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Shattock AJ, Johnson HC, Sim SY, Carter A, Lambach P, Hutubessy RCW, Thompson KM, Badizadegan K, Lambert B, Ferrari MJ, Jit M, Fu H, Silal SP, Hounsell RA, White RG, Mosser JF, Gaythorpe KAM, Trotter CL, Lindstrand A, O'Brien KL, Bar-Zeev N. Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization. Lancet 2024; 403:2307-2316. [PMID: 38705159 DOI: 10.1016/s0140-6736(24)00850-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND WHO, as requested by its member states, launched the Expanded Programme on Immunization (EPI) in 1974 to make life-saving vaccines available to all globally. To mark the 50-year anniversary of EPI, we sought to quantify the public health impact of vaccination globally since the programme's inception. METHODS In this modelling study, we used a suite of mathematical and statistical models to estimate the global and regional public health impact of 50 years of vaccination against 14 pathogens in EPI. For the modelled pathogens, we considered coverage of all routine and supplementary vaccines delivered since 1974 and estimated the mortality and morbidity averted for each age cohort relative to a hypothetical scenario of no historical vaccination. We then used these modelled outcomes to estimate the contribution of vaccination to globally declining infant and child mortality rates over this period. FINDINGS Since 1974, vaccination has averted 154 million deaths, including 146 million among children younger than 5 years of whom 101 million were infants younger than 1 year. For every death averted, 66 years of full health were gained on average, translating to 10·2 billion years of full health gained. We estimate that vaccination has accounted for 40% of the observed decline in global infant mortality, 52% in the African region. In 2024, a child younger than 10 years is 40% more likely to survive to their next birthday relative to a hypothetical scenario of no historical vaccination. Increased survival probability is observed even well into late adulthood. INTERPRETATION Since 1974 substantial gains in childhood survival have occurred in every global region. We estimate that EPI has provided the single greatest contribution to improved infant survival over the past 50 years. In the context of strengthening primary health care, our results show that equitable universal access to immunisation remains crucial to sustain health gains and continue to save future lives from preventable infectious mortality. FUNDING WHO.
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Affiliation(s)
- Andrew J Shattock
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Telethon Kids Institute, Perth, Australia; University of Western Australia, Perth, Australia
| | - Helen C Johnson
- Safinea, London, UK; London School of Economics and Political Science, London, UK; London School of Hygiene & Tropical Medicine, London, UK; University of Cambridge, Cambridge, UK
| | - So Yoon Sim
- World Health Organization, Geneva, Switzerland
| | | | | | | | | | | | - Brian Lambert
- Pennsylvania State University, University Park, PA, USA
| | | | - Mark Jit
- London School of Hygiene & Tropical Medicine, London, UK
| | - Han Fu
- London School of Hygiene & Tropical Medicine, London, UK
| | - Sheetal P Silal
- Modelling and Simulation Hub, Africa, Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa; Centre for Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Rachel A Hounsell
- Modelling and Simulation Hub, Africa, Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa; Centre for Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Richard G White
- London School of Hygiene & Tropical Medicine, London, UK; TB Modelling Group, Infectious Disease Epidemiology Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Caroline L Trotter
- University of Cambridge, Cambridge, UK; Imperial College London, London, UK
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Westenius E, Conner P, Pettersson M, Sahlin E, Papadogiannakis N, Lindstrand A, Iwarsson E. Whole-genome sequencing in prenatally detected congenital malformations: prospective cohort study in clinical setting. Ultrasound Obstet Gynecol 2024; 63:658-663. [PMID: 38268232 DOI: 10.1002/uog.27592] [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] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/26/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To investigate the diagnostic yield of trio whole-genome sequencing (WGS) in fetuses with various congenital malformations referred to a tertiary center for prenatal diagnosis. METHODS In this prospective study, 50 pregnancies with different congenital malformations, negative for trisomies and causative copy-number variants, were analyzed further with fetal-parental trio WGS analysis. Parents were eligible for inclusion if they accepted further investigation following the detection of isolated or multiple malformations on prenatal ultrasound. Cases with isolated increased nuchal translucency, gamete donation or multiple pregnancy were excluded. WGS with the Illumina Inc. 30× polymerase-chain-reaction-free short-read sequencing included analysis of single-nucleotide variants, insertions and deletions, structural variants, short tandem repeats and copy-number identification of SMN1 and SMN2 genes. RESULTS A molecular diagnosis was achieved in 13/50 (26%) cases. Causative sequence variants were identified in 12 genes: FGFR3 (n = 2), ACTA1 (n = 1), CDH2 (n = 1), COL1A2 (n = 1), DHCR7 (n = 1), EYA1 (n = 1), FBXO11 (n = 1), FRAS1 (n = 1), L1CAM (n = 1), OFD1 (n = 1), PDHA1 (n = 1) and SOX9 (n = 1). The phenotypes of the cases were divided into different groups, with the following diagnostic yields: skeletal malformation (4/9 (44%)), multisystem malformation (3/7 (43%)), central nervous system malformation (5/15 (33%)) and thoracic malformation (1/10 (10%)). Additionally, two cases carried variants that were considered potentially clinically relevant, even though they were assessed as variants of uncertain significance, according to the guidelines provided by the American College of Medical Genetics and Genomics. Overall, we identified a causative or potentially clinically relevant variant in 15/50 (30%) cases. CONCLUSIONS We demonstrate a diagnostic yield of 26% with clinical WGS in prenatally detected congenital malformations. This study emphasizes the benefits that WGS can bring to the diagnosis of fetal structural anomalies. It is important to note that causative chromosomal aberrations were excluded from our cohort before WGS. As chromosomal aberrations are a well-known cause of prenatally detected congenital malformations, future studies using WGS as a primary diagnostic test, including assessment of chromosomal aberrations, may show that the detection rate exceeds the diagnostic yield of this study. WGS can add clinically relevant information, explaining the underlying cause of the fetal anomaly, which will provide information concerning the specific prognosis of the condition, as well as estimate the risk of recurrence. A genetic diagnosis can also provide more reproductive choice for future pregnancies. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Westenius
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics and Genomics, Karolinska University Hospital, Stockholm, Sweden
| | - P Conner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - M Pettersson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics and Genomics, Karolinska University Hospital, Stockholm, Sweden
| | - E Sahlin
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics and Genomics, Karolinska University Hospital, Stockholm, Sweden
| | - N Papadogiannakis
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - A Lindstrand
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics and Genomics, Karolinska University Hospital, Stockholm, Sweden
| | - E Iwarsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics and Genomics, Karolinska University Hospital, Stockholm, Sweden
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Doshi RH, Nsasiirwe S, Dahlke M, Atagbaza A, Aluta OE, Tatsinkou AB, Dauda E, Vilajeliu A, Gurung S, Tusiime J, Braka F, Bwaka A, Wanyoike S, Brooks DJ, Blanc DC, Alexander JP, Dahl BA, Lindstrand A, Wiysonge CS. COVID-19 Vaccination Coverage - World Health Organization African Region, 2021-2023. MMWR Morb Mortal Wkly Rep 2024; 73:307-311. [PMID: 38602879 PMCID: PMC11008790 DOI: 10.15585/mmwr.mm7314a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
With the availability of authorized COVID-19 vaccines in early 2021, vaccination became an effective tool to reduce COVID-19-associated morbidity and mortality. Initially, the World Health Organization (WHO) set an ambitious target to vaccinate 70% of the global population by mid-2022. However, in July 2022, WHO recommended that all countries, including those in the African Region, prioritize COVID-19 vaccination of high-risk groups, including older adults and health care workers, to have the greatest impact on morbidity and mortality. As of December 31, 2023, approximately 860 million doses of COVID-19 vaccine had been delivered to countries in the African Region, and 646 million doses had been administered. Cumulatively, 38% of the African Region's population had received ≥1 dose, 32% had completed a primary series, and 21% had received ≥1 booster dose. Cumulative total population coverage with ≥1 dose ranged by country from 0.3% to 89%. Coverage with the primary series among older age groups was 52% (range among countries = 15%-96%); primary series coverage among health care workers was 48% (range = 13%-99%). Although the COVID-19 public health emergency of international concern was declared over in May 2023, current WHO recommendations reinforce the need to vaccinate priority populations at highest risk for severe COVID-19 disease and death and build more sustainable programs by integrating COVID-19 vaccination into primary health care, strengthening immunization across the life course, and improving pandemic preparedness.
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Trotter C, Giersing B, Lindstrand A, Bar-Zeev N, Cernuschi T, Franzel-Sassanpour L, Friede M, Hombach J, Jansen M, Hasso-Agopsowicz M, Koh M, Sim SY, Spasenoska D, Yeung KHT, Lambach P. A Practical Guide to Full Value of Vaccine Assessments. Vaccines (Basel) 2024; 12:201. [PMID: 38400184 PMCID: PMC10892982 DOI: 10.3390/vaccines12020201] [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: 12/21/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Articulating the wide range of health, social and economic benefits that vaccines offer may help to overcome obstacles in the vaccine development pipeline. A framework to guide the assessment and communication of the value of a vaccine-the Full Value of Vaccine Assessment (FVVA)-has been developed by the WHO. The FVVA framework offers a holistic assessment of the value of vaccines, providing a synthesis of evidence to inform the public health need of a vaccine, describing the supply and demand aspects, its market and its impact from a health, financial and economic perspective. This paper provides a practical guide to how FVVAs are developed and used to support investment in vaccines, ultimately leading to sustained implementation in countries. The FVVA includes a range of elements that can be broadly categorised as synthesis, vaccine development narrative and defining vaccine impact and value. Depending on the features of the disease/vaccine in question, different elements may be emphasised; however, a standardised set of elements is recommended for each FVVA. The FVVA should be developed by an expert group who represent a range of stakeholders, perspectives and geographies and ensure a fair, coherent and evidence-based assessment of vaccine value.
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Affiliation(s)
- Caroline Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, UK
- Imperial College, London W12 7TA, UK
| | - Birgitte Giersing
- Immunization Department, World Health Organization, 1202 Geneva, Switzerland; (B.G.); (L.F.-S.); (S.Y.S.); (K.H.T.Y.)
| | - Ann Lindstrand
- Immunization Department, World Health Organization, 1202 Geneva, Switzerland; (B.G.); (L.F.-S.); (S.Y.S.); (K.H.T.Y.)
| | - Naor Bar-Zeev
- Immunization Department, World Health Organization, 1202 Geneva, Switzerland; (B.G.); (L.F.-S.); (S.Y.S.); (K.H.T.Y.)
| | - Tania Cernuschi
- Immunization Department, World Health Organization, 1202 Geneva, Switzerland; (B.G.); (L.F.-S.); (S.Y.S.); (K.H.T.Y.)
| | - Lauren Franzel-Sassanpour
- Immunization Department, World Health Organization, 1202 Geneva, Switzerland; (B.G.); (L.F.-S.); (S.Y.S.); (K.H.T.Y.)
| | - Martin Friede
- Immunization Department, World Health Organization, 1202 Geneva, Switzerland; (B.G.); (L.F.-S.); (S.Y.S.); (K.H.T.Y.)
| | - Joachim Hombach
- Immunization Department, World Health Organization, 1202 Geneva, Switzerland; (B.G.); (L.F.-S.); (S.Y.S.); (K.H.T.Y.)
| | - Maarten Jansen
- Immunization Department, World Health Organization, 1202 Geneva, Switzerland; (B.G.); (L.F.-S.); (S.Y.S.); (K.H.T.Y.)
| | - Mateusz Hasso-Agopsowicz
- Immunization Department, World Health Organization, 1202 Geneva, Switzerland; (B.G.); (L.F.-S.); (S.Y.S.); (K.H.T.Y.)
| | - Mitsuki Koh
- Immunization Department, World Health Organization, 1202 Geneva, Switzerland; (B.G.); (L.F.-S.); (S.Y.S.); (K.H.T.Y.)
| | - So Yoon Sim
- Immunization Department, World Health Organization, 1202 Geneva, Switzerland; (B.G.); (L.F.-S.); (S.Y.S.); (K.H.T.Y.)
| | - Dijana Spasenoska
- Immunization Department, World Health Organization, 1202 Geneva, Switzerland; (B.G.); (L.F.-S.); (S.Y.S.); (K.H.T.Y.)
| | - Karene Hoi Ting Yeung
- Immunization Department, World Health Organization, 1202 Geneva, Switzerland; (B.G.); (L.F.-S.); (S.Y.S.); (K.H.T.Y.)
| | - Philipp Lambach
- Immunization Department, World Health Organization, 1202 Geneva, Switzerland; (B.G.); (L.F.-S.); (S.Y.S.); (K.H.T.Y.)
