Conflict And Vaccine-Preventable Disease In Children Under Five In The Eastern Mediterranean Region: A Systematic Review

Background: Conflict is one of the main reasons for our failure to reach worldwide immunization targets. An objective of 90% immunization coverage is included in the fourth Millennium Development Goal to reduce under-five mortality by two thirds, which is still far from achieved in the conflict-ridden Eastern Mediterranean Region (EMR). Despite global progress, vaccine-preventable deaths still account for 20% of childhood mortality under five years of age in the EMR, and communicable disease a third of all mortality. Conflict remains a critical root cause of low vaccination coverage in the EMR, resulting in high levels of vaccine-preventable disease, disability, and death. Research Question: The aim of this review is to assess the impact of conflict on vaccine-preventable disease vaccination coverage and outcomes in children under five in the Eastern Mediterranean Region. While international attention is drawn to outbreaks of polio and measles, several other easily avoidable infections are also responsible for high rates of morbidity and mortality, especially in children. This review will give a more holistic view on the burden of vaccine-preventable disease associated with conflict, as well as identify gaps in our current knowledge and explore common factors in prevention of immunization uptake. Methods: This systematic review was performed using the PRISMA guidelines. Search terms related to conflict, the EMR, vaccines in the WHO Expanded Programme for Immunization (EPI) package, and children were entered into MEDLINE, Embase, Global Health, and Cochrane. Eighty seven unique articles were identified, and after an abstract and full text review and a forward search, 26 were retained for data extraction and analysis. Results: Results were distributed between four different countries of origin (Afghanistan, Pakistan, Somalia, and Sudan), five different countries of study (Afghanistan, Pakistan, Sudan, Somalia, and Kenya), and six out of ten diseases in the EPI (poliovirus, measles, hepatitis B, tetanus, diphtheria, and pertussis). The majority of results addressed poliovirus (n=16) and measles (n=9). Outcomes, vaccination coverage, and barriers to vaccination was analyzed according to disease. Conclusions: There is a large gap of knowledge regarding vaccine-preventable diseases in children under five in conflict-affected areas of the Eastern Mediterranean Region. Understanding the prevalence, mortality, and barriers to vaccination involved in these challenging environments will help us reach the WHO goals of 90% vaccination coverage and reduce worldwide childhood mortality

Senior Recital: Zoe Adams and Alexandra Prow, mezzo-sopranos

https://digitalwindow.vassar.edu/musi_senior/1024/thumbnail.jp

Parents' Perceptions of School Transitions for Children with Exceptionalities: Four Mothers' Stories

The purpose of the present study was to explore the perceptions of parents of children with exceptionalities, transitioning from the community to formal school environments, learn more about current transition practices in Canada, and begin exploring potential areas for improvement. The present study employed a basic qualitative, interpretative research design using semi-structured interviews to discover parent perspectives of the barriers to effective transitions, and important factors that contribute to the success of transitions. The Ecological and Dynamic Model of Transition (Rimm-Kaufman & Pianta, 2000) supported the analyses of the data generated from the interviews. There were four major themes that emerged from the interview data. The first theme, Same Parent, New Role: Processing Emotional Responses and Balancing Increased Expectations During Transitions described the stress, frustration, isolation and barriers experienced by the parents during the transition process. This theme also highlighted the new and often daily challenges for the parents’ at home, school and in the community. Theme two, Unmet Needs, Ability To Thrive: Supporting Children with Exceptionalities focused on the child-specific experiences and how the parents’ supported their children in managing the difficulties of meeting the expectations of the formal school environment. The third theme, New Relationships, Limited Resources: Navigating The Formal School Environment centralized on the parents’ perceptions of schools, teachers and support teams. In this theme parents commented on the complexities of establishing new relationships with school staff that are collaborative, supportive and communicative. Finally, theme four, Financial Burdens Emotional Toll: Transitioning From Early Childhood Settings to Formal School, focused on both the challenges of accessing and the benefits of securing professional resources and services external to the school. The parents discussed the limitations of school resources and the unexpected need to locate and pay for or attain funding for additional supports. However, despite the many challenges that the participants within the current study faced, they all reported instances in which they were able to move forward, continue pursuing the needs of their child, adapt and adjust when faced with setbacks, and still reported benefits they would expect to see if change were made to current transition practices

Progress, Challenges And Opportunities In Fish Vaccine Development

In 2014 the contribution of aquaculture to supply food for human consumption overtook wild-caught fish for the first time. Despite improvements in the aquaculture industry, it has been estimated that as much as 10% of all cultured aquatic animals are lost because of infectious diseases, amounting to >10 billion USD in losses annually on a global scale. Vaccination to prevent disease is used routinely in finfish aquaculture, especially for Atlantic salmon (Salmo salar), while in a limited capacity (or not at all) in many other fish species due to lack of vaccines, poor performance or cost. There has, nevertheless, been impressive progress in fish vaccine development over the last 4 decades with 24 licenced fish vaccines now commercially available for use in a variety of fish species. These comprise whole killed, peptide subunit, recombinant protein, DNA and live attenuated vaccines. Challenges do, however, still exist as the majority of commercial vaccines are killed whole cell pathogen preparations administered by intraperitoneal injection. This may not be the optimal route to deliver some vaccines, but lack of effective adjuvants and basic knowledge on immune response has hindered progress in the development of mucosal vaccines. The cost of injecting fish may also be prohibitive in some countries leading to disease treatment (e.g. with antibiotics) rather than using preventative measures. It is important that these issues are addressed as the industry continues to grow globally. Exciting opportunities exist for rapid development of fish vaccines in the future, with continued reduction in cost of technologies (e.g. of whole genome sequencing), regulations changing (e.g. DNA vaccines can now authorised in Europe), the introduction of novel antigen expression and delivery systems (such as virus-like particles, VLPs), development of novel adjuvants and advancements in the elucidation of basic mechanisms of mucosal immunity. Development of effective mucosal vaccines and optimisation of their delivery will facilitate novel vaccine development, and enable the aquaculture industries in LMIC to use vaccination routinely in the future. In addition, effective use of emergency (autogenous) vaccines will assist in tackling emerging disease challenges

