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Kaur G, Danovaro-Holliday MC, Mwinnyaa G, Gacic-Dobo M, Francis L, Grevendonk J, Sodha SV, Sugerman C, Wallace A. Routine Vaccination Coverage - Worldwide, 2022. MMWR Morb Mortal Wkly Rep 2023; 72:1155-1161. [PMID: 37883326 PMCID: PMC10602616 DOI: 10.15585/mmwr.mm7243a1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
In 2020, the World Health Assembly endorsed the Immunization Agenda 2030 (IA2030), the 2021-2030 global strategy that envisions a world where everyone, everywhere, at every age, fully benefits from vaccines. This report reviews trends in World Health Organization and UNICEF immunization coverage estimates at global, regional, and national levels through 2022 and documents progress toward improving coverage with respect to the IA2030 strategy, which aims to reduce the number of children who have not received the first dose of a diphtheria-tetanus-pertussis-containing vaccine (DTPcv1) worldwide by 50% and to increase coverage with 3 diphtheria-tetanus-pertussis-containing vaccine doses (DTPcv3) to 90%. Worldwide, coverage ≥1 dose of DTPcv1 increased from 86% in 2021 to 89% in 2022 but remained below the 90% coverage achieved in 2019. Estimated DTPcv3 coverage increased from 81% in 2021 to 84% in 2022 but also remained below the 2019 coverage of 86%. Worldwide in 2022, 14.3 million children were not vaccinated with DTPcv1, a 21% decrease from 18.1 million in 2021, but an 11% increase from 12.9 million in 2019. Most children (84%) who did not receive DTPcv1 in 2022 lived in low- and lower-middle-income countries. COVID-19 pandemic-associated immunization recovery occurred in 2022 at the global level, but progress was unevenly distributed, especially among low-income countries. Urgent action is needed to provide incompletely vaccinated children with catch-up vaccinations that were missed during the pandemic, restore national vaccination coverage to prepandemic levels, strengthen immunization programs to build resiliency to withstand future unforeseen public health events, and further improve coverage to protect children from vaccine-preventable diseases.
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Belt RV, Abdullah S, Mounier-Jack S, Sodha SV, Danielson N, Dadari I, Olayinka F, Ray A, Crocker-Buque T. Improving Equity in Urban Immunization in Low- and Middle-Income Countries: A Qualitative Document Review. Vaccines (Basel) 2023; 11:1200. [PMID: 37515016 PMCID: PMC10386579 DOI: 10.3390/vaccines11071200] [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: 05/10/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION As the world continues to urbanize, particularly in low- and middle-income countries, understanding the barriers and effective interventions to improve urban immunization equity is critical to achieving both Immunization Agenda 2030 targets and the Sustainable Development Goals. Approximately 25 million children missed one or more doses of the diphtheria, tetanus and pertussis (DTP3) vaccine in 2021 and it is estimated that close to 30% of the world's children missing the first dose of DTP, known as zero-dose, live in urban and peri-urban settings. METHODS The aim of this research is to improve understanding of urban immunization equity through a qualitative review of mixed method studies, urban immunization strategies and funding proposals across more than 70 urban areas developed between 2016 and 2020, supported by Gavi, the Vaccine Alliance. These research studies and strategies created a body of evidence regarding the barriers to vaccination in urban settings and potential interventions relevant to low- and middle-income countries (LMICs) with a focus on the vaccination of urban poor, populations of concern and residents of informal settlements. Through the document review we identified common challenges to achieving equitable coverage in urban areas and mapped proposed interventions. RESULTS We identified 70 documents as part of the review and categorized results across (1) social determinants of health, (2) immunization service-delivery barriers and (3) quality of services. Barriers and solutions identified in the documents were categorized in these thematic areas, drawing information from results in more than 21 countries. CONCLUSION Populations of concern such as migrants, refugees, residents of informal settlements and the urban poor face barriers to accessing care which include poor availability and quality of service. Example solutions proposed to these challenges include tailored delivery strategies, improved use of digital data collection and child-friendly services. More research is required on the efficacy of the proposed interventions identified and on gender-specific dynamics in urban poor areas affecting equitable immunization coverage.
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Affiliation(s)
- Rachel Victoria Belt
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, 75 George Street, Oxford OX1 2RL, UK
| | - Shakil Abdullah
- Department of Anthropology, University of Connecticut, Storrs, CT 06269, USA
| | - Sandra Mounier-Jack
- Department of Global Health Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Samir V. Sodha
- Department of Immunization Vaccines and Biologicals, WHO Headquarters, Avenue Appia 20, 1202 Geneva, Switzerland
| | - Niklas Danielson
- Coverage & Equity Unit, Immunization Section, PG-Health, UNICEF Headquarters, 3 UN Plaza, New York, NY 10017, USA
| | - Ibrahim Dadari
- Coverage & Equity Unit, Immunization Section, PG-Health, UNICEF Headquarters, 3 UN Plaza, New York, NY 10017, USA
| | - Folake Olayinka
- Public Health Institute, STAR Fellow Department, 901 D St, SW, Suite 1040, Washington, DC 20024, USA
| | - Arindam Ray
- Bill & Melinda Gates Foundation, New Delhi 110075, India
| | - Tim Crocker-Buque
- Department of Global Health Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Dadari I, Belt RV, Iyengar A, Ray A, Hossain I, Ali D, Danielsson N, Sodha SV. Achieving the IA2030 Coverage and Equity Goals through a Renewed Focus on Urban Immunization. Vaccines (Basel) 2023; 11:809. [PMID: 37112721 PMCID: PMC10147013 DOI: 10.3390/vaccines11040809] [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: 02/25/2023] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
The 2021 WHO and UNICEF Estimates of National Immunization Coverage (WUENIC) reported approximately 25 million under-vaccinated children in 2021, out of which 18 million were zero-dose children who did not receive even the first dose of a diphtheria-tetanus-pertussis-(DPT) containing vaccine. The number of zero-dose children increased by six million between 2019, the pre-pandemic year, and 2021. A total of 20 countries with the highest number of zero-dose children and home to over 75% of these children in 2021 were prioritized for this review. Several of these countries have substantial urbanization with accompanying challenges. This review paper summarizes routine immunization backsliding following the COVID-19 pandemic and predictors of coverage and identifies pro-equity strategies in urban and peri-urban settings through a systematic search of the published literature. Two databases, PubMed and Web of Science, were exhaustively searched using search terms and synonyms, resulting in 608 identified peer-reviewed papers. Based on the inclusion criteria, 15 papers were included in the final review. The inclusion criteria included papers published between March 2020 and January 2023 and references to urban settings and COVID-19 in the papers. Several studies clearly documented a backsliding of coverage in urban and peri-urban settings, with some predictors or challenges to optimum coverage as well as some pro-equity strategies deployed or recommended in these studies. This emphasizes the need to focus on context-specific routine immunization catch-up and recovery strategies to suit the peculiarities of urban areas to get countries back on track toward achieving the targets of the IA2030. While more evidence is needed around the impact of the pandemic in urban areas, utilizing tools and platforms created to support advancing the equity agenda is pivotal. We posit that a renewed focus on urban immunization is critical if we are to achieve the IA2030 targets.
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Affiliation(s)
- Ibrahim Dadari
- Coverage & Equity Unit, Immunization Section, PG-Health, UNICEF Headquarters, 3 UN Plaza, New York, NY 10017, USA
- College of Public Health, University of South Florida, Tampa, FL 33612, USA
| | - Rachel V. Belt
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, 75 George Street, Oxford OX1 2JD, UK
| | - Ananya Iyengar
- Coverage & Equity Unit, Immunization Section, PG-Health, UNICEF Headquarters, 3 UN Plaza, New York, NY 10017, USA
- Johns Hopkins Bloomberg School of Public Health, International Vaccine Access Center (IVAC), Baltimore, MD 21231, USA
| | - Arindam Ray
- New Vaccines and Immunization Systems, Bill and Melinda Gates Foundation, New Delhi 110067, India
| | - Iqbal Hossain
- John Snow, Inc., 2733 Crystal Drive, Arlington, VA 22202, USA
| | - Daniel Ali
- Johns Hopkins Bloomberg School of Public Health, International Vaccine Access Center (IVAC), Baltimore, MD 21231, USA
| | - Niklas Danielsson
- Coverage & Equity Unit, Immunization Section, PG-Health, UNICEF Headquarters, 3 UN Plaza, New York, NY 10017, USA
| | - Samir V. Sodha
- Department of Immunization Vaccines and Biologicals, WHO Headquarters, Avenue Appia 20, 1211 Geneva, Switzerland
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Manandhar P, Wannemuehler K, Danovaro-Holliday MC, Nic Lochlainn L, Shendale S, Sodha SV. Corrigendum to "Use of catch-up vaccinations in the second year of life (2YL) platform to close immunity gaps: A secondary DHS analysis in Pakistan, Philippines, and South Africa" [Vaccine 41(1) (2023) 61-67]. Vaccine 2023; 41:2423-2424. [PMID: 36898930 PMCID: PMC9993170 DOI: 10.1016/j.vaccine.2023.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Affiliation(s)
- Porcia Manandhar
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Kathleen Wannemuehler
- Department of Biostatistics & Medical Informatics, University of Wisconsin - Madison, WI, USA
| | | | - Laura Nic Lochlainn
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Stephanie Shendale
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Samir V Sodha
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
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Wallace AS, Ryman TK, Privor-Dumm L, Morgan C, Fields R, Garcia C, Sodha SV, Lindstrand A, Nic Lochlainn LM. Leaving no one behind: Defining and implementing an integrated life course approach to vaccination across the next decade as part of the immunization Agenda 2030. Vaccine 2022:S0264-410X(22)01452-9. [PMID: 36503859 PMCID: PMC10414185 DOI: 10.1016/j.vaccine.2022.11.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 05/12/2021] [Revised: 10/12/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022]
Abstract
Strategic Priority 4 (SP4) of the Immunization Agenda 2030 aims to ensure that all people benefit from recommended immunizations throughout the life-course, integrated with essential health services. Therefore, it is necessary for immunization programs to have coordination and collaboration across all health programs. Although there has been progress, immunization platforms in the second year of life and beyond need continued strengthening, including booster doses and catch-up vaccination, for all ages, and recommended vaccines for older age groups. We note gaps in current vaccination programs policies and achieved coverage, in the second year of life and beyond. In 2021, the second dose of measles-containing vaccine (MCV2), given in the second year of life, achieved 71% global coverage vs 81% for MCV1. For adolescents, 60% of all countries have adopted human papillomavirus vaccines in their vaccination schedule with a global coverage rate of only 12 percent in 2021. Approximately 65% of the countries recommend influenza vaccines for older adults, high-risk adults and pregnant women, and only 25% recommended pneumococcal vaccines for older adults. To achieve an integrated life course approach to vaccination, we reviewed the evidence, gaps, and strategies in four focus areas: generating evidence for disease burden and potential vaccine impact in older age groups; building awareness and shifting policy beyond early childhood; building integrated delivery approaches throughout the life course; and identifying missed opportunities for vaccination, implementing catch-up strategies, and monitoring vaccination throughout the life course. We identified needs, such as tailoring strategies to the local context, conducting research and advocacy to mobilize resources and build political will. Mustering sufficient financial support and demand for an integrated life course approach to vaccination, particularly in times of COVID-19, is both a challenge and an opportunity.
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Affiliation(s)
- A S Wallace
- Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - T K Ryman
- Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - L Privor-Dumm
- Johns Hopkins Bloomberg School of Public Health, International Vaccine Access Center, Baltimore, MD, United States
| | - C Morgan
- Jhpiego, the Johns Hopkins University affiliate, Baltimore, MD, United States
| | - R Fields
- John Snow Inc., Arlington, VA, United States
| | - C Garcia
- Johns Hopkins Bloomberg School of Public Health, International Vaccine Access Center, Baltimore, MD, United States
| | - S V Sodha
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - A Lindstrand
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - L M Nic Lochlainn
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
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Blanc DC, Grundy J, Sodha SV, O'Connell TS, von Mühlenbrock HJM, Grevendonk J, Ryman T, Patel M, Olayinka F, Brooks A, Wahl B, Bar-Zeev N, Nandy R, Lindstrand A. Immunization programs to support primary health care and achieve universal health coverage. Vaccine 2022:S0264-410X(22)01218-X. [PMID: 36503857 DOI: 10.1016/j.vaccine.2022.09.086] [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: 05/19/2021] [Accepted: 09/28/2022] [Indexed: 12/13/2022]
Abstract
Gains in immunization coverage and delivery of primary health care service have stagnated in recent years. Remaining gaps in service coverage reflect multiple underlying reasons that may be amenable to improved health system design. Immunization systems and other primary health care services can be mutually supportive, for improved service delivery and for strengthening of Universal Health Coverage. Improvements require that dynamic and multi-faceted barriers and risks be addressed. These include workforce availability, quality data systems and use, leadership and management that is innovative, flexible, data driven and responsive to local needs. Concurrently, improvements in procurement, supply chain, logistics and delivery systems, and integrated monitoring of vaccine coverage and epidemiological disease surveillance with laboratory systems, and vaccine safety will be needed to support community engagement and drive prioritized actions and communication. Finally, political will and sustained resource commitment with transparent accountability mechanisms are required. The experience of the impact of COVID-19 pandemic on essential PHC services and the challenges of vaccine roll-out affords an opportunity to apply lessons learned in order to enhance vaccine services integrated with strong primary health care services and universal health coverage across the life course.
