Effectiveness of the polysaccharide pneumococcal vaccine among HIV-infected persons in Brazil: a case control study

Abstract\ud \ud \ud \ud Background\ud \ud Polysaccharide pneumococcal vaccine is recommended for use in HIV-infected adults in Brazil but there is uncertainty about its effectiveness in this patient population.\ud The main objective of this study was to assess the effectiveness of the 23-valent polysaccharide pneumococcal vaccine against invasive pneumococcal infection among HIV-infected adult patients in São Paulo, Brazil.\ud \ud \ud \ud Methods\ud \ud A case-control study of 79 cases and 242 controls matched on CD4+ cell count and health care setting was conducted. Among HIV-infected adults in São Paulo, Brazil, with and without S. pneumoniae recovered from a normally sterile site; prior receipt of 23 valent polysaccharide pneumococcal vaccine was determined by review of medical records and patient interview.\ud \ud \ud \ud Results\ud \ud After adjustment for confounding factors, the point estimate for the effectiveness of 23 valent polysaccharide vaccine among HIV-infected adults against all invasive pneumococcal infection was 18% (95% CI: <0 to 62%).\ud \ud \ud \ud Conclusion\ud \ud We were unable to demonstrate a statistically significant protective effect of 23 valent polysaccharide against invasive pneumococcal infection vaccine among HIV-infected adults in Brazil.\ud While the vaccine is relatively inexpensive and safe, its effectiveness among HIV-infected adults in Brazil is uncertain.Investigators by institution:Investigators by institution:Regina Rocha Gomes de Lemos, Marileide Januaria de Vasconcelos, Luis Carlos Pereira, Jr., Francisco Bonasser Filho, Roberta Schiavon Nogueira, Lucas Alberto Medeiros, Simone and Erica (Emilio Ribas Infectious Diseases Institute); Ana Teresa Rodrigues Viso and Graça Maria A. Vasconcelos (CRT DST/AIDS); Sigrid Sousa Santos (HC FMUSP and Casa da AIDS) and Marise Oliveria Fonseca (Casa da AIDS); Augusto Penalva (HC UNICAMP); Joao Mendonça and Esper Kallas (HSPE); Maria Cristina Brandileone, Silvana Tadeu Casagrande and Maria Luisa L.S. Guerra (Aldolfo Lutz Insitute); João Renato Pinho and Monica Simone (Bioquemistry Laboratory Jardins) and Ana Lucia Schmidt and Gilberto Torquato (Federal University of São Paulo).Regina Rocha Gomes de Lemos, Marileide Januaria de Vasconcelos, Luis Carlos Pereira, Jr., Francisco Bonasser Filho, Roberta Schiavon Nogueira, Lucas Alberto Medeiros, Simone and Erica (Emilio Ribas Infectious Diseases Institute); Ana Teresa Rodrigues Viso and Graça Maria A. Vasconcelos (CRT DST/AIDS); Sigrid Sousa Santos (HC FMUSP and Casa da AIDS) and Marise Oliveria Fonseca (Casa da AIDS); Augusto Penalva (HC UNICAMP); Joao Mendonça and Esper Kallas (HSPE); Maria Cristina Brandileone, Silvana Tadeu Casagrande and Maria Luisa L.S. Guerra (Aldolfo Lutz Insitute); João Renato Pinho and Monica Simone (Bioquemistry Laboratory Jardins) and Ana Lucia Schmidt and Gilberto Torquato (Federal University of São Paulo).We also thank the following individuals for their assistance: Guido Levi, Vasco Pedroso de Lima, Andre de Felice (Emilio Ribas Institute); Arthur Kalichman and Maria Clara Gianna (CRT DST/AIDS); Reinaldo Salomão (Federal University of São Paulo); Rogério de Jesus Pedro (UNICAMP); Olavo Munhoz, Eliana Gutierrez and Aloísio Segurado (Casa da AIDS) and the Emilio Ribas Center for Studies (CEER).We also thank the following individuals for their assistance: Guido Levi, Vasco Pedroso de Lima, Andre de Felice (Emilio Ribas Institute); Arthur Kalichman and Maria Clara Gianna (CRT DST/AIDS); Reinaldo Salomão (Federal University of São Paulo); Rogério de Jesus Pedro (UNICAMP); Olavo Munhoz, Eliana Gutierrez and Aloísio Segurado (Casa da AIDS) and the Emilio Ribas Center for Studies (CEER).Financial Support:Financial Support:This study was funded by the Fogarty AIDS International Training and Research Program (AITRP) through the Division of Epidemiology, School of Public Health of the University of California, Berkeley (D43 TW00003). Logistical support from the Emilio Ribas Infectious Diseases Institute, the Adolfo Lutz Institute, São Paulo State STD/AIDS Reference and Training Center, the Clinical Hospital of São Paulo State University (UNICAMP), and the Casa da AIDS. The Foundation for the Coordination of Higher Education and Graduate Training (CAPES) of the Brazilian Ministry of Education supported the main author during doutoradosanduiche.This study was funded by the Fogarty AIDS International Training and Research Program (AITRP) through the Division of Epidemiology, School of Public Health of the University of California, Berkeley (D43 TW00003). Logistical support from the Emilio Ribas Infectious Diseases Institute, the Adolfo Lutz Institute, São Paulo State STD/AIDS Reference and Training Center, the Clinical Hospital of São Paulo State University (UNICAMP), and the Casa da AIDS. The Foundation for the Coordination of Higher Education and Graduate Training (CAPES) of the Brazilian Ministry of Education supported the main author during "doutorado-sanduiche.

