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Debellut F, Gamage D, Kumar S, Wickramasinghe S, Ruwanpathirana T, Kariyawasam M, Perera CS, Ginige S, Cooray N, Pecenka C, Slavkovsky R, Scott LaMontagne D, Mvundura M. Human papillomavirus (HPV) vaccination program in Sri Lanka: Ongoing costs and operational context of a routinized program. Vaccine X 2024; 17:100456. [PMID: 38379668 PMCID: PMC10877402 DOI: 10.1016/j.jvacx.2024.100456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/22/2024] Open
Abstract
Existing evidence on the cost of human papillomavirus (HPV) vaccination programs has focused on pilot and demonstration projects or initial introductions, which resulted in a perceived high cost. We aimed to study the ongoing cost and operational context of an established HPV vaccination program in Sri Lanka. We conducted a retrospective operational research and microcosting study focusing on 2019. We collected data from 30 divisional health units, 10 districts, and the central level. We then evaluated financial and economic costs, reported by level of the health system, program activity, cost types, and per dose delivered. In 2019, Sri Lanka delivered a total of 314,815 doses of HPV vaccine. In our study sample, 95 % of the HPV vaccination sessions took place at schools, with peaks of delivery in February-March and September-October. The weighted mean financial cost per dose delivered was $0.27 (95 % confidence interval [CI]: $0.15-$0.39) and the economic cost per dose was $3.88 (95 % CI: $2.67-$5.10), excluding the cost of vaccines and supplies. Most of the cost was borne by the divisional health unit level. Service delivery and social mobilization were major contributors to overall costs at the divisional health unit level, and vaccine collection or distribution and storage were the most costly activities at the district and central levels. Cost drivers included the opportunity cost of health worker and non-health worker time at the divisional health unit level and capital costs for vehicles and equipment, along with fuel, maintenance, and energy, at the district and central levels. This study provides new evidence on the cost and cost drivers of a routinized HPV vaccination program. Results can be used for financial planning purposes in Sri Lanka and may inform other countries as they consider use of HPV vaccines.
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Affiliation(s)
| | - Deepa Gamage
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka
| | | | | | | | | | | | | | | | - Clint Pecenka
- Center for Vaccine Innovation and Access, PATH, Seattle, USA
| | - Rose Slavkovsky
- Center for Vaccine Innovation and Access, PATH, Seattle, USA
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Mvundura M, Slavkovsky R, Debellut F, Naddumba T, Bayeh A, Ndiaye C, Anena J, Vodicka E, Diop A, Gamage D, Musanabaganwa C, Tatkan G, Driwale A, Zelalem M, Badiane O, Ginige S, Hamilton E, Sibomana H, Lakew Y, Uwinkindi F, Dhufera A, Ampeire I, Kumar S, Lamontagne DS. Cost and operational context for national human papillomavirus (HPV) vaccine delivery in six low- and middle-income countries. Vaccine 2023; 41:7435-7443. [PMID: 37949752 DOI: 10.1016/j.vaccine.2023.11.008] [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: 10/04/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION There are concerns from immunization program planners about high delivery costs for human papillomavirus (HPV) vaccine. Most prior research evaluated costs of HPV vaccine delivery during demonstration projects or at introduction, showing relatively high costs, which may not reflect the costs beyond the pilot or introduction years. This study sought to understand the operational context and estimate delivery costs for HPV vaccine in six national programs, beyond their introduction years. METHODS Operational research and microcosting methods were used to retrospectively collect primary data on HPV vaccination program activities in Ethiopia, Guyana, Rwanda, Senegal, Sri Lanka, and Uganda. Data were collected from the national level and