Saleh M, Ho A, Alexander B, Oumzil H, Baral KP, Huang QS, Adebayo AA, Al-Abaidani I, von Horoch M, Cohen C, Tempia S, Mmbaga V, Chittaganpitch M, Casal M, Dang DA, Couto P, Nair H, Bresee JS, Olsen SJ, Azziz-Baumgartner E, Nuorti JP, Widdowson MA. Global burden of influenza-associated lower respiratory tract infections and hospitalizations among adults: A systematic review and meta-analysis. PLoS Med 2021; 18:e1003550. [PMID: 33647033 PMCID: PMC7959367 DOI: 10.1371/journal.pmed.1003550] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [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: 06/22/2020] [Revised: 03/15/2021] [Accepted: 01/27/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Influenza illness burden is substantial, particularly among young children, older adults, and those with underlying conditions. Initiatives are underway to develop better global estimates for influenza-associated hospitalizations and deaths. Knowledge gaps remain regarding the role of influenza viruses in severe respiratory disease and hospitalizations among adults, particularly in lower-income settings. METHODS AND FINDINGS We aggregated published data from a systematic review and unpublished data from surveillance platforms to generate global meta-analytic estimates for the proportion of acute respiratory hospitalizations associated with influenza viruses among adults. We searched 9 online databases (Medline, Embase, CINAHL, Cochrane Library, Scopus, Global Health, LILACS, WHOLIS, and CNKI; 1 January 1996-31 December 2016) to identify observational studies of influenza-associated hospitalizations in adults, and assessed eligible papers for bias using a simplified Newcastle-Ottawa scale for observational data. We applied meta-analytic proportions to global estimates of lower respiratory infections (LRIs) and hospitalizations from the Global Burden of Disease study in adults ≥20 years and by age groups (20-64 years and ≥65 years) to obtain the number of influenza-associated LRI episodes and hospitalizations for 2016. Data from 63 sources showed that influenza was associated with 14.1% (95% CI 12.1%-16.5%) of acute respiratory hospitalizations among all adults, with no significant differences by age group. The 63 data sources represent published observational studies (n = 28) and unpublished surveillance data (n = 35), from all World Health Organization regions (Africa, n = 8; Americas, n = 11; Eastern Mediterranean, n = 7; Europe, n = 8; Southeast Asia, n = 11; Western Pacific, n = 18). Data quality for published data sources was predominantly moderate or high (75%, n = 56/75). We estimate 32,126,000 (95% CI 20,484,000-46,129,000) influenza-associated LRI episodes and 5,678,000 (95% CI 3,205,000-9,432,000) LRI hospitalizations occur each year among adults. While adults <65 years contribute most influenza-associated LRI hospitalizations and episodes (3,464,000 [95% CI 1,885,000-5,978,000] LRI hospitalizations and 31,087,000 [95% CI 19,987,000-44,444,000] LRI episodes), hospitalization rates were highest in those ≥65 years (437/100,000 person-years [95% CI 265-612/100,000 person-years]). For this analysis, published articles were limited in their inclusion of stratified testing data by year and age group. Lack of information regarding influenza vaccination of the study population was also a limitation across both types of data sources. CONCLUSIONS In this meta-analysis, we estimated that influenza viruses are associated with over 5 million hospitalizations worldwide per year. Inclusion of both published and unpublished findings allowed for increased power to generate stratified estimates, and improved representation from lower-income countries. Together, the available data demonstrate the importance of influenza viruses as a cause of severe disease and hospitalizations in younger and older adults worldwide.
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Affiliation(s)
- Kathryn E. Lafond
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
- * E-mail: (KEL); (MAW)
| | - Rachael M. Porter
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Melissa J. Whaley
- US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Zhou Suizan
- Influenza Division, US Centers for Disease Control and Prevention, Beijing, China
| | - Zhang Ran
- Influenza Division, US Centers for Disease Control and Prevention, Beijing, China
| | - Mohammad Abdul Aleem
- Program for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Binay Thapa
- Royal Centre for Disease Control, Thimphu, Bhutan
| | - Borann Sar
- Centers for Disease Control and Prevention, Phnom Penh, Cambodia
| | | | - Zhibin Peng
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Luzhao Feng
- School of Population Medicine & Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | | | - Edith Nkwembe
- Institut National de Recherches Biomédicales, Kinshasa, République Démocratique du Congo
| | | | - William Ampofo
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Siddhartha Saha
- Influenza Division, US Centers for Disease Control and Prevention, New Delhi, India
| | | | - Amalya Mangiri
- US Centers for Disease Control and Prevention, Jakarta, Indonesia
| | - Vivi Setiawaty
- National Institute of Health Research and Development, Jakarta, Indonesia
| | | | - Sandra S. Chaves
- Influenza Division, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Dinagul Otorbaeva
- Department of State Sanitary Epidemiological Surveillance, Bishkek, Kyrgyzstan
| | - Onechanh Keosavanh
- National Center for Laboratory and Epidemiology, Vientiane, Lao People’s Democratic Republic
| | - Majd Saleh
- Epidemiological Surveillance Program, Lebanese Ministry of Public Health, Beirut, Lebanon
| | - Antonia Ho
- MRC–University of Glasgow Centre for Virus Research, Glasgow, United Kingdom
- Malawi–Liverpool–Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Hicham Oumzil
- Virology Department, Institut National d’Hygiène, Rabat, Morocco
- Faculty of Medicine, Microbiology RPU, Mohammed V University, Rabat, Morocco
| | | | - Q. Sue Huang
- WHO National Influenza Centre, Institute of Environmental Science and Research, Wellington, New Zealand
| | - Adedeji A. Adebayo
- Nigeria Centre for Disease Control, Federal Ministry of Health, Abuja, Nigeria
| | - Idris Al-Abaidani
- Directorate General of Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Marta von Horoch
- Ministerio de Salud Publica y Bienestar Social, Asunción, Paraguay
| | - Cheryl Cohen
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Stefano Tempia
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- MassGenics, Duluth, Georgia, United States of America
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Malinee Chittaganpitch
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Mariana Casal
- Arizona Department of Health Services, Phoenix, Arizona, United States of America
| | - Duc Anh Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Paula Couto
- Pan American Health Organization, Washington, District of Columbia, United States of America
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Joseph S. Bresee
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sonja J. Olsen
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eduardo Azziz-Baumgartner
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - J. Pekka Nuorti
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Marc-Alain Widdowson
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Nairobi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail: (KEL); (MAW)
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Diallo A, Diop OM, Diop D, Niang MN, Sugimoto JD, Ortiz JR, Faye EHA, Diarra B, Goudiaby D, Lewis KDC, Emery SL, Zangeneh SZ, Lafond KE, Sokhna C, Halloran ME, Widdowson MA, Neuzil KM, Victor JC. Effectiveness of Seasonal Influenza Vaccination in Children in Senegal During a Year of Vaccine Mismatch: A Cluster-randomized Trial. Clin Infect Dis 2020; 69:1780-1788. [PMID: 30689757 DOI: 10.1093/cid/ciz066] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 06/28/2018] [Accepted: 01/18/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The population effects of influenza vaccination in children have not been extensively studied, especially in tropical, developing countries. In rural Senegal, we assessed the total (primary objective) and indirect effectiveness of a trivalent inactivated influenza vaccine (IIV3). METHODS In this double-blind, cluster-randomized trial, villages were randomly allocated (1:1) for the high-coverage vaccination of children aged 6 months through 10 years with either the 2008-09 northern hemisphere IIV3 or an inactivated polio vaccine (IPV). Vaccinees were monitored for serious adverse events. All village residents, vaccinated and unvaccinated, were monitored for signs and symptoms of influenza illness using weekly home visits and surveillance in designated clinics. The primary outcome was all laboratory-confirmed symptomatic influenza. RESULTS Between 23 May and 11 July 2009, 20 villages were randomized, and 66.5% of age-eligible children were enrolled (3918 in IIV3 villages and 3848 in IPV villages). Follow-up continued until 28 May 2010. There were 4 unrelated serious adverse events identified. Among vaccinees, the total effectiveness against illness caused by the seasonal influenza virus (presumed to all be drifted A/H3N2, based on antigenic characterization data) circulating at high rates among children was 43.6% (95% confidence interval [CI] 18.6-60.9%). The indirect effectiveness against seasonal A/H3N2 was 15.4% (95% CI -22.0 to 41.3%). The total effectiveness against illness caused by the pandemic influenza virus (A/H1N1pdm09) was -52.1% (95% CI -177.2 to 16.6%). CONCLUSIONS IIV3 provided statistically significant, moderate protection to children in Senegal against circulating, pre-2010 seasonal influenza strains, but not against A/H1N1pdm09, which was not included in the vaccine. No indirect effects were measured. Further study in low-resource populations is warranted. CLINICAL TRIALS REGISTRATION NCT00893906.
