Estimating the transmission parameters of pneumococcal carriage in households

This paper analyses Streptococcus pneumoniae transmission dynamics in households using longitudinal data on pneumococcal (Pnc) carriage in the United Kingdom. Ten consecutive swabs were taken at 4-week intervals from all members of 121 households. The family status is derived from the observed Pnc carriage status of each family member. Transition matrices are built for each family size and composition containing the observed frequency of transitions between family statuses over a 28-day interval. A density-dependent transmission model is fitted to derive maximum-likelihood estimates of the duration of carriage and acquisition rates from the community and from infected individuals within the household. Parameter values are estimated for children (<5 years) and adults (5+years). The duration of carriage is longer in children <5 years of age than in older family members (51 vs. 19 days). Children are 3–4 times more likely than adults to acquire Pnc infection from the community. Transmission rates within the household suggest that adults are more infectious but less susceptible than children. Transmission within the household is most important in large families. The proportion of household-acquired infection ranges from 29 to 46% in households of three persons to 38–50% in larger households. Evidence of density-dependent within-household transmission is found, although the strength of this relationship is not clear from the model estimates

Identification of group B respiratory syncytial viruses that lack the 60-nucleotide duplication after six consecutive epidemics of total BA dominance at coastal Kenya

Respiratory syncytial virus BA genotype has reportedly replaced other group B genotypes worldwide. We report the observation of three group B viruses, all identical in G sequence but lacking the BA duplication, at a coastal district hospital in Kenya in early 2012. This follows a period of six consecutive respiratory syncytial virus (RSV) epidemics with 100% BA dominance among group B isolates. The new strains appear only distantly related to BA variants and to previously circulating SAB1 viruses last seen in the district in 2005, suggesting that they were circulating elsewhere undetected. These results are of relevance to an understanding of RSV persistence

Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy.

Cervical cerclage is a well-known surgical procedure carried out during pregnancy. It involves positioning of a suture (stitch) around the neck of the womb (cervix), aiming to give mechanical support to the cervix and thereby reduce risk of preterm birth. The effectiveness and safety of this procedure remains controversial. This is an update of a review last published in 2012.To assess whether the use of cervical stitch in singleton pregnancy at high risk of pregnancy loss based on woman's history and/or ultrasound finding of 'short cervix' and/or physical exam improves subsequent obstetric care and fetal outcome.We searched Cochrane Pregnancy and Childbirth's Trials Register (30 June 2016) and reference lists of identified studies.We included all randomised trials of cervical suturing in singleton pregnancies. Cervical stitch was carried out when the pregnancy was considered to be of sufficiently high risk due to a woman's history, a finding of short cervix on ultrasound or other indication determined by physical exam. We included any study that compared cerclage with either no treatment or any alternative intervention. We planned to include cluster-randomised studies but not cross-over trials. We excluded quasi-randomised studies. We included studies reported in abstract form only.Three review authors independently assessed trials for inclusion. Two review authors independently assessed risk of bias and extracted data. We resolved discrepancies by discussion. Data were checked for accuracy. The quality of the evidence was assessed using the GRADE approach.This updated review includes a total of 15 trials (3490 women); three trials were added for this update (152 women). Cerclage versus no cerclageOverall, cerclage probably leads to a reduced risk of perinatal death when compared with no cerclage, although the confidence interval (CI) crosses the line of no effect (RR 0.82, 95% CI 0.65 to 1.04; 10 studies, 2927 women; moderate quality evidence). Considering stillbirths and neonatal deaths separately reduced the numbers of events and sample size. Although the relative effect of cerclage is similar, estimates were less reliable with fewer data and assessed as of low quality (stillbirths RR 0.89, 95% CI 0.45 to 1.75; 5 studies, 1803 women; low quality evidence; neonatal deaths before discharge RR 0.85, 95% CI 0.53 to 1.39; 6 studies, 1714 women; low quality evidence). Serious neonatal morbidity was similar with and without cerclage (RR 0.80, 95% CI 0.55 to 1.18; 6 studies, 883 women; low-quality evidence). Pregnant women with and without cerclage were equally likely to have a baby discharged home healthy (RR 1.02, 95% CI 0.97 to 1.06; 4 studies, 657 women; moderate quality evidence).Pregnant women with cerclage were less likely to have preterm births compared to controls before 37, 34 (average RR 0.77, 95% CI 0.66 to 0.89; 9 studies, 2415 women; high quality evidence) and 28 completed weeks of gestation.Five subgroups based on clinical indication provided data for analysis (history-indicated; short cervix based on one-off ultrasound in high risk women; short cervix found by serial scans in high risk women; physical exam-indicated; and short cervix found on scan in low risk or mixed populations). There were too few trials in these clinical subgroups to make meaningful conclusions and no evidence of differential effects. Cerclage versus progesteroneTwo trials (129 women) compared cerclage to prevention with vaginal progesterone in high risk women with short cervix on ultrasound; these trials were too small to detect reliable, clinically important differences for any review outcome. One included trial compared cerclage with intramuscular progesterone (75 women) which lacked power to detect group differences. History indicated cerclage versus ultrasound indicated cerclageEvidence from two trials (344 women) was too limited to establish differences for clinically important outcomes.Cervical cerclage reduces the risk of preterm birth in women at high-risk of preterm birth and probably reduces risk of perinatal deaths. There was no evidence of any differential effect of cerclage based on previous obstetric history or short cervix indications, but data were limited for all clinical groups. The question of whether cerclage is more or less effective than other preventative treatments, particularly vaginal progesterone, remains unanswered

