1
|
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.
Collapse
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
| |
Collapse
|
2
|
Emukule GO, Mott JA, Spreeuwenberg P, Viboud C, Commanday A, Muthoka P, Munywoki PK, Nokes DJ, van der Velden K, Paget JW. Influenza activity in Kenya, 2007-2013: timing, association with climatic factors, and implications for vaccination campaigns. Influenza Other Respir Viruses 2016; 10:375-85. [PMID: 27100128 PMCID: PMC4947939 DOI: 10.1111/irv.12393] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Information on the timing of influenza circulation remains scarce in Tropical regions of Africa. OBJECTIVES We assessed the relationship between influenza activity and several meteorological factors (temperature, specific humidity, precipitation) and characterized the timing of influenza circulation and its implications to vaccination strategies in Kenya. METHODS We analyzed virologically confirmed influenza data for outpatient influenza-like illness (ILI), hospitalized for severe acute respiratory infections (SARI), and cases of severe pneumonia over the period 2007-2013. Using logistic and negative binomial regression methods, we assessed the independent association between climatic variables (lagged up to 4 weeks) and influenza activity. RESULTS There were multiple influenza epidemics occurring each year and lasting a median duration of 2-4 months. On average, there were two epidemics occurring each year in most of the regions in Kenya, with the first epidemic occurring between the months of February and March and the second one between July and November. Specific humidity was independently and negatively associated with influenza activity. Combinations of low temperature (<18°C) and low specific humidity (<11 g/kg) were significantly associated with increased influenza activity. CONCLUSIONS Our study broadens understanding of the relationships between seasonal influenza activity and meteorological factors in the Kenyan context. While rainfall is frequently thought to be associated with influenza circulation in the tropics, the present findings suggest low humidity is more important in Kenya. If annual vaccination were a component of a vaccination strategy in Kenya, the months of April to June are proposed as optimal for associated campaigns.
Collapse
Affiliation(s)
- Gideon O Emukule
- Centers for Disease Control and Prevention - Kenya Country Office, Nairobi, Kenya.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joshua A Mott
- Centers for Disease Control and Prevention - Kenya Country Office, Nairobi, Kenya.,Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA.,US Public Health Service, Rockville, MD, USA
| | - Peter Spreeuwenberg
- Netherlands Institute for Health Services research (NIVEL), Utrecht, The Netherlands
| | - Cecile Viboud
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Alexander Commanday
- Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Patrick K Munywoki
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - David J Nokes
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya.,School of Life Sciences, University of Warwick, Coventry, UK
| | - Koos van der Velden
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - John W Paget
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.,Netherlands Institute for Health Services research (NIVEL), Utrecht, The Netherlands
| |
Collapse
|
3
|
Caselton D, Arunga G, Emukule G, Muthoka P, Mayieka L, Kosgey A, Ochola R, Waiboci L, Feikin D, Mott J, Breiman R, Katz M. Does the length of specimen storage affect influenza testing results by real-time reverse transcription-polymerase chain reaction? an analysis of influenza surveillance specimens, 2008 to 2010. ACTA ACUST UNITED AC 2014; 19. [PMID: 25232920 DOI: 10.2807/1560-7917.es2014.19.36.20893] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In some influenza surveillance systems, timely transport to laboratories for reverse transcription-polymerase chain reaction (RT-PCR) testing is challenging.Guidelines suggest that samples can be stored at 4°Cfor up to 96 hours but the effect of longer storage times has not been systematically evaluated. We collected nasopharyngeal and oropharyngeal specimens from patients in Kenya and stored them in viral transport medium at 2 to 8°C before testing for influenza A and B using real-time RT-PCR. From April 2008 to November 2010, we collected 7,833 samples; 940 (12%) were positive for influenza. In multivariable analysis, specimens stored for six days were less likely to be influenza-positive compared to specimens stored between zero and one day (adjusted odds ratio (a OR): 0.49, 95%confidence interval (CI): 0.27–0.93). There was no statistically significant difference in influenza positivity of specimens stored for five days compared to zero to one day. There was no statistically significant relationship between days in refrigeration and cycle threshold(Ct) values for positive samples (p=0.31). We found that samples could remain in storage for at least five days without affecting the proportion-positive of samples,potentially increasing the feasibility of including influenza surveillance sites in remote areas.
