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Jayaprasad N, Borhade P, LeBoa C, Date K, Joshi S, Shimpi R, Andrews JR, Luby SP, Hoffman SA. Retrospective Review of Blood Culture-Confirmed Cases of Enteric Fever in Navi Mumbai, India: 2014-2018. Am J Trop Med Hyg 2023; 109:571-574. [PMID: 37549903 PMCID: PMC10484249 DOI: 10.4269/ajtmh.23-0102] [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] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 07/03/2023] [Indexed: 08/09/2023] Open
Abstract
India has one of the highest estimated burdens of enteric fever globally. Prior to the implementation of Typbar-TCV typhoid conjugate vaccine (TCV) in a public sector pediatric immunization campaign in Navi Mumbai, India, we conducted a retrospective review of blood culture-confirmed cases of typhoid and paratyphoid fevers to estimate the local burden of disease. This review included all blood cultures processed at a central microbiology laboratory, serving multiple hospitals, in Navi Mumbai (January 2014-May 2018) that tested positive for either Salmonella Typhi or Salmonella Paratyphi A. Of 40,670 blood cultures analyzed, 1,309 (3.2%) were positive for S. Typhi (1,201 [92%]) or S. Paratyphi A (108 [8%]). Culture positivity was highest in the last months of the dry season (April-June). Our findings indicate a substantial burden of enteric fever in Navi Mumbai and support the importance of TCV immunization campaigns and improved water, sanitation, and hygiene.
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Affiliation(s)
- Niniya Jayaprasad
- National Public Health Surveillance Project, World Health Organization–Country Office for India, New Delhi, India
| | - Priyanka Borhade
- National Public Health Surveillance Project, World Health Organization–Country Office for India, New Delhi, India
| | - Christopher LeBoa
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Kashmira Date
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shrikrishna Joshi
- Dr. Joshi’s Central Clinical Microbiology Laboratory, Navi Mumbai, India
| | - Rahul Shimpi
- National Public Health Surveillance Project, World Health Organization–Country Office for India, New Delhi, India
| | - Jason R. Andrews
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Stephen P. Luby
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Seth A. Hoffman
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
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da Silva KE, Date K, Hirani N, LeBoa C, Jayaprasad N, Borhade P, Warren J, Shimpi R, Hoffman SA, Mikoleit M, Bhatnagar P, Cao Y, Haldar P, Harvey P, Zhang C, Daruwalla S, Dharmapalan D, Gavhane J, Joshi S, Rai R, Rathod V, Shetty K, Warrier DS, Yadav S, Chakraborty D, Bahl S, Katkar A, Kunwar A, Yewale V, Dutta S, Luby SP, Andrews JR. Population structure and antimicrobial resistance patterns of Salmonella Typhi and Paratyphi A amid a phased municipal vaccination campaign in Navi Mumbai, India. mBio 2023; 14:e0117923. [PMID: 37504577 PMCID: PMC10470601 DOI: 10.1128/mbio.01179-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/22/2023] [Indexed: 07/29/2023] Open
Abstract
We performed whole-genome sequencing of 174 Salmonella Typhi and 54 Salmonella Paratyphi A isolates collected through prospective surveillance in the context of a phased typhoid conjugate vaccine introduction in Navi Mumbai, India. We investigate the temporal and geographical patterns of emergence and spread of antimicrobial resistance. We evaluated the relationship between the spatial distance between households and genetic clustering of isolates. Most isolates were non-susceptible to fluoroquinolones, with nearly 20% containing ≥3 quinolone resistance-determining region mutations. Two H58 isolates carried an IncX3 plasmid containing blaSHV-12, associated with ceftriaxone resistance, suggesting that the ceftriaxone-resistant isolates from India independently evolved on multiple occasions. Among S. Typhi, we identified two main clades circulating (2.2 and 4.3.1 [H58]); 2.2 isolates were closely related following a single introduction around 2007, whereas H58 isolates had been introduced multiple times to the city. Increasing geographic distance between isolates was strongly associated with genetic clustering (odds ratio [OR] = 0.72 per km; 95% credible interval [CrI]: 0.66-0.79). This effect was seen for distances up to 5 km (OR = 0.65 per km; 95% CrI: 0.59-0.73) but not seen for distances beyond 5 km (OR = 1.02 per km; 95% CrI: 0.83-1.26). There was a non-significant reduction in odds of clustering for pairs of isolates in vaccination communities compared with non-vaccination communities or mixed pairs compared with non-vaccination communities. Our findings indicate that S. Typhi was repeatedly introduced into Navi Mumbai and then spread locally, with strong evidence of spatial genetic clustering. In addition to vaccination, local interventions to improve water and sanitation will be critical to interrupt transmission. IMPORTANCE Enteric