Factors Associated with Missed Vaccination during Mass Immunization Campaigns

Achieving a high percentage of vaccination coverage with polio vaccine, while necessary, is not sufficient to eliminate or eradicate polio. The existence of pockets of under-vaccinated children has allowed outbreaks of polio in countries that have achieved high levels of vaccination coverage and in countries with no cases for many years. In a literature review, 35 articles were identified that described factors associated with missed vaccination in mass immunization campaigns. An annotated bibliography was developed for each article; these were then coded using the AnSWR program, and codes were organized into three larger thematic categories. These thematic areas were: (a) organization and implementation of mass campaigns; (b) population characteristics; and (c) knowledge and practices of caretakers. If these factors were geographically clustered, it was suspected that these clusters might have higher likelihood of becoming pockets of unvaccinated children. Immunization programme managers can target resources to identify if such clusters exist. If so, they can then ensure supervision of vaccination efforts in those sites and take further action, if indicated, to prevent or mitigate pockets of unvaccinated children

Evaluating the Experience of GAPS—A Methodology for Improving Quality of Mass Immunization Campaigns in Developing Countries

The existence of pockets of under-vaccinated persons has allowed outbreaks of disease in countries that have achieved high levels of vaccination coverage. A field-based methodology—GAPS (Geographic Assessment of Planning and Services)—was developed to predict, in advance of an immunization campaign, the sites of which are most likely to have a pocket of unvaccinated persons and then use this information to improve planning, supervision, and evaluation of the campaign. At this time, there have been two applications of GAPS (Nepal and Ethiopia). The purpose of this paper was to evaluate these two applications of GAPS and make recommendations regarding its future use. Structured, expert interviews were conducted with at least three campaign organizers to evaluate each application of GAPS using purposive sampling. An evaluation of an individual campaign was considered positive when at least two of the three campaign organizers considered GAPS to be useful and worthwhile. The three campaign organizers interviewed following the GAPS application in Ethiopia responded that GAPS was useful and worth the effort. In Nepal, all four campaign organizers responded that GAPS was useful and worth the effort. Some suggestions for improvement were also identified. Although this evaluation was limited in the number of applications evaluated, GAPS appears to have promise as a practical method to help improve the quality of mass immunization campaigns. And even if no pockets of unvaccinated persons are found, the method may serve as a rapid quality-check of administrative estimates of coverage. Further applications in different settings are needed to confirm these findings or under what circumstances GAPS might best be used. GAPS may also be considered for improving other types of health campaigns, such as distribution of insecticide-treated bednets, vitamin A capsules, and deworming medications

Falcon Research in Greenland, 1973

... During the summer of 1972 a research team initiated the first in-depth study of the peregrine falcon (Falco peregrinus) in West Greenland. Eight eyries (nests) of this endangered species were located in an inland sample area of 700 sq. mi. Detailed observations were taken of peregrine breeding behaviour at one eyrie. Seven of the eyries produced young, containing an average of 2.57 young per successful eyrie. This high reproductive rate indicates a healthy population, but analyses of 2 addled eggs revealed high p,p'-DDE as well as polychlorinated biphenyl (PCB) residues and eggshell fragments from 9 eggs showed a 14 per cent decrease in thickness compared with 42 eggs collected in Greenland before the introduction of DDT into the environment. ... The [1973] survey area consisted of 900 sq. mi. (2,330 sq. km.), including ice-cap, lakes, fjords, and other unsuitable habitat totalling about 150 sq. mi. (388 sq. km.). We found 10 occupied peregrine falcon nesting cliffs in the survey area in 1973. ... 9 eyries produced young. Of these 9, 7 were also successful in 1972, while another was occupied throughout the season by an aggressive pair, and at the ninth a lone female mildly defended the cliff. Of the 9 producing eyries in 1973, 1 contained 4 young, 5 contained 3 young each, 2 had 2 young each, and 1 held 1 young. This gives a total of 24 young peregrines and a production rate of 2.4 young per occupied eyrie, or 2.67 young per successful eyrie. These young were counted at advanced ages varying from 2.5 weeks to just before fledging. It is believed that all or almost all fledged. We found 1 occupied eyrie per 90 sq. mi. (233 sq. km.), or 1 successful eyrie per 100 sq. mi. (260 sq. km.). All young were banded with a metal band on the left tarsus and a red plastic band on the right. ... The colour bands signify the beginning of an international peregrine colour banding system established for quick geographical identification of banding locality. During the 2 summers, 9 gyrfalcon nesting cliffs were located in the survey area. We believe that at least 6 of the 9 locations were occupied in 1972. In 1973, 8 of the 9 cliffs were checked. Young were found at 4 sites. A fifth was observed from an aircraft and appeared to be active. Lone adults were observed at 2 other locations. Seven young gyrfalcons were banded out of 10 young found. One nest site was inaccessible and the young were not banded, accounting for the difference in number located and banded. The production rate per producing pair of gyrfalcons was 2.50 young. ... Our sample survey indicates that in 1973, as in 1972, the peregrine falcon reproduced normally in West Greenland. The slightly higher production rate in 1973 can possibly be attributed to warmer temperatures during the nesting period, as the summer of 1972 was unseasonably cool. However, the 1972 data on eggshell thinning and high DDE and PCB residues reveal that this population is precariously balanced, and severe reproductive failure threatens. Analysis of the 1973 addled egg and measurement of the additional eggshell fragments will supplement the 1972 results to provide a larger data base. ..