a sample of subnational administrative offices and health facilities. Operational data collected were tabulated as percentages and frequencies. Financial costs (monetary outlays) and economic costs (financial plus opportunity costs) were estimated, as was the cost per HPV vaccine dose delivered. Costing was done from the health system perspective and reported in 2019 United States dollars (US$). RESULTS Across the study countries, between 53 % and 99 % of HPV vaccination sessions were conducted in schools. Differences were observed in intensity and frequency with which program activities were conducted and resources used. Mean annual economic costs at health facilities in each country ranged from $1,207 to $3,190, while at the national level these ranged from $7,657 to $304,278. Mean annual HPV vaccine doses delivered per health facility in each country ranged from 162 to 761. Mean financial costs per dose per study country ranged from $0.27 to $3.32, while the economic cost per dose ranged from $3.09 to $17.20. CONCLUSION HPV vaccine delivery costs were lower than at introduction in some study countries. There were differences in the activities carried out for HPV vaccine delivery and the number of doses delivered, impacting the cost estimates.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Ganesh Tatkan
- Ministry of Health, Primary Health Care, Georgetown, Guyana
| | - Alfred Driwale
- Uganda National Expanded Programme on Immunization, Kampala, Uganda
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Sbarra AN, Jit M, Mosser JF, Ferrari M, Cutts F, Papania M, Kretsinger K, McCarthy KA, Thakkar N, Gaythorpe KAM, Gamage D, Krause LK, Dansereau E, Crowcroft N, Portnoy A. Population-Level Risk Factors Related to Measles Case Fatality: A Conceptual Framework Based on Expert Consultation and Literature Review. Vaccines (Basel) 2023; 11:1389. [PMID: 37631957 PMCID: PMC10458804 DOI: 10.3390/vaccines11081389] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/29/2023] Open
Abstract
A better understanding of population-level factors related to measles case fatality is needed to estimate measles mortality burden and impact of interventions such as vaccination. This study aimed to develop a conceptual framework of mechanisms associated with measles case fatality ratios (CFRs) and assess the scope of evidence available for related indicators. Using expert consultation, we developed a conceptual framework of mechanisms associated with measles CFR and identified population-level indicators potentially associated with each mechanism. We conducted a literature review by searching PubMed on 31 October 2021 to determine the scope of evidence for the expert-identified indicators. Studies were included if they contained evidence of an association between an indicator and CFR and were excluded if they were from non-human studies or reported non-original data. Included studies were assessed for study quality. Expert consultation identified five mechanisms in a conceptual framework of factors related to measles CFR. We identified 3772 studies for review and found 49 studies showing at least one significant association with CFR for 15 indicators (average household size, educational attainment, first- and second-dose coverage of measles-containing vaccine, human immunodeficiency virus prevalence, level of health care available, stunting prevalence, surrounding conflict, travel time to major city or settlement, travel time to nearest health care facility, under-five mortality rate, underweight prevalence, vitamin A deficiency prevalence, vitamin A treatment, and general malnutrition) and only non-significant associations for five indicators (antibiotic use for measles-related pneumonia, malaria prevalence, percent living in urban settings, pneumococcal conjugate vaccination coverage, vitamin A supplementation). Our study used expert consultation and a literature review to provide additional insights and a summary of the available evidence of these underlying mechanisms and indicators that could inform future measles CFR estimations.
