167 research outputs found
Hepatitis E virus infection in swine workers: A metaâanalysis
Hepatitis E virus (HEV) infects both humans and animals. Swine has been confirmed to be the principal natural reservoir, which raises a concern that HEV infection would be substantially increasing among swine workers. The present study calculated the pooled prevalence of IgG antibodies against HEV among swine workers and the general population in previous crossâsectional studies. We conducted a metaâanalysis comparing the prevalence of HEV infection between swine workers and the general population, including local residents, blood donors and nonâswine workers. Through searches in three databases (PubMed and OVID in English, and CNKI in Chinese) and after study selection, a total of 32 studies from 16 countries (from 1999 through 2018) were included in the metaâanalysis. A randomâeffect model was employed in the study; an I 2 statistic assessed heterogeneity, and the Eggerâs test detected publication bias. The comparative prevalence of antiâHEV IgG was pooled from the studies. Compared to the general population, the prevalence ratio (PR) for swine workers was estimated to be 1.52 (95% CI 1.38â1.76) with the I 2 being 71%. No publication bias was detected (p = 0.40). A subgroup analysis further indicated increased prevalence of antiâHEV IgG in the swine workers in Asia (PR = 1.49, 95% CI: 1.35â1.64), in Europe (PR = 1.93, 95% CI: 1.49â2.50) and in all five swineârelated occupations, including swine farmers, butchers, meat processors, pork retailers and veterinarians (PR ranged between 1.19 and 1.75). In summary, swine workers have a relatively higher prevalence of past HEV infection, and this finding is true across swineârelated occupations, which confirms zoonotic transmission between swine and swine workers.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147857/1/zph12548_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147857/2/zph12548.pd
Trends in childhood pneumococcal vaccine coverage in Shanghai, China, 2005â2011: a retrospective cohort study
Abstract
Background
In China, the pneumococcal conjugate vaccine (PCV7) and the pneumococcal polysaccharide vaccine (PPSV23) are not offered under the governmentâs Expanded Program on Immunization and are instead administered for a fee. PCV7 is more effective and covers more serotypes associated with invasive disease in children, but is also more expensive, than PPSV23. Because of their expense, there is concern that these vaccines, especially PCV7, have low uptake particularly among non-locals, migrants from outside of Shanghai. This paper characterizes the differential coverage of PCV7 and PPSV23 between locals and non-locals in Shanghai, and illustrates coverage trends over time.
Methods
In this retrospective cohort study, children born between 2005 and 2011 were sampled from the Shanghai Immunization Program Information System. Bivariate and multivariable analyses examined the relationships between demographic characteristics, residency status (non-locals vs locals), and vaccination coverage.
Results
PPSV23 coverage (29.8Â %) among children over 2Â years of age was higher than PCV7 coverage (10.1Â %) for locals and non-locals. Uptake of PCV7 increased substantially after children were 2Â years of age. Overall, non-local populations had higher PPSV23 coverage (OR: 1.34; 98Â % CI: 1.22, 1.46) but lower PCV7 coverage (OR: 0.617, 98Â % CI: 0.547, 0.695) than locals.
Conclusions
There is a need for increasing overall pneumococcal coverage in Shanghai children, particularly with the more effective PCV7 vaccine. Morbidity and mortality due to invasive pneumococcal disease for children <1Â year of age are unlikely to be mitigated if the current age-related vaccination patterns are not improved.http://deepblue.lib.umich.edu/bitstream/2027.42/117253/1/12889_2016_Article_2785.pd
Religion and Measles Vaccination in Indonesia, 1991-2017
INTRODUCTION: Some Muslim religious councils in Indonesia have ruled that measles vaccines contain haram (i.e., forbidden materials). This study evaluates the changes in measles vaccination coverage between 1991 and 2017 and compares vaccination coverage between Muslims and non-Muslims in Indonesia.
METHODS: A total of 7 cross-sectional in-person surveys of mothers in 1991-2017 in Indonesia were analyzed in 2019. Participants were asked about religion in 1991-2007, and 100 data sets of religion were imputed for 2012 and 2017. In this multiple imputation analysis, binomial regression models output prevalence differences adjusted for wealth, education, child\u27s sex, and mother\u27s age. A quadratic term for year (year X year) and an interaction term between year and religion evaluated changes in vaccination over time by religion.
RESULTS: The 7 data sets included 23,106 children aged 12-23 months, with the proportion of those who were Muslims ranging between 85% and 89% across the survey years. Between 1991 and 2017, measles vaccination coverage increased from 57% to 79% among non-Muslims and from 59% to 79% among Muslims. In the multivariable regression model, measles vaccination coverage increased by 1.6% each year (with a quadratic term of -0.05%, indicating some leveling over time). At baseline in 1991, non-Muslims had a vaccination coverage of 6.2% higher than that of Muslims, but this disparity decreased by -0.2% each year.
