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Chard AN, Nogareda F, Regan AK, Barraza MFO, Fasce RA, Vergara N, Avendaño M, Penayo E, Vázquez C, Von Horoch M, Michel F, Alfonso A, Mogdasy C, Chiparelli H, Goñi N, Alegretti M, Loayza S, Couto P, Rodriguez A, Salas D, Fowlkes AL, Azziz-Baumgartner E. End-of-season influenza vaccine effectiveness during the Southern Hemisphere 2022 influenza season - Chile, Paraguay, and Uruguay. Int J Infect Dis 2023; 134:39-44. [PMID: 37201863 PMCID: PMC10404161 DOI: 10.1016/j.ijid.2023.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/27/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVES This study estimated the 2022 end-of-season influenza vaccine effectiveness (VE) against severe acute respiratory illness (SARI) hospitalization in Chile, Paraguay, and Uruguay. METHODS We pooled surveillance data from SARI cases in 18 sentinel surveillance hospitals in Chile (n = 9), Paraguay (n = 2), and Uruguay (n = 7) from March 16-November 30, 2022. VE was estimated using a test-negative design and logistic regression models adjusted for country, age, sex, presence of ≥1 comorbidity, and week of illness onset. VE estimates were stratified by influenza virus type and subtype (when available) and influenza vaccine target population, categorized as children, individuals with comorbidities, and older adults, defined per countries' national immunization policies. RESULTS Among the 3147 SARI cases, there were 382 (12.1%) influenza test-positive case patients; 328 (85.9%) influenza case patients were in Chile, 33 (8.6%) were in Paraguay, and 21 (5.5%) were in Uruguay. In all countries, the predominant subtype was influenza A(H3N2) (92.6% of influenza cases). Adjusted VE against any influenza-associated SARI hospitalization was 33.8% (95% confidence interval: 15.3%, 48.2%); VE against influenza A(H3N2)-associated SARI hospitalization was 30.4% (95% confidence interval: 10.1%, 46.0%). VE estimates were similar across target populations. CONCLUSION During the 2022 influenza season, influenza vaccination reduced the odds of hospitalization among those vaccinated by one-third. Health officials should encourage influenza vaccination in accordance with national recommendations.
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Affiliation(s)
- Anna N Chard
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, USA.
| | | | - Annette K Regan
- Pan American Health Organization, Washington DC, USA; School of Nursing and Health Professions, University of San Francisco, San Francisco, USA; Fielding School of Public Health, University of California Los Angeles, Los Angeles, USA
| | | | - Rodrigo A Fasce
- Virology Department, Public Health Institute of Chile, Santiago, Chile
| | | | | | - Elena Penayo
- Ministry of Public Health and Social Welfare, Asunción, Paraguay
| | - Cynthia Vázquez
- Ministry of Public Health and Social Welfare, Asunción, Paraguay
| | - Marta Von Horoch
- Ministry of Public Health and Social Welfare, Asunción, Paraguay
| | | | | | | | | | | | | | - Sergio Loayza
- Pan American Health Organization, Washington DC, USA
| | - Paula Couto
- Pan American Health Organization, Washington DC, USA
| | | | - Daniel Salas
- Pan American Health Organization, Washington DC, USA
| | - Ashley L Fowlkes
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, USA
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Liu T, Wang P, Meng F, Ding G, Wu J, Song S, Sun L, Zhang S, Li Z, Xing W, Wang X. Incidence, circulation, and spatiotemporal analysis of seasonal influenza in Shandong, China, 2008-2019: A retrospective study. Influenza Other Respir Viruses 2022; 16:594-603. [PMID: 35014171 PMCID: PMC8983897 DOI: 10.1111/irv.12959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Understanding the influenza-like illness (ILI) incidence, circulation pattern of virus strains and spatiotemporal pattern of influenza transmission are important for designing control interventions. Based on the 10 years' surveillance data, we aimed to provide a baseline characterization and the epidemiology and dynamics of influenza virus in Shandong. METHODS We extracted surveillance and laboratory testing data. We estimated the ILI incidence and analyzed the predominant virus. A wavelet power analysis was used to illustrate the periodicity. In addition, we applied a linear regression model to characterize the correlation of influenza seasonality with longitude. RESULTS The average ILI incidence was estimated to be 3744.79 per 1 million (95% confidence interval [CI]: 2558.09-4931.45) during 2009-2018. Influenza A/H1N1 and A/H3N2 strains predominated in the most influenza seasons in Shandong. The annual amplitude of influenza epidemics decreased with longitude (P < 0.05). In contrast, the epidemic peak of influenza emerged earlier in the western region and increased with longitude in influenza A (P < 0.05). The annual peak of the influenza B epidemic lagged a median of 4.2 weeks compared with that of influenza A. CONCLUSIONS The development or modification of seasonal influenza vaccination strategies requires the recognition that the incidence is higher in preschool- and school-aged children. Although seasonal influenza circulates annually in Shandong, the predominant virus strain circulation pattern is extremely unpredictable and strengthening surveillance for the predominant virus strain is necessary. Lower longitude inland regions need to take nonpharmaceutical or pharmaceutical interventions in advance during influenza high-occurrence seasons.
