63 research outputs found
Diagnostic testing practices for diarrhoeal cases in South African public hospitals
BACKGROUND : Stool samples submitted for diagnostic testing represent a proportion of diarrhoeal cases seeking
healthcare, and an even smaller proportion of diarrhoeal cases in the community. Despite this, surveillance relies
heavily on these laboratory results. This study described diarrhoeal diagnostic practices and aetiological agents of
diarrhoea in patients admitted to three South African public hospitals in order to understand biases in surveillance
data, and inform guidelines, diagnostic and laboratory practices to improve clinical management.
METHODS : A doctorsā survey was conducted to determine sample submission, diarrhoeal treatment and barriers to
submitting samples for testing. Results for all samples submitted for routine diagnostics were obtained from the NHLS
Central Data Warehouse. An enhanced surveillance study enrolled patients with acute diarrhoea at the same hospitals
over the same period. Differences between routine culture results and molecular testing from the surveillance study
were described.
RESULTS : Stool samples were seldom submitted for diagnostic testing (median of 10% of admitted cases). Current
diagnostic guidelines were not useful, hence most doctors (75.1%) relied on their own clinical judgement or judgement
of a senior clinician. Although most doctors (90.3%) agreed that diagnostics were helpful for clinical management,
they reported patients being unwilling to provide samples and long laboratory turnaround times. Routine
diagnostic data represent cases with chronic diarrhoea and dysentery since doctors are most likely to submit specimens
for these cases. Pathogen yield (number of pathogens detected for samples tested for specific pathogens)
was significantly higher in the surveillance study, which used molecular methods, than through routine diagnostic
services (73.3% versus 8.2%, p < 0.001), including for viruses (48.9% versus 2.6%, p < 0.001), bacteria (40.1% versus 2.2%,
p < 0.001) and parasites (16.2% versus 3.6%, p < 0.001). Despite viruses being commonly detected in the surveillance
study, viral testing was seldom requested in routine diagnostic investigations.
CONCLUSIONS : Comprehensive diagnostic and treatment guidelines are required for diarrhoeal diseases. These guidelines
should be informed by local epidemiological data, where diagnostic testing is reserved for cases most likely to
benefit from specific treatment. Optimisation of current diagnostic processes and methods are required for these
cases, specifically in terms of minimising turnaround times while maximising diagnostic acumen.The ANDEMIA study was supported by the German Federal Ministry of Education and Research.http://www.biomedcentral.com/bmcinfectdisam2023Medical VirologyPaediatrics and Child Healt
Identifying gaps in hand hygiene practice to support tailored target audience messaging in Soweto : a cross-sectional community survey
Effective risk communication is essential for outbreak mitigation, as recently highlighted
during the coronavirus disease 2019 (COVID-19) pandemic. Hand hygiene is one of the
proposed public health interventions to protect against severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) acquisition and transmission along with social distancing,
improved ventilation, environmental cleaning, and wearing of masks. Improving hand
hygiene practices in the community requires an understanding of the socio-behavioural
context. This cross-sectional community survey in Soweto identified gaps in hand hygiene,
which can inform appropriate messaging at the community level. Only 42% of survey
respondents practiced adequate hand hygiene. Tailored educational messaging should be
targeted at young adults in particular, and the importance of soap for hand hygiene must be
emphasised for all age groups. Risk communication should expand to focus on preventing
multiple infectious diseases during and beyond the COVID-19 pandemic.GlaxoSmithKline and the German Federal Ministry of Education and Research. The CHAMPS programme is funded by the Bill & Melinda Gates Foundation.https://sajid.co.za/index.php/sajiddm2022Medical Virolog
Global respiratory syncytial virus-associated mortality in young children (RSV GOLD): a retrospective case series
Background: Respiratory syncytial virus (RSV) infection is an important cause of pneumonia mortality in young children. However, clinical data for fatal RSV infection are scarce. We aimed to identify clinical and socioeconomic characteristics of children aged younger than 5 years with RSV-related mortality using individual patient data.