Collapse
Affiliation(s)
- Dl Caselton
- Influenza Program, Global Disease Detection Division, Centers for Disease Control and Prevention, Kenya
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Katz MA, Muthoka P, Emukule GO, Kalani R, Njuguna H, Waiboci LW, Ahmed JA, Bigogo G, Feikin DR, Njenga MK, Breiman RF, Mott JA. Results from the first six years of national sentinel surveillance for influenza in Kenya, July 2007-June 2013. PLoS One 2014; 9:e98615. [PMID: 24955962 PMCID: PMC4067481 DOI: 10.1371/journal.pone.0098615] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 05/05/2014] [Indexed: 12/01/2022] Open
Abstract
Background Recent studies have shown that influenza is associated with significant disease burden in many countries in the tropics, but until recently national surveillance for influenza was not conducted in most countries in Africa. Methods In 2007, the Kenyan Ministry of Health with technical support from the CDC-Kenya established a national sentinel surveillance system for influenza. At 11 hospitals, for every hospitalized patient with severe acute respiratory illness (SARI), and for the first three outpatients with influenza-like illness (ILI) per day, we collected both nasopharyngeal and oropharyngeal swabs. Beginning in 2008, we conducted in-hospital follow-up for SARI patients to determine outcome. Specimens were tested by real time RT-PCR for influenza A and B. Influenza A-positive specimens were subtyped for H1, H3, H5, and (beginning in May 2009) A(H1N1)pdm09. Results From July 1, 2007 through June 30, 2013, we collected specimens from 24,762 SARI and 14,013 ILI patients. For SARI and ILI case-patients, the median ages were 12 months and 16 months, respectively, and 44% and 47% were female. In all, 2,378 (9.6%) SARI cases and 2,041 (14.6%) ILI cases were positive for influenza viruses. Most influenza-associated SARI cases (58.6%) were in children <2 years old. Of all influenza-positive specimens, 78% were influenza A, 21% were influenza B, and 1% were influenza A/B coinfections. Influenza circulated in every month. In four of the six years influenza activity peaked during July–November. Of 9,419 SARI patients, 2.7% died; the median length of hospitalization was 4 days. Conclusions During six years of surveillance in Kenya, influenza was associated with nearly 10 percent of hospitalized SARI cases and one-sixth of outpatient ILI cases. Most influenza-associated SARI and ILI cases were in children <2 years old; interventions to reduce the burden of influenza, such as vaccine, could consider young children as a priority group.
Collapse
Affiliation(s)
- Mark A. Katz
- Centers for Disease Control and Prevention-Kenya/Kenya Medical Research Institute, Nairobi, Kenya
- * E-mail:
| | | | - Gideon O. Emukule
- Centers for Disease Control and Prevention-Kenya/Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Henry Njuguna
- Centers for Disease Control and Prevention-Kenya/Kenya Medical Research Institute, Nairobi, Kenya
| | - Lilian W. Waiboci
- Centers for Disease Control and Prevention-Kenya/Kenya Medical Research Institute, Nairobi, Kenya
| | - Jamal A. Ahmed
- Centers for Disease Control and Prevention-Kenya/Kenya Medical Research Institute, Nairobi, Kenya
| | - Godfrey Bigogo
- Centers for Disease Control and Prevention-Kenya/Kenya Medical Research Institute, Nairobi, Kenya
| | - Daniel R. Feikin
- Centers for Disease Control and Prevention-Kenya/Kenya Medical Research Institute, Nairobi, Kenya
| | - Moses K. Njenga
- Centers for Disease Control and Prevention-Kenya/Kenya Medical Research Institute, Nairobi, Kenya
| | - Robert F. Breiman
- Centers for Disease Control and Prevention-Kenya/Kenya Medical Research Institute, Nairobi, Kenya
| | - Joshua A. Mott
- Centers for Disease Control and Prevention-Kenya/Kenya Medical Research Institute, Nairobi, Kenya
| |
Collapse
|
5
|