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Affiliation(s)
- Alyssa N. Sbarra
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Jonathan F. Mosser
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, WA 98195, USA
| | - Matthew Ferrari
- Department of Biology, Pennsylvania State University, State College, PA 16801, USA
| | - Felicity Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Mark Papania
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Katrina Kretsinger
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Kevin A. McCarthy
- Institute for Disease Modeling, Global Health Division, Bill & Melinda Gates Foundation, Seattle, WA 98109, USA
| | - Niket Thakkar
- Institute for Disease Modeling, Global Health Division, Bill & Melinda Gates Foundation, Seattle, WA 98109, USA
| | - Katy A. M. Gaythorpe
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London SW7 2BX, UK
| | - Deepa Gamage
- Epidemiology Unit, Ministry of Health, Colombo 01000, Sri Lanka
| | - L. Kendall Krause
- Global Development Division, Bill & Melinda Gates Foundation, Seattle, WA 98109, USA
| | - Emily Dansereau
- Global Development Division, Bill & Melinda Gates Foundation, Seattle, WA 98109, USA
| | - Natasha Crowcroft
- Department of Immunization, Vaccines and Biologicals, World Health Organization, 1202 Geneva, Switzerland
| | - Allison Portnoy
- Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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Pilic A, Reda S, Jo CL, Burchett H, Bastías M, Campbell P, Gamage D, Henaff L, Kagina B, Külper-Schiek W, Lunny C, Marti M, Muloiwa R, Pieper D, Thomas J, Tunis MC, Younger Z, Wichmann O, Harder T. Use of existing systematic reviews for the development of evidence-based vaccination recommendations: Guidance from the SYSVAC expert panel. Vaccine 2023; 41:1968-1978. [PMID: 36804216 PMCID: PMC10015272 DOI: 10.1016/j.vaccine.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/18/2023]
Abstract
National immunization technical advisory groups (NITAGs) develop immunization-related recommendations and assist policy-makers in making evidence informed decisions. Systematic reviews (SRs) that summarize the available evidence on a specific topic are a valuable source of evidence in the development of such recommendations. However, conducting SRs requires significant human, time, and financial resources, which many NITAGs lack. Given that SRs already exist for many immunization-related topics, and to prevent duplication and overlap of reviews, a more practical approach may be for NITAGs to use existing SRs. Nevertheless, it can be challenging to identify relevant SRs, to select one SR from among multiple SRs, or to critically assess and effectively use them. To support NITAGs, the London School of Hygiene and Tropical Medicine, Robert Koch Institute and collaborators developed the SYSVAC project, which consists of an online registry of systematic reviews on immunization-related topics and an e-learning course, that supports the use of them (both freely accessible at https://www.nitag-resource.org/sysvac-systematic-reviews). Drawing from the e-learning course and recommendations from an expert panel, this paper outlines methods for using existing systematic reviews when making immunization-related recommendations. With specific examples and reference to the SYSVAC registry and other resources, it offers guidance on locating existing systematic reviews; assessing their relevance to a research question, up-to-dateness, and methodological quality and/or risk of bias; and considering the transferability and applicability of their findings to other populations or settings.
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Affiliation(s)
- Antonia Pilic
- Robert Koch Institute, Seestrasse 10, 13353 Berlin, Germany.
| | - Sarah Reda
- Robert Koch Institute, Seestrasse 10, 13353 Berlin, Germany
| | - Catherine L Jo
- Robert Koch Institute, Seestrasse 10, 13353 Berlin, Germany
| | - Helen Burchett
- Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine (LSHTM), 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | | | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Govan Mbeki Building, Glasgow G4 0BA, United Kingdom
| | - Deepa Gamage
- Epidemiology Unit and Advisory Committee on Communicable Diseases, Ministry of Health, #231, De Saram Place, Colombo 10, Sri Lanka
| | - Louise Henaff