Methods: In this retrospective case series, we developed an online questionnaire to obtain individual patient data for clinical and socioeconomic characteristics of children aged younger than 5 years who died with community-acquired RSV infection between Jan 1, 1995, and Oct 31, 2015, through leading research groups for child pneumonia identified through a comprehensive literature search and existing research networks. For the literature search, we searched PubMed for articles published up to Feb 3, 2015, using the key terms āRSVā, ārespiratory syncytial virusā, or ārespiratory syncytial viralā combined with āmortalityā, āfatalityā, ādeathā, ādiedā, ādeathsā, or āCFRā for articles published in English. We invited researchers and clinicians identified to participate between Nov 1, 2014, and Oct 31, 2015. We calculated descriptive statistics for all variables.
Findings: We studied 358 children with RSV-related in-hospital death from 23 countries across the world, with data contributed from 31 research groups. 117 (33%) children were from low-income or lower middle-income countries, 77 (22%) were from upper middle-income countries, and 164 (46%) were from high-income countries. 190 (53%) were male. Data for comorbidities were missing for some children in low-income and middle-income countries. Available data showed that comorbidities were present in at least 33 (28%) children from low-income or lower middle-income countries, 36 (47%) from upper middle-income countries, and 114 (70%) from high-income countries. Median age for RSV-related deaths was 5Ā·0 months (IQR 2Ā·3ā11Ā·0) in low-income or lower middle-income countries, 4Ā·0 months (2Ā·0ā10Ā·0) in upper middle-income countries, and 7Ā·0 months (3Ā·6ā16Ā·8) in high-income countries.
Interpretation: This study is the first large case series of children who died with community-acquired RSV infection. A substantial proportion of children with RSV-related death had comorbidities. Our results show that perinatal immunisation strategies for children aged younger than 6 months could have a substantial impact on RSV-related child mortality in low-income and middle-income countries
Epidemiology of human astroviruses among children younger than 5 years : prospective hospitalābased sentinel surveillance in South Africa, 2009ā2014
BACKGROUND : The epidemiology of human astroviruses (HAstVs) in hospitalised patients less than 5 years of age from selected sites in South Africa was investigated. Diarrheagenic stool specimens collected from April 2009 to May 2014 were screened retrospectively for selected viruses, bacteria and parasites.
METHOD : Patient data were analysed to identify epidemiologic factors most frequently detected with HAstV infections. The following caseācomparisons were investigated; HAstVāpositive and HAstVānegative children, human immunodeficiency virus (HIV)āinfected and HIVāuninfected (HAstVāpositive) children and HIVāexposed and unexposed (HAstVāpositive HIVāuninfected) children.
RESULTS : Astrovirus was identified in 7.0% (234/3340) of cases and most frequently in ages 7 to 12 months (9.2%; 90/975) compared with 5.8% to 6.6% in other 6āmonth age groups. No seasonal trends were observed. More HAstVs were detected in children from homes that used outdoor water sources (7.6%) compared to indoor sources [5.7%; adjusted odds ratio (aOR), 1.5; 95% CI, 1.1ā2.1; Pā=ā0.009]. Astroviruses were detected in 8.4% (67/799) of HIVāuninfected patients that were exposed to HIV compared with 5.9% (74/1257) of HIVāunexposed patients ( Pā=ā0.032).
