Hepatitis A virus seroprevalence among children and adolescents in a high‑burden HIV setting in urban South Africa

Hepatitis A virus (HAV) infection is one of the most important global causes of viral hepatitis. Recent reviews suggested that HAV endemicity in South Africa could shift from high to intermediate. A hospital-based HAV seroprevalence study was conducted between February 2018 and December 2019 in Pretoria, South Africa. Systematic sampling was performed on children and adolescents (1–15 years) who attended outpatient services. Participants with a known HIV status and valid HAV serology results were included. Of the 1220 participants, the median age was 7 years (IQR: 4–11), with 648 (53.11%) males and 572 (46.89%) females. Of 628 (51.48%) HIV-infected participants, most (329, 71.83%) were both immunologically and virologically controlled or had low-level viremia (74, 16.16%). Almost three-quarters (894, 73.28%) were living in formal dwellings, and just over half (688, 56.39%) had access to clean water sources inside the house. Increasing age was associated with testing HAV IgG-positive (OR 1.25; 95% CI 1.20–1.30, p < 0.001), with 19.8% of participants one year of age compared with 86.7% of participants 15 years of age. This study suggests that South Africa has an intermediate HAV seroprevalence, with rates < 90% by 10 years of age (68.6%). Increased age and informal dwellings are statistically associated with HAV seropositivity, while HIV status does not significantly influence HAV seropositivity.DATA AVAILABILITY : Raw data were generated at Kalafong Provincial Tertiary Hospital and the University of Pretoria. Derived data supporting the fndings of this study are available from the corresponding author [NdP] on request.A Research Grant by Sanofi Pasteur.http://www.nature.com/scientificreportsam2023Paediatrics and Child Healt

Rubella vaccine introduction in the South African public vaccination schedule : mathematical modelling for decision making

CITATION: Motaze, Nkengafac Villyen et al. 2020. Rubella vaccine introduction in the South African public vaccination schedule : mathematical modelling for decision making. Vaccines, 8(3):383, doi:10.3390/vaccines8030383.The original publication is available at: https://www.mdpi.comBackground: age structured mathematical models have been used to evaluate the impact of rubella-containing vaccine (RCV) introduction into existing measles vaccination programs in several countries. South Africa has a well-established measles vaccination program and is considering RCV introduction. This study aimed to provide a comparison of different scenarios and their relative costs within the context of congenital rubella syndrome (CRS) reduction or elimination. Methods: we used a previously published age-structured deterministic discrete time rubella transmission model. We obtained estimates of vaccine costs from the South African medicines price registry and the World Health Organization. We simulated RCV introduction and extracted estimates of rubella incidence, CRS incidence and effective reproductive number over 30 years. Results: compared to scenarios without mass campaigns, scenarios including mass campaigns resulted in more rapid elimination of rubella and congenital rubella syndrome (CRS). Routine vaccination at 12 months of age coupled with vaccination of nine-year-old children was associated with the lowest RCV cost per CRS case averted for a similar percentage CRS reduction. Conclusion: At 80% RCV coverage, all vaccine introduction scenarios would achieve rubella and CRS elimination in South Africa. Any RCV introduction strategy should consider a combination of routine vaccination in the primary immunization series and additional vaccination of older childrenPublisher's versio

A comparative evaluation of PDQ-Evidence

BACKGROUND: A strategy for minimising the time and obstacles to accessing systematic reviews of health system evidence is to collect them in a freely available database and make them easy to find through a simple ‘Google-style’ search interface. PDQ-Evidence was developed in this way. The objective of this study was to compare PDQ-Evidence to six other databases, namely Cochrane Library, EVIPNet VHL, Google Scholar, Health Systems Evidence, PubMed and Trip. METHODS: We recruited healthcare policy-makers, managers and health researchers in low-, middle- and highincome countries. Participants selected one of six pre-determined questions. They searched for a systematic review that addressed the chosen question and one question of their own in PDQ-Evidence and in two of the other six databases which they would normally have searched. We randomly allocated participants to search PDQ-Evidence first or to search the two other databases first. The primary outcomes were whether a systematic review was found and the time taken to find it. Secondary outcomes were perceived ease of use and perceived time spent searching. We asked open-ended questions about PDQ-Evidence, including likes, dislikes, challenges and suggestions for improvements. RESULTS: A total of 89 people from 21 countries completed the study; 83 were included in the primary analyses and 6 were excluded because of data errors that could not be corrected. Most participants chose PubMed and Cochrane Library as the other two databases. Participants were more likely to find a systematic review using PDQ-Evidence than using Cochrane Library or PubMed for the pre-defined questions. For their own questions, this difference was not found. Overall, it took slightly less time to find a systematic review using PDQ-Evidence. Participants perceived that it took less time, and most participants perceived PDQ-Evidence to be slightly easier to use than the two other databases. However, there were conflicting views about the design of PDQ-Evidence. CONCLUSIONS: PDQ-Evidence is at least as efficient as other databases for finding health system evidence. However, using PDQ-Evidence is not intuitive for some people