Emukule GO, McMorrow M, Ulloa C, Khagayi S, Njuguna HN, Burton D, Montgomery JM, Muthoka P, Katz MA, Breiman RF, Mott JA. Predicting mortality among hospitalized children with respiratory illness in Western Kenya, 2009-2012. PLoS One 2014; 9:e92968. [PMID: 24667695 PMCID: PMC3965502 DOI: 10.1371/journal.pone.0092968] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/27/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pediatric respiratory disease is a major cause of morbidity and mortality in the developing world. We evaluated a modified respiratory index of severity in children (mRISC) scoring system as a standard tool to identify children at greater risk of death from respiratory illness in Kenya. MATERIALS AND METHODS We analyzed data from children <5 years old who were hospitalized with respiratory illness at Siaya District Hospital from 2009-2012. We used a multivariable logistic regression model to identify patient characteristics predictive for in-hospital mortality. Model discrimination was evaluated using the concordance statistic. Using bootstrap samples, we re-estimated the coefficients and the optimism of the model. The mRISC score for each child was developed by adding up the points assigned to each factor associated with mortality based on the coefficients in the multivariable model. RESULTS We analyzed data from 3,581 children hospitalized with respiratory illness; including 218 (6%) who died. Low weight-for-age [adjusted odds ratio (aOR) = 2.1; 95% CI 1.3-3.2], very low weight-for-age (aOR = 3.8; 95% CI 2.7-5.4), caretaker-reported history of unconsciousness (aOR = 2.3; 95% CI 1.6-3.4), inability to drink or breastfeed (aOR = 1.8; 95% CI 1.2-2.8), chest wall in-drawing (aOR = 2.2; 95% CI 1.5-3.1), and being not fully conscious on physical exam (aOR = 8.0; 95% CI 5.1-12.6) were independently associated with mortality. The positive predictive value for mortality increased with increasing mRISC scores. CONCLUSIONS A modified RISC scoring system based on a set of easily measurable clinical features at admission was able to identify children at greater risk of death from respiratory illness in Kenya.
Collapse
Affiliation(s)
- Gideon O. Emukule
- Kenya Medical Research Institute/Centers for Disease Control and Prevention-Kenya (KEMRI/CDC), Nairobi and Kisumu, Kenya
| | - Meredith McMorrow
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Chulie Ulloa
- Stanford University School of Medicine, Stanford, California, United States of America
| | - Sammy Khagayi
- Kenya Medical Research Institute/Centers for Disease Control and Prevention-Kenya (KEMRI/CDC), Nairobi and Kisumu, Kenya
| | - Henry N. Njuguna
- Kenya Medical Research Institute/Centers for Disease Control and Prevention-Kenya (KEMRI/CDC), Nairobi and Kisumu, Kenya
| | - Deron Burton
- Kenya Medical Research Institute/Centers for Disease Control and Prevention-Kenya (KEMRI/CDC), Nairobi and Kisumu, Kenya
| | - Joel M. Montgomery
- Kenya Medical Research Institute/Centers for Disease Control and Prevention-Kenya (KEMRI/CDC), Nairobi and Kisumu, Kenya
| | - Philip Muthoka
- Ministry of Public Health and Sanitation, Division of Disease Surveillance and Response, Nairobi, Kenya
| | - Mark A. Katz
- Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | | | - Joshua A. Mott
- Kenya Medical Research Institute/Centers for Disease Control and Prevention-Kenya (KEMRI/CDC), Nairobi and Kisumu, Kenya
| |
Collapse
|
6
|
Njuguna H, Ahmed J, Oria PA, Arunga G, Williamson J, Kosgey A, Muthoka P, Mott JA, Breiman RF, Katz MA. Uptake and effectiveness of monovalent influenza A (H1N1) pandemic 2009 vaccine among healthcare personnel in Kenya, 2010. Vaccine 2013; 31:4662-7. [PMID: 23859843 DOI: 10.1016/j.vaccine.2013.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 01/22/2013] [Revised: 06/07/2013] [Accepted: 07/02/2013] [Indexed: 01/17/2023]
Abstract
INTRODUCTION During April-June 2010, the Kenya Ministry of Public Health and Sanitation distributed free monovalent influenza A(H1N1)pdm09 vaccines to health care personnel (HCP) and other vulnerable groups. We conducted a prospective, cohort study among HCP to characterize influenza A(H1N1)pdm09 vaccine uptake, and to assess influenza A(H1N1)pdm09 vaccine effectiveness. METHODS We enrolled HCP from 5 hospitals and followed them for 6 months. At enrollment, we asked HCP if they had received the influenza A(H1N1)pdm09 vaccine and their reasons for their decision. We administered weekly questionnaires to participants about respiratory symptoms suffered during the previous week. Participants who had acute respiratory illness were asked