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Dadari I, Vilajeliu A, Berdaga V, Rozario S, Meyer P, Nic Lochlainn L, Horemans D, Toro N, Lihemo G, Bhardwaj S, Cowley P, Chang Blanc D, Conteh-Nordman F, Mirza I, Malm S, Ameda IM, Lindstrand A. Key Learnings from the Development and Early Use of Global Guidance on the Integration of COVID-19 Vaccination into Broader Health Systems. Vaccines (Basel) 2024; 12:196. [PMID: 38400179 PMCID: PMC10892213 DOI: 10.3390/vaccines12020196] [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: 12/21/2023] [Revised: 01/26/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
More than 13.5 billion COVID-19 vaccine doses were delivered between 2021 and 2023 through a mix of delivery platforms, with mass vaccination campaigns being the main approach. In 2022, with the continued circulation of SARS-CoV2 and the need for periodic boosters being most likely, countries were required to plan for more sustainable approaches to provide COVID-19 vaccinations. In this context of uncertainty, a global tool for integrating COVID-19 vaccines into immunization programs and as part of broader health systems was published jointly by the WHO and UNICEF to respond to country needs. This paper summarizes the approach to, and lessons learned during, the development of a global guidance document and describes some examples of its early use in low- and middle-income countries (LMICs). The guidance leveraged existing health system frameworks, proposed four steps for planning and implementing the COVID-19 vaccination integration journey, and identified investment areas. The development process maximized robust global stakeholder and country engagement, and the timeframe was aligned with donor funding windows to support countries with the integration of COVID-19 vaccination. The rapid dissemination of the guidance document allowed countries to ascertain their readiness for integrating COVID-19 vaccination and inform the development of national plans and funding applications. While progress has been made in specific areas (e.g., optimizing cold chain and logistics leveraging COVID-19 vaccination), in the context of decreasing demand for COVID-19 vaccines, reaching adult COVID-19 vaccine high-priority-use groups and engaging and coordinating with other health programs (beyond immunization) remain challenges, particularly in LMICs. We share the learning that despite the uncertainties of a pandemic, guidance documents can be developed and used within a short timeframe. Working in partnership with stakeholders within and beyond immunization towards a common objective is powerful and can allow progress to be made in terms of integrating health services and better preparing for future pandemics.
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Affiliation(s)
- Ibrahim Dadari
- Immunization Section, United Nations Children’s Fund (UNICEF) HQ, New York, NY 10017, USA
| | - Alba Vilajeliu
- Essential Programme on Immunization Unit, Immunization Vaccines & Biologicals Department, World Health Organization (WHO), 1202 Geneva, Switzerland; (A.V.)
| | - Viorica Berdaga
- Immunization Section, United Nations Children’s Fund (UNICEF) HQ, New York, NY 10017, USA
| | - Shalini Rozario
- Immunization Section, United Nations Children’s Fund (UNICEF) HQ, New York, NY 10017, USA
| | - Phoebe Meyer
- Immunization Section, United Nations Children’s Fund (UNICEF) HQ, New York, NY 10017, USA
| | - Laura Nic Lochlainn
- Essential Programme on Immunization Unit, Immunization Vaccines & Biologicals Department, World Health Organization (WHO), 1202 Geneva, Switzerland; (A.V.)
| | - Dirk Horemans
- Integrated Health Services Department, World Health Organization (WHO), 1202 Geneva, Switzerland
| | - Nuria Toro
- Integrated Health Services Department, World Health Organization (WHO), 1202 Geneva, Switzerland
| | - Gloria Lihemo
- Immunization Section, United Nations Children’s Fund (UNICEF) HQ, New York, NY 10017, USA
| | - Sanjay Bhardwaj
- Immunization Section, United Nations Children’s Fund (UNICEF) HQ, New York, NY 10017, USA
| | - Peter Cowley
- Health Systems Governance and Financing, World Health Organization (WHO), 1202 Geneva, Switzerland
| | - Diana Chang Blanc
- Essential Programme on Immunization Unit, Immunization Vaccines & Biologicals Department, World Health Organization (WHO), 1202 Geneva, Switzerland; (A.V.)
| | | | - Imran Mirza
- Immunization Section, United Nations Children’s Fund (UNICEF) HQ, New York, NY 10017, USA
| | - Shahira Malm
- Immunization Section, United Nations Children’s Fund (UNICEF) HQ, New York, NY 10017, USA
| | - Ida Marie Ameda
- UNICEF Eastern and Southern Africa Regional Office, Nairobi P.O. Box 44145, Kenya
| | - Ann Lindstrand
- Essential Programme on Immunization Unit, Immunization Vaccines & Biologicals Department, World Health Organization (WHO), 1202 Geneva, Switzerland; (A.V.)
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Martin LJ, Galanis I, Lepp T, Lindstrand A. Estimated number of reported vaccine-preventable disease cases averted following the introduction of routine vaccination programs in Sweden, 1910-2019. Eur J Public Health 2023; 33:1188-1193. [PMID: 37883058 PMCID: PMC10710358 DOI: 10.1093/eurpub/ckad169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Routine childhood vaccination programs have had enormous positive public health impacts worldwide. However, in some areas, these benefits may be impeded by vaccine hesitancy and undervaccination. We estimated the number of reported cases of measles, pertussis, mumps and poliomyelitis averted in Sweden after the introduction of routine childhood vaccination programs. METHODS We used annual national data on population size and the number of reported cases of measles (1911-2019), pertussis (1911-2019), mumps (1914-2019) and poliomyelitis (1910-2019) for Sweden. For each disease, we calculated the median and 95% confidence interval of the annual pre-vaccination incidence to estimate the number of counterfactual cases; that is, the estimated number of cases that would have been observed in the post-vaccination period had no vaccine been introduced (median incidence × average annual population). For the post-vaccination periods, we calculated reported cases averted and assumed all decreases were due to vaccines. RESULTS In total, for all four diseases combined, over 2.1 million cases were reported over the respective surveillance periods. Since the introduction of vaccinations, we estimate that over 1.5 million reported cases of these four diseases combined have been averted: measles (633 091), pertussis (608 670), mumps (262 951) and poliomyelitis (58 240). However, due to underreporting, especially during pre-vaccination years, these are likely underestimates. CONCLUSIONS Since the introduction of these routine childhood vaccination programs in Sweden, a substantial number of reported cases of vaccine-preventable diseases have been averted. Vigilance against both failure to vaccinate and undervaccination is necessary to prevent future increases of these vaccine-preventable diseases.
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Affiliation(s)
| | | | - Tiia Lepp
- Public Health Agency of Sweden, Solna, Sweden
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Salo H, Sakalauskaitè M, Lévy-Bruhl D, Lindstrand A, Valentiner-Branth P, Wichmann O, Puumalainen T. Prices of paediatric vaccines in European vaccination programmes. Vaccine X 2023; 15:100392. [PMID: 37779660 PMCID: PMC10539658 DOI: 10.1016/j.jvacx.2023.100392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/30/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023] Open
Abstract
Objective To compare the vaccine prices per vaccinated child under 18 and vaccine funding and procurement systems in the national vaccination programmes (NVPs) in Europe. Methods The on-line survey targeted to NVP managers collected data referred to the information available on 31 December 2016. The prices of vaccines were categorised into three groups. The price per child 1) fully vaccinated comprised all vaccines and doses offered in the NVP; 2) vaccinated with standard vaccines comprised the vaccines included in the NVP in all countries; 3) vaccinated with recent vaccines comprised the pneumococcal conjugate, human papillomavirus and rotavirus vaccines. Results In the 23 out of 32 countries that answered the survey, 17 funded the vaccines by taxes and six by social insurance. 18 countries procured the vaccines through public tenders or negotiations. Five countries purchased the vaccines by healthcare providers and reimbursed from the health insurance system.In the countries with vaccine procurement through public tenders the price per child vaccinated with standard vaccines ranged from €59 to €117 when using pentavalent and from €98 to €220 when using hexavalent vaccines. The mean price per child vaccinated with recent vaccines was €130 for the countries that offered pneumococcal conjugate and human papillomavirus vaccines and €142 for the countries that in addition included rotavirus vaccine.In the countries that purchased the vaccines by healthcare providers and reimbursed from the health insurance system the price per child vaccinated with standard vaccines ranged from €136 to €427. Conclusions The vaccine prices differ notably in Europe. Prices were lower in countries where vaccines in the NVP were tax-funded and nationally or regionally procured. Improved procurement systems could lead to substantial savings or possibilities to introduce more vaccines into the NVP.
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Affiliation(s)
- Heini Salo
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Milda Sakalauskaitè
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Daniel Lévy-Bruhl
- Santé Publique France, Agence Nationale de Santé Publique, Saint-Maurice cedex, France
| | | | - Palle Valentiner-Branth
- Department of Infectious Disease Epidemiology and Prevention, Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | | | - Taneli Puumalainen
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Department for Safety, Security and Health, Ministry of Social Affairs and Health, Helsinki, Finland
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Appelqvist E, Danielsson M, Jama A, Ask LS, Stenhammar C, Lindstrand A, Riesbeck K, Roth A. Parental views and the key role of nurses for high vaccine acceptance in Sweden - a focus group study. BMC Public Health 2023; 23:1786. [PMID: 37710197 PMCID: PMC10500778 DOI: 10.1186/s12889-023-16678-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND In Sweden, vaccine uptake is exceptionally high due to an efficient child immunization program. More than 97% of Swedish children were vaccinated at child health care centers (CHCs) according to the schedule at 2 years of age in 2021. From the age of 6 years, vaccinations are given within the school health care. Maintaining high vaccination coverage over time is one of the central motives to explore and understand drivers for vaccine acceptance. The current study aimed to assess parental vaccine acceptance concerning the national immunization program and explore factors contributing to the high vaccine acceptance in Sweden. METHODS Parents of children aged 1-2 years and 8-12 years were recruited through purposive sampling and asked to participate in focus groups held in three cities in Sweden, in February and March 2019. In total, 47 parents participated in two focus groups per city, one session for parents of younger (1-2 years) and older (8-12 years) children respectively. The focus group discussions were analyzed using qualitative content analysis. RESULTS Parents of children aged 1-2 years expressed the themes; strong compliance to and protection of the value of vaccinations; parents feel safe with an attentive relationship with their nurse; the spectrum of communication needs is essential to meet. For parents to children aged 8-12 years, the themes expressed were; vaccinate to do good for the individual and society; a foundation of trust is built at CHCs for decisions later on; decisions for vaccination become more complex as children get older; communication changes as children get older and need to be explicit and tailored to the situation. CONCLUSION Both individual and societal perspectives were shown to influence the vaccination decision for childhood immunizations, as manifested in parental reflections and experiences. As nurses have a key role, it is important to provide them with continued support and tools to facilitate their support for parents in making informed decisions. Continuous work for supporting driving factors for vaccination over time is needed to maintain high vaccine acceptance in Sweden.
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Affiliation(s)
- Emma Appelqvist
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden.
- Clinical Microbiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden.
| | - Madelene Danielsson
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
| | - Asha Jama
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Lina Schollin Ask
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
- Department of Women and Child Health, Karolinska Institutet, Stockholm, Sweden
| | - Christina Stenhammar
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
| | - Ann Lindstrand
- Department of Immunization, Vaccines and Biologicals, Unit Essential Programme On Immunization, World Health Organization (WHO) Headquarters, Geneva, Switzerland
| | - Kristian Riesbeck
- Clinical Microbiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Adam Roth
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Stockholm, Sweden
- Clinical Microbiology, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
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Helldén D, Tesfaye S, Gachen C, Lindstrand A, Källander K. Digital health funding for COVID-19 vaccine deployment across four major donor agencies. Lancet Digit Health 2023; 5:e627-e631. [PMID: 37625897 DOI: 10.1016/s2589-7500(23)00134-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 04/10/2023] [Accepted: 07/11/2023] [Indexed: 08/27/2023]
Abstract
The international response to the COVID-19 pandemic provided opportunities for countries to use digital technologies for vaccine deployment and associated activities, but misaligned digital investments could weaken or fragment national systems. In this review of 311 funding applications from 120 country governments to four donor agencies (UNICEF; Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and the World Bank) up to May 1, 2022, we found that 272 (87%) of the applications included at least one digital aspect and that substantial funding has been dedicated towards digital aspects from donors. The majority of digital aspects concerned immunisation information systems, vaccine acceptance and uptake, and COVID-19 surveillance. As the global community sets its sights on a COVID-19-free world, continued coordinated investments in digital health and health information systems for pandemic preparedness and response will be key to strengthening the resilience of health systems.