fever remains a major public health concern in many low- and middle-income countries, as antimicrobial resistance (AMR) continues to emerge. Geographical patterns of typhoidal Salmonella spread, critical to monitoring AMR and planning interventions, are poorly understood. We performed whole-genome sequencing of S. Typhi and S. Paratyphi A isolates collected in Navi Mumbai, India before and after a typhoid conjugate vaccine introduction. From timed phylogenies, we found two dominant circulating lineages of S. Typhi in Navi Mumbai-lineage 2.2, which expanded following a single introduction a decade prior, and 4.3.1 (H58), which had been introduced repeatedly from other parts of India, frequently containing "triple mutations" conferring high-level ciprofloxacin resistance. Using Bayesian hierarchical statistical models, we found that spatial distance between cases was strongly associated with genetic clustering at a fine scale (<5 km). Together, these findings suggest that antimicrobial-resistant S. Typhi frequently flows between cities and then spreads highly locally, which may inform surveillance and prevention strategies.
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Affiliation(s)
- Kesia Esther da Silva
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Kashmira Date
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nilma Hirani
- Grant Government Medical College & Sir J J Hospital, Mumbai, Maharashtra, India
| | - Christopher LeBoa
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA
| | - Niniya Jayaprasad
- World Health Organization-Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Priyanka Borhade
- World Health Organization-Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Joshua Warren
- Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Rahul Shimpi
- World Health Organization-Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Seth A. Hoffman
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Matthew Mikoleit
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pankaj Bhatnagar
- World Health Organization-Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Yanjia Cao
- Department of Geography, The University of Hong Kong, Hong Kong
| | - Pradeep Haldar
- Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | - Pauline Harvey
- World Health Organization-Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Chenhua Zhang
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Savita Daruwalla
- Department of Pediatrics, NMMC General Hospital, Navi Mumbai, India
| | | | - Jeetendra Gavhane
- Department of Pediatrics, MGM New Bombay Hospital, MGM Medical College, Navi Mumbai, India
| | - Shrikrishna Joshi
- Dr. Joshi’s Central Clinical Microbiology Laboratory, Navi Mumbai, India
| | - Rajesh Rai
- Department of Pediatrics & Neonatology, Dr. D.Y. Patil Medical College and Hospital, Navi Mumbai, India
| | - Varsha Rathod
- Rajmata Jijau Hospital, Airoli (NMMC), Navi Mumbai, India
| | - Keertana Shetty
- Department of Microbiology, Dr. D.Y. Patil Medical College and Hospital, Navi Mumbai, India
| | | | - Shalini Yadav
- Department of Microbiology, MGM New Bombay Hospital, Navi Mumbai, India
| | - Debjit Chakraborty
- National Institute of Cholera and Enteric Diseases, Indian Council of Medical Research, Kolkata, India
| | - Sunil Bahl
- World Health Organization South-East Asia Regional Office, New Delhi, India
| | - Arun Katkar
- World Health Organization-Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Abhishek Kunwar
- World Health Organization-Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Vijay Yewale
- Dr. Yewale Multispecialty Hospital for Children, Navi Mumbai, India
| | - Shanta Dutta
- National Institute of Cholera and Enteric Diseases, Indian Council of Medical Research, Kolkata, India
| | - Stephen P. Luby
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jason R. Andrews
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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Hoffman SA, LeBoa C, Date K, Haldar P, Harvey P, Shimpi R, An Q, Zhang C, Jayaprasad N, Horng L, Fagerli K, Borhade P, Chakraborty D, Bahl S, Katkar A, Kunwar A, Yewale V, Andrews JR, Bhatnagar P, Dutta S, Luby SP. Programmatic Effectiveness of a Pediatric Typhoid Conjugate Vaccine Campaign in Navi Mumbai, India. Clin Infect Dis 2023:7083728. [PMID: 36947143 DOI: 10.1093/cid/ciad132] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 01/25/2023] [Accepted: 03/03/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The WHO recommends vaccines for prevention and control of typhoid fever, especially where antimicrobial-resistant typhoid circulates. In 2018 the Navi Mumbai Municipal Corporation (NMMC), implemented a TCV campaign. The campaign targeted all children aged 9-months through 14-years within NMMC boundaries (∼320,000 children) over 2 vaccination phases. The phase 1 campaign occurred from July 14-August 25, 2018 (71% coverage, ∼113,420 children). We evaluated the phase 1 campaign's programmatic