A retrospective 5-year review of rubella in South Africa prior to the introduction of a rubella-containing vaccine

South Africa has yet to introduce a rubella-containing vaccine (RCV) into its Expanded Programme on Immunisation (EPI). Here we evaluated the incidence of laboratory-confirmed rubella and congenital rubella syndrome (CRS) cases over the years 2015 to 2019, to document the epidemiology of rubella and CRS within South Africa prior to a RCV introduction. This retrospective study evaluated the number of laboratory-confirmed rubella cases reported through the national febrile rash surveillance system. A positive test for rubella immunoglobulin M (IgM) antibodies was considered a confirmed rubella case. For CRS cases, we reported laboratory-confirmed CRS cases collected from 28 sentinel-sites from all nine provinces of South Africa. From 2015–2019, 19 773 serum samples were tested for rubella IgM antibodies, 6 643 (33.6%) were confirmed rubella cases. Rubella was seasonal, with peaks in spring (September to November). Case numbers were similar between males (n = 3 239; 50.1%) and females (n = 3 232; 49.9%). The highest burden of cases occurred in 2017 (n = 2 526; 38%). The median age was 5 years (IQR: 3–7 years). Importantly, of females with rubella, 5.0% (161 of 3 232) of the cases were among women of reproductive age (15–44 years). A total of 62 CRS cases were reported, the mortality rate was 12.9% (n = 8), and the most common birth defect was congenital heart disease. In conclusion, rubella is endemic in South Africa. Children below the age of 10 years were the most affected, however, rubella was also reported among women of reproductive age. The baseline data represented here provides insight into the burden of rubella and CRS in South Africa prior to the introduction of a RCV, and can enable planning of RCV introduction into the South African EPI.The National Institute for Communicable Diseases, a division of the National Health Laboratory Service, South Africa.http://www.plosone.orgdm2022School of Health Systems and Public Health (SHSPH

Clinical question: How does feedback compare with usual care or less intensive interventions for helping women stop smoking during pregnancy?

Providing feedback to pregnant women probably increases smoking abstinence in late pregnancy (29‐40 weeks’ gestation), but its impact on smoking reduction and other outcomes remains unclear

Clinical question: How does counselling compare with usual care or less intensive interventions for helping women stop smoking during pregnancy?

Counselling increased the number of women who abstained from smoking in late pregnancy (29‐40 weeks’ gestation) compared with usual care or less intensive interventions. Results for other outcomes were less clear, with fewer women assessed and trials failing to report important aspects of their methods....

Congenital rubella syndrome surveillance in South Africa using a sentinel site approach : a cross-sectional study

BACKGROUND. Congenital rubella syndrome (CRS) includes disorders associated with intrauterine rubella infection. Incidence of CRS is higher in countries with no rubella-containing vaccines (RCV) in their immunization schedules. In the World Health Organization African region, RCVs are being introduced as part of the 2012–2020 global measles and rubella strategic plan. This study aimed to describe the epidemiology of confirmed CRS in South Africa prior to introduction of RCVs in the immunization schedule. METHODS. This was a descriptive study with 28 sentinel sites reporting laboratory-confirmed CRS cases in all 9 provinces of South Africa. In the retrospective phase (2010 to 2014), CRS cases were retrieved from medical records, and in the prospective phase (2015 to 2017) clinicians at study sites reported CRS cases monthly. RESULTS. There were 42 confirmed CRS cases in the retrospective phase and 53 confirmed CRS cases in the prospective phase. Most frequently reported birth defects were congenital heart disease and cataracts. The median age of mothers of CRS cases was 21 years in the retrospective phase (range: 11 to 38 years) and 22 years in the prospective phase (range: 15 to 38 years). CONCLUSION. Baseline data on laboratory-confirmed CRS will enable planning and monitoring of RCV implementation in the South African Expanded Programme on Immunization program. Ninety-eight percent of mothers of infants with CRS were young women 14–30 years old, indicating a potential immunity gap in this age group for consideration during introduction of RCV.The NICD/NHLS, South Africahttp://cid.oxfordjournals.orgam2020Paediatrics and Child Healt

Burden of congenital rubella syndrome and potential impact of rubella vaccine introduction in South Africa

