Invasive bacterial disease trends and characterization of group B streptococcal isolates among young infants in southern Mozambique, 2001-2015

BACKGROUND: Maternal group B streptococcal (GBS) vaccines under development hold promise to prevent GBS disease in young infants. Sub-Saharan Africa has the highest estimated disease burden, although data on incidence and circulating strains are limited. We described invasive bacterial disease (IBD) trends among infants <90 days in rural Mozambique during 2001-2015, with a focus on GBS epidemiology and strain characteristics. METHODS: Community-level birth and mortality data were obtained from Manhica's demographic surveillance system. IBD cases were captured through ongoing surveillance at Manhica district hospital. Stored GBS isolates from cases underwent serotyping by multiplex PCR, antimicrobial susceptibility testing, and whole genome sequencing. RESULTS: There were 437 IBD cases, including 57 GBS cases. Significant declines in overall IBD, neonatal mortality, and stillbirth rates were observed (P<0.0001), but not for GBS (P = 0.17). In 2015, GBS was the leading cause of young infant IBD (2.7 per 1,000 live births). Among 35 GBS isolates available for testing, 31 (88.6%) were highly related serotype III isolates within multilocus sequence types (STs) 17 (68.6%) or 109 (20.0%). All seven ST109 isolates (21.9%) had elevated minimum inhibitory concentration (MIC) to penicillin (>/=0.12 mug/mL) associated with penicillin-binding protein (PBP) 2x substitution G398A. Epidemiologic and molecular data suggest this is a well-established clone. CONCLUSION: A notable young infant GBS disease burden persisted despite improvements in overall maternal and neonatal health. We report an established strain with pbp2x point mutation, a first-step mutation associated with reduced penicillin susceptibility within a well-known virulent lineage in rural Mozambique. Our findings further underscores the need for non-antibiotic GBS prevention strategies

Metodología WebML aplicada a un sistema de gestión de calidad en centros de investigación

Este trabajo presenta los resultados obtenidos, producto de la aplicación de la línea de investigación sobre sistemas de gestión de calidad (SGC) en la Universidad Nacional de Salta, sobre al estudio de la familia de Normas ISO aplicadas a Instituciones Educativas, en particular al Centro de Investigación y Desarrollo en Informática Aplicada (C.I.D.I.A.), dependiente de la Facultad de Ciencias Exactas. Todos los actores participantes del centro de investigación, tales como alumnos, docentes, personal de apoyo administrativo, investigadores, etc. persiguen como objetivo lograr la calidad en la educación, acorde a los requisitos legales y académicos establecidos por la institución. Para lograr este objetivo es necesario adoptar un modelo internacional de gestión de la calidad, en este caso se eligió a la familia de Normas ISO 9.001, el cual es un modelo que plantea un conjunto de criterios y elementos estandarizados cuya aplicación, evaluación y seguimiento busca facilitar el éxito de la gestión de calidad, aplicada a la institución. Las entidades educativas, y en particular los centros de investigación, no son ajenas a esta tendencia, tanto es así que el Instituto Argentino de Normalización (IRAM), a través del Comité General de Aseguramiento de la Calidad, diseñó en marzo de 2001 “La Guía de Interpretación de la Norma ISO 9001 para la Educación” con el objetivo de proveer lineamientos de cómo comprender e implementar la norma ISO 9.001 en el ámbito de la educación. Esta investigación se plantea estudiar las directrices que guían a los centros de investigación que presten servicio de capacitación y formación en todos los niveles, en cuanto a la implementación de un sistema de gestión de calidad (SGC) eficaz que cumpla los requisitos de la norma ISO 9001:2008). Como una segunda instancia se plantea el análisis, diseño e implementación de un prototipo funcional de un sistema de gestión de calidad (SGC) para el Centro de Investigación y Desarrollo en Informática Aplicada (C.I.D.I.A.), utilizando como metodología Web Modeling Lenguage (WebML), aplicando la herramienta CASE WebRatio. Se pretende que esta investigación sirva de referencia para cualquier implementación de calidad, dentro del ámbito educativo, y en especial en los centros de investigación.Eje: Ingeniería de SoftwareRed de Universidades con Carreras en Informática (RedUNCI

Metodología WebML aplicada a un sistema de gestión de calidad en centros de investigación

