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Sero-evaluation of Immune Responses to Vibrio cholerae in a Postelimination Setting.

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Sero-evaluation of Immune Responses to Vibrio cholerae in a Postelimination Setting.

Open Forum Infect Dis. 2020 May;7(5):ofaa136

Authors: Diep TT, Jensen O, Van Thuong N, Nhi NTN, Thu NNA, Quang VN, Hieu TC, Thang HA, Thuy ND, Thang HV, Tuyen HT, Ngan LD, Ha NTT, Dung TD, Anderson CP, Azman AS, Leung DT

Abstract
Cholera remains a significant public health problem worldwide. In settings of declining incidence, serosurveillance may be used to augment clinical surveillance. We utilized dried blood spot sampling and cholera-specific antibody testing to examine the serologic profiles of vaccinated and unvaccinated children in southern Vietnam, where cholera was recently eliminated.

PMID: 32462045 [PubMed]

Risk Factors for Epidemic Cholera in Lusaka, Zambia-2017.

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Risk Factors for Epidemic Cholera in Lusaka, Zambia-2017.

Am J Trop Med Hyg. 2020 May 26;:

Authors: Nanzaluka FH, Davis WW, Mutale L, Kapaya F, Sakubita P, Langa N, Gama A, N'cho HS, Malambo W, Murphy J, Blackstock A, Mintz E, Riggs M, Mukonka V, Sinyange N, Yard E, Brunkard J

Abstract
On October 6, 2017, the Zambia Ministry of Health declared a cholera outbreak in Lusaka. By December, 1,462 cases and 38 deaths had occurred (case fatality rate, 2.6%). We conducted a case-control study to identify risk factors and inform interventions. A case was any person with acute watery diarrhea (≥ 3 loose stools in 24 hours) admitted to a cholera treatment center in Lusaka from December 16 to 21, 2017. Controls were neighbors without diarrhea during the same time period. Up to two controls were matched to each case by age-group (1-4, 5-17, and ≥ 18 years) and neighborhood. Surveyors interviewed cases and controls, tested free chlorine residual (FCR) in stored water, and observed the presence of soap in the home. Conditional logistic regression was used to generate matched odds ratios (mORs) based on subdistricts and age-groups with 95% CIs. We enrolled 82 cases and 132 controls. Stored water in 71% of case homes had an FCR > 0.2 mg/L. In multivariable analyses, those who drank borehole water (mOR = 2.4, CI: 1.1-5.6), had close contact with a cholera case (mOR = 6.2, CI: 2.5-15), and were male (mOR = 2.5, CI: 1.4-5.0) had higher odds of being a cholera case than their matched controls. The use of groundwater for drinking, contact with a cholera case, and male gender were associated with cholera. Based on these findings, we recommended health education about household water chlorination and hygiene in the home. Emergency responses included providing chlorinated water through emergency tanks and maintaining adequate FCR levels through close monitoring of water sources.

PMID: 32458780 [PubMed - as supplied by publisher]

Interventions to improve oral vaccine performance: a systematic review and meta-analysis.

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Interventions to improve oral vaccine performance: a systematic review and meta-analysis.

