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Cortes-Azuero O, Lefrancq N, Nikolay B, McKee C, Cappelle J, Hul V, Ou TP, Hoem T, Lemey P, Rahman MZ, Islam A, Gurley ES, Duong V, Salje H. The genetic diversity of Nipah virus across spatial scales. J Infect Dis 2024:jiae221. [PMID: 38682164 DOI: 10.1093/infdis/jiae221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/19/2024] [Accepted: 04/25/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Nipah virus (NiV), a highly lethal virus in humans, circulates in Pteropus bats throughout South and Southeast Asia. Difficulty in obtaining viral genomes from bats means we have a poor understanding of NiV diversity. METHODS We develop phylogenetic approaches applied to the most comprehensive collection of genomes to date (N=257, 175 from bats, 73 from humans) from six countries over 22 years (1999-2020). We divide the four major NiV sublineages into 15 genetic clusters. Using Approximate Bayesian Computation fit to a spatial signature of viral diversity, we estimate the presence and the average size of genetic clusters per area. RESULTS We find that, within any bat roost, there are an average of 2.4 co-circulating genetic clusters, rising to 5.5 clusters at areas of 1500-2000km2. We estimate that each genetic cluster occupies an average area of 1.3million km2 (95%CI: 0.6-2.3 million), with 14 clusters in an area of 100,000km2 (95%CI: 6-24). In the few sites in Bangladesh and Cambodia where genomic surveillance has been concentrated, we estimate that most clusters have been identified, but only ∼15% of overall NiV diversity has been uncovered. CONCLUSION Our findings are consistent with entrenched co-circulation of distinct lineages, even within roosts, coupled with slow migration over larger spatial scales.
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Affiliation(s)
- Oscar Cortes-Azuero
- Department of Genetics, Downing Street, University of Cambridge, Cambridge CB2 3EH, UK
| | - Noémie Lefrancq
- Department of Genetics, Downing Street, University of Cambridge, Cambridge CB2 3EH, UK
| | | | - Clifton McKee
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | | | - Vibol Hul
- Virology Unit, Institut Pasteur du Cambodge, Pasteur Network, Phnom Penh 12201, Cambodia
| | - Tey Putita Ou
- Virology Unit, Institut Pasteur du Cambodge, Pasteur Network, Phnom Penh 12201, Cambodia
| | - Thavry Hoem
- Virology Unit, Institut Pasteur du Cambodge, Pasteur Network, Phnom Penh 12201, Cambodia
| | - Philippe Lemey
- Department of Microbiology, Immunology and Transplantation, KU Leuven, BE-3000 Leuven, Belgium
| | - Mohammed Ziaur Rahman
- Department of Microbiology, Immunology and Transplantation, KU Leuven, BE-3000 Leuven, Belgium
| | - Ausraful Islam
- Department of Microbiology, Immunology and Transplantation, KU Leuven, BE-3000 Leuven, Belgium
| | - Emily S Gurley
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Veasna Duong
- Virology Unit, Institut Pasteur du Cambodge, Pasteur Network, Phnom Penh 12201, Cambodia
| | - Henrik Salje
- Department of Genetics, Downing Street, University of Cambridge, Cambridge CB2 3EH, UK
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Dighe A, Khan AI, Bhuiyan TR, Islam MT, Khan ZH, Khan II, Hulse JD, Ahmed S, Rashid M, Hossain MZ, Rashid R, Hegde ST, Gurley ES, Qadri F, Azman AS. Annual risk of hepatitis E virus infection and seroreversion: Insights from a serological cohort in Sitakunda, Bangladesh. Epidemiol Infect 2024; 152:e52. [PMID: 38497497 PMCID: PMC11022260 DOI: 10.1017/s0950268824000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/01/2024] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
Hepatitis E virus (HEV) is a major cause of acute jaundice in South Asia. Gaps in our understanding of transmission are driven by non-specific symptoms and scarcity of diagnostics, impeding rational control strategies. In this context, serological data can provide important proxy measures of infection. We enrolled a population-representative serological cohort of 2,337 individuals in Sitakunda, Bangladesh. We estimated the annual risks of HEV infection and seroreversion both using serostatus changes between paired serum samples collected 9 months apart, and by fitting catalytic models to the age-stratified cross-sectional seroprevalence. At baseline, 15% (95 CI: 14-17%) of people were seropositive, with seroprevalence highest in the relatively urban south. During the study, 27 individuals seroreverted (annual seroreversion risk: 15%, 95 CI: 10-21%), and 38 seroconverted (annual infection risk: 3%, 95CI: 2-5%). Relying on cross-sectional seroprevalence data alone, and ignoring seroreversion, underestimated the annual infection risk five-fold (0.6%, 95 CrI: 0.5-0.6%). When we accounted for the observed seroreversion in a reversible catalytic model, infection risk was more consistent with measured seroincidence. Our results quantify HEV infection risk in Sitakunda and highlight the importance of accounting for seroreversion when estimating infection incidence from cross-sectional seroprevalence data.
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Affiliation(s)
- Amy Dighe
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | | | | | - Juan Dent Hulse
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shakeel Ahmed
- Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh
| | - Mamunur Rashid
- Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh
| | - Md Zakir Hossain
- Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh
| | - Rumana Rashid
- Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh
| | - Sonia T. Hegde
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emily S. Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Firdausi Qadri
- Infectious Disease Division, icddr, b, Dhaka, Bangladesh
| | - Andrew S. Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
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Hegde ST, Lee KH, Styczynski A, Jones FK, Gomes I, Das P, Gurley ES. Potential for Person-to-Person Transmission of Henipaviruses: A Systematic Review of the Literature. J Infect Dis 2024; 229:733-742. [PMID: 37925626 PMCID: PMC10938219 DOI: 10.1093/infdis/jiad467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/22/2023] [Accepted: 10/27/2023] [Indexed: 11/06/2023] Open
Abstract
Nipah virus Bangladesh (NiVB) is a bat-borne zoonosis transmitted between people through the respiratory route. The risk posed by related henipaviruses, including Hendra virus (HeV) and Nipah virus Malaysia (NiVM), is less clear. We conducted a broad search of the literature encompassing both human infections and animal models to synthesize evidence about potential for person-to-person spread. More than 600 human infections have been reported in the literature, but information on viral shedding was only available for 40 case-patients. There is substantial evidence demonstrating person-to-person transmission of NiVB, and some evidence for NiVM. Less direct evidence is available about the risk for person-to-person transmission of HeV, but animals infected with HeV shed more virus in the respiratory tract than those infected with NiVM, suggesting potential for transmission. As the group of known henipaviruses continues to grow, shared protocols for conducting and reporting from human investigations and animal experiments are urgently needed.
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Affiliation(s)
- Sonia T Hegde
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Kyu Han Lee
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Ashley Styczynski
- Division of Infectious Diseases and Geographic Medicine, Stanford University, California
| | - Forrest K Jones
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Isabella Gomes
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Pritimoy Das
- Institute of Health and Wellbeing, Federation University Australia, Ballarat, Victoria, Australia
| | - Emily S Gurley
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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4
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Ogbuanu IU, Otieno K, Varo R, Sow SO, Ojulong J, Duduyemi B, Kowuor D, Cain CJ, Rogena EA, Onyango D, Akelo V, Tippett Barr BA, terKuile F, Kotloff KL, Tapia MD, Keita AM, Juma J, Assefa N, Assegid N, Acham Y, Madrid L, Scott JAG, Arifeen SE, Gurley ES, Mahtab S, Dangor Z, Wadula J, Dutoit J, Madhi SA, Mandomando I, Torres-Fernandez D, Kincardett M, Mabunda R, Mutevedzi P, Madewell ZJ, Blau DM, Whitney CG, Samuels AM, Bassat Q. Burden of child mortality from malaria in high endemic areas: Results from the CHAMPS network using minimally invasive tissue sampling. J Infect 2024; 88:106107. [PMID: 38290664 DOI: 10.1016/j.jinf.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/07/2023] [Accepted: 01/17/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Malaria is a leading cause of childhood mortality worldwide. However, accurate estimates of malaria prevalence and causality among patients who die at the country level are lacking due to the limited specificity of diagnostic tools used to attribute etiologies. Accurate estimates are crucial for prioritizing interventions and resources aimed at reducing malaria-related mortality. METHODS Seven Child Health and Mortality Prevention Surveillance (CHAMPS) Network sites collected comprehensive data on stillbirths and children <5 years, using minimally invasive tissue sampling (MITS). A DeCoDe (Determination of Cause of Death) panel employed standardized protocols for assigning underlying, intermediate, and immediate causes of death, integrating sociodemographic, clinical, laboratory (including extensive microbiology, histopathology, and malaria testing), and verbal autopsy data. Analyses were conducted to ascertain the strength of evidence for cause of death (CoD), describe factors associated with malaria-related deaths, estimate malaria-specific mortality, and assess the proportion of preventable deaths. FINDINGS Between December 3, 2016, and December 31, 2022, 2673 deaths underwent MITS and had a CoD attributed from four CHAMPS sites with at least 1 malaria-attributed death. No malaria-attributable deaths were documented among 891 stillbirths or 924 neonatal deaths, therefore this analysis concentrates on the remaining 858 deaths among children aged 1-59 months. Malaria was in the causal chain for 42.9% (126/294) of deaths from Sierra Leone, 31.4% (96/306) in Kenya, 18.2% (36/198) in Mozambique, 6.7% (4/60) in Mali, and 0.3% (1/292) in South Africa. Compared to non-malaria related deaths, malaria-related deaths skewed towards older infants and children (p < 0.001), with 71.0% among ages 12-59 months. Malaria was the sole infecting pathogen in 184 (70.2%) of malaria-attributed deaths, whereas bacterial and viral co-infections were identified in the causal pathway in 24·0% and 12.2% of cases, respectively. Malnutrition was found at a similar level in the causal pathway of both malaria (26.7%) and non-malaria (30.7%, p = 0.256) deaths. Less than two-thirds (164/262; 62.6%) of malaria deaths had received antimalarials prior to death. Nearly all (98·9%) malaria-related deaths were deemed preventable. INTERPRETATION Malaria remains a significant cause of childhood mortality in the CHAMPS malaria-endemic sites. The high bacterial co-infection prevalence among malaria deaths underscores the potential benefits of antibiotics for severe malaria patients. Compared to non-malaria deaths, many of malaria-attributed deaths are preventable through accessible malaria control measures.
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Affiliation(s)
| | - Kephas Otieno
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Rosauro Varo
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Samba O Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | | | - Babatunde Duduyemi
- University of Sierra Leone Teaching Hospital Complex, Freetown, Sierra Leone
| | | | | | - Emily A Rogena
- School of Medicine, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | | | - Victor Akelo
- US Centers for Disease Control and Prevention--Kenya, Kisumu, Kenya
| | | | - Feiko terKuile
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Karen L Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Milagritos D Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Jane Juma
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nardos Assegid
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yenework Acham
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lola Madrid
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research (ICDDR,B), Dhaka, Bangladesh
| | - Emily S Gurley
- International Center for Diarrhoeal Diseases Research (ICDDR,B), Dhaka, Bangladesh; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeannette Wadula
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeanie Dutoit
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Inácio Mandomando
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Moçambique
| | - David Torres-Fernandez
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Milton Kincardett
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Rita Mabunda
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Portia Mutevedzi
- Emory Global Health Institute, Emory University, Atlanta, GA, USA
| | - Zachary J Madewell
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dianna M Blau
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Aaron M Samuels
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, USA; Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Quique Bassat
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique; ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain; Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain; CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain.
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5
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Mahtab S, Blau DM, Madewell ZJ, Ogbuanu I, Ojulong J, Lako S, Legesse H, Bangura JS, Bassat Q, Mandomando I, Xerinda E, Fernandes F, Varo R, Sow SO, Kotloff KL, Tapia MD, Keita AM, Sidibe D, Onyango D, Akelo V, Gethi D, Verani JR, Revathi G, Scott JAG, Assefa N, Madrid L, Bizuayehu H, Tirfe TT, El Arifeen S, Gurley ES, Islam KM, Alam M, Zahid Hossain M, Dangor Z, Baillie VL, Hale M, Mutevedzi P, Breiman RF, Whitney CG, Madhi SA. Post-mortem investigation of deaths due to pneumonia in children aged 1-59 months in sub-Saharan Africa and South Asia from 2016 to 2022: an observational study. Lancet Child Adolesc Health 2024; 8:201-213. [PMID: 38281495 PMCID: PMC10864189 DOI: 10.1016/s2352-4642(23)00328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND The Child Health and Mortality Prevention Surveillance (CHAMPS) Network programme undertakes post-mortem minimally invasive tissue sampling (MITS), together with collection of ante-mortem clinical information, to investigate causes of childhood deaths across multiple countries. We aimed to evaluate the overall contribution of pneumonia in the causal pathway to death and the causative pathogens of fatal pneumonia in children aged 1-59 months enrolled in the CHAMPS Network. METHODS In this observational study we analysed deaths occurring between Dec 16, 2016, and Dec 31, 2022, in the CHAMPS Network across six countries in sub-Saharan Africa (Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) and one in South Asia (Bangladesh). A standardised approach of MITS was undertaken on decedents within 24-72 h of death. Diagnostic tests included blood culture, multi-organism targeted nucleic acid amplifications tests (NAATs) of blood and lung tissue, and histopathology examination of various organ tissue samples. An interdisciplinary expert panel at each site reviewed case data to attribute the cause of death and pathogenesis thereof on the basis of WHO-recommended reporting standards. FINDINGS Pneumonia was attributed in the causal pathway of death in 455 (40·6%) of 1120 decedents, with a median age at death of 9 (IQR 4-19) months. Causative pathogens were identified in 377 (82·9%) of 455 pneumonia deaths, and multiple pathogens were implicated in 218 (57·8%) of 377 deaths. 306 (67·3%) of 455 deaths occurred in the community or within 72 h of hospital admission (presumed to be community-acquired pneumonia), with the leading bacterial pathogens being Streptococcus pneumoniae (108 [35·3%]), Klebsiella pneumoniae (78 [25·5%]), and non-typeable Haemophilus influenzae (37 [12·1%]). 149 (32·7%) deaths occurred 72 h or more after hospital admission (presumed to be hospital-acquired pneumonia), with the most common pathogens being K pneumoniae (64 [43·0%]), Acinetobacter baumannii (19 [12·8%]), S pneumoniae (15 [10·1%]), and Pseudomonas aeruginosa (15 [10·1%]). Overall, viruses were implicated in 145 (31·9%) of 455 pneumonia-related deaths, including 54 (11·9%) of 455 attributed to cytomegalovirus and 29 (6·4%) of 455 attributed to respiratory syncytial virus. INTERPRETATION Pneumonia contributed to 40·6% of all childhood deaths in this analysis. The use of post-mortem MITS enabled biological ascertainment of the cause of death in the majority (82·9%) of childhood deaths attributed to pneumonia, with more than one pathogen being commonly implicated in the same case. The prominent role of K pneumoniae, non-typable H influenzae, and S pneumoniae highlight the need to review empirical management guidelines for management of very severe pneumonia in low-income and middle-income settings, and the need for research into new or improved vaccines against these pathogens. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dianna M Blau
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zachary J Madewell
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Sandra Lako
- Aberdeen Women's Centre, Freetown, Sierra Leone
| | | | | | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal - Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain; Institutó Catalana de Recerca I Estudis Avançats, Barcelona, Spain; Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Instituto Nacional de Saúde, Maputo, Mozambique
| | - Elisio Xerinda
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Rosauro Varo
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal - Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
| | - Samba O Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Karen L Kotloff
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Milagritos D Tapia
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Diakaridia Sidibe
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | | | - Victor Akelo
- Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | - Dickson Gethi
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Jennifer R Verani
- National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gunturu Revathi
- Department of Pathology, Aga Khan University, Nairobi, Kenya
| | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lola Madrid
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Hiwot Bizuayehu
- Department of Microbiology, Addis Ababa Burn, Emergency and Trauma Hospital, Addis Ababa, Ethiopia
| | | | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Emily S Gurley
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kazi Munisul Islam
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Muntasir Alam
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | | | - Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vicky L Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Martin Hale
- National Health Laboratory Service, Department of Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Portia Mutevedzi
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Robert F Breiman
- Wits Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Cynthia G Whitney
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Wits Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.