Kinetics of the neutralizing antibody response to respiratory syncytial virus infections in a birth cohort

The kinetics of respiratory syncytial virus (RSV) neutralizing antibodies following birth, primary and secondary infections are poorly defined. The aims of the study were to measure and compare neutralizing antibody responses at different time points in a birth cohort followed-up over three RSV epidemics. Rural Kenyan children, recruited at birth between 2002 and 2003, were monitored for RSV infection over three epidemic seasons. Cord and 3-monthly sera, and acute and convalescent sera following RSV infection, were assayed in 28 children by plaque reduction neutralization test (PRNT). Relative to the neutralizing antibody titers of pre-exposure control sera (1.8 log10 PRNT), antibody titers following primary infection were (i) no different in sera collected between 0 and 0.4 months post-infection (1.9 log10 PRNT, P = 0.146), (ii) higher in sera collected between 0.5 and 0.9 (2.8 log10 PRNT, P < 0.0001), 1.0–1.9 (2.5 log10 PRNT, P < 0.0001), and 2.0–2.9 (2.3 log10 PRNT, P < 0.001) months post-infection, and (iii) no different in sera collected at between 3.0 and 3.9 months post-infection (2.0 log10 PRNT, P = 0.052). The early serum neutralizing response to secondary infection (3.02 log10 PRNT) was significantly greater than the early primary response (1.9 log10 PRNT, P < 0.0001). Variation in population-level virus transmission corresponded with changes in the mean cohort-level neutralizing titers. It is concluded that following primary RSV infection the neutralizing antibody response declines to pre-infection levels rapidly (∼3 months) which may facilitate repeat infection. The kinetics of the aggregate levels of acquired antibody reflect seasonal RSV occurrence, age, and infection history

A new regional climate model for POLAR-CORDEX : evaluation of a 30-year hindcast with COSMO-CLM2 over Antarctica

Continent-wide climate information over the Antarctic Ice Sheet (AIS) is important to obtain accurate information of present climate and reduce uncertainties of the ice sheet mass balance response and resulting global sea level rise to future climate change. In this study, the COSMO-CLM2 Regional Climate Model is applied over the AIS and adapted for the specific meteorological and climatological conditions of the region. A 30-year hindcast was performed and evaluated against observational records consisting of long-term ground-based meteorological observations, automatic weather stations, radiosoundings, satellite records, stake measurements and ice cores. Reasonable agreement regarding the surface and upper-air climate is achieved by the COSMO-CLM2 model, comparable to the performance of other state-of-the-art climate models over the AIS. Meteorological variability of the surface climate is adequately simulated, and biases in the radiation and surface mass balance are small. The presented model therefore contributes as a new member to the COordinated Regional Downscaling EXperiment project over the AIS (POLAR-CORDEX) and the CORDEX-CORE initiative

Community views on active case finding for tuberculosis in low- and middle-income countries: a qualitative evidence synthesis

Objectives: This is a protocol for a Cochrane Review (qualitative). The objectives are as follows:. To synthesize community views on tuberculosis active case finding programmes in low- and middle-income countries. Review question In areas of the world where tuberculosis is common, what views do communities and high-risk populations hold about tuberculosis active case finding programmes?. Target audience Policy groups at global, national and local levels considering, recommending, designing, or implementing active case finding programmes. Feasibility of programmes, as assessed by health staff, will not be part of this review