CONCLUSION : Astroviruses were most prevalent in children aged 7 to 12 months and were detected throughout the study period. The study was limited as only hospitalised patients were investigated and no comparisons were made to diarrhoeaāfree control groups. Future HAstV surveillance should include communityābased studies and children presenting at outpatient facilities.The Rotavirus Sentinel Surveillance Program was funded by GlaxoSmithKline (EāTrack 200238). Research was supported by a National Health Laboratory Service Research (004_94494) (SN) and the Poliomyelitis Research Foundation (15/22) (NAP).http://wileyonlinelibrary.com/journal/jmv2020-02-01hj2018Medical Virolog
Microorganisms detected in intussusception cases and controls in children <3 years in South Africa from 2013 to 2017
A matched case-control evaluated infectious etiologies in children <3 years in post-rotavirus vaccine intussusception surveillance. Adenovirus and adenovirus types C, A, and B were detected more frequently in cases versus controls at statistically significant values. Wild-type rotavirus, rotavirus vaccine strains, and human herpesvirus were not associated with intussusception.The Bill & Melinda Gates
Foundation and an Emerging
Global Leader Award from the Fogarty International Center of the NIH.https://academic.oup.com/ofidhj2024Medical VirologyNon
Case-control vaccine effectiveness studies: Data collection, analysis and reporting results
The case-control methodology is frequently used to evaluate vaccine effectiveness post-licensure. The results of such studies provide important insight into the level of protection afforded by vaccines in a \u27real world\u27 context, and are commonly used to guide vaccine policy decisions. However, the potential for bias and confounding are important limitations to this method, and the results of a poorly conducted or incorrectly interpreted case-control study can mislead policies. In 2012, a group of experts met to review recent experience with case-control studies evaluating vaccine effectiveness; we summarize the recommendations of that group regarding best practices for data collection, analysis, and presentation of the results of case-control vaccine effectiveness studies. Vaccination status is the primary exposure of interest, but can be challenging to assess accurately and with minimal bias. Investigators should understand factors associated with vaccination as well as the availability of documented vaccination status in the study context; case-control studies may not be a valid method for evaluating vaccine effectiveness in settings where many children lack a documented immunization history. To avoid bias, it is essential to use the same methods and effort gathering vaccination data from cases and controls. Variables that may confound the association between illness and vaccination are also important to capture as completely as possible, and where relevant, adjust for in the analysis according to the analytic plan. In presenting results from case-control vaccine effectiveness studies, investigators should describe enrollment among eligible cases and controls as well as the proportion with no documented vaccine history. Emphasis should be placed on confidence intervals, rather than point estimates, of vaccine effectiveness. Case-control studies are a useful approach for evaluating vaccine effectiveness; however careful attention must be paid to the collection, analysis and presentation of the data in order to best inform evidence-based vaccine policies
Case-control vaccine effectiveness studies: Preparation, design, and enrollment of cases and control
Case-control studies are commonly used to evaluate effectiveness of licensed vaccines after deployment in public health programs. Such studies can provide policy-relevant data on vaccine performance under \u27real world\u27 conditions, contributing to the evidence base to support and sustain introduction of new vaccines. However, case-control studies do not measure the impact of vaccine introduction on disease at a population level, and are subject to bias and confounding, which may lead to inaccurate results that can misinform policy decisions. In 2012, a group of experts met to review recent experience with case-control studies evaluating the effectiveness of several vaccines; here we summarize the recommendations of that group regarding best practices for planning, design and enrollment of cases and controls. Rigorous planning and preparation should focus on understanding the study context including healthcare-seeking and vaccination practices. Case-control vaccine effectiveness studies are best carried out soon after vaccine introduction because high coverage creates strong potential for confounding. Endpoints specific to the vaccine target are preferable to non-specific clinical syndromes since the proportion of non-specific outcomes preventable through vaccination may vary over time and place, leading to potentially confusing results. Controls should be representative of the source population from which cases arise, and are generally recruited from the community or health facilities where cases are enrolled. Matching of controls to cases for potential confounding factors is commonly used, although should be reserved for a limited number of key variables believed to be linked to both vaccination and disease. Case-control vaccine effectiveness studies can provide information useful to guide policy decisions and vaccine development, however rigorous preparation and design is essential
Diarrhoeal diseases in Soweto, South Africa, 2020 : a cross-sectional community survey
BACKGROUND : In South Africa, there are limited data on the burden of diarrhoea at a community level, specifically in
older children and adults. This community survey estimated rates of and factors associated with diarrhoea across all
ages and determined the proportion of cases presenting to healthcare facilities.
METHODS : Households were enrolled from an existing urban health and demographic surveillance site. A household
representative was interviewed to determine associated factors and occurrence of diarrhoea in the household, for
all household members, in the past 2 weeks (including symptoms and health seeking behaviour). Diarrhoeal rate of
any severity was calculated for 15 years age groups. Factors associated with diarrhoea
and health seeking behaviour were investigated using binomial logistic regression.
RESULTS : Diarrhoeal rate among respondents (2.5 episodes/person-year (95% CI, 1.8ā3.5)) was significantly higher
than for other household members (1.0 episodes/person-year (95% CI, 0.8ā1.4); IRR = 2.4 (95% CI, 1.5ā3.7) p < 0.001).