effectiveness in reducing typhoid cases at the community level. METHODS We established prospective, blood culture-based surveillance at 6 hospitals in Navi Mumbai, offering blood cultures to children presenting with fever ≥ 3 days. We employed a cluster-randomized (by administrative boundary) test-negative design to estimate the effectiveness of the vaccination campaign on pediatric typhoid cases. We matched test-positive, culture-confirmed typhoid cases with up to 3 test-negative, culture-negative controls by age and date of blood culture and assessed community vaccine campaign phase as an exposure using conditional logistic regression. RESULTS Between September 1, 2018-March 31, 2021, we identified 81 typhoid cases and matched these with 238 controls. Cases were 0.44 times as likely to live in vaccine campaign communities (programmatic effectiveness, 56%, 95%CI: 25%-74%, p=0.002). Cases ≥ 5-years-old were 0.37 times as likely (95% CI: 0.19-0.70; p-value = 0.002) and cases during the first year of surveillance were 0.30 times as likely (95% CI: 0.14-0.64; p-value = 0.002) to live in vaccine campaign communities. CONCLUSIONS Our findings support the use of TCV mass vaccination campaigns as effective population-based tools to combat typhoid fever.
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Affiliation(s)
- Seth A Hoffman
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Christopher LeBoa
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Kashmira Date
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pradeep Haldar
- Ministry of Health & Family Welfare, Government of India, New Delhi, India
| | - Pauline Harvey
- World Health Organization-Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Rahul Shimpi
- World Health Organization-Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Qian An
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Chenhua Zhang
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Niniya Jayaprasad
- World Health Organization-Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Lily Horng
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Kirsten Fagerli
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Priyanka Borhade
- World Health Organization-Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Debjit Chakraborty
- National Institute of Cholera and Enteric Diseases, Indian Council of Medical Research, Kolkata, India
| | - Sunil Bahl
- World Health Organization South-East Asia Regional Office, New Delhi, India
| | - Arun Katkar
- World Health Organization-Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Abhishek Kunwar
- World Health Organization-Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Vijay Yewale
- Dr. Yewale Multispecialty Hospital for Children, Navi Mumbai, India
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Pankaj Bhatnagar
- World Health Organization-Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Shanta Dutta
- National Institute of Cholera and Enteric Diseases, Indian Council of Medical Research, Kolkata, India
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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Purazo ML, Ice RJ, Shimpi R, Hoenerhoff M, Pugacheva EN. NEDD9 Overexpression Causes Hyperproliferation of Luminal Cells and Cooperates with HER2 Oncogene in Tumor Initiation: A Novel Prognostic Marker in Breast Cancer. Cancers (Basel) 2023; 15:1119. [PMID: 36831460 PMCID: PMC9954084 DOI: 10.3390/cancers15041119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/23/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
HER2 overexpression occurs in 10-20% of breast cancer patients. HER2+ tumors are characterized by an increase in Ki67, early relapse, and increased metastasis. Little is known about the factors influencing early stages of HER2- tumorigenesis and diagnostic markers. Previously, it was shown that the deletion of NEDD9 in mouse models of HER2 cancer interferes with tumor growth, but the role of NEDD9 upregulation is currently unexplored. We report that NEDD9 is overexpressed in a significant subset of HER2+ breast cancers and correlates with a limited response to anti-HER2 therapy. To investigate the mechanisms through which NEDD9 influences HER2-dependent tumorigenesis, we generated MMTV-Cre-NEDD9 transgenic mice. The analysis of mammary glands shows extensive ductal epithelium hyperplasia, increased branching, and terminal end bud expansion. The addition of oncogene Erbb2 (neu) leads to the earlier development of early hyperplastic benign lesions (~16 weeks), with a significantly shorter latency than the control mice. Similarly, NEDD9 upregulation in MCF10A-derived acini leads to hyperplasia-like DCIS. This phenotype is associated with activation of ERK1/2 and AURKA kinases, leading to an increased proliferation of luminal cells. These findings indicate that NEDD9 is setting permissive conditions for HER2-induced tumorigenesis, thus identifying this protein as a potential diagnostic marker for early detection.