Lancet Infect Dis. 2019 02;19(2):203-214

Authors: Church JA, Parker EP, Kirkpatrick BD, Grassly NC, Prendergast AJ

Abstract
BACKGROUND: Oral vaccines underperform in low-income and middle-income countries compared with in high-income countries. Whether interventions can improve oral vaccine performance is uncertain.
METHODS: We did a systematic review and meta-analysis of interventions designed to increase oral vaccine efficacy or immunogenicity. We searched Ovid-MEDLINE and Embase for trials published until Oct 23, 2017. Inclusion criteria for meta-analysis were two or more studies per intervention category and available seroconversion data. We did random-effects meta-analyses to produce summary relative risk (RR) estimates. This study is registered with PROSPERO (CRD42017060608).
FINDINGS: Of 2843 studies identified, 87 were eligible for qualitative synthesis and 66 for meta-analysis. 22 different interventions were assessed for oral poliovirus vaccine (OPV), oral rotavirus vaccine (RVV), oral cholera vaccine (OCV), and oral typhoid vaccines. There was generally high heterogeneity. Seroconversion to RVV was significantly increased by delaying the first RVV dose by 4 weeks (RR 1·37, 95% CI 1·16-1·62) and OPV seroconversion was increased with monovalent or bivalent OPV compared with trivalent OPV (RR 1·51, 95% CI 1·20-1·91). There was some evidence that separating RVV and OPV increased RVV seroconversion (RR 1·21, 95% CI 1·00-1·47) and that higher vaccine inoculum improved OCV seroconversion (RR 1·12, 95% CI 1·00-1·26). There was no evidence of effect for anthelmintics, antibiotics, probiotics, zinc, vitamin A, withholding breastfeeding, extra doses, or vaccine buffering.
INTERPRETATION: Most strategies did not improve oral vaccine performance. Delaying RVV and reducing OPV valence should be considered within immunisation programmes to reduce global enteric disease. New strategies to address the gap in oral vaccine efficacy are urgently required.
FUNDING: Wellcome Trust, Bill & Melinda Gates Foundation, UK Medical Research Council, and WHO Polio Research Committee.

PMID: 30712836 [PubMed - indexed for MEDLINE]

The incidence, aetiology, and adverse clinical consequences of less severe diarrhoeal episodes among infants and children residing in low-income and middle-income countries: a 12-month case-control study as a follow-on to the Global Enteric Multicenter...

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The incidence, aetiology, and adverse clinical consequences of less severe diarrhoeal episodes among infants and children residing in low-income and middle-income countries: a 12-month case-control study as a follow-on to the Global Enteric Multicenter Study (GEMS).

Lancet Glob Health. 2019 05;7(5):e568-e584

Authors: Kotloff KL, Nasrin D, Blackwelder WC, Wu Y, Farag T, Panchalingham S, Sow SO, Sur D, Zaidi AKM, Faruque ASG, Saha D, Alonso PL, Tamboura B, Sanogo D, Onwuchekwa U, Manna B, Ramamurthy T, Kanungo S, Ahmed S, Qureshi S, Quadri F, Hossain A, Das SK, Antonio M, Hossain MJ, Mandomando I, Acácio S, Biswas K, Tennant SM, Verweij JJ, Sommerfelt H, Nataro JP, Robins-Browne RM, Levine MM

