Evidence-based vaccinology: supporting evidence-informed considerations to introduce routine hepatitis A immunization in South Africa

Hepatitis A is a vaccine preventable disease caused by the Hepatitis A Virus (HAV). Currently, South Africa is classified by the World Health Organization (WHO) as a high hepatitis A endemic region where 90% of children are assumed to be “naturally immunised” following HAV exposure before the age of 10 years old. In high hepatitis A endemic settings, routine vaccination against HAV is not necessary due to high rates of “natural immunization”. Recent data suggest a possible shift from high to intermediate HAV endemicity may be occurring in South Africa. Countries with intermediate HAV endemicity and no routine hepatitis A vaccination program have a high risk of experiencing hepatitis A outbreaks and high costs associated with care. Currently, there is no routine vaccination program against HAV in South Africa. The aim of this PhD was to generate evidence for decision making on whether a routine vaccination program against HAV should be considered for introduction into the South African Expanded Program on Immunizations (EPI-SA). The objectives included gathering context-specific evidence on the epidemiologic features of hepatitis A, clinical characteristics of the disease, hepatitis A vaccine characteristics and cost of case management. Using this evidence, the PhD estimated the future epidemiology of hepatitis A and impacts of routine hepatitis A vaccination scenarios in the country. The PhD's overall methods were informed by the principles of Evidence-Based Vaccinology for developing vaccine recommendations. The project included a mixed-methods approach: systematic reviews, a retrospective clinical folder review, mathematical modelling, and economic evaluation. A dynamic transmission model was built to forecast the future epidemiology of hepatitis A and to simulate the impacts of several different childhood hepatitis A vaccination strategies in South Africa. Selected findings have been published in relevant peer-reviewed journals. In addition, a technical dossier was prepared to submit to the South African National Advisory Group on Immunization (NAGI) on behalf of the Hepatitis A Working Group for considerations of introducing hepatitis A vaccination into the South African EPI

NATO: Russia’s Response to Its Growing Presence

In the nearly thirty years since the fall of Communism in Eastern Europe, the Russian Federation has experienced a complex transition to democracy, the collapse of the Soviet Union, the implementation of shock therapy and a shift to a market economy and has dealt with numerous security threats from terrorism to international involvement in Central and Eastern Europe. This paper looks to examine the relationship between Russian security and foreign policy formation and its relationship with the North Atlantic Treaty Organization. In order to best understand and explain the growing instability along Russia’s western border, it is imperative that the extensive history between NATO, the former Soviet Union, and Russia be examined. This paper seeks to accomplish this by providing a brief history of NATO prior to 1991 before delving into the eras of Russian foreign policy after the Soviet Union’s collapse and how each approached Western institutions and NATO. This is followed by an evaluation of current Russian President Vladimir Putin and his public thoughts on NATO and current issues facing Eastern Europe and Russia. The goal of this research is to determine the role that NATO has played in Russian foreign policy formation since 1991 which has led to increased border defense and activity along Russia’s western border with the Baltic states and Ukraine. This paper argues that the continuation of NATO activity in the region following the fall of the Soviet Union, in conjunction with its inability to incorporate Russia into the organization, has led to decades of pushback from Russia and has most recently culminated in the implementation of Civilizationist ideology into their foreign policy development. Keywords: Russian Foreign Policy, Civilizationism, NATO (North Atlantic Treaty Organization), Expansionism, Security - Europea

A systematic review of the epidemiology of hepatitis A in Africa

Abstract Background Hepatitis A, caused by the hepatitis A virus (HAV), is a vaccine preventable disease. In Low and Middle-Income Countries (LMICs), poor hygiene and sanitation conditions are the main risk factors contributing to HAV infection. There have been, however, notable improvements in hygiene and sanitation conditions in many LMICs. As a result, there are studies showing a possible transition of some LMICs from high to intermediate HAV endemicity. The World Health Organization (WHO) recommends that countries should routinely collect, analyse and review local factors (including disease burden) to guide the development of hepatitis A vaccination programs. Up-to-date information on hepatitis A burden is, therefore, critical in aiding the development of country-specific recommendations on hepatitis A vaccination. Methods We conducted a systematic review to present an up-to-date, comprehensive synthesis of hepatitis A epidemiological data in Africa. Results The main results of this review include: 1) the reported HAV seroprevalence data suggests that Africa, as a whole, should not be considered as a high HAV endemic region; 2) the IgM anti-HAV seroprevalence data showed similar risk of acute hepatitis A infection among all age-groups; 3) South Africa could be experiencing a possible transition from high to intermediate HAV endemicity. The results of this review should be interpreted with caution as the reported data represents research work with significant sociocultural, economic and environmental diversity from 13 out of 54 African countries. Conclusions Our findings show that priority should be given to collecting HAV seroprevalence data and re-assessing the current hepatitis A control strategies in Africa to prevent future disease outbreaks