CONCLUSIONS: Measles vaccination increased in both Muslims and non-Muslims in Indonesia but has stagnated in recent years. Because of increased attention among Muslim groups on haram materials in vaccines since 2017, future studies should continue to examine the relationship between religion and vaccine uptake in Indonesia.
SUPPLEMENT INFORMATION: This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health
Hygienic practices and diarrheal illness among persons living in at-risk settings in Kabul, Afghanistan: a cross-sectional study
Abstract
Background
Sustained civil and military conflict, resulting in large numbers of internally displaced persons (IDP), in combination with rapid urbanization has strained public health and sanitation within cities in Afghanistan. In order to examine the association between preventive sanitary behaviors and diarrhea within two high risk settings located within Kabul, Afghanistan, this study aimed to evaluate the prevalence of hygienic practices and diarrheal illness in an IDP camp and an urban slum.
Methods
In this cross sectional study, a convenience sample of residents of an IDP camp and an urban slum in Kabul, Afghanistan, was used. Participants were asked to describe their hygienic practices and interviewers independently documented household sanitation. The knowledge and attitudes about and practice of hygienic activities to prevent diarrhea were compared between the two settings.
Results
Two hundred participants, 100 from each setting, were enrolled. Knowledge, attitudes, and practices regarding hygienic activities to prevent diarrhea were greater among the slum dwellers than the IDP. Fewer than half of participants washed their hands with soap before eating or after eating: 31Â % of slum dwellers washed before eating compared to 11Â % of IDPs (Pâ=â0.0050), and 25Â % of slum dwellers washed after defecating compared to 4Â % of IDPs (Pâ=â0.0020). The IDPs were more likely to share a latrine (Pâ=â0.0144) and less likely to disinfect their latrine than slum dwellers. Diarrhea in the household within the past 3Â months was more common in the IDP camp (54Â %) than the slum (20Â %) (Pâ=â0.0020).
Conclusions
Even though certain sanitary and hygienic practices were more common among slum dwellers than IDPs, the lack of hygienic activities in both setting indicates that interventions to change behavior, like increasing the availability of soap and encouraging hand washing, are needed. Any initiative will have to be developed in the context of pervasive illiteracy among persons in both of these settings.http://deepblue.lib.umich.edu/bitstream/2027.42/134634/1/12879_2016_Article_1789.pd
Timely measles vaccination in Tianjin, China: a cross-sectional study of immunization records and mothers
Abstract
Background
Measles is a highly infectious disease, and timely administration of two doses of vaccine can ensure adequate protection against measles for all ages in a population. This study aims to estimate the proportion of children aged 8Â months to 6Â years vaccinated on time with measles-containing vaccines (MCV) and vaccinated during the 2008 and 2010 measles supplementary immunization activities. This study also characterizes differences in mean age at vaccination and vaccination timeliness by demographic characteristics, and describes maternal knowledge of measles vaccination.
Methods
Immunization records were selected from a convenience sample of immunization clinics in Tianjin, China. From the records, overall vaccination coverage and timely vaccination coverage were calculated for different demographic groups. Mothers were also interviewed at these clinics to ascertain their knowledge of measles vaccination.
Results
Within the 329 immunization clinic records, childâs birth year and district of residence were found to be significant predictors of different measures of vaccine timeliness. Children born in 2009 had a lower age at MCV dose 2 administration (17.96Â months) than children born in 2005 (22.00Â months). Children living in Hebei, a district in the urban center of Tianjin were less likely to be vaccinated late than children living in districts further from the urban core of Tianjin. From the 31 interviews with mothers, most women believed that timely vaccination was very important and more than one dose was very necessary; most did not know whether their child needed another dose.