Thesis (PhD)--Stellenbosch University, 2021.ENGLISH SUMMARY : Background: Introduction of rubella vaccines into public vaccination schedules of all countries is necessary if global rubella elimination is to be achieved. Rubella is targeted for elimination in five World Health Organization (WHO) regions and several international organizations, under the stewardship of the WHO, are working towards this goal. Although there is no rubella elimination or control target for the WHO Africa region, there has been accelerated introduction of rubella vaccination on the continent. South African government is planning to introduce rubella vaccination in its Expanded Programme on Immunization (EPI) schedule and several epidemiological studies have been conducted to aid preparation of this public health intervention. In the absence of vaccination, rubella is mainly a mild endemic childhood viral illness that is asymptomatic in up to 50% of cases. The most severe consequences of rubella occur when infection occurs during pregnancy. These include miscarriages, stillbirths, intra-uterine growth restriction and congenital rubella syndrome. Rubella vaccines are therefore intended to prevent rubella and associated complications. In South Africa, rubella vaccines are not part of the EPI schedule and there is limited information on the epidemiology of rubella and its complications. In addition, the South African government has to cover the cost of introducing rubella vaccination. Therefore, the aim of this research project was to characterize the epidemiology of rubella and congenital rubella syndrome in South Africa, to assess the potential impact of introducing rubella vaccination in the EPI schedule. Methods: Four different studies were carried out as part of this PhD project: a cross-sectional descriptive study, a sero-survey, a mathematical modelling study and a systematic review. Results: The findings of a newly established CRS surveillance system to provide data on disease trends in the absence of rubella vaccination are presented in the first research component. We provided baseline data on laboratory-confirmed CRS that will enable planning and monitoring of RCV implementation in the South African EPI program. Ninety-eight percent of mothers of infants with CRS were young women 14 to 30 years old, indicating a potential immunity gap in this age group for consideration during introduction of RCV. In the second research component, we present results of testing on residual samples collected from public health facilities to identify immunity gaps in various age groups and genders. The bulk of individuals susceptible to rubella are children under sixteen years old and about 20% of individuals 16 to 49 years old are susceptible to rubella. In multivariable logistic regression, age and province of residence were found to be associated with rubella susceptibility.Webuilt on a previously published mathematical model adapted to the South African context in the third research component and provide insights into optimal scenarios for RCV introduction into the South African public immunization schedule. We simulated a number of scenarios that combined infant vaccination with vaccination of older individuals. Routine vaccination at 12 months of age coupled with vaccination of nine-year-old children was associated with the lowest RCV cost per CRS case averted for a similar percentage CRS reduction. Interestingly, at 80% RCV coverage, all vaccine introduction scenarios could achieve rubella and CRS elimination in South Africa.In the final research component, we systematically reviewed mathematical modelling studies to identify the most effective approach for countries introducing RCV into their public immunization schedules. There were variations in the manner in which individual studies reported outcomes. However, we found that better outcomes are obtained when rubella vaccination is introduced into public vaccination schedules at coverage figures of 80%, as recommended by WHO, or higher. Conclusion: The results from these different studies support the implementation of a strategy involving infant vaccination in combination with vaccination of older individuals. Further research projects are required to provide more detail on the burden of CRS and the economic impact of RCV introduction into the EPI schedule.AFRIKAANSE OPSOMMING : Agtergrond: Om rubella-entstowwe in openbare inentingsskedules van alle lande in te stel, is nodig om wêreldwye eliminasie van rubella te bereik. Rubella word geteiken vir uitskakeling in vyf streke van die Wêreldgesondheidsorganisasie (WGO) en verskeie internasionale organisasies, onder toesig van die WGO, werk daaraan. Alhoewel daar geen eliminasie- of beheerdoelwit vir rubella vir die WGO-Afrika bestaan nie, is daar 'n vinnige instelling van inenting teen rubella op die vasteland. Die Suid-Afrikaanse regering is van plan om rubella-inenting in te stel in sy program vir uitgebreide immunisering (EPI), en verskeie epidemiologiese studies is gedoen om die voorbereiding van hierdie ingryping in die gesondheid te help. In die afwesigheid van inenting, is rubella hoofsaaklik 'n ligte endemiese virussiekte by kinders wat in tot 50% van die gevalle asimptomaties is. Die ernstigste gevolge van rubella kom voor wanneer infeksie tydens swangerskap voorkom. Dit sluit miskrame, doodgeboortes, groeibeperking binne die baarmoeder en aangebore rubella-sindroom in. Inenting teen rubella is dus bedoel om rubella en gepaardgaande komplikasies te voorkom. In Suid-Afrika maak rubella-entstowwe nie deel uit van die EPI-skedule nie en is daar beperkte inligting oor die epidemiologie van rubella en die komplikasies daarvan. Daarbenewens moet die Suid-Afrikaanse regering die koste dek vir die instelling van rubella-inenting. Daarom was die doel van hierdie navorsingsprojek om die epidemiologie van rubella en aangebore rubella-sindroom in Suid-Afrika te karakteriseer, om die potensiële impak van die instelling van rubella-inenting in die EPI-skedule te bepaal. Metodes: Vier verskillende studies is uitgevoer as deel van hierdie PhD-projek; 'n beskrywende deursnee-studie, 'n sero-opname, 'n wiskundige modelleringstudie en 'n sistematiese oorsig. Resultate: Die bevindinge van 'n nuutgestigte CRS-bewakingstelsel om inligting oor siektetendense te verskaf in die afwesigheid van inenting teen rubella word in die eerste navorsingskomponent aangebied. Ons het basisdata gegee oor CRS wat deur laboratorium bevestig is, wat die beplanning en monitering van RCV-implementering in die Suid-Afrikaanse EPI-program moontlik maak. Agt-en-negentig persent van moeders van babas met CRS was jong vroue van 14 tot 30 jaar oud, wat dui op 'n moontlike immuniteitsgaping in hierdie ouderdomsgroep vir oorweging tydens die bekendstelling van RCV. In die tweede navorsingskomponent bied ons die resultate aan van die toetsing van residuele monsters wat van openbare gesondheidsinstellings versamel is om immuniteitsgapings in verskillende ouderdomsgroepe en geslagte te identifiseer. Die grootste deel van die individue wat vatbaar is vir rubella is kinders jonger as sestien jaar en ongeveer 20% van individue tussen 16 en 49 jaar oud is vatbaar vir rubella. In meerveranderlikke logistieke regressie is gevind dat ouderdom en provinsie geassosieer word met rubella vatbaarheid. Gebou op 'n voorheen gepubliseerde wiskundige model wat aangepas is vir die Suid-Afrikaanse konteks in die derde navorsingskomponent en bied insigte in optimale scenario's vir RCV-bekendstelling in die Suid-Afrikaanse openbare inentingskedule. Ons het 'n aantal scenario's gesimuleer wat baba-inenting kombineer met inenting van ouer persone. Roetine-inenting op 12-maande-ouderdom, tesame met die inenting van nege-jarige kinders, is geassosieer met die laagste RCV-koste per CRS-geval wat afgeweer is vir 'n soortgelyke persentasie CRS-vermindering. Interessant genoeg, met 80% RCV-dekking, kan alle inenting-inleidingscenario's rubella en CRS-uitskakeling in Suid-Afrika bereik. Daar was variasies in die wyse waarop individuele studies die uitkomste gerapporteer het. Ons het egter gevind dat beter resultate behaal word wanneer rubella-inenting in openbare inentingsskedules bekendgestel word teen 'n dekkingsyfer van 80%, soos aanbeveel deur die WGO, of hoër. Afsluiting: Die resultate van hierdie verskillende studies ondersteun die implementering van 'n strategie rakende baba-inenting in kombinasie met inenting van ouer individue. Verdere navorsingsprojekte is nodig om meer besonderhede te gee oor die las van CRS en die ekonomiese impak van die bekendstelling van RCV in die EPI-skedule.Doctora

