scholarly journals Community transmission of rotavirus infection in a vaccinated population in Malawi: a prospective household cohort study

2020 ◽  
Author(s):  
Aisleen Bennett ◽  
Louisa Pollock ◽  
Naor Bar-Zeev ◽  
Joseph A. Lewnard ◽  
Khuzwayo C. Jere ◽  
...  
Keyword(s):  
Low Income ◽  
Asymptomatic Infection ◽  
Vaccine Effectiveness ◽  
Low Income Countries ◽  
Rotavirus Vaccine ◽  
Rotavirus Infection ◽  
Indirect Transmission ◽  
Household Contacts ◽  
Asymptomatic Children ◽  
Increased Risk

AbstractBackgroundRotavirus vaccine effectiveness (VE) is reduced among children in low-income countries (LICs). Indirect (transmission-mediated) effects of rotavirus vaccine may contribute to the total population impact of vaccination. We estimated the effectiveness of rotavirus vaccine in preventing transmission of rotavirus to household contacts in Blantyre, Malawi.MethodsWe recruited vaccine-age-eligible children with acute rotavirus gastroenteritis (case-children), together with their household contacts. Clinical data and stool samples were collected from case-children at presentation, and prospectively from household contacts over 14 days. A single stool sample was collected from control households containing asymptomatic children age-matched to case-children. Samples were tested for rotavirus using real-time PCR. Risk factors for household transmission of rotavirus infection and clinical rotavirus disease were identified using logistic regression. Vaccine effectiveness against transmission (VET) was estimated as one minus the ratio of secondary attack rates (SAR) in vaccinated and unvaccinated populations, using VE estimates from the associated diarrhoeal surveillance platform to estimate the counterfactual SAR without vaccination.FindingsA total of 196 case-households and 55 control-households were recruited. Household SAR for rotavirus infection was high (65%); SAR for clinical disease was much lower (5%). Asymptomatic infection in control households was common (28%). Increasing disease severity was associated with increased risk of transmission of both rotavirus infection and disease to household contacts. Estimated VET was 39% (95% confidence interval 16-57%).InterpretationRotavirus vaccine has the potential to substantially reduce household rotavirus transmission. This should be considered in clinical and health economic assessments of vaccine impact.FundingWellcome Trust and NIH/NIAID.

scholarly journals Evaluating strategies to improve rotavirus vaccine impact during the second year of life in Malawi

2019 ◽  
Vol 11 (505) ◽  
pp. eaav6419 ◽  
Author(s):  
Virginia E. Pitzer ◽  
Aisleen Bennett ◽  
Naor Bar-Zeev ◽  
Khuzwayo C. Jere ◽  
Benjamin A. Lopman ◽  
...  
Keyword(s):  
Low Income ◽  
Transmission Rate ◽  
Natural Infection ◽  
Vaccine Effectiveness ◽  
Low Income Countries ◽  
Rotavirus Vaccine ◽  
Second Year Of Life ◽  
Vaccine Impact ◽  
Second Year ◽  
Induced Immunity

Rotavirus vaccination has substantially reduced the incidence of rotavirus-associated gastroenteritis (RVGE) in high-income countries, but vaccine impact and estimated effectiveness are lower in low-income countries for reasons that are poorly understood. We used mathematical modeling to quantify rotavirus vaccine impact and investigate reduced vaccine effectiveness, particularly during the second year of life, in Malawi, where vaccination was introduced in October 2012 with doses at 6 and 10 weeks. We fitted models to 12 years of prevaccination data and validated the models against postvaccination data to evaluate the magnitude and duration of vaccine protection. The observed rollout of vaccination in Malawi was predicted to lead to a 26 to 77% decrease in the overall incidence of moderate-to-severe RVGE in 2016, depending on assumptions about waning of vaccine-induced immunity and heterogeneity in vaccine response. Vaccine effectiveness estimates were predicted to be higher among 4- to 11-month-olds than 12- to 23-month-olds, even when vaccine-induced immunity did not wane, due to differences in the rate at which vaccinated and unvaccinated individuals acquire immunity from natural infection. We found that vaccine effectiveness during the first and second years of life could potentially be improved by increasing the proportion of infants who respond to vaccination or by lowering the rotavirus transmission rate. An additional dose of rotavirus vaccine at 9 months of age was predicted to lead to higher estimated vaccine effectiveness but to only modest (5 to 16%) reductions in RVGE incidence over the first 3 years after introduction, regardless of assumptions about waning of vaccine-induced immunity.