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Affiliation(s)
- Aldiouma Diallo
- UMR VITROME, Institut de Recherche Pour le Développement, Dakar, Senegal
| | | | - Doudou Diop
- UMR VITROME, Institut de Recherche Pour le Développement, Dakar, Senegal
| | | | - Jonathan D Sugimoto
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Justin R Ortiz
- Center for Vaccine Development, University of Maryland, Baltimore
| | | | - Bou Diarra
- UMR VITROME, Institut de Recherche Pour le Développement, Dakar, Senegal
| | | | | | - Shannon L Emery
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sahar Z Zangeneh
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kathryn E Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cheikh Sokhna
- UMR VITROME, Institut de Recherche Pour le Développement, Dakar, Senegal
| | - M Elizabeth Halloran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Department of Biostatistics, University of Washington, Seattle
| | - Marc-Alain Widdowson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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26
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Sullender WM, Fowler KB, Gupta V, Krishnan A, Ram Purakayastha D, Srungaram Vln R, Lafond KE, Saha S, Palomeque FS, Gargiullo P, Jain S, Lal R, Widdowson MA, Broor S. Efficacy of inactivated trivalent influenza vaccine in rural India: a 3-year cluster-randomised controlled trial. Lancet Glob Health 2020; 7:e940-e950. [PMID: 31200893 PMCID: PMC7347003 DOI: 10.1016/s2214-109x(19)30079-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 12/13/2018] [Accepted: 02/19/2019] [Indexed: 10/29/2022]
Abstract
BACKGROUND Paediatric vaccination against influenza can result in indirect protection, by reducing transmission to their unvaccinated contacts. We investigated whether influenza vaccination of children would protect them and their household members in a resource-limited setting. METHODS We did a cluster-randomised, blinded, controlled study in three villages in India. Clusters were defined as households (ie, dwellings that shared a courtyard), and children aged 6 months to 10 years were eligible for vaccination as and when they became age-eligible throughout the study. Households were randomly assigned (1:1) by a computer-based system to intramuscular trivalent inactivated influenza vaccine (IIV3) or a control of inactivated poliovirus vaccine (IPV) in the beginning of the study; vaccination occurred once a year for 3 years. The primary efficacy outcome was laboratory-confirmed influenza in a vaccinated child with febrile acute respiratory illness, analysed in the modified intention-to-treat population (ie, children who received at least one dose of vaccine, were under surveillance, and had not an influenza infection within 15 days of last vaccine dose). The secondary outcome for indirect effectiveness (surveillance study) was febrile acute respiratory illness in an unvaccinated household member of a vaccine study participant. Data from each year (year 1: November, 2009, to October, 2010; year 2: October, 2010, to October, 2011; and year 3: October, 2011, to May, 2012) were analysed separately. Safety was analysed among all participants who were vaccinated with at least one dose of the vaccine. This trial is registered with ClinicalTrials.gov, number NCT00934245. FINDINGS Between Nov 1, 2009, to May 1, 2012, we enrolled 3208 households, of which 1959 had vaccine-eligible children. 1010 households were assigned to IIV3 and 949 households were assigned to IPV. In 3 years, we vaccinated 4345 children (2132 with IIV3 and 2213 with IPV) from 1868 households (968 with IIV3 and 900 with IPV) with 10 813 unvaccinated household contacts. In year 1, influenza virus was detected in 151 (10%) of 1572 IIV3 recipients and 206 (13%) of 1633 of IPV recipients (total IIV3 vaccine efficacy 25·6% [95% CI 6·8-40·6]; p=0·010). In year 2, 105 (6%) of 1705 IIV3 recipients and 182 (10%) of 1814 IPV recipients had influenza (vaccine efficacy 41·0% [24·1-54·1]; p<0·0001). In year 3, 20 (1%) of 1670 IIV3 recipients and 81 (5%) of 1786 IPV recipients had influenza (vaccine efficacy 74·2% [57·8-84·3]; p<0·0001). In year 1, total vaccine efficacy against influenza A(H1N1)pdm09 was 14·5% (-20·4 to 39·3). In year 2, total vaccine efficacy against influenza A(H3N2) was 64·5% (48·5-75·5). Total vaccine efficacy against influenza B was 32·5% (11·3-48·6) in year 1, 4·9% (-38·9 to 34·9) in year 2, and 76·5% (59·4-86·4) in year 3. Indirect vaccine effectiveness was statistically significant only in year 3 (38·1% [7·4-58·6], p=0·0197) when influenza was detected in 39 (1%) of 4323 IIV3-allocated and 60 (1%) of 4121 IPV-allocated household unvaccinated individuals. In the IIV3 group, 225 (12%) of 1632 children in year 1, 375 (22%) of 1718 in year 2, and 209 (12%) of 1673 in year 3 had an adverse reaction (compared with 216 [13%] of 1730, 380 [21%] of 1825, and 235 [13%] of 1796, respectively, in the IPV group). The most common reactions in both groups were fever and tenderness at site. No vaccine-related deaths occurred in either group. INTERPRETATION IIV3 provided variable direct and indirect protection against influenza infection. Indirect protection was significant during the year of highest direct protection and should be considered when quantifying the effect of vaccination programmes. FUNDING US Centers for Disease Control and Prevention.
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Affiliation(s)
- Wayne M Sullender
- Department of Pediatrics, School of Medicine, and Center for Global Health, School of Public Health, University of Colorado Denver, Denver, CO, USA.
| | - Karen B Fowler
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vivek Gupta
- Community Ophthalmology Department, All India Institute of Medical Sciences, Delhi, India
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, Delhi, India
| | | | | | - Kathryn E Lafond
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Siddhartha Saha
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Paul Gargiullo
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Seema Jain
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Renu Lal
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marc-Alain Widdowson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shobha Broor
- Microbiology Department, All India Institute of Medical Sciences, Delhi, India
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Nguyen TTM, Lafond KE, Nguyen TX, Tran PD, Nguyen HM, Ha VTC, Do TT, Ha NT, Seward JF, McFarland JW. Acceptability of seasonal influenza vaccines among health care workers in Vietnam in 2017. Vaccine 2020; 38:2045-2050. [PMID: 32001072 DOI: 10.1016/j.vaccine.2019.12.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 04/03/2019] [Revised: 11/29/2019] [Accepted: 12/18/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION A demonstration project in Vietnam provided 11,000 doses of human seasonal influenza vaccine free of charge to healthcare workers (HCWs) in 4 provinces of Vietnam. Through this project, we conducted an acceptability survey to identify the main reasons that individuals chose to be vaccinated or not to inform and improve future immunization activities. METHODS We conducted a descriptive cross-sectional survey from May to August 2017 among HCWs at 13 selected health facilities. We employed logistic regression to determine the association between demographic and professional factors, and the decision to receive seasonal influenza vaccine. We performed post-hoc pairwise comparisons among reasons for and against vaccination using Chi square and Fisher's exact tests (for cell sizes <5). RESULTS A total of 1,450 HCWs participated in the survey, with a higher proportion of females than males (74% versus 26%). The median age of the participating HCWs was 35 years (median range 25.8-44.2). Among those surveyed, 700 (48%) HCWs were vaccinated against seasonal influenza during the first half of 2017. Younger HCWs under 30 and 30-39 years old were less likely to get vaccinated against seasonal influenza than HCWs ≥50 years old (OR = 0.5; 95%CI 0.4-0.8 and OR = 0.6; 95%CI 0.4-0.8 respectively). Nurses and other employees were more likely to get seasonal influenza vaccination than physicians (OR = 1.5; 95%CI 1.0-2.4 and OR = 2.0; 95%CI 1.2-3.2 respectively). The most common reason for accepting vaccination was fear of getting influenza (66%) and the most common reason for not getting vaccinated was concern about vaccine side effects (23%). CONCLUSION Acceptability of seasonal influenza vaccines in this setting varied among HCWs by age group and job category. Interventions to increase acceptance of vaccine among HCWs in this setting where influenza vaccine is being introduced free for the first time should include targeted risk communication on vaccine safety and efficacy.