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Affiliation(s)
- Marc L. Purazo
- WVU Cancer Institute, School of Medicine, West Virginia University, Morgantown, WV 26505, USA
| | - Ryan J. Ice
- WVU Cancer Institute, School of Medicine, West Virginia University, Morgantown, WV 26505, USA
| | - Rahul Shimpi
- WVU Cancer Institute, School of Medicine, West Virginia University, Morgantown, WV 26505, USA
| | - Mark Hoenerhoff
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Elena N. Pugacheva
- WVU Cancer Institute, School of Medicine, West Virginia University, Morgantown, WV 26505, USA
- Department of Biochemistry & Molecular Medicine, School of Medicine, West Virginia University, Morgantown, WV 26505, USA
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Song D, Pallas SW, Shimpi R, Ramaswamy N, Haldar P, Harvey P, Bhatnagar P, Katkar A, Jayaprasad N, Kunwar A, Bahl S, Morgan W, Hutubessy R, Date K, Mogasale V. Delivery cost of the first public sector introduction of typhoid conjugate vaccine in Navi Mumbai, India. PLOS Glob Public Health 2023; 3:e0001396. [PMID: 36962873 PMCID: PMC10022355 DOI: 10.1371/journal.pgph.0001396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 11/22/2022] [Indexed: 01/05/2023]
Abstract
Navi Mumbai Municipal Corporation (NMMC), a local government in Mumbai, India, implemented the first public sector TCV campaign in 2018. This study estimated the delivery costs of this TCV campaign using a Microsoft Excel-based tool based on a micro-costing approach from the government (NMMC) perspective. The campaign's financial (direct expenditures) and economic costs (financial costs plus the monetized value of additional donated or existing items) incremental to the existing immunization program were collected. The data collection methods involved consultations with NMMC staff, reviews of financial and programmatic records of NMMC and the World Health Organization (WHO), and interviews with the health staff of sampled urban health posts (UHPs). Three UHPs were purposively sampled, representing the three dominant residence types in the catchment area: high-rise, slum, and mixed (high-rise and slum) areas. The high-rise area UHP had lower vaccination coverage (47%) compared with the mixed area (71%) and slum area UHPs (76%). The financial cost of vaccine and vaccination supplies (syringes, safety boxes) was $1.87 per dose, and the economic cost was $2.96 per dose in 2018 US dollars. Excluding the vaccine and vaccination supplies cost, the financial delivery cost across the 3 UHPs ranged from $0.37 to $0.53 per dose, and the economic delivery cost ranged from $1.37 to $3.98 per dose, with the highest delivery costs per dose in the high-rise areas. Across all 11 UHPs included in the campaign, the weighted average financial delivery cost was $0.38 per dose, and the economic delivery cost was $1.49 per dose. WHO has recommended the programmatic use of TCV in typhoid-endemic countries, and Gavi has included TCV in its vaccine portfolio. This first costing study of large-scale TCV introduction within a public sector immunization program provides empirical evidence for policymakers, stakeholders, and future vaccine campaign planning.
