Screening intimate partner violence in the healthcare services during Covid-19 lockdowns in Israel

Background

Studies have shown increased rates of intimate partner violence (IPV) during the Covid-19 lockdowns. Healthcare services (HCS) have an important role in detection and screening of women victims of IPV. These women tend to visit the HCS more frequently, which creates an opportunity to detect, screen, and inform them about relevant support services.

Methods

We conducted an online survey during Israel's 2nd and 3rd lockdowns (October 2020-February 2021). A self-administrated structured questionnaire was distributed in Arabic and Hebrew via social media. Eligibility criteria included women >18 years old. 519 women completed the questionnaire: Palestinian-Arab=73; non-immigrant Jew=319; and immigrant Jew=127. We asked women whether they were ever screened (ES) for IPV or received information (RI) on support services in the HCS.

Results

37.2% of the women reported any IPV; Palestinian-Arab women reported higher rates of IPV (49.3%) compared to non-immigrant Jew (34.2%) and immigrant Jew (37.8%). Prevalence of ES and RI on support services were low among the total study sample (21.8%, 47% respectively). Only 12.1% reported on both (ES and RI). Among women who reported IPV, only 26.9% reported that they had been ES, 39.4% RI, and 13.5% both. Whilst Palestinian-Arab women victims of IPV reported higher ES and a lower RI (30.6%,25% respectively) non-immigrant and immigrant Jew reported the opposite -higher prevalence of RI and less ES (non-immigrant Jew 45%,25.7%. Immigrant Jew 37.5%,27%, respectively). In the multivariate analysis after adjusts, Palestinian-Arab women were less likely to RI regarding support services (OR = 0.33,90%CI=0.19-0.57), while immigrant Jew women had a greater chance to be ES in HCS (OR = 4.29, 90% CI=1.43-12.80).

Conclusions

To increase IPV detection in the HCS, there is a need for interventions on screening and providing information on support services specifically during emergencies where IPV is likely to increase.

Key messages

Maternal respectful care and Post-Traumatic Stress Disorder among postpartum mothers in Israel

Background

Maternal Respectful Care (MRC) approach was recommended by the WHO for improving maternal birth experience and mental health. We examined the association between MRC and Post-Traumatic Stress Disorder (PTSD) among postpartum women.

Methods

A cross-sectional study took place between November 2020 and October 2021. 817 postpartum women (Jewish- 444 Arab-373) were interviewed via Zoom due to Covid-19 limitations. MRC was measured by 26 statements from disrespectful/ abusive care during childbirth in facilities (DACF); 4 statements from the Mother on Respect questionnaire (MOR-feeling mistreatment based on ethno-national background, level of command of the Hebrew language and disagreement with the staff); and 4 statements regarding abuse of the NorVold Abuse Questionnaire (NorAQ). PTSD was measured by Solomon et al.'s tool, and dichotomized into 12 score cutoff. (Yes /No PTSD).

Results

PTSD prevalence was 14.3%, significantly higher among Palestinian-Arab compared to Jewish women (22.0%,7.9%, respectively), and it was higher in women who had lower MRC scores: did not receive postpartum education (19.9%,11.9 % respectively) received; received midwife support 11.7%,18.4% didn't receive; reported racism 26.1%,11.4% not; Felt humiliated at healthcare services vs. not (16.8% , 10.6%, respectively); women who reported mistreatment based on national/cultural background, compared to others (MOR) (36.6%,13.1%, respectively). In the multivariate analysis after adjusting to different independent variables, Palestinian-Arab women were 6.04 times at risk for PTSD (OR = 6.04,95% CI = 3.38-10.78),Women who reported racism are 2.14 times more likely to PTSD (OR = 2.14, 95% CI = 1.30-3.54). Women who reported feeling humiliated visiting the health care system are 2.08 times more likely to PTSD (OR = 2.08,95% CI = 1.23-3.52).

Conclusions

MRC is an important factor for maternal PTSD among postpartum women and it should be considered specifically among minority women.

Key messages

Multiple barriers for accessing mental health service among women attending shelters for women experiencing intimate partner violence

Introduction

While women victims of intimate partner violence (IPV) suffer the burden of mental health issues (MHI), they face many challenges accessing mental health services (MHS).

Objectives

We draw on the socioecological model and explore different level barriers for accessing MHS among women experiencing IPV.

Methods

We conducted a qualitative study in 2020-2021 at three levels: policy, practice and women’s experience. This included in-depth interviews with 19 policymakers from the Ministry of Health (MoH) and the Ministry of Social Welfare (MSW); four directors of shelters for women victims of IPV; 35 women (26 Arabs, 9 Jewish) attending shelters for women victims of IPV (age 22-50), and six focus groups with 26 social workers. Participants were asked about the barriers for utilizing MHS.

