The WHO 2016 verbal autopsy instrument: An international standard suitable for automated analysis by InterVA, InSilicoVA, and Tariff 2.0

Background Verbal autopsy (VA) is a practical method for determining probable causes of death at the population level in places where systems for medical certification of cause of death are weak. VA methods suitable for use in routine settings, such as civil registration and vital statistics (CRVS) systems, have developed rapidly in the last decade. These developments have been part of a growing global momentum to strengthen CRVS systems in low-income countries. With this momentum have come pressure for continued research and development of VA methods and the need for a single standard VA instrument on which multiple automated diagnostic methods can be developed. Methods and findings In 2016, partners harmonized a WHO VA standard instrument that fully incorporates the indicators necessary to run currently available automated diagnostic algorithms. The WHO 2016 VA instrument, together with validated approaches to analyzing VA data, offers countries solutions to improving information about patterns of cause-specific mortality. This VA instrument offers the opportunity to harmonize the automated diagnostic algorithms in the future. Conclusions Despite all improvements in design and technology, VA is only recommended where medical certification of cause of death is not possible. The method can nevertheless provide sufficient information to guide public health priorities in communities in which physician certification of deaths is largely unavailable. The WHO 2016 VA instrument, together with validated approaches to analyzing VA data, offers countries solutions to improving information about patterns of cause-specific mortality.The World Health Organization, Bill & Melinda Gates Foundation, and Bloomberg Philanthropies, under the Data for Health Initiative, funded the technical work and making the work publicly available. NM was partially supported by the World Health Organization under an Agreement of Performance of Work grant number 2015/ 535961 awarded to the Swiss Tropical and Public Health Institute, Basel, Switzerland. SJC was partially supported by the Bill & Melinda Gates Foundation grant number OPP1082114 awarded to the London School of Hygiene & Tropical Medicine, London, UK, with a subcontract to the University of Washington, Seattle, US. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Challenges in measuring measles case fatality ratios in settings without vital registration

Measles, a highly infectious vaccine-preventable viral disease, is potentially fatal. Historically, measles case-fatality ratios (CFRs) have been reported to vary from 0.1% in the developed world to as high as 30% in emergency settings. Estimates of the global burden of mortality from measles, critical to prioritizing measles vaccination among other health interventions, are highly sensitive to the CFR estimates used in modeling; however, due to the lack of reliable, up-to-date data, considerable debate exists as to what CFR estimates are appropriate to use. To determine current measles CFRs in high-burden settings without vital registration we have conducted six retrospective measles mortality studies in such settings. This paper examines the methodological challenges of this work and our solutions to these challenges, including the integration of lessons from retrospective all-cause mortality studies into CFR studies, approaches to laboratory confirmation of outbreaks, and means of obtaining a representative sample of case-patients. Our experiences are relevant to those conducting retrospective CFR studies for measles or other diseases, and to those interested in all-cause mortality studies

Heterotrophic bacteria associated with eggs and larvae of Penaeus indicus in a hatchery system

Abstract only.Total viable aerobic heterotrophic bacteria (THB) associated with egg, nauplius, zoea, mysis and postlarva of Penaeus indicus and seawater in a hatchery system were estimated for three years from 1981 to 1984. The bacterial population varied from 1.3 × 104 to 8.72 × l07/g in egg, 1.5 × 104 to 6.17 × 107/g in nauplius, 4 × 103 to 3.14 × 107/g in zoea, 1.35 × 106 to 1.25 × 108/g in mysis, 1.6 × 105 to 8.44 × 106/g in postlarva. Water contained a THB population of 1.2 X 105 to 2.8 × 108/100 ml. Species of Vibrio, Pseudomonas, Aeromonas, Acineto-bacter, Moraxella, members of the family Enterobac-teriaceae, Micrococcus, Bacillus, and Coryneform group were encountered. Gram-negative bacteria were found to be dominant in all stages and showed an increase from egg (81.3%) to postlarva (92.7%). However such an increase was not recorded in the respective water samples even though gram-negative bacteria were found to be dominant. Vibrio spp. were found in high numbers in postlarvae and it was to be increasing from egg (10.4%) to postlarva (80%). The number of larvae in culture pools gradually declined as the nauplii metamorphosed to postlarvae through zoea and mysis. In general, coincidence of higher percentage of Vibrio spp. and larval mortality was recorded. Physico-chemical factors such as salinity, temperature, pH, oxygen, inorganic phosphorus, organic phosphorus, inorganic nitrogen and organic nitrogen of water did not show much variation in the same set of pools. Relationship between the physico-chemical parameters, bacterial population and the number of larvae is discussed