Diarrhoeal rates were similar between age groups, however younger children (< 5 years) were more likely to
present to healthcare facilities than adults (OR = 5.9 (95% CI, 1.1ā31.4), p = 0.039). Oral rehydration solution was used
in 44.8% of cases. Having a child between 5 and 15 years in the household was associated with diarrhoea (OR = 2.3
(95% CI, 1.3ā3.9), p = 0.003) and, while 26.4% of cases sought healthcare, only 4.6% were hospitalised and only 3.4%
of cases had a stool specimen collected. While the majority of cases were mild, 13.8% of cases felt they required
healthcare but were unable to access it.
CONCLUSION : Diarrhoeal rate was high across all age groups in this community; however, older children and adults
were less likely to present to healthcare, and are therefore underrepresented through facility-based clinical
surveillance. Current diarrhoeal surveillance represents a fraction of the overall cases occurring in the community.SUPPLEMENTARY MATERIAL: FIGURE S1. Health seeking for reported diarrhoeal episodes. TABLE S1. Factors associated with ORS knowledge.This work was supported by GlaxoSmithKline [E-Track 200238] and the
German Federal Ministry of Education and Research [grant number
81203616] to SLJ. The CHAMPS program is funded by the Bill & Melinda
Gates Foundation (Grant OPP1126780).http://www.biomedcentral.com/bmcpublichealtham2022Medical Virolog
Trends in cases, hospitalizations, and mortality related to the Omicron BA.4/BA.5 subvariants in South Africa
BACKGROUND : In this study, we compared admission incidence risk and the risk of mortality in the Omicron BA.4/BA.5 wave to
previous waves.
METHODS : Data from South Africaās SARS-CoV-2 case linelist, national COVID-19 hospital surveillance system, and Electronic
Vaccine Data System were linked and analyzed. Wave periods were defined when the country passed a weekly incidence of 30 cases/
100 000 population. In-hospital case fatality ratios (CFRs) during the Delta, Omicron BA.1/BA.2, and Omicron BA.4/BA.5 waves
were compared using post-imputation random effect multivariable logistic regression models.
RESULTS : The CFR was 25.9% (N=37 538 of 144 778), 10.9% (N=6123 of 56 384), and 8.2% (N=1212 of 14 879) in the Delta,
Omicron BA.1/BA.2, and Omicron BA.4/BA.5 waves, respectively. After adjusting for age, sex, race, comorbidities, health sector,
and province, compared with the Omicron BA.4/BA.5 wave, patients had higher risk of mortality in the Omicron BA.1/BA.2 wave
(adjusted odds ratio [aOR], 1.3; 95% confidence interval [CI]: 1.2ā1.4) and Delta wave (aOR, 3.0; 95% CI: 2.8ā3.2). Being partially
vaccinated (aOR, 0.9; 95% CI: .9ā.9), fully vaccinated (aOR, 0.6; 95% CI: .6ā.7), and boosted (aOR, 0.4; 95% CI: .4ā.5) and having
prior laboratory-confirmed infection (aOR, 0.4; 95% CI: .3ā.4) were associated with reduced risks of mortality.
CONCLUSIONS : Overall, admission incidence risk and in-hospital mortality, which had increased progressively in South Africaās
first 3 waves, decreased in the fourth Omicron BA.1/BA.2 wave and declined even further in the fifth Omicron BA.4/BA.5 wave.
Mortality risk was lower in those with natural infection and vaccination, declining further as the number of vaccine doses increased.https://academic.oup.com/cid/am2024Human NutritionSDG-03:Good heatlh and well-bein
Safety and immunogenicity of a parenteral P2-VP8-P[8] subunit rotavirus vaccine in toddlers and infants in South Africa : a randomised, double-blind, placebo-controlled trial
BACKGROUND Efficacy of live oral rotavirus vaccines is reduced in low-income compared with high-income settings.
Parenteral non-replicating rotavirus vaccines might offer benefits over oral vaccines. We assessed the safety and
immunogenicity of the P2-VP8-P[8] subunit rotavirus vaccine at different doses in South African toddlers and infants.