Peregrine Falcon Survey, West Greenland, 1972

... The main purpose of the 1972 survey was to study a sample area of West Greenland to supply baseline data about peregrine falcons from which future surveys could determine the status and trends of this bird in Greenland. The main part of the study had as its goals: 1) to determine the density, distribution, and reproductive success of nesting peregrines in a sample area; 2) to band all peregrine nestlings found; 3) to determine prey species of the peregrine; 4) to make interspecific observations of peregrines and gyrfalcons; 5) to make detailed observations from a blind of a sample peregrine falcon eyrie; 6) to conduct a small-bird census in the area of the sample eyrie; 7) to make a photographic record in colour slides and movies of the investigations. ... Eight peregrine falcon eyries and 3 gyrfalcon eyries were found in the survey area. In all, 18 nestlings were found in the 8 peregrine eyries. Of the 8 eyries, 1 had no young, but showed signs of occupancy ... and was defended by an aggressive pair of falcons. Of the other 7 eyries where we found hatched young, 1 had 4 young, 4 had 3 young, and 2 had 1 young bird each. Of the total of 18 nestling peregrines, 13 were banded and 5 were fully-fledged, on the wing, and unable to be caught for banding. Of the peregrine nestlings banded, 9 were males and 4 were females. The number of nestlings (18) in the 8 peregrine eyries gave a production rate of 2.25 per eyrie, or 2.57 if an average is taken of the 7 eyries actually producing young. At 1 eyrie a young falcon was found dead (the eyrie with 4 young). We know that at least 8 of the remaining 17 young fledged successfully, but we are uncertain about the success of the others and cannot therefore make a definite statement on fledging ratio. We estimate, however, that the fledging rate of the peregrines in our survey area was at least 2.00 per producing eyrie. The maximum dimensions of our irregularly-shaped survey area were 39 x 34 miles (63 x 55 km). The estimated area of the survey was about 800 sq. mi. (2,072 sq. km), or about 700 sq. mi. (1,800 sq. km) when the surface area of fiords and lakes is excluded. The nesting density of the active, young-producing peregrine eyries (7) was about 1 pair per 100 sq. mi. (260 sq. km). ... At the 3 gyrfalcon (Falco rusticolus) eyries we found 8 nestlings or fully-fledged young, of which we were able to band 3. Peregrines and gyrfalcons (and a rare white-tailed sea eagle, Haliaetus albicilla) are the only avian predators nesting in southern West Greenland, although ravens (Corvus corax) competed for some nesting cliff sites. We collected remains of prey species and pellets at each falcon eyrie. Addled eggs (2) from 2 peregrine eyries were collected for pesticide analysis. Eggshell fragments for thickness determination were gathered at 5 peregrine eyries. ... Peregrine falcons in West Greenland appear to be in a healthy state as evidenced by a high nesting density (1/100 sq. mi.) and a high production rate (2.25/eyrie), especially in light of the unusually severe conditions in West Greenland during the winter and late spring of 1971-72. We found little interspecific competition for prey species between peregrines and gyrfalcons. The gyrfalcon is already nesting in West Greenland before the peregrines arrive from their winter migration to the south. The gyrfalcons could therefore be expected to be aggressive in defence of their nesting cliffs and thereby occupy optimal cliffs. Despite this, all the peregrines we studied occupied high, sheer, and quite optimal nesting cliffs. Gyrfalcons seemed to prefer a nesting site lower down on a cliff face than peregrines, and both falcons preferred high, sheer cliffs with a southern exposure. Ravens were relegated to lower, less desirable (more accessible) cliffs for nesting. We await pesticide analysis of the peregrine falcon eggs and prey species collected, as well as eggshell thickness determination. Before these facts are determined we can say nothing definite about the status of peregrines in Greenland. Nesting density and production, however, suggest that the status of the peregrine is better in Greenland than in other areas of the north. ..