Clinical question: How do financial incentives compare with usual care or less intensive interventions for helping women stop smoking during pregnancy?

Compared with usual care, financial incentives, when used as a single intervention, increased the number of women who abstained from smoking in late pregnancy (at 24‐40 weeks’ gestation) (on average, 227 vs 83 per 1000 women) and at 6 to 11 months postpartum (on average, 154 vs 40 per 1000 women). Results show no clear differences in smoking abstinence when financial incentives were used as part of tailored or multiple interventions in late pregnancy, or at 0 to 5 months postpartum. Financial incentives reduced self‐reported smoking in late pregnancy, but this was inconsistent with results from a randomized controlled trial (RCT) that used contingent and non‐contingent financial incentives that assessed smoking cessation biochemically. Findings of RCTs reveal no clear differences in preterm birth, low birth weight, or admission to neonatal intensive care unit (ICU); no RCTs reported very low birth weight or mortality (perinatal, stillbirth, neonatal). Compared with less intensive interventions, more women abstained from smoking in late pregnancy (on average, 304 vs 83 per 1000 women) and at 0 to 5 months postpartum (on average, 214 vs 59 per 1000 women) when financial incentives were included as part of multiple interventions. Smoking reduction, birth weight, preterm birth, mortality (perinatal, stillbirth, neonatal), and admission to neonatal ICU were not reported by these trials

Clinical question: How does health education or exercise compare with usual care or less intensive interventions for helping women stop smoking during pregnancy?

Heath education and exercise may be no better than usual care or less intensive interventions for helping women stop smoking during pregnancy, although evidence suggests that health education may help women reduce smoking in late pregnancy (at 24‐40 weeks’ gestation)