Methods This double-blind, randomised, placebo-controlled, dose-escalation trial was done at a single research unit
based at a hospital in South Africa in healthy HIV-uninfected toddlers (aged 2 to <3 years) and term infants (aged
6 to <8 weeks, without previous rotavirus vaccination). Block randomisation (computer-generated, electronic allocation)
was used to assign eligible toddlers (in a 6:1 ratio) and infants (in a 3:1 ratio) in each dose cohort (10 Ī¼g, followed by
30 Ī¼g, then 60 Ī¼g if doses tolerated) to parenteral P2-VP8-P[8] subunit rotavirus or placebo injection. The two highest
tolerated doses were then assessed in an expanded cohort (in a 1:1:1 ratio). Parents of participants and clinical, data, and
laboratory staff were masked to treatment assignment. P2-VP8-P[8] vaccine versus placebo was assessed first in toddlers
(single injection) and then in infants (three injections 4 weeks apart). The primary safety endpoints were local and
systemic reactions within 7 days after each injection, adverse events within 28 days after each injection, and all serious
adverse events, assessed in toddlers and infants who received at least one dose. In infants receiving all study injections,
primary immunogenicity endpoints were anti-P2-VP8-P[8] IgA and IgG and neutralising antibody seroresponses and
geometric mean titres 4 weeks after the third injection. This trial is registered at ClinicalTrials.gov, number NCT02109484.
FINDINGS Between March 17, 2014, and Sept 29, 2014, 42 toddlers (36 to vaccine and six to placebo) and 48 infants
(36 to vaccine and 12 to placebo) were enrolled in the dose-escalation phase, in which the 30 Ī¼g and 60 Ī¼g doses where
found to be the highest tolerated doses. A further 114 infants were enrolled in the expanded cohort between
Nov 3, 2014, and March 20, 2015, and all 162 infants (12 assigned to 10 Ī¼g, 50 to 30 Ī¼g, 50 to 60 Ī¼g, and 50 to placebo)
were included in the safety analysis. Serum IgA seroresponses were observed in 38 (81%, 95% CI 67ā91) of 47 infants
in the 30 Ī¼g group and 32 (68%, 53ā81) of 47 in the 60 Ī¼g group, compared with nine (20%, 10ā35) of 45 in the
placebo group; adjusted IgG seroresponses were seen in 46 (98%, 89ā100) of 47 infants in the 30 Ī¼g group and
47 (100%; 92ā100) of 47 in the 60 Ī¼g group, compared with four (9%, 2Ā·5ā21) of 45 in the placebo group; and adjusted
neutralising antibody seroresponses against the homologous Wa-strain were seen in 40 (85%, 72ā94) of 47 infants in
both the 30 Ī¼g and 60 Ī¼g groups, compared with three (7%, 1Ā·4ā18) of 45 participants in the placebo group. Solicited reactions following any injection occurred with similar frequency and severity in participants receiving vaccine and
those receiving placebo. Unsolicited adverse events were mostly mild and occurred at a similar frequency between
groups. Eight serious adverse events (one with placebo, two with 30 Ī¼g, and five with 60 Ī¼g) occurred in seven infants
within 28 days of any study injection, none of which were deemed related to study treatment.
INTERPRETATION The parenteral P2-VP8-P[8] vaccine was well tolerated and immunogenic in infants, providing a novel
approach to vaccination against rotavirus disease. On the basis of these results, a phase 1/2 trial of a trivalent P2-VP8
(P[4], P[6], and P[8]) subunit vaccine is underway at three sites in South Africa.Bill & Melinda Gates Foundation.MJG reports funding from PATH Vaccine Solutions and personal fees
from GlaxoSmithKline. AK and LJ report funding from PATH Vaccine
Solutions. NP reports honoraria from GlaxoSmithKline, Merck, and Aspen
Pharma. SAM reports grants from PATH, grants from Novartis and
GlaxoSmithKline, and grants and personal fees from Pfizer and the Bill &
Melinda Gates Foundation. MM reports laboratory service agreements
with PATH, Merck, and GlaxoSmithKline. IC reports funding from PATH
and is a paid consultant for PATH. MP is an employee of PATH, and
reports grants from the Bill & Melinda Gates Foundation. AF, JF, LD, and
SC declare no competing interests.http://www.thelancet.com/infectionam2017Medical Virolog
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