Group versus conventional antenatal care for women

© 2015 The Cochrane Collaboration. Background: Antenatal care is one of the key preventive health services used around the world. In most Western countries, antenatal care traditionally involves a schedule of one-to-one visits with a care provider. A different way of providing antenatal care involves use of a group model. Objectives: 1. To compare the effects of group antenatal care versus conventional antenatal care on psychosocial, physiological, labour and birth outcomes for women and their babies. 2. To compare the effects of group antenatal care versus conventional antenatal care on care provider satisfaction. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2014), contacted experts in the field and reviewed the reference lists of retrieved studies. Selection criteria: All identified published, unpublished and ongoing randomised and quasi-randomised controlled trials comparing group antenatal care with conventional antenatal care were included. Cluster-randomised trials were eligible, and one has been included. Cross-over trials were not eligible. Data collection and analysis: Two review authors independently assessed trials for inclusion and risk of bias and extracted data; all review authors checked data for accuracy. Main results: We included four studies (2350 women). The overall risk of bias for the included studies was assessed as acceptable in two studies and good in two studies. No statistically significant differences were observed between women who received group antenatal care and those given standard individual antenatal care for the primary outcome of preterm birth (risk ratio (RR) 0.75, 95% confidence interval (CI) 0.57 to 1.00; three trials; N = 1888). The proportion of low-birthweight (less than 2500 g) babies was similar between groups (RR 0.92, 95% CI 0.68 to 1.23; three trials; N = 1935). No group differences were noted for the primary outcomes small-for-gestational age (RR 0.92, 95% CI 0.68 to 1.24; two trials; N = 1473) and perinatal mortality (RR 0.63, 95% CI 0.32 to 1.25; three trials; N = 1943). Satisfaction was rated as high among women who were allocated to group antenatal care, but this outcome was measured in only one trial. In this trial, mean satisfaction with care in the group given antenatal care was almost five times greater than that reported by those allocated to standard care (mean difference 4.90, 95% CI 3.10 to 6.70; one study; N = 993). No differences in neonatal intensive care admission, initiation of breastfeeding or spontaneous vaginal birth were observed between groups. Several outcomes related to stress and depression were reported in one trial. No differences between groups were observed for any of these outcomes. No data were available on the effects of group antenatal care on care provider satisfaction. We used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach to assess evidence for seven prespecified outcomes; results ranged from low quality (perinatal mortality) to moderate quality (preterm birth, low birthweight, neonatal intensive care unit admission, breastfeeding initiation) to high quality (satisfaction with antenatal care, spontaneous vaginal birth). Authors' conclusions: Available evidence suggests that group antenatal care is positively viewed by women and is associated with no adverse outcomes for them or for their babies. No differences in the rate of preterm birth were reported when women received group antenatal care. This review is limited because of the small numbers of studies and women, and because one study contributed 42% of the women. Most of the analyses are based on a single study. Additional research is required to determine whether group antenatal care is associated with significant benefit in terms of preterm birth or birthweight

Continuous Invasion by Respiratory Viruses Observed in Rural Households During a Respiratory Syncytial Virus Seasonal Outbreak in Coastal Kenya.

BACKGROUND: Households are high-intensity close-contact environments favorable for transmission of respiratory viruses, yet little is known for low-income settings. METHODS: Active surveillance was completed on 47 households in rural coastal Kenya over 6 months during a respiratory syncytial virus (RSV) season. Nasopharyngeal swabs (NPSs) were taken from 483 household members twice weekly irrespective of symptoms. Using molecular diagnostics, NPSs from 6 households were screened for 15 respiratory viruses and the remainder of households only for the most frequent viruses observed: rhinovirus (RV), human coronavirus (HCoV; comprising strains 229E, OC43, and NL63), adenovirus (AdV), and RSV (A and B). RESULTS: Of 16928 NPSs tested for the common viruses, 4259 (25.2%) were positive for ≥1 target; 596 (13.8%) had coinfections. Detection frequencies were 10.5% RV (1780), 7.5% HCoV (1274), 7.3% AdV (1232), and 3.2% RSV (537). On average, each household and individual had 6 and 3 different viruses detected over the study period, respectively. Rhinovirus and HCoV were detected in all the 47 households while AdV and RSV were detected in 45 (95.7%) and 40 (85.1%) households, respectively. The individual risk of infection over the 6-month period was 93.4%, 80.1%, 71.6%, 61.5%, and 37.1% for any virus, RV, HCoV, AdV, and RSV, respectively. NPSs collected during symptomatic days and from younger age groups had higher prevalence of virus detection relative to respective counterparts. RSV was underrepresented in households relative to hospital admission data. CONCLUSIONS: In this household setting, respiratory virus infections and associated illness are ubiquitous. Future studies should address the health and economic implications of these observations

