Influence of temperature and rainfall on the evolution of cholera epidemics in Lusaka, Zambia, 2003-2006: analysis of a time series.

In this study, we aimed to describe the evolution of three cholera epidemics that occurred in Lusaka, Zambia, between 2003 and 2006 and to analyse the association between the increase in number of cases and climatic factors. A Poisson autoregressive model controlling for seasonality and trend was built to estimate the association between the increase in the weekly number of cases and weekly means of daily maximum temperature and rainfall. All epidemics showed a seasonal trend coinciding with the rainy season (November to March). A 1 degrees C rise in temperature 6 weeks before the onset of the outbreak explained 5.2% [relative risk (RR) 1.05, 95% CI 1.04-1.06] of the increase in the number of cholera cases (2003-2006). In addition, a 50 mm increase in rainfall 3 weeks before explained an increase of 2.5% (RR 1.02, 95% CI 1.01-1.04). The attributable risks were 4.9% for temperature and 2.4% for rainfall. If 6 weeks prior to the beginning of the rainy season an increase in temperature is observed followed by an increase in rainfall 3 weeks later, both exceeding expected levels, an increase in the number of cases of cholera within the following 3 weeks could be expected. Our explicative model could contribute to developing a warning signal to reduce the impact of a presumed cholera epidemic

Cost-effectiveness of introducing a domestic pneumococcal conjugate vaccine (PCV7-TT) into the Cuban national immunization programme.

OBJECTIVES: To evaluate the cost-effectiveness of introducing a domestic pneumococcal conjugate vaccine (PCV7-TT) into the Cuban National Immunization Program (NIP). METHODS: We compared PCV7-TT given at two, four and six months of age to a scenario without PCV7-TT, over a ten-year period (2020-2029). We calculated the cost (Cuban pesos - CUP) per Disability Adjusted Life Year (DALY) averted from a Government perspective. We compared results from a static cohort model and a parsimonious prediction model informed by the serotype distribution among pneumococcal carriers and cases. We ran probabilistic and deterministic uncertainty analyses. RESULTS: PCV7-TT could prevent 6897 (95% uncertainty interval, 4344-8750) hospitalizations and 189 (115-253) deaths in children <5 years of age, over the period 2020-2029. This could cost around 25 million (20-31) discounted CUP but would be offset by treatment cost savings of around 23 million (14-31). A parsimonious model predicted less favourable impact and cost-effectiveness but the cost per DALY averted was still less than 0.4 times the current GDP per capita. CONCLUSIONS: PCV7-TT is likely to be cost-effective in Cuba. The impact of the vaccine would need to be carefully monitored following its introduction into the NIP

Corrigendum to "Cost-effectiveness of introducing a domestic pneumococcal conjugate vaccine (PCV7-TT) into the Cuban national immunization programme" [Int. J. Infect. Dis. 97 (2020) 182-189].

The authors regret that the Methods section has error in the formula. Corrections follow. In the Modelling approach section… For a given week (w) of age, the number of disease events Dw was calculated as: [Figure presented] where: P × S × Aw is the number of disease events in week w of age; Vw is the effect of vaccination in week w of age; P is the number of person-years lived between birth and age 5.0 years in the birth cohort evaluated; S is the streptococcus pneumoniae (pneumococcal) disease event rate per 100,000 per year among children younger than 5 years before the introduction of vaccination; and Aw is the proportion of pneumococcal disease events in children younger than 5 years in week w of age. In the Pneumococcal disease burden inputs section… For each birth cohort, estimates of person-years lived between birth and age 5.0 years (P) were based on United Nations demographic projections (https://population.un.org/wpp/). We estimated disease event rates (S) separately for pneumococcal acute otitis media (AOM), non-severe pneumococcal pneumonia, severe pneumococcal pneumonia, pneumococcal meningitis and other non-pneumonia/non-meningitis pneumococcal disease (NPNM) (Table 1). The authors would like to apologise for any inconvenience caused

Setting up a Network to Estimate Influenza Vaccine Effectiveness in Latin America, 2013-2017

