Diphtheria and tetanus seroepidemiology among children in Ukraine, 2017

Global analysis of tetanus incidence and mortality in children under 5 years: findings from the Global Burden of Disease Study 2021

BACKGROUND

Understanding trends in the incidence and mortality of tetanus in infants and young children is essential to develop prevention and intervention strategies.

METHODS

Data on tetanus incidence and mortality among children aged under 5 years from 1990 to 2021 were obtained from the Global Burden of Disease Study 2021. Estimated annual percentage changes were calculated to assess the trends in the change of children's tetanus incidence and mortality and the burden of disease. The relationship between disease burden and Sociodemographic Index (SDI) was also analysed.

RESULTS

Globally, the incidence of children's tetanus decreased from 308 931 cases in 1990 to 17 788 cases in 2021. Similarly, tetanus mortality among children has decreased significantly over the past 30 years, from 24.62 per 100 000 to 1.34 per 100 000, with little gender difference observed. The highest rates were seen in the Caribbean, Central Sub-Saharan Africa, Eastern Sub-Saharan Africa, North Africa and the Middle East, South Asia, Southeast Asia and Western Sub-Saharan Africa. The incidence and mortality of tetanus in children are significantly different in areas with different SDI levels. The incidence and mortality in areas with low SDI are higher than those in areas with high SDI.

CONCLUSION

The incidence and mortality of tetanus in children have decreased to varying degrees worldwide, but they are still high in some regions, especially in countries with low SDI, which highlights the impact of socioeconomic factors on the outcome of the disease. More targeted supportive measures are imperative for mitigating the global burden posed by children's tetanus.

Integrated Serosurveillance of Infectious Diseases Using Multiplex Bead Assays: A Systematic Review

Integrated serological surveillance (serosurveillance) involves testing for antibodies to multiple pathogens (or species) simultaneously and can be achieved using multiplex bead assays (MBAs). This systematic review aims to describe pathogens studied using MBAs, the operational implementation of MBAs, and how the data generated were synthesised. In November and December 2023, four databases were searched for studies utilising MBAs for the integrated serosurveillance of infectious diseases. Two reviewers independently screened and extracted data regarding the study settings and population, methodology, seroprevalence results, and operational implementation elements. Overall, 4765 studies were identified; 47 were eligible for inclusion, of which 41% (n = 19) investigated multiple malaria species, and 14% performed concurrent surveillance of malaria in combination with other infectious diseases (n = 14). Additionally, 14 studies (29%) investigated a combination of multiple infectious diseases (other than malaria), and seven studies examined a combination of vaccine-preventable diseases. Haiti (n = 8) was the most studied country, followed by Ethiopia (n = 6), Bangladesh (n = 3), Kenya (n = 3), and Tanzania (n = 3). Only seven studies were found where integrated serosurveillance was the primary objective. The synthesis of data varied and included the investigation of age-specific seroprevalence (n = 25), risk factor analysis (n = 15), and spatial analysis of disease prevalence (n = 8). This review demonstrated that the use of MBAs for integrated surveillance of multiple pathogens is gaining traction; however, more research and capabilities in lower- and middle-income countries are needed to optimise and standardise sample collection, survey implementation, and the analysis and interpretation of results. Geographical and population seroprevalence data can enable targeted public health interventions, highlighting the potential and importance of integrated serological surveillance as a public health tool.

Who is missed in a community-based survey: Assessment and implications of biases due to incomplete sampling frame in a community-based serosurvey, Choma and Ndola Districts, Zambia, 2022

Community-based serological studies are increasingly relied upon to measure disease burden, identify population immunity gaps, and guide control and elimination strategies; however, there is little understanding of the potential for and impact of sampling biases on outcomes of interest. As part of efforts to quantify measles immunity gaps in Zambia, a community-based serological survey using stratified multi-stage cluster sampling approach was conducted in Ndola and Choma districts in May-June 2022, enrolling 1245 individuals. We carried out a follow-up study among individuals missed from the sampling frame of the serosurvey in July-August 2022, enrolling 672 individuals. We assessed the potential for and impact of biases in the community-based serosurvey by i) estimating differences in characteristics of households and individuals included and excluded (77% vs 23% of households) from the sampling frame of the serosurvey and ii) evaluating the magnitude these differences make on healthcare-seeking behavior, vaccination coverage, and measles seroprevalence. We found that missed households were 20% smaller and 25% less likely to have children. Missed individuals resided in less wealthy households, had different distributions of sex and occupation, and were more likely to seek care at health facilities. Despite these differences, simulating a survey in which missed households were included in the sampling frame resulted in less than a 5% estimated bias in these outcomes. Although community-based studies are upheld as the gold standard study design in assessing immunity gaps and underlying community health characteristics, these findings underscore the fact that sampling biases can impact the results of even well-conducted community-based surveys. Results from these studies should be interpreted in the context of the study methodology and challenges faced during implementation, which include shortcomings in establishing accurate and up-to-date sampling frames. Failure to account for these shortcomings may result in biased estimates and detrimental effects on decision-making.