Abstract
BACKGROUND: Diarrheal diseases remain a leading cause of illness and death among children younger than 5 years in low-income and middle-income countries. The Global Enteric Multicenter Study (GEMS) has described the incidence, aetiology, and sequelae of medically attended moderate-to-severe diarrhoea (MSD) among children aged 0-59 months residing in censused populations in sub-Saharan Africa and south Asia, where most child deaths occur. To further characterise this disease burden and guide interventions, we extended this study to include children with episodes of less-severe diarrhoea (LSD) seeking care at health centres serving six GEMS sites.
METHODS: We report a 1-year, multisite, age-stratified, matched case-control study following on to the GEMS study. Six sites (Bamako, Mali; Manhiça, Mozambique; Basse, The Gambia; Mirzapur, Bangladesh; Kolkata, India; and Bin Qasim Town, Karachi, Pakistan) participated in this study. Children aged 0-59 months at each site who sought care at a sentinel hospital or health centre during a 12-month period were screened for diarrhoea. New (onset after ≥7 diarrhoea-free days) and acute (onset within the previous 7 days) episodes of diarrhoea in children who had sunken eyes, whose skin lost turgor, who received intravenous hydration, who had dysentery, or who were hospitalised were eligible for inclusion as MSD. The remaining new and acute diarrhoea episodes among children who sought care at the same health centres were considered LSD. We aimed to enrol the first eight or nine eligible children with MSD and LSD at each site during each fortnight in three age strata: infants (aged 0-11 months), toddlers (aged 12-23 months), and young children (aged 24-59 months). For each included case of MSD or LSD, we enrolled one to three community control children without diarrhoea during the previous 7 days. From patients and controls we collected clinical and epidemiological data, anthropometric measurements, and faecal samples to identify enteropathogens at enrolment, and we performed a follow-up home visit about 60 days later to ascertain vital status, clinical outcome, and interval growth. Primary outcomes were to characterise, for MSD and LSD, the pathogen-specific attributable risk and population-based incidence values, and to assess the frequency of adverse clinical consequences associated with these two diarrhoeal syndromes.
FINDINGS: From Oct 31, 2011, to Nov 14, 2012, we recruited 2368 children with MSD, 3174 with LSD, and one to three randomly selected community control children without diarrhoea matched to cases with MSD (n=3597) or LSD (n=4236). Weighted adjusted population attributable fractions showed that most attributable cases of MSD and LSD were due to rotavirus, Cryptosporidium spp, enterotoxigenic Escherichia coli encoding heat-stable toxin (with or without genes encoding heat-labile enterotoxin), and Shigella spp. The attributable incidence per 100 child-years for LSD versus MSD, by age stratum, for rotavirus was 22·3 versus 5·5 (0-11 months), 9·8 versus 2·9 (12-23 months), and 0·5 versus 0·2 (24-59 months); for Cryptosporidium spp was 3·6 versus 2·3 (0-11 months), 4·3 versus 0·6 (12-23 months), and 0·3 versus 0·1 (24-59 months); for enterotoxigenic E coli encoding heat-stable toxin was 4·2 versus 0·1 (0-11 months), 5·2 versus 0·0 (12-23 months), and 1·1 versus 0·2 (24-59 months); and for Shigella spp was 1·0 versus 1·3 (0-11 months), 3·1 versus 2·4 (12-23 months), and 0·8 versus 0·7 (24-59 months). Participants with both MSD and LSD had significantly more linear growth faltering than controls at follow-up.
INTERPRETATION: Inclusion of participants with LSD markedly expands the population of children who experience adverse clinical and nutritional outcomes from acute diarrhoeal diseases. Since MSD and LSD have similar aetiologies, interventions targeting rotavirus, Shigella spp, enterotoxigenic E coli producing heat-stable toxin, and Cryptosporidium spp might substantially reduce the diarrhoeal disease burden and its associated nutritional faltering.
FUNDING: Bill & Melinda Gates Foundation.

PMID: 31000128 [PubMed - indexed for MEDLINE]

Waterborne & foodborne viral hepatitis: A public health perspective.

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Waterborne & foodborne viral hepatitis: A public health perspective.

Indian J Med Res. 2019 11;150(5):432-435

Authors: Sinha A, Dutta S

PMID: 31939386 [PubMed - indexed for MEDLINE]

Burden of dengue infection in India, 2017: a cross-sectional population based serosurvey.

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Burden of dengue infection in India, 2017: a cross-sectional population based serosurvey.

Lancet Glob Health. 2019 08;7(8):e1065-e1073

Authors: Murhekar MV, Kamaraj P, Kumar MS, Khan SA, Allam RR, Barde P, Dwibedi B, Kanungo S, Mohan U, Mohanty SS, Roy S, Sagar V, Savargaonkar D, Tandale BV, Topno RK, Sapkal G, Kumar CPG, Sabarinathan R, Kumar VS, Bitragunta S, Grover GS, Lakshmi PVM, Mishra CM, Sadhukhan P, Sahoo PK, Singh SK, Yadav CP, Bhagat A, Srivastava R, Dinesh ER, Karunakaran T, Govindhasamy C, Rajasekar TD, Jeyakumar A, Suresh A, Augustine D, Kumar PA, Kumar R, Dutta S, Toteja GS, Gupta N, Mehendale SM