scholarly journals Infrequent Transmission of Monovalent Human Rotavirus Vaccine Virus to Household Contacts of Vaccinated Infants in Malawi

2019 ◽  
Vol 219 (11) ◽  
pp. 1730-1734 ◽  
Author(s):  
Aisleen Bennett ◽  
Louisa Pollock ◽  
Khuzwayo C Jere ◽  
Virginia E Pitzer ◽  
Benjamin Lopman ◽  
...  
Keyword(s):  
Low Income ◽  
Indirect Effects ◽  
Horizontal Transmission ◽  
Vaccine Virus ◽  
Low Income Countries ◽  
Rotavirus Vaccine ◽  
Fecal Shedding ◽  
Household Contacts ◽  
Human Rotavirus ◽  
Stool Samples

Abstract Horizontal transmission of rotavirus vaccine virus may contribute to indirect effects of rotavirus vaccine, but data are lacking from low-income countries. Serial stool samples were obtained from Malawian infants who received 2 doses of monovalent human rotavirus vaccine (RV1) (days 4, 6, 8, and 10 after vaccination) and from their household contacts (8–10 days after vaccine). RV1 vaccine virus in stool was detected using semiquantitative real-time reverse-transcription polymerase chain reaction. RV1 fecal shedding was detected in 41 of 60 vaccinated infants (68%) and in 2 of 147 household contacts (1.4%). Horizontal transmission of vaccine virus within households is unlikely to make a major contribution to RV1 indirect effects in Malawi.

scholarly journals The Rotavirus Vaccine Landscape, an Update

Pathogens ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 520
Author(s):  
Roberto Cárcamo-Calvo ◽  
Carlos Muñoz ◽  
Javier Buesa ◽  
Jesús Rodríguez-Díaz ◽  
Roberto Gozalbo-Rovira
Keyword(s):  
Developing Countries ◽  
Mortality Rate ◽  
Low Income ◽  
State Of The Art ◽  
The State ◽  
Cold Chain ◽  
Low Income Countries ◽  
Rotavirus Vaccine ◽  
Oral Vaccines

Rotavirus is the leading cause of severe acute childhood gastroenteritis, responsible for more than 128,500 deaths per year, mainly in low-income countries. Although the mortality rate has dropped significantly since the introduction of the first vaccines around 2006, an estimated 83,158 deaths are still preventable. The two main vaccines currently deployed, Rotarix and RotaTeq, both live oral vaccines, have been shown to be less effective in developing countries. In addition, they have been associated with a slight risk of intussusception, and the need for cold chain maintenance limits the accessibility of these vaccines to certain areas, leaving 65% of children worldwide unvaccinated and therefore unprotected. Against this backdrop, here we review the main vaccines under development and the state of the art on potential alternatives.

scholarly journals Preterm Nutrition and Clinical Outcomes

2020 ◽  
Vol 7 ◽  
pp. 2333794X2093785
Author(s):  
Netsanet Workneh Gidi ◽  
Amha Mekasha ◽  
Assaye K. Nigussie ◽  
Robert L. Goldenberg ◽  
Elizabeth M. McClure ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Preterm Infants ◽  
Enteral Feeding ◽  
Low Income ◽  
Neonatal Intensive Care ◽  
Low Income Countries ◽  
Preterm Neonates ◽  
Risk Of Death ◽  
Increased Risk ◽  
Preterm Formula