Early prediction of median survival among a large AIDS surveillance cohort

<p>Abstract</p> <p>Background</p> <p>For individuals with AIDS, data exist relatively soon after diagnosis to allow estimation of "early" survival quantiles (<it>e.g.</it>, the 0.10, 0.15, 0.20 and 0.30 quantiles, etc.). Many years of additional observation must elapse before median survival, a summary measure of survival, can be estimated accurately. In this study, a new approach to predict AIDS median survival is presented and its accuracy tested using AIDS surveillance data.</p> <p>Methods</p> <p>The data consisted of 96,373 individuals who were reported to the HIV/AIDS Reporting System of the California Department of Health Services Office of AIDS as of December 31, 1996. We defined cohorts based on quarter year of diagnosis (<it>e.g.</it>, the "931" cohort consists of individuals diagnosed with AIDS in the first quarter of 1993). We used early quantiles (estimated using the Inverse Probability of Censoring Weighted estimator) of the survival distribution to estimate median survival by assuming a linear relationship between the earlier quantiles and median survival. From this model, median survival was predicted for cohorts for which a median could not be estimated empirically from the available data. This prediction was compared with the actual medians observed when using updated survival data reported at least five years later.</p> <p>Results</p> <p>Using the 0.15 quantile as the predictor and the data available as of December 31, 1996, we were able to predict the median survival of four cohorts (933, 934, 941, and 942) to be 34, 34, 31, and 29 months. Without this approach, there were insufficient data with which to make any estimate of median survival. The actual median survival of these four cohorts (using data as of December 31, 2001) was found to be 32, 40, 46, and 80 months, suggesting that the accuracy for this approach requires a minimum of three years to elapse from diagnosis to the time an accurate prediction can be made.</p> <p>Conclusion</p> <p>The results of this study suggest that early and accurate prediction of median survival time after AIDS diagnosis may be possible using early quantiles of the survival distribution. The methodology did not seem to work well during a period of significant change in survival as observed with highly active antiretroviral treatment, but results suggest that it may work well in a time of more gradual improvement in survival.</p

The Association of Bay Area Health Officials: Advancing Public Health through Regional Networks

The Association of Bay Area Health Officials (ABAHO) is a regional network of 13 local health jurisdictions in the San Francisco Bay Area. Since the early 1980’s the ABAHO network has brought together representatives from Bay Area health departments to address issues ranging from the emergence of the HIV/AIDS epidemic to pandemic influenza preparedness. Utilizing both a health officials committee and a public health preparedness subcommittee, the ABAHO network leverages the expertise and resources of local health departments to advance regional public health and promote communication and collaboration among neighboring counties.

Effectiveness of the polysaccharide pneumococcal vaccine among HIV-infected persons in Brazil: a case control study

Abstract Background Polysaccharide pneumococcal vaccine is recommended for use in HIV-infected adults in Brazil but there is uncertainty about its effectiveness in this patient population. The main objective of this study was to assess the effectiveness of the 23-valent polysaccharide pneumococcal vaccine against invasive pneumococcal infection among HIV-infected adult patients in São Paulo, Brazil. Methods A case-control study of 79 cases and 242 controls matched on CD4+ cell count and health care setting was conducted. Among HIV-infected adults in São Paulo, Brazil, with and without S. pneumoniae recovered from a normally sterile site; prior receipt of 23 valent polysaccharide pneumococcal vaccine was determined by review of medical records and patient interview. Results After adjustment for confounding factors, the point estimate for the effectiveness of 23 valent polysaccharide vaccine among HIV-infected adults against all invasive pneumococcal infection was 18% (95% CI: Conclusion We were unable to demonstrate a statistically significant protective effect of 23 valent polysaccharide against invasive pneumococcal infection vaccine among HIV-infected adults in Brazil. While the vaccine is relatively inexpensive and safe, its effectiveness among HIV-infected adults in Brazil is uncertain.</p

Identifying postelimination trends for the introduction and transmissibility of measles in the United States.