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Affiliation(s)
- Daniel Helldén
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | | | | | | | - Karin Källander
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; UNICEF, New York, NY, USA
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10
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Carter A, Msemburi W, Sim SY, Gaythorpe KAM, Lambach P, Lindstrand A, Hutubessy R. Modeling the impact of vaccination for the immunization Agenda 2030: Deaths averted due to vaccination against 14 pathogens in 194 countries from 2021 to 2030. Vaccine 2023:S0264-410X(23)00854-X. [PMID: 37537094 DOI: 10.1016/j.vaccine.2023.07.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/19/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The Immunization Agenda 2030 (IA2030) Impact Goal 1.1. aims to reduce the number of future deaths averted through immunization in the next decade. To estimate the potential impact of the aspirational coverage targets for IA2030, we developed an analytical framework and estimated the number of deaths averted due to an ambitious vaccination coverage scenario from 2021 to 2030 in 194 countries. METHOD A demographic model was used to determine annual age-specific mortality estimates associated with vaccine coverage rates. For ten pathogens (Hepatitis B virus, Haemophilus influenzae type B, human papillomavirus, Japanese encephalitis, measles, Neisseria meningitidis serogroup A, Streptococcus pneumoniae, rotavirus, rubella, yellow fever), we derived single measures of country-, age-, and pathogen-specific relative risk of deaths conditional upon coverage rates, leveraging the data from 18 modeling groups as part of the Vaccine Impact Model Consortium (VIMC) for 110 countries. We used a logistic regression model to extrapolate the relative risk estimates to countries that were not modeled by VIMC. For four pathogens (diphtheria, tetanus, pertussis and tuberculosis), we used estimates from the Global Burden of Disease 2019 study and existing literature on vaccine efficacy. A future scenario defining years of vaccine introduction and scale-up needed to reach aspirational targets was developed as an input to estimate the long-term impact of vaccination taking place from 2021 to 2030. FINDINGS Overall, an estimated 51.5 million (95 % CI: 44.0-63.2) deaths are expected to be averted due to vaccinations administered between the years 2021 and 2030. With immunization coverage projected to increase over 2021-2030 an average of 5.2 million per year (4.4-6.3) deaths will be averted annually, with 4.4 million (3.9-5.1) deaths be averted for the year 2021, gradually rising to 5.8 million (4.9-7.5) deaths averted in 2030. The largest proportion of deaths is attributed to Measles and Hepatitis B accounting for 18.8 million (17.8-20.0) and 14.0 million (11.5-16.9) of total deaths averted respectively. INTERPRETATION The results from this global analysis demonstrate the substantial potential mortality reductions achievable if the IA2030 targets are met by 2030. Deaths caused by vaccine preventable diseases disproportionately affect LMICs in the African region.
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Affiliation(s)
- Austin Carter
- University of Washington, Seattle, WA, USA; World Health Organization, Department of Immunization, Vaccines and Biologicals (IVB), Geneva, Switzerland.
| | - William Msemburi
- World Health Organization, Division of Data, Analytics and Delivery for Impact (DDI), Geneva, Switzerland.
| | - So Yoon Sim
- World Health Organization, Department of Immunization, Vaccines and Biologicals (IVB), Geneva, Switzerland.
| | | | - Philipp Lambach
- World Health Organization, Department of Immunization, Vaccines and Biologicals (IVB), Geneva, Switzerland.
| | - Ann Lindstrand
- World Health Organization, Department of Immunization, Vaccines and Biologicals (IVB), Geneva, Switzerland.
| | - Raymond Hutubessy
- World Health Organization, Department of Immunization, Vaccines and Biologicals (IVB), Geneva, Switzerland.
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11
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Nabia S, Wonodi CB, Vilajeliu A, Sussman S, Olson K, Cooke R, Udayakumar K, Twose C, Ezeanya N, Adefarrell AA, Lindstrand A. Experiences, Enablers, and Challenges in Service Delivery and Integration of COVID-19 Vaccines: A Rapid Systematic Review. Vaccines (Basel) 2023; 11:974. [PMID: 37243078 PMCID: PMC10222130 DOI: 10.3390/vaccines11050974] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
The COVID-19 vaccination is a crucial public health intervention for controlling the spread and severity of the SARS-CoV2 virus. COVID-19 vaccines have been developed in record time, but their deployment has varied across countries, owing to differences in health system capacity, demand for the vaccine, and purchasing power of countries. The aim of this rapid review is to summarize and synthesize experiences on COVID-19 vaccine service delivery and integration to inform future COVID-19 vaccination programming and contribute to the knowledge base for future pandemic management. A systematic search was conducted in PubMed, Scopus, and Global Index Medicus databases. Twenty-five studies were included in the analysis. Included studies spanned nine countries where COVID-19 vaccines were delivered through mass, mobile, and fixed-post vaccination service delivery models. There was limited evidence of integrating COVID-19 vaccines into routine services for pregnant women, people who inject drugs, and leveraging existing health programs to deliver COVID-19 vaccines to the general population. Common challenges reported were vaccine skepticism, lack of adequate health workers, and linguistic barriers to access. Partnerships with a variety of stakeholders and the involvement of volunteers were vital in overcoming barriers and contributed to the efficient functioning of COVID-19 vaccination programs.
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Affiliation(s)
- Sarah Nabia
- USAID’s MOMENTUM Country and Global Leadership, International Vaccine Access Center (IVAC), Johns Hopkins University, Baltimore, MD 21231, USA;
| | - Chizoba Barbara Wonodi
- USAID’s MOMENTUM Country and Global Leadership, International Vaccine Access Center (IVAC), Johns Hopkins University, Baltimore, MD 21231, USA;
| | - Alba Vilajeliu
- Department of Immunization, Vaccines & Biologicals (IVB), World Health Organization, WHO, 1211 Geneva, Switzerland; (A.V.); (A.L.)
| | - Sabine Sussman
- Duke-Robert J. Margolis, MD, Center for Health Policy, Washington, DC 20004, USA;
| | - Katharine Olson
- Duke Global Health Innovation Center, Durham, NC 27701, USA; (K.O.); (R.C.); (K.U.)
| | - Rianna Cooke
- Duke Global Health Innovation Center, Durham, NC 27701, USA; (K.O.); (R.C.); (K.U.)
| | - Krishna Udayakumar
- Duke Global Health Innovation Center, Durham, NC 27701, USA; (K.O.); (R.C.); (K.U.)
| | - Claire Twose
- Welch Medical Library, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Nwamaka Ezeanya
- Direct Consulting and Logistics Limited, Abuja 901101, Federal Capital Territory, Nigeria; (N.E.); (A.A.A.)
| | - Adewumi Adetola Adefarrell
- Direct Consulting and Logistics Limited, Abuja 901101, Federal Capital Territory, Nigeria; (N.E.); (A.A.A.)
| | - Ann Lindstrand
- Department of Immunization, Vaccines & Biologicals (IVB), World Health Organization, WHO, 1211 Geneva, Switzerland; (A.V.); (A.L.)
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12
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Appelqvist E, Jama A, Kulane A, Roth A, Lindstrand A, Godoy-Ramirez K. Exploring nurses' experiences of a tailored intervention to increase MMR vaccine acceptance in a Somali community in Stockholm, Sweden: a qualitative interview study. BMJ Open 2023; 13:e067169. [PMID: 36746543 PMCID: PMC9906253 DOI: 10.1136/bmjopen-2022-067169] [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: 02/08/2023] Open
Abstract
OBJECTIVES To explore nurses' experiences of a tailored intervention that supported them with knowledge and tools to use during encounters and dialogue with parents with low vaccine acceptance. DESIGN A qualitative study with in-depth interviews conducted in 2017. Data were analysed using thematic analysis. SETTING This study was part of a multicomponent intervention targeting Somali parents and the nurses at child health centres in the Rinkeby and Tensta neighbourhoods of Stockholm. An area with documented low measles, mumps and rubella (MMR) vaccination coverage. Previous research has revealed that Somali parents in the community delayed MMR vaccination due to fear of autism despite lack of scientific evidence. The interventions were implemented in 2015-2017. PARTICIPANTS Eleven nurses employed at the child health centres involved in the intervention participated in interviews. The tailored intervention targeting nurses included a series of seminars, a narrative film and an information card with key messages for distribution to parents. RESULTS The qualitative analysis revealed an overarching theme: perception of improved communication with parents. Two underlying themes were identified: (1) feeling more confident to address parents' MMR vaccine concerns and (2) diverse tools as useful support to dispel myth and reduce language barriers. CONCLUSION From the nurses' perspective, the tailored intervention was useful to improve communication with parents having vaccine concerns. Nurses have a crucial role in vaccine uptake and acceptance. Interventions aiming to strengthen their communication with parents are therefore essential, especially in areas with lower vaccine acceptance.
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Affiliation(s)
- Emma Appelqvist
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
- Department of Clinical Microbiology, Department of Translational Medicine, Lund University, Lund, Sweden
| | - Asha Jama
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Asli Kulane
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Adam Roth
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
- Department of Clinical Microbiology, Department of Translational Medicine, Lund University, Lund, Sweden
| | - Ann Lindstrand
- Department of Immunization, Vaccines and Biologicals, Unit Essential Programme on Immunization, WHO, Geneve, Switzerland
| | - Karina Godoy-Ramirez
- The Office of the Head for Communicable Disease Control and Health Protection, Public Health Agency of Sweden, Solna, Sweden
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13
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Wong MK, Brooks DJ, Ikejezie J, Gacic-Dobo M, Dumolard L, Nedelec Y, Steulet C, Kassamali Z, Acma A, Ajong BN, Adele S, Allan M, Cohen HA, Awofisayo-Okuyelu A, Campbell F, Cristea V, De Barros S, Edward NV, Waeber AREC, Guinko TN, Laurenson-Schafer H, Mahran M, Carrera RM, Mesfin S, Meyer E, Miglietta A, Mirembe BB, Mitri M, Nezu IH, Ngai S, Ejoh OO, Parikh SR, Peron E, Sklenovská N, Stoitsova S, Shimizu K, Togami E, Jin YW, Pavlin BI, Novak RT, Le Polain O, Fuller JA, Mahamud AR, Lindstrand A, Hersh BS, O’Brien K, Van Kerkhove MD. COVID-19 Mortality and Progress Toward Vaccinating Older Adults - World Health Organization, Worldwide, 2020-2022. MMWR Morb Mortal Wkly Rep 2023; 72:113-118. [PMID: 36730046 PMCID: PMC9927068 DOI: 10.15585/mmwr.mm7205a1] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
After the emergence of SARS-CoV-2 in late 2019, transmission expanded globally, and on January 30, 2020, COVID-19 was declared a public health emergency of international concern.* Analysis of the early Wuhan, China outbreak (1), subsequently confirmed by multiple other studies (2,3), found that 80% of deaths occurred among persons aged ≥60 years. In anticipation of the time needed for the global vaccine supply to meet all needs, the World Health Organization (WHO) published the Strategic Advisory Group of Experts on Immunization (SAGE) Values Framework and a roadmap for prioritizing use of COVID-19 vaccines in late 2020 (4,5), followed by a strategy brief to outline urgent actions in October 2021.† WHO described the general principles, objectives, and priorities needed to support country planning of vaccine rollout to minimize severe disease and death. A July 2022 update to the strategy brief§ prioritized vaccination of populations at increased risk, including older adults,¶ with the goal of 100% coverage with a complete COVID-19 vaccination series** for at-risk populations. Using available public data on COVID-19 mortality (reported deaths and model estimates) for 2020 and 2021 and the most recent reported COVID-19 vaccination coverage data from WHO, investigators performed descriptive analyses to examine age-specific mortality and global vaccination rollout among older adults (as defined by each country), stratified by country World Bank income status. Data quality and COVID-19 death reporting frequency varied by data source; however, persons aged ≥60 years accounted for >80% of the overall COVID-19 mortality across all income groups, with upper- and lower-middle-income countries accounting for 80% of the overall estimated excess mortality. Effective COVID-19 vaccines were authorized for use in December 2020, with global supply scaled up sufficiently to meet country needs by late 2021 (6). COVID-19 vaccines are safe and highly effective in reducing severe COVID-19, hospitalizations, and mortality (7,8); nevertheless, country-reported median completed primary series coverage among adults aged ≥60 years only reached 76% by the end of 2022, substantially below the WHO goal, especially in middle- and low-income countries. Increased efforts are needed to increase primary series and booster dose coverage among all older adults as recommended by WHO and national health authorities.
