Simulated effect of pneumococcal vaccination in the Netherlands on existing rules constructed in a non-vaccinated cohort predicting sequelae after bacterial meningitis

BACKGROUND: Previously two prediction rules identifying children at risk of hearing loss and academic or behavioral limitations after bacterial meningitis were developed. Streptococcus pneumoniae as causative pathogen was an important risk factor in both. Since 2006 Dutch children receive seven-valent conjugate vaccination against S. pneumoniae. The presumed effect of vaccination was simulated by excluding all children infected by S. pneumoniae with the serotypes included in the vaccine, from both previous collected cohorts (between 1990-1995). METHODS: Children infected by one of the vaccine serotypes were excluded from both original cohorts (hearing loss: 70 of 628 children; academic or behavioral limitations: 26 of 182 children). All identified risk factors were included in multivariate logistic regression models. The discriminative ability of both new models was calculated. RESULTS: The same risk factors as in the original models were significant. The discriminative ability of the original hearing loss model was 0.84 and of the new model 0.87. In the academic or behavioral limitations model it was 0.83 and 0.84 respectively. CONCLUSION: It can be assumed that the prediction rules will also be applicable on a vaccinated population. However, vaccination does not provide 100% coverage and evidence is available that serotype replacement will occur. The impact of vaccination on serotype replacement needs to be investigated, and the prediction rules must be validated externally

Worthy to Lose Some Money for Better Air Quality: Applications of Bayesian Networks on the Causal Effect of Income and Air Pollution on Life Satisfaction in Switzerland

One important determinant of well-being is the environmental quality. Many countries apply environmental regulations, reforms and policies for its improvement. However, the question is how the people value the environment, including the air quality. This study examines the association between air pollution and life satisfaction using the Swiss Household Panel survey over the years 2000–2013. We follow a Bayesian network (BN) strategy to estimate the causal effect of the income and air pollution on life satisfaction. We look at five main air pollutants: the ground-level ozone (O3), sulphur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO) and particulate matter of 10 micrometres (PM10). Then, we calculate the individuals’ marginal willingness to pay (MWTP) of reducing air pollution that aims to improve their life satisfaction. Beside the BN model, we take advantage of the panel structure of our data and we follow two approaches as robustness check. This includes the adapted probit fixed effects and the generalised methods of moments system. Our findings show that O3 and PM10 present the highest MWTP values ranging between $8000 and$12,000, followed by the remained air pollutants with MWTP extending between $2000 and$6500. Applying the BNs, we find that the causal effect of income on life satisfaction is substantially increased. We also show the causal effects of air pollutants remain almost the same, leading to lower values of willingness to pay

A preliminary study of pneumonia etiology among hospitalized children in Kenya.

BACKGROUND: Pneumonia is the leading cause of childhood death in the developing world. Higher-quality etiological data are required to reduce this mortality burden. METHODS: We conducted a case-control study of pneumonia etiology among children aged 1-59 months in rural Kenya. Case patients were hospitalized with World Health Organization-defined severe pneumonia (SP) or very severe pneumonia (VSP); controls were outpatient children without pneumonia. We collected blood for culture, induced sputum for culture and multiplex polymerase chain reaction (PCR), and obtained oropharyngeal swab specimens for multiplex PCR from case patients, and serum for serology and nasopharyngeal swab specimens for multiplex PCR from case patients and controls. RESULTS: Of 984 eligible case patients, 810 (84%) were enrolled in the study; 232 (29%) had VSP. Blood cultures were positive in 52 of 749 case patients (7%). A predominant potential pathogen was identified in sputum culture in 70 of 417 case patients (17%). A respiratory virus was detected by PCR from nasopharyngeal swab specimens in 486 of 805 case patients (60%) and 172 of 369 controls (47%). Only respiratory syncytial virus (RSV) showed a statistically significant association between virus detection in the nasopharynx and pneumonia hospitalization (odds ratio, 12.5; 95% confidence interval, 3.1-51.5). Among 257 case patients in whom all specimens (excluding serum specimens) were collected, bacteria were identified in 24 (9%), viruses in 137 (53%), mixed viral and bacterial infection in 39 (15%), and no pathogen in 57 (22%); bacterial causes outnumbered viral causes when the results of the case-control analysis were considered. CONCLUSIONS: A potential etiology was detected in >75% of children admitted with SP or VSP. Except for RSV, the case-control analysis did not detect an association between viral detection in the nasopharynx and hospitalization for pneumonia