Background. In low-income countries, preterm nutrition is often inadequately addressed. The aim of the study was to assess the patterns of feeding and associated clinical outcomes of preterm neonates admitted to neonatal intensive care units in Ethiopia. Method. This was a multicenter, prospective study. Infants’ clinical characteristics at birth, daily monitoring of feeding history, and weight measurements were collected. An outcome assessment was completed at 28 days. Result. For this analysis, 2560 infants (53% male) were eligible. The mean (SD) gestational age was 33.1 (2.2) weeks. During the hospital stay the proportion of infants on breast milk only, preterm formula, term formula, and mixed feeding was 58%, 27.4%, 1.6%, and 34.1%, respectively. Delay in enteral feeding was associated with increased risk of death (odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.33-2.78; P < .001) and (OR = 5.06, 95% CI = 3.23-7.87; P < .001) for 1 to 3 and 4 to 6 days of delay in enteral feeding, respectively, after adjusting for possible confounders. The length of delay in enteral feeding was associated with increased risk of hypoglycemia (OR = 1.2, 95% CI = 1.1-1.2; P = .005). The mortality rate was lower in hospitals providing preterm formula more often ( P = .04). Half of the infants continued losing weight at the time of discharge. Conclusion. Delayed enteral feeding significantly increases the risk of mortality before discharge and hypoglycemia in preterm infants in resource-limited settings. Ensuring adequate nutritional support of preterm infants is highly needed.

scholarly journals Rotavirus vaccine effectiveness in low-income settings: An evaluation of the test-negative design

Vaccine ◽  
2017 ◽  
Vol 35 (1) ◽  
pp. 184-190 ◽  
Author(s):  
Lauren M. Schwartz ◽  
M. Elizabeth Halloran ◽  
Ali Rowhani-Rahbar ◽  
Kathleen M. Neuzil ◽  
John C. Victor
Keyword(s):  
Low Income ◽  
Vaccine Effectiveness ◽  
Rotavirus Vaccine

The burden of multimorbidity: Physical health in the severely mentally ill population

2012 ◽  
Vol 09 (03) ◽  
pp. 137-142 ◽  
Author(s):  
H. L. Millar
Keyword(s):  
Physical Health ◽  
Low Income ◽  
Mentally Ill ◽  
Mental Health Problems ◽  
Good Practice ◽  
Low Income Countries ◽  
National Guidelines ◽  
Severely Mentally Ill ◽  
Increased Risk ◽  
Consensus Statements

SummaryThe concept of multimorbidity has attracted increasing interest over the past decade with the recognition of multiple burdens of disease and their costs for the individual, the societal cost and economic consequences. It has become evident that multimorbidity is the norm rather than the exception and occurring in an increasingly younger population particularly in areas of socioeconomic deprivation and low income countries. With multimorbidity comes an increased risk of mental health problems especially depression which impacts on the overall management of the physical health problem leading to potentially more complications and worse clinical and social outcomes. It is well established that the severely mentally ill population have a markedly reduced life expectancy due to predominantly comorbid medical problems including cardiovascular and metabolic disease. Despite a plethora of international and national guidelines and consensus statements outlining the requirement for screening and ongoing monitoring of this population, regular comprehensive health checks remain substandard. This selective review aims to highlight the challenges of multimorbidity within the health care systems; to provide guidance on good practice and to enable clinicians to deliver a more person centered co-ordinated approach to improve the health outcomes for multi morbidity in this highly vulnerable population.