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14
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Lindstrand A, Mast E, Churchill S, Rahimi N, Grevendork J, Brooks A, Magnus E, Nandy R, O'Brien KL. Implementing the immunization agenda 2030: A framework for action through coordinated planning, monitoring & evaluation, ownership & accountability, and communications & advocacy. Vaccine 2023:S0264-410X(21)01236-6. [PMID: 36639274 PMCID: PMC10801759 DOI: 10.1016/j.vaccine.2021.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/12/2021] [Accepted: 09/16/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Ann Lindstrand
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland.
| | - Eric Mast
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Nargis Rahimi
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Jan Grevendork
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland; Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | | | | | - Robin Nandy
- Program Division, United Nations Children's Fund (UNICEF), NY, USA
| | - Katherine L O'Brien
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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15
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O'Brien KL, Lemango E, Nandy R, Lindstrand A. The immunization Agenda 2030: A vision of global impact, reaching all, grounded in the realities of a changing world. Vaccine 2022:S0264-410X(22)00226-2. [PMID: 36528445 PMCID: PMC9754085 DOI: 10.1016/j.vaccine.2022.02.073] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 02/22/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Katherine L O'Brien
- Department of Immunizations, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Ephrem Lemango
- Health Section, Program Division, United Nations Children's Fund, NY, USA
| | - Robin Nandy
- Health Section, Program Division, United Nations Children's Fund, NY, USA
| | - Ann Lindstrand
- Department of Immunizations, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland.
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16
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Olayinka F, Sauer M, Menning L, Summers D, Wonodi C, Mackay S, MacDonald NE, Peter Figueroa J, Andriamitantsoa B, Bonsu G, Haldar P, Lindstrand A, Shimp L. Building and sustaining public and political commitment to the value of vaccination: Recommendations for the Immunization Agenda 2030 (Strategic Priority Area 2). Vaccine 2022:S0264-410X(22)01451-7. [PMID: 36528448 DOI: 10.1016/j.vaccine.2022.11.038] [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: 07/28/2021] [Revised: 08/11/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022]
Abstract
Vaccines have contributed to substantial improvements in health and social development outcomes for millions in recent decades. However, equitable access to immunization remains a critical challenge that has stalled progress toward improving several health indicators around the world. The COVID-19 pandemic has also negatively impacted routine immunization services around the world further threatening universal access to the benefits of lifesaving vaccines. To overcome these challenges, the Immunization Agenda 2030 (IA2030) focuses on increasing both commitment and demand for vaccines. There are three broad barriers that will need to be addressed in order to achieve national and subnational immunization targets: (1) shifting leadership priorities and resource constraints, (2) visibility of disease burden, and (3) social and behavioral drivers. IA2030 proposes a set of interventions to address these barriers. First, efforts to ensure government engagement on immunization financing, regulatory, and legislative frameworks. Next, those in subnational leadership positions and local community members need to be further engaged to ensure local commitment and demand. Governance structures and health agencies must accept responsibility and be held accountable for delivering inclusive, quality, and accessible services and for achieving national targets. Further, the availability of quality immunization services and commitment to adequate financing and resourcing must go hand-in-hand with public health programs to increase access to and demand for vaccination. Last, strengthening trust in immunization systems and improving individual and program resilience can help mitigate the risk of vaccine confidence crises. These interventions together can help ensure a world where everyone, everywhere has access to and uses vaccines for lifesaving vaccination.
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Affiliation(s)
| | - Molly Sauer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Lisa Menning
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | | | - Chizoba Wonodi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | | | | | | | - George Bonsu
- Expanded Program on Immunization, Government of Ghana, Accra, Ghana
| | - Pradeep Haldar
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Ann Lindstrand
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Lora Shimp
- JSI Research & Training Institute, Inc, Arlington, USA.
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17
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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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18
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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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19
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Westenius E, Sahlin E, Conner P, Lindstrand A, Iwarsson E. Diagnostic yield using whole-genome sequencing and in-silico panel of 281 genes associated with non-immune hydrops fetalis in clinical setting. Ultrasound Obstet Gynecol 2022; 60:487-493. [PMID: 35397126 PMCID: PMC9804469 DOI: 10.1002/uog.24911] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To investigate the diagnostic yield of clinical whole-genome sequencing (WGS) in prenatally diagnosed non-immune hydrops fetalis (NIHF). METHODS This was a retrospective study of 23 fetuses with prenatally diagnosed NIHF, negative for trisomies and copy-number variants, referred for analysis by WGS with an in-silico panel of 281 genes associated with hydrops fetalis. Due to identification of a high proportion of causative variants in the HRAS gene in the main cohort, Sanger sequencing of HRAS was performed in a replication cohort, consisting of 24 additional fetuses with NIHF that were negative for trisomies and copy-number variants and had not undergone WGS. RESULTS Of the 23 fetuses in the main cohort, a molecular diagnosis was achieved in 12 (52.2%). Pathogenic or likely pathogenic variants were identified in seven genes: HRAS (n = 5), RIT1 (n = 2), FOXP3 (n = 1), GLB1 (n = 1), MAP2K1 (n = 1), PTPN11 (n = 1) and RASA1 (n = 1). The inheritance pattern of the 12 causative variants was autosomal dominant in 10 cases (HRAS, MAP2K1, PTPN11, RASA1, RIT1), autosomal recessive in one (GLB1) and X-linked recessive in one (FOXP3). Of the 24 fetuses in the replication cohort, a pathogenic variant in HRAS was identified in one, resulting in an overall frequency of causative HRAS variants of 12.8% (6/47) in our two cohorts. CONCLUSIONS We demonstrate a diagnostic yield of 52% with clinical WGS in NIHF using an in-silico panel of 281 genes. However, the high diagnostic yield may be attributed to the small sample size and possible over-representation of severe phenotypes in the included fetuses. Bearing in mind that chromosomal abnormalities were excluded in our cohorts, a detection rate of up to 75% is possible in prenatally diagnosed NIHF when WGS analysis includes calling of chromosomal aberrations. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E. Westenius
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Clinical GeneticsKarolinska University HospitalStockholmSweden
| | - E. Sahlin
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Clinical GeneticsKarolinska University HospitalStockholmSweden
| | - P. Conner
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- Centre for Fetal MedicineKarolinska University HospitalStockholmSweden
| | - A. Lindstrand
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Clinical GeneticsKarolinska University HospitalStockholmSweden
| | - E. Iwarsson
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Clinical GeneticsKarolinska University HospitalStockholmSweden
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Westenius E, Sahlin E, Conner P, Lindstrand A, Iwarsson E. Reply. Ultrasound Obstet Gynecol 2022; 60:586. [PMID: 36183348 DOI: 10.1002/uog.26064] [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] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 05/27/2023]
Affiliation(s)
- E Westenius
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - E Sahlin
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - P Conner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - A Lindstrand
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - E Iwarsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
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21
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Goldin S, Hood N, Pascutto A, Bennett C, Barbosa de Lima AC, Devereaux N, Caric A, Rai K, Desai S, Lindstrand A, Struminger B. Building global capacity for COVID-19 vaccination through interactive virtual learning. Hum Resour Health 2022; 20:16. [PMID: 35120542 PMCID: PMC8815394 DOI: 10.1186/s12960-022-00710-7] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND To support the introduction of the COVID-19 vaccine, the World Health Organization and its partners developed an interactive virtual learning initiative through which vaccination stakeholders could receive the latest guidance, ask questions, and share their experiences. This initiative, implemented between 9 February 2021 and 15 June 2021, included virtual engagement between technical experts and participants during a 15-session interactive webinar series as well as web and text-messaging discussions in English and French. METHODS This article uses a mixed-methods approach to analyze survey data collected following each webinar and a post-series survey conducted after the series had concluded. Participant data were tracked for each session, and feedback surveys were conducted after each session to gauge experience quality and content usability. Chi-square tests were used to compare results across professions (health workers, public health practitioners, and others). RESULTS The COVID-19 Vaccination: Building Global Capacity webinar series reached participants in 179 countries or 93% of the WHO Member States; 75% of participants were from low- and middle-income countries. More than 60% of participants reported using the resources provided during the sessions, and 47% reported sharing these resources with colleagues. More than 79% of participants stated that this initiative significantly improved their confidence in preparing for and rolling out COVID-19 vaccinations; an additional 20% stated that the initiative "somewhat" improved their confidence. In the post-series survey, 70% of participants reported that they will "definitely use" the knowledge derived from this learning series in their work; an additional 20% will "probably use" and 9% would "possibly use" this knowledge in their work. CONCLUSION The COVID-19 Vaccination: Building Global Capacity learning initiative used a digital model of dynamic, interactive learning at scale. The initiative enhanced WHO's ability to disseminate knowledge, provide normative guidance, and share best practices to COVID-19 vaccination stakeholders in real time. This approach allowed WHO to hear the information needs of stakeholders and respond by developing guidance, tools, and training to support COVID-19 vaccine introduction. WHO and its partners can learn from this capacity-building experience and apply best practices for digital interactive learning to other health programs moving forward.
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Affiliation(s)
| | - Nancy Hood
- Project ECHO, University of New Mexico, Albuquerque, USA
| | | | - Celine Bennett
- Project ECHO, University of New Mexico, Albuquerque, USA
| | | | | | | | - Karan Rai
- Project ECHO, University of New Mexico, Albuquerque, USA
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22
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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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23
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Shen AK, Yu MA, Lindstrand A, Baxi SM, Jousset O, O'Brien K, Boulanger L. COVID-19 Partners Platform-Accelerating Response by Coordinating Plans, Needs, and Contributions During Public Health Emergencies: COVID-19 Vaccines Use Case. Glob Health Sci Pract 2021; 9:725-732. [PMID: 34933970 PMCID: PMC8691879 DOI: 10.9745/ghsp-d-21-00460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/02/2021] [Indexed: 06/14/2023]
Abstract
The World Health Organization COVID-19 Partners Platform represents the first step towards a new model of health crisis information sharing across stakeholders and could evolve into an engagement mechanism of choice for future cross-border public health emergencies.
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Affiliation(s)
- Angela K Shen
- World Health Organization, Health Emergencies Programme, Geneva, Switzerland.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - M Anne Yu
- World Health Organization, Health Emergencies Programme, Geneva, Switzerland
| | - Ann Lindstrand
- World Health Organization, Department of Immunization, Vaccines and Biologicals, Geneva, Switzerland
| | - Sanjiv M Baxi
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Katherine O'Brien
- World Health Organization, Department of Immunization, Vaccines and Biologicals, Geneva, Switzerland
| | - Lucy Boulanger
- World Health Organization, Health Emergencies Programme, Geneva, Switzerland
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24
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Affiliation(s)
- Angela K Shen
- Health Emergencies Programme, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Ann Lindstrand
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Benjamin Schreiber
- Programme Division, United Nations Children's Fund, New York, United States of America
| | - Kate O'Brien
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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25
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Hultman Dennison S, Hertting O, Bennet R, Eriksson M, Holmström M, Schollin Ask L, Lindstrand A, Dimitriou P, Stjärne P, Granath A. A Swedish population-based study of complications due to acute rhinosinusitis in children 5-18 years old. Int J Pediatr Otorhinolaryngol 2021; 150:110866. [PMID: 34416439 DOI: 10.1016/j.ijporl.2021.110866] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 06/08/2021] [Accepted: 08/04/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND There are few population-based studies of complications due to acute rhinosinusitis in children. The aim was to clarify the admission and complication rate and analyze bacterial cultures in children five to 18 years old in Stockholm, Sweden. METHODS This was a population-based observational cohort study with retrospectively collected data from individual medical records, from 1 July 2003 to 30 June 2016 in Stockholm, Sweden. Hospital admissions of children with a discharge diagnosis of rhinosinusitis and related complications were reviewed. RESULTS Incidence of admission due to acute rhinosinusitis was 7.8 per 100 000 children per year (boys 9.2, girls 6.2) and 61% of the admitted children were boys. A severe - postseptal orbital, intracranial or osseous - complication, was present in 34% of admissions (postseptal orbital 28%, intracranial 6%, osseous 4%), resulting in an incidence of 2.6 severe complications per 100 000 children per year (boys 3.6, girls 1.6). Orbital preseptal cellulitis was present in 88% of admissions. Incidence of surgery was 1.3 per 100 000 per year (boys 1.8, girls 0.8) and the percentage of admitted children that had surgery increased with age. S. pyogenes was the most common pathogen found in the whole cohort (29 admissions), while S. milleri was the most common pathogen found among the children with severe complication and surgery. CONCLUSIONS There is a relative high risk of severe complications in children between five to 18 years that are admitted due to acute rhinosinusitis. There is a need for prospective studies to further analyze the pathogens involved in complications due to acute rhinosinusitis.