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Affiliation(s)
- Dayoung Song
- Policy and Economic Research Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Sarah W Pallas
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rahul Shimpi
- World Health Organization, India Country Office, New Delhi, India
| | - N Ramaswamy
- Navi Mumbai Municipal Corporation, Navi Mumbai, India
| | - Pradeep Haldar
- Ministry of Family Health and Welfare, Government of India, New Delhi, India
| | - Pauline Harvey
- World Health Organization, India Country Office, New Delhi, India
| | - Pankaj Bhatnagar
- World Health Organization, India Country Office, New Delhi, India
| | - Arun Katkar
- World Health Organization, India Country Office, New Delhi, India
| | | | - Abhishek Kunwar
- World Health Organization, India Country Office, New Delhi, India
| | - Sunil Bahl
- World Health Organization, Regional Office for South-East Asia, New Delhi, India
| | - Win Morgan
- Levin and Morgan LLC, Bethesda, MD, United States of America
| | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Kashmira Date
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Vittal Mogasale
- Policy and Economic Research Department, International Vaccine Institute, Republic of Korea
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Taunk P, Shimpi R, Singh R, Collins J, Muthusamy VR, Day LW. GI endoscope reprocessing: a comparative review of organizational guidelines and guide for endoscopy units and regulatory agencies. Gastrointest Endosc 2022; 95:1048-1059.e2. [PMID: 35303991 DOI: 10.1016/j.gie.2021.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/12/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Pushpak Taunk
- Division of Gastroenterology, University of South Florida, Tampa, Florida, USA
| | - Rahul Shimpi
- Department of Gastroenterology, Duke University Medical Center, Durham, North Carolina, USA
| | - Ravi Singh
- Department of Gastroenterology, Great South Bay Endoscopy Center, LLC, East Patchogue, New York, USA
| | - James Collins
- Department of Digestive Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Lukejohn W Day
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
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Longley AT, Date K, Luby SP, Bhatnagar P, Bentsi-Enchill AD, Goyal V, Shimpi R, Katkar A, Yewale V, Jayaprasad N, Horng L, Kunwar A, Harvey P, Haldar P, Dutta S, Gidudu JF. Evaluation of Vaccine Safety After the First Public Sector Introduction of Typhoid Conjugate Vaccine-Navi Mumbai, India, 2018. Clin Infect Dis 2021; 73:e927-e933. [PMID: 33502453 PMCID: PMC8366822 DOI: 10.1093/cid/ciab059] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/22/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In December 2017, the World Health Organization (WHO) prequalified the first typhoid conjugate vaccine (TCV; Typbar-TCV). While no safety concerns were identified in pre- and postlicensure studies, WHO's Global Advisory Committee on Vaccine Safety recommended robust safety evaluation with large-scale TCV introductions. During July-August 2018, the Navi Mumbai Municipal Corporation (NMMC) launched the world's first public sector TCV introduction. Per administrative reports, 113 420 children 9 months-14 years old received TCV. METHODS We evaluated adverse events following immunization (AEFIs) using passive and active surveillance via (1) reports from the passive NMMC AEFI surveillance system, (2) telephone interviews with 5% of caregivers of vaccine recipients 48 hours and 7 days postvaccination, and (3) chart abstraction for adverse events of special interest (AESIs) among patients admitted to 5 hospitals using the Brighton Collaboration criteria followed by ascertainment of vaccination status. RESULTS We identified 222/113 420 (0.2%) vaccine recipients with AEFIs through the NMMC AEFI surveillance system: 211 (0.19%) experienced minor AEFIs, 2 (0.002%) severe, and 9 serious (0.008%). At 48 hours postvaccination, 1852/5605 (33%) caregivers reported ≥1 AEFI, including injection site pain (n = 1452, 26%), swelling (n = 419, 7.5%), and fever (n = 416, 7.4%). Of the 4728 interviews completed at 7 days postvaccination, the most reported AEFIs included fever (n = 200, 4%), pain (n = 52, 1%), and headache (n = 42, 1%). Among 525 hospitalized children diagnosed with an AESI, 60 were vaccinated; no AESIs were causally associated with TCV. CONCLUSIONS No unexpected safety signals were identified with TCV introduction. This provides further reassurance for the large-scale use of Typbar-TCV among children 9 months-14 years old.