Abstract
BACKGROUND: The burden of dengue virus (DENV) infection across geographical regions of India is poorly quantified. We estimated the age-specific seroprevalence, force of infection, and number of infections in India.
METHODS: We did a community-based survey in 240 clusters (118 rural, 122 urban), selected from 60 districts of 15 Indian states from five geographical regions. We enumerated each cluster, randomly selected (with an Andriod application developed specifically for the survey) 25 individuals from age groups of 5-8 years, 9-17 years, and 18-45 years, and sampled a minimum of 11 individuals from each age group (all the 25 randomly selected individuals in each age group were visited in their houses and individuals who consented for the survey were included in the study). Age was the only inclusion criterion; for the purpose of enumeration, individuals residing in the household for more than 6 months were included. Sera were tested centrally by a laboratory team of scientific and technical staff for IgG antibodies against the DENV with the use of indirect ELISA. We calculated age group specific seroprevalence and constructed catalytic models to estimate force of infection.
FINDINGS: From June 19, 2017, to April 12, 2018, we randomly selected 17 930 individuals from three age groups. Of these, blood samples were collected and tested for 12 300 individuals (5-8 years, n=4059; 9-17 years, n=4265; 18-45 years, n=3976). The overall seroprevalence of DENV infection in India was 48·7% (95% CI 43·5-54·0), increasing from 28·3% (21·5-36·2) among children aged 5-8 years to 41·0% (32·4-50·1) among children aged 9-17 years and 56·2% (49·0-63·1) among individuals aged between 18-45 years. The seroprevalence was high in the southern (76·9% [69·1-83·2]), western (62·3% [55·3-68·8]), and northern (60·3% [49·3-70·5]) regions. The estimated number of primary DENV infections with the constant force of infection model was 12 991 357 (12 825 128-13 130 258) and for the age-dependent force of infection model was 8 655 425 (7 243 630-9 545 052) among individuals aged 5-45 years from 30 Indian states in 2017.
INTERPRETATION: The burden of dengue infection in India was heterogeneous, with evidence of high transmission in northern, western, and southern regions. The survey findings will be useful in making informed decisions about introduction of upcoming dengue vaccines in India.
FUNDING: Indian Council of Medical Research.

PMID: 31201130 [PubMed - indexed for MEDLINE]

Identification of Widespread Antibiotic Exposure in Patients With Cholera Correlates With Clinically Relevant Microbiota Changes.

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Identification of Widespread Antibiotic Exposure in Patients With Cholera Correlates With Clinically Relevant Microbiota Changes.

J Infect Dis. 2019 10 08;220(10):1655-1666

Authors: Alexandrova L, Haque F, Rodriguez P, Marrazzo AC, Grembi JA, Ramachandran V, Hryckowian AJ, Adams CM, Siddique MSA, Khan AI, Qadri F, Andrews JR, Rahman M, Spormann AM, Schoolnik GK, Chien A, Nelson EJ

Abstract
BACKGROUND: A first step to combating antimicrobial resistance in enteric pathogens is to establish an objective assessment of antibiotic exposure. Our goal was to develop and evaluate a liquid chromatography-ion trap mass spectrometry (LC/MS) method to determine antibiotic exposure in patients with cholera.
METHODS: A priority list for targeted LC/MS was generated from medication-vendor surveys in Bangladesh. A study of patients with and those without cholera was conducted to collect and analyze paired urine and stool samples.
RESULTS: Among 845 patients, 11% (90) were Vibrio cholerae positive; among these 90 patients, analysis of stool specimens revealed ≥1 antibiotic in 86% and ≥2 antibiotics in 52%. Among 44 patients with cholera and paired urine and stool specimens, ≥1 antibiotic was detected in 98% and ≥2 antibiotics were detected in 84%, despite 55% self-reporting medication use. Compared with LC/MS, a low-cost antimicrobial detection bioassay lacked a sufficient negative predictive value (10%; 95% confidence interval, 6%-16%). Detection of guideline-recommended antibiotics in stool specimens did (for azithromycin; P = .040) and did not (for ciprofloxacin) correlate with V. cholerae suppression. A nonrecommended antibiotic (metronidazole) was associated with decreases in anaerobes (ie, Prevotella organisms; P < .001).
CONCLUSION: These findings suggest that there may be no true negative control group when attempting to account for antibiotic exposure in settings like those in this study.