- World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Benjamin Kagina
- University of Cape Town, Faculty of Health Sciences, Observatory, 7925 Cape Town, South Africa
| | | | - Carole Lunny
- Knowledge Translation Program, St Michael's Hospital, Unity Health Toronto, and Cochrane Hypertension Review Group, University of British Columbia, 2176 Health Sciences Mall, Vancouver, BC V6T1Z2, Canada
| | - Melanie Marti
- World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Rudzani Muloiwa
- University of Cape Town, Faculty of Health Sciences, Observatory, 7925 Cape Town, South Africa
| | - Dawid Pieper
- Brandenburg Medical School Theodor Fontane, Faculty of Health Sciences Brandenburg, Institute for Health Services and Health System Research, 15562 Rüdersdorf bei Berlin, Germany; Brandenburg Medical School Theodor Fontane, Center for Health Services Research, 15562 Rüdersdorf bei Berlin, Germany
| | - James Thomas
- Evidence for Policy and Practice Information and Co-ordinating (EPPI-) Centre, UCL Social Research Institute, University College London, 10 Woburn Square, London WC1H 0NR, United Kingdom
| | - Matthew C Tunis
- Public Health Agency of Canada, Centre for Immunization Readiness, 130 Colonnade Road, A.L. 6501H, Ottawa, Ontario K1A 0K9, Canada
| | - Zane Younger
- Robert Koch Institute, Seestrasse 10, 13353 Berlin, Germany
| | - Ole Wichmann
- Robert Koch Institute, Seestrasse 10, 13353 Berlin, Germany
| | - Thomas Harder
- Robert Koch Institute, Seestrasse 10, 13353 Berlin, Germany
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Karunaweera ND, Senanayake S, Ginige S, Silva H, Manamperi N, Samaranayake N, Dewasurendra R, Karunanayake P, Gamage D, de Silva N, Senarath U, Zhou G. Spatiotemporal distribution of cutaneous leishmaniasis in Sri Lanka and future case burden estimates. PLoS Negl Trop Dis 2021; 15:e0009346. [PMID: 33891608 PMCID: PMC8099137 DOI: 10.1371/journal.pntd.0009346] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 12/26/2020] [Revised: 05/05/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Leishmaniasis is a neglected tropical vector-borne disease, which is on the rise in Sri Lanka. Spatiotemporal and risk factor analyses are useful for understanding transmission dynamics, spatial clustering and predicting future disease distribution and trends to facilitate effective infection control. METHODS The nationwide clinically confirmed cutaneous leishmaniasis and climatic data were collected from 2001 to 2019. Hierarchical clustering and spatiotemporal cross-correlation analysis were used to measure the region-wide and local (between neighboring districts) synchrony of transmission. A mixed spatiotemporal regression-autoregression model was built to study the effects of climatic, neighboring-district dispersal, and infection carryover variables on leishmaniasis dynamics and spatial distribution. Same model without climatic variables was used to predict the future distribution and trends of leishmaniasis cases in Sri Lanka. RESULTS A total of 19,361 clinically confirmed leishmaniasis cases have been reported in Sri Lanka from 2001-2019. There were three phases identified: low-transmission phase (2001-2010), parasite population buildup phase (2011-2017), and outbreak phase (2018-2019). Spatially, the districts were divided into three groups based on similarity in temporal dynamics. The global mean correlation among district incidence dynamics was 0.30 (95% CI 0.25-0.35), and the localized mean correlation between neighboring districts was 0.58 (95% CI 0.42-0.73). Risk analysis for the seven districts with the highest incidence rates indicated that precipitation, neighboring-district effect, and infection carryover effect exhibited significant correlation with district-level incidence dynamics. Model-predicted incidence dynamics and case distribution matched well with observed results, except for the outbreak in 2018. The model-predicted 2020 case number is about 5,400 cases, with intensified transmission and expansion of high-transmission area. The predicted case number will be 9115 in 2022 and 19212 in 2025. CONCLUSIONS The drastic upsurge in leishmaniasis cases in Sri Lanka in the last few year was unprecedented and it was strongly linked to precipitation, high burden of localized infections and inter-district dispersal. Targeted interventions are urgently needed to arrest an uncontrollable disease spread.
