The State of the Region: Hampton Roads 2021

[From the introductory material] This is Old Dominion University’s 22nd annual State of the Region Report. While it represents the work of many people connected in various ways to the university, the report does not constitute an official viewpoint of Old Dominion, its president, Brian O. Hemphill, Ph.D., the Board of Visitors, the Strome College of Business or the generous donors who support the activities of the Dragas Center for Economic Analysis and Policy. Over the past year, we have endured the depths of the COVID-19 pandemic, the introduction of vaccines and a return to a semblance of normality in Hampton Roads. Even as the economy recovers in the region, Virginia and the nation, we cannot forget that some have been left behind. Invigorating growth that raises the fortunes of all is the challenge that lies before us. This task will involve difficult discussions about how to diversify our economy in the coming years. Hampton Roads plays a significant role in national security, provides college education to thousands of Virginians and is culturally diverse. Given these realities and the fact that many residents live in one community and work in another, solutions to our regional challenges will require conversations and policies that span jurisdictional boundaries. If there is an overarching lesson to be learned from the pandemic, it is simply that we are all in this together

The State of the Region: Hampton Roads 2020

[From the introductory material] This is Old Dominion University’s 21st annual State of the Region Report. While it represents the work of many people connected in various ways to the university, the report does not constitute an official viewpoint of Old Dominion, its president, John R. Broderick, the Board of Visitors, the Strome College of Business or the generous donors who support the activities of the Dragas Center for Economic Analysis and Policy. Although our devotion to this work remains steadfast, our enthusiasm, admittedly, has been dampened by the COVID-19 pandemic and the toll it has taken on the region, Commonwealth and nation. In consideration of the national conversation on race and inequality, we have included additional material to shed light on how race affects economic outcomes in Hampton Roads. Hampton Roads plays a significant role in our nation’s national security, provides college education to thousands of Virginians, is working to adapt to sea level rise and is culturally diverse. There are challenges, of course, but, as the adage goes, challenge and opportunity are two sides of the same coin. To adapt, improve and overcome, we must understand where we are and where we want to go. Our work seeks to contribute to this conversation without glossing over the challenges we face

The State of the Region: Hampton Roads 2022

[From the introductory material] This is Old Dominion University’s 23rd annual State of the Region Report. While it represents the work of many people connected in various ways to the university, the report does not constitute an official viewpoint of Old Dominion, its president, Brian O. Hemphill, Ph.D., the Board of Visitors, the Strome College of Business or the generous donors who support the activities of the Dragas Center for Economic Analysis and Policy. Over the past year, we have experienced the continued uncertainty of the COVID-19 pandemic, the rise of inflation, and geopolitical shocks that have affected our daily lives. We live, for better or worse, in uncertain times, and our resilience is likely to be tested in the coming years. The question before us remains the same as in many previous reports: How can we invigorate economic growth as a region that raises the fortunes of all, not just the most fortunate? We only need to look at neighboring metropolitan areas for examples of how setting aside parochial differences and working together can yield a sum that is greater than its parts. Hampton Roads faces two generational challenges: sea-level rise and the revolution in military affairs due to the transformative impact of unmanned weapons on the modern battlefield. If challenge and opportunity are two sides of the same coin, we must move beyond talk and into action, else we may be left behind. Our work seeks to inform without minimizing the challenges facing the region or downplaying the opportunities to emerge stronger and more resilient from the experiences of the past

The State of the Region: Hampton Roads 2018

[From the introductory material] This is Old Dominion University’s 19th annual State of the Region report. While it represents the work of many people connected in various ways to the university, the report does not constitute an official viewpoint of Old Dominion, its president, John R. Broderick, the Board of Visitors, the Strome College of Business or the generous donors who support the activities of the Dragas Center for Economic Analysis and Policy. The report maintains the goal of stimulating thought and discussion that will ultimately make Hampton Roads an even better place to live. We are proud of our region’s many successes and the key role we play in national security. We also realize that it is possible to improve our performance. To do so, we must have accurate, objective information about “where we stand” so we can move to “where we want to be.

HIV Exposure and Neonatal Sepsis: A Descriptive Etiological Study

Background: Low- and middle-income countries lack data on culture-confirmed sepsis in HIV-exposed infants, despite the reported heightened risk of infectious morbidity. This study describes culture-confirmed sepsis and antibiotic resistance patterns among HIV-exposed children in a large etiological cohort study in Kampala, Uganda. Methods: This was a prospective birth cohort study based at 2 Ugandan sites, as part of the Progressing Group B Streptococcal Vaccines (PROGRESS) study. Any infant with risk factors, signs, or symptoms of infection presenting before 3 months of age had a blood culture and nasopharyngeal swab taken to determine the etiology of neonatal and young infant sepsis. Results: Among 4492 blood cultures, 460 were obtained from HIV-exposed infants. Nine infants (1.9%) had positive blood cultures. The most frequently isolated organisms were Escherichia coli, group B Streptococcus, and Streptococcus viridans, and these organisms demonstrated resistance to the common antibiotics (aminoglycosides, penicillins, and cephalosporins) used for management of suspected sepsis. A higher proportion of the exposed babies died vs HIV-unexposed (15.8 vs 11.2; P = .005). Nasopharyngeal swabs were collected from 114 infants, with 7.9% positive for at least one virus or bacterium. Conclusions: Future work is needed to investigate why mortality among HIV-exposed infants persists despite maternal antiretroviral treatment. Antimicrobial resistance is an increasing concern in this setting