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Affiliation(s)
- Diana Chang Blanc
- Department of Immunizations, Vaccines & Biologicals, World Health Organization, Geneva, Switzerland
| | - John Grundy
- James Cook University, Queensland, Australia
| | - Samir V Sodha
- Department of Immunizations, Vaccines & Biologicals, World Health Organization, Geneva, Switzerland
| | - Thomas S O'Connell
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | | | - Jan Grevendonk
- Department of Immunizations, Vaccines & Biologicals, World Health Organization, Geneva, Switzerland
| | - Tove Ryman
- Bill and Melinda Gates Foundation, Seattle WA, United States
| | - Minal Patel
- Department of Immunizations, Vaccines & Biologicals, World Health Organization, Geneva, Switzerland
| | - Folake Olayinka
- U.S. Agency for International Development, Washington, United States
| | | | - Brian Wahl
- International Vaccine Access Center, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Naor Bar-Zeev
- International Vaccine Access Center, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Robin Nandy
- Health Section, Program Division, United Nations Children's Fund, NY, United States
| | - Ann Lindstrand
- Department of Immunizations, Vaccines & Biologicals, World Health Organization, Geneva, Switzerland.
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Rachlin A, Danovaro-Holliday MC, Murphy P, Sodha SV, Wallace AS. Routine Vaccination Coverage - Worldwide, 2021. MMWR Morb Mortal Wkly Rep 2022; 71:1396-1400. [PMID: 36327156 PMCID: PMC9639437 DOI: 10.15585/mmwr.mm7144a2] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
In 2020, the World Health Assembly endorsed the Immunization Agenda 2030, an ambitious global immunization strategy to reduce morbidity and mortality from vaccine-preventable diseases (1). This report updates a 2020 report (2) with global, regional,* and national vaccination coverage estimates and trends through 2021. Global estimates of coverage with 3 doses of diphtheria-tetanus-pertussis-containing vaccine (DTPcv3) decreased from an average of 86% during 2015-2019 to 83% in 2020 and 81% in 2021. Worldwide in 2021, 25.0 million infants (19% of the target population) were not vaccinated with DTPcv3, 2.1 million more than in 2020 and 5.9 million more than in 2019. In 2021, the number of infants who did not receive any DTPcv dose by age 12 months (18.2 million) was 37% higher than in 2019 (13.3 million). Coverage with the first dose of measles-containing vaccine (MCV1) decreased from an average of 85% during 2015-2019 to 84% in 2020 and 81% in 2021. These are the lowest coverage levels for DTPcv3 and MCV1 since 2008. Global coverage estimates were also lower in 2021 than in 2020 and 2019 for bacillus Calmette-Guérin vaccine (BCG) as well as for the completed series of Haemophilus influenzae type b vaccine (Hib), hepatitis B vaccine (HepB), polio vaccine (Pol), and rubella-containing vaccine (RCV). The COVID-19 pandemic has resulted in disruptions to routine immunization services worldwide. Full recovery to immunization programs will require context-specific strategies to address immunization gaps by catching up missed children, prioritizing essential health services, and strengthening immunization programs to prevent outbreaks (3).
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Mahachi K, Kessels J, Boateng K, Jean Baptiste Achoribo AE, Mitula P, Ekeman E, Nic Lochlainn L, Rosewell A, Sodha SV, Abela-Ridder B, Gabrielli AF. Zero- or missed-dose children in Nigeria: Contributing factors and interventions to overcome immunization service delivery challenges. Vaccine 2022; 40:5433-5444. [PMID: 35973864 PMCID: PMC9485449 DOI: 10.1016/j.vaccine.2022.07.058] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 06/11/2022] [Accepted: 07/24/2022] [Indexed: 11/28/2022]
Abstract
Comprehensive review of recent literature on zero- or missed-dose children in Nigeria. Risk factors are well-known and widely studied. Literature on interventions was scattered, and focussed on campaigns and polio. Gaps exist in investigating how to deliver sustainable immunization programs. Further work is needed to operationalise findings of this review.
'Zero-dose' refers to a person who does not receive a single dose of any vaccine in the routine national immunization schedule, while ‘missed dose’ refers to a person who does not complete the schedule. These people remain vulnerable to vaccine-preventable diseases, and are often already disadvantaged due to poverty, conflict, and lack of access to basic health services. Globally, more 22.7 million children are estimated to be zero- or missed-dose, of which an estimated 3.1 million (∼14 %) reside in Nigeria. We conducted a scoping review to synthesize recent literature on risk factors and interventions for zero- and missed-dose children in Nigeria. Our search identified 127 papers, including research into risk factors only (n = 66); interventions only (n = 34); both risk factors and interventions (n = 18); and publications that made recommendations only (n = 9). The most frequently reported factors influencing childhood vaccine uptake were maternal factors (n = 77), particularly maternal education (n = 22) and access to ante- and perinatal care (n = 19); heterogeneity between different types of communities – including location, region, wealth, religion, population composition, and other challenges (n = 50); access to vaccination, i.e., proximity of facilities with vaccines and vaccinators (n = 37); and awareness about immunization – including safety, efficacy, importance, and schedules (n = 18). Literature assessing implementation of interventions was more scattered, and heavily skewed towards vaccination campaigns and polio eradication efforts. Major evidence gaps exist in how to deliver effective and sustainable routine childhood immunization. Overall, further work is needed to operationalise the learnings from these studies, e.g. through applying findings to Nigeria’s next review of vaccination plans, and using this summary as a basis for further investigation and specific recommendations on effective interventions.
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Affiliation(s)
- Kurayi Mahachi
- College of Public Health, University of Iowa, Iowa City, Iowa, United States
| | | | - Kofi Boateng
- Nigeria Country Office, World Health Organization, Abuja, Nigeria
| | | | - Pamela Mitula
- Inter-Country Support Team, Regional Office for Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Ebru Ekeman
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Laura Nic Lochlainn
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Alexander Rosewell
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Samir V Sodha
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Bernadette Abela-Ridder
- Department of Control of Neglected Tropical Diseases (NTD), World Health Organization, Geneva, Switzerland
| | - Albis Francesco Gabrielli
- Department of Control of Neglected Tropical Diseases (NTD), World Health Organization, Geneva, Switzerland.
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Johns NE, Hosseinpoor AR, Chisema M, Danovaro-Holliday MC, Kirkby K, Schlotheuber A, Shibeshi M, Sodha SV, Zimba B. Association between childhood immunisation coverage and proximity to health facilities in rural settings: a cross-sectional analysis of Service Provision Assessment 2013-2014 facility data and Demographic and Health Survey 2015-2016 individual data in Malawi. BMJ Open 2022; 12:e061346. [PMID: 35879002 PMCID: PMC9328092 DOI: 10.1136/bmjopen-2022-061346] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Despite significant progress in childhood vaccination coverage globally, substantial inequality remains. Remote rural populations are recognised as a priority group for immunisation service equity. We aimed to link facility and individual data to examine the relationship between distance to services and immunisation coverage empirically, specifically using a rural population. DESIGN AND SETTING Retrospective cross-sectional analysis of facility data from the 2013-2014 Malawi Service Provision Assessment and individual data from the 2015-2016 Malawi Demographic and Health Survey, linking children to facilities within a 5 km radius. We examined associations between proximity to health facilities and vaccination receipt via bivariate comparisons and logistic regression models. PARTICIPANTS 2740 children aged 12-23 months living in rural areas. OUTCOME MEASURES Immunisation coverage for the six vaccines included in the Malawi Expanded Programme on Immunization schedule for children under 1 year at time of study, as well as two composite vaccination indicators (receipt of basic vaccines and receipt of all recommended vaccines), zero-dose pentavalent coverage, and pentavalent dropout. FINDINGS 72% (706/977) of facilities offered childhood vaccination services. Among children in rural areas, 61% were proximal to (within 5 km of) a vaccine-providing facility. Proximity to a vaccine-providing health facility was associated with increased likelihood of having received the rotavirus vaccine (93% vs 88%, p=0.004) and measles vaccine (93% vs 89%, p=0.01) in bivariate tests. In adjusted comparisons, how close a child was to a health facility remained meaningfully associated with how likely they were to have received rotavirus vaccine (adjusted OR (AOR) 1.63, 95% CI 1.13 to 2.33) and measles vaccine (AOR 1.62, 95% CI 1.11 to 2.37). CONCLUSION Proximity to health facilities was significantly associated with likelihood of receipt for some, but not all, vaccines. Our findings reiterate the vulnerability of children residing far from static vaccination services; efforts that specifically target remote rural populations living far from health facilities are warranted to ensure equitable vaccination coverage.
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Affiliation(s)
- Nicole E Johns
- Department of Data and Analytics, World Health Organization, Geneve, Switzerland
| | | | - Mike Chisema
- Preventive Health Services and Expanded Program on Immunization, Malawi Ministry of Health, Lilongwe, Malawi
| | | | - Katherine Kirkby
- Department of Data and Analytics, World Health Organization, Geneve, Switzerland
| | - Anne Schlotheuber
- Department of Data and Analytics, World Health Organization, Geneve, Switzerland
| | - Messeret Shibeshi
- Inter-Country Support Team for East and Southern Africa, World Health Organization, Harare, Zimbabwe
| | - Samir V Sodha
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneve, Switzerland
| | - Boston Zimba
- Malawi Country Office, World Health Organization, Lilongwe, Malawi
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Bergen N, Cata-Preta BO, Schlotheuber A, Santos TM, Danovaro-Holliday MC, Mengistu T, Sodha SV, Hogan DR, Barros AJD, Hosseinpoor AR. Economic-Related Inequalities in Zero-Dose Children: A Study of Non-Receipt of Diphtheria-Tetanus-Pertussis Immunization Using Household Health Survey Data from 89 Low- and Middle-Income Countries. Vaccines (Basel) 2022; 10:vaccines10040633. [PMID: 35455382 PMCID: PMC9028918 DOI: 10.3390/vaccines10040633] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 02/04/2023] Open
Abstract
Despite advances in scaling up new vaccines in low- and middle-income countries, the global number of unvaccinated children has remained high over the past decade. We used 2000–2019 household survey data from 154 surveys representing 89 low- and middle-income countries to assess within-country, economic-related inequality in the prevalence of one-year-old children with zero doses of diphtheria–tetanus–pertussis (DTP) vaccine. Zero-dose DTP prevalence data were disaggregated by household wealth quintile. Difference, ratio, slope index of inequality, concentration index, and excess change measures were calculated to assess the latest situation and change over time, by country income grouping for 17 countries with high zero-dose DTP numbers and prevalence. Across 89 countries, the median prevalence of zero-dose DTP was 7.6%. Within-country inequalities mostly favored the richest quintile, with 19 of 89 countries reporting a rich–poor gap of ≥20.0 percentage points. Low-income countries had higher inequality than lower–middle-income countries and upper–middle-income countries (difference between the median prevalence in the poorest and richest quintiles: 14.4, 8.9, and 2.7 percentage points, respectively). Zero-dose DTP prevalence among the poorest households of low-income countries declined between 2000 and 2009 and between 2010 and 2019, yet economic-related inequality remained high in many countries. Widespread economic-related inequalities in zero-dose DTP prevalence are particularly pronounced in low-income countries and have remained high over the previous decade.