PMID: 31192364 [PubMed - indexed for MEDLINE]

Risk and Protective Factors for Cholera Deaths during an Urban Outbreak-Lusaka, Zambia, 2017-2018.

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Risk and Protective Factors for Cholera Deaths during an Urban Outbreak-Lusaka, Zambia, 2017-2018.

Am J Trop Med Hyg. 2020 03;102(3):534-540

Authors: Mutale LS, Winstead AV, Sakubita P, Kapaya F, Nyimbili S, Mulambya NL, Nanzaluka FH, Gama A, Mwale V, Kim S, Ngosa W, Yard E, Sinyange N, Mintz E, Brunkard J, Mukonka V

Abstract
The Republic of Zambia declared a cholera outbreak in Lusaka, the capital, on October 6, 2017. By mid-December, 20 of 661 reported cases had died (case fatality rate 3%), prompting the CDC and the Zambian Ministry of Health through the Zambia National Public Health Institute to investigate risk factors for cholera mortality. We conducted a study of cases (cholera deaths from October 2017 to January 2018) matched by age-group and onset date to controls (persons admitted to a cholera treatment center [CTC] and discharged alive). A questionnaire was administered to each survivor (or relative) and to a family member of each decedent. We used univariable exact conditional logistic regression to calculate matched odds ratios (mORs) and 95% CIs. In the analysis, 38 decedents and 76 survivors were included. Median ages for decedents and survivors were 38 (range: 0.5-95) and 25 (range: 1-82) years, respectively. Patients aged > 55 years and those who did not complete primary school had higher odds of being decedents (matched odds ratio [mOR] 6.3, 95% CI: 1.2-63.0, P = 0.03; mOR 8.6, 95% CI: 1.8-81.7, P < 0.01, respectively). Patients who received immediate oral rehydration solution (ORS) at the CTC had lower odds of dying than those who did not receive immediate ORS (mOR 0.1, 95% CI: 0.0-0.6, P = 0.02). Cholera prevention and outbreak response should include efforts focused on ensuring access to timely, appropriate care for older adults and less educated populations at home and in health facilities.

PMID: 31933465 [PubMed - indexed for MEDLINE]

Special Feature: 165 Years After Broad Street: Progress in Spatial/Temporal Analysis to Identify Infectious Disease Outbreaks.

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Special Feature: 165 Years After Broad Street: Progress in Spatial/Temporal Analysis to Identify Infectious Disease Outbreaks.

Health Secur. 2019 Jul/Aug;17(4):253-254

Authors: Kobokovich A

PMID: 31433276 [PubMed - indexed for MEDLINE]

Emergence of Novel Coronavirus and COVID-19: whether to stay or die out?

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Emergence of Novel Coronavirus and COVID-19: whether to stay or die out?

