Added value of the measles-rubella supplementary immunization activity in reaching unvaccinated and under-vaccinated children, a cross-sectional study in five Indian districts, 2018-20

INTRODUCTION

Supplementary immunization activities (SIAs) aim to interrupt measles transmission by reaching susceptible children, including children who have not received the recommended two routine doses of MCV before the SIA. However, both strategies may miss the same children if vaccine doses are highly correlated. How well SIAs reach children missed by routine immunization is a key metric in assessing the added value of SIAs.

METHODS

Children aged 9 months to younger than 5 years were enrolled in cross-sectional household serosurveys conducted in five districts in India following the 2017-2019 measles-rubella (MR) SIA. History of measles containing vaccine (MCV) through routine services or SIA was obtained from documents and verbal recall. Receipt of a first or second MCV dose during the SIA was categorized as "added value" of the SIA in reaching un- and under-vaccinated children.

RESULTS

A total of 1,675 children were enrolled in these post-SIA surveys. The percentage of children receiving a 1st or 2nd dose through the SIA ranged from 12.8% in Thiruvananthapuram District to 48.6% in Dibrugarh District. Although the number of zero-dose children prior to the SIA was small in most sites, the proportion reached by the SIA ranged from 45.8% in Thiruvananthapuram District to 94.9% in Dibrugarh District. Fewer than 7% of children remained measles zero-dose after the MR SIA (range: 1.1-6.4%) compared to up to 28% before the SIA (range: 7.3-28.1%).

DISCUSSION

We demonstrated the MR SIA provided considerable added value in terms of measles vaccination coverage, although there was variability across districts due to differences in routine and SIA coverage, and which children were reached by the SIA. Metrics evaluating the added value of an SIA can help to inform the design of vaccination strategies to better reach zero-dose or undervaccinated children.

Wavelet Based Characterization of Vertebral Trabecular Bone Structure from MR Images of Specimen at 3 Tesla Compared to MicroCT Measurements

Trabecular bone structure and bone density contribute to the strength of bone and are important in the study of osteoporosis. Wavelets are a powerful tool to characterize and quantify texture in an image. In this study the thickness of trabecular bone was analyzed in 8 cylindrical cores of the vertebral spine. Images were obtained from 3 Tesla (T) magnetic resonance imaging (MRI) and micro-computed tomography (μCT). Results from the wavelet based analysis of trabecular bone were compared with standard two-dimensional (2D) structural parameters (analogous to bone histomorphometry) obtained using mean intercept length (MR images) and direct three-dimensional (3D) distance transformation methods (μCT images). Additionally, the bone volume fraction was determined from MR images. We conclude that the wavelet based analyses delivers comparable results to the established MR histomorphometric measurements. The average deviation in trabecular thickness was less than one pixel size between the wavelet and the standard approach for both MR and μCT analysis. Since the wavelet based method is less sensitive to image noise, we see an advantage of wavelet analysis of trabecular bone for MR imaging when going to higher resolution.

Foundations for effective strategies to control sexually transmitted infections: voices from rural Kenya

Achieving maximal benefit from clinic-based, sexually transmitted infection (STI) control strategies requires that persons seek treatment at public clinics. Community-based, ethnographic research methods were used to examine patterns of health-seeking behavior for sexually transmitted infections in western Kenya. Illness narratives of sexually transmitted infections provided the basis for an analysis of sequential steps in health-seeking behavior, namely recognition, classification, overcoming stigma, identification of treatment options and selection of a course of therapy. A variety of terms were used to identify STI, including multiple terms referring to "women's disease". The stigma associated with STI, reflected in the terminology, was based on a set of beliefs on the causes, contagiousness and sequelae of STI, and resulted in delays in seeking treatment. Five commonly used treatment options were identified, with multiple sources of care often used concurrently. The desire for privacy, cost and belief in the efficacy of traditional medicines strongly influenced health-seeking behaviour. A belief that sexually transmitted infections must be transmitted in order to achieve cure was professed by several respondents and promoted by a traditional healer. Implications for STI control strategies are derived, including the development of educational messages and the design of clinics.

An outbreak of gentamicin-resistant Klebsiella bacteraemia at a children's hospital

An outbreak of Klebsiella bacteraemia at the Ethio-Swedish Childrens' Hospital, Addis Abeba, Ethiopia is described. The epidemic occurred between February 1988 and February 1990 and appeared to originate in the neonatal nursery and subsequently spread to involve other wards in the hospital. Resistance to several antibiotics, including gentamicin, was common. The importance of effective surveillance and the early institution of control measures for the prevention of nosocomial infection are discussed.

Child abuse: case presentation and discussion of medical and legal issues in Ethiopia

The case of a five years old girl who was physically abused is presented. The case serves to illustrate a number of clinical and epidemiological features of child abuse. Medical and legal aspects of child abuse are then discussed, with special reference to the problem in Ethiopia.