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Affiliation(s)
- Nicole Bergen
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (N.B.); (A.S.)
| | - Bianca O. Cata-Preta
- International Center for Equity in Health, Federal University of Pelotas, Rua Mal Deodoro 1160, Pelotas 96020-220, Brazil; (B.O.C.-P.); (T.M.S.); (A.J.D.B.)
| | - Anne Schlotheuber
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (N.B.); (A.S.)
| | - Thiago M. Santos
- International Center for Equity in Health, Federal University of Pelotas, Rua Mal Deodoro 1160, Pelotas 96020-220, Brazil; (B.O.C.-P.); (T.M.S.); (A.J.D.B.)
| | - M. Carolina Danovaro-Holliday
- Department of Immunization, Vaccines and Biologicals, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (M.C.D.-H.); (S.V.S.)
| | - Tewodaj Mengistu
- Gavi, The Vaccine Alliance, 40 Chemin du Pommier, 1218 Geneva, Switzerland; (T.M.); (D.R.H.)
| | - Samir V. Sodha
- Department of Immunization, Vaccines and Biologicals, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (M.C.D.-H.); (S.V.S.)
| | - Daniel R. Hogan
- Gavi, The Vaccine Alliance, 40 Chemin du Pommier, 1218 Geneva, Switzerland; (T.M.); (D.R.H.)
| | - Aluisio J. D. Barros
- International Center for Equity in Health, Federal University of Pelotas, Rua Mal Deodoro 1160, Pelotas 96020-220, Brazil; (B.O.C.-P.); (T.M.S.); (A.J.D.B.)
| | - Ahmad Reza Hosseinpoor
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (N.B.); (A.S.)
- Correspondence: ; Tel.: +41-22-791-3205
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Ho LL, Gurung S, Mirza I, Nicolas HD, Steulet C, Burman AL, Danovaro-Holliday MC, Sodha SV, Kretsinger K. Impact of the SARS-CoV-2 pandemic on vaccine-preventable disease campaigns. Int J Infect Dis 2022; 119:201-209. [PMID: 35398300 PMCID: PMC8985404 DOI: 10.1016/j.ijid.2022.04.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [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] [Received: 12/01/2021] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has contributed to the widespread disruption of immunization services, including the postponement of mass vaccination campaigns. METHODS In May 2020, the World Health Organization (WHO) and partners started monitoring COVID-19-related disruptions to mass vaccination campaigns against cholera, measles, meningitis A, polio, tetanus-diphtheria, typhoid and yellow fever through the Immunization Repository Campaign Delay Tracker. The authors reviewed the number and target population of reported preventive and outbreak response vaccination campaigns scheduled, postponed, canceled and reinstated, at four time-points: May 2020, December 2020, May 2021 and December 2021. FINDINGS Mass vaccination campaigns across all vaccines were disrupted heavily by COVID-19. In May 2020, 105 of 183 (57%) campaigns were postponed or canceled in 57 countries due to COVID-19, with an estimated 796 million postponed or missed vaccine doses. Campaign resumption was observed beginning in July 2020. In December 2021, 77 of 472 (16%) campaigns in 54 countries, mainly in the African Region, were still postponed or canceled due to COVID-19, with about 382 million postponed or missed vaccine doses. INTERPRETATION There is likely high risk of vaccine-preventable disease outbreaks due to an increased number of susceptible persons resulting from the large-scale mass vaccination campaign postponement caused by COVID-19 across all regions.
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Affiliation(s)
- Lee Lee Ho
- World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland.
| | - Santosh Gurung
- World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Imran Mirza
- United Nations Children's Fund, 125 Maiden Lane, New York, NY 10038, USA
| | | | - Claudia Steulet
- World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Ashley L Burman
- World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - Samir V Sodha
- World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
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Shet A, Carr K, Danovaro-Holliday MC, Sodha SV, Prosperi C, Wunderlich J, Wonodi C, Reynolds HW, Mirza I, Gacic-Dobo M, O'Brien KL, Lindstrand A. Impact of the SARS-CoV-2 pandemic on routine immunisation services: evidence of disruption and recovery from 170 countries and territories. The Lancet Global Health 2022; 10:e186-e194. [PMID: 34951973 PMCID: PMC8691849 DOI: 10.1016/s2214-109x(21)00512-x] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/29/2021] [Accepted: 10/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background The SARS-CoV-2 pandemic has revealed the vulnerability of immunisation systems worldwide, although the scale of these disruptions has not been described at a global level. This study aims to assess the impact of COVID-19 on routine immunisation using triangulated data from global, country-based, and individual-reported sources obtained during the pandemic period. Methods This report synthesised data from 170 countries and territories. Data sources included administered vaccine-dose data from January to December, 2019, and January to December, 2020, WHO regional office reports, and a WHO-led pulse survey administered in April, 2020, and June, 2020. Results were expressed as frequencies and proportions of respondents or reporting countries. Data on vaccine doses administered were weighted by the population of surviving infants per country. Findings A decline in the number of administered doses of diphtheria–pertussis–tetanus-containing vaccine (DTP3) and first dose of measles-containing vaccine (MCV1) in the first half of 2020 was noted. The lowest number of vaccine doses administered was observed in April, 2020, when 33% fewer DTP3 doses were administered globally, ranging from 9% in the WHO African region to 57% in the South-East Asia region. Recovery of vaccinations began by June, 2020, and continued into late 2020. WHO regional offices reported substantial disruption to routine vaccination sessions in April, 2020, related to interrupted vaccination demand and supply, including reduced availability of the health workforce. Pulse survey analysis revealed that 45 (69%) of 65 countries showed disruption in outreach services compared with 27 (44%) of 62 countries with disrupted fixed-post immunisation services. Interpretation The marked magnitude and global scale of immunisation disruption evokes the dangers of vaccine-preventable disease outbreaks in the future. Trends indicating partial resumption of services highlight the urgent need for ongoing assessment of recovery, catch-up vaccination strategy implementation for vulnerable populations, and ensuring vaccine coverage equity and health system resilience. Funding US Agency for International Development.
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Dzeyie KA, Dhanapaul S, Rubeshkumar P, Desing S, Vignesh MS, Raveendran I, Kumar P, Kathuria S, Choudhary S, Saroha E, Siromany V, Raju M, Ganeshkumar P, Ponnaiah M, Sodha SV, Laserson K, Bhatnagar T, Kapoor L, Bahl A, Jain SK, Gupta S, Murhekar MV, Singh SK. Outbreak of ceftriaxone-resistant Salmonella enterica serotype Typhi-Tiruchirappalli, Tamil Nadu, India, June 2018. IJID Regions 2021; 1:60-64. [PMID: 35757827 PMCID: PMC9216270 DOI: 10.1016/j.ijregi.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
Surveillance detected ceftriaxone-resistant Salmonella enterica serotype Typhi Investigation revealed illness associated with eating in a restaurant Illness likely due to contaminated food and use of unchlorinated water Investigation highlights the value of surveillance in detecting emerging pathogens Timely and detailed investigations and strengthening of food safety are required
Objectives In May 2018, a laboratory network for antimicrobial resistance (AMR) surveillance in Tamil Nadu, India, detected a cluster of Salmonella enterica serotype Typhi (S. Typhi) isolates resistant to ceftriaxone. We investigated to describe the epidemiology and identify risk factors for the outbreak. Methods We conducted unmatched case-control studies. We defined a case as illness (fever with abdominal pain, diarrhea or vomiting) in a person with blood culture-confirmed ceftriaxone-resistant S. Typhi isolated between January 1 and July 4, 2018 in Tiruchirappalli, Tamil Nadu. We interviewed cases using a semi-structured questionnaire to identify common exposures to food, water and places visited. Results We identified 7 cases (5 men) during March 25–June 8, 2018, median age 23 years (range: 12–42); all were hospitalized, none died. Eating at Restaurant A (odds ratio [OR]=22) and chicken gravy (OR=16) was associated with illness. Of the 10 workers at Restaurant A, stool culture from 8 did not detect S. Typhi; 2 did not consent to provide samples. Five water samples around the restaurant showed low or no residual chlorine content. Conclusions The investigation highlights the value of AMR surveillance in detecting emerging pathogens and the need for timely investigations, along with strengthening food safety.
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Affiliation(s)
- Kevisetuo A. Dzeyie
- India Epidemic Intelligence Service Programme, National Centre for Disease Control, New Delhi, India
- Corresponding author Dr. Kevisetuo Anthony Dzeyie, Address: Epidemiology Complex Disease Control Building, Third Floor, National Centre for Disease Control, 22-Sham Nath Marg, Civil Lines, Delhi: 110054, Mobile number: 8447729350
| | - Sankara Dhanapaul
- KAP Vishwanatham Government Medical College, Tiruchirappalli, Tamil Nadu, India
| | | | | | - M S Vignesh
- Department of Public Health and Preventive Medicine, State Government of Tamil Nadu, India
| | - I Raveendran
- Department of Public Health and Preventive Medicine, State Government of Tamil Nadu, India
| | - Prem Kumar
- Department of Public Health and Preventive Medicine, State Government of Tamil Nadu, India
| | | | - Sushma Choudhary
- South Asia Field Epidemiology and Technology Network, New Delhi, India
| | - Ekta Saroha
- Division of Global Health Protection, Centers for Disease Control and Prevention, New Delhi, India
| | - Valan Siromany
- Division of Global Health Protection, Centers for Disease Control and Prevention, New Delhi, India
| | - Mohankumar Raju
- Public Health Institute, India Office, Chennai, Tamil Nadu, India
| | | | | | - Samir V. Sodha
- Division of Global Health Protection, Centers for Disease Control and Prevention, New Delhi, India
| | - Kayla Laserson
- Division of Global Health Protection, Centers for Disease Control and Prevention, New Delhi, India
| | - Tarun Bhatnagar
- National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Lata Kapoor
- National Centre for Disease Control, New Delhi, India
| | - Arti Bahl
- National Centre for Disease Control, New Delhi, India
| | - Sudhir K Jain
- National Centre for Disease Control, New Delhi, India
| | - Sunil Gupta
- National Centre for Disease Control, New Delhi, India
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Muhoza P, Danovaro-Holliday MC, Diallo MS, Murphy P, Sodha SV, Requejo JH, Wallace AS. Routine Vaccination Coverage - Worldwide, 2020. MMWR Morb Mortal Wkly Rep 2021; 70:1495-1500. [PMID: 34710074 PMCID: PMC8553029 DOI: 10.15585/mmwr.mm7043a1] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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15
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Kirkby K, Bergen N, Schlotheuber A, Sodha SV, Danovaro-Holliday MC, Hosseinpoor AR. Subnational inequalities in diphtheria-tetanus-pertussis immunization in 24 countries in the African Region. Bull World Health Organ 2021; 99:627-639. [PMID: 34475600 PMCID: PMC8381099 DOI: 10.2471/blt.20.279232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To analyse subnational inequality in diphtheria-tetanus-pertussis (DTP) immunization dropout in 24 African countries using administrative data on receipt of the first and third vaccine doses (DTP1 and DTP3, respectively) collected by the Joint Reporting Process of the World Health Organization and the United Nations Children's Fund. METHODS Districts in each country were grouped into quintiles according to the proportion of children who dropped out between DTP1 and DTP3 (i.e. the dropout rate). We used six summary measures to quantify inequalities in dropout rates between districts and compared rates with national dropout rates and DTP1 and DTP3 immunization coverage. FINDINGS The median dropout rate across countries was 2.4% in quintiles with the lowest rate and 14.6% in quintiles with the highest rate. In eight countries, the difference between the highest and lowest quintiles was 14.9 percentage points or more. In most countries, underperforming districts in the quintile with the highest rate tended to lag disproportionately behind the others. This divergence was not evident from looking only at national dropout rates. Countries with the largest inequalities in absolute subnational dropout rate tended to have lower estimated national DTP1 and DTP3 immunization coverage. CONCLUSION There were marked inequalities in DTP immunization dropout rates between districts in most countries studied. Monitoring dropout at the subnational level could help guide immunization interventions that address inequalities in underserved areas, thereby improving overall DTP3 coverage. The quality of administrative data should be improved to ensure accurate and timely assessment of geographical inequalities in immunization.
