mHEALTH INTERVENTIONS TO IMPROVE MEASLES VACCINATION COVERAGE AND TIMELINESS: AN ASSESSMENT OF THE IMMEDIATE AND LONG-TERM IMPACT ON VACCINE-SEEKING IN RURAL KENYA

Vaccine-preventable diseases cause considerable childhood morbidity and mortality in low- and middle-income countries (LMICs). To inform scaled use of mobile phone-based interventions (mHealth) to improve pediatric vaccination uptake in LMICs, we evaluated the following: i. Using current evidence, do short message service (SMS) reminders improve vaccination uptake? ii. Can SMS reminders with unconditional mobile money (mMoney) incentives improve first-dose measles-containing vaccine (MCV1) uptake? iii. What is the impact of temporary SMS reminders and mMoney incentives on long-term vaccine-seeking? We conducted: 1) A systematic review and meta-analysis of the impact of SMS reminders on pediatric vaccination uptake. 2) A randomized controlled trial in Kenya to assess the impact of SMS reminders with or without unconditional mMoney incentives on MCV1 uptake (the M-SIMI study). Participants received no interventions (Control), SMS reminders alone, or SMS reminders plus 150 Kenya Shillings (SMS+150KES). 3) A post-trial follow-up study (the MSBC study) in Kenya to assess vaccine-seeking after withdrawal of SMS reminders and incentives among former M-SIMU study participants. Systematic review and meta-analysis (11 studies): SMS reminders significantly improved third-dose diphtheria, tetanus and pertussis (DTP3) timeliness but not DTP3 uptake and full vaccination by age 12 months. Insufficient number of studies precluded meta-analysis for MCVs. M-SIMI study (N= 455): Compared to Control infants, MCV1 coverage within four weeks of the recommended age was significantly higher among SMS+150KES infants but not among SMS only infants. Neither intervention significantly improved MCV1 coverage by age 12 months. MSBC study (N= 218): Withdrawal of SMS reminders and incentives was associated with statistically insignificant decreases in MCV1-seeking for subsequent children (SC) and statistically significant decreases in MCV2-seeking for some former M-SIMU children. Decreased MCV1-seeking translated to lower-than-expected coverage among SC of former M-SIMU intervention caregivers compared to Control SC. SMS reminders can increase vaccination uptake. Unconditional incentives may have no added effect on MCV1 uptake over SMS reminders alone. Withdrawal of SMS reminders and incentives could reduce measles vaccine-seeking

Evaluation of Dried Blood and Cerebrospinal Fluid Filter Paper Spots for Storing and Transporting Clinical Material for the Molecular Diagnosis of Invasive Meningococcal Disease.

To improve the storage and transport of clinical specimens for the diagnosis of Neisseria meningitidis (Nm) infections in resource-limited settings, we have evaluated the performance of dried blood spot (DBS) and dried cerebrospinal fluid spot (DCS) assays. DBS and DCS were prepared on filter paper from liquid specimens previously tested for Nm in the United Kingdom. Nm was detected and genogrouped by real-time PCR performed on crude genomic DNA extracted from the DBS (n = 226) and DCS (n = 226) specimens. Targeted whole-genome sequencing was performed on a subset of specimens, DBS (n = 4) and DCS (n = 6). The overall agreement between the analysis of liquid and dried specimens was (94.2%; 95% CI 90.8–96.7) for blood and (96.4%; 95% CI 93.5–98.0) for cerebrospinal fluid. Relative to liquid specimens as the reference, the DBS and DCS assays had sensitivities of (89.1%; 95% CI 82.7–93.8) and (94.2%; 95% CI 88.9–97.5), respectively, and both assays had specificities above 98%. A genogroup was identified by dried specimen analysis for 81.9% of the confirmed meningococcal infections. Near full-length Nm genome sequences (>86%) were obtained for all ten specimens tested which allowed determination of the sequence type, clonal complex, presence of antimicrobial resistance and other meningococcal genotyping. Dried blood and CSF filter spot assays offer a practical alternative to liquid specimens for the molecular and genomic characterisation of invasive meningococcal diseases in low-resource settings