Este trabajo presenta los resultados obtenidos, producto de la aplicación de la línea de investigación sobre sistemas de gestión de calidad (SGC) en la Universidad Nacional de Salta, sobre al estudio de la familia de Normas ISO aplicadas a Instituciones Educativas, en particular al Centro de Investigación y Desarrollo en Informática Aplicada (C.I.D.I.A.), dependiente de la Facultad de Ciencias Exactas. Todos los actores participantes del centro de investigación, tales como alumnos, docentes, personal de apoyo administrativo, investigadores, etc. persiguen como objetivo lograr la calidad en la educación, acorde a los requisitos legales y académicos establecidos por la institución. Para lograr este objetivo es necesario adoptar un modelo internacional de gestión de la calidad, en este caso se eligió a la familia de Normas ISO 9.001, el cual es un modelo que plantea un conjunto de criterios y elementos estandarizados cuya aplicación, evaluación y seguimiento busca facilitar el éxito de la gestión de calidad, aplicada a la institución. Las entidades educativas, y en particular los centros de investigación, no son ajenas a esta tendencia, tanto es así que el Instituto Argentino de Normalización (IRAM), a través del Comité General de Aseguramiento de la Calidad, diseñó en marzo de 2001 “La Guía de Interpretación de la Norma ISO 9001 para la Educación” con el objetivo de proveer lineamientos de cómo comprender e implementar la norma ISO 9.001 en el ámbito de la educación. Esta investigación se plantea estudiar las directrices que guían a los centros de investigación que presten servicio de capacitación y formación en todos los niveles, en cuanto a la implementación de un sistema de gestión de calidad (SGC) eficaz que cumpla los requisitos de la norma ISO 9001:2008). Como una segunda instancia se plantea el análisis, diseño e implementación de un prototipo funcional de un sistema de gestión de calidad (SGC) para el Centro de Investigación y Desarrollo en Informática Aplicada (C.I.D.I.A.), utilizando como metodología Web Modeling Lenguage (WebML), aplicando la herramienta CASE WebRatio. Se pretende que esta investigación sirva de referencia para cualquier implementación de calidad, dentro del ámbito educativo, y en especial en los centros de investigación.Eje: Ingeniería de SoftwareRed de Universidades con Carreras en Informática (RedUNCI

Metodología WebML aplicada a un sistema de gestión de calidad en centros de investigación

Este trabajo presenta los resultados obtenidos, producto de la aplicación de la línea de investigación sobre sistemas de gestión de calidad (SGC) en la Universidad Nacional de Salta, sobre al estudio de la familia de Normas ISO aplicadas a Instituciones Educativas, en particular al Centro de Investigación y Desarrollo en Informática Aplicada (C.I.D.I.A.), dependiente de la Facultad de Ciencias Exactas. Todos los actores participantes del centro de investigación, tales como alumnos, docentes, personal de apoyo administrativo, investigadores, etc. persiguen como objetivo lograr la calidad en la educación, acorde a los requisitos legales y académicos establecidos por la institución. Para lograr este objetivo es necesario adoptar un modelo internacional de gestión de la calidad, en este caso se eligió a la familia de Normas ISO 9.001, el cual es un modelo que plantea un conjunto de criterios y elementos estandarizados cuya aplicación, evaluación y seguimiento busca facilitar el éxito de la gestión de calidad, aplicada a la institución. Las entidades educativas, y en particular los centros de investigación, no son ajenas a esta tendencia, tanto es así que el Instituto Argentino de Normalización (IRAM), a través del Comité General de Aseguramiento de la Calidad, diseñó en marzo de 2001 “La Guía de Interpretación de la Norma ISO 9001 para la Educación” con el objetivo de proveer lineamientos de cómo comprender e implementar la norma ISO 9.001 en el ámbito de la educación. Esta investigación se plantea estudiar las directrices que guían a los centros de investigación que presten servicio de capacitación y formación en todos los niveles, en cuanto a la implementación de un sistema de gestión de calidad (SGC) eficaz que cumpla los requisitos de la norma ISO 9001:2008). Como una segunda instancia se plantea el análisis, diseño e implementación de un prototipo funcional de un sistema de gestión de calidad (SGC) para el Centro de Investigación y Desarrollo en Informática Aplicada (C.I.D.I.A.), utilizando como metodología Web Modeling Lenguage (WebML), aplicando la herramienta CASE WebRatio. Se pretende que esta investigación sirva de referencia para cualquier implementación de calidad, dentro del ámbito educativo, y en especial en los centros de investigación.Eje: Ingeniería de SoftwareRed de Universidades con Carreras en Informática (RedUNCI