Carbenoxolone does not cross the blood brain barrier: an HPLC study

BACKGROUND: Carbenoxolone (CBX) is a widely used gap junctional blocker. Considering several reports indicating that transient gap junctional blockade could be a favourable intervention following injuries to central nervous tissue, and some current enthusiasm in studies using systemic injections of CBX, it is imperative to consider the penetration of CBX into central nervous tissue after systemic administrations. So far, only very indirect evidence suggests that CBX penetrates into the central nervous system after systemic administrations. We thus determined the amounts of CBX present in the blood and the cerebrospinal fluid of rats after intraperitoneal administration, using high performance liquid chromatography RESULTS: CBX was found in the blood of the animals, up to 90 minutes post-injection. However, the cerebrospinal fluid concentration of CBX was negligible. CONCLUSION: Thus, we conclude that, most likely, CBX does not penetrate the blood brain barrier and therefore recommend careful consideration in the manner of administration, when a central effect is desired

Factors Associated with Missed Vaccination during Mass Immunization Campaigns

Achieving a high percentage of vaccination coverage with polio vaccine, while necessary, is not sufficient to eliminate or eradicate polio. The existence of pockets of under-vaccinated children has allowed outbreaks of polio in countries that have achieved high levels of vaccination coverage and in countries with no cases for many years. In a literature review, 35 articles were identified that described factors associated with missed vaccination in mass immunization campaigns. An annotated bibliography was developed for each article; these were then coded using the AnSWR program, and codes were organized into three larger thematic categories. These thematic areas were: (a) organization and implementation of mass campaigns; (b) population characteristics; and (c) knowledge and practices of caretakers. If these factors were geographically clustered, it was suspected that these clusters might have higher likelihood of becoming pockets of unvaccinated children. Immunization programme managers can target resources to identify if such clusters exist. If so, they can then ensure supervision of vaccination efforts in those sites and take further action, if indicated, to prevent or mitigate pockets of unvaccinated children

Evaluating the Experience of GAPS\u2014A Methodology for Improving Quality of Mass Immunization Campaigns in Developing Countries

The existence of pockets of under-vaccinated persons has allowed outbreaks of disease in countries that have achieved high levels of vaccination coverage. A field-based methodology\u2014GAPS (Geographic Assessment of Planning and Services)\u2014was developed to predict, in advance of an immunization campaign, the sites of which are most likely to have a pocket of unvaccinated persons and then use this information to improve planning, supervision, and evaluation of the campaign. At this time, there have been two applications of GAPS (Nepal and Ethiopia). The purpose of this paper was to evaluate these two applications of GAPS and make recommendations regarding its future use. Structured, expert interviews were conducted with at least three campaign organizers to evaluate each application of GAPS using purposive sampling. An evaluation of an individual campaign was considered positive when at least two of the three campaign organizers considered GAPS to be useful and worthwhile. The three campaign organizers interviewed following the GAPS application in Ethiopia responded that GAPS was useful and worth the effort. In Nepal, all four campaign organizers responded that GAPS was useful and worth the effort. Some suggestions for improvement were also identified. Although this evaluation was limited in the number of applications evaluated, GAPS appears to have promise as a practical method to help improve the quality of mass immunization campaigns. And even if no pockets of unvaccinated persons are found, the method may serve as a rapid quality-check of administrative estimates of coverage. Further applications in different settings are needed to confirm these findings or under what circumstances GAPS might best be used. GAPS may also be considered for improving other types of health campaigns, such as distribution of insecticide-treated bednets, vitamin A capsules, and deworming medications