African swine fever : an Update

PòsterFebre

La representació de la memòria històrica. Anàlisi dels programes televisius que tracten la Guerra Civil i el franquisme a Catalunya

El present treball estudia la representació de la memòria històrica a través del mitjà televisiu a Catalunya. En concret, se centra en la representació dels esdeveniments més traumàtics de la història contemporània d'Espanya, la Guerra Civil i el franquisme. A partir de l'anàlisi de cinc productes recents de característiques diferents s'estableixen els punts en comú i les variants en el discurs sobre la memòria històrica transmès per la televisió.El presente trabajo estudia la representación de la memoria histórica a través del medio televisivo en Cataluña. En concreto, se centra en la representación de los acontecimientos más traumáticos de la historia contemporánea de España, la Guerra Civil y el franquismo. A partir del análisis de cinco productos recientes de características diferentes se establecen los puntos en común y las variantes en el discurso sobre la memoria histórica transmitido por la televisión.This study examines the representation of historical memory on television in Catalonia. In particular, it focuses on the representation of the most traumatic events in the contemporary history of Spain, the Civil War and the Francoist Spain. It is based on the analysis of five recent products with different characteristics, in order to define the points in common and the differences of the discourse on the historical memory broadcasted by television

Dry deposition and canopy uptake in Mediterranean holm-oak forests estimated with a canopy budget model : a focus on N estimations

Bulk/wet and throughfall fluxes of major compounds were measured from June 2011 to June 2013 at four Mediterranean holm-oak (Quercus ilex) forests in the Iberian Peninsula. Regression analysis between net throughfall fluxes and precipitation indicated that the best defined canopy process was leaching for K⁺ and uptake for NH₄⁺ at all sites. A more variable response between sites was found for Na⁺, Ca²⁺, SO₄²⁻ and Cl⁻, which suggests that the interplay of dry deposition, leaching and uptake at the canopy was different depending on site climate and air quality characteristics. A canopy budget model (CBM) was used to try to discriminate between the canopy processes and enable to estimate dry deposition and uptake fluxes at three of the sites that complied with the model specifications. To derive N uptake, an efficiency factor of NH₄⁺ vs. NO₃⁻ uptake (xNH₄) corresponding to moles of NH₄⁺ taken up for each NO₃⁻ mol, has to be determined. Up to now, a value of 6 has been proposed for temperate forests, but we lack information for Mediterranean forests. Experimental determination of N absorption on Quercus ilex seedlings in Spain suggests efficiency factors from 1 to 6. Based on these values, a sensitivity analysis for xNH₄ was performed and the NH₄N and NO₃N modeled dry deposition was compared with dry deposition estimated with independent methods (inferential modeling and washing of branches). At two sites in NE Spain under a milder Mediterranean climate, the best match was obtained for xNH4 = 6, corroborating results from European temperate forests. Based on this value, total DIN deposition was 12-13 kg N ha−1 y−1 at these sites. However, for a site in central Spain under drier conditions, variation of the NH4+ efficiency factor had little effect on DD estimates (which ranged from 2 to 2.6 kg N ha⁻¹ y⁻¹ with varying xNH₄); when added to wet deposition, this produced a total N deposition in the range 2.6-3.4 kg N ha⁻¹ y⁻¹. Dry deposition was the predominant pathway for N, accounting for 60-80% of total deposition, while for base cations wet deposition dominated (55-65%). Nitrogen deposition values at the northwestern sites were close to the empirical critical load proposed for evergreen sclerophyllous Mediterranean forests (15-17 kg N ha⁻¹ y⁻¹). When organic N deposition at these forests is added (3 kg N ha⁻¹ y⁻¹), the total N input to the sites in NE Spain are close to the critical loads for Mediterranean evergreen oak forests

Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Kenyan blood donors.