Results

We identified complex multifaced barriers regarding the accessibility and quality of MHS among women victims of IPV. At the policy level, we identified structural organizational barriers related to the division of responsibilities between the two offices (MoH and MSW). These included lack of collaboration, funding and information transmission and insufficient communication mechanisms. At the practice level, shelters’ directors and social workers raised barriers, most of which were related to divisions in knowledge, terminology, and treatment approaches among mental healthcare providers and social welfare therapists. The women themselves raised issues related to stigma, lack of family support and continuity of MHS.

Conclusions

To improve MHS access, it is crucial to overcome the multiple barriers (individual, family, therapeutic and organizational) that are faced by women who are experiencing IPV.

Disclosure

No significant relationships.

Trust the directives and physical distancing during three COVID-19 lockdowns in Israel

 

The emergence of the COVID-19 virus highlighted the importance of public trust in official directives during a pandemic. As part of the measures taken to reduce the spread of the coronavirus, people were asked to maintain physical distancing. Compliance with physical distancing influenced by trust levels which are generally lower in minority groups. The current study aimed to explore the trust level and compliance with the physical distancing relationship among Arab minority and Jewish populations during three lockdowns during the COVID -19 outbreak in Israel. Three cross-sectional online surveys were conducted among a convenience sample of Jews and Arabs adults (≥18 years old) citizens of Israel following the first (April to June 2020), second (October to November 2020), and third lockdown (January to February 2021). The surveys collected demographic data, compliance with physical distancing, and trust level in official sources. In total, 613 (N = 281 Arab, N = 281 Jewish) participants completed the first online survey, 542 (N = 223 Arab, N = 319 Jewish) completed the second survey, and 98 (N = 38 Arab, N = 60 Jewish) completed the third survey. In the three surveys, both populations, Arabs and Jews, reported higher levels of trust in health professionals than in politicians. The level of trust and keeping physical distancing during the three lockdowns were significantly lower among Arab compared to the Jewish participants. However, the association between trust and social distancing was significant only in the first lockdown (OR = 2.02, 95% CI 1.37-2.97) but not in the second and third lockdowns. Trust in official directives is an important determinant of citizens' compliance with physical distancing guidelines during a pandemic. Minority groups have lower trust levels and face more challenges for keeping physical distancing. This should be brought to the policymakers' attention to increase trust and physical distancing among them.

Key messages

Understanding the relationship between trust and compliance and its potential consequences during a pandemic warrant particular attention in the present context of a global pandemic.

It is of utmost importance to identify the unique characteristics of sub-populations and minority populations in which there may be additional factors affecting compliance.

PositivMasc: masculinities and violence against women among young people. Identifying discourses and developing strategies for change, a mixed-method study protocol

INTRODUCTION

Despite public policies and legislative changes aiming to curtail men's violence against women (VAW) around the world, women continue to be exposed to VAW throughout their life. One in three women in Europe has reported physical or sexual abuse. Men who display unequitable masculinities are more likely to be perpetrators. VAW is increasingly appearing at younger ages. The aims of the project are fourfold: (1) to explore and position the discourses that young people (men and women, 18-24 years) in Sweden, Spain, Ireland and Israel use in their understanding of masculinities, (2) to explore how these discourses influence young people's attitudes, behaviours and responses to VAW, (3) to explore individual and societal factors supporting and promoting anti-VAW masculinities discourses and (4) to develop actions and guidelines to support and promote anti-VAW masculinities in these settings.

METHODS AND ANALYSIS

A participatory explorative mixed-method study will be used. In Phase 1, qualitative methods will be used to identify the discourses that young people and stakeholders use to conceptualise masculinities, VAW and the actions that are needed to support and promote antiviolence masculinities. In Phase 2, concept mapping will be used to quantify the coherence, relative importance and perceived relationship between the different actions to support and promote anti-VAW masculinities. Phase 3 is a knowledge creation and translation phase, based on findings from Phases 1 and 2, where actions and guidelines to promote and support anti-VAW masculinities will be developed.

ETHICS AND DISSEMINATION

Ethical clearance has been obtained from ethics review boards in each country. Results will be disseminated through peer-reviewed publications, presentations at international conferences, policy briefs, social media and through the project online hub. With its multicountry approach, our project results seek to inform policies and interventions aimed at promoting discourses which challenge hegemonic masculinities.