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6
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Hegde ST, Khan AI, Perez-Saez J, Khan II, Hulse JD, Islam MT, Khan ZH, Ahmed S, Bertuna T, Rashid M, Rashid R, Hossain MZ, Shirin T, Wiens KE, Gurley ES, Bhuiyan TR, Qadri F, Azman AS. Clinical surveillance systems obscure the true cholera infection burden in an endemic region. Nat Med 2024; 30:888-895. [PMID: 38378884 PMCID: PMC10957480 DOI: 10.1038/s41591-024-02810-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/09/2024] [Indexed: 02/22/2024]
Abstract
Our understanding of cholera transmission and burden largely relies on clinic-based surveillance, which can obscure trends, bias burden estimates and limit the impact of targeted cholera-prevention measures. Serological surveillance provides a complementary approach to monitoring infections, although the link between serologically derived infections and medically attended disease incidence-shaped by immunological, behavioral and clinical factors-remains poorly understood. We unravel this cascade in a cholera-endemic Bangladeshi community by integrating clinic-based surveillance, healthcare-seeking and longitudinal serological data through statistical modeling. Combining the serological trajectories with a reconstructed incidence timeline of symptomatic cholera, we estimated an annual Vibrio cholerae O1 infection incidence rate of 535 per 1,000 population (95% credible interval 514-556), with incidence increasing by age group. Clinic-based surveillance alone underestimated the number of infections and reported cases were not consistently correlated with infection timing. Of the infections, 4 in 3,280 resulted in symptoms, only 1 of which was reported through the surveillance system. These results impart insights into cholera transmission dynamics and burden in the epicenter of the seventh cholera pandemic, where >50% of our study population had an annual V. cholerae O1 infection, and emphasize the potential for a biased view of disease burden and infection risk when depending solely on clinical surveillance data.
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Affiliation(s)
- Sonia T Hegde
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
| | - Ashraful Islam Khan
- Infectious Disease Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Javier Perez-Saez
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
- Unit of Population Epidemiology, Geneva University Hospitals, Geneva, Switzerland
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Ishtiakul Islam Khan
- Infectious Disease Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Juan Dent Hulse
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
| | - Md Taufiqul Islam
- Infectious Disease Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Zahid Hasan Khan
- Infectious Disease Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Shakeel Ahmed
- Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh
| | - Taner Bertuna
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
| | - Mamunur Rashid
- Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh
| | - Rumana Rashid
- Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh
| | - Md Zakir Hossain
- Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Kirsten E Wiens
- Department of Epidemiology, Temple University, Philadelphia, PA, USA
| | - Emily S Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
| | - Taufiqur Rahman Bhuiyan
- Infectious Disease Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Firdausi Qadri
- Infectious Disease Division, icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh.
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA.
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland.
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland.
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Garcia Gomez E, Igunza KA, Madewell ZJ, Akelo V, Onyango D, El Arifeen S, Gurley ES, Hossain MZ, Chowdhury MAI, Islam KM, Assefa N, Scott JAG, Madrid L, Tilahun Y, Orlien S, Kotloff KL, Tapia MD, Keita AM, Mehta A, Magaço A, Torres-Fernandez D, Nhacolo A, Bassat Q, Mandomando I, Ogbuanu I, Cain CJ, Luke R, Kamara SIB, Legesse H, Madhi S, Dangor Z, Mahtab S, Wise A, Adam Y, Whitney CG, Mutevedzi PC, Blau DM, Breiman RF, Tippett Barr BA, Rees CA. Identifying delays in healthcare seeking and provision: The Three Delays-in-Healthcare and mortality among infants and children aged 1-59 months. PLOS Glob Public Health 2024; 4:e0002494. [PMID: 38329969 PMCID: PMC10852234 DOI: 10.1371/journal.pgph.0002494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
Delays in illness recognition, healthcare seeking, and in the provision of appropriate clinical care are common in resource-limited settings. Our objective was to determine the frequency of delays in the "Three Delays-in-Healthcare", and factors associated with delays, among deceased infants and children in seven countries with high childhood mortality. We conducted a retrospective, descriptive study using data from verbal autopsies and medical records for infants and children aged 1-59 months who died between December 2016 and February 2022 in six sites in sub-Saharan Africa and one in South Asia (Bangladesh) and were enrolled in Child Health and Mortality Prevention Surveillance (CHAMPS). Delays in 1) illness recognition in the home/decision to seek care, 2) transportation to healthcare facilities, and 3) the receipt of clinical care in healthcare facilities were categorized according to the "Three Delays-in-Healthcare". Comparisons in factors associated with delays were made using Chi-square testing. Information was available for 1,326 deaths among infants and under 5 children. The majority had at least one identified delay (n = 854, 64%). Waiting >72 hours after illness recognition to seek health care (n = 422, 32%) was the most common delay. Challenges in obtaining transportation occurred infrequently when seeking care (n = 51, 4%). In healthcare facilities, prescribed medications were sometimes unavailable (n = 102, 8%). Deceased children aged 12-59 months experienced more delay than infants aged 1-11 months (68% vs. 61%, P = 0.018). Delays in seeking clinical care were common among deceased infants and children. Additional study to assess the frequency of delays in seeking clinical care and its provision among children who survive is warranted.
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Affiliation(s)
- Elisa Garcia Gomez
- Emory University School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | | | - Zachary J. Madewell
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Victor Akelo
- Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | | | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Emily S. Gurley
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Mohammad Zahid Hossain
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Kazi Munisul Islam
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nega Assefa
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Harar, Ethiopia
| | | | - Lola Madrid
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Harar, Ethiopia
| | - Yenenesh Tilahun
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Harar, Ethiopia
| | - Stian Orlien
- College of Medicine and Health Sciences, University of Hargeisa, Hargeisa, Somaliland
- Department of Paediatrics, Vestfold Hospital Trust, Tønsberg, Norway
| | - Karen L. Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Milagritos D. Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | - Ashka Mehta
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Amilcar Magaço
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - David Torres-Fernandez
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal – Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Ariel Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal – Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institució Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal – Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Moçambique
| | | | | | - Ronita Luke
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | - Shabir Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Amy Wise
- Department of Obstetrics and Gynaecology, Rahima Mossa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Yasmin Adam
- Department of Obstetrics and Gynaecology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Cynthia G. Whitney
- Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Portia C. Mutevedzi
- Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Dianna M. Blau
- Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Robert F. Breiman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | | | - Chris A. Rees
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
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8
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Aune KT, Grantz KH, Menezes NP, Robsky KO, Gurley ES, Marx MA, Phelan-Emrick DF. Demographic and Geographic Characterization of Excess Mortality During the COVID-19 Pandemic in Baltimore City, Maryland, March 2020 to March 2021. Am J Epidemiol 2024; 193:267-276. [PMID: 37715454 PMCID: PMC10840074 DOI: 10.1093/aje/kwad186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 06/30/2023] [Accepted: 09/12/2023] [Indexed: 09/17/2023] Open
Abstract
Estimates of excess mortality can provide insight into direct and indirect impacts of the coronavirus disease 2019 (COVID-19) pandemic beyond deaths specifically attributed to COVID-19. We analyzed death certificate data from Baltimore City, Maryland, from March 1, 2020, to March 31, 2021, and found that 1,725 individuals (95% confidence interval: 1,495, 1,954) died in excess of what was expected from all-cause mortality trends in 2016-2019; 1,050 (61%) excess deaths were attributed to COVID-19. Observed mortality was 23%-32% higher than expected among individuals aged 50 years and older. Non-White residents of Baltimore City also experienced 2 to 3 times higher rates of excess mortality than White residents (e.g., 37.4 vs. 10.7 excess deaths per 10,000 population among Black residents vs. White residents). There was little to no observed excess mortality among residents of hospice, long-term care, and nursing home facilities, despite accounting for nearly 30% (312/1,050) of recorded COVID-19 deaths. There was significant geographic variation in excess mortality within the city, largely following racial population distributions. These results demonstrate the substantial and unequal impact of the COVID-19 pandemic on Baltimore City residents and the importance of building robust, timely surveillance systems to track disparities and inform targeted strategies to remediate the impact of future epidemics.
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Affiliation(s)
| | - Kyra H Grantz
- Correspondence to Dr. Kyra Grantz, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore MD 21215 (e-mail: )
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9
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Verani JR, Blau DM, Gurley ES, Akelo V, Assefa N, Baillie V, Bassat Q, Berhane M, Bunn J, Cossa ACA, El Arifeen S, Gunturu R, Hale M, Igunza A, Keita AM, Kenneh S, Kotloff KL, Kowuor D, Mabunda R, Madewell ZJ, Madhi S, Madrid L, Mahtab S, Miguel J, Murila FV, Ogbuanu IU, Ojulong J, Onyango D, Oundo JO, Scott JAG, Sow S, Tapia M, Traore CB, Velaphi S, Whitney CG, Mandomando I, Breiman RF. Child deaths caused by Klebsiella pneumoniae in sub-Saharan Africa and south Asia: a secondary analysis of Child Health and Mortality Prevention Surveillance (CHAMPS) data. Lancet Microbe 2024; 5:e131-e141. [PMID: 38218193 PMCID: PMC10849973 DOI: 10.1016/s2666-5247(23)00290-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 07/25/2023] [Accepted: 08/30/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Klebsiella pneumoniae is an important cause of nosocomial and community-acquired pneumonia and sepsis in children, and antibiotic-resistant K pneumoniae is a growing public health threat. We aimed to characterise child mortality associated with this pathogen in seven high-mortality settings. METHODS We analysed Child Health and Mortality Prevention Surveillance (CHAMPS) data on the causes of deaths in children younger than 5 years and stillbirths in sites located in seven countries across sub-Saharan Africa (Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) and south Asia (Bangladesh) from Dec 9, 2016, to Dec 31, 2021. CHAMPS sites conduct active surveillance for deaths in catchment populations and following reporting of an eligible death or stillbirth seek consent for minimally invasive tissue sampling followed by extensive aetiological testing (microbiological, molecular, and pathological); cases are reviewed by expert panels to assign immediate, intermediate, and underlying causes of death. We reported on susceptibility to antibiotics for which at least 30 isolates had been tested, and excluded data on antibiotics for which susceptibility testing is not recommended for Klebsiella spp due to lack of clinical activity (eg, penicillin and ampicillin). FINDINGS Among 2352 child deaths with cause of death assigned, 497 (21%, 95% CI 20-23) had K pneumoniae in the causal chain of death; 100 (20%, 17-24) had K pneumoniae as the underlying cause. The frequency of K pneumoniae in the causal chain was highest in children aged 1-11 months (30%, 95% CI 26-34; 144 of 485 deaths) and 12-23 months (28%, 22-34; 63 of 225 deaths); frequency by site ranged from 6% (95% CI 3-11; 11 of 184 deaths) in Bangladesh to 52% (44-61; 71 of 136 deaths) in Ethiopia. K pneumoniae was in the causal chain for 450 (22%, 95% CI 20-24) of 2023 deaths that occurred in health facilities and 47 (14%, 11-19) of 329 deaths in the community. The most common clinical syndromes among deaths with K pneumoniae in the causal chain were sepsis (44%, 95% CI 40-49; 221 of 2352 deaths), sepsis in conjunction with pneumonia (19%, 16-23; 94 of 2352 deaths), and pneumonia (16%, 13-20; 80 of 2352 deaths). Among K pneumoniae isolates tested, 121 (84%) of 144 were resistant to ceftriaxone and 80 (75%) of 106 to gentamicin. INTERPRETATION K pneumoniae substantially contributed to deaths in the first 2 years of life across multiple high-mortality settings, and resistance to antibiotics used for sepsis treatment was common. Improved strategies are needed to rapidly identify and appropriately treat children who might be infected with this pathogen. These data suggest a potential impact of developing and using effective K pneumoniae vaccines in reducing neonatal, infant, and child deaths globally. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Jennifer R Verani
- Center for Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya.
| | - Dianna M Blau
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily S Gurley
- Maternal and Child Health Division, International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Victor Akelo
- Center for Global Health, US Centers for Disease Control and Prevention Kenya, Kisumu, Kenya
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Vicky Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Quique Bassat
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Institució Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain; Hospital Sant Joan de Déu, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Mussie Berhane
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - James Bunn
- World Health Organization, Sierra Leone, Freetown, Sierra Leone
| | - Anelsio C A Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Shams El Arifeen
- Maternal and Child Health Division, International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | | | - Martin Hale
- National Health Laboratory Service, Department of Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Aggrey Igunza
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Adama M Keita
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Sartie Kenneh
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Karen L Kotloff
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Rita Mabunda
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Zachary J Madewell
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shabir Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Lola Madrid
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Judice Miguel
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | | | | | | | - Joe O Oundo
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Samba Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Milagritos Tapia
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Cheick B Traore
- Department of Pathological Anatomy and Cytology, University Hospital of Point G, Bamako, Mali
| | - Sithembiso Velaphi
- Department of Pediatrics, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cynthia G Whitney
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Instituto Nacional de Saúde (INS), Maputo, Mozambique
| | - Robert F Breiman
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Johannesburg, South Africa
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Styczynski A, Amin MB, Hoque KI, Parveen S, Md Pervez AF, Zeba D, Akhter A, Pitchik H, Islam MA, Hossain MI, Saha SR, Gurley ES, Luby S. Perinatal colonization with extended-spectrum beta-lactamase-producing and carbapenem-resistant Gram-negative bacteria: a hospital-based cohort study. Antimicrob Resist Infect Control 2024; 13:13. [PMID: 38281974 PMCID: PMC10823664 DOI: 10.1186/s13756-024-01366-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a growing global health threat that contributes to substantial neonatal mortality. Bangladesh has reported some of the highest rates of AMR among bacteria causing neonatal sepsis. As AMR colonization among newborns can predispose to infection with these bacteria, we aimed to characterize the frequency of and risk factors for colonization of mothers and newborns during hospitalization for delivery. METHODS We enrolled pregnant women presenting for delivery to a tertiary care hospital in Faridpur, Bangladesh. We collected vaginal and rectal swabs from mothers pre- and post-delivery, rectal swabs from newborns, and swabs from the hospital environment. Swabs were plated on agars selective for extended-spectrum-beta-lactamase producing bacteria (ESBL-PB) and carbapenem-resistant bacteria (CRB). We performed logistic regression to determine factors associated with ESBL-PB/CRB colonization. RESULTS We enrolled 177 women and their newborns during February-October 2020. Prior to delivery, 77% of mothers were colonized with ESBL-PB and 15% with CRB. 79% of women underwent cesarean deliveries (C-section). 98% of women received antibiotics. Following delivery, 98% of mothers and 89% of newborns were colonized with ESBL-PB and 89% of mothers and 72% of newborns with CRB. Of 290 environmental samples, 77% were positive for ESBL-PB and 69% for CRB. Maternal pre-delivery colonization was associated with hospitalization during pregnancy (RR for ESBL-PB 1.24, 95% CI 1.10-1.40; CRB 2.46, 95% CI 1.39-4.37). Maternal post-delivery and newborn colonization were associated with C-section (RR for maternal CRB 1.31, 95% CI 1.08-1.59; newborn ESBL-PB 1.34, 95% CI 1.09-1.64; newborn CRB 1.73, 95% CI 1.20-2.47). CONCLUSIONS In this study, we observed high rates of colonization with ESBL-PB/CRB among mothers and newborns, with pre-delivery colonization linked to prior healthcare exposure. Our results demonstrate this trend may be driven by intense use of antibiotics, frequent C-sections, and a contaminated hospital environment. These findings highlight that greater attention should be given to the use of perinatal antibiotics, improved surgical stewardship for C-sections, and infection prevention practices in healthcare settings to reduce the high prevalence of colonization with AMR organisms.
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Affiliation(s)
- Ashley Styczynski
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, CA, USA.
| | - Mohammed Badrul Amin
- Laboratory of Food Safety and One Health, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Kazi Injamamul Hoque
- Laboratory of Food Safety and One Health, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Shahana Parveen
- Programme on Emerging Infections, icddr,b, Dhaka, Bangladesh
| | - Abu Faisal Md Pervez
- Department of Pediatrics, Bangabandhu Sheikh Mujib Medical College, Faridpur, Bangladesh
| | - Dilruba Zeba
- Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical College, Faridpur, Bangladesh
| | - Akhi Akhter
- Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical College, Faridpur, Bangladesh
| | - Helen Pitchik
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Mohammad Aminul Islam
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, USA
| | - Muhammed Iqbal Hossain
- Laboratory of Food Safety and One Health, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Sumita Rani Saha
- Laboratory of Food Safety and One Health, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Emily S Gurley
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, CA, USA
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11
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Fagre AC, Islam A, Reeves WK, Kading RC, Plowright RK, Gurley ES, McKee CD. Bartonella Infection in Fruit Bats and Bat Flies, Bangladesh. Microb Ecol 2023; 86:2910-2922. [PMID: 37656196 DOI: 10.1007/s00248-023-02293-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/27/2023] [Indexed: 09/02/2023]
Abstract
Bats harbor diverse intracellular Bartonella bacteria, but there is limited understanding of the factors that influence transmission over time. Investigation of Bartonella dynamics in bats could reveal general factors that control transmission of multiple bat-borne pathogens, including viruses. We used molecular methods to detect Bartonella DNA in paired bat (Pteropus medius) blood and bat flies in the family Nycteribiidae collected from a roost in Faridpur, Bangladesh between September 2020 and January 2021. We detected high prevalence of Bartonella DNA in bat blood (35/55, 64%) and bat flies (59/60, 98%), with sequences grouping into three phylogenetic clades. Prevalence in bat blood increased over the study period (33% to 90%), reflecting an influx of juvenile bats in the population and an increase in the prevalence of bat flies. Discordance between infection status and the clade/genotype of detected Bartonella was also observed in pairs of bats and their flies, providing evidence that bat flies take blood meals from multiple bat hosts. This evidence of bat fly transfer between hosts and the changes in Bartonella prevalence during a period of increasing nycteribiid density support the role of bat flies as vectors of bartonellae. The study provides novel information on comparative prevalence and genetic diversity of Bartonella in pteropodid bats and their ectoparasites, as well as demographic factors that affect Bartonella transmission and potentially other bat-borne pathogens.