The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Africa is poorly described. The first case of SARS-CoV-2 in Kenya was reported on 12 March 2020, and an overwhelming number of cases and deaths were expected, but by 31 July 2020, there were only 20,636 cases and 341 deaths. However, the extent of SARS-CoV-2 exposure in the community remains unknown. We determined the prevalence of anti-SARS-CoV-2 immunoglobulin G among blood donors in Kenya in April-June 2020. Crude seroprevalence was 5.6% (174 of 3098). Population-weighted, test-performance-adjusted national seroprevalence was 4.3% (95% confidence interval, 2.9 to 5.8%) and was highest in urban counties Mombasa (8.0%), Nairobi (7.3%), and Kisumu (5.5%). SARS-CoV-2 exposure is more extensive than indicated by case-based surveillance, and these results will help guide the pandemic response in Kenya and across Africa

Mortality associated with third-generation cephalosporin resistance in Enterobacterales bloodstream infections at eight sub-Saharan African hospitals (MBIRA): a prospective cohort study

Bacteria of the order Enterobacterales are common pathogens causing bloodstream infections in sub-Saharan Africa and are frequently resistant to third-generation cephalosporin antibiotics. Although third-generation cephalosporin resistance is believed to lead to adverse outcomes, this relationship is difficult to quantify and has rarely been studied in this region. We aimed to measure the effects associated with resistance to third-generation cephalosporins in hospitalised patients with Enterobacterales bloodstream infection in Africa. We conducted a prospective, matched, parallel cohort study at eight hospitals across sub-Saharan Africa. We recruited consecutive patients of all age groups with laboratory-confirmed Enterobacterales bloodstream infection and matched them to at least one patient without bloodstream infection on the basis of age group, hospital ward, and admission date. Date of infection onset (and enrolment) was defined as the day of blood sample collection for culturing. Patients infected with bacteria with a cefotaxime minimum inhibitory concentration of 1 mg/L or lower were included in the third-generation cephalosporin-susceptible (3GC-S) cohort, and the remainder were included in the third-generation cephalosporin-resistant (3GC-R) cohort. The primary outcomes were in-hospital death and death within 30 days of enrolment. We used adjusted multivariable regression models to first compare patients with bloodstream infection against matched patients within the 3GC-S and 3GC-R cohorts, then compared estimates between cohorts. Between Nov 1, 2020, and Jan 31, 2022, we recruited 878 patients with Enterobacterales bloodstream infection (221 [25·2%] to the 3GC-S cohort and 657 [74·8%] to the 3GC-R cohort) and 1634 matched patients (420 [25·7%] and 1214 [74·3%], respectively). 502 (57·2%) bloodstream infections occurred in neonates and infants (age 0-364 days). Klebsiella pneumoniae (393 [44·8%] infections) and Escherichia coli (224 [25·5%] infections) were the most common Enterobacterales species identified. The proportion of patients who died in hospital was higher in patients with bloodstream infection than in matched controls in the 3GC-S cohort (62 [28·1%] of 221 vs 22 [5·2%] of 420; cause-specific hazard ratio 6·79 [95% CI 4·06-11·37] from Cox model) and the 3GC-R cohort (244 [37·1%] of 657 vs 115 [9·5%] of 1214; 5·01 [3·96-6·32]). The ratio of these cause-specific hazard ratios showed no significant difference in risk of in-hospital death in the 3GC-R cohort versus the 3GC-S cohort (0·74 [0·42-1·30]). The ratio of relative risk of death within 30 days (0·82 [95% CI 0·53-1·27]) also indicated no difference between the cohorts. Patients with bloodstream infections with Enterobacterales bacteria either resistant or susceptible to third-generation cephalosporins had increased mortality compared with uninfected matched patients, with no differential effect related to third-generation cephalosporin-resistance status. However, this finding does not account for time to appropriate antibiotic treatment, which remains clinically important to optimise. Measures to prevent transmission of Enterobacterales could reduce bloodstream infection-associated mortality from both drug-resistant and drug-susceptible bacterial strains in Africa

Temporal trends of SARS-CoV-2 seroprevalence during the first wave of the COVID-19 epidemic in Kenya.