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Affiliation(s)
- Thoa Thi Minh Nguyen
- Influenza Division, U.S. Centers for Disease Control and Prevention, Hanoi, Viet Nam.
| | - Kathryn E Lafond
- Influenza Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tung Xuan Nguyen
- General Department of Preventive Medicine, Ministry of Health, Hanoi, Viet Nam
| | - Phu Dac Tran
- General Department of Preventive Medicine, Ministry of Health, Hanoi, Viet Nam
| | - Hang Minh Nguyen
- General Department of Preventive Medicine, Ministry of Health, Hanoi, Viet Nam
| | - Van Thi Cam Ha
- General Department of Preventive Medicine, Ministry of Health, Hanoi, Viet Nam
| | - Thu Thi Do
- General Department of Preventive Medicine, Ministry of Health, Hanoi, Viet Nam
| | - Nga Thu Ha
- Influenza Division, U.S. Centers for Disease Control and Prevention, Hanoi, Viet Nam
| | | | - Jeffrey W McFarland
- Influenza Division, U.S. Centers for Disease Control and Prevention, Hanoi, Viet Nam
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Pallas SW, Ahmeti A, Morgan W, Preza I, Nelaj E, Ebama M, Levin A, Lafond KE, Bino S. Program cost analysis of influenza vaccination of health care workers in Albania. Vaccine 2020; 38:220-227. [PMID: 31669063 PMCID: PMC10621071 DOI: 10.1016/j.vaccine.2019.10.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/16/2019] [Revised: 10/01/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Since 2012, WHO has recommended influenza vaccination for health care workers (HCWs), which has different costs than routine infant immunization; however, few cost estimates exist from low- and middle-income countries. Albania, a middle-income country, has self-procured influenza vaccine for some HCWs since 2014, supplemented by vaccine donations since 2016 through the Partnership for Influenza Vaccine Introduction (PIVI). We conducted a cost analysis of HCW influenza vaccination in Albania to inform scale-up and sustainability decisions. METHODS We used the WHO's Seasonal Influenza Immunization Costing Tool (SIICT) micro-costing approach to estimate incremental costs from the government perspective of facility-based vaccination of HCWs in Albania with trivalent inactivated influenza vaccine for the 2018-19 season based on 2016-17 season data from administrative records, key informant consultations, and a convenience sample of site visits. Scenario analyses varied coverage, vaccine presentation, and vaccine prices. RESULTS In the baseline scenario, 13,377 HCWs (70% of eligible HCWs) would be vaccinated at an incremental financial cost of US$61,296 and economic cost of US$161,639. Vaccine and vaccination supplies represented the largest share of financial (89%) and economic costs (44%). Per vaccinated HCW financial cost was US$4.58 and economic cost was US$12.08 including vaccine and vaccination supplies (US$0.49 and US$6.76 respectively without vaccine and vaccination supplies). Scenarios with higher coverage, pre-filled syringes, and higher vaccine prices increased total economic and financial costs, although the economic cost per HCW vaccinated decreased with higher coverage as some costs were spread over more HCWs. Across all scenarios, economic costs were <0.07% of Albania's estimated government health expenditure, and <5.07% of Albania's estimated immunization program economic costs. CONCLUSIONS Cost estimates can help inform decisions about scaling up influenza vaccination for HCWs and other risk groups.
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Affiliation(s)
| | | | | | - Iria Preza
- Institute of Public Health, Tirana, Albania
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Porter RM, Goldin S, Lafond KE, Hedman L, Ungkuldee M, Kurzum J, Azziz-Baumgartner E, Nannei C, Bresee JS, Moen A. Does having a seasonal influenza program facilitate pandemic preparedness? An analysis of vaccine deployment during the 2009 pandemic. Vaccine 2019; 38:1152-1159. [PMID: 31839465 PMCID: PMC6992512 DOI: 10.1016/j.vaccine.2019.11.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/05/2019] [Accepted: 11/08/2019] [Indexed: 12/31/2022]
Abstract
Background: National seasonal influenza programs have been recommended as a foundation for pandemic preparedness. During the 2009 pandemic, WHO aimed to increase Member States’ equitable access to influenza vaccines through pandemic vaccine donation. Methods: This analysis explores whether the presence of a seasonal influenza program contributed to more rapid national submission of requirements to receive vaccine during the 2009 influenza pandemic. Data from 2009 influenza vaccine donation, deployment, and surveillance initiatives were collected during May-September 2018 from WHO archival material. Data about the presence of seasonal influenza vaccine programs prior to 2009 were gathered from the WHO-UNICEF Joint Reporting Form. Cox proportional hazards models were used to assess the relationship between presence of a seasonal influenza program and time to submission of a national deployment and vaccination plan and to vaccine delivery. Finding: Of 97 countries eligible to receive WHO-donated vaccine, 83 (86%) submitted national deployment and vaccination plans and 77 (79%) received vaccine. Countries with a seasonal influenza vaccine program were more likely to submit a national deployment and vaccination plan (hazards ratio [HR] 2.1; 95% confidence interval [CI]. Countries with regulatory delays were less likely to receive vaccine than those without these delays (HR 0.4, 95% CI: 0.2–0.6). Interpretation: During the 2009 pandemic, eligible countries with a seasonal influenza vaccine program were more ready to receive and use donated vaccines than those without a program. Our findings suggest that robust seasonal influenza vaccine programs increase national familiarity with the management of influenza vaccines and therefore enhance pandemic preparedness.
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Affiliation(s)
- Rachael M Porter
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | - Kathryn E Lafond
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa Hedman
- World Health Organization, Geneva, Switzerland
| | | | - Jordan Kurzum
- Sidney Kimmel Medical College, Philadelphia, PA, USA
| | | | | | - Joseph S Bresee
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ann Moen
- World Health Organization, Geneva, Switzerland
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Lafond KE, Praptiningsih CY, Mangiri A, Syarif M, Triada R, Mulyadi E, Septiawati C, Setiawaty V, Samaan G, Storms AD, Uyeki TM, Iuliano AD. Seasonal Influenza and Avian Influenza A(H5N1) Virus Surveillance among Inpatients and Outpatients, East Jakarta, Indonesia, 2011-2014. Emerg Infect Dis 2019; 25:2031-2039. [PMID: 31625837 PMCID: PMC6810195 DOI: 10.3201/eid2511.181844] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
During October 2011-September 2014, we screened respiratory specimens for seasonal and avian influenza A(H5N1) virus infections among outpatients with influenza-like illness and inpatients with severe acute respiratory infection (SARI) in East Jakarta, an Indonesia district with high incidence of H5N1 virus infection among poultry. In total, 31% (1,875/6,008) of influenza-like illness case-patients and 15% (571/3,811) of SARI case-patients tested positive for influenza virus. Influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B virus infections were detected in all 3 years, and the epidemic season extended from November through May. Although 28% (2,810/10,135) of case-patients reported exposure to poultry, only 1 SARI case-patient with an H5N1 virus infection was detected. Therefore, targeted screening among case-patients with high-risk poultry exposures (e.g., a recent visit to a live bird market or close proximity to sick or dead poultry) may be a more efficient routine surveillance strategy for H5N1 virus in these types of settings.
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Bresee JS, Lafond KE, McCarron M, Azziz-Baumgartner E, Chu SY, Ebama M, Hinman AR, Xeuatvongsa A, Bino S, Richardson D, Porter RM, Moen A, McKinlay M. The partnership for influenza vaccine introduction (PIVI): Supporting influenza vaccine program development in low and middle-income countries through public-private partnerships. Vaccine 2019; 37:5089-5095. [PMID: 31288998 PMCID: PMC6685526 DOI: 10.1016/j.vaccine.2019.06.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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] [Received: 04/12/2019] [Revised: 05/22/2019] [Accepted: 06/17/2019] [Indexed: 01/15/2023]
Abstract
Influenza vaccination remains the most effective tool for reducing seasonal influenza disease burden. Few Low and Middle-Income Countries (LMICs) have robust, sustainable annual influenza national vaccination programs. The Partnership for Influenza Vaccine Introduction (PIVI) was developed as a public-private partnership to support LMICs to develop and sustain national vaccination programs through time-limited vaccine donations and technical support. We review the first 5 years of experience with PIVI, including the concept, country progress toward sustainability, and lesson learned. Between 2013 and 2018, PIVI worked with Ministries of Health in 17 countries. Eight countries have received donated vaccines and technical support; of these, two have transitioned to sustained national support of influenza vaccination and six are increasing national support of the vaccine programs towards full transition to local vaccine program support by 2023. Nine additional countries have received technical support for building the evidence base for national policy development and/or program evaluation. PIVI has resulted in increased use of vaccines in partner countries, and early countries have demonstrated progress towards sustainability, suggesting that a model of vaccine and technical support can work in LMICs. PIVI expects to add new country partners as current countries transition to self-reliance.