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Affiliation(s)
| | | | | | - Hermali Silva
- Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | | | | | | | | | - Nissanka de Silva
- Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Upul Senarath
- Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Guofa Zhou
- University of California Irvine, Irvine, California, United States of America
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Karunaweera ND, Ginige S, Senanayake S, Silva H, Manamperi N, Samaranayake N, Siriwardana Y, Gamage D, Senerath U, Zhou G. Spatial Epidemiologic Trends and Hotspots of Leishmaniasis, Sri Lanka, 2001-2018. Emerg Infect Dis 2021; 26:1-10. [PMID: 31855147 PMCID: PMC6924882 DOI: 10.3201/eid2601.190971] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Leishmaniasis, a neglected tropical disease, is on the decline in South Asia. However, cases of cutaneous leishmaniasis have risen in Sri Lanka since 2001, and the lack of in-depth research on its epidemiologic characteristics hampers control efforts. We analyzed data collected from patients with cutaneous leishmaniasis in Sri Lanka during 2001-2018 to study temporal and geographic trends and identify and monitor disease hotspots. We noted a progression in case rates, including a sharp rise in 2018, showing temporal expansion of disease-prevalent areas and 2 persistent hotspots. The northern hotspot shifted and shrank over time, but the southern hotspot progressively expanded and remained spatially static. In addition, we noted regional incidence differences for age and sex. We provide evidence of temporally progressive and spatially expanding incidence of leishmaniasis in Sri Lanka with distinct geographic patterns and disease hotspots, signaling an urgent need for effective disease control interventions.
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Gamage D, Mach O, Ginige S, Weldon WC, Oberste MS, Jeyaseelan V, Sutter RW. Poliovirus Type 2 Seroprevalence Following Full- or Fractional-Dose Inactivated Poliovirus Vaccine in the Period After Sabin Type 2 Withdrawal in Sri Lanka. J Infect Dis 2020; 219:1887-1892. [PMID: 30649505 DOI: 10.1093/infdis/jiz026] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/11/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In July 2016, Sri Lanka replaced 1 intramuscular dose of inactivated poliovirus vaccine (IPV) with 2 doses of intradermal fractional-dose IPV (fIPV) in its routine immunization schedule. We carried out a survey of seroprevalence of antipolio antibodies in children who received 2 fIPV doses and compared it with those who received 1 full IPV dose. METHODS Children born between March and December 2016 were randomly selected from 3 Sri Lankan districts (Colombo, Badulla, and Anuradhapura). Serum samples were collected and tested for presence of neutralizing antibodies to poliovirus types 1, 2, and 3. RESULTS Seroprevalence of antipolio antibodies was 100% in all districts for poliovirus type 1 and poliovirus type 3; it ranged between 90% and 93% for poliovirus type 2 (PV2) in children who received 1 full IPV dose and between 78% and 100% in those receiving 2 fIPV doses (P = .22). The median reciprocal titers of anti-PV2 antibodies were similar in children who received full-dose IPV and those who received fIPV (1:64 vs 1:45, respectively; P = .11). CONCLUSIONS Our study demonstrated not only that Sri Lanka succeeded in maintaining very high primary immunization coverage also but that it is feasible for a national immunization program to implement fIPV immunization and achieve high coverage with intradermal application. The seroprevalence of anti-PV2 antibodies did not decrease after the introduction of fIPV.
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Affiliation(s)
- Deepa Gamage
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka
| | - Ondrej Mach
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
| | - Samitha Ginige
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka
| | - William C Weldon
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - M Steven Oberste
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Roland W Sutter
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
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Gamage D, Mach O, Palihawadana P, Zhang Y, Weldon WC, Oberste MS, Gunasena S, Sutter RW. Boosting of Mucosal Immunity After Fractional-Dose Inactivated Poliovirus Vaccine. J Infect Dis 2019; 218:1876-1882. [PMID: 29982532 DOI: 10.1093/infdis/jiy389] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/25/2018] [Indexed: 11/13/2022] Open
Abstract
Background Inactivated poliovirus vaccine (IPV) boosts mucosal immunity in persons previously vaccinated with oral poliovirus vaccine (OPV). We assessed whether fractional-dose IPV (fIPV, 1/5th of full dose) administered intradermally also boosts mucosal immunity. Methods Children 10-12 years old were enrolled in Sri Lanka and randomized to receive one dose IPV, fIPV, or no IPV vaccine. One month later, they received OPV challenge. Blood was collected at enrolment and before challenge; stool was collected at 3, 7, and 14 days post-challenge. Sera were analysed for presence of poliovirus neutralizing antibodies; stool was analysed for poliovirus. Results We analysed 304/309 (98%) enrolled subjects. There were 16/97 (16%), 9/99 (9%), and 72/95 (76%) subjects excreting poliovirus after challenge in the IPV, fIPV and "No IPV Vaccine" study arms, respectively (P < .001 for comparison of IPV [or fIPV] vs "No IPV Vaccine"; P = .1 for comparisons of fIPV vs IPV). Relative decrease in excretion prevalence was 80% and 88% to IPV and fIPV, respectively, compared with the "No IPV Vaccine" control arm. Conclusions Single fIPV dose boosted mucosal immunity to a similar degree as single full dose of IPV. This finding provides further evidence in support of fIPV for poliovirus outbreak response at the time of IPV global supply shortage. Clinical trials registration Australia New Zealand Clinical Trial Registry ACTRN12616000124437p.