22. IS HELICOBACTER PYLORI A STI? - A PILOT STUDY

Sexual Health ◽  
2007 ◽  
Vol 4 (4) ◽  
pp. 293
Author(s):  
S. Sawleshwarkar ◽  
G. Eslick ◽  
C. Chung ◽  
R. Jones ◽  
A. Mindel
Keyword(s):  
Risk Factors ◽  
Helicobacter Pylori ◽  
Sexual Risk ◽  
Low Income ◽  
Adult Population ◽  
Helicobacter Pylori Infection ◽  
Low Income Countries ◽  
Health Clinic ◽  
Enzyme Linked Immunosorbent Assay ◽  
Increased Risk

Background: Helicobacter pylori is responsible for chronic gastritis and peptic ulcer disease and is associated with an increased risk of developing stomach cancer. The seroprevalence of Helicobacter pylori in the Australian-born adult population is about 20% and increases with age. The exact mode of transmission of Helicobacter pylori infection remains unknown and it has been suggested that sexual transmission may be important. This study is a preliminary investigation into a possible association between sexual risk factors and Helicobacter pylori infection. Subjects and methods: All patients aged 18 and above, presenting to the Parramatta Sexual Health Clinic and were having blood taken for any other purpose, were eligible for the study. Blood samples were collected for Helicobacter pylori serology using an enzyme-linked immunosorbent assay to detect Helicobacter pylori IgG. Demographic information and data regarding sexual behaviour and risk factors for sexually transmitted infections was obtained. The sample size to detect a 15% difference between the study population and the general Australian population with 90% power was 105. To allow for minor variations we plan to recruit 125 participants. Results: To date, 65 patients (75.4% males) have been enrolled in the study and 10 (7 males and 3 females) (15.4%) were positive for Helicobacter pylori. One additional result was equivocal. 24.6% of the participants were born outside Australia and out of 8 who belonged to middle and low-income countries, three had positive serology. The full results of the study, including seroprevalence and the demographic and sexual risk factors, will be presented.

scholarly journals Molecular Diversity of Giardia duodenalis, Cryptosporidium spp., and Blastocystis sp. in Symptomatic and Asymptomatic Schoolchildren in Zambézia Province (Mozambique)

Pathogens ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 255 ◽  
Author(s):  
Aly S. Muadica ◽  
Pamela C. Köster ◽  
Alejandro Dashti ◽  
Begoña Bailo ◽  
Marta Hernández-de-Mingo ◽  
...  
Keyword(s):  
Low Income ◽  
Molecular Diversity ◽  
Giardia Duodenalis ◽  
Molecular Data ◽  
Low Income Countries ◽  
Medical Attention ◽  
Cryptosporidium Spp ◽  
Asymptomatic Children ◽  
Common Causes ◽  
Blastocystis Sp

Infections by the protist enteroparasites Giardia duodenalis, Cryptosporidium spp., and, to a much lesser extent, Blastocystis sp. are common causes of childhood diarrhoea in low-income countries. This molecular epidemiological study assesses the frequency and molecular diversity of these pathogens in faecal samples from asymptomatic schoolchildren (n = 807) and symptomatic children seeking medical attention (n = 286) in Zambézia province, Mozambique. Detection and molecular characterisation of pathogens was conducted by polymerase chain reaction (PCR)-based methods coupled with Sanger sequencing. Giardia duodenalis was the most prevalent enteric parasite found [41.7%, 95% confidence interval (CI): 38.8–44.7%], followed by Blastocystis sp. (14.1%, 95% CI: 12.1–16.3%), and Cryptosporidium spp. (1.6%, 95% CI: 0.9–2.5%). Sequence analyses revealed the presence of assemblages A (7.0%, 3/43) and B (88.4%, 38/43) within G. duodenalis-positive children. Four Cryptosporidium species were detected, including C. hominis (30.8%; 4/13), C. parvum (30.8%, 4/13), C. felis (30.8%, 4/13), and C. viatorum (7.6%, 1/13). Four Blastocystis subtypes were also identified including ST1 (22.7%; 35/154), ST2 (22.7%; 35/154), ST3 (45.5%; 70/154), and ST4 (9.1%; 14/154). Most of the genotyped samples were from asymptomatic children. This is the first report of C. viatorum and Blastocystis ST4 in Mozambique. Molecular data indicate that anthropic and zoonotic transmission (the latter at an unknown rate) are important spread pathways of diarrhoea-causing pathogens in Mozambique.