to contact our surveillance clinician, and nasopharyngeal and oropharyngeal specimens were collected and later tested for influenza by real-time reverse-transcriptase polymerase-chain-reaction. Vaccine effectiveness was estimated by comparing the incidence of acute respiratory illness, absenteeism from work due to respiratory illness and laboratory-confirmed influenza among vaccinated and unvaccinated HCP. RESULTS We enrolled 3803 HCP from the five hospitals; 64% received influenza vaccine. Vaccinated HCP were more likely to develop acute respiratory illness (ARI) and more likely to report missed days of work due to respiratory illness compared to non-vaccinated HCP (adjusted incidence rate ratio (aIRR) 1.50, 95% confidence intervals (CI): 1.33-1.70) and (aIRR 2.02, 95% CI: 1.41-2.88), respectively. Of 531 samples collected from vaccinated and non-vaccinated HCP, 30 were influenza A and 3 were influenza B. Two influenza A(H1N1)pdm09 subtypes were isolated; one from vaccinated and the other from non-vaccinated HCP. DISCUSSION AND CONCLUSIONS A majority of Kenyan HCP surveyed reported receiving the influenza A(H1N1)pdm09 vaccine. Because of low circulation of influenza A(H1N1)pdm09 virus during the study period, vaccine effectiveness could not be determined. The findings of increased ARI events and missed days of work among vaccinated HCP were likely confounded by vaccine-seeking behavioral factors.
Collapse
Affiliation(s)
- Henry Njuguna
- Centers for Disease Control and Prevention-Kenya (CDC-K), Nairobi, Kenya.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Oria PA, Arunga G, Lebo E, Wong JM, Emukule G, Muthoka P, Otieno N, Mutonga D, Breiman RF, Katz MA. Assessing parents' knowledge and attitudes towards seasonal influenza vaccination of children before and after a seasonal influenza vaccination effectiveness study in low-income urban and rural Kenya, 2010-2011. BMC Public Health 2013; 13:391. [PMID: 23617891 PMCID: PMC3639236 DOI: 10.1186/1471-2458-13-391] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 04/22/2013] [Indexed: 11/10/2022] Open
Abstract
Background Influenza vaccine is rarely used in Kenya, and little is known about attitudes towards the vaccine. From June-September 2010, free seasonal influenza vaccine was offered to children between 6 months and 10 years old in two Population-Based Infectious Disease Surveillance (PBIDS) sites. This survey assessed attitudes about influenza, uptake of the vaccine and experiences with childhood influenza vaccination. Methods We administered a questionnaire and held focus group discussions with parents of children of enrollment age in the two sites before and after first year of the vaccine campaign. For pre-vaccination focus group discussions, we randomly selected mothers and fathers who had an eligible child from the PBIDS database to participate. For the post-vaccination focus group discussions we stratified parents whose children were eligible for vaccination into fully vaccinated, partially vaccinated and non-vaccinated groups. Results Overall, 5284 and 5755 people completed pre and post-vaccination questionnaires, respectively, in Kibera and Lwak. From pre-vaccination questionnaire results, among parents who were planning on vaccinating their children, 2219 (77.6%) in Kibera and 1780 (89.6%) in Lwak said the main reason was to protect the children from seasonal influenza. In the pre-vaccination discussions, no parent had heard of the seasonal influenza vaccine. At the end of the vaccine campaign, of 18,652 eligible children, 5,817 (31.2%) were fully vaccinated, 2,073 (11.1%) were partially vaccinated and, 10,762 (57.7%) were not vaccinated. In focus group discussions, parents who declined vaccine were concerned about vaccine safety or believed seasonal influenza illness was not severe enough to warrant vaccination. Parents who declined the vaccine were mainly too busy [251(25%) in Kibera and 95 (10.5%) in Lwak], or their child was away during the vaccination period [199(19.8%) in Kibera; 94(10.4%) in Lwak]. Conclusion If influenza vaccine were to be introduced more broadly in Kenya, effective health messaging will be needed on vaccine side effects and frequency and potential severity of influenza infection.