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Affiliation(s)
- Joseph S Bresee
- Influenza Division, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Center for Vaccine Equity, Task Force for Global Health, Atlanta, GA, USA.
| | - Kathryn E Lafond
- Influenza Division, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Margaret McCarron
- Influenza Division, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan Y Chu
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Malembe Ebama
- Center for Vaccine Equity, Task Force for Global Health, Atlanta, GA, USA
| | - Alan R Hinman
- Center for Vaccine Equity, Task Force for Global Health, Atlanta, GA, USA
| | - Anonh Xeuatvongsa
- Ministry of Health, Lao Peoples Democratic Republic, Vientiane, Laos
| | | | - Dominique Richardson
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachael M Porter
- Influenza Division, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ann Moen
- Influenza Division, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark McKinlay
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Krishnan A, Kumar R, Broor S, Gopal G, Saha S, Amarchand R, Choudekar A, Purkayastha DR, Whitaker B, Pandey B, Narayan VV, Kabra SK, Sreenivas V, Widdowson MA, Lindstrom S, Lafond KE, Jain S. Epidemiology of viral acute lower respiratory infections in a community-based cohort of rural north Indian children. J Glob Health 2019; 9:010433. [PMID: 31131104 PMCID: PMC6513504 DOI: 10.7189/jogh.09.010433] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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] [Indexed: 12/13/2022] Open
Abstract
Background In India, community-based acute lower respiratory infections (ALRI) burden studies are limited, hampering development of prevention and control strategies. Methods We surveyed children <10 years old at home weekly from August 2012-August 2014, for cough, sore throat, rhinorrhoea, ear discharge, and shortness of breath. Symptomatic children were assessed for ALRI using World Health Organization definitions. Nasal and throat swabs were obtained from all ALRI cases and asymptomatic controls and tested using polymerase chain reaction for respiratory syncytial virus (RSV), human metapneumovirus (hMPV), parainfluenza viruses (PIV), and influenza viruses (IV). We estimated adjusted odds ratios (aOR) using logistic regression to calculate etiologic fractions (EF). We multiplied agent-specific ALRI incidence rates by EF to calculate the adjusted incidence as episodes per child-year. Results ALRI incidence was 0.19 (95% confidence interval (CI) = 0.18-0.20) episode per child-year. Association between virus and ALRI was strongest for RSV (aOR = 15.9; 95% CI = 7.3-34.7; EF = 94%) and least for IV (aOR = 4.6; 95% CI = 2.0-10.6; EF = 78%). Adjusted agent-specific ALRI incidences were RSV (0.03, 95% CI = 0.02-0.03), hMPV (0.02, 95% CI = 0.01-0.02), PIV (0.02, 95% CI = 0.01-0.02), and IV (0.01, 95% CI = 0.01-0.01) episode per child-year. Conclusions ALRI among children in rural India was high; RSV was a significant contributor.
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Affiliation(s)
- Anand Krishnan
- All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- All India Institute of Medical Sciences, New Delhi, India
| | - Shobha Broor
- SGT Medical College, Hospital & Research Institute, Gurgaon, India
| | - Giridara Gopal
- All India Institute of Medical Sciences, New Delhi, India
| | - Siddhartha Saha
- Influenza Division, US Centers for Disease Control and Prevention- India country office, New Delhi, India
| | | | | | | | - Brett Whitaker
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bharti Pandey
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sushil K Kabra
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Marc-Alain Widdowson
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Stephen Lindstrom
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathryn E Lafond
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Seema Jain
- Influenza Division, US Centers for Disease Control and Prevention- India country office, New Delhi, India.,US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Ba-Nguz A, Shah A, Bresee JS, Lafond KE, Cavallaro K, Shefer A, Donadel M, Seward JF. Supporting national immunization technical advisory groups (NITAGs) in resource-constrained settings. New strategies and lessons learned from the Task Force for Global Health’s Partnership for influenza vaccine introduction. Vaccine 2019; 37:3646-3653. [DOI: 10.1016/j.vaccine.2019.05.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/07/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
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Xeuatvongsa A, Mott JA, Khanthamaly V, Patthammavong C, Phounphenghak K, McKinlay M, Mirza S, Lafond KE, McCarron M, Corwin A, Moen A, Olsen SJ, Bresee JS. Progress toward sustainable influenza vaccination in the Lao Peoples' Democratic Republic, 2012-2018. Vaccine 2019; 37:3002-3005. [PMID: 31027926 DOI: 10.1016/j.vaccine.2019.04.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/03/2019] [Accepted: 04/08/2019] [Indexed: 11/24/2022]
Abstract
Despite global recommendations for influenza vaccination of high-risk, target populations, few low and middle-income countries have national influenza vaccination programs. Between 2012 and 2017, Lao PDR planned and conducted a series of activities to develop its national influenza vaccine program as a part of its overall national immunization program. In this paper, we review the underlying strategic planning for this process, and outline the sequence of activities, research studies, partnerships, and policy decisions that were required to build Laos' influenza vaccine program. The successful development and sustainability of the program in Laos offers lessons for other low and middle-income countries interested in initiating or expanding influenza immunization.
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Affiliation(s)
| | - J A Mott
- Centers for Disease Control and Prevention, Bangkok, Thailand
| | - V Khanthamaly
- Centers for Disease Control and Prevention, Vientiane, Laos
| | | | | | - M McKinlay
- Task Force for Global Health, Atlanta, GA, USA
| | - S Mirza
- Centers for Disease Control and Prevention, Atlanta GA, USA
| | - K E Lafond
- Centers for Disease Control and Prevention, Atlanta GA, USA
| | - M McCarron
- Centers for Disease Control and Prevention, Atlanta GA, USA
| | - A Corwin
- Thammasat University, Faculty of Public Health, Bangkok, Thailand
| | - A Moen
- Centers for Disease Control and Prevention, Atlanta GA, USA
| | - S J Olsen
- Centers for Disease Control and Prevention, Atlanta GA, USA
| | - J S Bresee
- Centers for Disease Control and Prevention, Atlanta GA, USA.
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Diallo A, Victor JC, Feser J, Ortiz JR, Kanesa-Thasan N, Ndiaye M, Diarra B, Cheikh S, Diene D, Ndiaye T, Ndiaye A, Lafond KE, Widdowson MA, Neuzil KM. Immunogenicity and safety of MF59-adjuvanted and full-dose unadjuvanted trivalent inactivated influenza vaccines among vaccine-naïve children in a randomized clinical trial in rural Senegal. Vaccine 2018; 36:6424-6432. [PMID: 30224199 PMCID: PMC6327321 DOI: 10.1016/j.vaccine.2018.08.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 02/02/2018] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Effective, programmatically suitable influenza vaccines are needed for low-resource countries. MATERIALS AND METHODS This phase II, placebo-controlled, randomized safety and immunogenicity trial (NCT01819155) was conducted in Senegal using the 2012-2013 Northern Hemisphere trivalent influenza vaccine (TIV) formulation. Participants were allocated in a 2:2:1 ratio to receive TIV (full-dose for all age groups), adjuvanted TIV (aTIV), or placebo. Participants were stratified into age groups: 6-11, 12-35, and 36-71 months. All participants were vaccine-naïve and received two doses of study vaccine 4 weeks apart. The two independent primary objectives were to estimate the immunogenicity of TIV and of aTIV as the proportion of children with a hemagglutination inhibition (HI) antibody titer of ≥1:40 to each vaccine strain at 28 days post-dose two. Safety was evaluated by solicited local and systemic reactions, unsolicited adverse events, and serious adverse events. RESULTS 296 children received TIV, aTIV, or placebo, and 235 were included in the final analysis. After two doses, children aged 6-11, 12-35, and 36-71 months receiving TIV had HI titers ≥1:40 against A/H1N1 (73.1%, 94.1%, and 97.0%), A/H3N2 (96.2%, 100.0%, and 100.0%), and B (80.8%, 97.1%, and 97.0%), respectively. After two doses, 100% children aged 6-11, 12-35, and 36-71 months receiving aTIV had ≥1:40 titers against A/H1N1, A/H3N2, and B. After a single dose, the aTIV response was comparable to or greater than the TIV response for all vaccine strains. TIV and aTIV reactogenicity were similar, except for mild elevation in temperature (37.5-38.4 °C) which occurred more frequently in aTIV than TIV after each vaccine dose. TIV and aTIV had similarly increased pain/tenderness at the injection site compared to placebo. CONCLUSIONS Both aTIV and full-dose TIV were well-tolerated and immunogenic in children aged 6-71 months. These vaccines may play a role in programmatically suitable strategies to prevent influenza in low-resource settings.
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Affiliation(s)
- Aldiouma Diallo
- UMR Vitrome, Institut de Recherche Pour le Développement, Dakar, Senegal.
| | - John C Victor
- Center for Vaccine Innovation and Access, PATH, Seattle, USA.
| | - Jodi Feser
- Center for Vaccine Innovation and Access, PATH, Seattle, USA.
| | - Justin R Ortiz
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA.
| | | | - Moussa Ndiaye
- UMR Vitrome, Institut de Recherche Pour le Développement, Dakar, Senegal
| | - Bou Diarra
- Senegal Ministry of Health and Social Welfare, Dakar, Senegal
| | - Sathie Cheikh
- UMR Vitrome, Institut de Recherche Pour le Développement, Dakar, Senegal
| | - Djibril Diene
- UMR Vitrome, Institut de Recherche Pour le Développement, Dakar, Senegal
| | - Tofene Ndiaye
- UMR Vitrome, Institut de Recherche Pour le Développement, Dakar, Senegal.
| | - Assane Ndiaye
- UMR Vitrome, Institut de Recherche Pour le Développement, Dakar, Senegal
| | - Kathryn E Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA.
| | - Marc-Alain Widdowson
- Division of Global Health Protection, CDC Kenya, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya; Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA.
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA.