Observed SARS-CoV-2 infections and deaths are low in tropical Africa raising questions about the extent of transmission. We measured SARS-CoV-2 IgG by ELISA in 9,922 blood donors across Kenya and adjusted for sampling bias and test performance. By 1st September 2020, 577 COVID-19 deaths were observed nationwide and seroprevalence was 9.1% (95%CI 7.6-10.8%). Seroprevalence in Nairobi was 22.7% (18.0-27.7%). Although most people remained susceptible, SARS-CoV-2 had spread widely in Kenya with apparently low associated mortality

SARS-CoV-2 seroprevalence in three Kenyan health and demographic surveillance sites, December 2020-May 2021

Background Most of the studies that have informed the public health response to the COVID-19 pandemic in Kenya have relied on samples that are not representative of the general population. We conducted population-based serosurveys at three Health and Demographic Surveillance Systems (HDSSs) to determine the cumulative incidence of infection with SARS-CoV-2. Methods We selected random age-stratified population-based samples at HDSSs in Kisumu, Nairobi and Kilifi, in Kenya. Blood samples were collected from participants between 01 Dec 2020 and 27 May 2021. No participant had received a COVID-19 vaccine. We tested for IgG antibodies to SARS-CoV-2 spike protein using ELISA. Locally-validated assay sensitivity and specificity were 93% (95% CI 88–96%) and 99% (95% CI 98–99.5%), respectively. We adjusted prevalence estimates using classical methods and Bayesian modelling to account for the sampling scheme and assay performance. Results We recruited 2,559 individuals from the three HDSS sites, median age (IQR) 27 (10–78) years and 52% were female. Seroprevalence at all three sites rose steadily during the study period. In Kisumu, Nairobi and Kilifi, seroprevalences (95% CI) at the beginning of the study were 36.0% (28.2–44.4%), 32.4% (23.1–42.4%), and 14.5% (9.1–21%), and respectively; at the end they were 42.0% (34.7–50.0%), 50.2% (39.7–61.1%), and 24.7% (17.5–32.6%), respectively. Seroprevalence was substantially lower among children (&lt;16 years) than among adults at all three sites (p≤0.001). Conclusion By May 2021 in three broadly representative populations of unvaccinated individuals in Kenya, seroprevalence of anti-SARS-CoV-2 IgG was 25–50%. There was wide variation in cumulative incidence by location and age. </jats:sec

Sero-surveillance for IgG to SARS-CoV-2 at antenatal care clinics in three Kenyan referral hospitals: Repeated cross-sectional surveys 2020-21.

INTRODUCTION: The high proportion of SARS-CoV-2 infections that have remained undetected presents a challenge to tracking the progress of the pandemic and estimating the extent of population immunity. METHODS: We used residual blood samples from women attending antenatal care services at three hospitals in Kenya between August 2020 and October 2021and a validated IgG ELISA for SARS-Cov-2 spike protein and adjusted the results for assay sensitivity and specificity. We fitted a two-component mixture model as an alternative to the threshold analysis to estimate of the proportion of individuals with past SARS-CoV-2 infection. RESULTS: We estimated seroprevalence in 2,981 women; 706 in Nairobi, 567 in Busia and 1,708 in Kilifi. By October 2021, 13% of participants were vaccinated (at least one dose) in Nairobi, 2% in Busia. Adjusted seroprevalence rose in all sites; from 50% (95%CI 42-58) in August 2020, to 85% (95%CI 78-92) in October 2021 in Nairobi; from 31% (95%CI 25-37) in May 2021 to 71% (95%CI 64-77) in October 2021 in Busia; and from 1% (95% CI 0-3) in September 2020 to 63% (95% CI 56-69) in October 2021 in Kilifi. Mixture modelling, suggests adjusted cross-sectional prevalence estimates are underestimates; seroprevalence in October 2021 could be 74% in Busia and 72% in Kilifi. CONCLUSIONS: There has been substantial, unobserved transmission of SARS-CoV-2 in Nairobi, Busia and Kilifi Counties. Due to the length of time since the beginning of the pandemic, repeated cross-sectional surveys are now difficult to interpret without the use of models to account for antibody waning