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Affiliation(s)
- Katherine Kirkby
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Nicole Bergen
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Anne Schlotheuber
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Samir V Sodha
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | | | - Ahmad Reza Hosseinpoor
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
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Causey K, Fullman N, Sorensen RJD, Galles NC, Zheng P, Aravkin A, Danovaro-Holliday MC, Martinez-Piedra R, Sodha SV, Velandia-González MP, Gacic-Dobo M, Castro E, He J, Schipp M, Deen A, Hay SI, Lim SS, Mosser JF. Estimating global and regional disruptions to routine childhood vaccine coverage during the COVID-19 pandemic in 2020: a modelling study. Lancet 2021; 398:522-534. [PMID: 34273292 PMCID: PMC8285122 DOI: 10.1016/s0140-6736(21)01337-4] [Citation(s) in RCA: 172] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/17/2021] [Accepted: 06/08/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The COVID-19 pandemic and efforts to reduce SARS-CoV-2 transmission substantially affected health services worldwide. To better understand the impact of the pandemic on childhood routine immunisation, we estimated disruptions in vaccine coverage associated with the pandemic in 2020, globally and by Global Burden of Disease (GBD) super-region. METHODS For this analysis we used a two-step hierarchical random spline modelling approach to estimate global and regional disruptions to routine immunisation using administrative data and reports from electronic immunisation systems, with mobility data as a model input. Paired with estimates of vaccine coverage expected in the absence of COVID-19, which were derived from vaccine coverage models from GBD 2020, Release 1 (GBD 2020 R1), we estimated the number of children who missed routinely delivered doses of the third-dose diphtheria-tetanus-pertussis (DTP3) vaccine and first-dose measles-containing vaccine (MCV1) in 2020. FINDINGS Globally, in 2020, estimated vaccine coverage was 76·7% (95% uncertainty interval 74·3-78·6) for DTP3 and 78·9% (74·8-81·9) for MCV1, representing relative reductions of 7·7% (6·0-10·1) for DTP3 and 7·9% (5·2-11·7) for MCV1, compared to expected doses delivered in the absence of the COVID-19 pandemic. From January to December, 2020, we estimated that 30·0 million (27·6-33·1) children missed doses of DTP3 and 27·2 million (23·4-32·5) children missed MCV1 doses. Compared to expected gaps in coverage for eligible children in 2020, these estimates represented an additional 8·5 million (6·5-11·6) children not routinely vaccinated with DTP3 and an additional 8·9 million (5·7-13·7) children not routinely vaccinated with MCV1 attributable to the COVID-19 pandemic. Globally, monthly disruptions were highest in April, 2020, across all GBD super-regions, with 4·6 million (4·0-5·4) children missing doses of DTP3 and 4·4 million (3·7-5·2) children missing doses of MCV1. Every GBD super-region saw reductions in vaccine coverage in March and April, with the most severe annual impacts in north Africa and the Middle East, south Asia, and Latin America and the Caribbean. We estimated the lowest annual reductions in vaccine delivery in sub-Saharan Africa, where disruptions remained minimal throughout the year. For some super-regions, including southeast Asia, east Asia, and Oceania for both DTP3 and MCV1, the high-income super-region for DTP3, and south Asia for MCV1, estimates suggest that monthly doses were delivered at or above expected levels during the second half of 2020. INTERPRETATION Routine immunisation services faced stark challenges in 2020, with the COVID-19 pandemic causing the most widespread and largest global disruption in recent history. Although the latest coverage trajectories point towards recovery in some regions, a combination of lagging catch-up immunisation services, continued SARS-CoV-2 transmission, and persistent gaps in vaccine coverage before the pandemic still left millions of children under-vaccinated or unvaccinated against preventable diseases at the end of 2020, and these gaps are likely to extend throughout 2021. Strengthening routine immunisation data systems and efforts to target resources and outreach will be essential to minimise the risk of vaccine-preventable disease outbreaks, reach children who missed routine vaccine doses during the pandemic, and accelerate progress towards higher and more equitable vaccination coverage over the next decade. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Kate Causey
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Reed J D Sorensen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Natalie C Galles
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Aleksandr Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA; Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | | | - Ramon Martinez-Piedra
- Pan American Health Organization, Comprehensive Family Immunization Unit, Washington, DC, USA
| | - Samir V Sodha
- Department of Immunization, Vaccines and Biologicals, Word Health Organization, Geneva, Switzerland
| | | | - Marta Gacic-Dobo
- Department of Immunization, Vaccines and Biologicals, Word Health Organization, Geneva, Switzerland
| | - Emma Castro
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jiawei He
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Megan Schipp
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Amanda Deen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Jonathan F Mosser
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA; Pediatric Infectious Diseases, Seattle Children's Hospital, Seattle, WA, USA.
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Maramraj KK, Latha MLK, Reddy R, Sodha SV, Kaur S, Dikid T, Reddy S, Jain SK, Singh SK. Addressing Reemergence of Diphtheria among Adolescents through Program Integration in India. Emerg Infect Dis 2021; 27:953-956. [PMID: 33622492 PMCID: PMC7920661 DOI: 10.3201/eid2703.203205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/24/2022] Open
Abstract
We report a diphtheria outbreak mostly among children (median 12 years; range 4–26 years) of a religious minority in urban India. Case-fatality rate (15%, 19/124) was higher among unimmunized patients (relative risk 4.1, 95% CI 1.5–11.7). We recommend mandating and integrating immunization into school health programs to prevent reemergence.
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Singh SK, Murhekar M, Gupta S, Minh NNT, Sodha SV. Building public health capacity through India epidemic intelligence service and field epidemiology training programs in India. Indian J Public Health 2021; 65:S1-S4. [PMID: 33753583 DOI: 10.4103/ijph.ijph_1212_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sujeet Kumar Singh
- Director, National Centre for Disease Control (NCDC), Ministry of Health and Family Welfare, New Delhi, India
| | - Manoj Murhekar
- Director, National Institute of Epidemiology, Indian Council of Medical Research (ICMR-NIE), Chennai, Tamil Nadu, India
| | - Sanjay Gupta
- Head of Division, Epidemiology, National Institute of Health and Family Welfare (NIHFW), New Delhi, India
| | - Nhu Nguyen Tran Minh
- Team Lead, Health Security and Emergency Response, World Health Organization (WHO) Country Office, New Delhi, India
| | - Samir V Sodha
- Resident Advisor, Division of Global Health Protection, U.S. Centers for Disease Control and Prevention (CDC), New Delhi, India
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Velayudhan A, Nayak J, Murhekar MV, Dikid T, Sodha SV. Shellfish poisoning outbreaks in Cuddalore District, Tamil Nadu, India. Indian J Public Health 2021; 65:S29-S33. [PMID: 33753589 DOI: 10.4103/ijph.ijph_1070_20] [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] [Indexed: 11/04/2022] Open
Abstract
Background Two suspected shellfish poisoning events were reported in Cuddalore District in Tamil Nadu, India, between January and April 2015. Objectives The study was conducted to confirm the outbreaks and to identify the source and risk factors. Methods For both outbreaks, a case was defined as a person with nausea, vomiting, or dizziness. Sociodemographic details and symptoms were noted down. Data were also collected in a standard 3-day food frequency questionnaire, along with a collection of clam samples. A case-control study was initiated in the April outbreak. Stool samples were collected from cases, and clam vendors were interviewed. Results In an outbreak that happened in January, all the twenty people reported to be consumed clams were diagnosed as cases (100% attack rate, 100% exposure rate). In the April outbreak, we identified 199 cases (95% attack rate). In both outbreaks, the clams were identified as genus Meretrix meretrix. The most common reported symptoms were dizziness and vomiting. The clams heated and consumed within 30-60 min. No heavy metals or chemicals were detected in the clams, but assays for testing shellfish toxins were unavailable. All 64 selected cases reported clam consumption (100% exposure rate) as did 11 controls (17% exposure rate). Illness was associated with a history of eating of clams (odds ratio = 314, 95% confidence interval = 39-512). Of the six stool samples tested, all were culture negative for Salmonella, Shigella, and Vibrio cholerae. The water at both sites was contaminated with garbage and sewage. Conclusion Coordinated and timely efforts by a multidisciplinary team of epidemiologists, marine biologists, and food safety officers led to the outbreaks' containment.
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Affiliation(s)
- Anoop Velayudhan
- EIS Officer, Epidemic Intelligence Service India Programme, National Centre for Disease Control, New Delhi, India
| | - Janardhan Nayak
- EIS Officer, Epidemic Intelligence Service India Programme, National Centre for Disease Control, New Delhi, India
| | | | - Tanzin Dikid
- Deputy Director, National Centers for Disease Control, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Samir V Sodha
- Resident Advisor, EIS CDC India, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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20
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Sheoran P, Rammayyan A, Shukla HK, Dikid T, Yadav R, Sodha SV. An outbreak investigation of acute Diarrheal Disease, Nagpur District, Maharashtra, India. Indian J Public Health 2021; 65:S14-S17. [PMID: 33753586 DOI: 10.4103/ijph.ijph_962_20] [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] [Indexed: 11/04/2022] Open
Abstract
Background Acute diarrheal disease (ADD) accounts for 12 million cases and 1216 deaths annually in India. On July 13, 2016, an ADD outbreak was reported from Sawargaon village from Nagpur district, Maharashtra. Objective The outbreak was investigated to describe the epidemiology and suggest control and preventive measures. Methods A case was defined as a person experiencing at least one loose stool in Sawargaon village between July 9, 2016, and July 31, 2016. We searched for cases by enhanced passive surveillance. We collected stool samples for bacterial culture and tested water from multiple water sources for fecal coliforms. We also reviewed sanitary practices and rainfall data. Results A total of 889 cases were identified, with 51% female, 280 hospitalizations (31%), and two deaths. The median age was 27 years (range 6 months to 90 years). Cases started on July 9, a week after heavy rains. District authorities started chlorination of water sources on July 13 and cases declined soon after. Two of nine stool samples tested positive for Vibrio cholera O1 serogroup. Of the 18 water samples collected, 16 (88%) samples from multiple sources, including wells, hand pumps, and taps, were positive for fecal coliforms. Of 1,885 households in the village, 450 (24%) households had no toilets and open defecation was commonly observed in the nearby river bed. Conclusions This ADD outbreak was likely associated with drinking contaminated groundwater, which probably occurred after heavy rainfall in an area of open defecation. We recommended providing chlorinated drinking water, promoting safe sanitation practices, including building more public and private toilets, and enhancing diagnostic laboratory capacity.
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Affiliation(s)
- Prasoon Sheoran
- India Epidemic Intelligence Services (EIS) Officer, Delhi, India
| | - A Rammayyan
- India Epidemic Intelligence Services (EIS) Officer, Delhi, India
| | - H K Shukla
- India Epidemic Intelligence Services (EIS) Officer, Delhi, India
| | - T Dikid
- Joint Director, Division of Epidemiology, National Centre for Disease Control, Delhi, India
| | - Rajesh Yadav
- Public Health Specialist, US Center for Disease Control and Prevention, Delhi, India
| | - S V Sodha
- Resident Advisor, US Center for Disease Control and Prevention, Delhi, India
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Gupta G, Singh A, Dikid T, Saroha E, Sodha SV. Acute diarrheal disease outbreak in Muzaffarpur Village, Chandauli District, Uttar Pradesh, India. Indian J Public Health 2021; 65:S34-S40. [PMID: 33753590 DOI: 10.4103/ijph.ijph_1111_20] [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] [Indexed: 11/04/2022] Open
Abstract
Background Acute diarrheal disease (ADD) outbreaks frequently occur in the Gangetic plains of Uttar Pradesh, India. In August 2017, Muzaffarpur village, Uttar Pradesh, reported an ADD outbreak. Objectives Outbreak investigation was conducted to find out the epidemiology and to identify the risk factors. Methods A 1:1 area-matched case-control study was conducted. Suspected ADD case was defined as ≥3 loose stools or vomiting within 24 h in a Muzaffarpur resident between August 7 and September 9, 2017. A control was defined as an absence of loose stools and vomiting in a resident between August 7 and September 9, 2017. A matched odds ratio (mOR) with 95% confidence intervals (CIs) was calculated. Drinking water was assessed to test for the presence of any contamination. Stool specimens were tested for Vibrio cholerae, and water samples were also tested for any fecal contamination and residual chlorine. Results Among 70 cases (female = 60%; median age = 12 years, range = 3 months-70 years), two cases died and 35 cases were hospitalized. Area-A in Muzaffarpur had the highest attack rate (8%). The index case washed soiled clothes at well - A1 1 week before other cases occurred. Among 67 case-control pairs, water consumption from well-A1 (mOR: 43.00; 95% CI: 2.60-709.88) and not washing hands with soap (mOR: 2.87; 95% CI: 1.28-6.42) were associated with illness. All seven stool specimens tested negative for V. cholerae. All six water samples, including one from well-A1, tested positive for fecal contamination with <0.2 ppm of residual chlorine. Conclusion This outbreak was associated with consumption of contaminated well water and hand hygiene. We recommended safe water provision, covering wells, handwashing with soap, access to toilets, and improved laboratory capacity for testing diarrheal pathogens.