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Kumar R, Amarchand R, Narayan VV, Saha S, Lafond KE, Kapoor SK, Dar L, Jain S, Krishnan A. Challenges in conducting a community-based influenza vaccine trial in a rural community in northern India. Hum Vaccin Immunother 2018; 14:1909-1913. [PMID: 29617177 PMCID: PMC6150048 DOI: 10.1080/21645515.2018.1460182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/04/2022] Open
Abstract
Evidence on influenza vaccine effectiveness from low and middle countries (LMICs) is limited due to limited institutional capacities; lack of adequate resources; and lack of interest by ministries of health for influenza vaccine introduction. There are concerns that the highest ethical standards will be compromised during trials in LMICs leading to mistrust of clinical trials. These factors pose regulatory and operational challenges to researchers in these countries. We conducted a community-based vaccine trial to assess the efficacy of live attenuated influenza vaccine and inactivated influenza vaccine in rural north India. Key regulatory challenges included obtaining regulatory approvals, reporting of adverse events, and compensating subjects for trial-related injuries; all of which were required to be completed in a timely fashion. Key operational challenges included obtaining audio-visual consent; maintaining a low attrition rate; and administering vaccines during a narrow time period before the influenza season, and under extreme heat. We overcame these challenges through advanced planning, and sustaining community engagement. We adapted the trial procedures to cope with field conditions by conducting mock vaccine camps; and planned for early morning vaccination to mitigate threats to the cold chain. These lessons may help investigators to confront similar challenges in other LMICs.
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Affiliation(s)
- Rakesh Kumar
- a All India Institute of Medical Sciences, Ansari Nagar , New Delhi , India
| | - Ritvik Amarchand
- a All India Institute of Medical Sciences, Ansari Nagar , New Delhi , India
| | | | - Siddhartha Saha
- b Centers for Disease Control and Prevention , 1600 Clifton Road, Atlanta , GA , USA
| | - Kathryn E Lafond
- b Centers for Disease Control and Prevention , 1600 Clifton Road, Atlanta , GA , USA
| | | | - Lalit Dar
- a All India Institute of Medical Sciences, Ansari Nagar , New Delhi , India
| | - Seema Jain
- b Centers for Disease Control and Prevention , 1600 Clifton Road, Atlanta , GA , USA
| | - Anand Krishnan
- a All India Institute of Medical Sciences, Ansari Nagar , New Delhi , India
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Saha S, Gupta V, Dawood FS, Broor S, Lafond KE, Chadha MS, Rai SK, Krishnan A. Estimation of community-level influenza-associated illness in a low resource rural setting in India. PLoS One 2018; 13:e0196495. [PMID: 29698505 PMCID: PMC5919664 DOI: 10.1371/journal.pone.0196495] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 04/13/2018] [Indexed: 11/19/2022] Open
Abstract
Objective To estimate rates of community-level influenza-like-illness (ILI) and influenza-associated ILI in rural north India. Methods During 2011, we conducted household-based healthcare utilization surveys (HUS) for any acute medical illness (AMI) in preceding 14days among residents of 28villages of Ballabgarh, in north India. Concurrently, we conducted clinic-based surveillance (CBS) in the area for AMI episodes with illness onset ≤3days and collected nasal and throat swabs for influenza virus testing using real-time polymerase chain reaction. Retrospectively, we applied ILI case definition (measured/reported fever and cough) to HUS and CBS data. We attributed 14days of risk-time per person surveyed in HUS and estimated community ILI rate by dividing the number of ILI cases in HUS by total risk-time. We used CBS data on influenza positivity and applied it to HUS-based community ILI rates by age, month, and clinic type, to estimate the community influenza-associated ILI rates. Findings The HUS of 69,369 residents during the year generated risk-time of 3945 person-years (p-y) and identified 150 (5%, 95%CI: 4–6) ILI episodes (38 ILI episodes/1,000 p-y; 95% CI 32–44). Among 1,372 ILI cases enrolled from clinics, 126 (9%; 95% CI 8–11) had laboratory-confirmed influenza (A (H3N2) = 72; B = 54). After adjusting for age, month, and clinic type, overall influenza-associated ILI rate was 4.8/1,000 p-y; rates were highest among children <5 years (13; 95% CI: 4–29) and persons≥60 years (11; 95%CI: 2–30). Conclusion We present a novel way to use HUS and CBS data to generate estimates of community burden of influenza. Although the confidence intervals overlapped considerably, higher point estimates for burden among young children and older adults shows the utility for exploring the value of influenza vaccination among target groups.
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Affiliation(s)
- Siddhartha Saha
- Influenza Program, US Center for Disease Control and Prevention-India office, New Delhi, India
- * E-mail:
| | - Vivek Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Fatimah S. Dawood
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shobha Broor
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kathryn E. Lafond
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Sanjay K. Rai
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Susilarini NK, Haryanto E, Praptiningsih CY, Mangiri A, Kipuw N, Tarya I, Rusli R, Sumardi G, Widuri E, Sembiring MM, Noviyanti W, Widaningrum C, Lafond KE, Samaan G, Setiawaty V. Estimated incidence of influenza-associated severe acute respiratory infections in Indonesia, 2013-2016. Influenza Other Respir Viruses 2017; 12:81-87. [PMID: 29205865 PMCID: PMC5818340 DOI: 10.1111/irv.12496] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2017] [Indexed: 11/27/2022] Open
Abstract
Background Indonesia's hospital‐based Severe Acute Respiratory Infection (SARI) surveillance system, Surveilans Infeksi Saluran Pernafasan Akut Berat Indonesia (SIBI), was established in 2013. While respiratory illnesses such as SARI pose a significant problem, there are limited incidence‐based data on influenza disease burden in Indonesia. This study aimed to estimate the incidence of influenza‐associated SARI in Indonesia during 2013‐2016 at three existing SIBI surveillance sites. Methods From May 2013 to April 2016, inpatients from sentinel hospitals in three districts of Indonesia (Gunung Kidul, Balikpapan, Deli Serdang) were screened for SARI. Respiratory specimens were collected from eligible inpatients and screened for influenza viruses. Annual incidence rates were calculated using these SIBI‐enrolled influenza‐positive SARI cases as a numerator, with a denominator catchment population defined through hospital admission survey (HAS) to identify respiratory‐coded admissions by age to hospitals in the sentinel site districts. Results From May 2013 to April 2016, there were 1527 SARI cases enrolled, of whom 1392 (91%) had specimens tested and 199 (14%) were influenza‐positive. The overall estimated annual incidence of influenza‐associated SARI ranged from 13 to 19 per 100 000 population. Incidence was highest in children aged 0‐4 years (82‐114 per 100 000 population), followed by children 5‐14 years (22‐36 per 100 000 population). Conclusions Incidence rates of influenza‐associated SARI in these districts indicate a substantial burden of influenza hospitalizations in young children in Indonesia. Further studies are needed to examine the influenza burden in other potential risk groups such as pregnant women and the elderly.
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Affiliation(s)
- Ni K Susilarini
- Center for Research and Development for Biomedical and Basic Technology of Health, NIHRD, Ministry of Health, Central Jakarta, Indonesia
| | - Edy Haryanto
- Acute Respiratory Infection Sub Directorate, Directorate General of Disease Control and Prevention, Ministry of Health, Central Jakarta, Indonesia
| | | | - Amalya Mangiri
- US Centers for Disease Control and Prevention, Jakarta, Indonesia
| | - Natalie Kipuw
- Center for Research and Development for Biomedical and Basic Technology of Health, NIHRD, Ministry of Health, Central Jakarta, Indonesia
| | - Irmawati Tarya
- Acute Respiratory Infection Sub Directorate, Directorate General of Disease Control and Prevention, Ministry of Health, Central Jakarta, Indonesia
| | - Roselinda Rusli
- Center for Research and Development for Biomedical and Basic Technology of Health, NIHRD, Ministry of Health, Central Jakarta, Indonesia
| | - Gestafiana Sumardi
- Acute Respiratory Infection Sub Directorate, Directorate General of Disease Control and Prevention, Ministry of Health, Central Jakarta, Indonesia
| | - Endang Widuri
- World Health Organization, Central Jakarta, Indonesia
| | - Masri M Sembiring
- Center for Research and Development for Biomedical and Basic Technology of Health, NIHRD, Ministry of Health, Central Jakarta, Indonesia
| | - Widya Noviyanti
- Acute Respiratory Infection Sub Directorate, Directorate General of Disease Control and Prevention, Ministry of Health, Central Jakarta, Indonesia
| | - Christina Widaningrum
- Acute Respiratory Infection Sub Directorate, Directorate General of Disease Control and Prevention, Ministry of Health, Central Jakarta, Indonesia
| | - Kathryn E Lafond
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gina Samaan
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Vivi Setiawaty
- Center for Research and Development for Biomedical and Basic Technology of Health, NIHRD, Ministry of Health, Central Jakarta, Indonesia
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Mangiri A, Iuliano AD, Wahyuningrum Y, Praptiningsih CY, Lafond KE, Storms AD, Samaan G, Ariawan I, Soeharno N, Kreslake JM, Storey JD, Uyeki TM. Physician's knowledge, attitudes, and practices regarding seasonal influenza, pandemic influenza, and highly pathogenic avian influenza A (H5N1) virus infections of humans in Indonesia. Influenza Other Respir Viruses 2016; 11:93-99. [PMID: 27554302 PMCID: PMC5155649 DOI: 10.1111/irv.12428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2016] [Indexed: 01/13/2023] Open
Abstract
Indonesia has reported highest number of fatal human cases of highly pathogenic avian influenza (HPAI) A (H5N1) virus infection worldwide since 2005. There are limited data available on seasonal and pandemic influenza in Indonesia. During 2012, we conducted a survey of clinicians in two districts in western Java, Indonesia, to assess knowledge, attitudes, and practices (KAP) of clinical diagnosis, testing, and treatment of patients with seasonal influenza, pandemic influenza, or HPAI H5N1 virus infections. Overall, a very low percentage of physician participants reported ever diagnosing hospitalized patients with seasonal, pandemic, or HPAI H5N1 influenza. Use of influenza testing was low in outpatients and hospitalized patients, and use of antiviral treatment was very low for clinically diagnosed influenza patients. Further research is needed to explore health system barriers for influenza diagnostic testing and availability of antivirals for treatment of influenza in Indonesia.