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Affiliation(s)
- S Hultman Dennison
- Department of otorhinolaryngology, Karolinska University Hospital, Eugeniavägen 3, 171 64, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Solnavägen 1, 171 77, Stockholm, Sweden.
| | - Olof Hertting
- Section for Pediatric Infectious Diseases, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Anna Steckséns gata 35, 171 64, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Solnavägen 1, 171 77, Stockholm, Sweden
| | - Rutger Bennet
- Section for Pediatric Infectious Diseases, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Anna Steckséns gata 35, 171 64, Stockholm, Sweden
| | - Margareta Eriksson
- Section for Pediatric Infectious Diseases, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Anna Steckséns gata 35, 171 64, Stockholm, Sweden
| | - Mats Holmström
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Solnavägen 1, 171 77, Stockholm, Sweden
| | - Lina Schollin Ask
- Public Health Agency of Sweden, Nobels väg 18, 171 65, Stockholm, Sweden; Sach's Children and Youth Hospital, South General Hospital, Sjukhusbacken 10, 118 83, Stockholm, Sweden; Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Solnavägen 1, 171 77, Stockholm, Sweden
| | - Ann Lindstrand
- WHO Department of Immunization, vaccines and Biologicals, Avenue Appia 20, 1211, Geneva 27, Switzerland
| | - Praxitelis Dimitriou
- Department of Neuroradiology, Karolinska University Hospital, Eugeniavägen 3, 171 64, Stockholm, Sweden
| | - Pär Stjärne
- Department of otorhinolaryngology, Karolinska University Hospital, Eugeniavägen 3, 171 64, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Solnavägen 1, 171 77, Stockholm, Sweden
| | - Anna Granath
- Department of otorhinolaryngology, Karolinska University Hospital, Eugeniavägen 3, 171 64, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Ear, Nose and Throat Diseases, Karolinska Institutet, Solnavägen 1, 171 77, Stockholm, Sweden
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Abstract
Immunization is among the most cost-effective public health interventions available and is estimated to have averted at least 37 million deaths between 2000 and 2019. Since the establishment of the Expanded Programme on Immunization in 1974, global vaccination coverage increased and the coverage gap between rich and poor countries decreased. Creation of Gavi, the Vaccine Alliance, in 2000 allowed the poorest countries in the world to benefit from new, life-saving vaccines and expand the breadth of protection against an increasing number of vaccine-preventable diseases. Despite this progress, inequities in access to and uptake of vaccines persist. Opportunities to realize the full potential of vaccines are within reach but require focused, tailored and committed action by Governments and immunization stakeholders. The Immunization Agenda 2030 provides a framework for action during the next decade to attain a world where everyone, everywhere, at every age fully benefits from vaccines for good health and well-being.
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Affiliation(s)
- Ann Lindstrand
- Immunization Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | | | - Diana Chang-Blanc
- Immunization Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | - Daniel Feikin
- Immunization Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
| | - Katherine L O'Brien
- Immunization Vaccines and Biologicals Department, World Health Organization, Geneva, Switzerland
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Dub T, Søborg B, Andersen PH, Gudnason T, Nøkleby H, Lindstrand A, Carlsson RM, Nohynek H. Immunisation of healthcare workers in the Nordic countries: Variation in recommendations and practices and a lack of assessment. ACTA ACUST UNITED AC 2021; 26. [PMID: 33509337 PMCID: PMC7848784 DOI: 10.2807/1560-7917.es.2021.26.4.1900555] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Healthcare workers (HCWs) are at increased risk of both exposure and transmission of infectious disease. Two European Union (EU) directives state that health services are responsible for assessing their employees’ potential exposure to infectious diseases and offering immunisation free of charge. We assessed current policy for immunisation of HCWs and the availability of vaccine coverage data in the Nordic countries by surveying national vaccination experts in Denmark, Finland, Iceland, Norway and Sweden, as well as Swedish county medical officers (CMOs). All national experts and 17 of 21 Swedish CMOs responded. All EU countries had transposed the European directives into national law, while Norway and Iceland had similar national legislation. Recommendations or guidelines were issued in Denmark, Finland, Iceland, Norway and 15 of 17 responding Swedish counties. The range of diseases covered differed by countries and Swedish counties. HCW vaccine coverage data were not systematically collected; incomplete estimates were only available for Finland and two Swedish counties. In conclusion, recommendations or guidelines exist in the Nordic countries, but their impact cannot be assessed, as vaccine uptake among HCWs is not currently measured. Systematic collection of data is a necessary step towards improving HCW immunisation policy and practice in the Nordic countries.
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Affiliation(s)
- Timothee Dub
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | | | - Peter Henrik Andersen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Thorolfur Gudnason
- Centre for Health Security and Communicable Disease Control, Directorate of Health, Reykjavik, Iceland
| | | | - Ann Lindstrand
- Unit for Vaccination Programmes, Public Health Agency of Sweden, Solna, Sweden
| | - Rose-Marie Carlsson
- Unit for Vaccination Programmes, Public Health Agency of Sweden, Solna, Sweden
| | - Hanna Nohynek
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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Moss WJ, Shendale S, Lindstrand A, O'Brien KL, Turner N, Goodman T, Kretsinger K. Feasibility assessment of measles and rubella eradication. Vaccine 2021; 39:3544-3559. [PMID: 34045102 DOI: 10.1016/j.vaccine.2021.04.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/14/2021] [Indexed: 12/28/2022]
Abstract
This report addresses the epidemiological aspects and feasibility of measles and rubella eradication and the potential resource requirements in response to the request of the Director-General at the Seventieth World Health Assembly held on May 31, 2017. A guiding principle is that the path toward measles and rubella eradication should serve to strengthen primary health care, promote universal health coverage, and be a pathfinder for new vision and strategy for immunization over the next decade as laid out in the Immunization Agenda 2030. Specifically, this report: 1) highlights the importance of measles and rubella as global health priorities; 2) reviews the current global measles and rubella situation; 3) summarizes prior assessments of the feasibility of measles and rubella eradication; 4) assesses the progress and challenges in achieving regional measles and rubella elimination; 5) assesses additional considerations for measles and rubella eradication, including the results of modelling and economic analyses; 6) assesses the implications of establishing a measles and rubella eradication goal and the process for setting an eradication target date; 7) proposes a framework for determining preconditions for setting a target date for measles and rubella eradication and how these preconditions should be understood and used; and 8) concludes with recommendations endorsed by SAGE.
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Affiliation(s)
- William J Moss
- International Vaccine Access Center, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Stephanie Shendale
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Ann Lindstrand
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Katherine L O'Brien
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Nikki Turner
- Division of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Tracey Goodman
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Katrina Kretsinger
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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Jama A, Godoy-Ramirez K, Byström E, Burström B, Roth A, Lindstrand A, Kulane A. Tailored intervention with peer-to-peer as a tool to promote childhood vaccination in migrants. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1253] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
A tailored intervention about childhood vaccination in Stockholm, Sweden, has focused on different activities with the aim to improve vaccination confidence and in particular Measles, Mumps and Rubella (MMR) vaccination coverage. The intervention included provided peer education focusing on vaccination information, the vaccine-preventable diseases, child development and communication skills in Somali and Swedish language and for the peers to further inform other parents in their communities.
Aim
This study aims to explore peers’ experiences of the interventions and their role to promote vaccination confidence.
Methods
This study follows a qualitative methodology with in-depth interviews and the data collection is ongoing. The study participants consist of seven peers who participated in the program. The interviews aimed to explore how the peers used the training in real life. All interviews conducted were tape-recorded and transcribed verbatim in order to facilitate deep content analysis. The analysis followed a content analysis, by first coding the data and then developing categories and emerging themes.
Results
Preliminary findings show that peers expressed the importance of having a training that equipped them with knowledge and confidence to discuss fact-based information with hesitant parents. The peers shared that after the training they had several opportunities to talk about childhood vaccinations in particular MMR vaccination with other parents. Some peers took an active role in reaching other parents by utilising the film and the cards to facilitate their dialogue. Other also acknowledged that when they could not answer a specific question, they encouraged the parents to address the query with the child health clinic nurses.
Conclusions
The use of a peer-to-peer concept to increase vaccination confidence provides additional forums for parents to dialogue about their concerns and receive correct vaccination information.
Key messages
Tailored interventions in close collaboration with communities are crucial for sustainable improvements of vaccination acceptance and coverage. The peer-to-peer concept provides a new arena to reach vaccination hesitant parents and can complement the communication on vaccination from health care provides.
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Affiliation(s)
- A Jama
- Department of Communicable Disease Control and Health Protec, Public Health Agency of Sweden, Solna, Sweden
- Department of Global Public Health, Stockholm, Sweden, Karolinska Institute, Solna, Sweden
| | - K Godoy-Ramirez
- Department of Communicable Disease Control and Health Protec, Public Health Agency of Sweden, Solna, Sweden
| | - E Byström
- Department of Communicable Disease Control and Health Protec, Public Health Agency of Sweden, Solna, Sweden
| | - B Burström
- Department of Global Public Health, Stockholm, Sweden, Karolinska Institute, Solna, Sweden
| | - A Roth
- Department of Communicable Disease Control and Health Protec, Public Health Agency of Sweden, Solna, Sweden
| | - A Lindstrand
- Department of Immunization, Vaccines, and Biologicals, WHO, Geneva, Switzerland
| | - A Kulane
- Department of Global Public Health, Stockholm, Sweden, Karolinska Institute, Solna, Sweden
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30
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Jama A, Byström E, Rubin J, Kulane A, Lindstrand A, Godoy-Ramirez K. Tailored communication intervention in a Somali community, Sweden, to improve vaccine confidence. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1443] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Sweden sustains a high and stable vaccination coverage for measles-mumps-rubella (MMR) vaccination (>96%) but despite a high national coverage, there may be local gaps. One example is a Stockholm suburb hosting a population with largely Somali origin that since 1998 has showed low MMR vaccine rates (70%). A baseline study using the Tailoring Immunisation Programme (TIP), child health clinics (CHC) nurses reported poor communication with vaccine hesitant parents who worried that the MMR vaccine may cause autism. Following, a tailored intervention with emphasis on strong and preferred oral communication was designed to address parentś concerns and, seminars to reinforce nurses in improving their encounter with parents.
Methods
The intervention was developed using the TIP guide including an adapted version of the Behaviour Change Wheel model, it included communication tools (films, videos), public seminars in Somali on MMR vaccine, vaccine-preventable diseases and autism, and training of peer parent group. CHC nurses were given tailored seminars with updated information on vaccines with emphasis on how to communicate with vaccine hesitant parents.
Results
Preliminary results suggest that the tools implemented have been well received by all stakeholders and a positive trend in vaccination coverage has been observed. Parents have engaged actively, 32 parents completed the peer-to-peer training and all nurses attended the seminars. Preliminary data of qualitative interviews with 11 nurses indicates that increased knowledge strengthened their confidence to meet the parents and address vaccine hesitancy. The films and information materials facilitated the nursés communication with parents.
Conclusions
Tailored communication interventions need to be tested, implemented and evaluated as tools to motivate change in parental attitudes and to strengthened health care providers role aiming to increase vaccine acceptance and resilience in the immunisation programmes.
Key messages
Tailored communication intervention on vaccination need to be implemented and evaluated as tools to motivate changes in attitudes and behaviours regarding vaccine acceptance. Tailored interventions has been positively received by all target groups and a positive trend in vaccination coverage has been observed.