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Affiliation(s)
- Anna C Fagre
- Department of Microbiology, Immunology, and Pathology, Center for Vector-Borne Infectious Diseases, Colorado State University, Fort Collins, CO, USA
| | | | - Will K Reeves
- C.P. Gillette Museum of Arthropod Diversity, Fort Collins, CO, USA
| | - Rebekah C Kading
- Department of Microbiology, Immunology, and Pathology, Center for Vector-Borne Infectious Diseases, Colorado State University, Fort Collins, CO, USA
| | - Raina K Plowright
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY, USA
| | - Emily S Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Clifton D McKee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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12
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Hassan MZ, Sturm-Ramirez K, Islam MS, Afreen S, Rahman MZ, Kafi MAH, Chowdhury S, Khan SU, Rahman M, Nasreen S, Davis CT, Levine MZ, Rahman M, Luby SP, Azziz-Baumgartner E, Iuliano AD, Uyeki TM, Gurley ES. Interpretation of molecular detection of avian influenza A virus in respiratory specimens collected from live bird market workers in Dhaka, Bangladesh: infection or contamination? Int J Infect Dis 2023; 136:22-28. [PMID: 37652093 DOI: 10.1016/j.ijid.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVES Interpreting real-time reverse transcription-polymerase chain reaction (rRT-PCR) results for human avian influenza A virus (AIV) detection in contaminated settings like live bird markets (LBMs) without serology or viral culture poses a challenge. METHODS During February-March 2012 and November 2012-February 2013, we screened workers at nine LBMs in Dhaka, Bangladesh, to confirm molecular detections of AIV RNA in respiratory specimens with serology. We tested nasopharyngeal (NP) and throat swabs from workers with influenza-like illness (ILI) and NP, throat, and arm swabs from asymptomatic workers for influenza virus by rRT-PCR and sera for seroconversion and antibodies against HPAI A(H5N1) and A(H9N2) viruses. RESULTS Among 1273 ILI cases, 34 (2.6%) had A(H5), 56 (4%) had A(H9), and six (0.4%) had both A(H5) and A(H9) detected by rRT-PCR. Of 192 asymptomatic workers, A(H5) was detected in eight (4%) NP and 38 (20%) arm swabs. Of 28 ILI cases with A(H5) or A(H9) detected, none had evidence of seroconversion, but one (3.5%) and 12 (43%) were seropositive for A(H5) and A(H9), respectively. CONCLUSION Detection of AIV RNA in respiratory specimens from symptomatic and asymptomatic LBM workers without evidence of seroconversion or virus isolation suggests environmental contamination, emphasizing caution in interpreting rRT-PCR results in high viral load settings.
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Affiliation(s)
- Md Zakiul Hassan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | | | | | - Sadia Afreen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | - Sukanta Chowdhury
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Salah Uddin Khan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mustafizur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Sharifa Nasreen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; University of British Columbia, Vancouver, Canada
| | - C Todd Davis
- Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Min Z Levine
- Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | | | - A D Iuliano
- Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Timothy M Uyeki
- Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Emily S Gurley
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Azuero OC, Lefrancq N, Nikolay B, McKee C, Cappelle J, Hul V, Ou TP, Hoem T, Lemey P, Rahman MZ, Islam A, Gurley ES, Duong V, Salje H. The genetic diversity of Nipah virus across spatial scales. medRxiv 2023:2023.07.14.23292668. [PMID: 37502973 PMCID: PMC10370237 DOI: 10.1101/2023.07.14.23292668] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Nipah virus (NiV), a highly lethal virus in humans, circulates silently in Pteropus bats throughout South and Southeast Asia. Difficulty in obtaining genomes from bats means we have a poor understanding of NiV diversity, including how many lineages circulate within a roost and the spread of NiV over increasing spatial scales. Here we develop phylogenetic approaches applied to the most comprehensive collection of genomes to date (N=257, 175 from bats, 73 from humans) from six countries over 22 years (1999-2020). In Bangladesh, where most human infections occur, we find evidence of increased spillover risk from one of the two co-circulating sublineages. We divide the four major NiV sublineages into 15 genetic clusters (emerged 20-44 years ago). Within any bat roost, there are an average of 2.4 co-circulating genetic clusters, rising to 5.5 clusters at areas of 1,500-2,000 km2. Using Approximate Bayesian Computation fit to a spatial signature of viral diversity, we estimate that each genetic cluster occupies an average area of 1.3 million km2 (95%CI: 0.6-2.3 million), with 14 clusters in an area of 100,000 km2 (95%CI: 6-24). In the few sites in Bangladesh and Cambodia where genomic surveillance has been concentrated, we estimate that most of the genetic clusters have been identified, but only ~15% of overall NiV diversity has been uncovered. Our findings are consistent with entrenched co-circulation of distinct lineages, even within individual roosts, coupled with slow migration over larger spatial scales.
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Affiliation(s)
| | - Noémie Lefrancq
- Department of Genetics, University of Cambridge, Cambridge CB2 3EH, UK
| | | | - Clifton McKee
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | | | - Vibol Hul
- Virology Unit, Institut Pasteur du Cambodge, Pasteur Network, Phnom Penh 12201, Cambodia
| | - Tey Putita Ou
- Virology Unit, Institut Pasteur du Cambodge, Pasteur Network, Phnom Penh 12201, Cambodia
| | - Thavry Hoem
- Virology Unit, Institut Pasteur du Cambodge, Pasteur Network, Phnom Penh 12201, Cambodia
| | - Philippe Lemey
- Department of Microbiology, Immunology and Transplantation, KU Leuven, BE-3000 Leuven, Belgium
| | | | - Ausraful Islam
- Infectious Diseases Division, icddr,b, Dhaka 1000, Bangladesh
| | - Emily S. Gurley
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Veasna Duong
- Virology Unit, Institut Pasteur du Cambodge, Pasteur Network, Phnom Penh 12201, Cambodia
| | - Henrik Salje
- Department of Genetics, University of Cambridge, Cambridge CB2 3EH, UK
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14
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Islam MS, Gurley ES, Banu S, Hossain K, Heffelfinger JD, Amin Chowdhury KI, Ahmed S, Afreen S, Islam MT, Rahman SMM, Rahman A, Pearson ML, Chai SJ. Prevalence and incidence of tuberculosis infection among healthcare workers in chest diseases hospitals, Bangladesh: Putting infection control into context. PLoS One 2023; 18:e0291484. [PMID: 37756289 PMCID: PMC10529546 DOI: 10.1371/journal.pone.0291484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Healthcare workers (HCWs) are at increased risk of tuberculosis infection (TBI). We estimated the prevalence and incidence of TBI and risk factors among HCWs in Bangladeshi hospitals to target TB infection prevention and control (IPC) interventions. METHODS During 2013-2016, we conducted a longitudinal study among HCWs in four chest disease hospitals. At baseline, we administered a questionnaire on sociodemographic and occupational factors for TB, tuberculin skin tests (TST) in all hospitals, and QuantiFERON ®-TB Gold in-Tube (QFT-GIT) tests in one hospital. We assessed factors associated with baseline TST positivity (induration ≥10mm), TST conversion (induration increase ≥10mm from baseline), baseline QFT-GIT positivity (interferon-gamma ≥0.35 IU/mL), and QFT-GIT conversion (interferon-gamma <0.35 IU/mL to ≥0.35 IU/mL). We included factors with a biologically plausible relationship with TBI identified in prior studies or having an association (p = <0.20) in the bivariate analyses with TST positivity or QFT-GIT positivity in multivariable generalized linear models. The Kaplan-Meier was used to estimate the cumulative TBI incidence rate per 100 person-years. RESULTS Of the 758 HCWs invited, 732 (97%) consented to participate and 731 completed the one-step TST, 40% had a positive TST result, and 48% had a positive QFT-GIT result. In multivariable models, HCWs years of service 11-20 years had 2.1 (95% CI: 1.5-3.0) times higher odds of being TST-positive and 1.6 (95% CI 1.1-2.5) times higher odds of QFT-GIT-positivity at baseline compared with those working ≤10 years. HCWs working 11-20 years in pulmonary TB ward had 2.0 (95% CI: 1.4-2.9) times higher odds of TST positivity, and those >20 years had 2.5 (95% CI: 1.3-4.9) times higher odds of QFT-GIT-positivity at baseline compared with those working <10 years. TBI incidence was 4.8/100 person-years by TST and 4.2/100 person-years by QFT-GIT. Females had 8.5 (95% CI: 1.5-49.5) times higher odds of TST conversion than males. CONCLUSIONS Prevalent TST and QFT-GIT positivity was associated with an increased number of years working as a healthcare worker and in pulmonary TB wards. The incidence of TBI among HCWs suggests ongoing TB exposure in these facilities and an urgent need for improved TB IPC in chest disease hospitals in Bangladesh.
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Affiliation(s)
- Md. Saiful Islam
- icddr,b, Dhaka, Bangladesh
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Emily S. Gurley
- icddr,b, Dhaka, Bangladesh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | - James D. Heffelfinger
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | | | | | | | | | | | | | - Michele L. Pearson
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Shua J. Chai
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
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15
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Bear AP, Bennett WL, Katz J, Lee KH, Chowdhury AI, Bari S, El Arifeen S, Gurley ES. Self-reported diabetes or hypertension diagnoses and antenatal care among child-bearing women in rural Bangladesh: A cross-sectional study. PLOS Glob Public Health 2023; 3:e0002175. [PMID: 37708098 PMCID: PMC10501644 DOI: 10.1371/journal.pgph.0002175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 08/08/2023] [Indexed: 09/16/2023]
Abstract
Health care systems in low- and middle-income countries may not meet the needs of pregnant women where the burden of diabetes and hypertension is rapidly increasing. We asked recently pregnant women about ever having been screened for or diagnosed with hypertension or diabetes and their ANC-seeking experiences in a cross-sectional survey. We used chi-squared tests and logistic regression to test the associations between self-reported coverage of hypertension and diabetes screening, diagnoses, and elements of ANC by age, wealth, educational attainment, and gravidity. Among 4,692 respondents, for hypertension, 97% reported having been screened and 10% of screened women reported a diagnosis. Women 30-39 years of age (aOR 3.02, 95% CI 2.00, 4.56) or in the top wealth quintile (aOR 1.70, 95% CI 1.18, 2.44) were more likely to be diagnosed with hypertension compared to reference groups. Any hypertension diagnosis was associated with reporting four or more antenatal care contacts (44% vs. 35%, p < 0.01), blood pressure measurements (85% vs. 79%, p < 0.01), and urine tests (71% vs. 61%, p < 0.01) conducted during ANC visits. For diabetes, 46% of respondents reported having been screened and 3% of screened women reported a diagnosis. Women 30-39 years of age were more likely to be diagnosed with diabetes (aOR 8.19, 95% CI 1.74, 38.48) compared to the reference group. Any diabetes diagnosis was associated with reporting four or more ANC contacts (48% vs. 36%, p = 0.04) and having blood testing during pregnancy (83% vs. 66%, p < 0.01). However, the frequency and quality of ANC was below the national guidelines among all groups. Focused efforts to ensure that women receive the recommended number of ANC contacts, coupled with improved compliance with ANC guidelines, would improve awareness of hypertension and diabetes among women in Bangladesh.
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Affiliation(s)
- Allyson P. Bear
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Wendy L. Bennett
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kyu Han Lee
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Atique Iqbal Chowdhury
- Division of Maternal and Child Health, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sanwarul Bari
- Division of Maternal and Child Health, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shams El Arifeen
- Division of Maternal and Child Health, International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Emily S. Gurley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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16
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Rees CA, Igunza KA, Madewell ZJ, Akelo V, Onyango D, El Arifeen S, Gurley ES, Hossain MZ, Rahman A, Alam M, Scott JAG, Assefa N, Madrid L, Belachew A, Leulseged H, Kotloff KL, Sow SO, Tapia MD, Keita AM, Sidibe D, Sitoe A, Varo R, Ajanovic S, Bassat Q, Mandomando I, Tippett Barr BA, Ogbuanu I, Cain CJ, Bassey IA, Luke R, Gassama K, Madhi S, Dangor Z, Mahtab S, Velaphi S, du Toit J, Mutevedzi PC, Blau DM, Breiman RF, Whitney CG. Provider adherence to clinical care recommendations for infants and children who died in seven low- and middle-income countries in the Child Health and Mortality Prevention Surveillance (CHAMPS) network. EClinicalMedicine 2023; 63:102198. [PMID: 37692079 PMCID: PMC10484959 DOI: 10.1016/j.eclinm.2023.102198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023] Open
Abstract
Background Most childhood deaths globally are considered preventable through high-quality clinical care, which includes adherence to clinical care recommendations. Our objective was to describe adherence to World Health Organization recommendations for the management of leading causes of death among children. Methods We conducted a retrospective, descriptive study examining clinical data for children aged 1-59 months who were hospitalized and died in a Child Health and Mortality Prevention Surveillance (CHAMPS) catchment, December 2016-June 2021. Catchment areas included: Baliakandi and Faridpur, Bangladesh; Kersa, Haramaya, and Harar, Ethiopia; Kisumu and Siaya, Kenya; Bamako, Mali; Manhiça and Quelimane, Mozambique; Makeni, Sierra Leone; Soweto, South Africa. We reviewed medical records of those who died from lower respiratory tract infections, sepsis, malnutrition, malaria, and diarrheal diseases to determine the proportion who received recommended treatments and compared adherence by hospitalization duration. Findings CHAMPS enrolled 460 hospitalized children who died from the leading causes (median age 12 months, 53.0% male). Median hospital admission was 31 h. There were 51.0% (n = 127/249) of children who died from lower respiratory tract infections received supplemental oxygen. Administration of intravenous fluids for sepsis (15.9%, n = 36/226) and supplemental feeds for malnutrition (14.0%, n = 18/129) were uncommon. There were 51.4% (n = 55/107) of those who died from malaria received antimalarials. Of the 80 children who died from diarrheal diseases, 76.2% received intravenous fluids. Those admitted for ≥24 h more commonly received antibiotics for lower respiratory tract infections and sepsis, supplemental feeds for malnutrition, and intravenous fluids for sepsis than those admitted <24 h. Interpretation Provision of recommended clinical care for leading causes of death among young children was suboptimal. Further studies are needed to understand the reasons for deficits in clinical care recommendation adherence. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- Chris A. Rees
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States of America
- Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | | | - Zachary J. Madewell
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Victor Akelo
- Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | | | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Emily S. Gurley
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Mohammad Zahid Hossain
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Afruna Rahman
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Muntasir Alam
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Nega Assefa
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lola Madrid
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Anteneh Belachew
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Ethiopia
| | - Haleluya Leulseged
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Hararghe Health Research, Haramaya University, Ethiopia
| | - Karen L. Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Samba O. Sow
- Centre pour le Développement des Vaccins-Mali, Bamako, Mali
| | - Milagritos D. Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | | | | | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Rosauro Varo
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Sara Ajanovic
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- ISGlobal - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Moçambique
| | | | | | | | | | - Ronita Luke
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Shabir Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ziyaad Dangor
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sithembiso Velaphi
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeanie du Toit
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Portia C. Mutevedzi
- Global Health Institute, Emory University, Atlanta, GA, United States of America
| | - Dianna M. Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Robert F. Breiman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Cynthia G. Whitney
- Global Health Institute, Emory University, Atlanta, GA, United States of America
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17
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Mahtab S, Madewell ZJ, Madhi SA, Wise A, Swart PJ, Velaphi S, Mandomando I, Bramugy J, Mabunda R, Xerinda E, Scott AG, Assefa N, Madrid L, Bweihun M, Temesgen F, Onyango D, Akelo V, Oliech R, Otieno P, Verani JR, Arifeen SE, Gurley ES, Alam M, Rahman A, Hossain MZ, Sow S, Kotloff K, Tapia M, Keita AM, Sanogo D, Ogbuanu I, Ojulong J, Lako S, Ita O, Kaluma E, Wilson T, Mutevedzi P, Barr BAT, Whitney CG, Blau DM, Bassat Q. Stillbirths and Neonatal Deaths Caused by Group B Streptococcus in Africa and South Asia Identified Through Child Health and Mortality Prevention Surveillance (CHAMPS). Open Forum Infect Dis 2023; 10:ofad356. [PMID: 37674633 PMCID: PMC10478157 DOI: 10.1093/ofid/ofad356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/10/2023] [Indexed: 09/08/2023] Open
Abstract
Background Invasive Group B Streptococcus (GBS) is a common cause of early-onset neonatal sepsis and is also associated with stillbirth. This study aimed to determine the proportion of stillborn infants and infants who died between 0 and 90 days attributable to GBS using postmortem minimally invasive tissue sampling (MITS) in 7 low- and middle-income countries (LMICs) participating in Child Health and Mortality Prevention Surveillance (CHAMPS). Methods Deaths that occurred between December 2016 and December 2021 were investigated with MITS, including culture for bacteria of blood and cerebrospinal fluid (CSF), multipathogen polymerase chain reaction on blood, CSF, and lung tissue and histopathology of lung, liver, and brain. Data collection included clinical record review and verbal autopsy. Expert panels reviewed all information and assigned causes of death. Results We evaluated 2966 deaths, including stillborn infants (n = 1322), infants who died during first day of life (0 to <24 hours, n = 597), early neonatal deaths (END) (1 day to <7 days; END; n = 593), and deaths from 7 to 90 days (n = 454). Group B Streptococcus was determined to be in the causal pathway of death for 2.7% of infants (79 of 2, 966; range, 0.3% in Sierra Leone to 7.2% in South Africa), including 2.3% (31 of 1322) of stillbirths, 4.7% (28 of 597) 0 to <24 hours, 1.9% (11 of 593) END, and 2.0% (9 of 454) of deaths from 7 to 90 days of age. Among deaths attributed to GBS with birth weight data available, 61.9% (39 of 63) of decedents weighed <2500 grams at birth. Group B Streptococcus sepsis was the postmortem diagnosis for 100% (31 of 31) of stillbirths. For deaths <90 days, postmortem diagnoses included GBS sepsis (83.3%, 40 of 48), GBS meningitis (4.2%, 2 of 48), and GBS pneumonia (2.1%, 1 of 48). Conclusions Our study reveals significant heterogeneity in the contribution of invasive GBS disease to infant mortality across different countries, emphasizing the need for tailored prevention strategies. Moreover, our findings highlight the substantial impact of GBS on stillbirths, shedding light on a previously underestimated aspect in LMICs.