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Affiliation(s)
- Ginisha Gupta
- India EIS Officer, Division of Epidemiology, National Centre for Disease Control, New Delhi, India
| | - Akhileshwar Singh
- India EIS Officer, Division of Epidemiology, National Centre for Disease Control, New Delhi, India
| | - Tanzin Dikid
- Joint Director, Division of Epidemiology, National Centre for Disease Control, New Delhi, India
| | - Ekta Saroha
- Public Health Specialist, US Centers for Disease Control and Prevention, New Delhi, India
| | - Samir V Sodha
- EIS Resident Advisor, US Centers for Disease Control and Prevention, New Delhi, India
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Dutta BP, Kumar N, Meshram KC, Yadav R, Sodha SV, Gupta S. Cholera outbreak associated with contaminated water sources in paddy fields, Mandla District, Madhya Pradesh, India. Indian J Public Health 2021; 65:S46-S50. [PMID: 33753592 DOI: 10.4103/ijph.ijph_1118_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Mandla District in Madhya Pradesh, India, reported a suspected cholera outbreak from Ghughri subdistrict on August 18, 2016. Objective We investigated to determine risk factors and recommend control and prevention measures. Methods We defined a case as >3 loose stools in 24 h in a Ghughri resident between July 20 and August 19, 2016. We identified cases by passive surveillance in health facilities and by a house-to-house survey in 28 highly affected villages. We conducted a 1:2 unmatched case-control study, collected stool samples for culture, and tested water sources for fecal contamination. Results We identified 628 cases (61% female) from 96 villages; the median age was 27 years (range: 1 month-76 years). Illnesses began 7 days after rainfall with 259 (41%) hospitalizations and 14 (2%) deaths in people from remote villages who died before reaching a health facility; 12 (86%) worked in paddy fields. Illness was associated with drinking well water within paddy fields (odds ratio [OR] = 4.0, 95% confidence interval [CI] = 1.4-8.0) and not washing hands with soap after defecation (OR = 6.1, CI = 1.7-21). Of 34 stool cultures, 11 (34%) tested positive for Vibrio cholerae O1 Ogawa. We observed open defecation in affected villages around paddy fields. Of 16 tested water sources in paddy fields, eight (50%) were protected, but 100% had fecal contamination. Conclusion We recommended education regarding pit latrine sanitation and safe water, especially in paddy fields, provision of oral rehydration solution in remote villages, and chlorine tablets for point-of-use treatment of drinking water.
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Affiliation(s)
- Biswa Prakash Dutta
- India Epidemic Intelligence Service Officer, Epidemiology Division, National Centre for Disease Control, Delhi, India
| | - Nishant Kumar
- Deputy Director, Integrated Disease Surveillance Program, National Centre for Disease Control, Delhi, India
| | - K C Meshram
- Chief Medical and Health Officer Mandla, Department of Health and Family Welfare, Madhya Pradesh, India
| | - Rajesh Yadav
- Public Health Specialist, Division of Global Health Protection, Centers for Disease Control and Prevention, Delhi, India
| | - Samir V Sodha
- Resident Advisor, India EIS Programme, Division of Global Health Protection, Centers for Disease Control and Prevention, Delhi, India
| | - Sonia Gupta
- Additional Director, National Centre for Disease Control, Director General of Health Services, Delhi, India
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Lowang D, Dhuria M, Yadav R, Mylliem P, Sodha SV, Khasnobis P. Measles outbreak among children ≤15 years old, Jaintia Hills District, Meghalaya, India, 2017. Indian J Public Health 2021; 65:S5-S9. [PMID: 33753584 DOI: 10.4103/ijph.ijph_960_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Of 1115 measles outbreaks during 2015 in India, 61,255 suspected measles cases were reported. In 2016, a measles outbreak was reported at East and West Jaintia Hills districts in Meghalaya State, India. Objectives The outbreak was investigated to describe the epidemiology, estimate vaccination coverage and vaccine effectiveness (VE), determine risk factors for the disease, and recommend control and prevention measures. Methods A measles case was defined as new-onset fever with maculopapular rash occurring between May 1, 2016, and January 21, 2017, in a resident of East and West Jaintia Hills. Cases were identified by active and passive surveillance. Serum and urine samples were collected from cases with laboratory diagnosis for confirmation. A retrospective cohort study was conducted to estimate vaccination coverage, VE, and risk factors for the disease. Results We identified 382 cases (51% female). The attack rate was 24% with three deaths. The case fatality rate was <1%. The median age was 4 years (range: 3 months-12 years). Among children 12-60 months, 128 (56%) received measles-containing-vaccine first-dose (MCV1), 85 (37%) received measles-containing-vaccine second-dose (MCV2), and 80 (35%) received Vitamin A. VE for MCV1 was 78% and for MCV2 94%. Being unvaccinated for MCV1 (relative risk [RR] = 9.7, 95% confidence interval [CI] = 4.6-20.5) and MCV2 (RR = 17.4, 95% CI = 4.3-69.4) were both strongly associated with illness. Conclusions Poor vaccination coverage led to the measles outbreak in East and West Jaintia Hills districts of Meghalaya. Strengthening the routine immunization systems and improving Vitamin A uptake is essential to prevent further outbreaks.
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Affiliation(s)
- Dipu Lowang
- Epidemic Intelligence Service Officer, Integrated Disease Surveillance Programme, National Centre for Disease Control, Delhi, India
| | - Meera Dhuria
- Deputy Director, Epidemiology Division, National Centre for Diseases Control, Delhi, India
| | - Rajesh Yadav
- Public Health Specialist, Division of Global Health Protection, Centers for Disease Control and Prevention, Delhi, India
| | - Pynshainam Mylliem
- Entomologist, Integrated Disease Surveillance Unit, Shillong, Meghalaya, India
| | - Samir V Sodha
- Resident Advisor, Division of GLobal Health Protection, Centers for Disease Control and Prevention, Delhi, India
| | - Pradeep Khasnobis
- National Programme Officer, Integrated Disease Surveillance Programme, National Centre for Disease Control, Delhi, India
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Maramraj KK, Latha MK, Reddy R, Sodha SV, Kaur S, Dikid T, Reddy S, Jain S, Singh SK. Addressing Reemergence of Diphtheria among Adolescents through Program Integration in India. Emerg Infect Dis 2021. [DOI: 10.3201/eid2205.203502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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25
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Maramraj KK, Latha MK, Reddy R, Sodha SV, Kaur S, Dikid T, Reddy S, Jain S, Singh SK. Addressing Reemergence of Diphtheria among Adolescents through Program Integration in India. Emerg Infect Dis 2021. [DOI: 10.3201/eid2205.203205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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26
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Patil AA, Velayudhan A, Durairaj GK, Khasnobis P, Sodha SV. Outbreak investigation of foodborne illness among political rally attendees, Cuddalore, Tamil Nadu, India. Indian J Public Health 2021; 65:S55-S58. [PMID: 33753594 PMCID: PMC10408200 DOI: 10.4103/ijph.ijph_1069_20] [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] [Indexed: 11/04/2022] Open
Abstract
In July 2015, we investigated a foodborne illness outbreak in Sithalikuppam and Verupachi villages, Cuddalore district, Tamil Nadu, among the political rally attendees to determine the risk factors for illness. We conducted a retrospective cohort study, calculated risk ratio for the food exposures, and cultured stool specimens. Of 55 rally attendees, we identified 36 (65%) case patients; 32 (89%) had diarrhea and 20 (56%) had vomiting. Median incubation period was 14 h. Eighty-nine percent (32/36) of those who ate lemon rice at dinner had illness compared to 21% (4/19) of those who did not (RR 4.2). Of the six nonattendees who ate leftovers on July 25, all ate only lemon rice and became ill. Stool cultures were negative for Salmonella, Shigella, and Vibrio species. Lemon rice was probably contaminated with enterotoxins such as from Bacillus cereus. Our findings highlighted need for community food safety education and importance of thorough outbreak investigations.
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Affiliation(s)
- Amol Annasaheb Patil
- India Epidemic Intelligence Service Officer, National Centre for Disease Control, Delhi
| | - Anoop Velayudhan
- India Epidemic Intelligence Service Officer, National Centre for Disease Control, Delhi
| | - G. K. Durairaj
- State Epidemiologist, Department of Public Health and Preventive Medicine, Government of Tamil Nadu, Chennai, Tamil Nadu, India
| | - Pradeep Khasnobis
- Joint Director, Integrated Disease Surveillance Programme, National Centre for Disease Control, Ministry of Health and Family Welfare Government of India, New Delhi
| | - Samir V. Sodha
- Resident Advisor, Epidemic Intelligence Service Programme, Centers for Disease Control and Prevention India
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Chard AN, Gacic-Dobo M, Diallo MS, Sodha SV, Wallace AS. Routine Vaccination Coverage - Worldwide, 2019. MMWR Morb Mortal Wkly Rep 2020; 69:1706-1710. [PMID: 33187395 PMCID: PMC7660669 DOI: 10.15585/mmwr.mm6945a7] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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28
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Patel MK, Goodson JL, Alexander JP, Kretsinger K, Sodha SV, Steulet C, Gacic-Dobo M, Rota PA, McFarland J, Menning L, Mulders MN, Crowcroft NS. Progress Toward Regional Measles Elimination - Worldwide, 2000-2019. MMWR Morb Mortal Wkly Rep 2020; 69:1700-1705. [PMID: 33180759 PMCID: PMC7660667 DOI: 10.15585/mmwr.mm6945a6] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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29
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Kumar Rastogi N, Goel K, Jain T, V Sodha S, Yadav R, Shekhar Aggarwal C, Dhariwal A. Evaluation of National Injury Surveillance Centre, India, 2015-16. Indian J Community Health 2020. [DOI: 10.47203/ijch.2020.v32i01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Globally, injuries accounts for 9% of all deaths, but India account for 11%. Due to limited data on injury characteristics, National Injury Surveillance Centre (NISC) was established in 2014 in New Delhi. Aim & Objectives: To evaluate attributes of NISC and make evidence-based recommendations. Methods and Material: We conducted cross-sectional study and used US Centers for Disease Control and Prevention guidelines to assess simplicity, flexibility, acceptability, stability, timeliness, representativeness, usefulness, and data quality. We reviewed 2015 records and interviewed 20 key-informants. We used Epi-Info7 for analysis. Results: NISC captured 4043 injuries in 2015 from one hospital. Among five data entry operators, four reported lengthy format, but all reported it easy. Among ten relevant key-informants, all reported data-management software easy. System demonstrated flexibility in three variables. All 20 staff reported willingness to participate, and 90% felt quarterly reporting acceptable. Regarding stability, data was collected for 361/365 days. Quarterly reports were available but only submitted annually. Regarding usefulness, all WHO-recommended variables included. Regarding data quality, 17% data-fields were missing. Conclusion: NISC is simple, flexible, stable, acceptable and potentially useful based on data captured. Timeliness based on annual reporting is high, can be improved to quarterly. We recommend training to improve data quality and integration of additional hospitals to improve representativeness.
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Maramraj KK, Subbalakshmi G, Ali MS, Dikid T, Yadav R, Sodha SV, Jain SK, Singh SK. A community-wide acute diarrheal disease outbreak associated with drinking contaminated water from shallow bore-wells in a tribal village, India, 2017. BMC Public Health 2020; 20:231. [PMID: 32059660 PMCID: PMC7023695 DOI: 10.1186/s12889-020-8263-2] [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] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 01/22/2020] [Indexed: 12/04/2022] Open
Abstract
Background In 2016, India reported 709 acute diarrheal disease (ADD) outbreaks (> 25% of all outbreaks). Tribal populations are at higher risk with 27% not having accessibility to safe drinking water and 75% households not having toilets. On June 26, 2017 Pedda-Gujjul-Thanda, a tribal village reported an acute diarrheal disease (ADD) outbreak. We investigated to describe the epidemiology, identify risk factors, and provide evidence-based recommendations. Methods We defined a case as ≥3 loose stools within 24 h in Pedda-Gujjul-Thanda residents from June 24–30, 2017. We identified cases by reviewing hospital records and house-to-house survey. We conducted a retrospective cohort study and collected stool samples for culture. We assessed drinking water supply and sanitation practices and tested water samples for faecal-contamination. Results We identified 191 cases (65% females) with median age 36 years (range 4–80 years) and no deaths. The attack-rate (AR) was 37% (191/512). Downhill colonies (located on slope of hilly terrains of the village) reported higher ARs (56%[136/243], p < 0.001) than others (20%[55/269]). Symptoms included diarrhea (100%), fever (17%), vomiting (16%) and abdominal pain (13%). Drinking water from five shallow bore-wells located in downhill colonies was significantly associated with illness (RR = 4.6, 95%CI = 3.4–6.1 and population attributable fraction 61%). In multi-variate analysis, drinking water from the shallow bore-wells located in downhill colonies (aOR = 7.9, [95% CI =4.7–13.2]), illiteracy (aOR =6, [95% CI = 3.6–10.1]), good hand-washing practice (aOR = 0.4, [95%CI = 0.2–0.7]) and household water treatment (aOR = 0.3, [95%CI = 0.2–0.5]) were significantly associated with illness. Two stool cultures were negative for Vibrio cholerae. Heavy rainfall was reported from June 22–24. Five of six water samples collected from shallow bore-wells located in downhill colonies were positive for faecal contamination. Conclusion An ADD outbreak with high attack rate in a remote tribal village was associated with drinking water from shallow downhill bore-wells, likely contaminated via runoff from open defecation areas after heavy rains. Based on our recommendations, immediate public health actions including repair of leakages at contaminated water sources and alternative supply of purified canned drinking water to families, and as long-term public health measures construction of house-hold latrines and piped-water supply initiated.