A comparison of all-cause and cause-specific mortality by household socioeconomic status across seven INDEPTH network health and demographic surveillance systems in sub-Saharan Africa

Background: Understanding socioeconomic disparities in all-cause and cause-specific mortality can help inform prevention and treatment strategies. Objectives: To quantify cause-specific mortality rates by socioeconomic status across seven health and demographic surveillance systems (HDSS) in five countries (Ethiopia, Kenya, Malawi, Mozambique, and Nigeria) in the INDEPTH Network in sub-Saharan Africa. Methods: We linked demographic residence data with household survey data containing living standards and education information we used to create a poverty index. Person-years lived and deaths between 2003 and 2016 (periods varied by HDSS) were stratified in each HDSS by age, sex, year, and number of deprivations on the poverty index (0–8). Causes of death were assigned to each death using the InterVA-4 model based on responses to verbal autopsy questionnaires. We estimated rate ratios between socioeconomic groups (2–4 and 5–8 deprivations on our poverty index compared to 0–2 deprivations) for specific causes of death and calculated life expectancy for the deprivation groups. Results: Our pooled data contained almost 3.5 million person-years of observation and 25,038 deaths. All-cause mortality rates were higher among people in households with 5–8 deprivations on our poverty index compared to 0–2 deprivations, controlling for age, sex, and year (rate ratios ranged 1.42 to 2.06 across HDSS sites). The poorest group had consistently higher death rates in communicable, maternal, neonatal, and nutritional conditions (rate ratios ranged 1.34–4.05) and for non-communicable diseases in several sites (1.14–1.93). The disparities in mortality between 5–8 deprivation groups and 0–2 deprivation groups led to lower life expectancy in the higher-deprivation groups by six years in all sites and more than 10 years in five sites. Conclusions: We show large disparities in mortality on the basis of socioeconomic status across seven HDSS in sub-Saharan Africa due to disparities in communicable disease mortality and from non-communicable diseases in some sites. Life expectancy gaps between socioeconomic groups within sites were similar to the gaps between high-income and lower-middle-income countries. Prevention and treatment efforts can benefit from understanding subpopulations facing higher mortality from specific conditions

Pneumococcal carriage and serotype distribution among children with and without pneumonia in Mozambique, 2014-2016.

BACKGROUND:Pneumococcal colonization is a precursor to pneumonia, and pneumococcal conjugate vaccines (PCV) can decrease vaccine-type (VT) colonization. Pneumococcal colonization studies are traditionally done among healthy children in the community; however, VT colonization prevalence may differ between these children and those with pneumonia. We assessed overall and VT pneumococcal colonization and factors associated with colonization among children with and without pneumonia after Mozambique introduced 10-valent PCV (PCV10) in 2013. METHODS:We used data from ongoing pneumonia surveillance in children aged <5 years and from cross-sectional nasopharyngeal colonization surveys conducted in October 2014 -April 2015 and October 2015 -May 2016. Pneumonia was defined using WHO standard criteria for radiologically confirmed pneumonia. Children with pneumonia enrolled from January 2014 -April 2016 were compared to children without pneumonia enrolled from the cross-sectional surveys. Clinical data and nasopharyngeal (NP) swabs were collected from each child. NP specimens were cultured for pneumococci, and culture-negative specimens from children with pneumonia underwent polymerase chain reaction (PCR). RESULTS:Of 778 and 927 children with and without pneumonia, 97.4% and 27.0% were exposed to antibiotics before swab collection, respectively. Based on culture, pneumococcal colonization was 45.1% for children with and 84.5% for children without pneumonia (P<0.001); VT pneumococcal colonization was 18.6% for children with and 23.4% for children without pneumonia (P = 0.02). The addition of PCR in children with pneumonia increased overall and VT-pneumococcal colonization to 79.2% and 31.1%, respectively. In multivariable analysis including PCR results, pneumonia was associated with VT pneumococcal colonization (adjusted OR: 1.4, 95%CI: 1.10-1.78). CONCLUSION:Vaccine-type pneumococcal colonization remains common among children with and without pneumonia post-PCV10 introduction in Mozambique. In a population of children with high antibiotic exposure, the use of PCR for culture-negative NP swabs can improve assessment of pneumococcal colonization and circulating serotypes

Pneumococcal carriage and serotype distribution among children with and without pneumonia in Mozambique, 2014-2016