Crit Rev Microbiol. 2020 Mar;46(2):182-193

Authors: Biswas A, Bhattacharjee U, Chakrabarti AK, Tewari DN, Banu H, Dutta S

Abstract
The last century has witnessed several assaults from RNA viruses, resulting in millions of death throughout the world. The 21st century appears no longer an exception, with the trend continued with escalated fear of SARS coronavirus in 2002 and further concern of influenza H5N1 in 2003. A novel influenza virus created the first pandemic of the 21st century, the pandemic flu in 2009 preceded with the emergence of another deadly virus, MERS-CoV in 2012. A novel coronavirus "SARS-CoV-2" (and the disease COVID-19) emerged suddenly, causing a rapid outbreak with a moderate case fatality rate. This virus is continuing to cause health care providers grave concern due to the lack of any existing immunity in the human population, indicating their novelty and lack of previous exposure. The big question is whether this novel virus will be establishing itself in an endemic form or will it eventually die out? Endemic viruses during circulation may acquire mutations to infect naïve, as well as individual with pre-existing immunity. Continuous monitoring is strongly advisable, not only to the newly infected individuals, but also to those recovered individuals who were infected by SARS-CoV-2 as re-infection may lead to the selection of escape mutants and subsequent dissemination to the population.

PMID: 32282268 [PubMed - indexed for MEDLINE]

Coronavirus (COVID-19) in Haiti: A Call for Action.

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Coronavirus (COVID-19) in Haiti: A Call for Action.

J Community Health. 2020 06;45(3):437-439

Authors: Louis-Jean J, Cenat K, Sanon D, Stvil R

Abstract
Recently, the cholera outbreak in Haiti demonstrated just how unprepared the country is to rapidly isolate an outbreak of this magnitude, and its vulnerability to the COVID-19 pandemic. This communication briefly examines the health system in Haiti and its vulnerability toward the COVID-19 outbreak.

PMID: 32303920 [PubMed - indexed for MEDLINE]

[The surprising disappearance of cholera in Haiti].

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[The surprising disappearance of cholera in Haiti].

Rev Prat. 2019 Sep;69(7):763-765

Authors: Piarroux R, Rebaudet S

PMID: 32233320 [PubMed - indexed for MEDLINE]

[Prophylactic representations, discourses and practices during the cholera epidemic (1886-1887, Mendoza, Argentina)].

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[Prophylactic representations, discourses and practices during the cholera epidemic (1886-1887, Mendoza, Argentina)].

Hist Cienc Saude Manguinhos. 2019 Jan-Mar;26(1):187-207

Authors: Aguerregaray R

Abstract
The article takes a look into the disciplinary projects approved by the authorities in the province of Mendoza (Argentina) during the cholera epidemic that took place during the summer of 1886-1887. Although the projects were intended to ameliorate the sanitary conditions of the whole of the population, these were focused and applied more intensively on the underprivileged sectors and their areas of inhabitance. This follows the ideas and representations created by the State regarding the illness and its death during this period.

PMID: 30942310 [PubMed - indexed for MEDLINE]

Development of a loop-mediated isothermal amplification assay for Vibrio cholerae O1 and O139.

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Development of a loop-mediated isothermal amplification assay for Vibrio cholerae O1 and O139.

Mol Cell Probes. 2019 06;45:65-67

Authors: Izumiya H, Morita M, Arakawa E, Ngo TC, Nguyen HT, Nguyen DT, Ohnishi M

Abstract
A loop-mediated isothermal amplification assay was developed. It was designed for recognizing Vibrio cholerae O1/O139, where atpA, rfbN, and wfbR genes were adopted. The assay specifically detected the target with sensitivities of 5-67 copies per reaction in 1 h. The assay will aid rapid detection of the cholera bacterium.

PMID: 31082474 [PubMed - indexed for MEDLINE]

Genomic epidemiology of Vibrio cholerae reveals the regional and global spread of two epidemic non-toxigenic lineages.

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Genomic epidemiology of Vibrio cholerae reveals the regional and global spread of two epidemic non-toxigenic lineages.