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Affiliation(s)
- Kiran Kumar Maramraj
- National Centre for Disease Control, 22 Sham Nath Marg, New Delhi, 110054, India.
| | - G Subbalakshmi
- State health department, Hyderabad, Telangana, 500095, India
| | | | - Tanzin Dikid
- National Centre for Disease Control, 22 Sham Nath Marg, New Delhi, 110054, India
| | - Rajesh Yadav
- Division of Global Health Protection, United States Centers for Disease Control and Prevention, New Delhi, India
| | - Samir V Sodha
- Division of Global Health Protection, United States Centers for Disease Control and Prevention, New Delhi, India.,Division of Global Health Protection, United States Centers for Disease Control and Prevention, Atlanta, USA
| | - Sudhir Kumar Jain
- National Centre for Disease Control, 22 Sham Nath Marg, New Delhi, 110054, India
| | - Sujeet Kumar Singh
- National Centre for Disease Control, 22 Sham Nath Marg, New Delhi, 110054, India
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31
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Patel MK, Dumolard L, Nedelec Y, Sodha SV, Steulet C, Gacic-Dobo M, Kretsinger K, McFarland J, Rota PA, Goodson JL. Progress Toward Regional Measles Elimination - Worldwide, 2000-2018. MMWR Morb Mortal Wkly Rep 2019; 68:1105-1111. [PMID: 31805033 PMCID: PMC6897527 DOI: 10.15585/mmwr.mm6848a1] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Thangaraj JWV, Vasanthapuram R, Machado L, Arunkumar G, Sodha SV, Zaman K, Bhatnagar T, Hameed SKS, Kumar A, Abdulmajeed J, Velayudhan A, Deoshatwar A, Desai AS, Kumar KH, Gupta N, Laserson K, Murhekar M. Risk Factors for Acquiring Scrub Typhus among Children in Deoria and Gorakhpur Districts, Uttar Pradesh, India, 2017. Emerg Infect Dis 2019; 24:2364-2367. [PMID: 30457537 PMCID: PMC6256400 DOI: 10.3201/eid2412.180695] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Scrub typhus is associated with outbreaks of acute encephalitis syndrome in Uttar Pradesh, India. A case-control study indicated that children residing, playing, or visiting fields; living with firewood stored indoors; handling cattle fodder; and practicing open defecation were at increased risk for scrub typhus. Communication messages should focus on changing these behaviors.
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Nayak P, Sodha SV, Laserson KF, Padhi AK, Swain BK, Hossain SS, Shrivastava A, Khasnobis P, Venkatesh SR, Patnaik B, Dash KC. A cutaneous Anthrax outbreak in Koraput District of Odisha-India 2015. BMC Public Health 2019; 19:470. [PMID: 32326927 PMCID: PMC6696704 DOI: 10.1186/s12889-019-6787-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 12/17/2022] Open
Abstract
Background Cutaneous anthrax in humans is associated with exposure to infected animals or animal products and has a case fatality rate of up to 20% if untreated. During May to June 2015, an outbreak of cutaneous anthrax was reported in Koraput district of Odisha, India, an area endemic for anthrax. We investigated the outbreak to identify risk factors and recommend control measures. Method We defined a cutaneous anthrax case as skin lesions (e.g., papule, vesicle or eschar) in a person residing in Koraput district with illness onset between February 1 and July 15, 2015. We established active surveillance through a house to house survey to ascertain additional cases and conducted a 1:2 unmatched case control study to identify modifiable risk factors. In case control study, we included cases with illness onset between May 1 and July 15, 2015. We defined controls as neighbours of case without skin lesions since last 3 months. Ulcer exudates and rolled over swabs from wounds were processed in Gram stain in the Koraput district headquarter hospital laboratory. Result We identified 81 cases (89% male; median age 38 years [range 5–75 years]) including 3 deaths (case fatality rate = 4%). Among 37 cases and 74 controls, illness was significantly associated with eating meat of ill cattle (OR: 14.5, 95% CI: 1.4–85.7) and with close handling of carcasses of ill animals such as burying, skinning, or chopping (OR: 342, 95% CI: 40.5–1901.8). Among 20 wound specimens collected, seven showed spore-forming, gram positive bacilli, with bamboo stick appearance suggestive of Bacillus anthracis. Conclusion Our investigation revealed significant associations between eating and handling of ill animals and presence of anthrax-like organisms in lesions. We immediately initiated livestock vaccination in the area, educated the community on safe handling practices and recommended continued regular anthrax animal vaccinations to prevent future outbreaks.
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Affiliation(s)
- Priyakanta Nayak
- National Centre for Disease Control, 22 Shamnath Marg, Civil Lines, New Delhi, India.
| | - Samir V Sodha
- United States Centers for Disease Control and Prevention, Delhi, India.,Division of Global Health Protection, Centers for Global Health, Centers for Disease Control and Prevention, Atlanta, USA
| | - Kayla F Laserson
- United States Centers for Disease Control and Prevention, Delhi, India.,Division of Global Health Protection, Centers for Global Health, Centers for Disease Control and Prevention, Atlanta, USA
| | - Arun K Padhi
- Directorate of Health Services, Bhubaneswar, Odisha, India
| | | | - Shaikh S Hossain
- United States Centers for Disease Control and Prevention, Delhi, India
| | - Aakash Shrivastava
- National Centre for Disease Control, 22 Shamnath Marg, Civil Lines, New Delhi, India
| | - Pradeep Khasnobis
- National Centre for Disease Control, 22 Shamnath Marg, Civil Lines, New Delhi, India
| | - Srinivas R Venkatesh
- National Centre for Disease Control, 22 Shamnath Marg, Civil Lines, New Delhi, India
| | - Bikash Patnaik
- Directorate of Health Services, Bhubaneswar, Odisha, India
| | - Kailash C Dash
- Directorate of Health Services, Bhubaneswar, Odisha, India
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Ward K, Stewart S, Wardle M, Sodha SV, Tanifum P, Ayebazibwe N, Mayanja R, Luzze H, Ehlman DC, Conklin L, Abbruzzese M, Sandhu HS. Building health workforce capacity for planning and monitoring through the Strengthening Technical Assistance for routine immunization training (START) approach in Uganda. Vaccine 2019; 37:2821-2830. [PMID: 31000410 PMCID: PMC6522686 DOI: 10.1016/j.vaccine.2019.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/28/2018] [Revised: 03/23/2019] [Accepted: 04/08/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The Global Vaccine Action Plan identifies workforce capacity building as a key strategy to achieve strong immunization programs. The Strengthening Technical Assistance for Routine Immunization Training (START) approach aimed to utilize practical training methods to build capacity of district and health center staff to implement routine immunization (RI) planning and monitoring activities, as well as build supportive supervision skills of district staff. METHODS First implemented in Uganda, the START approach was executed by trained external consultants who used existing tools, resources, and experiences to mentor district-level counterparts and, with them, conducted on-the-job training and mentorship of health center staff over several site visits. Implementation was routinely monitored using daily activity reports, pre and post surveys of resources and systems at districts and health centers and interviews with START consultants. RESULTS From July 2013 through December 2014 three START teams of four consultants per team, worked 6 months each across 50 districts in Uganda including the five divisions of Kampala district (45% of all districts). They conducted on-the-job training in 444 selected under-performing health centers, with a median of two visits to each (range 1-7, IQR: 1-3). More than half of these visits were conducted in collaboration with the district immunization officer, providing the opportunity for mentorship of district immunization officers. Changes in staff motivation and awareness of challenges; availability and completion of RI planning and monitoring tools and systems were observed. However, the START consultants felt that potential durability of these changes may be limited by contextual factors, including external accountability, availability of resources, and individual staff attitude. CONCLUSIONS Mentoring and on-the-job training offer promising alternatives to traditional classroom training and audit-focused supervision for building health workforce capacity. Further evidence regarding comparative effectiveness of these strategies and durability of observed positive change is needed.
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Affiliation(s)
- Kirsten Ward
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, Georgia 30329, United States.
| | - Steven Stewart
- Formally, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, Georgia 30329, United States.
| | - Melissa Wardle
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, Georgia 30329, United States.
| | - Samir V Sodha
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, Georgia 30329, United States.
| | - Patricia Tanifum
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, Georgia 30329, United States.
| | - Nicholas Ayebazibwe
- African Field Epidemiology Network (AFENET) Secretariat, Wings B & C, Ground Floor, Lugogo House, Plot 42 Lugogo House, Lugogo Bypass, Kampala, Uganda.
| | - Robert Mayanja
- Formally with the Uganda National Expanded Program on Immunization, Ministry of Health, Uganda.
| | - Henry Luzze
- Uganda National Expanded Program on Immunization, Ministry of Health, Uganda
| | - Daniel C Ehlman
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, Georgia 30329, United States.
| | - Laura Conklin
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, Georgia 30329, United States.
| | - Molly Abbruzzese
- The Bill & Melinda Gates Foundation, 500 Fifth Ave North, Seattle, WA 98109, United States.
| | - Hardeep S Sandhu
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, Georgia 30329, United States.
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Moghe CS, Goel P, Singh J, Nayak NR, Dhuria M, Jain R, Yadav R, Saroha E, Sodha SV, Aggarwal CS, Venkatesh S. Mumps outbreak investigation in Jaisalmer, Rajasthan, India, June-September 2016. J Med Virol 2018; 91:347-350. [PMID: 30252936 DOI: 10.1002/jmv.25324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/19/2018] [Indexed: 11/07/2022]
Abstract
Mumps, a vaccine-preventable disease, cause inflammation of salivary glands and may cause severe complications, such as encephalitis, meningitis, deafness, and orchitis/oophoritis. In India, mumps vaccine is not included in the universal immunization program and during 2009 to 2014, 72 outbreaks with greater than 1500 cases were reported. In August 2016, a suspected mumps outbreak was reported in Jaisalmer block, Rajasthan. We investigated to confirm the etiology, describe the epidemiology, and recommend prevention and control measures. We defined a case as swelling in the parotid region in a Jaisalmer block resident between 23 June 2016 and 10 September 2016. We searched for cases in health facilities and house-to-house in affected villages and hamlets. We tested blood samples of cases for mumps immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA). We found 162 cases (60% males) with a median age of 9.4 years (range: 7 month-38 years) and 65 (40%) were females. Symptoms included fever (70%) and bilateral swelling in neck (65%). None of them were vaccinated against mumps. Most (84%) cases were school-going children (3-16 years old). The overall attack rate was 2%. Village A, with two hamlets, had the highest attack rate (hamlet 1 = 13% and hamlet 2 = 12%). School A of village A, hamlet 1, which accommodated 200 children in two classrooms, had an attack rate of 55%. Of 18 blood samples from cases, 11 tested positive for mumps IgM ELISA. This was a confirmed mumps outbreak in Jaisalmer block that disproportionately affected school-going children. We recommended continued surveillance, 5-day absence from school, and vaccination.
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Affiliation(s)
- Chandrakant S Moghe
- Department of Epidemiology, National Centre of Disease Control, Delhi, India
| | - Pramod Goel
- Department of Epidemiology, National Centre of Disease Control, Delhi, India
| | - Jalam Singh
- Department of Health and Family Welfare, Government of Rajasthan, Jaisalmer, India
| | - Naina Ram Nayak
- Department of Health and Family Welfare, Government of Rajasthan, Jaisalmer, India
| | - Meera Dhuria
- Department of Epidemiology, National Centre of Disease Control, Delhi, India
| | - Ruchi Jain
- Integrated Disease Surveillance Programme, National Centre of Disease Control, Delhi, India
| | - Rajesh Yadav
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Delhi, India
| | - Ekta Saroha
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Delhi, India
| | - Samir V Sodha
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Delhi, India
| | - C S Aggarwal
- Department of Epidemiology, National Centre of Disease Control, Delhi, India
| | - Srinivas Venkatesh
- Department of Epidemiology, National Centre of Disease Control, Delhi, India
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Nelson KN, Wallace AS, Sodha SV, Daniels D, Dietz V. Assessing strategies for increasing urban routine immunization coverage of childhood vaccines in low and middle-income countries: A systematic review of peer-reviewed literature. Vaccine 2016; 34:5495-5503. [PMID: 27692772 DOI: 10.1016/j.vaccine.2016.09.038] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 05/19/2016] [Revised: 09/01/2016] [Accepted: 09/15/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Immunization programs in developing countries increasingly face challenges to ensure equitable delivery of services within cities where rapid urban growth can result in informal settlements, poor living conditions, and heterogeneous populations. A number of strategies have been utilized in developing countries to ensure high community demand and equitable availability of urban immunization services; however, a synthesis of the literature on these strategies has not previously been undertaken. METHODS We reviewed articles published in English in peer-reviewed journals between 1990 and 2013 that assessed interventions for improving routine immunization coverage in urban areas in low- and middle-income countries. We categorized the intervention in each study into one of three groups: (1) interventions aiming to increase utilization of immunization services; (2) interventions aiming to improve availability of immunization services by healthcare providers, or (3) combined availability and utilization interventions. We summarized the main quantitative outcomes from each study and effective practices from each intervention category. RESULTS Fifteen studies were identified; 87% from the African, Eastern Mediterranean and Southeast Asian regions of the World Health Organization (WHO). Six studies were randomized controlled trials, eight were pre- and post-intervention evaluations, and one was a cross-sectional study. Four described interventions designed to improve availability of routine immunization services, six studies described interventions that aimed to increase utilization, and five studies aiming to improve both availability and utilization of services. All studies reported positive change in their primary outcome indicator, although seven different primary outcomes indicators were used across studies. Studies varied considerably with respect to the type of intervention assessed, study design, and length of intervention assessment. CONCLUSION Few studies have assessed interventions designed explicitly for the unique challenges facing immunization programs in urban areas. Further research on sustainability, scalability, and cost-effectiveness of interventions is needed to fill this gap.