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Affiliation(s)
- Sana Mahtab
- South African Medical Research Council, Vaccines Infectious Diseases and Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zachary J Madewell
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shabir A Madhi
- South African Medical Research Council, Vaccines Infectious Diseases and Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amy Wise
- National Health for Laboratory Service in South Africa, Johannesburg, South Africa
| | - Peter J Swart
- Department of Obstetrics and Gynecology, Rahima Mossa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Sithembiso Velaphi
- Department of Pediatrics, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Instituto Nacional de Saúde (INS), Maputo, Mozambique
| | - Justina Bramugy
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Rita Mabunda
- ISGlobal—Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
| | - Elisio Xerinda
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lola Madrid
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | | | | | - Dickens Onyango
- Kisumu County Department of Health, Ministry of Health, Kisumu, Kenya
| | - Victor Akelo
- US Centers for Disease Control and Prevention–Kenya, Kisumu, Kenya
| | - Richard Oliech
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Peter Otieno
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Jennifer R Verani
- National Center for Immunization and Respiratory Disease, Centers for Disease Control, Atlanta, Georgia, USA
| | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research (icddr, b), Dhaka, Bangladesh
| | - Emily S Gurley
- International Center for Diarrhoeal Diseases Research (icddr, b), Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Muntasir Alam
- International Center for Diarrhoeal Diseases Research (icddr, b), Dhaka, Bangladesh
| | - Afruna Rahman
- International Center for Diarrhoeal Diseases Research (icddr, b), Dhaka, Bangladesh
| | | | - Samba Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Karen Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Milagritos Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Doh Sanogo
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | | | | | - Sandra Lako
- Aberdeen Women's Centre in Freetown, Sierra Leone
| | | | | | - Tais Wilson
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Portia Mutevedzi
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Beth A Tippett Barr
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Cynthia G Whitney
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Dianna M Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal—Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
- Institutó Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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18
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Hegde S, Khan AI, Perez-Saez J, Khan II, Hulse JD, Islam MT, Khan ZH, Ahmed S, Bertuna T, Rashid M, Rashid R, Hossain MZ, Shirin T, Wiens K, Gurley ES, Bhuiyan TR, Qadri F, Azman AS. Estimating the gap between clinical cholera and true community infections: findings from an integrated surveillance study in an endemic region of Bangladesh. medRxiv 2023:2023.07.18.23292836. [PMID: 37502941 PMCID: PMC10371108 DOI: 10.1101/2023.07.18.23292836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Our understanding of cholera transmission and burden largely rely on clinic-based surveillance, which can obscure trends, bias burden estimates and limit the impact of targeted cholera-prevention measures. Serologic surveillance provides a complementary approach to monitoring infections, though the link between serologically-derived infections and medically-attended disease - shaped by immunological, behavioral, and clinical factors - remains poorly understood. We unravel this cascade in a cholera-endemic Bangladeshi community by integrating clinic-based surveillance, healthcare seeking, and longitudinal serological data through statistical modeling. We found >50% of the study population had a V. cholerae O1 infection annually, and infection timing was not consistently correlated with reported cases. Four in 2,340 infections resulted in symptoms, only one of which was reported through the surveillance system. These results provide new insights into cholera transmission dynamics and burden in the epicenter of the 7th cholera pandemic and provide a framework to synthesize serological and clinical surveillance data.
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Affiliation(s)
- Sonia Hegde
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Javier Perez-Saez
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Unit of Population Epidemiology, Geneva University Hospitals, Geneva, Switzerland
| | | | - Juan Dent Hulse
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Shakeel Ahmed
- Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh
| | - Taner Bertuna
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mamunur Rashid
- Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh
| | - Rumuna Rashid
- Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh
| | - Md Zakir Hossain
- Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Kirsten Wiens
- Department of Epidemiology, Temple University, Philadelphia, USA
| | - Emily S Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
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19
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Lee KH, Chowdhury AI, Rahman QSU, Cunningham SA, Parveen S, Bari S, El Arifeen S, Gurley ES. Child marriage in rural Bangladesh and impact on obstetric complications and perinatal death: Findings from a health and demographic surveillance system. PLoS One 2023; 18:e0288746. [PMID: 37467226 DOI: 10.1371/journal.pone.0288746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 06/27/2023] [Indexed: 07/21/2023] Open
Abstract
Adolescent pregnancies, a risk factor for obstetric complications and perinatal mortality, are driven by child marriage in many regions of South Asia. We used data collected between 2017-2019 from 56,155 married adolescents and women in a health and demographic surveillance system to present a population-level description of historical trends in child marriage from 1990-2019 as well as epidemiologic associations between maternal age and pregnancy outcomes in Baliakandi, a rural sub-district of Bangladesh. For pregnancies identified between 2017-2019, we used Kaplan-Meier estimates to examine timing of first pregnancies after first marriage and multinomial logistic regression to estimate associations between maternal age and perinatal death. We described the frequency of self-reported obstetric complications at labor and delivery by maternal age. In 1990, 71% of all marriages were to female residents under 18 years of age. This decreased to 57% in 2010, with the largest reduction among females aged 10-12 years (22% to 3%), and to 53% in 2019. Half of all newly married females were pregnant within a year of marriage, including adolescent brides. Although we observed a decline in child marriages since 1990, over half of all marriages in 2019 were to child brides in Baliakandi. In this same population, adolescent pregnancies were more likely to result in obstetric complications (13-15 years: 36%, 16-17 years: 32%, 18-34 years: 23%; χ2 test, p<0.001) and perinatal deaths (13-15 years: stillbirth OR 2.23, 95% CI 1.01-2.42; 16-17 years: early neonatal death OR 1.57, 95% CI: 1.01-2.42) compared to adult pregnancies. Preventing child marriage can improve the health of girls and contribute to Bangladesh's commitment to reducing child mortality.
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Affiliation(s)
- Kyu Han Lee
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | | | - Solveig A Cunningham
- Department of Global Health, Emory University, Atlanta, Georgia, United States of America
| | | | - Sanwarul Bari
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | | | - Emily S Gurley
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
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20
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Bassat Q, Blau DM, Ogbuanu IU, Samura S, Kaluma E, Bassey IA, Sow S, Keita AM, Tapia MD, Mehta A, Kotloff KL, Rahman A, Islam KM, Alam M, El Arifeen S, Gurley ES, Baillie V, Mutevedzi P, Mahtab S, Thwala BN, Tippett Barr BA, Onyango D, Akelo V, Rogena E, Onyango P, Omore R, Mandomando I, Ajanovic S, Varo R, Sitoe A, Duran-Frigola M, Assefa N, Scott JAG, Madrid L, Tesfaye T, Dessie Y, Madewell ZJ, Breiman RF, Whitney CG, Madhi SA. Causes of Death Among Infants and Children in the Child Health and Mortality Prevention Surveillance (CHAMPS) Network. JAMA Netw Open 2023; 6:e2322494. [PMID: 37494044 PMCID: PMC10372710 DOI: 10.1001/jamanetworkopen.2023.22494] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
Importance The number of deaths of children younger than 5 years has been steadily decreasing worldwide, from more than 17 million annual deaths in the 1970s to an estimated 5.3 million in 2019 (with 2.8 million deaths occurring in those aged 1-59 months [53% of all deaths in children aged <5 years]). More detailed characterization of childhood deaths could inform interventions to improve child survival. Objective To describe causes of postneonatal child deaths across 7 mortality surveillance sentinel sites in Africa and Asia. Design, Setting, and Participants The Child Health and Mortality Prevention Surveillance (CHAMPS) Network conducts childhood mortality surveillance in sub-Saharan Africa and South Asia using innovative postmortem minimally invasive tissue sampling (MITS). In this cross-sectional study, MITS was conducted in deceased children aged 1 to 59 months at 7 sites in sub-Saharan Africa and South Asia from December 3, 2016, to December 3, 2020. Data analysis was conducted between October and November 2021. Main Outcomes and Measures The expert panel attributed underlying, intermediate, and immediate conditions in the chain of events leading to death, based on histopathologic analysis, microbiological diagnostics, clinical data, and verbal autopsies. Results In this study, MITS was performed in 632 deceased children (mean [SD] age at death, 1.3 [0.3] years; 342 [54.1%] male). The 6 most common underlying causes of death were malnutrition (104 [16.5%]), HIV (75 [11.9%]), malaria (71 [11.2%]), congenital birth defects (64 [10.1%]), lower respiratory tract infections (LRTIs; 53 [8.4%]), and diarrheal diseases (46 [7.2%]). When considering immediate causes only, sepsis (191 [36.7%]) and LRTI (129 [24.8%]) were the 2 dominant causes. An infection was present in the causal chain in 549 of 632 deaths (86.9%); pathogens most frequently contributing to infectious deaths included Klebsiella pneumoniae (155 of 549 infectious deaths [28.2%]; 127 [81.9%] considered nosocomial), Plasmodium falciparum (122 of 549 [22.2%]), and Streptococcus pneumoniae (109 of 549 [19.9%]). Other organisms, such as cytomegalovirus (57 [10.4%]) and Acinetobacter baumannii (39 [7.1%]; 35 of 39 [89.7%] considered nosocomial), also played important roles. For the top underlying causes of death, the median number of conditions in the chain of events leading to death was 3 for malnutrition, 3 for HIV, 1 for malaria, 3 for congenital birth defects, and 1 for LRTI. Expert panels considered 494 of 632 deaths (78.2%) preventable and 26 of 632 deaths (4.1%) preventable under certain conditions. Conclusions and Relevance In this cross-sectional study investigating causes of child mortality in the CHAMPS Network, results indicate that, in these high-mortality settings, infectious diseases continue to cause most deaths in infants and children, often in conjunction with malnutrition. These results also highlight opportunities for action to prevent deaths and reveal common interaction of various causes in the path toward death.
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Affiliation(s)
- Quique Bassat
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça-CISM, Maputo, Mozambique
- ICREA, Pg. Lluís Companys 23, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública-CIBERESP, Madrid, Spain
| | - Dianna M Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Samba Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Milagritos D Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Ashka Mehta
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Karen L Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Afruna Rahman
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Kazi Munisul Islam
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Muntasir Alam
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Emily S Gurley
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Vicky Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Portia Mutevedzi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bukiwe Nana Thwala
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Victor Akelo
- Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | - Emily Rogena
- Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | - Peter Onyango
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Inacio Mandomando
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça-CISM, Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Moçambique
| | - Sara Ajanovic
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça-CISM, Maputo, Mozambique
| | - Rosauro Varo
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça-CISM, Maputo, Mozambique
| | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça-CISM, Maputo, Mozambique
| | | | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Lola Madrid
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Tseyon Tesfaye
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Yadeta Dessie
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Zachary J Madewell
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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21
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Madrid L, Vyas KJ, Kancherla V, Leulseged H, Suchdev PS, Bassat Q, Sow SO, El Arifeen S, Madhi SA, Onyango D, Ogbuanu I, Scott JAG, Blau D, Mandomando I, Keita AM, Gurley ES, Mahtab S, Akelo V, Sannoh S, Tilahun Y, Varo R, Onwuchekwa U, Rahman A, Adam Y, Omore R, Lako S, Xerinda E, Islam KM, Wise A, Tippet-Barr BA, Kaluma E, Ajanovic S, Kotloff KL, Hossain MZ, Mutevedzi P, Tapia MD, Rogena E, Moses F, Whitney CG, Assefa N. Neural tube defects as a cause of death among stillbirths, infants, and children younger than 5 years in sub-Saharan Africa and southeast Asia: an analysis of the CHAMPS network. Lancet Glob Health 2023; 11:e1041-e1052. [PMID: 37271162 PMCID: PMC10282076 DOI: 10.1016/s2214-109x(23)00191-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/26/2023] [Accepted: 04/04/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Neural tube defects are common birth defects resulting in severe morbidity and mortality; they can largely be prevented with periconceptional maternal intake of folic acid. Understanding the occurrence of neural tube defects and their contribution to mortality in settings where their burden is highest could inform prevention and health-care policy. We aimed to estimate the mortality attributed to neural tube defects in seven countries in sub-Saharan Africa and southeast Asia. METHODS This analysis used data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network and health and demographic surveillance systems from South Africa, Mozambique, Bangladesh, Kenya, Mali, Ethiopia, and Sierra Leone. All stillbirths and infants and children younger than 5 years who died, who were enrolled in CHAMPS, whose families consented to post-mortem minimally invasive tissue sampling (MITS) between Jan 1, 2017, and Dec 31, 2021, and who were assigned a cause of death by a determination of cause of death panel as of May 24, 2022, were included in this analysis, regardless the cause of death. MITS and advanced diagnostic methods were used to describe the frequency and characteristics of neural tube defects among eligible deaths, identify risk factors, and estimate the mortality fraction and mortality rate (per 10 000 births) by CHAMPS site. FINDINGS Causes of death were determined for 3232 stillbirths, infants, and children younger than 5 years, of whom 69 (2%) died with a neural tube defect. Most deaths with a neural tube defect were stillbirths (51 [74%]); 46 (67%) were neural tube defects incompatible with life (ie, anencephaly, craniorachischisis, or iniencephaly) and 22 (32%) were spina bifida. Deaths with a neural tube defect were more common in Ethiopia (adjusted odds ratio 8·09 [95% CI 2·84-23·02]), among female individuals (4·40 [2·44-7·93]), and among those whose mothers had no antenatal care (2·48 [1·12-5·51]). Ethiopia had the highest adjusted mortality fraction of deaths with neural tube defects (7·5% [6·7-8·4]) and the highest adjusted mortality rate attributed to neural tube defects (104·0 per 10 000 births [92·9-116·4]), 4-23 times greater than in any other site. INTERPRETATION CHAMPS identified neural tube defects, a largely preventable condition, as a common cause of death among stillbirths and neonatal deaths, especially in Ethiopia. Implementing interventions such as mandatory folic acid fortification could reduce mortality due to neural tube defects. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Lola Madrid
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Kartavya J Vyas
- Emory Global Health Institute, Emory University, Atlanta, GA, USA
| | - Vijaya Kancherla
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Haleluya Leulseged
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Parminder S Suchdev
- Emory Global Health Institute, Emory University, Atlanta, GA, USA; Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ICREA, Barcelona, Spain; Paediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Samba O Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Dianna Blau
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Instituto Nacional de Saúde, Maputo, Mozambique
| | - Adama M Keita
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Emily S Gurley
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Victor Akelo
- US Centers for Disease Control and Prevention Kenya, Kisumu, Kenya
| | | | - Yenenesh Tilahun
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Rosauro Varo
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Uma Onwuchekwa
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Afruna Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Yasmin Adam
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Elisio Xerinda
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Amy Wise
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Sara Ajanovic
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Karen L Kotloff
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Portia Mutevedzi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Milagritos D Tapia
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Emily Rogena
- Department of Pathology, School of Medicine, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Francis Moses
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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22
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Stamm BD, Tamerius J, Reddy S, Barlow S, Hamer C, Kempken A, Goss M, He C, Bell C, Arnold M, Checovich M, Temte E, Norton D, Chen G, Baltus J, Gurley ES, Temte JL. The Influence of Rapid Influenza Diagnostic Testing on Clinician Decision-Making for Patients With Acute Respiratory Infection in Urgent Care. Clin Infect Dis 2023; 76:1942-1948. [PMID: 36723863 PMCID: PMC10249985 DOI: 10.1093/cid/ciad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/06/2023] [Accepted: 01/20/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The potential benefits of using rapid influenza diagnostic tests (RIDTs) in urgent care facilities for clinical care and prescribing practices are understudied. We compared antiviral and antibiotic prescribing, imaging, and laboratory ordering in clinical encounters with and without RIDT results. METHODS We compared patients with acute respiratory infection (ARI) symptoms who received an RIDT and patients who did not at 2 urgent care facilities. Primary analysis using 1-to-1 exact matching resulted in 1145 matched pairs to which McNemar 2 × 2 tests were used to assess the association between the likelihood of prescribing, imaging/laboratory ordering, and RIDT use. Secondary analysis compared the same outcomes using logistic regression among the RIDT-tested population between participants who tested negative (RIDT(-)) and positive (RIDT(+)). RESULTS Primary analysis revealed that compared to the non-RIDT-tested population, RIDT(+) patients were more likely to be prescribed antivirals (OR, 10.23; 95% CI, 5.78-19.72) and less likely to be prescribed antibiotics (OR, 0.15; 95% CI, .08-.27). Comparing RIDT-tested to non-RIDT-tested participants, RIDT use increased antiviral prescribing odds (OR, 3.07; 95% CI, 2.25-4.26) and reduced antibiotic prescribing odds (OR, 0.52; 95% CI, .43-.63). Secondary analysis identified increased odds of prescribing antivirals (OR, 28.21; 95% CI, 18.15-43.86) and decreased odds of prescribing antibiotics (OR, 0.20; 95% CI, .13-.30) for RIDT(+) participants compared with RIDT(-). CONCLUSIONS Use of RIDTs in patients presenting with ARI symptoms influences clinician diagnostic and treatment decision-making, which could lead to improved patient outcomes, population-level reductions in influenza burden, and a decreased threat of antibiotic resistance.