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Affiliation(s)
- Deepa Gamage
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka
| | - Ondrej Mach
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
| | | | - Yiting Zhang
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William C Weldon
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - M Steven Oberste
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Roland W Sutter
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
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Ruwanpathirana T, Senanayake S, Gunawardana N, Munasinghe A, Ginige S, Gamage D, Amarasekara J, Lokuketagoda B, Chulasiri P, Amunugama S, Palihawadana P, Caplin B, Pearce N. Prevalence and risk factors for impaired kidney function in the district of Anuradhapura, Sri Lanka: a cross-sectional population-representative survey in those at risk of chronic kidney disease of unknown aetiology. BMC Public Health 2019. [PMID: 31200694 DOI: 10.1186/s12889‐019‐7117‐2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the last 20 years there have been reports of a form of chronic kidney disease of unknown cause (CKDu) affecting rural communities in the North Central Province of Sri Lanka. Valid prevalence estimates, using a standardised methodology, are needed to assess the burden of disease, assess secular trends, and perform international comparisons. METHODS We conducted a cross-sectional representative population survey in five study areas with different expected prevalences of CKDu. We used a proxy definition of CKDu involving a single measure of impaired kidney function (eGFR< 60 mL/min/1.7m2, using the CKD-Epi formula) in the absence of hypertension, diabetes or heavy proteinuria. RESULTS A total of 4803 participants (88.7%) took part in the study and 202 (6.0%; 95% CI 5.2-6.8) had a low eGFR in the absence of hypertension, diabetes and heavy proteinuria and hence met the criteria for proxy CKDu. The proportion of males (11.2%; 95% CI 9.2-13.1) were triple than the females (3.7%; 95% CI 2.9-4.5). Advancing age and history of CKD among parents or siblings were risk factors for low GFR among both males and females while smoking was found to be a risk factor among males. CONCLUSIONS These data, collected using a standardised methodology demonstrate a high prevalence of impaired kidney function, not due to known causes of kidney disease, in the selected study areas of the Anuradhapura district of Sri Lanka. The aetiology of CKDu in Sri Lanka remains unclear and there is a need for longitudinal studies to describe the natural history and to better characterise risk factors for the decline in kidney function.
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Affiliation(s)
| | - Sameera Senanayake
- Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo, 10, Sri Lanka.
