Correlation between AFRIMS and commercial anti-HEV IgM Assay.

*<p>AFRIMS in-house anti-HEV IgM Immunoassay as described in Myint 2006.</p>**<p>Anti-HEV IgM Enzyme Immunoassay 1056, Medical Biological Service (MBS), Milano, Italy.</p

Case and control screening and selection diagram.

<p>Case and control screening and selection diagram.</p

Geographic location and layout of the ICDDR,B Matlab Health Research Center.

<p>* *Modified, with permission, from Canada's International Development Research Center, <a href="http://www.idrc.ca" target="_blank">www.idrc.ca</a> and the ICDDR,B <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0061351#pone.0061351-Health1" target="_blank">[52]</a>.</p

Exposure characteristics of acute hepatitis E patients and age-matched controls.

<p>NB. Conservative case definition includes only individuals found to be anti-HEV IgM seropositive by the AFRIMS assay. The liberal case definition includes individuals found positive by either AFRIMS or the MBS assay.</p>*<p>“None” is not shown, comparison of livestock ownership uses “None” as the reference category (OR = 1.0).</p>**<p>Recent is defined as in the three months prior to the onset of illness/interview</p>†<p>Defined as the number of times eating food prepared outside the home in an average week.</p>§<p>p<0.005, Univariate conditional (fixed effects) logistic regression (CLR) comparing cases and controls.</p>‡<p>“Don't know” (n<5) responses not shown/included in analysis.</p>||<p>p<0.05, Univariate conditional (fixed effects) logistic regression comparing cases and controls.</p>††<p>In an age category stratified analysis (≤15, 16–30,>30) only the≤15 group remained significantly at risk, likely due to low n's in each age category.</p>‡‡<p>This association likely reflects a local practice of seeking initial care from traditional “faith” healers early during hepatitis-like illnesses.</p

Demographic characteristics of acute hepatitis E disease patients and age-matched controls.

<p>NB. Conservative case definition includes only individuals found to be anti-HEV IgM seropositive by the AFRIMS assay. The liberal case definition includes individuals found positive by either AFRIMS or the MBS assay.</p>*<p>p<0.05, Univariate conditional (fixed effects) logistic regression comparing cases and controls.</p>**<p>Comparison of marital status excluded individuals ineligible for marriage as an exposure as age≤15, Divorced/Widowed not shown (n = 2).</p>†<p>“Don't Know” responses excluded, each category tested against “None/Housework”, adjusting for other categories of employment in a multivariate conditional logistic regression model.</p>¶<p>Poor nutritional status defined by Mid-upper Arm Circumference (MUAC)<22.5. MUAC comparison was restricted to participants>15 y.o.</p>‡<p>Comparison of education excluded individuals ineligible for schooling as an exposure as age<7.</p>§<p>A household score was created based on the sum of ordinal values issued for the type of roof, floor and wall construction. The OR was calculated for every one unit increase in household score (p>0.05, NS).</p

Additional file 1: of Barriers to and motivators of handwashing behavior among mothers of neonates in rural Bangladesh

Guideline for semi-structured observation, The semi-structured observation data collection guideline has been included to better understand how the data was collected and therefore results were presented in Figs. 2 and 3. (DOCX 22 kb

IgA and Neutralizing Antibodies to Influenza A Virus in Human Milk: A Randomized Trial of Antenatal Influenza Immunization

<div><p>Background</p><p>Antenatal immunization of mothers with influenza vaccine increases serum antibodies and reduces the rates of influenza illness in mothers and their infants. We report the effect of antenatal immunization on the levels of specific anti-influenza IgA levels in human breast milk. (ClinicalTrials.gov identifier NCT00142389; <a href="http://clinicaltrials.gov/ct2/show/NCT00142389" target="_blank">http://clinicaltrials.gov/ct2/show/NCT00142389</a>).</p><p>Methods and Findings</p><p>The Mother's Gift study was a prospective, blinded, randomized controlled trial that assigned 340 pregnant Bangladeshi mothers to receive either trivalent inactivated influenza vaccine, or 23-valent pneumococcal polysaccharide vaccine during the third trimester. We evaluated breast milk at birth, 6 weeks, 6 months, and 12 months, and serum at 10 weeks and 12 months. Milk and serum specimens from 57 subjects were assayed for specific IgA antibody to influenza A/New Caledonia (H1N1) using an enzyme-linked immunosorbent assay (ELISA) and a virus neutralization assay, and for total IgA using ELISA. Influenza-specific IgA levels in breast milk were significantly higher in influenza vaccinees than in pneumococcal controls for at least 6 months postpartum (<i>p</i> = 0.04). Geometric mean concentrations ranged from 8.0 to 91.1 ELISA units/ml in vaccinees, versus 2.3 to 13.7 ELISA units/mL in controls. Virus neutralization titers in milk were 1.2 to 3 fold greater in vaccinees, and correlated with influenza-specific IgA levels (r = 0.86). Greater exclusivity of breastfeeding in the first 6 months of life significantly decreased the expected number of respiratory illness with fever episodes in infants of influenza-vaccinated mothers (<i>p</i> = 0.0042) but not in infants of pneumococcal-vaccinated mothers (<i>p</i> = 0.4154).</p><p>Conclusions</p><p>The sustained high levels of actively produced anti-influenza IgA in breast milk and the decreased infant episodes of respiratory illness with fever suggest that breastfeeding may provide local mucosal protection for the infant for at least 6 months. Studies are needed to determine the cellular and immunologic mechanisms of breast milk-mediated protection after antepartum immunization.</p><p>Trial Registration</p><p>ClinicalTrials.gov <a href="http://clinicaltrials.gov/ct2/show/NCT00142389" target="_blank">NCT00142389</a></p></div

Breast milk IgA antibodies and influenza virus neutralization titers in influenza and control vaccines.

<p>Abbreviations: N, number; CI, confidence interval; GMC, geometric mean concentration.</p

Geometric mean adjusted influenza-specific IgA in breast milk in influenza versus control vaccines.

<p>Geometric mean adjusted influenza-specific IgA antibody is significantly higher in the breast milk of influenza vaccinees compared to control vaccinees for at least 6 months postpartum.</p

Maternal and infant characteristics by vaccine group.

*<p>p values were calculated using a T test for all variables except Place of Delivery, Delivery Type, and Infant Sex (Chi Squared). ⁺ N = 14⁺⁺ N = 16.</p