PLoS Negl Trop Dis. 2020 02;14(2):e0008046

Authors: Wang H, Yang C, Sun Z, Zheng W, Zhang W, Yu H, Wu Y, Didelot X, Yang R, Pan J, Cui Y

Abstract
Non-toxigenic Vibrio cholerae isolates have been found associated with diarrheal disease globally, however, the global picture of non-toxigenic infections is largely unknown. Among non-toxigenic V. cholerae, ctxAB negative, tcpA positive (CNTP) isolates have the highest risk of disease. From 2001 to 2012, 71 infectious diarrhea cases were reported in Hangzhou, China, caused by CNTP serogroup O1 isolates. We sequenced 119 V. cholerae genomes isolated from patients, carriers and the environment in Hangzhou between 2001 and 2012, and compared them with 850 publicly available global isolates. We found that CNTP isolates from Hangzhou belonged to two distinctive lineages, named L3b and L9. Both lineages caused disease over a long time period with usually mild or moderate clinical symptoms. Within Hangzhou, the spread route of the L3b lineage was apparently from rural to urban areas, with aquatic food products being the most likely medium. Both lineages had been previously reported as causing local endemic disease in Latin America, but here we show that global spread of them has occurred, with the most likely origin of L3b lineage being in Central Asia. The L3b lineage has spread to China on at least three occasions. Other spread events, including from China to Thailand and to Latin America were also observed. We fill the missing links in the global spread of the two non-toxigenic serogroup O1 V. cholerae lineages that can cause human infection. The results are important for the design of future disease control strategies: surveillance of V. cholerae should not be limited to ctxAB positive strains.

PMID: 32069325 [PubMed - indexed for MEDLINE]

Humanistic Epidemiology: Love in the time of cholera, COVID-19 and other outbreaks.

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Humanistic Epidemiology: Love in the time of cholera, COVID-19 and other outbreaks.

Eur J Epidemiol. 2020 Apr 25;:

Authors: Soriano JB

PMID: 32335765 [PubMed - as supplied by publisher]

Unmasking herd protection by an oral cholera vaccine in a cluster-randomized trial.

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Unmasking herd protection by an oral cholera vaccine in a cluster-randomized trial.

Int J Epidemiol. 2019 08 01;48(4):1252-1261

Authors: Ali M, Qadri F, Kim DR, Islam T, Im J, Ahmmed F, Chon Y, Islam Khan A, Zaman K, Marks F, Clemens JD

Abstract
BACKGROUND: Several studies have shown that inactivated, whole-cell oral cholera vaccines (OCVs) confer both direct protection on vaccinees and herd protection on populations. Because our earlier cluster-randomized effectiveness trial (CRT) in urban Bangladesh failed to detect OCV herd protection, we reanalysed the trial to assess whether herd effects were masked in our original analysis.
METHODS: A total of 267 270 persons were randomized to 90 approximately equal-sized clusters. In 60 clusters persons aged 1 year and older were eligible to receive OCV and in 30 clusters persons received no intervention and served as controls. We analysed OCV protection against severely dehydrating cholera for the entire clusters, as in our original analysis, and for subclusters consisting of residents of innermost households. We hypothesized that if OCV herd protection was attenuated by cholera transmission into the clusters from the outside in this densely populated setting, herd protection would be most evident in the innermost households.
RESULTS: During 2 years of follow-up of all residents of the clusters, total protection (protection of OCV recipients relative to control residents) was 58% [95% confidence interval (CI): 43%, 70%; P<0.0001], indirect protection (protection of non-OCV recipients in OCV clusters relative to control participants) was 16% (95% CI: -20%, 41%; P=0.35) and overall OCV protection (protection of all residents in the OCV clusters relative to control residents) was 46% (95% CI: 30%, 59%; P<0.0001). Analyses of the inner 75% and 50% households of the clusters showed similar findings. However, total protection was 75% (95% CI: 50%, 87%, P<0.0001), indirect protection 52% (95% CI: -9%, 79%; P=0.08) and overall protection 72% (95% CI: 49%, 84%; P<0.0001) for the innermost 25% households.
CONCLUSION: Consistent with past studies, substantial OCV herd protective effects were identified, but were unmasked only by analysing innermost households of the clusters. Caution is needed in defining clusters for analysis of vaccine herd effects in CRTs of vaccines.