An evaluation of a physics-based firn model and a semi-empirical firn model across the Greenland Ice Sheet (1980–2020)

The Greenland Ice Sheet's (GrIS) firn layer buffers the ice sheet's contribution to sea level rise by storing meltwater in its pore space. However, available pore space and meltwater retention capability is lost due to ablation of the firn layer and refreezing of meltwater as near-surface ice slabs in the firn. Understanding how firn properties respond to climate is important for constraining the GrIS's future contribution to sea level rise in a warming climate. Observations of firn density provide detailed information about firn properties, but they are spatially and temporally limited. Here we use two firn models, the physics-based SNOWPACK model and the Community Firn Model configured with a semi-empirical densification equation (CFM-GSFC), to quantify firn properties across the GrIS from 1980 through 2020. We use an identical forcing (Modern-Era Retrospective Analysis for Research and Applications, version 2 (MERRA-2) atmospheric reanalysis) for SNOWPACK and the CFM-GSFC in order to isolate firn model differences. To evaluate the models, we compare simulated firn properties, including firn air content (FAC), to measurements from the Surface Mass Balance and Snow on Sea Ice Working Group (SUMup) dataset of snow and firn density. Both models perform well (mean absolute percentage errors of 14 % in SNOWPACK and 16 % in the CFM-GSFC), though their performance is hindered by the spatial resolution of the atmospheric forcing. In the ice-sheet-wide simulations, the 1980–1995 average spatially integrated FAC (i.e., air volume in the firn) for the upper 100 m is 34 645 km3 from SNOWPACK and 28 581 km3 from the CFM-GSFC. The discrepancy in the magnitude of the modeled FAC stems from differences in densification with depth and variations in the sensitivity of the models to atmospheric forcing. In more recent years (2005–2020), both models simulate substantial depletion of pore space. During this period, the spatially integrated FAC across the entire GrIS decreases by 3.2 % (−66.6 km3 yr−1) in SNOWPACK and 1.5 % (−17.4 km3 yr−1) in the CFM-GSFC. These differing magnitudes demonstrate how model differences propagate throughout the FAC record. Over the full modeled record (1980–2020), SNOWPACK simulates a loss of pore space equivalent to 3 mm of sea level rise buffering, while the CFM-GSFC simulates a loss of 1 mm. The greatest depletion in FAC is along the margins and especially along the western margin where observations and models show the formation of near-surface, low-permeability ice slabs that may inhibit meltwater storage.</p

A wind-driven snow redistribution module for Alpine3D v3.3.0: adaptations designed for downscaling ice sheet surface mass balance

Ice sheet surface mass balance describes the net snow accumulation at the ice sheet surface. On the Antarctic ice sheet, winds redistribute snow, resulting in a surface mass balance that is variable in both space and time. Representing wind-driven snow redistribution processes in models is critical for local assessments of surface mass balance, repeat altimetry studies, and interpretation of ice core accumulation records. To this end, we have adapted Alpine3D, an existing distributed snow modeling framework, to downscale Antarctic surface mass balance to horizontal resolutions up to 1 km. In particular, we have introduced a new two-dimensional advection-based wind-driven snow redistribution module that is driven by an offline coupling between WindNinja, a wind downscaling model, and Alpine3D. We then show that large accumulation variability can be at least partially explained by terrain-induced wind speed variations which subsequently redistribute snow around rolling topography. By comparing Alpine3D to airborne-derived snow accumulation measurements within a testing domain over Pine Island Glacier in West Antarctica, we demonstrate that our Alpine3D downscaling approach improves surface mass balance estimates when compared to the Modern-Era Retrospective analysis for Research and Applications, Version 2 (MERRA-2), a global atmospheric reanalysis which we use as atmospheric forcing. In particular, when compared to MERRA-2, Alpine3D reduces simulated surface mass balance root mean squared error by 23.4 mmw.e.yr-1 (13 %) and increases variance explained by 24 %. Despite these improvements, our results demonstrate that considerable uncertainty stems from the employed saltation model, confounding simulations of surface mass balance variability.</p