The Grizzly, November 14, 2013

Bearitones and B\u27Naturals Perform This Weekend • UCEA Waste Watching at the Philadelphia Marathon • Climate and Sustainability Action Plan Announced • Process of Making New Classes at UC • UCDC Hosts Local Choreographers • Ursinus Athletics Honors Graduates • Wind Ensemble Performance • Opinion: Assign Credit for Varsity Athletics; Academic Probation Policy Exempts Athletics • Women\u27s Basketball Will Rely on Young Talent • UC Wrestlers Ready to Meet Expectations • Exciting Weekend for UC Athleticshttps://digitalcommons.ursinus.edu/grizzlynews/1893/thumbnail.jp

A retrospective study assessing the clinical outcomes and costs of acute hepatitis A in Cape Town, South Africa

Background While some evidence has been demonstrated the cost-effectiveness of routine hepatitis A vaccination in middle-income countries, the evidence is still limited in other settings including in South Africa. Given this, the evidence base around the cost of care for hepatitis A needs to be developed towards considerations of introducing hepatitis A vaccines in the national immunisation schedule and guidelines. Objectives To describe the severity, clinical outcomes, and cost of hepatitis A cases presenting to two tertiary healthcare centers in Cape Town, South Africa. Methods We conducted a retrospective folder review of patients presenting with hepatitis A at two tertiary level hospitals providing care for urban communities of metropolitan Cape Town, South Africa. Patients included in this folder review tested positive for hepatitis A immunoglobulin M between 1 January 2008 and 1 March 2018. Results In total, 239 folders of hepatitis A paediatric patients < 15 years old and 212 folders of hepatitis A adult patients $$\ge$$ ≥ 15 years old were included in the study. Before presenting for tertiary level care, more than half of patients presented for an initial consultation at either a community clinic or general physician. The mean length of hospital stay was 7.45 days for adult patients and 3.11 days for paediatric patients. Three adult patients in the study population died as a result of hepatitis A infection and 29 developed complicated hepatitis A. One paediatric patient in the study population died as a result of hepatitis A infection and 27 developed complicated hepatitis A, including 4 paediatric patients diagnosed with acute liver failure. The total cost per hepatitis A hospitalisation was $1935.41 for adult patients and$563.06 for paediatric patients, with overhead costs dictated by the length of stay being the largest cost driver. Conclusion More than 1 in every 10 hepatitis A cases (13.3%) included in this study developed complicated hepatitis A or resulted in death. Given the severity of clinical outcomes and high costs associated with hepatitis A hospitalisation, it is important to consider the introduction of hepatitis A immunisation in the public sector in South Africa to potentially avert future morbidity, mortality, and healthcare spending

Development and application of the DePtH framework for categorising the agentic demands of population health interventions [Pre-print]

The ‘agentic demand’ of population health interventions may influence intervention effectiveness and equity, yet the absence of an adequate framework to classify agentic demands limits the fields’ advancement. We systematically developed the DEmands for PopulaTion Health Interventions (DePtH) framework identifying three constructs influencing agentic demand - exposure (initial contact with intervention), mechanism of action (how the intervention enables or discourages behaviour), and engagement (recipient response), combined into twenty classifications. We conducted expert qualitative feedback and reliability testing, revised the framework and applied it in a proof-of-concept review, combining it with data on overall effectiveness and equity of dietary and physical activity interventions. Intervention components were concentrated in a small number of classifications; DePtH classification appeared to be related to intervention equity but not effectiveness. This framework holds potential for future research, policy and practice, facilitating the design, selection, evaluation and synthesis of evidence

Development and application of the Demands for Population Health Interventions (Depth) framework for categorising the agentic demands of population health interventions

Background: The ‘agentic demand’ of population health interventions (PHIs) refers to the capacity, resources and freedom to act that interventions demand of their recipients to benefit, which have a socio-economical pattern. Highly agentic interventions, e.g. information campaigns, rely on recipients noticing and responding to the intervention and thus might affect intervention effectiveness and equity. The absence of an adequate framework to classify agentic demands limits the fields’ ability to systematically explore these associations. Methods: We systematically developed the Demands for Population Health Interventions (Depth) framework using an iterative approach: (1) Developing the Depth framework by systematically identifying examples of PHIs aiming to promote healthier diets and physical activity, coding of intervention actors and actions and synthesising the data to develop the framework; (2) Testing the Depth framework in online workshops with academic and policy experts and a quantitative reliability assessment. We applied the final framework in a proof-of-concept review, extracting studies from three existing equity focused systematic reviews on framework category, overall effectiveness and differential socioeconomic effects and visualised the findings in Harvest Plots. Results: The Depth framework identifies three constructs influencing agentic demand: exposure - initial contact with intervention (2 levels), mechanism of action - how the intervention enables or discourages behaviour (5 levels), and engagement - recipient response (2 levels). When combined, these constructs form a matrix of twenty possible classifications. In the proof-of-concept review, we classified all components of 31 interventions according to the Depth framework. Intervention components were concentrated in a small number of Depth classifications; Depth classification appeared to be related to intervention equity but not effectiveness. Conclusions: This framework holds potential for future research, policy and practice, facilitating the design, selection and evaluation of interventions and evidence synthesis