| | | | | | - Samitha Ginige
- Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo, 10, Sri Lanka
| | - Deepa Gamage
- Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo, 10, Sri Lanka
| | - Jagath Amarasekara
- Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo, 10, Sri Lanka
| | | | | | | | - Paba Palihawadana
- Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo, 10, Sri Lanka
| | - Ben Caplin
- Department of Renal Medicine, University College London, London, UK
| | - Neil Pearce
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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10
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Ruwanpathirana T, Senanayake S, Gunawardana N, Munasinghe A, Ginige S, Gamage D, Amarasekara J, Lokuketagoda B, Chulasiri P, Amunugama S, Palihawadana P, Caplin B, Pearce N. Prevalence and risk factors for impaired kidney function in the district of Anuradhapura, Sri Lanka: a cross-sectional population-representative survey in those at risk of chronic kidney disease of unknown aetiology. BMC Public Health 2019; 19:763. [PMID: 31200694 PMCID: PMC6570843 DOI: 10.1186/s12889-019-7117-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 02/06/2019] [Accepted: 06/06/2019] [Indexed: 11/16/2022] Open
Abstract
Background Over the last 20 years there have been reports of a form of chronic kidney disease of unknown cause (CKDu) affecting rural communities in the North Central Province of Sri Lanka. Valid prevalence estimates, using a standardised methodology, are needed to assess the burden of disease, assess secular trends, and perform international comparisons. Methods We conducted a cross-sectional representative population survey in five study areas with different expected prevalences of CKDu. We used a proxy definition of CKDu involving a single measure of impaired kidney function (eGFR< 60 mL/min/1.7m2, using the CKD-Epi formula) in the absence of hypertension, diabetes or heavy proteinuria. Results A total of 4803 participants (88.7%) took part in the study and 202 (6.0%; 95% CI 5.2–6.8) had a low eGFR in the absence of hypertension, diabetes and heavy proteinuria and hence met the criteria for proxy CKDu. The proportion of males (11.2%; 95% CI 9.2–13.1) were triple than the females (3.7%; 95% CI 2.9–4.5). Advancing age and history of CKD among parents or siblings were risk factors for low GFR among both males and females while smoking was found to be a risk factor among males. Conclusions These data, collected using a standardised methodology demonstrate a high prevalence of impaired kidney function, not due to known causes of kidney disease, in the selected study areas of the Anuradhapura district of Sri Lanka. The aetiology of CKDu in Sri Lanka remains unclear and there is a need for longitudinal studies to describe the natural history and to better characterise risk factors for the decline in kidney function. Electronic supplementary material The online version of this article (10.1186/s12889-019-7117-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Sameera Senanayake
- Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo, 10, Sri Lanka.
| | | | | | - Samitha Ginige
- Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo, 10, Sri Lanka
| | - Deepa Gamage
- Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo, 10, Sri Lanka
| | - Jagath Amarasekara
- Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo, 10, Sri Lanka
| | | | | | | | - Paba Palihawadana
- Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo, 10, Sri Lanka
| | - Ben Caplin
- Department of Renal Medicine, University College London, London, UK
| | - Neil Pearce
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Gamage D, Ginige S, Palihawadana P. National introduction of fractional-dose inactivated polio vaccine in Sri Lanka following the global "switch". WHO South East Asia J Public Health 2018; 7:79-83. [PMID: 30136665 DOI: 10.4103/2224-3151.239418] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
As part of the Polio eradication and endgame strategic plan 2013-2018 to achieve and sustain a polio-free world, the use of oral polio vaccine (OPV) must eventually be stopped. This process started in April 2016, with the worldwide, planned synchronized "switch", whereby use of OPV containing poliovirus type 2 ceased. Prior to the switch, in line with international guidance on risk mitigation, Sri Lanka had introduced a single full dose (0.5 mL intramuscularly) of inactivated polio vaccine (IPV) into routine immunization. However, the two global suppliers of World Health Organization (WHO)-prequalified IPV had significant challenges in scaling up production to meet the new demand, resulting in a global shortage in April 2016. The WHO Strategic Advisory Group of Experts on Immunization recommended that countries should consider a two-dose schedule of intradermal fractional IPV (fIPV). After rapid consideration of the programmatic cost and logistic implications, Sri Lanka was the first country to roll out this dose-sparing schedule nationwide. The country ensured smooth implementation of fIPV use, reaching out to all eligible infants, maintaining equity and sustaining the IPV vaccination. With expedited refresher training in intradermal vaccination, confident, well-trained and dedicated health-care staff, from the field up to provincial levels, worked together as a dedicated team. Health authorities at all levels reported that public acceptance of the additional injections of the new schedule was high. A post-introduction evaluation and an assessment of population-level immunity are under way.