Etiology and antimicrobial resistance of culture-positive infections in Ugandan infants: a cohort study of 7000 neonates and infants

Background Epidemiological evidence about the etiology and antimicrobial resistance of neonatal infections remains limited in low-resource settings. We aimed to describe the etiology of neonatal infections in a prospective observational cohort study conducted at two hospital sites in Kampala, Uganda. Methods Babies admitted to either unit with risk factors or signs of sepsis, pneumonia, or meningitis had a blood culture, nasopharyngeal swab, and lumbar puncture (if indicated) collected. Basic demographics were collected, and babies were followed up until discharge or death to determine admission outcome. Blood cultures were processed using the BACTEC system and identification confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Cerebrospinal fluid was processed using standard microbiological testing and swabs were processed using the multiplex real-time polymerase chain reaction assay. Antimicrobial susceptibilities of bacterial isolates to World Health Organization–recommended first-line antibiotics (ampicillin or benzylpenicillin and gentamicin) were assessed using e-tests. Results A total of 7323 infants with signs or risk factors for sepsis had blood cultures, 2563 had nasopharyngeal swabs, and 23 had lumbar punctures collected. Eleven percent of blood cultures and 8.6% of swabs were positive. Inpatient mortality was 12.1%, with 27.7% case fatality observed among infants with Gram-negative bloodstream infections. Escherichia coli (14.8%), Acinetobacter spp. (10.3%), and Klebsiella spp. (7.6%), were notable contributors to Gram-negative sepsis, whereas Group B Streptococcus was the predominant Gram-positive pathogen identified (13.5%). Almost 60% of Gram-negative pathogens were ampicillin- and gentamicin-resistant

Epidemiology of Group B Streptococcus: Maternal colonization and infant disease in Kampala, Uganda

Background Child survival rates have improved globally, but neonatal mortality due to infections, such as group B Streptococcus (GBS), remains a significant concern. The global burden of GBS-related morbidity and mortality is substantial. However, data from low and middle-income countries is lacking. Vaccination during pregnancy could be a feasible strategy to address GBS-related disease burden. Methods We assessed maternal rectovaginal GBS colonization and neonatal disease rates in a prospective cohort of 6062 women-infant pairs. Surveillance for invasive infant disease occurred in parallel at two Kampala hospital sites. In a nested case-control study, we identified infants <90 days of age with invasive GBS disease (iGBS) (n=24) and healthy infants born to mothers colonized with GBS (n=72). We measured serotype-specific anti-capsular immunoglobulin G in cord blood/infant sera using a validated multiplex Luminex assay. Results We found a high incidence of iGBS (1.0 per 1,000 live births) within the first 90 days of life across the surveillance sites, associated with a high case fatality rate (18.2%). Maternal GBS colonization prevalence was consistent with other studies in the region (14.7%; 95% confidence interval 13.7-15.6%). IgG geometric mean concentrations were lower in cases than controls for serotypes Ia (0.005 vs 0.12 µg/mL; p=0.05), III (0.011 vs 0.036 µg/mL; p=0.07) and in an aggregate analysis of all serotypes, (0.014 vs 0.05 µg/mL; p=0.02). Conclusions We found that GBS is an important cause of neonatal and young infant disease in Uganda and confirmed that maternally derived antibodies were lower in early-onset GBS cases than in healthy exposed controls

Infectious causes of stillbirths: a descriptive etiological study in Uganda

Background Every year an estimated 2–3 million babies are stillborn, with a high burden in Africa. Infection is an important driver of stillbirth. There is a lack of data on the bacterial causes of stillbirth in Uganda, contributing to a lack of interventions such as effective prophylaxis and development of maternal vaccine options against the most implicated pathogens. Methods The PROGRESS study was an observational cohort study undertaken in Kampala, Uganda, between November 2018 and April 2021. If a woman delivered a stillborn baby, consent was sought for the collection of a heart-blood aspirate. One to three mL of blood was collected and sent for culture using the BD Bactec blood culture system. Organism identification was performed using biochemical testing and matrix-assisted laser desorption/ionization–time of flight mass spectrometry. Susceptibilities to appropriate panels of antimicrobials were determined by agar dilution. Results Kawempe Hospital registered 34 517 births in the study period, of which 1717 (5.0%) were stillbirths. A total of 581 (33.8%) were recruited into the study, and heart blood aspirates were performed on 569 (97.9%). Blood samples were sufficient for analysis of 476, with a total of 108 positive cultures (22.7% of sampled stillbirths). Fifty-nine of 108 blood cultures contained organisms that were considered potential pathogens, giving a pathogen positivity rate of 12.4%. Common pathogens included Enterococcus spp. (n = 14), Escherichia coli (n = 13), viridans streptococci (n = 18), Klebsiella pneumoniae (n = 6), and group B Streptococcus (n = 5). Gram-negative organisms were frequently resistant to commonly used first-line antimicrobials. Conclusions The high proportion of stillbirths caused by likely pathogenic bacteria in Uganda highlights the potential for prevention with prophylaxis and stresses the need for further investment in this area