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Affiliation(s)
- Brian D Stamm
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | | | | | - Shari Barlow
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Caroline Hamer
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Ashley Kempken
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Maureen Goss
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Cecilia He
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Cristalyne Bell
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Mitchell Arnold
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Mary Checovich
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Emily Temte
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Derek Norton
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Guanhua Chen
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Jeffrey Baltus
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
| | - Emily S Gurley
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jonathan L Temte
- School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WisconsinUSA
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23
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Hasan SMM, Sturm-Ramirez K, Kamal AHM, Islam MA, Rahman M, Kile JC, Kennedy ED, Gurley ES, Islam MS. Quail Rearing Practices and Potential for Avian Influenza Virus Transmission, Bangladesh. Ecohealth 2023; 20:167-177. [PMID: 37455270 DOI: 10.1007/s10393-023-01643-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023]
Abstract
In 2015, human influenza surveillance identified a human infection with A/H9N2 in Dhaka, Bangladesh with evidence of exposure to a sick quail. We conducted in-depth interviews with household quail caregivers, pet bird retail shop owners, and mobile vendors, key informant interviews with pet bird wholesale shop owners, one group discussion with pet bird retail shop workers and unstructured observations in households, pet bird wholesale and retail markets, and mobile bird vendor's travelling areas to explore quail rearing and selling practices among households, mobile vendors, and retail pet bird and wholesale bird markets in Dhaka. Every day, quail were supplied from 23 districts to two wholesale markets, and then sold to households and restaurants directly, or through bird shops and mobile vendors. All respondents (67) reported keeping quail with other birds in cages, feeding quail, cleaning feeding pots, removing quail faeces, slaughtering sick quail, and discarding dead quail. Children played with quail and assisted in slaughtering of quail. Most respondents (94%) reported rinsing hands with water only after slaughtering and disposing of wastes and dead quail. No personal protective equipment was used during any activities. Frequent unprotected contact with quail and their by-products potentially increased the risk of cross-species avian influenza virus transmission. Avian influenza surveillance in retail pet bird and wholesale bird markets, mobile vendors, and households may identify cases promptly and reduce the risk of virus transmission.
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Affiliation(s)
- S M Murshid Hasan
- Programme for Emerging Infections, Infectious Diseases Division, ICDDR,B, Dhaka, Bangladesh.
- Department of Society and Health, Mahidol University, Bangkok, Thailand.
| | | | - Abu-Hena Mostofa Kamal
- Programme for Emerging Infections, Infectious Diseases Division, ICDDR,B, Dhaka, Bangladesh
- Department of Humanities, Khulna University of Engineering and Technology (KUET), Khulna, Bangladesh
| | - Mohammad Ariful Islam
- Programme for Emerging Infections, Infectious Diseases Division, ICDDR,B, Dhaka, Bangladesh
| | - Mahmudur Rahman
- Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh
| | - James C Kile
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Erin D Kennedy
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily S Gurley
- Programme for Emerging Infections, Infectious Diseases Division, ICDDR,B, Dhaka, Bangladesh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Md Saiful Islam
- Programme for Emerging Infections, Infectious Diseases Division, ICDDR,B, Dhaka, Bangladesh
- School of Population Health, University of New South Wales, Sydney, Australia
- Research School of Population Health, ANU College of Health and Medicine, The Australian National University, Canberra, Australia
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Kumar AA, Lee KH, Pervez AFM, Bari S, Deb C, Arifeen SE, Islam F, Gurley ES. Factors Associated with Neonatal Survival in a Special Care Newborn Unit in a Tertiary Care Hospital in Bangladesh. Am J Trop Med Hyg 2023; 108:844-850. [PMID: 36878210 PMCID: PMC10077006 DOI: 10.4269/ajtmh.22-0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 12/05/2022] [Indexed: 03/08/2023] Open
Abstract
The 2020 neonatal mortality rate in Bangladesh was 17 deaths per 1,000 live births, higher than the 2030 Sustainable Development Goal target (12 deaths per 1,000 live births). Over the past decade, Bangladesh has established special care newborn units (SCANUs) in medical facilities countrywide to improve neonatal survival. We conducted a retrospective cohort study in the SCANU of a tertiary-level healthcare facility in Bangladesh to study neonatal survival and associated risk factors using descriptive statistics and logistic regression models. Of 674 neonates admitted to the unit between January and November 2018, 263 (39%) died in hospital, 309 (46%) were discharged against medical advice, 90 (13%) were discharged healthy, and 12 (2%) had other discharge statuses. The median duration of time spent in hospital was 3 days, and 60% were admitted at birth. Neonates delivered via Cesarean section (adjusted odds ratio [aOR]: 2.5; 95% CI: 1.2-5.6) had an increased odds of recovering and being discharged, whereas those diagnosed with prematurity and/or low birth weight at admission (aOR: 0.2; 95% CI: 0.1-0.4) had a decreased odds of doing so. The high mortality rate and large number of neonates discharged against medical advice suggest a need to investigate the etiology of death and the factors leading to children leaving hospital prior to recovery. Medical records lacked information on gestational age that could provide key insights about mortality risk and age of viability in this setting. Addressing these knowledge gaps in SCANUs may enable better support for the improvement of child survival.
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Affiliation(s)
- Ananya A. Kumar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kyu Han Lee
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Sanwarul Bari
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Chayon Deb
- Faridpur Medical College Hospital, Faridpur, Bangladesh
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Farzana Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Emily S. Gurley
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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Shanta IS, Luby SP, Hossain K, Heffelfinger JD, Kilpatrick AM, Haider N, Rahman T, Chakma S, Ahmed SSU, Sharker Y, Pulliam JRC, Kennedy ED, Gurley ES. Human Exposure to Bats, Rodents and Monkeys in Bangladesh. Ecohealth 2023; 20:53-64. [PMID: 37099204 PMCID: PMC10131556 DOI: 10.1007/s10393-023-01628-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/28/2023] [Accepted: 04/05/2023] [Indexed: 06/11/2023]
Abstract
Bats, rodents and monkeys are reservoirs for emerging zoonotic infections. We sought to describe the frequency of human exposure to these animals and the seasonal and geographic variation of these exposures in Bangladesh. During 2013-2016, we conducted a cross-sectional survey in a nationally representative sample of 10,002 households from 1001 randomly selected communities. We interviewed household members about exposures to bats, rodents and monkeys, including a key human-bat interface-raw date palm sap consumption. Respondents reported observing rodents (90%), bats (52%) and monkeys (2%) in or around their households, although fewer reported direct contact. The presence of monkeys around the household was reported more often in Sylhet division (7%) compared to other divisions. Households in Khulna (17%) and Rajshahi (13%) were more likely to report drinking date palm sap than in other divisions (1.5-5.6%). Date palm sap was mostly consumed during winter with higher frequencies in January (16%) and February (12%) than in other months (0-5.6%). There was a decreasing trend in drinking sap over the three years. Overall, we observed substantial geographic and seasonal patterns in human exposure to animals that could be sources of zoonotic disease. These findings could facilitate targeting emerging zoonoses surveillance, research and prevention efforts to areas and seasons with the highest levels of exposure.
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Affiliation(s)
- Ireen Sultana Shanta
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
| | | | - Kamal Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | | | - Najmul Haider
- The Royal Veterinary College, University of London, London, UK
| | - Taifur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shovon Chakma
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Syed Sayeem Uddin Ahmed
- Department of Epidemiology and Public Health, Sylhet Agricultural University, Sylhet, Bangladesh
| | - Yushuf Sharker
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- University of Florida, Gainesville, USA
| | - Juliet R C Pulliam
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Erin D Kennedy
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily S Gurley
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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26
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Islam A, Cannon DL, Rahman MZ, Khan SU, Epstein JH, Daszak P, Luby SP, Montgomery JM, Klena JD, Gurley ES. Nipah Virus Exposure in Domestic and Peridomestic Animals Living in Human Outbreak Sites, Bangladesh, 2013-2015. Emerg Infect Dis 2023; 29:393-396. [PMID: 36692447 PMCID: PMC9881791 DOI: 10.3201/eid2902.221379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Spillovers of Nipah virus (NiV) from Pteropus bats to humans occurs frequently in Bangladesh, but the risk for spillover into other animals is poorly understood. We detected NiV antibodies in cattle, dogs, and cats from 6 sites where spillover human NiV infection cases occurred during 2013-2015.
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27
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Mahtab S, Madhi SA, Baillie VL, Els T, Thwala BN, Onyango D, Tippet-Barr BA, Akelo V, Igunza KA, Omore R, Arifeen SE, Gurley ES, Alam M, Chowdhury AI, Rahman A, Bassat Q, Mandomando I, Ajanovic S, Sitoe A, Varo R, Sow SO, Kotloff KL, Badji H, Tapia MD, Traore CB, Ogbuanu IU, Bunn J, Luke R, Sannoh S, Swarray-Deen A, Assefa N, Scott JAG, Madrid L, Marami D, Fentaw S, Diaz MH, Martines RB, Breiman RF, Madewell ZJ, Blau DM, Whitney CG. Causes of death identified in neonates enrolled through Child Health and Mortality Prevention Surveillance (CHAMPS), December 2016 -December 2021. PLOS Glob Public Health 2023; 3:e0001612. [PMID: 36963040 PMCID: PMC10027211 DOI: 10.1371/journal.pgph.0001612] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/27/2023] [Indexed: 03/26/2023]
Abstract
Each year, 2.4 million children die within their first month of life. Child Health and Mortality Prevention Surveillance (CHAMPS) established in 7 countries aims to generate accurate data on why such deaths occur and inform prevention strategies. Neonatal deaths that occurred between December 2016 and December 2021 were investigated with MITS within 24-72 hours of death. Testing included blood, cerebrospinal fluid and lung cultures, multi-pathogen PCR on blood, CSF, nasopharyngeal swabs and lung tissue, and histopathology examination of lung, liver and brain. Data collection included clinical record review and family interview using standardized verbal autopsy. The full set of data was reviewed by local experts using a standardized process (Determination of Cause of Death) to identify all relevant conditions leading to death (causal chain), per WHO recommendations. For analysis we stratified neonatal death into 24-hours of birth, early (1-<7 days) and late (7-<28 days) neonatal deaths. We analyzed 1458 deaths, 41% occurring within 24-hours, 41% early and 18% late neonatal deaths. Leading underlying causes of death were complications of intrapartum events (31%), complications of prematurity (28%), infections (17%), respiratory disorders (11%), and congenital malformations (8%). In addition to the underlying cause, 62% of deaths had additional conditions and 14% had ≥3 other conditions in the causal chain. The most common causes considering the whole causal chain were infection (40%), prematurity (32%) and respiratory distress syndrome (28%). Common maternal conditions linked to neonatal death were maternal hypertension (10%), labour and delivery complications (8%), multiple gestation (7%), placental complications (6%) obstructed labour and chorioamnionitis (5%, each). CHAMPS' findings showing the full causal chain of events that lead to death, in addition to maternal factors, highlights the complexities involved in each death along with the multiple opportunities for prevention. Highlighting improvements to prenatal and obstetric care and infection prevention are urgently needed in high-mortality settings.
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Affiliation(s)
- Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Vicky L Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Toyah Els
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Bukiwe Nana Thwala
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Victor Akelo
- Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Kitiezo Aggrey Igunza
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Richard Omore
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Emily S Gurley
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Muntasir Alam
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | | | - Afruna Rahman
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Quique Bassat
- ISGlobal-Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- Institutó Catalana de Recerca I Estudis Avançats [ICREA], Barcelona, Spain
- Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública [CIBERESP], Madrid, Spain
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
- Instituto Nacional de Saúde [INS], Maputo, Mozambique
| | - Sara Ajanovic
- ISGlobal-Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
| | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Rosauro Varo
- ISGlobal-Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça [CISM], Maputo, Mozambique
| | - Samba O Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Karen L Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Henry Badji
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Milagritos D Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Cheick B Traore
- Department of Pathological Anatomy and Cytology, University Hospital of Point G, Bamako, Mali
| | | | - James Bunn
- World Health Organization-Sierra Leone, Freetown, Sierra Leone
| | - Ronita Luke
- Ola During Children's Hospital, Freetown, Sierra Leone
| | - Sulaiman Sannoh
- St. Luke's University Health Network, Easton, Pennsylvania, United States of America
| | | | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - J Anthony G Scott
- Department of Infectious Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Lola Madrid
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Infectious Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Dadi Marami
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Surafel Fentaw
- Bacterial and Mycology Unit, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Maureen H Diaz
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Roosecelis B Martines
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Robert F Breiman
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Zachary J Madewell
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Dianna M Blau
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Cynthia G Whitney
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
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Sultana R, Nahar N, Luby SP, Swarna ST, Gurley ES, Tamason CC, Khan S, Rimi NA, Kabir H, Saifullah MK, Howlader SR, Jensen PKM. Measuring Water Quantity Used for Personal and Domestic Hygiene and Determinants of Water Use in a Low-Income Urban Community. Int J Environ Res Public Health 2022; 19:ijerph192315656. [PMID: 36497732 PMCID: PMC9737866 DOI: 10.3390/ijerph192315656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 06/01/2023]
Abstract
There is a paucity of recent research on direct water quantity measurement for personal and domestic hygiene. We aimed to measure the water quantity used for personal and domestic hygiene and to explore the reasons and determinants for variation of water usage. We conducted this study from September 2014 to June 2016 in a low-income urban community in Dhaka. In 12 households, the team conducted a day-long bimonthly ethnographic observation for one year to measure the volume of water used per activity per person. They conducted 28 in-depth interviews to explore the reasons for changes of water usage. Participants used a median of 75 L (61-100) of water per capita per day (LCPD) and of this 75 LCPD they used a median of 39 LCPD (26-58) for personal hygiene. Women used less water than men. Individual and social norms, beliefs, and weather determinants determined personal hygiene. Water availability determined domestic hygiene (e.g., washing dishes, toilets and bathrooms). This study helps to elucidate a range of determinants of water usage of the participants from the participants' perspective. The quantity of water used for domestic and personal hygiene and its relationship to fecal-oral transmitted disease can be explored in future research.