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Affiliation(s)
- A Jama
- Department of Communicable Disease Control and Health Protection, Public Health Agency of Sweden, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - E Byström
- Department of Communicable Disease Control and Health Protection, Public Health Agency of Sweden, Stockholm, Sweden
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - J Rubin
- Regional Preventive Child Health Services, Stockholm County Council, Stockholm, Sweden
| | - A Kulane
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - A Lindstrand
- Department of Immunization, Vaccines, andBiologicals, WHO, Geneva, Switzerland
| | - K Godoy-Ramirez
- Department of Communicable Disease Control and Health Protection, Public Health Agency of Sweden, Stockholm, Sweden
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Chrapkowska C, Galanis I, Kark M, Lepp T, Lindstrand A, Roth A, Nilsson A. Validation of the new Swedish vaccination register – Accuracy and completeness of register data. Vaccine 2020; 38:4104-4110. [DOI: 10.1016/j.vaccine.2020.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
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Byström E, Lindstrand A, Bergström J, Riesbeck K, Roth A. Confidence in the National Immunization Program among parents in Sweden 2016 – A cross-sectional survey. Vaccine 2020; 38:3909-3917. [DOI: 10.1016/j.vaccine.2020.01.078] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 01/23/2023]
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Jama A, Lindstrand A, Ali M, Butler R, Kulane A. Nurses' Perceptions Of MMR Vaccine Hesitancy In An Area With Low Vaccination Coverage. Pediatric Health Med Ther 2019; 10:177-182. [PMID: 31908567 PMCID: PMC6927220 DOI: 10.2147/phmt.s212921] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 09/09/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND AND AIM Measles, mumps, and rubella vaccine (MMR) coverage is low in an area in the Northern part of Stockholm, Sweden. The overall aim of this study was to explore the perceptions, views, and experiences of child health clinic nurses related to vaccine hesitancy in Rinkeby and Tensta. METHODS The study focused specifically on hesitancy towards measles-mumps-rubella (MMR) vaccination. Eleven in-depth interviews were conducted in Swedish with female nurses who were directly responsible for vaccination programmes. Their thoughts and experiences were sought using probing and question rephrasing techniques. Transcripts of the data were analysed using content analysis. RESULTS Four themes emerged, namely hesitancy among Somali parents, lack of confidence in the MMR vaccine, loss of confidence in other vaccines due to mistrust of the MMR vaccine, and complacency regarding vaccination in general. CONCLUSION There is a strong influence of fear of vaccine-induced autism among parents in the Somali community in areas of Stockholm, that requires continued attention by the health care providers.
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Affiliation(s)
- Asha Jama
- The Public Health Agency of Sweden, Stockholm, Sweden
- Equity and Health Policy Research Group, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - Ann Lindstrand
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - Mona Ali
- The Public Health Agency of Sweden, Stockholm, Sweden
| | - Robb Butler
- United Nations Children’s Fund Programme Division, UNICEF, New York, NY, USA
| | - Asli Kulane
- Equity and Health Policy Research Group, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
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Dennison SH, Ask LS, Eriksson M, Granath A, Hertting O, Bennet R, Lindstrand A, Masaba P, Dimitriou P, Stjärne P. Serious complications due to acute rhinosinusitis in children up to five years old in Stockholm, Sweden - Still a challenge in the pneumococcal conjugate vaccine era. Int J Pediatr Otorhinolaryngol 2019; 121:50-54. [PMID: 30861428 DOI: 10.1016/j.ijporl.2019.02.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The aim of this study was to analyze the rate of admissions, the rate of serious complications (postseptal orbital complications and surgery) and the bacterial etiology of acute rhinosinusitis in hospitalized children under five years old in Stockholm County, eight years after the introduction of the pneumococcal conjugate vaccine (PCV). The secondary aim was to compare this period with the period four years prior to the vaccine's introduction. METHODS This was a population-based, descriptive observational study with retrospectively collected data from 1 July 2008 to 30 June 2016 in Stockholm County. Hospital admissions of children with a discharge diagnosis of rhinosinusitis and related complications were reviewed and compared to the pre-PCV period of 2003-2007. RESULTS A total of 215 children were admitted, for a yearly incidence of 18.8 per 100 000 children (22.8 for boys, 14.6 for girls). Computer tomography-verified postseptal orbital complications occurred in 29 cases (13.5%) and surgery was necessary in nine (4.2%). Pathogens other than Streptococcus pneumoniae were found in the cases with postseptal complication or surgery (Streptococcus pyogenes in four, Haemophilus influenzae in three and Staphylococcus aureus in one case). In comparison to the four years pre-PCV, the incidence of admission decreased from 43.81 to 20.31 and 17.45 per 100 000/year for the two four-year periods after vaccine introduction. The incidence of CT-verified postseptal complication increased slightly from 1.51 to 2.34 and 2.74 per 100 000/year. The incidence of surgeries increased marginally but continued to be very low, from 0.22 to 0.54 and 1.03 per 100 000/year. CONCLUSIONS Complications due to acute rhinosinusitis in children living in Stockholm County continues to be very rare after the introduction of pneumococcal vaccine. Hospitalization has decreased for children under five years old after PCV introduction, but the incidence or postseptal complications and surgery in the same population increased slightly. Predominantly bacteria other than Streptococcus pneumoniae was found. There is a need of larger studies to determine trends, and a need of prospective studies to elucidate the bacterial etiology, of serious complications due to acute rhinosinusitis in children.
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Affiliation(s)
- S Hultman Dennison
- Department of Otorhinolaryngology, Karolinska University Hospital, Karolinska vägen, 171 76, Solna, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Ear, Nose- and Throat Diseases, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - L Schollin Ask
- South General Hospital, Sachs' Children and Youth Hospital, Sjukhusbacken 10, 118 83, Stockholm, Sweden; Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - M Eriksson
- Astrid Lindgren Children´s Hospital, Karolinska University Hospital, Department of Pediatric Infectious Diseases, Eugeniavägen 23, 171 64, Solna, Stockholm, Sweden
| | - A Granath
- Department of Otorhinolaryngology, Karolinska University Hospital, Karolinska vägen, 171 76, Solna, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Ear, Nose- and Throat Diseases, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - O Hertting
- Astrid Lindgren Children´s Hospital, Karolinska University Hospital, Department of Pediatric Infectious Diseases, Eugeniavägen 23, 171 64, Solna, Stockholm, Sweden
| | - R Bennet
- Astrid Lindgren Children´s Hospital, Karolinska University Hospital, Department of Pediatric Infectious Diseases, Eugeniavägen 23, 171 64, Solna, Stockholm, Sweden
| | - A Lindstrand
- Department of Public Health Sciences, Division of Global Health, Karolinska Institutet, 171 77, Stockholm, Sweden; Public Health Agency of Sweden, Nobels väg 18, 171 65, Solna, Sweden
| | - P Masaba
- Department of Radiology, Karolinska University Hospital, Karolinska Vägen, 171 76, Solna, Stockholm, Sweden
| | - P Dimitriou
- Department of Radiology, Karolinska University Hospital, Karolinska Vägen, 171 76, Solna, Stockholm, Sweden
| | - P Stjärne
- Department of Otorhinolaryngology, Karolinska University Hospital, Karolinska vägen, 171 76, Solna, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Ear, Nose- and Throat Diseases, Karolinska Institutet, 171 77, Stockholm, Sweden
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35
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St-Martin G, Lindstrand A, Sandbu S, Fischer TK. Selection and Interpretation of Scientific Evidence in Preparation for Policy Decisions: A Case Study Regarding Introduction of Rotavirus Vaccine Into National Immunization Programs in Sweden, Norway, Finland, and Denmark. Front Public Health 2018; 6:131. [PMID: 29868539 PMCID: PMC5960676 DOI: 10.3389/fpubh.2018.00131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 12/04/2017] [Accepted: 04/17/2018] [Indexed: 11/13/2022] Open
Abstract
The World Health Organization recommends inclusion of rotavirus vaccines in national immunization programs (NIPs) worldwide. Nordic countries are usually considered comparable in terms of demographics and health-care services and have comparable rotavirus disease burden. Nevertheless, the countries have reached different decisions regarding rotavirus vaccine: Norway and Finland have already introduced rotavirus vaccines into their NIPs and Sweden is currently changing its recommendation and vaccines will now be introduced on a national scale while Denmark has decided against it. This study focuses on the selection and interpretation of medical and epidemiological evidence used during the decision-making processes in Sweden, Norway, Finland, and Denmark. The so-called "severity criteria" is identified as one of the main reasons for the different policy decisions reached across the Nordic countries.
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Affiliation(s)
- Gry St-Martin
- Virology Surveillance and Research Unit, Statens Serum Institut, Copenhagen, Denmark
| | | | - Synne Sandbu
- Department of Vaccine Preventable Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Thea Kølsen Fischer
- Virology Surveillance and Research Unit, Statens Serum Institut, Copenhagen, Denmark.,Center for Global Health, Department of Infectious Diseases, University of Southern Denmark, Odense, Denmark
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36
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Jama A, Godoy-Ramirez K, Byström E, Karregård S, Rubin J, Kulane A, Lindstrand A. 4.4-O7Tailored communication interventions targeting Somali community in Sweden regarding MMR vaccination. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.146] [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: 11/13/2022] Open
Affiliation(s)
- A Jama
- Public Health Agency of Sweden, Stockholm, Sweden
| | | | - E Byström
- Public Health Agency of Sweden, Stockholm, Sweden
| | - S Karregård
- Public Health Agency of Sweden, Stockholm, Sweden
| | - J Rubin
- Regional Preventive Child Health Services, Stockholm County Council, Sweden
| | - A Kulane
- Karolinska Institute, Department of Public Health Sciences, Stockholm, Sweden
| | - A Lindstrand
- Public Health Agency of Sweden, Stockholm, Sweden
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37
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Byström E, Lindstrand A, Roth A. Attitudes towards vaccinations in the National Immunization Program among parents in Sweden 2016. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.382] [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: 11/14/2022] Open
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38
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Jama A, Godoy-Ramirez K, Byström E, Karregård S, Rubin J, Kulane A, Lindstrand A. Tailored communication interventions targeting Somali community in Sweden regarding MMR vaccination. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx189.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Jama
- The Public Health Agency of Sweden (PHAS), Stockholm, Sweden
| | - K Godoy-Ramirez
- The Public Health Agency of Sweden (PHAS), Stockholm, Sweden
| | - E Byström
- The Public Health Agency of Sweden (PHAS), Stockholm, Sweden
| | - S Karregård
- The Public Health Agency of Sweden (PHAS), Stockholm, Sweden
| | - J Rubin
- Regional Preventive Child Health Services, Stockholm County Council, Stockholm, Sweden
| | - A Kulane
- Karolinska Institute, Department of Public Health Sciences, Stockholm, Sweden
| | - A Lindstrand
- The Public Health Agency of Sweden (PHAS), Stockholm, Sweden
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39
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Schollin Ask L, Hjern A, Lindstrand A, Olen O, Sjögren E, Blennow M, Örtqvist Å. Receiving early information and trusting Swedish child health centre nurses increased parents' willingness to vaccinate against rotavirus infections. Acta Paediatr 2017; 106:1309-1316. [PMID: 28419538 DOI: 10.1111/apa.13872] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/15/2017] [Accepted: 04/10/2017] [Indexed: 11/28/2022]
Abstract
AIM Rotavirus vaccines are effective against severe infections, but have a modest impact on mortality in high-income countries. Parental knowledge and attitudes towards vaccines are crucial for high vaccination coverage. This study aimed to identify why parents refused to let their infant have the vaccination or were unsure. METHODS This cross-sectional study was based on 1,063 questionnaires completed by the parents of newborn children in 2014. Stepwise logistic regression was used to identify the main predictors. RESULTS Most (81%) parents intended to vaccinate their child against the rotavirus, while 19% were unwilling or uncertain. Parents with less education and children up to five weeks of age were more likely to be unwilling or uncertain about vaccinating their child. Factors associated with a refusal or uncertainty about vaccinating were not having enough information about the vaccine, no intention of accepting other vaccines, paying little heed to the child health nurses' recommendations, thinking that the rotavirus was not a serious illness and not believing that the vaccine provided protection against serious forms of gastroenteritis. CONCLUSION Early information, extra information for parents with less education and close positive relationships between parents and child health nurses were important factors in high rotavirus vaccination rates.