As of 2018, 40 (77%) of 50 countries/territories in Latin America and the Caribbean have established policies for seasonal influenza vaccination. Despite high coverage levels among the high-risk groups targeted for vaccination, these countries have not routinely measured influenza vaccine effectiveness (VE). We aimed to estimate VE in preventing influenza-associated severe illness among young children and the elderly in Latin America to demonstrate the value of current vaccination strategies and sustain investments in influenza vaccines. We built on the existing severe acute respiratory infections (SARI) surveillance platforms, integrating data from immunization programs to conduct a multi-country case test-negative control study at 123 sentinel hospitals during 2013–2017 in Argentina, Brazil, Chile, Colombia, Costa-Rica, Honduras, El Salvador, Panama, and Paraguay. Surveillance staff identified children aged six months‒2 years and adults aged ≥60 years (both eligible for influenza vaccination provided free of charge by immunization programs) among patients hospitalized with SARI and collected a respiratory specimen from them within ten days of illness onset. Cases were SARI case-patients with influenza virus infection confirmed by reverse transcription polymerase chain reaction (RT-PCR); controls were SARI case-patients RT-PCR negative for influenza viruses. An individual was considered vaccinated if he/she had documented proof of vaccination during the most recent influenza vaccination campaign/season and at least 14 days before the onset of symptoms. We defined full vaccination as the receipt of one dose among adults, and children aged ≤2 years if previously vaccinated; two doses were required for full vaccination of vaccine naïve children aged ≤2 years. All countries used trivalent inactivated influenza vaccines. We used a two-stage random effects model to estimate pooled VE per target age group (children or older adults), adjusting for calendar time (month of illness onset), age, sex, and underlying medical conditions. When restricting the analysis to data from five consecutive seasons, in five countries that contributed consistently to the multicenter study, we included 9,197 SARI cases (3,160 children and 6,037 adults) in VE analyses. Overall VE against any influenza virus was 37% [95%CI: 33%─40%]. Among young children, the adjusted VE for covariates (VEadj) against any circulating influenza type/subtype was 32% [95%CI: 15%─45%] for children who received two doses and 11% [95%CI: -32%─40%] for those who received one dose. A similar pattern of higher VEadj point estimates were observed for A(H3N2) and B viruses. Among older adults, the VEadj against any circulating influenza virus was 40% [28%─51%]. A(H1N1)-specific Vadj was 44% [30%─55%], A(H3N2)-specific VEadj was 36% [24%─47%] and influenza B specific VE was 19% [-12%, 41%]. The VEadj against any circulating influenza type/subtype was 44% for those consecutively vaccinated in two seasons, 39% for those vaccinated in the current season only and 23% for those vaccinated in the prior season only. Trivalent inactivated influenza vaccines prevented more than one third (37%) of influenza-associated hospitalizations among children aged ≤2 years and adults≥60 years during 2013–2017. Sentinel surveillance networks in middle-income countries, such as some Latin American countries, could provide a simple platform to estimate regional influenza VE annually. Inter-institutional and multidisciplinary efforts between epidemiology, laboratory, and immunization programs was key to the successful implementation. Pooling data from multiple countries and seasons allowed us to obtain more robust estimates of VE per target group and type/subtype of the influenza virus.  Doctorat en Santé Publiqueinfo:eu-repo/semantics/nonPublishe

READ-ing antimicrobial stewardship in the Caribbean: a tri-nation document review

Objective. To explore the antimicrobial stewardship policy landscape in three English-speaking Caribbean countries (Barbados, Guyana, and Saint Lucia) and examine the key enablers and challenges to the design and implementation of formal antimicrobial stewardship programs. Methods. A document analysis that searched for existing policy, communications, and contributions on antimicrobial stewardship from these three countries, adapting the READ (Ready materials; Extract data; Analyze data; Distill findings) approach, a systematic procedure for health policy document review. Results. The search strategy identified 726 initial records. Of those, 15 (2%) met the inclusion criteria. The analysis included official policy documents (n = 3), scholarly works/reviews (n = 3), advocacy documents (n = 2), news articles (n = 4), and confidential reports (n = 3) from the three countries. Conclusions. Critical matters such as cross-programmatic coordination, the significance of individual action, and the need for bidirectional knowledge discourse are prominent in optimizing antimicrobial stewardship adaptation in these countries. CARICOM regional coordination has positively impacted the integration of infection prevention and control with antimicrobial stewardship across this knowledge network