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Affiliation(s)
- Rebeca Sultana
- Copenhagen Center for Disaster Research, Global Health Section, Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
- Institute of Health Economics, University of Dhaka, Dhaka 1000, Bangladesh
- icddr,b, Dhaka 1212, Bangladesh
| | - Nazmun Nahar
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Stephen P. Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA 94305, USA
| | | | - Emily S. Gurley
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Charlotte Crim Tamason
- Copenhagen Center for Disaster Research, Global Health Section, Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
| | | | | | | | | | | | - Peter Kjær Mackie Jensen
- Copenhagen Center for Disaster Research, Global Health Section, Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
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Saiful Islam M, Gurley ES, Banu S, Hossain K, Heffelfinger JD, Amin Chowdhury KI, Ahmed S, Afreen S, Mazidur Rahman SM, Pearson ML, Chai SJ. 84. Prevalence and incidence of latent tuberculosis infection among healthcare workers in chest diseases hospitals, Bangladesh: Putting infection control into context. Infect Dis Health 2022. [DOI: 10.1016/j.idh.2022.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Madewell ZJ, Whitney CG, Velaphi S, Mutevedzi P, Mahtab S, Madhi SA, Fritz A, Swaray-Deen A, Sesay T, Ogbuanu IU, Mannah MT, Xerinda EG, Sitoe A, Mandomando I, Bassat Q, Ajanovic S, Tapia MD, Sow SO, Mehta A, Kotloff KL, Keita AM, Tippett Barr BA, Onyango D, Oele E, Igunza KA, Agaya J, Akelo V, Scott JAG, Madrid L, Kelil YE, Dufera T, Assefa N, Gurley ES, El Arifeen S, Spotts Whitney EA, Seib K, Rees CA, Blau DM. Prioritizing Health Care Strategies to Reduce Childhood Mortality. JAMA Netw Open 2022; 5:e2237689. [PMID: 36269354 PMCID: PMC9587481 DOI: 10.1001/jamanetworkopen.2022.37689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Although child mortality trends have decreased worldwide, deaths among children younger than 5 years of age remain high and disproportionately circumscribed to sub-Saharan Africa and Southern Asia. Tailored and innovative approaches are needed to increase access, coverage, and quality of child health care services to reduce mortality, but an understanding of health system deficiencies that may have the greatest impact on mortality among children younger than 5 years is lacking. OBJECTIVE To investigate which health care and public health improvements could have prevented the most stillbirths and deaths in children younger than 5 years using data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used longitudinal, population-based, and mortality surveillance data collected by CHAMPS to understand preventable causes of death. Overall, 3390 eligible deaths across all 7 CHAMPS sites (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) between December 9, 2016, and December 31, 2021 (1190 stillbirths, 1340 neonatal deaths, 860 infant and child deaths), were included. Deaths were investigated using minimally invasive tissue sampling (MITS), a postmortem approach using biopsy needles for sampling key organs and fluids. MAIN OUTCOMES AND MEASURES For each death, an expert multidisciplinary panel reviewed case data to determine the plausible pathway and causes of death. If the death was deemed preventable, the panel identified which of 10 predetermined health system gaps could have prevented the death. The health system improvements that could have prevented the most deaths were evaluated for each age group: stillbirths, neonatal deaths (aged <28 days), and infant and child deaths (aged 1 month to <5 years). RESULTS Of 3390 deaths, 1505 (44.4%) were female and 1880 (55.5%) were male; sex was not recorded for 5 deaths. Of all deaths, 3045 (89.8%) occurred in a healthcare facility and 344 (11.9%) in the community. Overall, 2607 (76.9%) were deemed potentially preventable: 883 of 1190 stillbirths (74.2%), 1010 of 1340 neonatal deaths (75.4%), and 714 of 860 infant and child deaths (83.0%). Recommended measures to prevent deaths were improvements in antenatal and obstetric care (recommended for 588 of 1190 stillbirths [49.4%], 496 of 1340 neonatal deaths [37.0%]), clinical management and quality of care (stillbirths, 280 [23.5%]; neonates, 498 [37.2%]; infants and children, 393 of 860 [45.7%]), health-seeking behavior (infants and children, 237 [27.6%]), and health education (infants and children, 262 [30.5%]). CONCLUSIONS AND RELEVANCE In this cross-sectional study, interventions prioritizing antenatal, intrapartum, and postnatal care could have prevented the most deaths among children younger than 5 years because 75% of deaths among children younger than 5 were stillbirths and neonatal deaths. Measures to reduce mortality in this population should prioritize improving existing systems, such as better access to antenatal care, implementation of standardized clinical protocols, and public education campaigns.
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Affiliation(s)
- Zachary J. Madewell
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Sithembiso Velaphi
- Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Portia Mutevedzi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sana Mahtab
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Shabir A. Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ashleigh Fritz
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Alim Swaray-Deen
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Tom Sesay
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | | | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Instituto Nacional de Saúde, Maputo, Mozambique
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal–Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
- Institutó Catalana de Recerca I Estudis Avançats, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Sara Ajanovic
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal–Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
| | - Milagritos D. Tapia
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Samba O. Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Ashka Mehta
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Karen L. Kotloff
- Department of Pediatrics and Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore
| | - Adama M. Keita
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | | | | | | | | | - Janet Agaya
- Kenya Medical Research Institute-Center for Global Health Research, Kisumu, Kenya
| | - Victor Akelo
- Centers for Disease Control and Prevention–Kenya, Kisumu, Kenya
| | - J. Anthony G. Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lola Madrid
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yunus-Edris Kelil
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tadesse Dufera
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Emily S. Gurley
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Ellen A. Spotts Whitney
- International Association of National Public Health Institutes, Global Health Institute, Emory University, Atlanta, Georgia
| | - Katherine Seib
- International Association of National Public Health Institutes, Global Health Institute, Emory University, Atlanta, Georgia
| | - Chris A. Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Dianna M. Blau
- Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, Georgia
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Quincer E, Philipsborn R, Morof D, Salzberg NT, Vitorino P, Ajanovic S, Onyango D, Ogbuanu I, Assefa N, Sow SO, Mutevedzi P, El Arifeen S, Tippet Barr BA, Scott JAG, Mandomando I, Kotloff KL, Jambai A, Akelo V, Cain CJ, Chowdhury AI, Gure T, Igunza KA, Islam F, Keita AM, Madrid L, Mahtab S, Mehta A, Mitei PK, Ntuli C, Ojulong J, Rahman A, Samura S, Sidibe D, Thwala BN, Varo R, Madhi SA, Bassat Q, Gurley ES, Blau DM, Whitney CG. Insights on the differentiation of stillbirths and early neonatal deaths: A study from the Child Health and Mortality Prevention Surveillance (CHAMPS) network. PLoS One 2022; 17:e0271662. [PMID: 35862419 PMCID: PMC9302850 DOI: 10.1371/journal.pone.0271662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/05/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction The high burden of stillbirths and neonatal deaths is driving global initiatives to improve birth outcomes. Discerning stillbirths from neonatal deaths can be difficult in some settings, yet this distinction is critical for understanding causes of perinatal deaths and improving resuscitation practices for live born babies. Methods We evaluated data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network to compare the accuracy of determining stillbirths versus neonatal deaths from different data sources and to evaluate evidence of resuscitation at delivery in accordance with World Health Organization (WHO) guidelines. CHAMPS works to identify causes of stillbirth and death in children <5 years of age in Bangladesh and 6 countries in sub-Saharan Africa. Using CHAMPS data, we compared the final classification of a case as a stillbirth or neonatal death as certified by the CHAMPS Determining Cause of Death (DeCoDe) panel to both the initial report of the case by the family member or healthcare worker at CHAMPS enrollment and the birth outcome as stillbirth or livebirth documented in the maternal health record. Results Of 1967 deaths ultimately classified as stillbirth, only 28 (1.4%) were initially reported as livebirths. Of 845 cases classified as very early neonatal death, 33 (4%) were initially reported as stillbirth. Of 367 cases with post-mortem examination showing delivery weight >1000g and no maceration, the maternal clinical record documented that resuscitation was not performed in 161 cases (44%), performed in 14 (3%), and unknown or data missing for 192 (52%). Conclusion This analysis found that CHAMPS cases assigned as stillbirth or neonatal death after DeCoDe expert panel review were generally consistent with the initial report of the case as a stillbirth or neonatal death. Our findings suggest that more frequent use of resuscitation at delivery and improvements in documentation around events at birth could help improve perinatal outcomes.
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Affiliation(s)
- Elizabeth Quincer
- Department of Pediatrics and Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia, United States of America
| | - Rebecca Philipsborn
- Department of Pediatrics and Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia, United States of America
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Diane Morof
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Durban, South Africa
| | - Navit T. Salzberg
- Public Health Informatics, The Task Force for Global Health, Atlanta, Georgia, United States of America
| | - Pio Vitorino
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
| | - Sara Ajanovic
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
| | | | | | - Nega Assefa
- College of Health Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Samba O. Sow
- Centre pour le Développement des Vaccines (CVD-Mali), Bamako, Mali
| | - Portia Mutevedzi
- MRC Vaccines and Infectious Diseases Analytics (VIDA) Research Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Beth A. Tippet Barr
- Center for Global Health, Centers for Disease Control and Prevention, Kisumu, Kenya
| | - J. Anthony G. Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
- Instituto Nacional de Saúde [INS], Maputo, Mozambique
| | - Karen L. Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Amara Jambai
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Victor Akelo
- Center for Global Health, Centers for Disease Control and Prevention, Kisumu, Kenya
| | | | | | - Tadesse Gure
- College of Health Medical Sciences, Haramaya University, Harar, Ethiopia
| | | | - Farzana Islam
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | | | - Lola Madrid
- College of Health Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sana Mahtab
- MRC Vaccines and Infectious Diseases Analytics (VIDA) Research Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Ashka Mehta
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | - Constance Ntuli
- MRC Vaccines and Infectious Diseases Analytics (VIDA) Research Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | | | - Afruna Rahman
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | | | | | - Bukiwe Nana Thwala
- Wits Health Consortium, University of Witwatersrand, Johannesburg, South Africa
| | - Rosauro Varo
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
- ISGlobal- Hospital Clinic—Universitat de Barcelona, Barcelona, Spain
| | - Shabir A. Madhi
- MRC Vaccines and Infectious Diseases Analytics (VIDA) Research Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
- ISGlobal- Hospital Clinic—Universitat de Barcelona, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital de Sant Joan de Deu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigacion Biomedica en Red de Epidemiologia y Salud, Madrid, Spain
| | - Emily S. Gurley
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Dianna M. Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Cynthia G. Whitney
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
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McKee CD, Islam A, Rahman MZ, Khan SU, Rahman M, Satter SM, Islam A, Yinda CK, Epstein JH, Daszak P, Munster VJ, Hudson PJ, Plowright RK, Luby SP, Gurley ES. Nipah Virus Detection at Bat Roosts after Spillover Events, Bangladesh, 2012-2019. Emerg Infect Dis 2022; 28:1384-1392. [PMID: 35731130 PMCID: PMC9239894 DOI: 10.3201/eid2807.212614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Knowledge of the dynamics and genetic diversity of Nipah virus circulating in bats and at the human-animal interface is limited by current sampling efforts, which produce few detections of viral RNA. We report a series of investigations at Pteropus medius bat roosts identified near the locations of human Nipah cases in Bangladesh during 2012–2019. Pooled bat urine was collected from 23 roosts; 7 roosts (30%) had >1 sample in which Nipah RNA was detected from the first visit. In subsequent visits to these 7 roosts, RNA was detected in bat urine up to 52 days after the presumed exposure of the human case-patient, although the probability of detection declined rapidly with time. These results suggest that rapidly deployed investigations of Nipah virus shedding from bat roosts near human cases could increase the success of viral sequencing compared with background surveillance and could enhance understanding of Nipah virus ecology and evolution.
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Ruiz-Aravena M, McKee C, Gamble A, Lunn T, Morris A, Snedden CE, Yinda CK, Port JR, Buchholz DW, Yeo YY, Faust C, Jax E, Dee L, Jones DN, Kessler MK, Falvo C, Crowley D, Bharti N, Brook CE, Aguilar HC, Peel AJ, Restif O, Schountz T, Parrish CR, Gurley ES, Lloyd-Smith JO, Hudson PJ, Munster VJ, Plowright RK. Ecology, evolution and spillover of coronaviruses from bats. Nat Rev Microbiol 2022; 20:299-314. [PMID: 34799704 PMCID: PMC8603903 DOI: 10.1038/s41579-021-00652-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 12/24/2022]
Abstract
In the past two decades, three coronaviruses with ancestral origins in bats have emerged and caused widespread outbreaks in humans, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the first SARS epidemic in 2002-2003, the appreciation of bats as key hosts of zoonotic coronaviruses has advanced rapidly. More than 4,000 coronavirus sequences from 14 bat families have been identified, yet the true diversity of bat coronaviruses is probably much greater. Given that bats are the likely evolutionary source for several human coronaviruses, including strains that cause mild upper respiratory tract disease, their role in historic and future pandemics requires ongoing investigation. We review and integrate information on bat-coronavirus interactions at the molecular, tissue, host and population levels. We identify critical gaps in knowledge of bat coronaviruses, which relate to spillover and pandemic risk, including the pathways to zoonotic spillover, the infection dynamics within bat reservoir hosts, the role of prior adaptation in intermediate hosts for zoonotic transmission and the viral genotypes or traits that predict zoonotic capacity and pandemic potential. Filling these knowledge gaps may help prevent the next pandemic.
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Affiliation(s)
- Manuel Ruiz-Aravena
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, MT, USA
| | - Clifton McKee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amandine Gamble
- Department of Ecology and Evolutionary Biology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tamika Lunn
- Centre for Planetary Health and Food Security, Griffith University, Nathan, QLD, Australia
| | - Aaron Morris
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Celine E Snedden
- Department of Ecology and Evolutionary Biology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Claude Kwe Yinda
- National Institute of Allergy and Infectious Diseases, Hamilton, MT, USA
| | - Julia R Port
- National Institute of Allergy and Infectious Diseases, Hamilton, MT, USA
| | - David W Buchholz
- Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Yao Yu Yeo
- Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Christina Faust
- Department of Biology, Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA
| | - Elinor Jax
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Lauren Dee
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Devin N Jones
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, MT, USA
| | - Maureen K Kessler
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, MT, USA
- Department of Ecology, Montana State University, Bozeman, MT, USA
| | - Caylee Falvo
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, MT, USA
| | - Daniel Crowley
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, MT, USA
| | - Nita Bharti
- Department of Biology, Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA
| | - Cara E Brook
- Department of Ecology and Evolution, University of Chicago, Chicago, IL, USA
| | - Hector C Aguilar
- Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Alison J Peel
- Centre for Planetary Health and Food Security, Griffith University, Nathan, QLD, Australia
| | - Olivier Restif
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Tony Schountz
- Department of Microbiology, Immunology, and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Colin R Parrish
- Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Emily S Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - James O Lloyd-Smith
- Department of Ecology and Evolutionary Biology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Peter J Hudson
- Department of Biology, Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA
| | - Vincent J Munster
- National Institute of Allergy and Infectious Diseases, Hamilton, MT, USA
| | - Raina K Plowright
- Department of Microbiology and Cell Biology, Montana State University, Bozeman, MT, USA.
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Madewell ZJ, Whitney CG, Assefa N, Bassat Q, Arifeen SE, Gurley ES, Jambai A, Kotloff KL, Madhi SA, Mandomando I, Ogbuanu IU, Onyango D, Scott JAG, Sow SO, Barr BAT, Blau DM. Prioritising health-care strategies to reduce childhood mortality, insights from Child Health and Mortality Prevention Surveillance (CHAMPS): a longitudinal study. The Lancet Global Health 2022. [DOI: 10.1016/s2214-109x(22)00137-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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35
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Mhajabin S, Hossain AT, Nusrat N, Jabeen S, Ameen S, Banik G, Tahsina T, Ahmed A, Sadeq-Ur Rahman Q, Gurley ES, Bari S, Chowdhury AI, Arifeen SE, Mehta R, Rahman AE. Indirect effects of the early phase of the COVID-19 pandemic on the coverage of essential maternal and newborn health services in a rural subdistrict in Bangladesh: results from a cross-sectional household survey. BMJ Open 2022; 12:e056951. [PMID: 35115357 PMCID: PMC8814430 DOI: 10.1136/bmjopen-2021-056951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE This paper presents the effect of the early phase of COVID-19 on the coverage of essential maternal and newborn health (MNH) services in a rural subdistrict of Bangladesh. DESIGN Cross-sectional household survey with random sampling. SETTING Baliakandi subdistrict, Rajbari district, Bangladesh. PARTICIPANTS Data were collected from women who were on the third trimester of pregnancy during the early phase of the pandemic (111) and pre-pandemic periods (115) to measure antenatal care (ANC) service coverage. To measure birth, postnatal care (PNC) and essential newborn care (ENC), data were collected from women who had a history of delivery during the early phase of the pandemic (163) and pre-pandemic periods (166). EXPOSURE Early phase of the pandemic included a strict national lockdown between April and June 2020, and pre-pandemic was defined as August-October 2019. OUTCOME OF INTEREST Changes in the coverage of selected MNH services (ANC, birth, PNC, ENC) during the early phase of COVID-19 pandemic compared with the pre-pandemic period, estimated by two-sample proportion tests. FINDINGS Among women who were on the third trimester of pregnancy during the early phase of the pandemic period, 77% (95% CI: 70% to 85%) received at least one ANC from a medically trained provider (MTP) during the third trimester, compared with 83% (95% CI: 76% to 90%) during the pre-pandemic period (p=0.33). Among women who gave birth during the early phase of the pandemic period, 72% (95% CI: 66% to 79%) were attended by an MTP, compared with 63% (95% CI: 56% to 71%) during the pre-pandemic period (p=0.08). Early initiation of breast feeding was practised among 38% (95% CI: 31% to 46%) of the babies born during the early phase of the pandemic period. It was 37% (95% CI: 29% to 44%) during the pre-pandemic period (p=0.81). The coverage of ANC, birth, PNC and ENC did not differ by months of pandemic and pre-pandemic periods; only the coverage of at least one ANC from an MTP significantly differed among the women who were 7 months pregnant during the early phase of the pandemic (35%, 95% CI: 26% to 44%) and pre-pandemic (49%, 95% CI: 39% to 58%) (p=0.04). CONCLUSION The effect of the early phase of the pandemic including lockdown on the selected MNH service coverage was null in the study area. The nature of the lockdown, the availability and accessibility of private sector health services in that area, and the combating strategies at the rural level made it possible for the women to avail the required MNH services.