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Affiliation(s)
- Ashley T Longley
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kashmira Date
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephen P Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California,USA
| | - Pankaj Bhatnagar
- World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Adwoa D Bentsi-Enchill
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Vineet Goyal
- World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Rahul Shimpi
- World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Arun Katkar
- World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Vijay Yewale
- Dr Yewale Multi Specialty Hospital for Children, Navi Mumbai, India
| | - Niniya Jayaprasad
- World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Lily Horng
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California,USA
| | - Abhishek Kunwar
- World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Pauline Harvey
- World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Pradeep Haldar
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Shanta Dutta
- National Institute of Cholera and Enteric Diseases, Indian Council of Medical Research, Kolkata, India
| | - Jane F Gidudu
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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8
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Date K, Shimpi R, Luby S, N R, Haldar P, Katkar A, Wannemuehler K, Mogasale V, Pallas S, Song D, Kunwar A, Loharikar A, Yewale V, Ahmed D, Horng L, Wilhelm E, Bahl S, Harvey P, Dutta S, Bhatnagar P. Decision Making and Implementation of the First Public Sector Introduction of Typhoid Conjugate Vaccine-Navi Mumbai, India, 2018. Clin Infect Dis 2021; 71:S172-S178. [PMID: 32725235 DOI: 10.1093/cid/ciaa597] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Typhoid fever prevention and control efforts are critical in an era of rising antimicrobial resistance among typhoid pathogens. India remains one of the highest typhoid disease burden countries, although a highly efficacious typhoid conjugate vaccine (TCV), prequalified by the World Health Organization in 2017, has been available since 2013. In 2018, the Navi Mumbai Municipal Corporation (NMMC) introduced TCV into its immunization program, targeting children aged 9 months to 14 years in 11 of 22 areas (Phase 1 campaign). We describe the decision making, implementation, and delivery costing to inform TCV use in other settings. METHODS We collected information on the decision making and campaign implementation in addition to administrative coverage from NMMC and partners. We then used a microcosting approach from the local government (NMMC) perspective, using a new Microsoft Excel-based tool to estimate the financial and economic vaccination campaign costs. RESULTS The planning and implementation of the campaign were led by NMMC with support from multiple partners. A fixed-post campaign was conducted during weekends and public holidays in July-August 2018 which achieved an administrative vaccination coverage of 71% (ranging from 46% in high-income to 92% in low-income areas). Not including vaccine and vaccination supplies, the average financial cost and economic cost per dose of TCV delivery were $0.45 and $1.42, respectively. CONCLUSION The first public sector TCV campaign was successfully implemented by NMMC, with high administrative coverage in slums and low-income areas. Delivery cost estimates provide important inputs to evaluate the cost-effectiveness and affordability of TCV vaccination through public sector preventive campaigns.
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Affiliation(s)
- Kashmira Date
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rahul Shimpi
- World Health Organization, India Country Office, New Delhi, India
| | | | - Ramaswami N
- Navi Mumbai Municipal Corporation, Navi Mumbai, India
| | - Pradeep Haldar
- Ministry of Health and Family Welfare, Government of India, India
| | - Arun Katkar
- World Health Organization, India Country Office, New Delhi, India
| | - Kathleen Wannemuehler
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Sarah Pallas
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dayoung Song
- International Vaccine Institute, Republic of Korea
| | - Abhishek Kunwar
- World Health Organization, India Country Office, New Delhi, India
| | - Anagha Loharikar
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Vijay Yewale
- Dr. Yewale Multispecialty Hospital, Navi Mumbai, India
| | - Danish Ahmed
- World Health Organization, India Country Office, New Delhi, India
| | - Lily Horng
- Stanford University, Stanford, California, USA
| | - Elisabeth Wilhelm
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sunil Bahl
- World Health Organization, Regional Office for South-East Asia, New Delhi, India
| | - Pauline Harvey
- World Health Organization, India Country Office, New Delhi, India
| | - Shanta Dutta
- National Institute of Cholera and Enteric Diseases-Indian Council for Medical Research, Kolkata, India
| | - Pankaj Bhatnagar
- World Health Organization, India Country Office, New Delhi, India
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9
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Horton A, Posner S, Sullivan B, Cornejo J, Davis A, Fields M, McIntosh T, Gellad Z, Shimpi R, Gyawali CP, Patel A. Esophageal contractile segment impedance from high-resolution impedance manometry correlates with mean nocturnal baseline impedance and acid exposure time from 24-hour pH-impedance monitoring. Dis Esophagus 2020; 33:5865407. [PMID: 32607563 DOI: 10.1093/dote/doaa063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/10/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022]