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Affiliation(s)
- Kristin N Nelson
- Emory University, 201 Dowman Drive, Atlanta, GA 30322, United States.
| | - Aaron S Wallace
- Emory University, 201 Dowman Drive, Atlanta, GA 30322, United States; Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS-A04, Atlanta, GA 30329, United States
| | - Samir V Sodha
- Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS-A04, Atlanta, GA 30329, United States
| | - Danni Daniels
- Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS-A04, Atlanta, GA 30329, United States
| | - Vance Dietz
- Global Immunization Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS-A04, Atlanta, GA 30329, United States
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Sánchez D, Sodha SV, Kurtis HJ, Ghisays G, Wannemuehler KA, Danovaro-Holliday MC, Ropero-Álvarez AM. Vaccination Week in the Americas, 2011: an opportunity to assess the routine vaccination program in the Bolivarian Republic of Venezuela. BMC Public Health 2015; 15:395. [PMID: 25909437 PMCID: PMC4409707 DOI: 10.1186/s12889-015-1723-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 09/29/2014] [Accepted: 03/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaccination Week in the Americas (VWA) is an annual initiative in countries and territories of the Americas every April to highlight the work of national expanded programs on immunization (EPI) and increase access to vaccination services for high-risk population groups. In 2011, as part of VWA, Venezuela targeted children aged less than 6 years in 25 priority border municipalities using social mobilization to increase institution-based vaccination. Implementation of social communication activities was decentralized to the local level. We conducted a survey in one border municipality of Venezuela to evaluate the outcome of VWA 2011 and provide a snapshot of the overall performance of the routine EPI at that level. METHODS We conducted a coverage survey, using stratified cluster sampling, in the Venezuelan municipality of Bolivar (bordering Colombia) in August 2011. We collected information for children aged <6 years through caregiver interviews and transcription of vaccination card data. We estimated each child's eligibility to receive a specific vaccine dose during VWA 2011 and whether or not they were actually vaccinated during VWA activities. We also estimated baseline vaccination coverage, timeliness and 95% confidence intervals (CI), and used chi-square tests to compare coverage across age cohorts, taking into account the sampling design. RESULTS We surveyed 839 children from 698 households; 93% of children had a vaccination card. Among households surveyed, 216 (31%) caregivers reported having heard about a vaccination activity during April or May 2011. Of the 528 children eligible to receive a vaccine during VWA, 24% received at least one dose, while 13% received all doses due. Overall, baseline coverage with routine vaccines, as measured by the survey, was >85%, with a few exceptions. CONCLUSION Low levels of VWA awareness among caregivers probably contributed to the limited vaccination of eligible children during the VWA activities in Bolivar in 2011. However, vaccine coverage for most EPI vaccines was high. Additionally, high vaccination card availability and high participation in VWA among those caregivers aware of it in 2011 suggest public trust in the EPI program in the municipality. Health authorities have used survey findings to inform changes to the routine EPI and better VWA implementation in subsequent years.
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Affiliation(s)
- Daniel Sánchez
- Programa Nacional de Inmunizaciones de Venezuela, Ministerio del Poder Popular para la Salud (MPPS), Caracas, Bolivarian Republic of Venezuela.
| | - Samir V Sodha
- Centers for Disease Control and Prevention, Atlanta, GA, 30329-4027, USA.
| | - Hannah J Kurtis
- Comprehensive Family Immunization Unit, Pan American Health Organization, 525 23rd St NW, Washington DC, 20037-2895, USA.
| | - Gladys Ghisays
- Pan American Health Organization Country Office, Caracas, Bolivarian Republic of Venezuela. .,Current address: Pan American Health Organization Country Office, Quito, Ecuador.
| | | | - M Carolina Danovaro-Holliday
- Comprehensive Family Immunization Unit, Pan American Health Organization, 525 23rd St NW, Washington DC, 20037-2895, USA.
| | - Alba María Ropero-Álvarez
- Comprehensive Family Immunization Unit, Pan American Health Organization, 525 23rd St NW, Washington DC, 20037-2895, USA.
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Abstract
BACKGROUND Global coverage with the third dose of diphtheria-tetanus-pertussis vaccine among children under 1 year of age stagnated at ∼ 83-84% during 2008-13. SOURCES OF DATA Annual World Health Organization and UNICEF-derived national vaccination coverage estimates. AREAS OF AGREEMENT Incomplete vaccination is associated with poor socioeconomic status, lower education, non-use of maternal-child health services, living in conflict-affected areas, missed immunization opportunities and cancelled vaccination sessions. AREAS OF CONTROVERSY Vaccination platforms must expand to include older ages including the second year of life. Immunization programmes, including eradication and elimination initiatives such as those for polio and measles, must integrate within the broader health system. GROWING POINTS The Global Vaccine Action Plan (GVAP) 2011-20 is a framework for strengthening immunization systems, emphasizing country ownership, shared responsibility, equity, integration, sustainability and innovation. AREAS TIMELY FOR DEVELOPING RESEARCH Immunization programmes should identify, monitor and evaluate gaps and interventions within the GVAP framework.
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Affiliation(s)
- S V Sodha
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, MS A-04, Atlanta, GA 30333, USA
| | - V Dietz
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, MS A-04, Atlanta, GA 30333, USA
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Harris JB, Gacic-Dobo M, Eggers R, Brown DW, Sodha SV. Global routine vaccination coverage, 2013. MMWR Morb Mortal Wkly Rep 2014; 63:1055-8. [PMID: 25412062 PMCID: PMC5779507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In 1974, the World Health Organization (WHO) established the Expanded Program on Immunization to ensure that all children have access to routinely recommended vaccines. Since then, global coverage with the four core vaccines (Bacille Calmette-Guérin vaccine [for protection against tuberculosis], diphtheria-tetanus-pertussis vaccine [DTP], polio vaccine, and measles vaccine) has increased from <5% to ≥84%, and additional vaccines have been added to the recommended schedule. Coverage with the third dose of DTP vaccine (DTP3) by age 12 months is a key indicator of immunization program performance. Estimated global DTP3 coverage has remained at 83%-84% since 2009, with estimated 2013 coverage at 84%. Global coverage estimates for the second routine dose of measles-containing vaccine (MCV2) are reported for the first time in 2013; global coverage was 35% by the end of the second year of life and 53% when including older age groups. Improvements in equity of access and use of immunization services will help ensure that all children are protected from vaccine-preventable diseases.
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Affiliation(s)
- Jennifer B. Harris
- Global Immunization Division, Center for Global Health, CDC,Epidemic Intelligence Service, CDC,Corresponding author: Jennifer Harris, , 404-639-4498
| | - Marta Gacic-Dobo
- Department of Immunization, Vaccines and Biologicals, World Health Organization
| | - Rudolf Eggers
- Department of Immunization, Vaccines and Biologicals, World Health Organization
| | - David W. Brown
- Division of Data, Research and Policy, United Nations Children’s Fund
| | - Samir V. Sodha
- Global Immunization Division, Center for Global Health, CDC
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Mettee Zarecki SL, Bennett SD, Hall J, Yaeger J, Lujan K, Adams-Cameron M, Winpisinger Quinn K, Brenden R, Biggerstaff G, Hill VR, Sholtes K, Garrett NM, Lafon PC, Barton Behravesh C, Sodha SV. US outbreak of human Salmonella infections associated with aquatic frogs, 2008-2011. Pediatrics 2013; 131:724-31. [PMID: 23478862 DOI: 10.1542/peds.2012-2031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Although amphibians are known Salmonella carriers, no such outbreaks have been reported. We investigated a nationwide outbreak of human Salmonella Typhimurium infections occurring predominantly among children from 2008 to 2011. METHODS We conducted a matched case-control study. Cases were defined as persons with Salmonella Typhimurium infection yielding an isolate indistinguishable from the outbreak strain. Controls were persons with recent infection with Salmonella strains other than the outbreak strain and matched to cases by age and geography. Environmental samples were obtained from patients' homes; traceback investigations were conducted. RESULTS We identified 376 cases from 44 states from January 1, 2008, to December 31, 2011; 29% (56/193) of patients were hospitalized and none died. Median patient age was 5 years (range <1-86 years); 69% were children <10 years old (253/367). Among 114 patients interviewed, 69 (61%) reported frog exposure. Of patients who knew frog type, 79% (44/56) reported African dwarf frogs (ADF), a type of aquatic frog. Among 18 cases and 29 controls, illness was significantly associated with frog exposure (67% cases versus 3% controls, matched odds ratio 12.4, 95% confidence interval 1.9-infinity). Environmental samples from aquariums containing ADFs in 8 patients' homes, 2 ADF distributors, and a day care center yielded isolates indistinguishable from the outbreak strain. Traceback investigations of ADFs from patient purchases converged to a common ADF breeding facility. Environmental samples from the breeding facility yielded the outbreak strain. CONCLUSIONS ADFs were the source of this nationwide pediatric predominant outbreak. Pediatricians should routinely inquire about pet ownership and advise families about illness risks associated with animals.
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Affiliation(s)
- Shauna L Mettee Zarecki
- Epidemic Intelligence Service, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Sodha SV, Menon M, Trivedi K, Ati A, Figueroa ME, Ainslie R, Wannemuehler K, Quick R. Microbiologic effectiveness of boiling and safe water storage in South Sulawesi, Indonesia. J Water Health 2011; 9:577-585. [PMID: 21976204 DOI: 10.2166/wh.2011.255] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In Indonesia, where diarrhea remains a major cause of mortality among children <5 years, the government promotes boiling of drinking water. We assessed the impact of boiling on water quality in South Sulawesi. We surveyed randomly selected households with at least one child <5 years old in two rural districts and tested source and stored water samples for Escherichia coli contamination. Among 242 households, 96% of source and 51% of stored water samples yielded E. coli. Unboiled water samples, obtained from 15% of households, were more likely to yield E. coli than boiled samples [prevalence ratios (PR) = 2.0, 95% confidence interval (CI) 1.7-2.5]. Water stored in wide-mouthed (PR = 1.4, 95% CI = 1.1-1.8) or uncovered (PR = 1.8, 95% CI = 1.3-2.4) containers, or observed to be touched by the respondent's hands (PR = 1.6, 95% CI = 1.3-2.1) was more likely to yield E. coli. A multivariable model showed that households that did not boil water were more likely to have contaminated stored water than households that did boil water (PR = 1.9, 95% CI = 1.5-2.3). Although this study demonstrated the effectiveness of boiling in reducing contamination, overall impact on water quality was suboptimal. Future studies are needed to identify factors behind the success of boiling water in Indonesia to inform efforts to scale up other effective water treatment practices.
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Affiliation(s)
- Samir V Sodha
- Centers for Disease Control and Prevention, Division of Foodborne, Waterborne, and Environmental Diseases, 1600 Clifton Road, MS E-05 Atlanta, GA 30333, USA.