scholarly journals Impact of maternal antibodies and microbiota development on the immunogenicity of oral rotavirus vaccine in African, Indian, and European infants

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Edward P. K. Parker ◽  
Christina Bronowski ◽  
Kulandaipalayam Natarajan C. Sindhu ◽  
Sudhir Babji ◽  
Blossom Benny ◽  
...  
Keyword(s):  
Low Income ◽  
Early Life ◽  
Maternal Antibodies ◽  
Low Income Countries ◽  
Rotavirus Vaccine ◽  
Specific Antibodies ◽  
Environmental Enteric Dysfunction ◽  
The Uk ◽  
Antibody Levels ◽  
Microbiota Diversity

AbstractIdentifying risk factors for impaired oral rotavirus vaccine (ORV) efficacy in low-income countries may lead to improvements in vaccine design and delivery. In this prospective cohort study, we measure maternal rotavirus antibodies, environmental enteric dysfunction (EED), and bacterial gut microbiota development among infants receiving two doses of Rotarix in India (n = 307), Malawi (n = 119), and the UK (n = 60), using standardised methods across cohorts. We observe ORV shedding and seroconversion rates to be significantly lower in Malawi and India than the UK. Maternal rotavirus-specific antibodies in serum and breastmilk are negatively correlated with ORV response in India and Malawi, mediated partly by a reduction in ORV shedding. In the UK, ORV shedding is not inhibited despite comparable maternal antibody levels to the other cohorts. In both India and Malawi, increased microbiota diversity is negatively correlated with ORV immunogenicity, suggesting that high early-life microbial exposure may contribute to impaired vaccine efficacy.

scholarly journals Barriers and opportunities for refugee mental health services: clinician recommendations from Jordan

2021 ◽  
Vol 8 ◽  
Author(s):  
Majd Al-Soleiti ◽  
Mahmoud Abu Adi ◽  
Ayat Nashwan ◽  
Eric Rafla-Yuan
Keyword(s):  
Mental Health ◽  
Health System ◽  
Mental Health Professionals ◽  
Low Income ◽  
Health Professionals ◽  
Mental Health Treatment ◽  
Qualitative Interviews ◽  
Low Income Countries ◽  
Syrian Refugees ◽  
Increased Risk

Abstract Background Jordan has received more than three million refugees from bordering countries during times of conflict, including over 600 000 Syrian refugees between 2011 and 2021. Amidst this humanitarian crisis, a new mental health system for Syrian refugees has developed in Jordan, with most clinical services administered through non-governmental organizations. Prior studies have identified increased risk of psychiatric disorders in refugee populations and significant barriers for Syrian refugees seeking mental health treatment, but few have reviewed the organization or ability of local systems to meet the needs of this refugee population. Methods Qualitative interviews of mental health professionals working with refugees in Jordan were conducted and thematically analyzed to assess efficacy and organizational dynamics. Results Interviewees described barriers to care inherent in many refugee settings, including financial limitations, shortages of mental health professionals, disparate geographic accessibility, stigma, and limited or absent screening protocols. Additional barriers not previously described in Jordan were identified, including clinician burnout, organizational metrics restricting services, insufficient visibility of services, and security restrictions. Advantages of the Jordanian system were also identified, including a receptive sociopolitical response fostering coordination and collaboration, open-door policies for accessing care, the presence of community and grassroots approaches, and improvements to health care infrastructure benefiting the local populace. Conclusions These findings highlight opportunities and pitfalls for program development in Jordan and other middle- and low-income countries. Leveraging clinician input can promote health system efficacy and improve mental health outcomes for refugee patients.

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