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Affiliation(s)
- Amalya Mangiri
- US Centers for Disease Control and Prevention, Jakarta, Indonesia
| | - A Danielle Iuliano
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yunita Wahyuningrum
- Johns Hopkins Center for Communication Programs, Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kathryn E Lafond
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aaron D Storms
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gina Samaan
- US Centers for Disease Control and Prevention, Jakarta, Indonesia
| | - Iwan Ariawan
- Center for Health Research, Universitas Indonesia, Jakarta, Indonesia
| | - Nugroho Soeharno
- Center for Health Research, Universitas Indonesia, Jakarta, Indonesia
| | - Jennifer M Kreslake
- Johns Hopkins Center for Communication Programs, Bloomberg School of Public Health, Baltimore, MD, USA
| | - J Douglas Storey
- Johns Hopkins Center for Communication Programs, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Timothy M Uyeki
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Victor JC, Lewis KDC, Diallo A, Niang MN, Diarra B, Dia N, Ortiz JR, Widdowson MA, Feser J, Hoagland R, Emery SL, Lafond KE, Neuzil KM. Efficacy of a Russian-backbone live attenuated influenza vaccine among children in Senegal: a randomised, double-blind, placebo-controlled trial. Lancet Glob Health 2016; 4:e955-e965. [PMID: 27746224 PMCID: PMC5118222 DOI: 10.1016/s2214-109x(16)30201-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 07/19/2016] [Accepted: 08/01/2016] [Indexed: 12/20/2022]
Abstract
Background Live attenuated influenza vaccines have been shown to significantly reduce influenza in diverse populations of children, but no efficacy studies have been done in resource-poor tropical settings. In Senegal, we assessed the efficacy and safety of a live attenuated influenza vaccine based on Russian-derived master donor viruses and licensed as a single dose. Methods In this double-blind, placebo-controlled, parallel group, single-centre trial done near Niakhar, Senegal, generally healthy children aged 2–5 years were randomly allocated (2:1) to receive a single intranasal dose of masked trivalent live attenuated influenza vaccine or placebo. The allocation sequence was computer-generated by PATH with block sizes of three. The manufacturer provided vaccine and placebo in coded vials to preserve blinding. Participants were monitored through the predictable influenza season in Senegal for adverse events and signs and symptoms of influenza using weekly home visits and surveillance in clinics. The primary outcome was symptomatic laboratory-confirmed influenza caused by any strain and occurring from 15 days post-vaccination to the end of the study. The primary analysis was per protocol. This study is registered with ClinicalTrials.gov, number NCT01854632. Findings Between May 23, and July 1, 2013, 1761 children were randomly assigned, 1174 to receive live attenuated influenza vaccine and 587 to receive placebo. The per-protocol set included 1173 vaccinees and 584 placebo recipients followed up to Dec 20, 2013. Symptomatic influenza was laboratory-confirmed in 210 (18%) of 1173 recipients of live attenuated influenza vaccine and 105 (18%) of placebo recipients, giving a vaccine efficacy of 0·0% (95% CI −26·4 to 20·9). Adverse events were balanced between the study groups. Two girls who had received live attenuated influenza vaccine died, one due to anasarca 12 days postvaccination and one due to malnutrition 70 days postvaccination. Interpretation Live attenuated influenza vaccine was well tolerated in young children in Senegal, but did not provide protection against influenza. Further study in such populations, which might experience extended periods of influenza circulation, is warranted. Funding US Centers for Disease Control and Prevention and Bill & Melinda Gates Foundation.
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Affiliation(s)
| | | | - Aldiouma Diallo
- Mixed Research Unit 198, Institut de Recherche Pour le Développement, Dakar, Senegal
| | - Mbayame N Niang
- Senegal National Influenza Center, Institut Pasteur de Dakar, Dakar, Senegal
| | - Bou Diarra
- Mixed Research Unit 198, Institut de Recherche Pour le Développement, Dakar, Senegal
| | - Ndongo Dia
- Senegal National Influenza Center, Institut Pasteur de Dakar, Dakar, Senegal
| | - Justin R Ortiz
- PATH, Seattle, WA, USA; Departments of Global Health and Medicine, University of Washington, Seattle, WA, USA
| | - Marc-Alain Widdowson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Shannon L Emery
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kathryn E Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
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Lafond KE, Nair H, Rasooly MH, Valente F, Booy R, Rahman M, Kitsutani P, Yu H, Guzman G, Coulibaly D, Armero J, Jima D, Howie SRC, Ampofo W, Mena R, Chadha M, Sampurno OD, Emukule GO, Nurmatov Z, Corwin A, Heraud JM, Noyola DE, Cojocaru R, Nymadawa P, Barakat A, Adedeji A, von Horoch M, Olveda R, Nyatanyi T, Venter M, Mmbaga V, Chittaganpitch M, Nguyen TH, Theo A, Whaley M, Azziz-Baumgartner E, Bresee J, Campbell H, Widdowson MA. Global Role and Burden of Influenza in Pediatric Respiratory Hospitalizations, 1982-2012: A Systematic Analysis. PLoS Med 2016; 13:e1001977. [PMID: 27011229 PMCID: PMC4807087 DOI: 10.1371/journal.pmed.1001977] [Citation(s) in RCA: 249] [Impact Index Per Article: 31.1] [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: 03/03/2015] [Accepted: 02/05/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The global burden of pediatric severe respiratory illness is substantial, and influenza viruses contribute to this burden. Systematic surveillance and testing for influenza among hospitalized children has expanded globally over the past decade. However, only a fraction of the data has been used to estimate influenza burden. In this analysis, we use surveillance data to provide an estimate of influenza-associated hospitalizations among children worldwide. METHODS AND FINDINGS We aggregated data from a systematic review (n = 108) and surveillance platforms (n = 37) to calculate a pooled estimate of the proportion of samples collected from children hospitalized with respiratory illnesses and positive for influenza by age group (<6 mo, <1 y, <2 y, <5 y, 5-17 y, and <18 y). We applied this proportion to global estimates of acute lower respiratory infection hospitalizations among children aged <1 y and <5 y, to obtain the number and per capita rate of influenza-associated hospitalizations by geographic region and socio-economic status. Influenza was associated with 10% (95% CI 8%-11%) of respiratory hospitalizations in children <18 y worldwide, ranging from 5% (95% CI 3%-7%) among children <6 mo to 16% (95% CI 14%-20%) among children 5-17 y. On average, we estimated that influenza results in approximately 374,000 (95% CI 264,000 to 539,000) hospitalizations in children <1 y-of which 228,000 (95% CI 150,000 to 344,000) occur in children <6 mo-and 870,000 (95% CI 610,000 to 1,237,000) hospitalizations in children <5 y annually. Influenza-associated hospitalization rates were more than three times higher in developing countries than in industrialized countries (150/100,000 children/year versus 48/100,000). However, differences in hospitalization practices between settings are an important limitation in interpreting these findings. CONCLUSIONS Influenza is an important contributor to respiratory hospitalizations among young children worldwide. Increasing influenza vaccination coverage among young children and pregnant women could reduce this burden and protect infants <6 mo.
