Ascertainment of childhood vaccination histories in northern Malawi

OBJECTIVE: To assess factors related to recorded vaccine uptake, which may confound the evaluation of vaccine impact.METHODS: Analysis of documented vaccination histories of children under 5 years and demographic and socio-economic characteristics collected by a demographic surveillance system in Karonga District, Malawi. Associations between deviations from the standard vaccination schedule and characteristics that are likely to be associated with increased mortality were determined by multivariate logistic regression.RESULTS: Approximately 78% of children aged 6-23 months had a vaccination document, declining to <50% by 5 years of age. Living closer to an under-5 clinic, having a better educated father, and both parents being alive were associated with having a vaccination document. For a small percentage of children, vaccination records were incomplete and/or faulty. Vaccination uptake was high overall, but delayed among children living further from the nearest under-5 clinic or from poorer socio-economic backgrounds. Approximately 9% of children had received their last dose of DPT with or after measles vaccine. These children were from relatively less educated parents, and were more likely to have been born outside the health services.CONCLUSIONS: Though overall coverage in this community was high and variation in coverage according to child or parental characteristics small, there was strong evidence of more timely coverage among children from better socio-economic conditions and among those who lived closer to health facilities. These factors are likely to be strong confounders in the association of vaccinations with mortality, and may offer an alternative explanation for the non-specific mortality impact of vaccines described by other studies

Lessons for the past : Third World evidence and the reinterpretation of developed world mortality declines

Measles is the largest single killing infection of children in the world, and it is likely that its toll is heightened by the occurrence of a serious delayed effect of early infection. Variations in measles mortality, and in the seriousness of infection, have often been explained in terms of nutritional factors, but intercountry comparisons within the Third World fail to bear this out. In this paper an alternative interpretation is developed, based on the severity of the infective dose to which individuals are exposed. It is shown that this can account for a wide variety of observations which are inexplicable on the nutritional hypothesis, and can also explain the severity of virginsoil epidemics without reference to the effects of genetic selection. The exposure hypothesis predicts that measles vaccination should have a marked effect on childhood mortality as a whole, and this prediction is born out in practice. The success of this interpretation has important implications for our understanding of historical mortality declines in the developed countries, particularly the decline in smallpox mortality

A randomized trial of a standard dose of Edmonston-Zagreb measles vaccine given at 4.5 months of age: effect on total hospital admissions.

Observational studies and trials from low-income countries indicate that measles vaccine has beneficial nonspecific effects, protecting against non-measles-related mortality. It is not known whether measles vaccine protects against hospital admissions. Between 2003 and 2007, 6417 children who had received the third dose of diphtheria, tetanus, and pertussis vaccine were randomly assigned to receive measles vaccine at 4.5 months or no measles vaccine; all children were offered measles vaccine at 9 months of age. Using hospital admission data from the national pediatric ward in Bissau, Guinea-Bissau, we compared admission rates between enrollment and the 9-month vaccination in Cox models, providing admission hazard rate ratios (HRRs) for measles vaccine versus no measles vaccine. All analyses were conducted stratified by sex and reception of neonatal vitamin A supplementation (NVAS). Before enrollment the 2 groups had similar admission rates. Following enrollment, the measles vaccine group had an admission HRR of 0.70 (95% confidence interval [CI], .52-.95), with a ratio of 0.53 (95% CI, .32-.86) for girls and 0.86 (95% CI, .58-1.26) for boys. For children who had not received NVAS, the admission HRR was 0.53 (95% CI, .34-.84), with an effect of 0.30 (95% CI, .13-.70) for girls and 0.73 (95% CI, .42-1.28) for boys (P = .08, interaction test). The reduction in admissions was separately significant for measles infection (admission HRR, 0 [95% CI, 0-.24]) and respiratory infections (admission HRR, 0.37 [95% CI, .16-.89]). Early measles vaccine may have major benefits for infant morbidity patterns and healthcare costs. Clinical trials registration NCT00168558

CLIMATE CHANGE AND HOMELESSNESS IN DENVER, COLORADO: THE EFFECTS OF EXTREME HEAT AND REDUCED AIR QUALITY ON UNHOUSED POPULATIONS

Climate change is expected to have very intense impacts on the climate of Denver, Colorado. There will be an increase in the severity of heat waves, droughts, wildfires, and air pollution. At the same time, there are over 9,000 individuals experiencing homelessness every day in the city. Previous studies have noted that various social and economic factors, as well as constant exposure to the elements, lead to higher vulnerability amongst the homeless. This research aims to illuminate how climate change affects the homeless living in Denver and evaluate local responses. Understanding these concerns will help to better inform climate mitigation and adaptation policies. A review of the literature demonstrates how the homeless will experience greater mortality and suffering because of extreme heat and poor air quality in Denver. However, as of 2022, the City and County of Denver have not made sufficient efforts to include unhoused populations in their climate justice efforts for mitigation, adaptation, and resiliency to climate change. Interviews conducted with those who have lived experience of homelessness suggest that there is a great need for additional resources and policies tailored to their concerns. Improving the homeless communities’ quality of life can increase their resiliency to climate change. This means improving local housing, hygiene, food, and mental health services. Safer and cleaner outdoor spaces and shelters need to be provided to those in need of emergency or temporary shelter. Denver’s camping ban is not an effective policy measure to help the homeless in the face of the changing climate, as it leads to negative physical and mental health outcomes, as well as prevents people from creating shelter from the elements. Climate policies should consult the unhoused and formally address their vulnerability within Denver. Further research is needed to properly assess where and how the homeless will be most affected by the changing climate. Education and advocacy are also important to consider moving forward. The homeless should be given resources to protect themselves from changing climate patterns, and there is a great need for more compassion toward the homeless

Estimates of measles case fatality ratios: a comprehensive review of community-based studies.

BACKGROUND: Global deaths from measles have decreased notably in past decades, due to both increases in immunization rates and decreases in measles case fatality ratios (CFRs). While some aspects of the reduction in measles mortality can be monitored through increases in immunization coverage, estimating the level of measles deaths (in absolute terms) is problematic, particularly since incidence-based methods of estimation rely on accurate measures of measles CFRs. These ratios vary widely by geographic and epidemiologic context and even within the same community from year-to-year. METHODS: To understand better the variations in CFRs, we reviewed community-based studies published between 1980 and 2008 reporting age-specific measles CFRs. RESULTS: The results of the search consistently document that measles CFRs are highest in unvaccinated children under age 5 years; in outbreaks; the lowest CFRs occur in vaccinated children regardless of setting. The broad range of case and death definitions, study populations and geography highlight the complexities in extrapolating results for global public health planning. CONCLUSIONS: Values for measles CFRs remain imprecise, resulting in continued uncertainty about the actual toll measles exacts

Commentary: Challenging public health orthodoxies—prophesy or heresy?†

In 1633, after many years of skirmishing with the Catholic Church over his support for Copernicus’ heliocentric theory of the universe, Galileo was finally sentenced by the inquisition to prison and religious penances. In a formal ceremony at the church of Santa Maria Sofia Minerva, he was forced to abjure his errors, and spent the rest of his life under house arrest in Sienna. The prophet had been convicted as a heretic. Without, yet, wishing to confer the status of prophet on Peter Aaby and his disciples based in Guinea Bissau, there are significant parallels in their persistent challenges to some of the deepest rooted public health orthodoxies of the present day. Aaby has a long history of interrogating datasets in a way that others hav