Conclusions
When reviewing MCV coverage in China, most studies do not consider timeliness. However, this study shows that overall vaccination coverage can greatly overestimate vaccination coverage within certain segments of the population, such as young infants.http://deepblue.lib.umich.edu/bitstream/2027.42/109549/1/12889_2014_Article_6997.pd
Pneumococcal vaccination coverage among children with sickle cell anemia, sickle cell trait, and normal hemoglobin
BackgroundChildren with sickle cell anemia and sickle cell trait are at an increased risk of invasive pneumococcal disease compared to children with normal hemoglobin. We assessed and compared pneumococcal vaccination status among these three groups.ProcedureChildren with sickle cell anemia and sickle cell trait were identified using Michigan newborn screening records (1997â2014); each child was matched to four children with normal hemoglobin based on age, Medicaid enrollment (at least 1 year from 2012â2014), race, and census tract. Vaccination records were obtained from the stateâs immunization system. Pneumococcal vaccine coverage (PCV7 or PCV13 depending on date of administration) was assessed at milestone ages of 3, 5, 7, and 16 months. The proportion of children with vaccine coverage at each milestone was calculated overall and compared among children with sickle cell anemia, sickle cell trait, and normal hemoglobin using chiâsquare tests.ResultsThe study population consisted of 355 children with sickle cell anemia, 17,319 with sickle cell trait, and 70,757 with normal hemoglobin. The proportion of children with ageâappropriate pneumococcal vaccination coverage was low at each milestone and generally decreased over time. Children with sickle cell anemia were more likely to be covered compared to children with sickle cell trait or normal hemoglobin.ConclusionsDespite higher pneumococcal vaccination coverage among children with sickle cell anemia, opportunities for improvement exist among all children. Targeted interventions will benefit from mechanisms to identify children with increased risks such as sickle cell anemia or trait to improve pneumococcal vaccination coverage among these groups.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145560/1/pbc27282.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/145560/2/pbc27282_am.pd
Chikungunya virus infection in Indonesia: a systematic review and evolutionary analysis
Abstract
Background
Despite the high number of chikungunya cases in Indonesia in recent years, comprehensive epidemiological data are lacking. The systematic review was undertaken to provide data on incidence, the seroprevalence of anti-Chikungunya virus (CHIKV) IgM and IgG antibodies, mortality, the genotypes of circulating CHIKV and travel-related cases of chikungunya in the country. In addition, a phylogenetic and evolutionary analysis of Indonesian CHIKV was conducted.
Methods
A systematic review was conducted to identify eligible studies from EMBASE, MEDLINE, PubMed and Web of Science as of October 16th 2017. Studies describing the incidence, seroprevalence of IgM and IgG, mortality, genotypes and travel-associated chikungunya were systematically reviewed. The maximum likelihood phylogenetic and evolutionary rate was estimated using Randomized Axelerated Maximum Likelihood (RAxML), and the Bayesian Markov chain Monte Carlo (MCMC) method identified the Time to Most Recent Common Ancestors (TMRCA) of Indonesian CHIKV. The systematic review was registered in the PROSPERO database (CRD42017078205).
Results
Chikungunya incidence ranged between 0.16-36.2 cases per 100,000 person-year. Overall, the median seroprevalence of anti-CHIKV IgM antibodies in both outbreak and non-outbreak scenarios was 13.3% (17.7 and 7.3% for outbreak and non-outbreak events, respectively). The median seroprevalence of IgG antibodies in both outbreak and non-outbreak settings was 18.5% (range 0.0â73.1%). There were 130 Indonesian CHIKV sequences available, of which 120 (92.3%) were of the Asian genotype and 10 (7.7%) belonged to the East/Central/South African (ECSA) genotype. The ECSA genotype was first isolated in Indonesia in 2008 and was continually sampled until 2011. All ECSA viruses sampled in Indonesia appear to be closely related to viruses that caused massive outbreaks in Southeast Asia countries during the same period. Massive nationwide chikungunya outbreaks in Indonesia were reported during 2009â2010 with a total of 137,655 cases. Our spatio-temporal, phylogenetic and evolutionary data suggest that these outbreaks were likely associated with the introduction of the ECSA genotype of CHIKV to Indonesia.
Conclusions
Although no deaths have been recorded, the seroprevalence of anti-CHIKV IgM and IgG in the Indonesian population have been relatively high in recent years following re-emergence in early 2001. There is sufficient evidence to suggest that the introduction of ECSA into Indonesia was likely associated with massive chikungunya outbreaks during 2009â2010.https://deepblue.lib.umich.edu/bitstream/2027.42/148282/1/12879_2019_Article_3857.pd
Streptococcus pneumoniae and Haemophilus influenzae type b carriage in Chinese children aged 12â18 months in Shanghai, China: a cross-sectional study
Abstract
Background
The bacteria Streptococcus pneumoniae (pneumococcus) and Haemophilus influenzae type b (Hib) are leading causes of childhood pneumonia and meningitis and are major contributors to worldwide mortality in children younger than 5Â years of age. Asymptomatic nasopharyngeal carriage of pneumococcus and Hib was determined for healthy children in Shanghai in 2009.
Methods
Children from 5 immunization clinics were enrolled in this study. Specimens from the nasopharynx were collected and cultured in Columbia and chocolate agar to identify pneumococcal and Hib carriage. Pneumococcal specimens were serotyped with the Neufeld test, and antibiotic resistance for pneumococcal and Hib specimens used the E-test method. Significance of risk factors for carriage was assessed through chi-square tests.