Moroccan National Immunization Technical Advisory Group: a valuable asset for the national immunization program and the immunization agenda in the EMRO region

The main mission of a National Immunization Technical Advisory Group (NITAG) is to provide impartial, evidence-based recommendations on immunization to the Ministry of Health. We report on the findings from an evaluation of the Moroccan NITAG with emphasis on its functionality, quality of work processes and outputs, and its integration into the immunization policy process. We conducted a cross-sectional study from October to December 2019. We used the standardized, US-CDC/WHO-developed “simplified assessment tool for national immunization technical advisory groups”. The evaluation included eight participants. The evaluation has shown that it fully complies with the WHO recommendations. Among its strengths, the Moroccan NITAG has a solid legal basis, diverse expertise and many years of combined experience. This composition contributed to the credibility and strength of its recommendations and facilitated their implementation. The NITAG could, however, benefit from implementing written declarations of interests and standardized operating procedures in addition to establishing a standardized methodology to guide and document the decision-making process. The Moroccan NITAG could also gain from inviting members with public health/epidemiology research experience and from exchanging with other NITAGs in the region and globally. Finally, ensuring sustainable funding for the NITAG‘s activities will be crucial, so that it can continue its valuable support to the national immunization program

Effectiveness of influenza vaccines in preventing severe influenza illness among adults: A systematic review and meta-analysis of test-negative design case-control studies

Objectives Summary evidence of influenza vaccine effectiveness (IVE) against hospitalized influenza is lacking. We conducted a meta-analysis of studies reporting IVE against laboratory-confirmed hospitalized influenza among adults. Methods We searched Pubmed (January 2009 to November 2016) for studies that used test-negative design (TND) to enrol patients hospitalized with influenza-associated conditions. Two independent authors selected relevant articles. We calculated pooled IVE against any and (sub)type specific influenza among all adults, and stratified by age group (18–64 and 65 years and above) using random-effects models. Results We identified 3411 publications and 30 met our inclusion criteria. Between 2010–11 and 2014–15, the pooled seasonal IVE was 41% (95%CI:34;48) for any influenza (51% (95%CI:44;58) among people aged 18–64y and 37% (95%CI:30;44) among ≥65 years). IVE was 48% (95%CI:37;59),37% (95%CI:24;50) and 38% (95%CI:23;53) against influenza A(H1N1)pdm09, A(H3N2) and B, respectively. Among persons aged ≥65 year, IVE against A(H3N2) was 43% (95%CI:33;53) in seasons when circulating and vaccine strains were antigenically similar and 14% (95%CI:-3;30) when A(H3N2) variant viruses predominated. Conclusions Influenza vaccines provided moderate protection against influenza-associated hospitalizations among adults. They seemed to provide low protection among elderly in seasons where vaccine and circulating A(H3N2) strains were antigenically variant.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Progress in vaccination towards hepatitis B control and elimination in the Region of the Americas

Abstract Background Over recent decades, the Region of the Americas has made significant progress towards hepatitis B elimination. We summarize the countries/territories’ efforts in introducing and implementing hepatitis B (HB) vaccination and in evaluating its impact on HB virus seroprevalence. Methods We collected information about HB vaccination schedules, coverage estimates, and year of vaccine introduction from countries/territories reporting to the Pan American Health Organization/World Health Organization (PAHO/WHO) through the WHO/UNICEF Joint Reporting Form on Immunization. We obtained additional information regarding countries/territories vaccination recommendations and strategies through communications with Expanded Program on Immunization (EPI) managers and national immunization survey reports. We identified vaccine impact studies conducted and published in the Americas. Results As of October 2016, all 51 countries/territories have included infant HB vaccination in their official immunization schedule. Twenty countries, whose populations represent over 90% of the Region’s births, have included nationwide newborn HB vaccination. We estimated at 89% and 75%, the regional three-dose series and the birth dose HB vaccination coverage, respectively, for 2015. The impact evaluations of infant HB immunization programs in the Region have shown substantial reductions in HB surface antigen (HBsAg) seroprevalence. Conclusion The achievements of vaccination programs in the Americas suggest that the elimination of perinatal and early childhood HB transmission could be feasible in the short-term. Moreover, the data gathered indicate that the Region may have already achieved the 2020 WHO goal for HB control