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Affiliation(s)
- Ti Liu
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Ping Wang
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai'an, China
| | - Fanyu Meng
- Statistical Analysis Center, Linyi Central Hospital, Linyi, China
| | - Guoyong Ding
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai'an, China
| | - Julong Wu
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Shaoxia Song
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Lin Sun
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Shengyang Zhang
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Zhong Li
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Weijia Xing
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai'an, China
| | - Xianjun Wang
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
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Knowledge, attitudes, and practices of seasonal influenza vaccination among older adults in nursing homes and daycare centers, Honduras. PLoS One 2021; 16:e0246382. [PMID: 33571242 PMCID: PMC7877760 DOI: 10.1371/journal.pone.0246382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/16/2021] [Indexed: 12/23/2022] Open
Abstract
Background Older adults represent 70–90% of seasonal influenza-related deaths and 50–70% of influenza-related hospitalizations. Vaccination is the most efficient means of preventing influenza and reducing influenza-related illnesses. We aimed to describe knowledge, attitudes, and practices (KAP) of seasonal influenza vaccination among older adults in Honduras. Methods From August 29–October 26, 2018, we conducted a cross-sectional KAP survey regarding seasonal influenza vaccinations to samples of older adults 1) admitted to nursing homes and 2) attending daycare centers. We used the Minimental State Examination (MMSE) psychometric tool to assess the cognitive status of older adults and included participants with scores of ≥23 points in the survey. We reported frequency distributions for demographics, KAP of influenza virus and vaccination, and vaccination coverage. We used logistic regression to analyze associations between demographics and verified influenza vaccination. Results Of 511 MMSE participants, 341 completed the survey (95 adults in 12 nursing homes and 246 older adults in ten daycare centers). Almost all participants knew that influenza causes severe illness and may be transmitted from person to person, vaccination is safe and protects against disease, and older adults have greater risk of complications. Of 284 participants with verified vaccinations, 81.3% were vaccinated for influenza: 87.9% attending daycare centers and 61.4% in nursing homes. Among all participants, verified current influenza vaccination was associated with self-reported influenza vaccination in previous year (aOR: 14.05; 95% CI: 5.36–36.81); no formal education (aOR: 4.83; 95% CI: 1.63–14.37) or primary school education (aOR: 4.51; 95% CI: 1.79–11.37) having ≥secondary as reference; and indigenous (aOR: 4.55; 95% CI: 1.18–17.49) having Mestizo as reference. Reasons for vaccination were perceived self-benefits, protection against influenza complications, favorable vaccination hours, and healthcare provider recommendations. Conclusion Four-fifths of older adults were vaccinated for seasonal influenza. Educational efforts provided in conjunction with vaccination campaigns resulted in high knowledge of influenza virus, transmission, and vaccination. Further outreach regarding disease risks and vaccine safety needs to be directed towards older adults in nursing homes who had lower knowledge and coverage than older adults in daycare centers.