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Affiliation(s)
- Deepa Gamage
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka
| | - Samitha Ginige
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka
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Gamage D, Palihawadana P, Mach O, Weldon WC, Oberste SM, Sutter RW. Achieving high seroprevalence against polioviruses in Sri Lanka--results from a serological survey, 2014. J Epidemiol Glob Health 2015; 5:S67-71. [PMID: 26166424 PMCID: PMC6688167 DOI: 10.1016/j.jegh.2015.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 11/17/2022] Open
Abstract
The immunization program in Sri Lanka consistently reaches >90% coverage with oral poliovirus vaccines (OPV), and no polio supplementary vaccination campaigns have been conducted since 2003. We evaluated serological protection against polioviruses in children. A cross-sectional community-based survey was performed in three districts of Sri Lanka (Colombo, Badulla, and Killinochi). Randomly selected children in four age groups (9–11 months, 3–4 years, 7–9 years, and 15 years) were tested for poliovirus neutralizing antibodies. All 400 enrolled children completed the study. The proportion of seropositive children for poliovirus Type 1 and Type 2 was >95% for all age groups; for poliovirus Type 3 it was 95%, 90%, 77%, and 75% in the respective age groups. The vaccination coverage in our sample based on vaccination cards or parental recall was >90% in all age groups. Most Sri Lankan children are serologically protected against polioviruses through routine immunization only. This seroprevalence survey provided baseline data prior to the anticipated addition of inactivated poliovirus vaccine (IPV) into the Sri Lankan immunization program and the switch from trivalent OPV (tOPV) to bivalent OPV (bOPV).
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Affiliation(s)
- Deepa Gamage
- Epidemiology Unit, Ministry of Health, Sri Lanka
| | | | - Ondrej Mach
- Polio Eradication Department, World Health Organization, Geneva, Switzerland.
| | - William C Weldon
- Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Steven M Oberste
- Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Roland W Sutter
- Polio Eradication Department, World Health Organization, Geneva, Switzerland
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Gamage D, Galagoda G, Palihawadana P. Impact of rubella vaccination on elimination of congenital rubella syndrome in Sri Lanka: progress and challenges. WHO South East Asia J Public Health 2015; 4:189-196. [PMID: 28607318 DOI: 10.4103/2224-3151.206689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Rubella infection in pregnancy can lead to pathologies, including miscarriage, stillbirth and congenital rubella syndrome (CRS) in the neonate. Rubella vaccination can prevent all occurrences of CRS. In Sri Lanka, significant outbreaks of CRS occurred in 1994 and 1995, with 275 and 212 reported cases. In 1996, Sri Lanka introduced rubella vaccination for women aged 16-44 years, to stop CRS. Measles-rubella vaccine was introduced into the routine immunization schedule in 2001 and additional campaigns were carried out in 2003 (all 11-15 year olds) and 2004 (all 16-20 year olds). Reported immunization coverage with a single dose of a rubella-containing vaccine has been more than 95% since 2000. Laboratory-supported surveillance for rubella and CRS was started in 1992. Reported rubella cases fell from 364 (incidence 19/million population) in 1999 to 96 cases (incidence 5/million population) in 2002 and further to 12 cases (incidence 0.6/ million population) in 2014. Laboratory-supported CRS surveillance was started in 1990 and the highest number of CRS cases, 275 (incidence 77/100 000 live births), was diagnosed in 1994. Reported CRS cases fell from 22 cases (incidence 7/100 000 live births) in 2002 to 3 cases (incidence <1/100 000 live births) in 2014. Almost 20 years of routine rubella vaccination has resulted in >96% reduction in reported rubella cases and a corresponding >98% reduction in CRS cases. Despite this great achievement, work remains to eliminate rubella and CRS from Sri Lanka.
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Affiliation(s)
- Deepa Gamage
- Epidemiology Unit, Ministry of Health, Sri Lanka
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