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Affiliation(s)
- Lina Schollin Ask
- Sachs′ Children and Youth Hospital; South General Hospital; Stockholm Sweden
- Department of Medicine; Clinical Epidemiology Unit; Karolinska Institutet; Stockholm Sweden
| | - Anders Hjern
- Sachs′ Children and Youth Hospital; South General Hospital; Stockholm Sweden
- Department of Medicine; Clinical Epidemiology Unit; Karolinska Institutet; Stockholm Sweden
- CHESS, Centre for Health Equity Studies; Stockholm University and Karolinska Institutet; Stockholm, Sweden
| | - Ann Lindstrand
- Public Health Agency of Sweden; Stockholm Sweden
- Department of Public Health Sciences; Division of Global Health; Karolinska Institutet; Stockholm Sweden
| | - Ola Olen
- Sachs′ Children and Youth Hospital; South General Hospital; Stockholm Sweden
- Department of Medicine; Clinical Epidemiology Unit; Karolinska Institutet; Stockholm Sweden
| | | | - Margareta Blennow
- Sachs′ Children and Youth Hospital; South General Hospital; Stockholm Sweden
| | - Åke Örtqvist
- Stockholm County Council; Department of Communicable Disease Control and Prevention; Stockholm Sweden
- Unit of Infectious Diseases; Department of Medicine, Karolinska Solna; Karolinska Institutet; Stockholm, Sweden
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Smith-Palmer A, Oates K, Webster D, Taylor S, Scott KJ, Smith G, Parcell B, Lindstrand A, Wallensten A, Fredlund H, Widerström M, McMenamin J. Outbreak of Neisseria meningitidis capsular group W among scouts returning from the World Scout Jamboree, Japan, 2015. ACTA ACUST UNITED AC 2017; 21:30392. [PMID: 27918267 PMCID: PMC5144938 DOI: 10.2807/1560-7917.es.2016.21.45.30392] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/04/2016] [Indexed: 11/20/2022]
Abstract
The 23rd World Scout Jamboree was held in Japan from 28 July to 8 August 2015 and was attended by over 33,000 scouts from 162 countries. An outbreak of invasive meningococcal disease capsular group W was investigated among participants, with four confirmed cases identified in Scotland, who were all associated with one particular scout unit, and two confirmed cases in Sweden; molecular testing showed the same strain to be responsible for illness in both countries. The report describes the public health action taken to prevent further cases and the different decisions reached with respect to how wide to extend the offer of chemoprophylaxis in the two countries; in Scotland, chemoprophylaxis was offered to the unit of 40 participants to which the four cases belonged and to other close contacts of cases, while in Sweden chemoprophylaxis was offered to all those returning from the Jamboree. The report also describes the international collaboration and communication required to investigate and manage such multinational outbreaks in a timely manner.
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Affiliation(s)
| | - Ken Oates
- NHS Highland, Inverness, United Kingdom
| | | | | | - Kevin J Scott
- Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Glasgow, United Kingdom
| | - Gemma Smith
- International Health Regulations National Focal Point, Public Health England, London, United Kingdom
| | | | | | | | - Hans Fredlund
- National Reference Laboratory for Pathogenic Neisseria, Örebro University, Örebro, Sweden
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41
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Schollin Ask L, Hultman Dennison S, Stjärne P, Granath A, Srivastava S, Eriksson M, Lindstrand A, Ryd Rinder M. Most preschool children hospitalised for acute rhinosinusitis had orbital complications, more common in the youngest and among boys. Acta Paediatr 2017; 106:268-273. [PMID: 27797408 DOI: 10.1111/apa.13650] [Citation(s) in RCA: 17] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 09/07/2016] [Accepted: 10/26/2016] [Indexed: 11/29/2022]
Abstract
AIM This study established the incidence of acute rhinosinusitis and related orbital complications in tertiary care in Stockholm County and surveyed the clinical outcomes. METHODS This was a population-based, retrospective, observational study, from July 1, 2003 to June 30, 2007, of the hospital admissions records of 213 children up to five years old, with a diagnosis of sinusitis and related complications. RESULTS Preseptal cellulitis was present in 171 of the 213 admissions, which equated to an incidence of orbital complications due to acute rhinosinusitis of 36 per 100 000 people per year (95% confidence interval 26-49). Postseptal complications occurred in seven cases. The incidence rate ratio for hospitalisation of children less than two years old with rhinosinusitis compared with children aged 2-5 years was 2.8 (95% confidence interval 1.8-4.4). The incidence among boys was 53 per 100 000 people per year and 36 per 100 000 people per year for girls, and the incidence rate ratio was 1.5 (95% confidence interval 1.0-2.3). The most common bacterial finding was Streptococcus pneumoniae. CONCLUSION Most children hospitalised for acute rhinosinusitis had an orbital complication, and this was more common in children under the age of two years and boys. Severe postseptal complications were rare.
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Affiliation(s)
- L Schollin Ask
- Sach′s Children and Youth Hospital South General Hospital Stockholm Sweden
- Department of Medicine Clinical Epidemiology Unit Karolinska Institutet Stockholm Sweden
| | - S Hultman Dennison
- Department of Otorhinolaryngology Karolinska University Hospital Stockholm Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC) Division of Ear, Nose‐ and Throat Diseases Karolinska Institutet Stockholm Sweden
| | - P Stjärne
- Department of Otorhinolaryngology Karolinska University Hospital Stockholm Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC) Division of Ear, Nose‐ and Throat Diseases Karolinska Institutet Stockholm Sweden
| | - A Granath
- Department of Otorhinolaryngology Karolinska University Hospital Stockholm Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC) Division of Ear, Nose‐ and Throat Diseases Karolinska Institutet Stockholm Sweden
| | - S Srivastava
- Department of Radiology Karolinska University Hospital Stockholm Sweden
| | - M Eriksson
- Astrid Lindgren Children′s Hospital Karolinska University Hospital Stockholm Sweden
| | - A Lindstrand
- Public Health Agency of Sweden Solna Sweden
- Department of Public Health Sciences Division of Global Health Karolinska Institutet Stockholm Sweden
| | - M Ryd Rinder
- Sach′s Children and Youth Hospital South General Hospital Stockholm Sweden
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42
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Sterky E, Bennet R, Lindstrand A, Eriksson M, Nilsson A. The impact of pneumococcal conjugate vaccine on community-acquired pneumonia hospitalizations in children with comorbidity. Eur J Pediatr 2017; 176:337-342. [PMID: 28070670 PMCID: PMC5321702 DOI: 10.1007/s00431-016-2843-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 12/20/2016] [Accepted: 12/23/2016] [Indexed: 01/04/2023]
Abstract
UNLABELLED The burden of community-acquired pneumonia (CAP) in high-income countries is still significant. The introduction of pneumococcal conjugate vaccines (PCV) has reduced the overall need for hospitalization for CAP. However, it is not clear whether children with underlying disease also have benefitted from the PCV immunization programme. Children 0 to <5 years of age hospitalized with CAP and discharged with an ICD-10 code of J13-J18.9 between November 1, 2005, and April 30, 2007 (pre-vaccination period), and November 1, 2010, and April 30, 2012 (post-vaccination period), were eligible for this study. Data on hospitalization and discharge diagnoses were retrieved from the Hospital Registry. In addition, chart review was performed in 50% of the patients. Our result confirmed a decrease in hospitalization rate for CAP in the PCV13 period. Chart review revealed that half of the patients had underlying comorbidity and these children had more severe symptoms and required longer hospital stay. Intensive care was provided to less than 10% of the children and mostly for children with an underlying neurological disease. CONCLUSIONS We show that all children have benefitted from the reduction of CAP hospitalization after introduction of PCV. Our finding emphasizes the importance of children with chronic diseases receiving adequate vaccinations that may protect from lower respiratory diseases. What is known? • Community-acquired pneumonia is a leading infectious cause of hospitalizations and death among children <5 years of age globally • Pneumococcal conjugate vaccine reduces the hospitalizations of all-cause pneumonia What is new? • We show that also children with underlying comorbidities have benefitted from PCV immunization with a reduction of CAP hospitalization • We show that approximately half of all children hospitalized with CAP also have underlying comorbidities.
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Affiliation(s)
- Ellinor Sterky
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Ann Lindstrand
- Paediatric Infectious Diseases Unit, Paediatric Emergency Department, Astrid Lindgren’s Children Hospital, Stockholm, Sweden
| | | | - Anna Nilsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. .,Childhood Cancer Research Unit Q6:05, Astrid Lindgren Childrens Hospital, Stockholm, Sweden.
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43
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Bramswig NC, Lüdecke HJ, Pettersson M, Albrecht B, Bernier RA, Cremer K, Eichler EE, Falkenstein D, Gerdts J, Jansen S, Kuechler A, Kvarnung M, Lindstrand A, Nilsson D, Nordgren A, Pfundt R, Spruijt L, Surowy HM, de Vries BBA, Wieland T, Engels H, Strom TM, Kleefstra T, Wieczorek D. Identification of new TRIP12 variants and detailed clinical evaluation of individuals with non-syndromic intellectual disability with or without autism. Hum Genet 2016; 136:179-192. [PMID: 27848077 DOI: 10.1007/s00439-016-1743-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 10/28/2016] [Indexed: 01/28/2023]
Abstract
The ubiquitin pathway is an enzymatic cascade including activating E1, conjugating E2, and ligating E3 enzymes, which governs protein degradation and sorting. It is crucial for many physiological processes. Compromised function of members of the ubiquitin pathway leads to a wide range of human diseases, such as cancer, neurodegenerative diseases, and neurodevelopmental disorders. Mutations in the thyroid hormone receptor interactor 12 (TRIP12) gene (OMIM 604506), which encodes an E3 ligase in the ubiquitin pathway, have been associated with autism spectrum disorder (ASD). In addition to autistic features, TRIP12 mutation carriers showed intellectual disability (ID). More recently, TRIP12 was postulated as a novel candidate gene for intellectual disability in a meta-analysis of published ID cohorts. However, detailed clinical information characterizing the phenotype of these individuals was not provided. In this study, we present seven novel individuals with private TRIP12 mutations including two splice site mutations, one nonsense mutation, three missense mutations, and one translocation case with a breakpoint in intron 1 of the TRIP12 gene and clinically review four previously published cases. The TRIP12 mutation-positive individuals presented with mild to moderate ID (10/11) or learning disability [intelligence quotient (IQ) 76 in one individual], ASD (8/11) and some of them with unspecific craniofacial dysmorphism and other anomalies. In this study, we provide detailed clinical information of 11 TRIP12 mutation-positive individuals and thereby expand the clinical spectrum of the TRIP12 gene in non-syndromic intellectual disability with or without ASD.
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Affiliation(s)
- Nuria C Bramswig
- Institut für Humangenetik, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany.
| | - H-J Lüdecke
- Institut für Humangenetik, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany.,Institut für Humangenetik, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - M Pettersson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - B Albrecht
- Institut für Humangenetik, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - R A Bernier
- Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - K Cremer
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - E E Eichler
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - D Falkenstein
- Institut für Humangenetik, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany.,Institut für Humangenetik, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - J Gerdts
- Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - S Jansen
- Department of Human Genetics, Donders Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Kuechler
- Institut für Humangenetik, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - M Kvarnung
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - A Lindstrand
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - D Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden.,Science for Life Laboratory, Karolinska Institutet Science Park, Solna, Sweden
| | - A Nordgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - R Pfundt
- Department of Human Genetics, Donders Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L Spruijt
- Department of Human Genetics, Donders Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H M Surowy
- Institut für Humangenetik, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - B B A de Vries
- Department of Human Genetics, Donders Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - T Wieland
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany.,Institute of Human Genetics, Technische Universität München, Munich, Germany
| | - H Engels
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - T M Strom
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany.,Institute of Human Genetics, Technische Universität München, Munich, Germany
| | - T Kleefstra
- Department of Human Genetics, Donders Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - D Wieczorek
- Institut für Humangenetik, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany.,Institut für Humangenetik, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
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Lindstrand A, Kalyango J, Alfvén T, Darenberg J, Kadobera D, Bwanga F, Peterson S, Henriques-Normark B, Källander K. Pneumococcal Carriage in Children under Five Years in Uganda-Will Present Pneumococcal Conjugate Vaccines Be Appropriate? PLoS One 2016; 11:e0166018. [PMID: 27829063 PMCID: PMC5102345 DOI: 10.1371/journal.pone.0166018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 02/16/2016] [Accepted: 09/21/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Pneumonia is the major cause of death in children globally, with more than 900,000 deaths annually in children under five years of age. Streptococcus pneumoniae causes most deaths, most often in the form of community acquired pneumonia. Pneumococcal conjugate vaccines (PCVs) are currently being implemented in many low-income countries. PCVs decrease vaccine-type pneumococcal carriage, a prerequisite for invasive pneumococcal disease, and thereby affects pneumococcal disease and transmission. In Uganda, PCV was launched in 2014, but baseline data is lacking for pneumococcal serotypes in carriage. OBJECTIVES To study pneumococcal nasopharyngeal carriage and serotype distribution in children under 5 years of age prior to PCV introduction in Uganda. METHODS Three cross-sectional pneumococcal carriage surveys were conducted in 2008, 2009 and 2011, comprising respectively 150, 587 and 1024 randomly selected children aged less than five years from the Iganga/Mayuge Health and Demographic Surveillance Site. The caretakers were interviewed about illness history of the child and 1723 nasopharyngeal specimens were collected. From these, 927 isolates of S. pneumoniae were serotyped. RESULTS Overall, the carriage rate of S. pneumoniae was 56% (957/1723). Pneumococcal carriage was associated with illness on the day of the interview (OR = 1.50, p = 0.04). The most common pneumococcal serotypes were in descending order 19F (16%), 23F (9%), 6A (8%), 29 (7%) and 6B (7%). One percent of the strains were non-typeable. The potential serotype coverage rate for PCV10 was 42% and 54% for PCV13. CONCLUSION About half of circulating pneumococcal serotypes in carriage in the Ugandan under-five population studied was covered by available PCVs.