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Madewell ZJ, Chacón-Fuentes R, Jara J, Mejía-Santos H, Molina IB, Alvis-Estrada JP, Coello-Licona R, Montejo B. Knowledge, attitudes, and practices of seasonal influenza vaccination in postpartum women, Honduras. PLoS One 2021; 16:e0246385. [PMID: 33571256 PMCID: PMC7877664 DOI: 10.1371/journal.pone.0246385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/16/2021] [Indexed: 12/20/2022] Open
Abstract
Background Influenza during pregnancy may cause serious neonatal outcomes including stillbirth, fetal distress, preterm birth, congenital abnormalities, and stunted growth. Pregnant women are the highest priority group for seasonal influenza vaccination, but low coverage has been repeatedly reported in this population. Understanding reasons for and for not receiving the seasonal influenza vaccine is needed to design communication strategies to increase vaccination coverage. This study aimed to describe knowledge, attitudes, and practices (KAP) of seasonal influenza vaccination among women giving birth in public maternity hospitals in Honduras. Methods From August 20–October 8, 2018, we conducted a cross-sectional KAP survey regarding seasonal influenza vaccinations to a sample of postpartum women who gave birth in maternity hospitals and clinics from the Ministry of Health of Honduras and Honduran Social Security Institute. We reported frequency distributions for demographics, KAP of influenza vaccine, and vaccination coverage. We used logistic regression to analyze unadjusted and adjusted associations between sociodemographic characteristics and influenza vaccination. Results We surveyed 842 postpartum women in 17 healthcare facilities. Of 534 postpartum women with term pregnancy and verified vaccinations, 417 (78.1%; 95% CI: 74.6–81.6%) were vaccinated for influenza. Factors associated with verified influenza vaccination included receipt of vaccination recommendations by a healthcare worker during prenatal check-ups (aOR: 16.46; 95% CI: 9.73–27.85), concurrent chronic disease (aOR: 5.00; 95% CI: 1.25–20.07), and influenza vaccination of other children in the household (aOR: 2.28; 95% CI: 1.19–4.39). The most cited reasons for vaccination were perceived benefits for both mother and infant and easy access. Reasons for non-vaccination were: vaccine was not offered and fear of side effects, harm to the infant, and needles or pain caused by injection. Conclusion Influenza vaccination was well received among postpartum women in Honduras. Increasing clinician recommendations for vaccination and assuring the vaccine is readily available to women during prenatal visits may increase vaccination rates.
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Affiliation(s)
- Zachary J. Madewell
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
- * E-mail:
| | - Rafael Chacón-Fuentes
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Jorge Jara
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Homer Mejía-Santos
- Unidad de Vigilancia de la Salud, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | - Ida-Berenice Molina
- Programa Ampliado de Inmunizaciones, Secretaría de Salud de Honduras, Tegucigalpa, Honduras
| | | | - Rosa Coello-Licona
- Vigilancia Epidemiológica, Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras
| | - Belinda Montejo
- Vigilancia Epidemiológica, Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras
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Gentile A, Paget J, Bellei N, Torres JP, Vazquez C, Laguna-Torres VA, Plotkin S. Influenza in Latin America: A report from the Global Influenza Initiative (GII). Vaccine 2019; 37:2670-2678. [PMID: 30975568 DOI: 10.1016/j.vaccine.2019.03.081] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 03/29/2019] [Accepted: 03/31/2019] [Indexed: 01/01/2023]
Abstract
The Global Influenza Initiative (GII) is a global expert group that aims to raise acceptance and uptake of influenza vaccines globally and provides recommendations and strategies to address challenges at local, national, regional, and global levels. This article provides a consolidated estimation of disease burden in Latin America, currently lacking in published literature, and delivers the GII recommendations specific to Latin America that provide guidance to combat existing vaccination challenges. While many countries worldwide, especially in the tropics and subtropics, do not have a seasonal influenza policy, 90% of Latin American countries have a seasonal influenza policy in place. Local governments in the Latin American countries and The Pan American Health Organization's Technical Advisory Group on Vaccine-preventable Diseases play a major role in improving the vaccination coverage and reducing the overall disease burden. Influenza seasonality poses the biggest challenge in deciding on optimal timing for vaccination in Latin America, as in temperate climates seasonal influenza activity peaks during the winter months (November-February and May-October) in the northern and southern hemispheres, respectively, while in the tropics and subtropical regions it usually occurs throughout the year, but especially during the rainy season. Besides this, vaccine mismatch with circulating strains, misconception concerning influenza vaccine effectiveness, and poor disease and vaccine awareness among the public are also key challenges that need to be overcome. Standardization of clinical case definitions is important across all Latin American countries. Surveillance (mostly passive) has improved substantially in the Latin American countries over the past decade, but more is still required to better understand the disease burden and help inform policies.
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Affiliation(s)
- Angela Gentile
- Ricardo Gutiérrez Children's Hospital, 1405 Buenos Aires, Argentina.
| | - John Paget
- Netherlands Institute for Health Services Research (NIVEL), 3513 CR Utrecht, the Netherlands.
| | - Nancy Bellei
- Department of Medicine, Federal University of São Paulo, 04024-002 São Paulo, Brazil.
| | - Juan Pablo Torres
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Faculty of Medicine, University of Chile, 1058 Santiago, Chile.
| | - Cynthia Vazquez
- Department of Virology, Central Laboratory for Public Health, 1429 Asunción, Paraguay
| | - V Alberto Laguna-Torres
- Tropical Medicine Institute Daniel A. Carrion, Virology Section, San Marcos University, 15081 Lima, Peru
| | - Stanley Plotkin
- University of Pennsylvania, Vaxconsult, Doylestown, PA 18907, USA.