Collapse
Affiliation(s)
- Prisca Adhiambo Oria
- Kenya Medical Research Institute/Centers for Disease Control and Prevention (KEMRI/CDC), Nairobi, Kenya.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Osoro EM, Munyua P, Muthoka P, Gikundi S, Njenga MK, Lifumo S, Achilla R, Waiboci L, Nzioka C, Omolo J, Feikin DR, Breiman RF, Katz MA. Hospitalized patients with pandemic (H1N1) 2009, Kenya. Emerg Infect Dis 2012; 17:1744-6. [PMID: 21888810 PMCID: PMC3322052 DOI: 10.3201/eid1709.100992] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
To describe the epidemiology and clinical course of patients hospitalized with pandemic (H1N1) 2009 in Kenya, we reviewed medical records of 49 such patients hospitalized during July–November 2009. The median age (7 years) was lower than that in industrialized countries. More patients had HIV than the general Kenyan population.
Collapse
|
9
|
Kim C, Ahmed JA, Eidex RB, Nyoka R, Waiboci LW, Erdman D, Tepo A, Mahamud AS, Kabura W, Nguhi M, Muthoka P, Burton W, Breiman RF, Njenga MK, Katz MA. Comparison of nasopharyngeal and oropharyngeal swabs for the diagnosis of eight respiratory viruses by real-time reverse transcription-PCR assays. PLoS One 2011; 6:e21610. [PMID: 21738731 PMCID: PMC3128075 DOI: 10.1371/journal.pone.0021610] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 06/03/2011] [Indexed: 11/18/2022] Open
Abstract
Background Many acute respiratory illness surveillance systems collect and test nasopharyngeal (NP) and/or oropharyngeal (OP) swab specimens, yet there are few studies assessing the relative measures of performance for NP versus OP specimens. Methods We collected paired NP and OP swabs separately from pediatric and adult patients with influenza-like illness or severe acute respiratory illness at two respiratory surveillance sites in Kenya. The specimens were tested for eight respiratory viruses by real-time reverse transcription-polymerase chain reaction (qRT-PCR). Positivity for a specific virus was defined as detection of viral nucleic acid in either swab. Results Of 2,331 paired NP/OP specimens, 1,402 (60.1%) were positive for at least one virus, and 393 (16.9%) were positive for more than one virus. Overall, OP swabs were significantly more sensitive than NP swabs for adenovirus (72.4% vs. 57.6%, p<0.01) and 2009 pandemic influenza A (H1N1) virus (91.2% vs. 70.4%, p<0.01). NP specimens were more sensitive for influenza B virus (83.3% vs. 61.5%, p = 0.02), parainfluenza virus 2 (85.7%, vs. 39.3%, p<0.01), and parainfluenza virus 3 (83.9% vs. 67.4%, p<0.01). The two methods did not differ significantly for human metapneumovirus, influenza A (H3N2) virus, parainfluenza virus 1, or respiratory syncytial virus. Conclusions The sensitivities were variable among the eight viruses tested; neither specimen was consistently more effective than the other. For respiratory disease surveillance programs using qRT-PCR that aim to maximize sensitivity for a large number of viruses, collecting combined NP and OP specimens would be the most effective approach.
Collapse
Affiliation(s)
- Curi Kim
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jamal A. Ahmed
- Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya
| | - Rachel B. Eidex
- Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya
| | - Raymond Nyoka
- Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya
| | | | - Dean Erdman
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Adan Tepo
- Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya
| | | | | | | | - Philip Muthoka
- Ministry of Public Health and Sanitation, Nairobi, Kenya
| | - Wagacha Burton
- United Nations High Commissioner for Refugees, Nairobi, Kenya
| | | | | | - Mark A. Katz
- Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya
- * E-mail:
| |
Collapse
|