Improving Characterization of Understudied Human Microbiomes Using Targeted Phylogenetics.

Whole-genome bacterial sequences are required to better understand microbial functions, niche-specific bacterial metabolism, and disease states. Although genomic sequences are available for many of the human-associated bacteria from commonly tested body habitats (e.g., feces), as few as 13% of bacterium-derived reads from other sites such as the skin map to known bacterial genomes. To facilitate a better characterization of metagenomic shotgun reads from underrepresented body sites, we collected over 10,000 bacterial isolates originating from 14 human body habitats, identified novel taxonomic groups based on full-length 16S rRNA gene sequences, clustered the sequences to ensure that no individual taxonomic group was overselected for sequencing, prioritized bacteria from underrepresented body sites (such as skin and respiratory and urinary tracts), and sequenced and assembled genomes for 665 new bacterial strains. Here, we show that addition of these genomes improved read mapping rates of Human Microbiome Project (HMP) metagenomic samples by nearly 30% for the previously underrepresented phylum Fusobacteria, and 27.5% of the novel genomes generated here had high representation in at least one of the tested HMP samples, compared to 12.5% of the sequences in the public databases, indicating an enrichment of useful novel genomic sequences resulting from the prioritization procedure. As our understanding of the human microbiome continues to improve and to enter the realm of therapy developments, targeted approaches such as this to improve genomic databases will increase in importance from both an academic and a clinical perspective.IMPORTANCE The human microbiome plays a critically important role in health and disease, but current understanding of the mechanisms underlying the interactions between the varying microbiome and the different host environments is lacking. Having access to a database of fully sequenced bacterial genomes provides invaluable insights into microbial functions, but currently sequenced genomes for the human microbiome have largely come from a limited number of body sites (primarily feces), while other sites such as the skin, respiratory tract, and urinary tract are underrepresented, resulting in as little as 13% of bacterium-derived reads mapping to known bacterial genomes. Here, we sequenced and assembled 665 new bacterial genomes, prioritized from a larger database to select underrepresented body sites and bacterial taxa in the existing databases. As a result, we substantially improve mapping rates for samples from the Human Microbiome Project and provide an important contribution to human bacterial genomic databases for future studies

Using geographically weighted regression to explore the spatially heterogeneous spread of bovine tuberculosis in England and Wales

An understanding of the factors that affect the spread of endemic bovine tuberculosis (bTB) is critical for the development of measures to stop and reverse this spread. Analyses of spatial data need to account for the inherent spatial heterogeneity within the data, or else spatial autocorrelation can lead to an overestimate of the significance of variables. This study used three methods of analysis—least-squares linear regression with a spatial autocorrelation term, geographically weighted regression (GWR) and boosted regression tree (BRT) analysis—to identify the factors that influence the spread of endemic bTB at a local level in England and Wales. The linear regression and GWR methods demonstrated the importance of accounting for spatial differences in risk factors for bTB, and showed some consistency in the identification of certain factors related to flooding, disease history and the presence of multiple genotypes of bTB. This is the first attempt to explore the factors associated with the spread of endemic bTB in England and Wales using GWR. This technique improves on least-squares linear regression approaches by identifying regional differences in the factors associated with bTB spread. However, interpretation of these complex regional differences is difficult and the approach does not lend itself to predictive models which are likely to be of more value to policy makers. Methods such as BRT may be more suited to such a task. Here we have demonstrated that GWR and BRT can produce comparable outputs