The manpower crisis facing radiation oncology

Data from several sources document that the number of radiation oncologists being trained is substantially above the number projected as recently as 1983. This paper addresses the manpower crisis facing radiation oncology and includes information on the supply of and need for specialists, as well as possible courses of action given current circumstances.

A Legionella-like bacterium related to WIGA in a fatal case of pneumonia

An unusual bacterium serologically related to a "rickettsia-like agent," designated previously as WIGA, was seen in lung tissue from a patient who died of pneumonia of unknown cause. A fluorescent antibody conjugate prepared with the WIGA organism, isolated in 1959, was used to stain the lung tissue. Enormous numbers of fluorescent bacteria in the lungs of this patient confirm the pathogenicity of this unusual bacterium.

Gene mapping in Mus musculus by interspecific cell hybridization: assignment of the genes for tripeptidase-1 to chromosome 10, dipeptidase-2 to chromosome 18, acid phosphatase-1 to chromosome 12, and adenylate kinase-1 to chromosome 2

Chinese hamster X mouse somatic cell hybrids segregating mouse chromosomes were examined for their mouse chromosome content using trypsin-Giemsa (GTG) banding and Hoechst 33258 staining techniques. Simultaneously, they were scored for the presence of 24 mouse enzymes. The results confirm the assignments of 11 genes previously mapped by sexual genetics: Dip-1 and Id-1 to chromosome 1; Pgm-2 and Pgd to 4; Pgm-1 to 5; Gpi-1 to 7; Gr-1 to 8; Mpi-1 and Mod-1 to 9; Np-1 and Es-10 to 14. They also confirm chromosomally the assignments of 3 genes that were made by other somatic cell genetic studies: Aprt to 8; Hprt and alpha-gal to the X chromosome. But most importantly, four enzyme loci are assigned to four chromosomes that until now were not known to carry a biochemical marker which is expressed in cultured cells: Trip-1 to 10; Dip-2 to 18; Acp-1 to 12; and Ak-1 to 2. Cytogenetic examination of clones showing discordant segregation of HPRT and A-GAL, suggested the assignment of alpha-gal to region XE leads to XF of the mouse X chromosome. The cytologic studies provide a comparison between data from sexual genetics and somatic cell hybrids and validate hybrid cell techniques. They provide evidence of the reliability of scoring chromosomes by GTG and Hoechst staining and stress the importance of identifying clones with multiple chromosome rearrangements. Striking examples of norandom segregation of mouse chromosomes were observed in these hybrids with preferential retention of 15 and segregation of 11 and the Y chromosome.

Cervical gonorrhea in women using different methods of contraception

Cultures were made from the cervix, rectum, and oropharynx of 2,019 women to determine the prevalence of gonorrhea. For patients of similar race and age, the rates of cervical gonorrhea among users of oral contraceptives (10.6/100) or IUD users (9.5/100) were significantly greater than observed with patients using barrier methods, condom-diaphragm-foam (1.7/100). On the other hand, there were no significant differences in rates of rectal or oral infection by method of contraception. Postpartum patients were found to have similar infection rates at all three sites as a comparable group of nonpuerperas. Recommendations for utilization of barrier methods are made for suitable patients, including those in the immediate puerperium.

Prevalence of gonorrhoea among women using various methods of contraception

Among 2,005 women attending a contraceptive clinic 9-3 per cent. were found to have gonorrhoea. When these women were classified according to the method of contraception used at the time of their initial visit to the clinic, the following prevalence of gonorrhoea was observed: oral contraceptives 11-5 per cent., intrauterine contraceptive devices 9-9 per cent., barrier methods (condom-diaphragm-foam) 4-2 per cent. These differences are statistically significant. The authors suggest that the additional protective advantage of barrier methods should be considered when the physician and patient are selecting appropriate methods of contraception.

Gonorrhea detection in a family planning clinic: a cost-benefit analysis of 2,000 triplicate cultures

Among 2,019 women screened by triplicate culture technique, 191 (9.5 per cent) had one or more positive cultures of specimens for Neisseria gonorrhoeae. The prevalence rates by site of infection were as follows: cervix-8.1 per cent; rectum-2.4 per cent, and oropharynx-0.9 per cent. Of the 191 patients with gonorrhea, 163 (85 per cent) had a positive culture of the cervical specimen. Addition of routine cultures of rectal and oropharyngeal specimens detected only 15 per cent of positive cases, while tripling the cost of the screening program. Based on a cost-benefit anallysis, a culture of the cervical specimen is most appropriate for routine screening, and cultures of rectal and/or oropharyngeal specimens should be obtained on a selected basic only.