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Affiliation(s)
- Kathryn E. Lafond
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- School of Health Sciences, University of Tampere, Tampere, Finland
- * E-mail: (KEL); (MAW)
| | - Harish Nair
- Centre for Global Health Research, University of Edinburgh, Edinburgh, United Kingdom
- Public Health Foundation of India, New Delhi, India
| | - Mohammad Hafiz Rasooly
- Afghanistan National Public Health Institute, Ministry of Public Health, Kabul, Afghanistan
| | - Fátima Valente
- National Directorate of Public Health, Ministry of Health, Luanda, Angola
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Paul Kitsutani
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hongjie Yu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | | | | | - Julio Armero
- Ministerio de Salud de El Salvador, San Salvador, El Salvador
| | - Daddi Jima
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Stephen R. C. Howie
- Medical Research Council Unit, Fajara, The Gambia
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - William Ampofo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Ricardo Mena
- Ministerio de Salud Publica y Asistencia Social, Guatemala City, Guatemala
| | | | - Ondri Dwi Sampurno
- National Institute of Health Research and Development, Jakarta, Indonesia
| | | | | | - Andrew Corwin
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jean Michel Heraud
- National Influenza Centre, Virology Unit, Institut Pasteur of Madagascar, Antananarivo, Madagascar
| | - Daniel E. Noyola
- Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | - Radu Cojocaru
- National Centre for Public Health, Chisinau, Republic of Moldova
| | | | - Amal Barakat
- Institut National d’Hygiène, Ministère de la Santé, Rabat, Morocco
| | | | - Marta von Horoch
- Ministerio de Salud Publica y Bienestar Social, Asunción, Paraguay
| | - Remigio Olveda
- Research Institute for Tropical Medicine, Manila, Philippines
| | | | - Marietjie Venter
- National Institute for Communicable Diseases, Johannesburg, South Africa
- Zoonoses Research Unit, Department Medical Virology, University of Pretoria, Pretoria, South Africa
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | | | | | - Andros Theo
- Virology Laboratory, University Teaching Hospital, Lusaka, Zambia
| | - Melissa Whaley
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eduardo Azziz-Baumgartner
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Joseph Bresee
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Harry Campbell
- Centre for Global Health Research, University of Edinburgh, Edinburgh, United Kingdom
| | - Marc-Alain Widdowson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail: (KEL); (MAW)
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Krishnan A, Amarchand R, Gupta V, Lafond KE, Suliankatchi RA, Saha S, Rai S, Misra P, Purakayastha DR, Wahi A, Sreenivas V, Kapil A, Dawood F, Pandav CS, Broor S, Kapoor SK, Lal R, Widdowson MA. Epidemiology of acute respiratory infections in children - preliminary results of a cohort in a rural north Indian community. BMC Infect Dis 2015; 15:462. [PMID: 26502931 PMCID: PMC4624162 DOI: 10.1186/s12879-015-1188-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 10/07/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite acute respiratory infections being a major cause of death among children in developing countries including India, there is a lack of community-based studies that document its burden and aetiology. METHODS A dynamic cohort of children aged 0-10 years was established in four villages in a north Indian state of Haryana from August 2012 onwards. Trained health workers conducted weekly home visits to screen children for acute respiratory infection (ARI) defined as one of the following: cough, sore throat, nasal congestion, earache/discharge, or breathing difficulty. Nurses clinically assessed these children to grade disease severity based on standard age-specific guidelines into acute upper or lower respiratory infection (AURI or ALRI) and collected nasal/throat swabs for pathogen testing. RESULTS Our first year results show that ARI incidence in 0-10 years of age was 5.9 (5.8-6.0) per child-year with minimal gender difference, the ALRI incidence in the under-five age group was higher among boys (0.43; 0.39-0.49) as compared to girls (0.31; 0.26-0.35) per child year. Boys had 2.4 times higher ARI-related hospitalization rate as compared to girls. CONCLUSION ARI impose a significant burden on the children of this cohort. This study platform aims to provide better evidence for prevention and control of pneumonia in developing countries.
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Affiliation(s)
- Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | | | - Vivek Gupta
- The INCLEN Trust International, New Delhi, 110020, India.
| | - Kathryn E Lafond
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA.
| | | | - Siddhartha Saha
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA.
| | - Sanjay Rai
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Puneet Misra
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Debjani Ram Purakayastha
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Abhishek Wahi
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Vishnubhatla Sreenivas
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Fatimah Dawood
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA.
| | - Chandrakant S Pandav
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Shobha Broor
- The INCLEN Trust International, New Delhi, 110020, India.
| | | | - Renu Lal
- Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA.
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Lafond KE, Tam JS, Bresee JS, Widdowson MA. International meeting on influenza vaccine effectiveness, 3-4 December 2012, Geneva, Switzerland. Vaccine 2015; 32:6591-5. [PMID: 25446822 DOI: 10.1016/j.vaccine.2014.09.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 09/30/2014] [Indexed: 11/25/2022]
Abstract
On December 3–4 2012, the World Health Organization convened a meeting of influenza vaccine effectiveness (VE) experts from over 25 countries in Geneva, Switzerland, to review recent developments in the global influenza vaccine landscape and evaluate approaches to determining the effectiveness of influenza vaccine products among target populations. Vaccine manufacturers from Thailand, Vietnam, India, and Brazil shared recent advances illustrating the expansion of influenza vaccine production worldwide. Randomized controlled trials are underway in several low and middle-income countries including India, Thailand, Bangladesh, and South Africa, to fill knowledge gaps in target populations such as children and pregnant women. National and international networks in the United States, Canada, Europe, Latin America and Australia are conducting multi-site observational studies with shared methodologies to generate national influenza VE estimates and pool data for regional estimates. Standardized VE estimation methods are key to generating point estimates that are comparable internationally and across different settings.
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Affiliation(s)
- Kathryn E Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Lafond KE, Dalhatu I, Shinde V, Ekanem EE, Ahmed S, Peebles P, Kudumu M, Bynum M, Salami K, Okeibunor J, Schwingl P, Mounts A, Nasidi A, Gross D. Notifiable disease reporting among public sector physicians in Nigeria: a cross-sectional survey to evaluate possible barriers and identify best sources of information. BMC Health Serv Res 2014; 14:568. [PMID: 25391377 PMCID: PMC4233090 DOI: 10.1186/s12913-014-0568-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 10/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since 2001, Nigeria has collected information on epidemic-prone and other diseases of public health importance through the Integrated Disease Surveillance and Response system (IDSR). Currently 23 diseases are designated as "notifiable" through IDSR, including human infection with avian influenza (AI). Following an outbreak of highly pathogenic avian influenza A(H5N1) in Nigerian poultry populations in 2006 and one laboratory confirmed human infection in 2007, a study was carried out to describe knowledge, perceptions, and practices related to infectious disease reporting through the IDSR system, physicians' preferred sources of heath information, and knowledge of AI infection in humans among public sector physicians in Nigeria. METHODS During November to December 2008, 245 physicians in six Nigerian cities were surveyed through in-person interviews. Survey components included reporting practices for avian influenza and other notifiable diseases, perceived obstacles to disease reporting, methods for obtaining health-related information, and knowledge of avian influenza among participating physicians. RESULTS All 245 respondents reported that they had heard of AI and that humans could become infected with AI. Two-thirds (163/245) had reported a notifiable disease. The most common perceived obstacles to reporting were lack of infrastructure/logistics or reporting system (76/245, 31%), lack of knowledge among doctors about how to report or to whom to report (64/245, 26%), and that doctors should report certain infectious diseases (60/245, 24%). Almost all participating physicians (>99%) reported having a cell phone that they currently use, and 86% reported using the internet at least weekly. CONCLUSIONS Although the majority of physicians surveyed were knowledgeable of and had reported notifiable diseases, they identified many perceived obstacles to reporting. In order to effectively identify human AI cases and other infectious diseases through IDSR, reporting system requirements need to be clearly communicated to participating physicians, and perceived obstacles, such as lack of infrastructure, need to be addressed. Future improvements to the reporting system should account for increased utilization of the internet, as well as cell phone and email-based communication.
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Hirve S, Krishnan A, Dawood FS, Lele P, Saha S, Rai S, Gupta V, Lafond KE, Juvekar S, Potdar V, Broor S, Lal RB, Chadha M. Incidence of influenza-associated hospitalization in rural communities in western and northern India, 2010-2012: a multi-site population-based study. J Infect 2014; 70:160-70. [PMID: 25218056 DOI: 10.1016/j.jinf.2014.08.015] [Citation(s) in RCA: 25] [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: 05/30/2014] [Revised: 08/02/2014] [Accepted: 08/05/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The global burden of influenza is increasingly recognized, but data from India remain sparse. We conducted a multi-site population-based surveillance study to estimate and compare rates of influenza-associated hospitalization at two rural Indian health and demographic surveillance system (HDSS) sites at Ballabgarh and Vadu during 2010-2012. METHODS Prospective facility-based surveillance for all hospitalizations (excluding those for trauma, elective surgery and obstetric, ophthalmic or psychiatric reasons) was conducted at 72 health facilities. After collection of clinical details, patients had nasopharyngeal swabs taken and tested by reverse transcription polymerase chain reaction for influenza viruses. Annual healthcare utilization surveys (HUS) were conducted in HDSS households to identify proportion of hospitalizations occurring at non-study facilities to adjust for hospitalizations missed through facility-based surveillance. RESULTS HUS showed that 69% and 67% of hospitalizations occurred at study facilities at Ballabgarh and Vadu, respectively. Overall, 6004 patients hospitalized with acute medical illness at participating facilities were enrolled (1717 from Ballabgarh; 4287 from Vadu). The proportion of patients with influenza was higher at Vadu than Ballabgarh annually (2010: 21% vs. 5%, p < 0.05; 2011: 18% vs. 5%, p < 0.05; 2012: 23% vs. 5%, p < 0.05). Annual adjusted influenza-associated hospitalization rates were 5-11 fold higher in Vadu (20.3-51.6 per 10,000) vs Ballabgarh (4.4-6.3 per 10,000). At both sites, influenza A/H1N1pdm09 and B predominated during 2010, A/H3N2 and B during 2011, and A/H1N1pdm09 and B during 2012. CONCLUSION The markedly different influenza hospitalization rates by season and across communities in India highlight the need for sustained multi-site surveillance system for estimating national influenza disease burden. That would be the first step for initiating discussions around Influenza prevention and control strategies in the country.