Abstract
Esophageal baseline impedance (BI) acquired during esophageal contraction (contractile segment impedance [CSI]) is proposed to improve BI accuracy in gastroesophageal reflux disease (GERD). We evaluated associations between CSI and conventional and novel GERD metrics. We analyzed high-resolution impedance manometry (HRIM) and ambulatory pH-impedance studies from 51 patients (58.6 ± 1.5 years; 26% F) with GERD symptoms studied off antisecretory therapy. Patients with achalasia or absent contractility were excluded. CSI (averaged across 10 swallows) and BI-HRIM (from the resting landmark phase) were acquired from the distal impedance sensors (distal sensor and 5 cm above the lower esophageal sphincter). Acid exposure time (AET) and mean nocturnal baseline impedance (MNBI) were calculated. Associations between CSI, BI-HRIM, MNBI, and AET were evaluated using correlation (Pearson) and receiver operating characteristic (ROC) analysis. Presenting symptoms included heartburn (67%), regurgitation (12%), cough (12%), and chest pain (10%). CSI-distal and CSI-5 each correlated with BI-HRIM, AET, and distal MNBI. Associations with AET were numerically stronger for CSI-distal (r = -0.46) and BI-HRIM-distal (r = -0.44) than CSI-5 (r = -0.33), BI-HRIM-5 (r = -0.28), or distal MNBI (r < -0.36). When compared to AET <4%, patients with AET >6% had significantly lower CSI-distal and BI-HRIM-distal values but not CSI-5, BI-HRIM-5, or MNBI. ROC areas under the curve for AET >6% were numerically higher for CSI-distal (0.81) than BI-HRIM-distal (0.77), distal MNBI (0.68-0.75), CSI-5 (0.68), or BI-HRIM-5 (0.68). CSI from HRIM studies inversely correlates with pathologic AET and has potential to augment the evaluation of GERD.
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Affiliation(s)
- Anthony Horton
- Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA.,Division of Gastroenterology, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Shai Posner
- Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA.,Division of Gastroenterology, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Brian Sullivan
- Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA.,Division of Gastroenterology, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Jennifer Cornejo
- Division of Gastroenterology, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Andrea Davis
- Division of Gastroenterology, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Monika Fields
- Division of Gastroenterology, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Thasha McIntosh
- Division of Gastroenterology, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Ziad Gellad
- Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA.,Division of Gastroenterology, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Rahul Shimpi
- Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA
| | - Amit Patel
- Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA.,Division of Gastroenterology, Durham Veterans Affairs Medical Center, Durham, NC, USA
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10
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Horton A, Sullivan B, Charles K, McIntosh T, Davis A, Gellad Z, Shimpi R, Gyawali CP, Patel A. Esophageal Baseline Impedance From High-resolution Impedance Manometry Correlates With Mean Nocturnal Baseline Impedance From pH-impedance Monitoring. J Neurogastroenterol Motil 2020; 26:455-462. [PMID: 32388941 PMCID: PMC7547185 DOI: 10.5056/jnm19142] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/04/2019] [Accepted: 12/30/2019] [Indexed: 12/20/2022] Open
Abstract
Background/Aims Esophageal baseline impedance (BI) can be extracted from pH-impedance tracings as mean nocturnal baseline impedance (MNBI), and from high-resolution impedance manometry (HRIM), but it is unknown if values are similar between acquisition methods across HRIM manufacturers. We aim to assess correlations between MNBI and BI from HRIM (BI-HRIM) from 2 HRIM manufacturers in the setting of physiologic acid exposure time (AET). Methods HRIM and pH-impedance monitoring demonstrating physiologic AET (< 4%) off proton pump inhibitors were required. BI-HRIM was extracted as the average from 5 cm and 10 cm above the lower esophageal sphincter. Distal BI-HRIM (DBI-HRIM) was also extracted from the most distal channel (Medtronic studies). MNBI was extracted from 6 channels. Concordance between BI-HRIM across manufacturers with MNBI was analyzed. Results Thirty-six patients met the inclusion criteria (59.6 ± 1.7 years; 22% female; body mass index 30.5 ± 0.7; AET 1.6 ± 0.2%). Although MNBI was similar at all channels (P ≥ 0.18), Diversatek BI-HRIM was lower than Medtronic BI-HRIM (P = 0.003). Overall, BI-HRIM correlated with MNBI at corresponding recording sites, 7 cm and 9 cm (P < 0.05), but not at other sites (P ≥ 0.19). Pearson’s correlations > 0.5 were seen at MNBI at 7 cm for both systems, and at 9 cm for Medtronic. DBI-HRIM correlated with MNBI at 3 cm and 5 cm (P < 0.03), but not at other locations (P > 0.1). Conclusions While numeric differences exist between manufacturers, BI-HRIM correlates with MNBI from corresponding channels in patients with physiologic AET. Comparison with AET elevation is needed to determine correlations between pathologic MNBI with BI-HRIM across manufacturers. The optimal HRIM channels from which BI values should be extracted also warrants further study.