[Health Situation in Ukraine Before Onset of War and Its Relevance for Health Care for Ukrainian Refugees in Germany: Literature Review, Risk Analysis, and Priority Setting]

BACKGROUND

Health needs of refugees are not only determined by exposure to war and fleeing. Determinants during the life course also play a role. We therefore examined the health situation in Ukraine before Russia's invasion in 2022 and its relevance for health care for Ukrainian refugees in Germany from the perspective of the Public Health Service.

METHOD

Rapid search in the Medline data base, and in relevant Ukrainian and international health data bases; narrative synthesis of findings, followed by a prioritization of health problems and interventions by two medical doctors, using the risk matrix approach.

RESULTS

Immunization coverage is low for Covid-19, resulting in outbreaks in refugee shelters. There are vaccination gaps for measles and other basic immunizations, particularly in older children; children aged 2-5 years have not received the second measles dose. HIV and TB therapies may be interrupted due to the need to flee. Among elderly refugees, insufficiently treated cardiovascular diseases and pre-existing psychological trauma as well as cancers in need of acute care predominate. Ukrainian refugees may mistrust state-associated health measures, as the vaccination gaps indicate.

CONCLUSION

Refugees should be able to access curative and preventive health care without bureaucratic obstacles and entitlement restrictions. Analyzing Ukrainian health statistics and respective scientific publications helps the Public Health Service to adapt its interventions, and to avoid inefficient allocation of resources.

Systematic review of health and disease in Ukrainian children highlights poor child health and challenges for those treating refugees

Aim

Millions of Ukrainian children have been internally displaced or fled to other countries because of the Russian war. This systematic review focused on their health needs and future challenges for clinicians.

Methods

A systematic literature search of the Medline, Embase and MedRxiv databases from 1 January 2010 to 31 March 2022 identified 1628 papers on the health of Ukrainian children and 112 were relevant to this review.

Results

In 2019, under‐5 mortality was 8 per 1000 live births in Ukraine. Underweight and adverse childhood experiences, including child abuse, were frequent compared to other European countries, while childhood obesity seemed less common. Alcohol consumption was common in women of reproductive age, including during pregnancy, risking foetal alcohol syndrome. Neonatal screening programmes provided low coverage. Vaccine hesitancy was common and vaccination rates were low. Other concerns were measles, HIV, antibiotic resistance and multi‐resistant tuberculosis. Many children are expected to suffer from psychological and physical trauma due to the war. Other healthcare challenges include low COVID‐19 vaccination rates and a preference for secondary and tertiary care, rather than primary care. Many people cannot afford medication.

Conclusion

Ukrainian children often have poor health and host countries need to be aware of their needs.

Public health issues and health rendezvous for migrants from conflict zones in Ukraine: A French practice guideline

Given the number of people leaving the war zone in Ukraine and arriving in France, the French high council for public health (HCSP) has drawn up a number of recommendations. The experts have taken into account the vulnerability of migrant populations, which is exacerbated by (a) promiscuity that increases the risk of exposure to infectious agents; (b) the psychological consequences of conflict, family separation and exile; (c) prevalence in Ukraine of communicable diseases such as (possibly multi-resistant) tuberculosis, HIV and HCV; (d) low vaccination coverage (risk of circulation of poliovirus) and (e) the risk of spreading infectious diseases (Covid-19, measles…). Consequently, experts recommend that priority be given to: (i) Initial (immediate) reception, which will help to provide emergency care and to assess immediate needs (psychological disorders, risk of medication breakdown and risk of infection); (ii) Other priority measures (vaccination catch-up, including vaccination against SARS-CoV-2 and mandatory vaccination for children's entry into school, screening for post-traumatic stress disorder and tuberculosis) must be implemented as soon as feasible. At this stage, it is imperative: To ensure coordination and access to information throughout the country, by providing medico-social support (opening of social rights and access to care); To digitize medical data for the purposes of traceability; To use professional interpreting and/or health facilitators, or else, if necessary, digital translation tools. (iii) Finally, experts stress the need for vigilance in terms of management, conservation of social rights and continuity of care after the initial period, and organization of a "health rendezvous" within four months of a migrant's entering the country.

Vaccination of Ukrainian Refugees: Need for Urgent Action

The unprovoked aggression of Russian military forces on Ukraine in February 2022 has caused a high influx of refugees, including children, to neighboring countries, particularly Poland. This caused additional pressures on the healthcare system and the need to meet challenges for public health, such as those related to infectious diseases. Here, we discuss the potential epidemiological risks associated with the war-induced influx of refugees (coronavirus disease 2019, measles, pertussis, tetanus, and poliomyelitis) and highlight the need for their swift management through institutional support, educational campaigns, counteracting antiscience misinformation, and pursuing vaccinations of refugees but also improving or maintaining good levels of immunization in populations of countries welcoming them. These are necessary actions to avoid overlapping of war and infectious diseases and associated public health challenges.