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Affiliation(s)
- Shema Mhajabin
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Nowrin Nusrat
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Sabrina Jabeen
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Shafiqul Ameen
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Goutom Banik
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Tazeen Tahsina
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Anisuddin Ahmed
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | | | - Sanwarul Bari
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Atique Iqbal Chowdhury
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Rajesh Mehta
- WHO Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
- Usher Institute, University of Edinburgh, Edinburgh, UK
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36
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Hegde ST, Bhuiyan TR, Akhtar M, Islam T, Hulse JD, Khan ZH, Khan II, Ahmed S, Rashid M, Rashid R, Gurley ES, Shirin T, Khan AI, Azman AS, Qadri F. Predictors of Nonseroconversion after SARS-CoV-2 Infection. Emerg Infect Dis 2022; 28:492-493. [PMID: 35076367 PMCID: PMC8798696 DOI: 10.3201/eid2802.211971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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37
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Bhuiyan TR, Hulse JD, Hegde ST, Akhtar M, Islam T, Khan ZH, Khan II, Ahmed S, Rashid M, Rashid R, Gurley ES, Shirin T, Khan AI, Azman AS, Qadri F. SARS-CoV-2 Seroprevalence before Delta Variant Surge, Chattogram, Bangladesh, March–June 2021. Emerg Infect Dis 2022; 28:429-431. [PMID: 35076007 PMCID: PMC8798688 DOI: 10.3201/eid2802.211689] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A March–June 2021 representative serosurvey among Sitakunda subdistrict (Chattogram, Bangladesh) residents found an adjusted prevalence of severe acute respiratory syndrome coronavirus 2 antibodies of 64.1% (95% credible interval 60.0%–68.1%). Before the Delta variant surge, most residents had been infected, although cumulative confirmed coronavirus disease incidence was low.
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Hegde ST, Bhuiyan TR, Akhtar M, Islam T, Hulse JD, Khan ZH, Khan II, Ahmed S, Rashid M, Rashid R, Gurley ES, Shirin T, Khan AI, Azman AS, Qadri F. High Infection Attack Rate after SARS-CoV-2 Delta Surge, Chattogram, Bangladesh. Emerg Infect Dis 2022; 28:491-492. [PMID: 35076375 PMCID: PMC8798703 DOI: 10.3201/eid2802.212417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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39
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Redd AD, Peetluk LS, Jarrett BA, Hanrahan C, Schwartz S, Rao A, Jaffe AE, Peer AD, Jones CB, Lutz CS, McKee CD, Patel EU, Rosen JG, Garrison Desany H, McKay HS, Muschelli J, Andersen KM, Link MA, Wada N, Baral P, Young R, Boon D, Grabowski MK, Gurley ES. Curating the Evidence About COVID-19 for Frontline Public Health and Clinical Care: The Novel Coronavirus Research Compendium. Public Health Rep 2021; 137:197-202. [PMID: 34969294 DOI: 10.1177/00333549211058732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The public health crisis created by the COVID-19 pandemic has spurred a deluge of scientific research aimed at informing the public health and medical response to the pandemic. However, early in the pandemic, those working in frontline public health and clinical care had insufficient time to parse the rapidly evolving evidence and use it for decision-making. Academics in public health and medicine were well-placed to translate the evidence for use by frontline clinicians and public health practitioners. The Novel Coronavirus Research Compendium (NCRC), a group of >60 faculty and trainees across the United States, formed in March 2020 with the goal to quickly triage and review the large volume of preprints and peer-reviewed publications on SARS-CoV-2 and COVID-19 and summarize the most important, novel evidence to inform pandemic response. From April 6 through December 31, 2020, NCRC teams screened 54 192 peer-reviewed articles and preprints, of which 527 were selected for review and uploaded to the NCRC website for public consumption. Most articles were peer-reviewed publications (n = 395, 75.0%), published in 102 journals; 25.1% (n = 132) of articles reviewed were preprints. The NCRC is a successful model of how academics translate scientific knowledge for practitioners and help build capacity for this work among students. This approach could be used for health problems beyond COVID-19, but the effort is resource intensive and may not be sustainable in the long term.
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Affiliation(s)
- Andrew D Redd
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.,School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lauren S Peetluk
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brooke A Jarrett
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Colleen Hanrahan
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sheree Schwartz
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Amrita Rao
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Andrew E Jaffe
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Lieber Institute for Brain Development, Baltimore, MD, USA
| | - Austin D Peer
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Carli B Jones
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Chelsea S Lutz
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Clifton D McKee
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Eshan U Patel
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph G Rosen
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Henri Garrison Desany
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Heather S McKay
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Zanvyl Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - John Muschelli
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kathleen M Andersen
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Nikolas Wada
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Prativa Baral
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ruth Young
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Denali Boon
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Corteva Inc, Indianapolis, IN, USA
| | - M Kate Grabowski
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Emily S Gurley
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Hegde ST, Lee EC, Islam Khan A, Lauer SA, Islam MT, Rahman Bhuiyan T, Lessler J, Azman AS, Qadri F, Gurley ES. Clinical Cholera Surveillance Sensitivity in Bangladesh and Implications for Large-Scale Disease Control. J Infect Dis 2021; 224:S725-S731. [PMID: 34453539 PMCID: PMC8687068 DOI: 10.1093/infdis/jiab418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background A surveillance system that is sensitive to detecting high burden areas is critical for achieving widespread disease control. In 2014, Bangladesh established a nationwide, facility-based cholera surveillance system for Vibrio cholerae infection. We sought to measure the sensitivity of this surveillance system to detect cases to assess whether cholera elimination targets outlined by the Bangladesh national control plan can be adequately measured. Methods We overlaid maps of nationally representative annual V cholerae seroincidence onto maps of the catchment areas of facilities where confirmatory laboratory testing for cholera was conducted, and we identified its spatial complement as surveillance greyspots, areas where cases likely occur but go undetected. We assessed surveillance system sensitivity and changes to sensitivity given alternate surveillance site selection strategies. Results We estimated that 69% of Bangladeshis (111.7 million individuals) live in surveillance greyspots and that 23% (25.5 million) of these individuals live in areas with the highest V cholerae infection rates. Conclusions The cholera surveillance system in Bangladesh has the ability to monitor progress towards cholera elimination goals among 31% of the country’s population, which may be insufficient for accurately measuring progress. Increasing surveillance coverage, particularly in the highest risk areas, should be considered.
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Affiliation(s)
- Sonia T Hegde
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth C Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Stephen A Lauer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Emily S Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Ahmed S, Dorin F, Satter SM, Sarker AR, Sultana M, Gastanaduy PA, Parashar U, Tate JE, Heffelfinger JD, Gurley ES, Khan JAM. The economic burden of rotavirus hospitalization among children < 5 years of age in selected hospitals in Bangladesh. Vaccine 2021; 39:7082-7090. [PMID: 34756769 DOI: 10.1016/j.vaccine.2021.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 09/16/2021] [Accepted: 10/04/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Rotavirus is a common cause of severe acute gastroenteritis among young children. Estimation of the economic burden would provide informed decision about investment on prevention strategies (e.g., vaccine and/or behavior change), which has been a potential policy discussion in Bangladesh for several years. METHODS We estimated the societal costs of children <5 years for hospitalization from rotavirus gastroenteritis (RVGE) and incidences of catastrophic health expenditure. A total of 360 children with stool specimens positive for rotavirus were included in this study from 6 tertiary hospitals (3 public and 3 private). We interviewed the caregiver of the patient and hospital staff to collect cost from patient and health facility perspectives. We estimated the economic cost considering 2015 as the reference year. RESULTS The total societal per-patient costs to treat RVGE in the public hospital were 126 USD (95% CI: 116-136) and total household costs were 161 USD (95% CI: 145-177) in private facilities. Direct costs constituted 38.1% of total household costs. The out-of-pocket payments for RVGE hospitalization was 23% of monthly income and 76% of households faced catastrophic healthcare expenditures due to this expense. The estimated total annual household treatment cost for the country was 10 million USD. CONCLUSIONS A substantial economic burden of RVGE in Bangladesh was observed in this study. Any prevention of RVGE through cost-effective vaccination or/and behavioural change would contribute to substantial economic benefits to Bangladesh.
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Affiliation(s)
- Sayem Ahmed
- icddr,b, Dhaka, Bangladesh; Mathematical Modelling Group, Oxford University Clinical Research Unit (OUCRU), Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom.
| | | | | | - Abdur Razzaque Sarker
- icddr,b, Dhaka, Bangladesh; University of Strathclyde, Glasgow, Scotland, UK; Bangladesh Institute of Development Studies, Dhaka, Bangladesh
| | - Marufa Sultana
- icddr,b, Dhaka, Bangladesh; Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | | | - Umesh Parashar
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - James D Heffelfinger
- icddr,b, Dhaka, Bangladesh; Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily S Gurley
- icddr,b, Dhaka, Bangladesh; John Hopkins University, Baltimore, MD, USA
| | - Jahangir A M Khan
- icddr,b, Dhaka, Bangladesh; Karolinska Institutet, Stockholm, Sweden; School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
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Abstract
Background Hepatitis E virus (HEV) genotypes 1 and 2 are a major cause of avoidable morbidity and mortality in South Asia. Despite the high risk of death among infected pregnant women, scarce incidence data has been a contributing factor to global policy recommendations against the introduction of licensed hepatitis E vaccines, one of the only effective prevention tools. Methods We tested serum from a nationally representative serosurvey in Bangladesh for anti-HEV immunoglobulin G and estimated seroprevalence. We used Bayesian geostatistical models to generate high-resolution maps of seropositivity and examined variability in seropositivity by individual-level, household-level, and community-level risk factors using spatial logistic regression. Results We tested serum samples from 2924 individuals from 70 communities representing all divisions of Bangladesh and estimated a national seroprevalence of 20% (95% confidence interval [CI], 17%–24%). Seropositivity increased with age and male sex (odds ratio, 2.2 male vs female; 95% CI, 1.8–2.8). Community-level seroprevalence ranged widely (0–78%) with higher seroprevalence in urban areas, including Dhaka, with a 3.0-fold (95% credible interval, 2.3–3.7) higher seroprevalence than the rest of the country. Conclusions Hepatitis E infections are common throughout Bangladesh. Strengthening surveillance for hepatitis E, especially in urban areas, can provide additional evidence to appropriately target interventions.
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Affiliation(s)
- Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | | | - Aybüke Koyuncu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Henrik Salje
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,University of Cambridge, Cambridge, UK
| | | | - Emily S Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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43
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Nikolay B, Ribeiro Dos Santos G, Lipsitch M, Rahman M, Luby SP, Salje H, Gurley ES, Cauchemez S. Assessing the feasibility of Nipah vaccine efficacy trials based on previous outbreaks in Bangladesh. Vaccine 2021; 39:5600-5606. [PMID: 34426025 DOI: 10.1016/j.vaccine.2021.08.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nipah virus (NiV) is an emerging, bat-borne pathogen that can be transmitted from person-to-person. Vaccines are currently being developed for NiV, and studies have been funded to evaluate their safety and immunogenicity. An important unanswered question is whether it will be possible to evaluate the efficacy of vaccine candidates in phase III clinical trials in a context where spillovers from the zoonotic reservoir are infrequent and associated with small outbreaks. The objective of this study was to investigate the feasibility of conducting a phase III vaccine trial in Bangladesh, the only country regularly reporting NiV cases. METHODS We used simulations based on previously observed NiV cases from Bangladesh, an assumed vaccine efficacy of 90% and other NiV vaccine target characteristics, to compare three vaccination study designs: (i) cluster randomized ring vaccination, (ii) cluster randomized mass vaccination, and (iii) an observational case-control study design. RESULTS The simulations showed that, assuming a ramp-up period of 10 days and a mean hospitalization delay of 4 days,a cluster-randomized ring vaccination trial would require 516 years and over 163,000 vaccine doses to run a ring vaccination trial under current epidemic conditions. A cluster-randomized mass vaccination trial in the two most affected districts would take 43 years and 1.83 million vaccine doses. An observational case-control design in these two districts would require seven years and 2.5 million vaccine doses. DISCUSSION Without a change in the epidemiology of NiV, ring vaccination or mass vaccination trials are unlikely to be completed within a reasonable time window. In this light, the remaining options are: (i) not conducting a phase III trial until the epidemiology of NiV changes, (ii) identifying alternative ways to licensure such as observational studies or controlled studies in animals such as in the US Food and Drug Administration's (FDA) Animal Rule.
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Affiliation(s)
- Birgit Nikolay
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR2000, CNRS, 75015 Paris, France
| | | | - Marc Lipsitch
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Stephen P Luby
- Infectious Diseases and Geographic Medicine Division, Stanford University, Stanford, CA, USA
| | - Henrik Salje
- Department of Genetics, University of Cambridge, Cambridge, UK.
| | - Emily S Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR2000, CNRS, 75015 Paris, France
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Mazur NI, Löwensteyn YN, Willemsen JE, Gill CJ, Forman L, Mwananyanda LM, Blau DM, Breiman RF, Madhi SA, Mahtab S, Gurley ES, El Arifeen S, Assefa N, Scott JAG, Onyango D, Tippet Barr BA, Kotloff KL, Sow SO, Mandomando I, Ogbuanu I, Jambai A, Bassat Q, Caballero MT, Polack FP, Omer S, Kazi AM, Simões EAF, Satav A, Bont LJ. Global Respiratory Syncytial Virus-Related Infant Community Deaths. Clin Infect Dis 2021; 73:S229-S237. [PMID: 34472576 PMCID: PMC8411255 DOI: 10.1093/cid/ciab528] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a leading cause of pediatric death, with >99% of mortality occurring in low- and lower middle-income countries. At least half of RSV-related deaths are estimated to occur in the community, but clinical characteristics of this group of children remain poorly characterized. METHODS The RSV Global Online Mortality Database (RSV GOLD), a global registry of under-5 children who have died with RSV-related illness, describes clinical characteristics of children dying of RSV through global data sharing. RSV GOLD acts as a collaborative platform for global deaths, including community mortality studies described in this supplement. We aimed to compare the age distribution of infant deaths <6 months occurring in the community with in-hospital. RESULTS We studied 829 RSV-related deaths <1 year of age from 38 developing countries, including 166 community deaths from 12 countries. There were 629 deaths that occurred <6 months, of which 156 (25%) occurred in the community. Among infants who died before 6 months of age, median age at death in the community (1.5 months; IQR: 0.8-3.3) was lower than in-hospital (2.4 months; IQR: 1.5-4.0; P < .0001). The proportion of neonatal deaths was higher in the community (29%, 46/156) than in-hospital (12%, 57/473, P < 0.0001). CONCLUSIONS We observed that children in the community die at a younger age. We expect that maternal vaccination or immunoprophylaxis against RSV will have a larger impact on RSV-related mortality in the community than in-hospital. This case series of RSV-related community deaths, made possible through global data sharing, allowed us to assess the potential impact of future RSV vaccines.
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Affiliation(s)
- Natalie I Mazur
- Division of Infectious Diseases, Department of Pediatrics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Yvette N Löwensteyn
- Division of Infectious Diseases, Department of Pediatrics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Joukje E Willemsen
- Division of Infectious Diseases, Department of Pediatrics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Christopher J Gill
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Leah Forman
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Lawrence M Mwananyanda
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Dianna M Blau
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Robert F Breiman
- Emory University, Global Health Institute, Child Health and Mortality Prevention Surveillance (CHAMPS) Network, Atlanta, Georgia, USA
| | - Shabir A Madhi
- South African Medical Research Council-Vaccines and Infectious Diseases Analytics Research Unit, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation-Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sana Mahtab
- Department of Science and Technology/National Research Foundation-Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Emily S Gurley
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shams El Arifeen
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - J Anthony G Scott
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Karen L Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health and Division of Infectious Disease and Tropical Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Samba O Sow
- Center for Vaccine Development, Bamako, Mali
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Instituto Nacional de Saúde (INS), Ministério da Saúde, Maputo, Mozambique
| | | | - Amara Jambai
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Catalan Institution for Research and Advanced Studies (ICREA), Pg. Lluís Companys 23, Barcelona, Spain.,Department of Pediatrics, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Mauricio T Caballero
- Fundación Infant, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Fernando P Polack
- Fundación Infant, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Saad Omer
- Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, USA.,Yale Institute for Global Health, New Haven, Connecticut, USA
| | | | - Eric A F Simões
- Department of Pediatrics and Center for Global Health, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Ashish Satav
- Mahatma Gandhi Tribal Hospital, Kadhava, Maharashtra, India
| | - Louis J Bont
- Division of Infectious Diseases, Department of Pediatrics, University Medical Centre Utrecht, Utrecht, The Netherlands.,Respiratory Syncytial Virus Network (ReSViNET) Foundation, Zeist, The Netherlands
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Blau DM, Baillie VL, Els T, Mahtab S, Mutevedzi P, Keita AM, Kotloff KL, Mehta A, Sow SO, Tapia MD, Tippett Barr BA, Oluoch BO, Onyango C, Revathi G, Verani JR, Abayneh M, Assefa N, Madrid L, Oundo JO, Scott JAG, Bassat Q, Mandomando I, Sitoe A, Valente M, Varo R, Bassey IA, Cain CJ, Jambai A, Ogbuanu I, Ojulong J, Alam M, El Arifeen S, Gurley ES, Rahman A, Rahman M, Waller JL, Dewey B, Breiman RF, Whitney CG, Madhi SA. Deaths Attributed to Respiratory Syncytial Virus in Young Children in High-Mortality Rate Settings: Report from Child Health and Mortality Prevention Surveillance (CHAMPS). Clin Infect Dis 2021; 73:S218-S228. [PMID: 34472577 PMCID: PMC8411256 DOI: 10.1093/cid/ciab509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Lower respiratory tract infections are a leading cause of death in young children, but few studies have collected the specimens needed to define the role of specific causes. The Child Health and Mortality Prevention Surveillance (CHAMPS) platform aims to investigate causes of death in children aged <5 years in high–mortality rate settings, using postmortem minimally invasive tissue sampling and other advanced diagnostic techniques. We examined findings for deaths identified in CHAMPS sites in 7 countries in sub-Saharan Africa and south Asia to evaluate the role of respiratory syncytial virus (RSV). Methods We included deaths that occurred between December 2016 and December 2019. Panels determined causes of deaths by reviewing all available data including pathological results from minimally invasive tissue sampling, polymerase chain reaction screening for multiple infectious pathogens in lung tissue, nasopharyngeal swab, blood, and cerebrospinal fluid samples, clinical information from medical records, and verbal autopsies. Results We evaluated 1213 deaths, including 695 in neonates (aged <28 days), 283 in infants (28 days to <12 months), and 235 in children (12–59 months). RSV was detected in postmortem specimens in 67 of 1213 deaths (5.5%); in 24 deaths (2.0% of total), RSV was determined to be a cause of death, and it contributed to 5 other deaths. Younger infants (28 days to <6 months of age) accounted for half of all deaths attributed to RSV; 6.5% of all deaths in younger infants were attributed to RSV. RSV was the underlying and only cause in 4 deaths; the remainder (n = 20) had a median of 2 (range, 1–5) other conditions in the causal chain. Birth defects (n = 8) and infections with other pathogens (n = 17) were common comorbid conditions. Conclusions RSV is an important cause of child deaths, particularly in young infants. These findings add to the substantial body of literature calling for better treatment and prevention options for RSV in high–mortality rate settings.