<div><p>Background</p><p>Pneumococcal colonization is a precursor to pneumonia, and pneumococcal conjugate vaccines (PCV) can decrease vaccine-type (VT) colonization. Pneumococcal colonization studies are traditionally done among healthy children in the community; however, VT colonization prevalence may differ between these children and those with pneumonia. We assessed overall and VT pneumococcal colonization and factors associated with colonization among children with and without pneumonia after Mozambique introduced 10-valent PCV (PCV10) in 2013.</p><p>Methods</p><p>We used data from ongoing pneumonia surveillance in children aged <5 years and from cross-sectional nasopharyngeal colonization surveys conducted in October 2014 –April 2015 and October 2015 –May 2016. Pneumonia was defined using WHO standard criteria for radiologically confirmed pneumonia. Children with pneumonia enrolled from January 2014 –April 2016 were compared to children without pneumonia enrolled from the cross-sectional surveys. Clinical data and nasopharyngeal (NP) swabs were collected from each child. NP specimens were cultured for pneumococci, and culture-negative specimens from children with pneumonia underwent polymerase chain reaction (PCR).</p><p>Results</p><p>Of 778 and 927 children with and without pneumonia, 97.4% and 27.0% were exposed to antibiotics before swab collection, respectively. Based on culture, pneumococcal colonization was 45.1% for children with and 84.5% for children without pneumonia (<i>P</i><0.001); VT pneumococcal colonization was 18.6% for children with and 23.4% for children without pneumonia (<i>P</i> = 0.02). The addition of PCR in children with pneumonia increased overall and VT-pneumococcal colonization to 79.2% and 31.1%, respectively. In multivariable analysis including PCR results, pneumonia was associated with VT pneumococcal colonization (adjusted OR: 1.4, 95%CI: 1.10–1.78).</p><p>Conclusion</p><p>Vaccine-type pneumococcal colonization remains common among children with and without pneumonia post-PCV10 introduction in Mozambique. In a population of children with high antibiotic exposure, the use of PCR for culture-negative NP swabs can improve assessment of pneumococcal colonization and circulating serotypes.</p></div

Characteristics of children aged <5 years with and without pneumonia in Manhiça and Maputo, Mozambique, 2014–2016.

<p>Characteristics of children aged <5 years with and without pneumonia in Manhiça and Maputo, Mozambique, 2014–2016.</p

Distribution of serotypes among children aged < 5 years with pneumococcal colonization in Manhiça and Maputo, Mozambique, 2014–2016.

<p>Distribution of serotypes among children aged < 5 years with pneumococcal colonization in Manhiça and Maputo, Mozambique, 2014–2016.</p

Invasive bacterial disease trends and characterization of group B streptococcal isolates among young infants in southern Mozambique, 2001-2015

BACKGROUND: Maternal group B streptococcal (GBS) vaccines under development hold promise to prevent GBS disease in young infants. Sub-Saharan Africa has the highest estimated disease burden, although data on incidence and circulating strains are limited. We described invasive bacterial disease (IBD) trends among infants <90 days in rural Mozambique during 2001-2015, with a focus on GBS epidemiology and strain characteristics. METHODS: Community-level birth and mortality data were obtained from Manhica's demographic surveillance system. IBD cases were captured through ongoing surveillance at Manhica district hospital. Stored GBS isolates from cases underwent serotyping by multiplex PCR, antimicrobial susceptibility testing, and whole genome sequencing. RESULTS: There were 437 IBD cases, including 57 GBS cases. Significant declines in overall IBD, neonatal mortality, and stillbirth rates were observed (P<0.0001), but not for GBS (P = 0.17). In 2015, GBS was the leading cause of young infant IBD (2.7 per 1,000 live births). Among 35 GBS isolates available for testing, 31 (88.6%) were highly related serotype III isolates within multilocus sequence types (STs) 17 (68.6%) or 109 (20.0%). All seven ST109 isolates (21.9%) had elevated minimum inhibitory concentration (MIC) to penicillin (>/=0.12 mug/mL) associated with penicillin-binding protein (PBP) 2x substitution G398A. Epidemiologic and molecular data suggest this is a well-established clone. CONCLUSION: A notable young infant GBS disease burden persisted despite improvements in overall maternal and neonatal health. We report an established strain with pbp2x point mutation, a first-step mutation associated with reduced penicillin susceptibility within a well-known virulent lineage in rural Mozambique. Our findings further underscores the need for non-antibiotic GBS prevention strategies