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Belser JA, Johnson A, Pulit-Penaloza JA, Pappas C, Pearce MB, Tzeng WP, Hossain MJ, Ridenour C, Wang L, Chen LM, Wentworth DE, Katz JM, Maines TR, Tumpey TM. Pathogenicity testing of influenza candidate vaccine viruses in the ferret model. Virology 2017; 511:135-141. [PMID: 28846898 PMCID: PMC5791157 DOI: 10.1016/j.virol.2017.08.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/15/2017] [Accepted: 08/16/2017] [Indexed: 12/28/2022]
Abstract
The development of influenza candidate vaccine viruses (CVVs) for pre-pandemic vaccine production represents a critical step in pandemic preparedness. The multiple subtypes and clades of avian or swine origin influenza viruses circulating world-wide at any one time necessitates the continuous generation of CVVs to provide an advanced starting point should a novel zoonotic virus cross the species barrier and cause a pandemic. Furthermore, the evolution and diversity of novel influenza viruses that cause zoonotic infections requires ongoing monitoring and surveillance, and, when a lack of antigenic match between circulating viruses and available CVVs is identified, the production of new CVVs. Pandemic guidelines developed by the WHO Global Influenza Program govern the design and preparation of reverse genetics-derived CVVs, which must undergo numerous safety and quality tests prior to human use. Confirmation of reassortant CVV attenuation of virulence in ferrets relative to wild-type virus represents one of these critical steps, yet there is a paucity of information available regarding the relative degree of attenuation achieved by WHO-recommended CVVs developed against novel viruses with pandemic potential. To better understand the degree of CVV attenuation in the ferret model, we examined the relative virulence of six A/Puerto Rico/8/1934-based CVVs encompassing five different influenza A subtypes (H2N3, H5N1, H5N2, H5N8, and H7N9) compared with the respective wild-type virus in ferrets. Despite varied virulence of wild-type viruses in the ferret, all CVVs examined showed reductions in morbidity and viral shedding in upper respiratory tract tissues. Furthermore, unlike the wild-type counterparts, none of the CVVs spread to extrapulmonary tissues during the acute phase of infection. While the magnitude of virus attenuation varied between virus subtypes, collectively we show the reliable and reproducible attenuation of CVVs that have the A/Puerto Rico/9/1934 backbone in a mammalian model.
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Affiliation(s)
- Jessica A Belser
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adam Johnson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joanna A Pulit-Penaloza
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Claudia Pappas
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Melissa B Pearce
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wen-Pin Tzeng
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M Jaber Hossain
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Callie Ridenour
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Li Wang
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Li-Mei Chen
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David E Wentworth
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jacqueline M Katz
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Taronna R Maines
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Terrence M Tumpey
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Ang LW, Tien WS, Lin RTP, Cui L, Cutter J, James L, Goh KT. Characterization of influenza activity based on virological surveillance of influenza-like illness in tropical Singapore, 2010-2014. J Med Virol 2016; 88:2069-2077. [PMID: 27152935 DOI: 10.1002/jmv.24566] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2016] [Indexed: 11/10/2022]
Abstract
Singapore is situated in the tropics where the seasonality of influenza is not as well defined as that of temperate countries. We examined the circulation of influenza viruses in the community in terms of the characteristics of influenza activity. We reviewed laboratory-confirmed virological data collected between 2010 and 2014 under the national influenza surveillance programme. Influenza activity was measured by the proportion of specimens from outpatients with influenza-like illness tested positive for influenza virus based on 4-weekly moving interval. Seasonal epidemics occurred around the end of previous year or the beginning and middle of the year. Increases in influenza positivity were more pronounced when there was a change in the predominant circulating influenza virus type/subtype to influenza A(H3N2). Influenza epidemics lasted about 12 weeks on average, with longer duration when there was a change in the predominant influenza type/subtype and especially when it was associated with influenza A(H3N2). Continuous influenza surveillance is important as it could provide early warning of imminent surges in virus transmission, and allow for timely implementation of public health prevention and control interventions to minimize influenza-associated disease burden. J. Med. Virol. 88:2069-2077, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Li Wei Ang
- Epidemiology and Disease Control Division, Ministry of Health, Singapore.
| | - Wee Siong Tien
- Communicable Diseases Division, Ministry of Health, Singapore
| | | | - Lin Cui
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Jeffery Cutter
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Lyn James
- Epidemiology and Disease Control Division, Ministry of Health, Singapore
| | - Kee Tai Goh
- Communicable Diseases Division, Ministry of Health, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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