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Cavallaro E, Date K, Medus C, Meyer S, Miller B, Kim C, Nowicki S, Cosgrove S, Sweat D, Phan Q, Flint J, Daly ER, Adams J, Hyytia-Trees E, Gerner-Smidt P, Hoekstra RM, Schwensohn C, Langer A, Sodha SV, Rogers MC, Angulo FJ, Tauxe RV, Williams IT, Behravesh CB. Salmonella typhimurium infections associated with peanut products. N Engl J Med 2011; 365:601-10. [PMID: 21848461 DOI: 10.1056/nejmoa1011208] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Contaminated food ingredients can affect multiple products, each distributed through various channels and consumed in multiple settings. Beginning in November 2008, we investigated a nationwide outbreak of salmonella infections. METHODS A case was defined as laboratory-confirmed infection with the outbreak strain of Salmonella Typhimurium occurring between September 1, 2008, and April 20, 2009. We conducted two case-control studies, product "trace-back," and environmental investigations. RESULTS Among 714 case patients identified in 46 states, 166 (23%) were hospitalized and 9 (1%) died. In study 1, illness was associated with eating any peanut butter (matched odds ratio, 2.5; 95% confidence interval [CI], 1.3 to 5.3), peanut butter-containing products (matched odds ratio, 2.2; 95% CI, 1.1 to 4.7), and frozen chicken products (matched odds ratio, 4.6; 95% CI, 1.7 to 14.7). Investigations of focal clusters and single cases associated with nine institutions identified a single institutional brand of peanut butter (here called brand X) distributed to all facilities. In study 2, illness was associated with eating peanut butter outside the home (matched odds ratio, 3.9; 95% CI, 1.6 to 10.0) and two brands of peanut butter crackers (brand A: matched odds ratio, 17.2; 95% CI, 6.9 to 51.5; brand B: matched odds ratio, 3.6; 95% CI, 1.3 to 9.8). Both cracker brands were made from brand X peanut paste. The outbreak strain was isolated from brand X peanut butter, brand A crackers, and 15 other products. A total of 3918 peanut butter-containing products were recalled between January 10 and April 29, 2009. CONCLUSIONS Contaminated peanut butter and peanut products caused a nationwide salmonellosis outbreak. Ingredient-driven outbreaks are challenging to detect and may lead to widespread contamination of numerous food products.
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Affiliation(s)
- Elizabeth Cavallaro
- National Center for Emerging and Zoonotic Infectious Diseases, Division of Foodborne, Waterborne and Environmental Diseases, Program Office for Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, USA.
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Bhattarai A, Villanueva J, Palekar RS, Fagan R, Sessions W, Winter J, Berman L, Lute J, Leap R, Marchbanks T, Sodha SV, Moll M, Xu X, Fry A, Fiore A, Ostroff S, Swerdlow DL. Viral shedding duration of pandemic influenza A H1N1 virus during an elementary school outbreak--Pennsylvania, May-June 2009. Clin Infect Dis 2011; 52 Suppl 1:S102-8. [PMID: 21342880 DOI: 10.1093/cid/ciq026] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We report shedding duration of 2009 pandemic influenza A (pH1N1) virus from a school-associated outbreak in Pennsylvania during May through June 2009. Outbreak-associated students or household contacts with influenza-like illness (ILI) onset within 7 days of interview were recruited. Nasopharyngeal specimens, collected every 48 hours until 2 consecutive nonpositive tests, underwent real-time reverse transcriptase polymerase chain reaction (rRT-PCR) and culture for pH1N1 virus. Culture-positive specimens underwent virus titrations. Twenty-six (median age, 8 years) rRT-PCR-positive persons, for pH1N1 virus, were included in analysis. Median shedding duration from fever onset by rRT-PCR was 6 days (range, 1-13) and 5 days (range, 1-7) by culture. Following fever resolution virus was isolated for a median of 2 days (range, 0-5). Highest and lowest virus titers detected, 2 and 5 days following fever onset, were 3.2 and 1.2 log(10) TCID(50)/mL respectively. Overall, shedding duration in children and adults were similar to seasonal influenza viruses.
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Affiliation(s)
- Achuyt Bhattarai
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Marchbanks TL, Bhattarai A, Fagan RP, Ostroff S, Sodha SV, Moll ME, Lee BY, Chang CCH, Ennis B, Britz P, Fiore A, Nguyen M, Palekar R, Archer WR, Gift TL, Leap R, Nygren BL, Cauchemez S, Angulo FJ, Swerdlow D. An outbreak of 2009 pandemic influenza A (H1N1) virus infection in an elementary school in Pennsylvania. Clin Infect Dis 2011; 52 Suppl 1:S154-60. [PMID: 21342888 DOI: 10.1093/cid/ciq058] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In May 2009, one of the earliest outbreaks of 2009 pandemic influenza A virus (pH1N1) infection resulted in the closure of a semi-rural Pennsylvania elementary school. Two sequential telephone surveys were administered to 1345 students (85% of the students enrolled in the school) and household members in 313 households to collect data on influenza-like illness (ILI). A total of 167 persons (12.4%) among those in the surveyed households, including 93 (24.0%) of the School A students, reported ILI. Students were 3.1 times more likely than were other household members to develop ILI (95% confidence interval [CI], 2.3-4.1). Fourth-grade students were more likely to be affected than were students in other grades (relative risk, 2.2; 95% CI, 1.2-3.9). pH1N1 was confirmed in 26 (72.2%) of the individuals tested by real-time reverse-transcriptase polymerase chain reaction. The outbreak did not resume upon the reopening of the school after the 7-day closure. This investigation found that pH1N1 outbreaks at schools can have substantial attack rates; however, grades and classrooms are affected variably. Additional study is warranted to determine the effectiveness of school closure during outbreaks.
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Affiliation(s)
- Tiffany L Marchbanks
- Centers for Disease Control and Prevention/Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship Program, Pennsylvania Department of Health, Harrisburg, Pennsylvania, USA.
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Barton Behravesh C, Mody RK, Jungk J, Gaul L, Redd JT, Chen S, Cosgrove S, Hedican E, Sweat D, Chávez-Hauser L, Snow SL, Hanson H, Nguyen TA, Sodha SV, Boore AL, Russo E, Mikoleit M, Theobald L, Gerner-Smidt P, Hoekstra RM, Angulo FJ, Swerdlow DL, Tauxe RV, Griffin PM, Williams IT. 2008 outbreak of Salmonella Saintpaul infections associated with raw produce. N Engl J Med 2011; 364:918-27. [PMID: 21345092 DOI: 10.1056/nejmoa1005741] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Raw produce is an increasingly recognized vehicle for salmonellosis. We investigated a nationwide outbreak that occurred in the United States in 2008. METHODS We defined a case as diarrhea in a person with laboratory-confirmed infection with the outbreak strain of Salmonella enterica serotype Saintpaul. Epidemiologic, traceback, and environmental studies were conducted. RESULTS Among the 1500 case subjects, 21% were hospitalized, and 2 died. In three case-control studies of cases not linked to restaurant clusters, illness was significantly associated with eating raw tomatoes (matched odds ratio, 5.6; 95% confidence interval [CI], 1.6 to 30.3); eating at a Mexican-style restaurant (matched odds ratio, 4.6; 95% CI, 2.1 to ∞) and eating pico de gallo salsa (matched odds ratio, 4.0; 95% CI, 1.5 to 17.8), corn tortillas (matched odds ratio, 2.3; 95% CI, 1.2 to 5.0), or salsa (matched odds ratio, 2.1; 95% CI, 1.1 to 3.9); and having a raw jalapeño pepper in the household (matched odds ratio, 2.9; 95% CI, 1.2 to 7.6). In nine analyses of clusters associated with restaurants or events, jalapeño peppers were implicated in all three clusters with implicated ingredients, and jalapeño or serrano peppers were an ingredient in an implicated item in the other three clusters. Raw tomatoes were an ingredient in an implicated item in three clusters. The outbreak strain was identified in jalapeño peppers collected in Texas and in agricultural water and serrano peppers on a Mexican farm. Tomato tracebacks did not converge on a source. CONCLUSIONS Although an epidemiologic association with raw tomatoes was identified early in this investigation, subsequent epidemiologic and microbiologic evidence implicated jalapeño and serrano peppers. This outbreak highlights the importance of preventing raw-produce contamination.
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Affiliation(s)
- Casey Barton Behravesh
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Mody RK, Greene SA, Gaul L, Sever A, Pichette S, Zambrana I, Dang T, Gass A, Wood R, Herman K, Cantwell LB, Falkenhorst G, Wannemuehler K, Hoekstra RM, McCullum I, Cone A, Franklin L, Austin J, Delea K, Behravesh CB, Sodha SV, Yee JC, Emanuel B, Al-Khaldi SF, Jefferson V, Williams IT, Griffin PM, Swerdlow DL. National outbreak of Salmonella serotype saintpaul infections: importance of Texas restaurant investigations in implicating jalapeño peppers. PLoS One 2011; 6:e16579. [PMID: 21373185 PMCID: PMC3044132 DOI: 10.1371/journal.pone.0016579] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [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: 11/04/2010] [Accepted: 01/05/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In May 2008, PulseNet detected a multistate outbreak of Salmonella enterica serotype Saintpaul infections. Initial investigations identified an epidemiologic association between illness and consumption of raw tomatoes, yet cases continued. In mid-June, we investigated two clusters of outbreak strain infections in Texas among patrons of Restaurant A and two establishments of Restaurant Chain B to determine the outbreak's source. METHODOLOGY/PRINCIPAL FINDINGS We conducted independent case-control studies of Restaurant A and B patrons. Patients were matched to well controls by meal date. We conducted restaurant environmental investigations and traced the origin of implicated products. Forty-seven case-patients and 40 controls were enrolled in the Restaurant A study. Thirty case-patients and 31 controls were enrolled in the Restaurant Chain B study. In both studies, illness was independently associated with only one menu item, fresh salsa (Restaurant A: matched odds ratio [mOR], 37; 95% confidence interval [CI], 7.2-386; Restaurant B: mOR, 13; 95% CI 1.3-infinity). The only ingredient in common between the two salsas was raw jalapeño peppers. Cultures of jalapeño peppers collected from an importer that supplied Restaurant Chain B and serrano peppers and irrigation water from a Mexican farm that supplied that importer with jalapeño and serrano peppers grew the outbreak strain. CONCLUSIONS/SIGNIFICANCE Jalapeño peppers, contaminated before arrival at the restaurants and served in uncooked fresh salsas, were the source of these infections. Our investigations, critical in understanding the broader multistate outbreak, exemplify an effective approach to investigating large foodborne outbreaks. Additional measures are needed to reduce produce contamination.
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Affiliation(s)
- Rajal K Mody
- Scientific Education and Professional Development Program Office, Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
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Sodha SV, Lynch M, Wannemuehler K, Leeper M, Malavet M, Schaffzin J, Chen T, Langer A, Glenshaw M, Hoefer D, Dumas N, Lind L, Iwamoto M, Ayers T, Nguyen T, Biggerstaff M, Olson C, Sheth A, Braden C. Multistate outbreak of Escherichia coli O157:H7 infections associated with a national fast-food chain, 2006: a study incorporating epidemiological and food source traceback results. Epidemiol Infect 2011; 139:309-16. [PMID: 20429971 DOI: 10.1017/s0950268810000920] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A multistate outbreak of Escherichia coli O157:H7 infections occurred in the USA in November-December 2006 in patrons of restaurant chain A. We identified 77 cases with chain A exposure in four states - Delaware, New Jersey, New York, and Pennsylvania. Fifty-one (66%) patients were hospitalized, and seven (9%) developed haemolytic uraemic syndrome; none died. In a matched analysis controlling for age in 31 cases and 55 controls, illness was associated with consumption of shredded iceberg lettuce [matched odds ratio (mOR) 8·0, 95% confidence interval (CI) 1·1-348·1] and shredded cheddar cheese (mOR 6·2, CI 1·7-33·7). Lettuce, an uncooked ingredient, was more commonly consumed (97% of patients) than cheddar cheese (84%) and a single source supplied all affected restaurants. A single source of cheese could not explain the regional distribution of outbreak cases. The outbreak highlights challenges in conducting rapid multistate investigations and the importance of incorporating epidemiological study results with other investigative findings.
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Affiliation(s)
- S V Sodha
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Gift TL, Palekar RS, Sodha SV, Kent CK, Fagan RP, Archer WR, Edelson PJ, Marchbanks T, Bhattarai A, Swerdlow D, Ostroff S, Meltzer MI. Household effects of school closure during pandemic (H1N1) 2009, Pennsylvania, USA. Emerg Infect Dis 2010; 16:1315-7. [PMID: 20678335 PMCID: PMC3298323 DOI: 10.3201/eid1608.091827] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To determine the effects of school closure, we surveyed 214 households after a 1-week elementary school closure because of pandemic (H1N1) 2009. Students spent 77% of the closure days at home, 69% of students visited at least 1 other location, and 79% of households reported that adults missed no days of work to watch children.
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Affiliation(s)
- Thomas L Gift
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Berger CN, Sodha SV, Shaw RK, Griffin PM, Pink D, Hand P, Frankel G. Fresh fruit and vegetables as vehicles for the transmission of human pathogens. Environ Microbiol 2010; 12:2385-97. [DOI: 10.1111/j.1462-2920.2010.02297.x] [Citation(s) in RCA: 581] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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