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Affiliation(s)
- Anthony Horton
- Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA
| | - Brian Sullivan
- Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA.,Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Katie Charles
- Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA
| | | | - Andrea Davis
- Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Ziad Gellad
- Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA.,Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Rahul Shimpi
- Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA
| | - Amit Patel
- Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA.,Durham Veterans Affairs Medical Center, Durham, NC, USA
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11
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Shimpi R, Patel D, Raval K. Human urinary myiasis by Psychoda albipennis: A case report and review of literature. Urol Case Rep 2018; 21:122-123. [PMID: 30294551 PMCID: PMC6168961 DOI: 10.1016/j.eucr.2018.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 08/22/2018] [Indexed: 11/18/2022] Open
Affiliation(s)
- R Shimpi
- Department of Urology, Ruby Hall Clinic, Pune, India
| | - Darshan Patel
- Department of Urology, Ruby Hall Clinic, Pune, India
| | - K Raval
- Department of Urology, Ruby Hall Clinic, Pune, India
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12
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Murhekar MV, Ahmad M, Shukla H, Abhishek K, Perry RT, Bose AS, Shimpi R, Kumar A, Kaliaperumal K, Sethi R, Selvaraj V, Kamaraj P, Routray S, Das VN, Menabde N, Bahl S. Measles case fatality rate in Bihar, India, 2011-12. PLoS One 2014; 9:e96668. [PMID: 24824641 PMCID: PMC4019661 DOI: 10.1371/journal.pone.0096668] [Citation(s) in RCA: 8] [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] [Received: 11/05/2013] [Accepted: 04/10/2014] [Indexed: 11/22/2022] Open
Abstract
Background Updated estimates of measles case fatality rates (CFR) are critical for monitoring progress towards measles elimination goals. India accounted for 36% of total measles deaths occurred globally in 2011. We conducted a retrospective cohort study to estimate measles CFR and identify the risk factors for measles death in Bihar–one of the north Indian states historically known for its low vaccination coverage. Methods We systematically selected 16 of the 31 laboratory-confirmed measles outbreaks occurring in Bihar during 1 October 2011 to 30 April 2012. All households of the villages/urban localities affected by these outbreaks were visited to identify measles cases and deaths. We calculated CFR and used multivariate analysis to identify risk factors for measles death. Results The survey found 3670 measles cases and 28 deaths (CFR: 0.78, 95% confidence interval: 0.47–1.30). CFR was higher among under-five children (1.22%) and children belonging to scheduled castes/tribes (SC/ST, 1.72%). On multivariate analysis, independent risk factors associated with measles death were age <5 years, SC/ST status and non-administration of vitamin A during illness. Outbreaks with longer interval between the occurrence of first case and notification of the outbreak also had a higher rate of deaths. Conclusions Measles CFR in Bihar was low. To further reduce case fatality, health authorities need to ensure that SC/ST are targeted by the immunization programme and that outbreak investigations target for vitamin A treatment of cases in high risk groups such as SC/ST and young children and ensure regular visits by health-workers in affected villages to administer vitamin A to new cases.
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Affiliation(s)
| | - Mohammad Ahmad
- World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India
| | - Hemant Shukla
- World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India; World Health Organization, Geneva, Switzerland
| | - Kunwar Abhishek
- World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India
| | | | - Anindya S Bose
- World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India; Bill and Melinda Gates Foundation, New Delhi, India
| | - Rahul Shimpi
- World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India
| | - Arun Kumar
- World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India
| | | | - Raman Sethi
- World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India
| | | | | | - Satyabrata Routray
- World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India
| | - Vidya Nand Das
- Rajendra Memorial Research Institute for Medical Sciences, Patna, Bihar
| | - Nata Menabde
- World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India
| | - Sunil Bahl
- World Health Organization- Country Office for India, National Polio Surveillance Project, New Delhi, India
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