Results
Among 614 children, 16.6Â % had pneumococcal carriage and 8.0Â % Hib carriage. The predominant serotype of pneumococcus that was isolated was 19Â F (52.9Â %); serotype coverage was 68.6Â % for both 7-valent pneumococcal conjugate vaccine (PCV) and PCV-10, and 82.3Â % for PCV-13. Household residency and fatherâs education were both significantly related to pneumococcal and Hib carriage. The majority of S. pneumoniae isolates were sensitive to most antimicrobials but there were high levels of resistance to azithromycin (51.0Â %) and erythromycin (51.0Â %). Haemophilus influenzae isolates were sensitive to almost all antimicrobials tested although 12.2Â % of isolates were resistant to ampicillin.
Conclusions
The pneumococcal and Hib vaccines require payment, and the children with the highest burden of disease may not be receiving these vaccines. Moreover, the presence of high antibiotic susceptibility towards pneumococcus, and to a lesser extent towards Hib, underscores the need for preventive protection against these diseases. Public funding of pneumococcal and Hib vaccines would be one mechanism to increase uptake of these vaccines.http://deepblue.lib.umich.edu/bitstream/2027.42/134553/1/12879_2016_Article_1485.pd
The role of severity perceptions and beliefs in natural infections in Shanghai parentsâ vaccine decision-making: a qualitative study
Abstract
Background
China has reduced incidence of vaccine-preventable diseases through its Expanded Program on Immunization (EPI). Vaccines outside of the EPI are not provided for free by the government, however. This study explored how the stated importance of different disease and vaccine-related attributes interacted with beliefs about the immune system of a child to affect Chinese parentsâ decision to obtain a non-EPI vaccine.
Methods
Mothers and fathers of young children at immunization clinics in Shanghai, China, were interviewed about vaccine decision-making and what attributes of a disease were important when making this decision. An inductive thematic analysis explored their beliefs about disease attributes and how these related to vaccination decisions.
Results
Among the 34 interviews, severity of the diseaseâparticularly in causing long-term disabilityâwas the most commonly cited factor influencing a parentâs decision to get a vaccine for their child. Many parents believed that natural infection was preferable to vaccination, as long as disease was not severe, and many were concerned that imported vaccines were inadequate for Chinese childrenâs physical constitutions. All these beliefs could influence the decision to vaccinate.
Conclusions
Many parents do not appear to understand how and why vaccines can support development of a healthy immune system. Because severity emerged as parentsâ overriding concern when making decisions about vaccines, marketing for a childhood vaccine could focus on the severe condition that a vaccine can protect against.https://deepblue.lib.umich.edu/bitstream/2027.42/144525/1/12889_2018_Article_5734.pd
The association of religion with maternal and child health outcomes in South Asian countries
Objective Theological beliefs play an important role in cultural norms and could impact womenâs prenatal and postpartum decisions in South Asia, which has a high burden of disease in children and pregnant women. The aim of this study is to identify any associations religion may have in affecting a womanâs decision-making ability, and how that in turn affects maternal and child health, at a group level in multiple South Asian countries. Study design Cross-sectional study utilizing secondary data analysis. Methods We used Demographic and Health Surveys (DHS) between 2014 and 2018 in Afghanistan, Bangladesh, India, Maldives, Myanmar, Nepal, and Pakistan. Not every countryâs survey asked about religion, so we imputed these results based on Census data. We assessed maternal and child health through a composite coverage index (CCI), which accounts for family planning, attendance of a skilled attendant at birth, antenatal care, BCG vaccinations, 3 doses of diphtheria-tetanus-pertussis vaccine, measles vaccine, oral rehydration therapy, and seeking care if the child has pneumonia. The relationship between religion, womenâs empowerment, and CCI was assessed through linear regression models. Results The sample included 57,972 mothers who had children aged 12â23 months. CCI is observed to be affected by family income, in addition to religion and country. CCI was higher in Hindus (2.8%, 95% CI: 2.4%, 3.1%) and Buddhists (2.0%, 95% CI: 1.2%, 2.9%) than Muslims. Motherâs age, education, income, decision-making autonomy, and attitude towards beatings were all related to CCI. In a model stratified by religion, age, education, and income were significant predictors of CCI for both Muslims and non-Muslims, but were more impactful among Muslims. Conclusion Though multiple imputation had to be used to fill in gaps in religion data, this study demonstrates that maternal and child health outcomes continue to be a concern in South Asia, especially for Muslim women. Given the importance of religious beliefs, utilizing a simple indicator, such as the CCI could be helpful for monitoring these outcomes and provides a tangible first step for communities to address gaps in care resulting from disparities in maternal empowerment
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