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Affiliation(s)
- Dianna M Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Vicky L Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Toyah Els
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Portia Mutevedzi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ashka Mehta
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Samba O Sow
- Centre pour le Développement des Vaccins, Ministère de la Santé, Bamako, Mali
| | - Milagritos D Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | - Clayton Onyango
- Centers for Disease Control and Prevention, Kenya, Kisumu, Kenya
| | - Gunturu Revathi
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Jennifer R Verani
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mahlet Abayneh
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nega Assefa
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Lola Madrid
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.,College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Joseph O Oundo
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - J Anthony G Scott
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Quique Bassat
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom.,ISGlobal-Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Institutó Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
| | - Inacio Mandomando
- ISGlobal-Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Antonio Sitoe
- ISGlobal-Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
| | - Marta Valente
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Rosauro Varo
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom.,ISGlobal-Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | | | | - Emily S Gurley
- Crown Agents, Freetown, Sierra Leone.,International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | | | | | - Jessica L Waller
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Betsy Dewey
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Cynthia G Whitney
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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Alam M, Jahan MI, Jahan S, Blau DM, Rahman A, Rahman MZ, Hossain MZ, Gurley ES, Arifeen SE, Rahman M. Coding-Complete Sequence of a SARS-CoV-2 B.1.1.25 Lineage Obtained from an 8-Day-Old Deceased Neonate. Microbiol Resour Announc 2021; 10:e0075621. [PMID: 34472974 PMCID: PMC8411918 DOI: 10.1128/mra.00756-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 11/25/2022] Open
Abstract
We report the complete genome sequence of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain, hCoV-19/Bangladesh/icddrb-CHAMPS-BDAA02205/2021, obtained from a nasopharyngeal swab from a deceased neonate from Faridpur, Bangladesh. The strain belongs to lineage B.1.1.25 but contains some notable mutations similar to the B.1.1.7 lineage.
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Affiliation(s)
- Muntasir Alam
- Virology Laboratory, icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - M. Ishrat Jahan
- Virology Laboratory, icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shafina Jahan
- Virology Laboratory, icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Dianna M. Blau
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Afruna Rahman
- Virology Laboratory, icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mohammed Ziaur Rahman
- Virology Laboratory, icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mohammad Zahid Hossain
- Virology Laboratory, icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Emily S. Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shams El Arifeen
- Virology Laboratory, icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mustafizur Rahman
- Virology Laboratory, icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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Islam A, McKee C, Ghosh PK, Abedin J, Epstein JH, Daszak P, Luby SP, Khan SU, Gurley ES. Seasonality of Date Palm Sap Feeding Behavior by Bats in Bangladesh. Ecohealth 2021; 18:359-371. [PMID: 34609649 DOI: 10.1007/s10393-021-01561-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
Pteropus bats are the natural reservoir for Nipah virus, and in Bangladesh, it is transmitted to people through consumption of raw or fermented date palm sap. Our objective was to understand seasonal patterns of bat feeding on date palm sap at a location where sap is collected year-round. Seven nights each month over three years, we mounted infrared cameras in four trees to observe bats' feeding behavior at date palm trees harvested for fermented sap production. We described the frequency of bat visits, duration of bat visits, and duration of bat-sap contact by month and by year. We captured 42,873 bat visits during 256 camera-nights of observation, of which 3% were Pteropus and 94% were non-Pteropus bats. Though the frequency of Pteropus bat visits to each tree/night was much lower than non-Pteropus bat visits, Pteropus bats stayed in contact with sap longer than non-Pteropus bats. Frequency of bat visits was higher during winter compared to other seasons, which may arise as a consequence of limited availability of food sources during this period or may be related to seasonal characteristics of the sap. Seasonal alignment of sap consumption by humans and bats may have consequences for viral spillover into humans.
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Affiliation(s)
- Ausraful Islam
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), IPH Building, Shaheed Tajuddin Ahmed Sarani, Room 302968, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Clifton McKee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Probir Kumar Ghosh
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), IPH Building, Shaheed Tajuddin Ahmed Sarani, Room 302968, Mohakhali, Dhaka, 1212, Bangladesh
| | - Jaynal Abedin
- Insight Centre for Data Analytics, National University of Ireland Galway, Galway, Ireland
| | | | | | - Stephen P Luby
- Department of Medicine, Division of Infectious Diseases & Geographic Medicine, Stanford University, 300 Pasteur Dr., L-134, Stanford, CA, 94305, USA
| | | | - Emily S Gurley
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), IPH Building, Shaheed Tajuddin Ahmed Sarani, Room 302968, Mohakhali, Dhaka, 1212, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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Breiman RF, Blau DM, Mutevedzi P, Akelo V, Mandomando I, Ogbuanu IU, Sow SO, Madrid L, El Arifeen S, Garel M, Thwala NB, Onyango D, Sitoe A, Bassey IA, Keita AM, Alemu A, Alam M, Mahtab S, Gethi D, Varo R, Ojulong J, Samura S, Mehta A, Ibrahim AM, Rahman A, Vitorino P, Baillie VL, Agaya J, Tapia MD, Assefa N, Chowdhury AI, Scott JAG, Gurley ES, Kotloff KL, Jambai A, Bassat Q, Tippett-Barr BA, Madhi SA, Whitney CG. Postmortem investigations and identification of multiple causes of child deaths: An analysis of findings from the Child Health and Mortality Prevention Surveillance (CHAMPS) network. PLoS Med 2021; 18:e1003814. [PMID: 34591862 PMCID: PMC8516282 DOI: 10.1371/journal.pmed.1003814] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 10/14/2021] [Accepted: 09/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The current burden of >5 million deaths yearly is the focus of the Sustainable Development Goal (SDG) to end preventable deaths of newborns and children under 5 years old by 2030. To accelerate progression toward this goal, data are needed that accurately quantify the leading causes of death, so that interventions can target the common causes. By adding postmortem pathology and microbiology studies to other available data, the Child Health and Mortality Prevention Surveillance (CHAMPS) network provides comprehensive evaluations of conditions leading to death, in contrast to standard methods that rely on data from medical records and verbal autopsy and report only a single underlying condition. We analyzed CHAMPS data to characterize the value of considering multiple causes of death. METHODS AND FINDINGS We examined deaths identified from December 2016 through November 2020 from 7 CHAMPS sites (in Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa), including 741 neonatal, 278 infant, and 241 child <5 years deaths for which results from Determination of Cause of Death (DeCoDe) panels were complete. DeCoDe panelists included all conditions in the causal chain according to the ICD-10 guidelines and assessed if prevention or effective management of the condition would have prevented the death. We analyzed the distribution of all conditions listed as causal, including underlying, antecedent, and immediate causes of death. Among 1,232 deaths with an underlying condition determined, we found a range of 0 to 6 (mean 1.5, IQR 0 to 2) additional conditions in the causal chain leading to death. While pathology provides very helpful clues, we cannot always be certain that conditions identified led to death or occurred in an agonal stage of death. For neonates, preterm birth complications (most commonly respiratory distress syndrome) were the most common underlying condition (n = 282, 38%); among those with preterm birth complications, 256 (91%) had additional conditions in causal chains, including 184 (65%) with a different preterm birth complication, 128 (45%) with neonatal sepsis, 69 (24%) with lower respiratory infection (LRI), 60 (21%) with meningitis, and 25 (9%) with perinatal asphyxia/hypoxia. Of the 278 infant deaths, 212 (79%) had ≥1 additional cause of death (CoD) beyond the underlying cause. The 2 most common underlying conditions in infants were malnutrition and congenital birth defects; LRI and sepsis were the most common additional conditions in causal chains, each accounting for approximately half of deaths with either underlying condition. Of the 241 child deaths, 178 (75%) had ≥1 additional condition. Among 46 child deaths with malnutrition as the underlying condition, all had ≥1 other condition in the causal chain, most commonly sepsis, followed by LRI, malaria, and diarrheal disease. Including all positions in the causal chain for neonatal deaths resulted in 19-fold and 11-fold increases in attributable roles for meningitis and LRI, respectively. For infant deaths, the proportion caused by meningitis and sepsis increased by 16-fold and 11-fold, respectively; for child deaths, sepsis and LRI are increased 12-fold and 10-fold, respectively. While comprehensive CoD determinations were done for a substantial number of deaths, there is potential for bias regarding which deaths in surveillance areas underwent minimally invasive tissue sampling (MITS), potentially reducing representativeness of findings. CONCLUSIONS Including conditions that appear anywhere in the causal chain, rather than considering underlying condition alone, markedly changed the proportion of deaths attributed to various diagnoses, especially LRI, sepsis, and meningitis. While CHAMPS methods cannot determine when 2 conditions cause death independently or may be synergistic, our findings suggest that considering the chain of events leading to death can better guide research and prevention priorities aimed at reducing child deaths.
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Affiliation(s)
- Robert F. Breiman
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Dianna M. Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Portia Mutevedzi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Innovation/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Victor Akelo
- US Centers for Disease Control and Prevention-Kenya, Kisumu, Kenya
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
- Instituto Nacional de Saúde [INS], Manhiça, Mozambique
| | | | - Samba O. Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Lola Madrid
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Mischka Garel
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Nana Bukiwe Thwala
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Innovation/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | | | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
| | | | - Adama Mamby Keita
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Addisu Alemu
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Muntasir Alam
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Sana Mahtab
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Innovation/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Dickson Gethi
- Kenya Medical Research Institute (KEMRI) Center for Global Health Research, Kisumu, Kenya
| | - Rosauro Varo
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
- Universitat de Barcelona, Barcelona, Spain
| | | | | | - Ashka Mehta
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | - Afruna Rahman
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
| | - Pio Vitorino
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
| | - Vicky L. Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Janet Agaya
- Kenya Medical Research Institute (KEMRI) Center for Global Health Research, Kisumu, Kenya
| | - Milagritos D. Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | | | - J. Anthony G. Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Emily S. Gurley
- International Center for Diarrhoeal Diseases Research (icddr,b), Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Karen L. Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Amara Jambai
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça [CISM], Manhica, Mozambique
- ISGlobal, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital de Sant Joan de Deu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigacion Biomedica en Red de Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
| | | | - Shabir A. Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Innovation/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Cynthia G. Whitney
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
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Chowdhury S, Azziz-Baumgartner E, Kile JC, Hoque MA, Rahman MZ, Hossain ME, Ghosh PK, Ahmed SSU, Kennedy ED, Sturm-Ramirez K, Gurley ES. Association of Biosecurity and Hygiene Practices with Environmental Contamination with Influenza A Viruses in Live Bird Markets, Bangladesh. Emerg Infect Dis 2021; 26:2087-2096. [PMID: 32818393 PMCID: PMC7454050 DOI: 10.3201/eid2609.191029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In Bangladesh, live bird market environments are frequently contaminated with avian influenza viruses. Shop-level biosecurity practices might increase risk for environmental contamination. We sought to determine which shop-level biosecurity practices were associated with environmental contamination. We surveyed 800 poultry shops to describe biosecurity practices and collect environmental samples. Samples from 205 (26%) shops were positive for influenza A viral RNA, 108 (14%) for H9, and 60 (8%) for H5. Shops that slaughtered poultry, kept poultry overnight, remained open without rest days, had uneven muddy floors, held poultry on the floor, and housed sick and healthy poultry together were more frequently positive for influenza A viruses. Reported monthly cleaning seemed protective, but disinfection practices were not otherwise associated with influenza A virus detection. Slaughtering, keeping poultry overnight, weekly rest days, infrastructure, and disinfection practices could be targets for interventions to reduce environmental contamination.
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Sultana R, Luby SP, Gurley ES, Rimi NA, Swarna ST, Khan JAM, Nahar N, Ghosh PK, Howlader SR, Kabir H, Khan S, Jensen PKM. Cost of illness for severe and non-severe diarrhea borne by households in a low-income urban community of Bangladesh: A cross-sectional study. PLoS Negl Trop Dis 2021; 15:e0009439. [PMID: 34115764 PMCID: PMC8221788 DOI: 10.1371/journal.pntd.0009439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 06/23/2021] [Accepted: 05/03/2021] [Indexed: 01/08/2023] Open
Abstract
The illness cost borne by households, known as out-of-pocket expenditure, was 74% of the total health expenditure in Bangladesh in 2017. Calculating economic burden of diarrhea of low-income urban community is important to identify potential cost savings strategies and prioritize policy decision to improve the quality of life of this population. This study aimed to estimate cost of illness and monthly percent expenditure borne by households due diarrhea in a low-income urban settlement of Dhaka, Bangladesh. We conducted this study in East Arichpur area of Tongi township in Dhaka, Bangladesh from September 17, 2015 to July 26, 2016. We used the World Health Organization (WHO) definition of three or more loose stool in 24 hours to enroll patients and enrolled 106 severe patients and 158 non-severe patients from Tongi General Hospital, local pharmacy and study community. The team enrolled patients between the first to third day of the illness (≤ 72 hours) and continued daily follow-up by phone until recovery. We considered direct and indirect costs to calculate cost-per-episode. We applied the published incidence rate to estimate the annual cost of diarrhea. The estimated average cost of illness for patient with severe diarrhea was US$ 27.39 [95% CI: 24.55, 30.23] (2,147 BDT), 17% of the average monthly income of the households. The average cost of illness for patient with non-severe diarrhea was US$ 6.36 [95% CI: 5.19, 7.55] (499 BDT), 4% of the average monthly income of households. A single diarrheal episode substantially affects financial condition of low-income urban community residents: a severe episode can cost almost equivalent to 4.35 days (17%) and a non-severe episode can cost almost equivalent to 1 day (4%) of household’s income. Preventing diarrhea preserves health and supports financial livelihoods. The illness cost borne by households, known as out-of-pocket expenditure was 74% of the total health expenditure in Bangladesh in 2017. Most of the studies in Bangladesh that estimated the cost of diarrheal illness collected data from hospital patients and mostly targeted under-five children. Information on economic burden of diarrhea borne by households of low-income urban communities who commonly had ≤ 2 US$ dollar income per capita per day still remained unknown. We conducted this study in East Arichpur area of Tongi township in Dhaka, Bangladesh from September 2015 to July 2016 to estimate cost of illness and monthly percent expenditure borne by households due diarrhea in a low-income urban settlement of Dhaka, Bangladesh. The estimated average cost of illness for patient with severe diarrhea was US$ 27.39 (2,147 BDT) and non-severe diarrhea was US$ 6.36 (499 BDT). A single diarrheal episode substantially affects financial capability of the low-income urban community: a severe episode can cost 4.35 days (17%) and a non-severe episode can cost 1 day (4%) of income of a households. Preventing diarrhea preserves health and supports financial livelihoods.
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Affiliation(s)
- Rebeca Sultana
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Institute of Health Economics, University of Dhaka, Dhaka, Bangladesh
- icddr,b, Dhaka, Bangladesh
- * E-mail:
| | - Stephen P. Luby
- Stanford University, Stanford, California, United States of America
| | - Emily S. Gurley
- icddr,b, Dhaka, Bangladesh
- John Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | | | - Nazmun Nahar
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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