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Affiliation(s)
- Ann Lindstrand
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Public Health Agency of Sweden, Stockholm, Sweden
- * E-mail:
| | - Joan Kalyango
- Makerere University School of Public Health, Kampala, Uganda
| | - Tobias Alfvén
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Stockholm, Sweden
| | | | - Daniel Kadobera
- Makerere University School of Public Health, Kampala, Uganda
- Ministry of Health, Kampala, Uganda
- Health and Demographic Surveillance Site, Iganga/Mayuge, Uganda
| | - Freddie Bwanga
- Makerere University Faculty of Medicine, Kampala, Uganda
| | - Stefan Peterson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Makerere University School of Public Health, Kampala, Uganda
- Department of International Maternal and Child health, Women´s and children´s health, Uppsala University, Uppsala, Sweden
| | - Birgitta Henriques-Normark
- Public Health Agency of Sweden, Stockholm, Sweden
- Department of Microbiology, Tumor and Cellbiology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Microbiology, Karolinska University hospital, Stockholm, Sweden
| | - Karin Källander
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Makerere University School of Public Health, Kampala, Uganda
- Malaria Consortium, London, United Kingdom
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Godoy-Ramirez K, Jama A, Byström E, Karregård S, Hedlin M, Martin H, Hervius Askling H, Kulane A, Lindstrand A. Tailored communication to hard-to-reach groups–A pilot in a Somali community, Sweden, on vaccination. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw174.226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lindstrand A, Galanis I, Darenberg J, Morfeldt E, Naucler P, Blennow M, Alfvén T, Henriques-Normark B, Örtqvist Å. Unaltered pneumococcal carriage prevalence due to expansion of non-vaccine types of low invasive potential 8years after vaccine introduction in Stockholm, Sweden. Vaccine 2016; 34:4565-4571. [PMID: 27473304 DOI: 10.1016/j.vaccine.2016.07.031] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 07/03/2016] [Accepted: 07/18/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the carriage prevalence, serotype distribution, and antibiotic resistance for pneumococcal carriage isolates collected 4-8years after introduction of pneumococcal conjugate vaccines (PCVs) in Stockholm, Sweden, and to identify risk factors for carriage and calculate the invasive disease potential for emerging serotypes. METHODS Nasopharyngeal aspirates were collected from 3024 children aged 0-<5years at regular visits at 23 Child Health Centers in Stockholm County in 2011-2015, and from 787 parents in 2014-2015. The invasive disease potential was calculated for serotypes using invasive disease isolates from 824 patients of all ages identified in the Stockholm County during the same time period as the carriage isolates. RESULTS A total carriage prevalence of 30% did not change during the study period. Non-vaccine types (NVT) dominated (94% by 2015) and the most common serotypes in descending order were 11A, 23B, 35F and 21. Risk factors for carriage were: age ⩾3months-<3years, having siblings, attending day-care and having travelled abroad the last 3months. Antibiotic resistance remained low. The invasive disease potential was high for NVT 8, 9N, 12F, and 22F, while low for a majority of emerging NVTs in carriage. CONCLUSION The carriage prevalence remained the same 4-8years after vaccine introduction, but serotype replacement became almost complete. A majority of emerging NVTs in carriage showed a low invasive disease potential. Carriage studies are an important complement to invasive disease surveillance to understand the full effect of PCV vaccine programs.
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Affiliation(s)
- Ann Lindstrand
- The Public Health Agency Sweden, SE-171 82, Solna, Sweden; Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
| | - Ilias Galanis
- The Public Health Agency Sweden, SE-171 82, Solna, Sweden
| | | | - Eva Morfeldt
- The Public Health Agency Sweden, SE-171 82, Solna, Sweden
| | - Pontus Naucler
- Department of Medicine, Unit of Infectious Diseases, Karolinska University Hospital, SE-171 76, Solna, Sweden
| | - Margareta Blennow
- Sachs' Children and Youth Hospital, South General Hospital, SE-118 83 Stockholm, Sweden; Department of Clinical Sciences and Education, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Tobias Alfvén
- Department of Public Health Sciences, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Sachs' Children and Youth Hospital, South General Hospital, SE-118 83 Stockholm, Sweden
| | - Birgitta Henriques-Normark
- The Public Health Agency Sweden, SE-171 82, Solna, Sweden; Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, SE-171 77 Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Åke Örtqvist
- Department of Medicine, Unit of Infectious Diseases, Karolinska University Hospital, SE-171 76, Solna, Sweden; Department of Communicable Disease Control and Prevention, SE-118 83, Stockholm County Council, Sweden
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Lindstrand A. [Not Available]. Lakartidningen 2016; 113:DZDM. [PMID: 27046769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Galanis I, Lindstrand A, Darenberg J, Browall S, Nannapaneni P, Sjöström K, Morfeldt E, Naucler P, Blennow M, Örtqvist Å, Henriques-Normark B. Effects of PCV7 and PCV13 on invasive pneumococcal disease and carriage in Stockholm, Sweden. Eur Respir J 2016; 47:1208-18. [PMID: 26797033 PMCID: PMC4819883 DOI: 10.1183/13993003.01451-2015] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [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: 08/31/2015] [Accepted: 12/01/2015] [Indexed: 01/05/2023]
Abstract
The effects of pneumococcal conjugated vaccines (PCVs) need to be investigated. In Stockholm County, Sweden, PCV7 was introduced in the childhood immunisation programme in 2007 and changed to PCV13 in 2010.Over 90% of all invasive isolates during 2005-2014 (n=2336) and carriage isolates, 260 before and 647 after vaccine introduction, were characterised by serotyping, molecular typing and antibiotic susceptibility, and serotype diversity was calculated. Clinical information was collected for children and adults with invasive pneumococcal disease (IPD).The IPD incidence decreased post-PCV7, but not post-PCV13, in vaccinated children. Beneficial herd effects were seen in older children and adults, but not in the elderly. The herd protection was more pronounced post-PCV7 than post-PCV13. PCV7 serotypes decreased. IPD caused by PCV13 serotypes 3 and 19A increased post-PCV7. Post-PCV13, serotypes 6A and 19A, but not serotype 3, decreased. The serotype distribution changed in carriage and IPD to nonvaccine types, also in nonvaccinated populations. Expansion of non-PCV13 serotypes was largest following PCV13 introduction. Serotype diversity increased and nonvaccine clones emerged, such as CC433 (serotype 22F) in IPD and CC62 (serotype 11A) in carriage. In young children, meningitis, septicaemia and severe rhinosinusitis, but not bacteraemic pneumonia, decreased.Pneumococcal vaccination leads to expansion of new or minor serotypes/clones, also in nonvaccinated populations.
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Affiliation(s)
- Ilias Galanis
- Public Health Agency of Sweden, Solna, Sweden These authors contributed equally to this article
| | - Ann Lindstrand
- Public Health Agency of Sweden, Solna, Sweden Dept of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden These authors contributed equally to this article
| | - Jessica Darenberg
- Public Health Agency of Sweden, Solna, Sweden These authors contributed equally to this article
| | - Sarah Browall
- Dept of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden Dept of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Priyanka Nannapaneni
- Dept of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Pontus Naucler
- Dept of Medicine Solna, Infectious Diseases Unit, Karolinska Institutet, Stockholm, Sweden Dept of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Margareta Blennow
- Sachs' Children's Hospital, South General Hospital, Stockholm, Sweden Dept of Clinical Sciences and Education, Karolinska Institutet, Stockholm, Sweden
| | - Åke Örtqvist
- Dept of Medicine Solna, Infectious Diseases Unit, Karolinska Institutet, Stockholm, Sweden Dept of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden These authors contributed equally to this article
| | - Birgitta Henriques-Normark
- Public Health Agency of Sweden, Solna, Sweden Dept of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden Dept of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden These authors contributed equally to this article
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Kalyango JN, Lindstrand A, Rutebemberwa E, Ssali S, Kadobera D, Karamagi C, Peterson S, Alfven T. Increased use of community medicine distributors and rational use of drugs in children less than five years of age in Uganda caused by integrated community case management of fever. Am J Trop Med Hyg 2015; 87:36-45. [PMID: 23136276 PMCID: PMC3748520 DOI: 10.4269/ajtmh.2012.11-0733] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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] [Indexed: 11/13/2022] Open
Abstract
We compared use of community medicine distributors (CMDs) and drug use under integrated community case management and home-based management strategies in children 6–59 months of age in eastern Uganda. A cross-sectional study with 1,095 children was nested in a cluster randomized trial with integrated community case management (CMDs treating malaria and pneumonia) as the intervention and home-based management (CMDs treating only malaria) as the control. Care-seeking from CMDs was higher in intervention areas (31%) than in control areas (22%; P = 0.01). Prompt and appropriate treatment of malaria was higher in intervention areas (18%) than in control areas (12%; P = 0.03) and among CMD users (37%) than other health providers (9%). The mean number of drugs among CMD users compared with other health providers was 1.6 versus 2.4 in intervention areas and 1.4 versus 2.3 in control areas. Use of CMDs was low. However, integrated community case management of childhood illnesses increased use of CMDs and rational drug use.
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Affiliation(s)
- Joan N. Kalyango
- *Address correspondence to Joan N. Kalyango, Department of Public Health Sciences, Division of Global Health, Karolinska Institutet, Stockholm, Sweden. E-mail:
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Rhedin S, Lindstrand A, Hjelmgren A, Ryd-Rinder M, Öhrmalm L, Tolfvenstam T, Örtqvist Å, Rotzén-Östlund M, Zweygberg-Wirgart B, Henriques-Normark B, Broliden K, Naucler P. Respiratory viruses associated with community-acquired pneumonia in children: matched case-control study. Thorax 2015; 70:847-53. [PMID: 26077969 DOI: 10.1136/thoraxjnl-2015-206933] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/25/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is the leading cause of death in children worldwide and a substantial proportion of childhood CAP is caused by viruses. A better understanding of the role of virus infections in this condition is needed to improve clinical management and preventive measures. The aim of the study was therefore to assess the association between specific respiratory viruses and childhood CAP. METHODS A case-control study was conducted during 3 years in Stockholm, Sweden. Cases were children aged ≤5 years with radiological CAP. Healthy controls were consecutively enrolled at child health units during routine visits and matched to cases on age and calendar time. Nasopharyngeal aspirates were obtained and analysed by real-time PCR for 15 viruses. Multivariate conditional logistic regression was used to account for coinfections with other viruses and baseline characteristics. RESULTS A total of 121 cases, of which 93 cases met the WHO criteria for radiological pneumonia, and 240 controls were included in the study. Viruses were detected in 81% of the cases (n=98) and 56% of the controls (n=134). Influenza virus, metapneumovirus and respiratory syncytial virus were detected in 60% of cases and were significantly associated with CAP with ORs >10. There was no association with parainfluenza virus, human enterovirus or rhinovirus and coronavirus and bocavirus were negatively associated with CAP. CONCLUSIONS Our study indicates viral CAP is an underestimated disease and points out hMPV as a new important target for the prevention of childhood CAP.
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Affiliation(s)
- Samuel Rhedin
- Department of Medicine Solna, Infectious Diseases Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ann Lindstrand
- The Public Health Agency of Sweden, Stockholm, Sweden Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Annie Hjelmgren
- Department of Medicine Solna, Infectious Diseases Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Malin Ryd-Rinder
- Department of Clinical Science and Education, Karolinska Institutet, Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden
| | - Lars Öhrmalm
- Department of Medicine Solna, Infectious Diseases Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Tolfvenstam
- Department of Medicine Solna, Infectious Diseases Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden The Public Health Agency of Sweden, Stockholm, Sweden
| | - Åke Örtqvist
- Department of Medicine Solna, Infectious Diseases Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden Department of Communicable Disease and Control, Stockholm County Council, Stockholm, Sweden
| | - Maria Rotzén-Östlund
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Benita Zweygberg-Wirgart
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Birgitta Henriques-Normark
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Broliden
- Department of Medicine Solna, Infectious Diseases Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Pontus Naucler
- Department of Medicine Solna, Infectious Diseases Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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