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Affiliation(s)
- Siddhivinayak Hirve
- Vadu Rural Health Program, King Edward Memorial Hospital Research Center, Pune, India
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Fatimah S Dawood
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, USA
| | - Pallavi Lele
- Vadu Rural Health Program, King Edward Memorial Hospital Research Center, Pune, India
| | - Siddhartha Saha
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, USA
| | - Sanjay Rai
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Gupta
- National Institute of Mental Health and Allied Sciences, Bangalore, India
| | - Kathryn E Lafond
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, USA
| | - Sanjay Juvekar
- Vadu Rural Health Program, King Edward Memorial Hospital Research Center, Pune, India
| | - Varsha Potdar
- National Institute of Virology, Indian Council of Medical Research, 20-A, Dr Ambedkar Road, Pune 411001, India
| | | | - Renu B Lal
- Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, USA
| | - Mandeep Chadha
- National Institute of Virology, Indian Council of Medical Research, 20-A, Dr Ambedkar Road, Pune 411001, India.
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Abstract
Prevention of influenza infection through vaccination is the best strategy to reduce its disease burden; however, annual revaccination is required to provide protection from circulating virus strains. Currently available influenza vaccines are trivalent inactivated influenza vaccines (IIV) or live-attenuated influenza vaccines (LAIV); however, quadrivalent formulations of IIV and LAIV are expected to be available for the 2013-2014 influenza season. Among children 6 months through 8 years of age receiving their first influenza vaccination, 2 doses of vaccines are required to provide adequate protection. Because of the wide range of circulating influenza viruses and host immune responses, estimates of vaccine effectiveness vary widely by year, age group, and vaccine studied. We summarize the evidence base for pediatric influenza vaccination, and we describe the challenges and limitations of protecting this population with currently available vaccines.
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Affiliation(s)
- Kathryn E Lafond
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Janet A Englund
- Pediatric Infectious Diseases, Seattle Children's Hospital, University of Washington, Seattle
| | - John S Tam
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Joseph S Bresee
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Hirve S, Chadha M, Lele P, Lafond KE, Deoshatwar A, Sambhudas S, Juvekar S, Mounts A, Dawood F, Lal R, Mishra A. Performance of case definitions used for influenza surveillance among hospitalized patients in a rural area of India. Bull World Health Organ 2012; 90:804-12. [PMID: 23226892 DOI: 10.2471/blt.12.108837] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 08/15/2012] [Accepted: 08/16/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess case definitions for influenza in a rural community in India. METHODS Residents of the study area who were hospitalized for any acute medical condition for at least one night between May 2009 and April 2011 were enrolled. Respiratory specimens were collected and tested for influenza viruses in a reverse-transcription polymerase chain reaction (PCR). The PCR results were taken as the "gold standard" in evaluating the performance of several case definitions. FINDINGS Of the 3179 patients included in the final analysis, 21% (665) were PCR-positive for influenza virus, 96% reported fever and 4% reported shortness of breath. The World Health Organization (WHO) case definition for severe acute respiratory illness had a sensitivity of 11% among patients aged < 5 years and of 3% among older patients. When shortness of breath was excluded from the definition, sensitivities increased (to 69% and 70%, respectively) and corresponding specificities of 43% and 53% were recorded. Among patients aged ≥ 5 years, WHO's definition of a case of influenza-like illness had a sensitivity of 70% and a specificity of 53%. The addition of "cough and reported or measured fever" increased sensitivity to 80% but decreased specificity to 42%. CONCLUSION The inclusion of shortness of breath in WHO's case definition for severe acute respiratory illness may grossly underestimate the burden posed by influenza in hospitals. The exclusion of shortness of breath from this definition or, alternatively, the inclusion of "cough and measured or reported fever" may improve estimates of the burden.
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Doshi SS, Stauffer KE, Fiebelkorn AP, Lafond KE, Davidson HA, Apostolou A, Taylor TH, Smith W, Karcz AN, Watson JR, Openo KP, Brooks JG, Zheteyeva Y, Schrag SJ, Fry AM. The burden and severity of illness due to 2009 pandemic influenza A (H1N1) in a large US city during the late summer and early fall of 2009. Am J Epidemiol 2012; 176:519-26. [PMID: 22952308 DOI: 10.1093/aje/kws137] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [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: 11/14/2022] Open
Abstract
In estimates of illness severity from the spring wave of the 2009 influenza A (H1N1) pandemic, reported case fatality proportions were less than 0.05%. In prior pandemics, subsequent waves of illness were associated with higher mortality. The authors evaluated the burden of the pandemic H1N1 (pH1N1) outbreak in metropolitan Atlanta, Georgia, in the fall of 2009, when increased influenza activity heralded the second wave of the pandemic in the United States. Using data from a community survey, existing surveillance systems, public health laboratories, and local hospitals, they estimated numbers of pH1N1-associated illnesses, emergency department (ED) visits, hospitalizations, intensive care unit (ICU) admissions, and deaths occurring in metropolitan Atlanta during the period August 16, 2009-September 26, 2009. The authors estimated 132,140 pediatric and 132,110 adult symptomatic cases of pH1N1 in metropolitan Atlanta during the investigation time frame. Among children, these cases were associated with 4,560 ED visits, 190 hospitalizations, 51 ICU admissions, and 4 deaths. Among adults, they were associated with 1,130 ED visits, 590 hospitalizations, 140 ICU admissions, and 63 deaths. The combined symptomatic case hospitalization proportion, case ICU admission proportion, and case fatality proportion were 0.281%, 0.069%, and 0.024%, respectively. Influenza burden can be estimated using existing data and local surveys. The increased severity reported for subsequent waves in past pandemics was not evident in this investigation. Nevertheless, the second pH1N1 pandemic wave led to substantial numbers of ED visits, hospitalizations, and deaths in metropolitan Atlanta.
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Affiliation(s)
- Saumil S Doshi
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Abstract
Please cite this paper as: Ortiz et al. (2012) Pandemic influenza in Africa, lessons learned from 1968: a systematic review of the literature. Influenza and Other Respiratory Viruses 6(1), 11–24. Background To help understand the potential impact of the 2009 H1N1 pandemic in Africa, we reviewed published data from Africa of the two previous influenza pandemics. Methods We conducted a systematic search of three biomedical databases for articles in any language on 1957 H2N2 or 1968 H3N2 pandemic influenza virus infection in Africa published from January 1950 through August 2008. Results We identified 1327 potentially relevant articles, and 298 warranted further review. Fourteen studies on 1968 H3N2 influenza met inclusion criteria, while two studies identified describing 1957 H2N2 were excluded for data limitations. Among these 14 studies, community attack rates for symptomatic infection during all 1968 pandemic waves were around 20%. However, the proportion infected in communities ranged from 6% in isolated communities to 100% in enclosed populations. A total of 22–64% of sampled clinic patients and 8–72% of hospitalized patients had evidence of 1968 H3N2 virus infection. After the second pandemic wave, up to 41–75% of persons tested had serological evidence of 1968 H3N2 virus infection. Conclusion The 1968 H3N2 influenza pandemic, generally regarded as mild worldwide, appears to have had a substantial impact upon public health in Africa. Without more epidemiologic data the impact of the 2009 H1N1 pandemic in Africa cannot be assumed to have been mild. Assessment of the burden of 2009 H1N1 virus and future influenza pandemics in Africa should attempt to assess disease impact by a variety of methods, including substudies among specific populations.
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Affiliation(s)
- Justin R Ortiz
- Department of Medicine, University of Washington, Seattle, USA.
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Affiliation(s)
- Werner C Albrich
- Respiratory and Meningeal Pathogens Research Unit, Chris Hani-Baragwanath Hospital, Old Nurses Home, 1st Floor West Wing, Bertsham, Gauteng, 2013, South Africa; Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.
| | - Shabir A Madhi
- Respiratory and Meningeal Pathogens Research Unit, Chris Hani-Baragwanath Hospital, Old Nurses Home, 1st Floor West Wing, Bertsham, Gauteng, 2013, South Africa
| | - Kathryn E Lafond
- Hubert Department of Global Health, Rollins School of Public Health, Emory University School of Medicine, Atlanta, GA, USA
| | - Keith P Klugman
- Respiratory and Meningeal Pathogens Research Unit, Chris Hani-Baragwanath Hospital, Old Nurses Home, 1st Floor West Wing, Bertsham, Gauteng, 2013, South Africa; Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University School of Medicine, Atlanta, GA, USA
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