PMID: 30968110 [PubMed - indexed for MEDLINE]

Public health round-up.

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Public health round-up.

Bull World Health Organ. 2019 Dec 01;97(12):793-794

Authors:

PMID: 31819285 [PubMed - indexed for MEDLINE]

Vaccines for Older Travelers.

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Vaccines for Older Travelers.

Interdiscip Top Gerontol Geriatr. 2020;43:158-181

Authors: Jilg W

Abstract
People who travel to countries where they are at risk of contracting specific infections often need specific vaccines. To make correct recommendations in this respect several points have to be considered. The state of health of the traveler should be known as well as his or her destination and travel style. Very important, however, is the age of the traveler. As advancing age leads to changes in the immune system, in older individuals many infections are more severe. On the other hand, most vaccines are less immunogenic in the elderly. In this chapter, we will discuss which vaccines are necessary for older travelers visiting (mainly) tropical and subtropical countries, how these vaccines have to be used, and if perhaps their use has to be altered in older individuals. First, standard vaccinations will be addressed. When the immunization state of the individual is incomplete because certain vaccinations are expired or missing, it has to be updated. Vaccinations against tetanus, diphtheria, influenza, pneumococcal diseases, measles, and poliomyelitis have to be considered in this respect, because the risk of getting infected with these diseases in tropical and subtropical regions or in regions with poor hygienic conditions is often higher or at least the same as in industrialized countries. The second and main part of this chapter contains the typical travel vaccines. We will deal with vaccinations against cholera, hepatitis A and B, Japanese encephalitis, invasive meningococcal diseases, rabies, typhoid fever, and yellow fever. Clinical courses and epidemiology of the different infections are presented. The respective vaccines are discussed in detail, especially their efficiency in older individuals as far as data are available in this respect. Finally, recommendations for their use in older travelers will be given.

PMID: 32305985 [PubMed - as supplied by publisher]

COVID-19: Hygiene and Public Health to the front.

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COVID-19: Hygiene and Public Health to the front.

Acta Biomed. 2020 04 07;91(3-S):7-8

Authors: Signorelli C, Fara GM

Abstract
Public Health professionals and academics have been on the frontline of Italian history during the COVID-19 response like they never did before. Ancient professors of Hygiene such as Celli, Pagliani, Sclavo, Petragnani, Seppilli and Giovanardi flanked politicians in other critical moments. They helped them to manage healthcare reforms, earthquakes response, Seveso Dioxin disaster, cholera and poliomielitis epidemics and other health threats.   The ongoing COVID-19 epidemic has highlighted the paramount importance of the practical application of basic concepts of public health, which were considered so far became obsolete, such as personal hygiene, quarantine, individual protective devices or basic epidemiological measures. Hygiene and Public Health used to have a targeted audience in professionals and lecturers. Nowadays, these topics are critical and of concern of a much larger audience. Public Health women and men are now asked to act in task forces, media broadcasts, webinars and consulting activities.   In phase 2 of this epidemic - which is about to begin when this volume is to be published - the role of Public Health professionals could become even more relevant. However, this unexpected season must be managed with seriousness and intelligence, capitalizing it also for the future. If our Post-Graduate Schools of Public Health ("Igiene e Medicina Preventiva"), our scientific associations, our academic lecturers and our officers do not prove to be up to the situation, a dull future for the discipline might very well be. On the contrary, if as we all hope, we will be able to ride the wave of a dramatic health crisis, transforming it into a relevant scientific and professional opportunity, then we will be able to build on the post-COVID-19 a cutting-edge, a more attractive, relevant and modern discipline. This Supplement of Acta Biomedica, planned before the onset of the epidemic emergency in Italy, but already successful in presenting two papers on COVID-19, is further proof of how current and lively our discipline is.

PMID: 32275261 [PubMed - indexed for MEDLINE]

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