Comparative evaluation of Polymerase Chain Reaction - Restriction Enzyme Analysis (PRA) and Sequencing of Heat shock protein 65 (hsp65) gene for identification of aquatic mycobacteria

Traditional identification of mycobacteria based on cultural and biochemical tests can take several weeks and may fail to provide a precise identification. Polymerase Chain Reaction-restriction analysis (PRA) of the gene encoding heat shock protein 65kDA (hsp65) gene has been proposed as a rapid and inexpensive alternative approach. Despite being widely used for differentiation of mammalian mycobacteria, this method has only been applied in the identification of a small number of aquatic mycobacteria. The present study aimed to evaluate the potential use of PRA of hsp65 for the identification of aquatic mycobacteria compared with sequence analysis. Seventy one mycobaterial isolates including, 10 type/reference strains and the remainder field isolates, were subjected to PRA of a 441 bp fragment of this gene. For 68 representative isolates, sequence analysis was performed. All rapidly and slow growing mycobacteria had best matches with 99.3% to 100% similarity with their corresponding species in the databanks. PRA proved to be a simple and rapid method for identifying aquatic mycobacteria. However, the incidence of similar or identical restriction patterns for some species of mycobacteria, and in particular, identification of new species of mycobacteria is a major problem using such a method. In contrast, the nucleic acid sequencing of the hsp65 gene yielded unambiguous results

Immunostaining of spores and plasmodia of disparate myxozoan genera with comments on the properties of the sporular mucus envelope

Species of the phylum Myxozoa are common parasites of fish and can cause severe losses in cultured species. Although a number of myxozoan life-cycles have now been elucidated, little is known about the biology of these organisms in the fish host. Monoclonal antibody B4 raised to the myxozoan Tetracapsuloides bryosalmonae has been previously noted to react with a number of species infecting fish kidney. We present the results of a survey of 55 myxosporean species that determined that this antibody detects an antigen on the spore surface of 33 of these species in the genera Myxobolus, Sphaerospora and Thelohanellus. However, there appears to be no clear relationship between those spores that contain the MAb B4 reactive antigen and the host or organ in which they are detected. The antigen appears to be synthesized in the plasmodial cytoplasm and is intimately associated with the surface of the spore capsules and, where present, the mucus envelope. The nature of this envelope is further discussed in relation to its formation and distinctive properties

The Effect of Visual Feedback on Lumbar Spinal Mobility in Subjects with Low Back Pain

Purpose: This study was designed to determine if visual feedback via a laser pointer would enhance quality of lumbar mobility exercise in quadruped. A secondary aim of this study was to compare mobility assessed using the valid and reliable Modified-Modified Schober Test (MMST) to mobility measured indirectly using the laser pointer. Subjects: 69 Methods: Adult participants with no low back pain (LBP) in the previous year or back surgery were randomly assigned to one of three groups for two sessions: Control (blindfolded during both), Intervention A (blindfolded then visual feedback), or Intervention B (visual feedback then blindfolded). Baseline standing lumbar flexion was assessed, then each participant assumed quadruped over a longitudinally oriented 44-inch floor grid while wearing a laser pointer attached to a waist belt. Participants performed alternating quadruped lumbar flexion (QLF) and extension (QLE), with each session \u3e48hrs apart. Visual feedback was provided via laser pointer. All attempts were video recorded. Results: Training using a laser pointer did not have a significant impact on lumbar excursion in quadruped (p = .106, p = .681, respectively). Mobility scores remained consistent for the control (p = .823) and intervention groups (p = .124). A moderate-to-strong correlation (r = .638) was found between MMST values and the average QLF. Conclusions: Visual feedback training using a laser transit was ineffective at increasing lumbar mobility. MMST flexion values were moderately correlated with QLF performance, suggesting the laser light transit shows potential to be used as a means of quantifying lumbar flexion range of motion

Persistence of Renibacterium salmoninarum in experimentally infected rainbow trout (Oncorhynchus mykiss)

The persistence of Renibacterium salmoninarum (Rs) in rainbow trout (Oncorhynchus mykiss) experimentally infected with either a virulent or non-virulent strain of Rs was examined in this study. Mortalities from bacterial kidney disease (BKD) peaked at 48 % 6 weeks post-challenge with the virulent strain, but no mortality from BKD occurred in fish infected with the avirulent strain. Culture on Selective Kidney Disease Medium (SKDM), a polymerase chain reaction (PCR) and an enzyme linked immunosorbent assay (ELISA) were used to monitor the duration of the infection. The presence of bacteria in challenged fish could be detected by PCR at 12 and 20 weeks post-challenge with non-virulent and virulent strains, respectively. On the other hand, it was only possible to detect Rs NCIMB 1113 by ELISA and by culture on SKDM up to 10 weeks and 12 weeks, respectively. Furthermore, the avirulent isolate was not detected in fish injected with this strain on SKDM or by ELISA. Using the methods of detection described, it would appear that the fish were able to clear the virulent Rs by week 22 post-challenge