The continued elimination of measles requires accurate assessment of its epidemiology and a critical evaluation of how its incidence is changing with time. National surveillance of measles in the United States between 2001 and 2011 provides data on the number of measles introductions and the size of the resulting transmission chains. These data allow inference of the effective reproduction number, Reff, and the probability of an outbreak occurring. Our estimate of 0.52 (95% confidence interval: 0.44, 0.60) for Reff is smaller than prior results. Our findings are relatively insensitive to the possibility that as few as 75% of cases were detected. Although we confirm that measles remains eliminated, we identify an increasing trend in the number of measles cases with time. We show that this trend is likely attributable to an increase in the number of disease introductions rather than a change in the transmissibility of measles. However, we find that transmissibility may increase substantially if vaccine coverage drops by as little as 1%. Our general approach of characterizing the case burden of measles is applicable to the epidemiologic assessment of other weakly transmitting or vaccine-controlled pathogens that are either at risk of emerging or on the brink of elimination

The epidemiology and surveillance response to pandemic influenza A (H1N1) among local health departments in the San Francisco Bay Area

Abstract Background Public health surveillance and epidemiologic investigations are critical public health functions for identifying threats to the health of a community. Very little is known about how these functions are conducted at the local level. The purpose of the Epidemiology Networks in Action (EpiNet) Study was to describe the epidemiology and surveillance response to the 2009 pandemic influenza A (H1N1) by city and county health departments in the San Francisco Bay Area in California. The study also documented lessons learned from the response in order to strengthen future public health preparedness and response planning efforts in the region. Methods In order to characterize the epidemiology and surveillance response, we conducted key informant interviews with public health professionals from twelve local health departments in the San Francisco Bay Area. In order to contextualize aspects of organizational response and performance, we recruited two types of key informants: public health professionals who were involved with the epidemiology and surveillance response for each jurisdiction, as well as the health officer or his/her designee responsible for H1N1 response activities. Information about the organization, data sources for situation awareness, decision-making, and issues related to surge capacity, continuity of operations, and sustainability were collected during the key informant interviews. Content and interpretive analyses were conducted using ATLAS.ti software. Results The study found that disease investigations were important in the first months of the pandemic, often requiring additional staff support and sometimes forcing other public health activities to be put on hold. We also found that while the Incident Command System (ICS) was used by all participating agencies to manage the response, the manner in which it was implemented and utilized varied. Each local health department (LHD) in the study collected epidemiologic data from a variety of sources, but only case reports (including hospitalized and fatal cases) and laboratory testing data were used by all organizations. While almost every LHD attempted to collect school absenteeism data, many respondents reported problems in collecting and analyzing these data. Laboratory capacity to test influenza specimens often aided an LHD’s ability to conduct disease investigations and implement control measures, but the ability to test specimens varied across the region and even well-equipped laboratories exceeded their capacity. As a whole, the health jurisdictions in the region communicated regularly about key decision-making (continued on next page) (continued from previous page) related to the response, and prior regional collaboration on pandemic influenza planning helped to prepare the region for the novel H1N1 influenza pandemic. The study did find, however, that many respondents (including the majority of epidemiologists interviewed) desired an increase in regional communication about epidemiology and surveillance issues. Conclusion The study collected information about the epidemiology and surveillance response among LHDs in the San Francisco Bay Area that has implications for public health preparedness and emergency response training, public health best practices, regional public health collaboration, and a perceived need for information sharing

Identifying postelimination trends for the introduction and transmissibility of measles in the United States.

The continued elimination of measles requires accurate assessment of its epidemiology and a critical evaluation of how its incidence is changing with time. National surveillance of measles in the United States between 2001 and 2011 provides data on the number of measles introductions and the size of the resulting transmission chains. These data allow inference of the effective reproduction number, Reff, and the probability of an outbreak occurring. Our estimate of 0.52 (95% confidence interval: 0.44, 0.60) for Reff is smaller than prior results. Our findings are relatively insensitive to the possibility that as few as 75% of cases were detected. Although we confirm that measles remains eliminated, we identify an increasing trend in the number of measles cases with time. We show that this trend is likely attributable to an increase in the number of disease introductions rather than a change in the transmissibility of measles. However, we find that transmissibility may increase substantially if vaccine coverage drops by as little as 1%. Our general approach of characterizing the case burden of measles is applicable to the epidemiologic assessment of other weakly transmitting or vaccine-controlled pathogens that are either at risk of emerging or on the brink of elimination