Trust in health care systems Arab minority, Jewish immigrant and non-immigrant

Background

The objective of this study was to examine the level of trust towards Israel’s health care services (HCS) among Palestinian-Arab minority, Jewish immigrant, and non-immigrant Jewish citizens. Previous studies have shown that minorities and immigrants have less trust in health care system (HCSys), which might represent a barrier in access to, and utilization of HCS.

Methods

We obtained cross-sectional nationwide census data from the 2017 Social Survey of the Israel Central Bureau of Statistics. We studied levels of trust in the HCSys based on a survey question: ’Do you have trust in the healthcare system?” We conducted logistic regression analysis within and between the study groups to compare levels of trust, after adjustment for different relevant covariates in different models.

Results

Compared to non-immigrant Jews, Arabs had higher trust in the HCS (odds ratio (OR)=3.08, 95% confidence intervals (CI)=3.06,3.10) and compared to non-immigrant Jews, immigrant Jews had more trust (OR = 1.96, 95% CI = 1.94,1.98), even after adjusting for gender, age, education level, religiosity level, perceived discrimination, self-rated health status, HCS use, and having private health insurance. The variables that predicted trust in the HCSys were different in each ethnic group.

Conclusions

Contrary to our hypothesis and to previous research, Arab and immigrant Jewish respondents in our study had greater trust in the HCS compared to non-immigrant Jews. This might relate to different expectations among our study groupsof the patient-caregiver relations which might affect the access to and utilization of HCS and finally might affect the quality of care.

Key messages

Exceptionally, in Israel, the Arab minority and Jewish immigrants have more trust in the health care system compared with non-immigrant Jews. More research is needed to understand how trust among minority groups relates to the patterns of utilization of HCS and raises question regarding the quality of care.

Examining cultural, psychosocial, community and behavioural factors in relationship to socioeconomic inequalities in limiting longstanding illness among the Arab minority in Israel

BACKGROUND

Few studies have examined the explanatory pathways to social inequalities in health within ethnic minorities. The current study examined the relative contributions of specific pathways explaining the associations between socioeconomic status (SES) and limiting longstanding illness (LLI) among the Arab minority in Israel.

METHODS

A cross-sectional study of a random sample of 902 individuals aged 30-70 selected in a multistage sampling procedure. SES was measured by education, land ownership and relative family income. Five-stage logistic regressions assessed the attenuations in the odds of LLI among those with lower SES compared to higher SES after including relevant groups of explanatory factors: psychosocial, behavioural and community, and their integration.

RESULTS

Rates of LLI were significantly higher in participants with lower SES. Inclusion of groups of explanatory variables attenuated all SES-LLI associations in a similar pattern: psychosocial factors played a main explanatory role, yielding 15-40% attenuation in odds ratios (OR). The contribution of community indicators was modest (10-21%); health behaviours had a marginal contribution (6-7%). Cultural factors were not associated with SES or LLI. The integrative model contributed up to 49% reduction in the OR.

CONCLUSIONS

The significant associations between SES and LLI suggest that formative policy to reduce SES-LLI disparities should emphasise creating opportunities for economic development to improve SES, which was the main predictor of inequalities. Combining strategies of community capacity building and reinforcement of individual inner resources might be complementary. Such conclusions might apply to other minorities in a similar context, for which future studies are required.

Role of inflammatory mediators in the suppression of insulin receptor phosphorylation in circulating mononuclear cells of obese subjects

AIMS/HYPOTHESIS

Obesity is associated with insulin resistance and inflammation. The circulating human mononuclear cell (MNC) has been shown to respond to low-dose insulin infusion. We have now investigated whether in obesity: (1) phosphorylated insulin receptor beta subunit (p-INSR-beta) is reduced in the MNC; (2) pro-inflammatory mediators including inhibitor of kappa light polypeptide gene enhancer in B cells-kinase beta (IKBKB), suppressor of cytokine signalling-3 (SOCS) and protein kinase C-beta 2 (PRKCB2) are increased and related to p-INSR-beta; and (3) the reduction in MNC p-INSR-beta is related to the reduction in insulin sensitivity.

MATERIALS AND METHODS

MNCs were prepared from fasting blood samples of 16 normal weight and 16 obese female subjects.

RESULTS

Our data show that p-INSR-beta is reduced significantly in MNCs from obese subjects compared with that of normal controls. MNCs from obese subjects have higher IKBKB expression, increased nuclear factor kappa B (NFkappaB) binding and higher mRNA expression of TNFAIP1 and IL6 genes. NFkappaB binding, TNFAIP1 mRNA and plasma C-reactive protein are inversely related to p-INSR-beta. PRKCB2 mRNA and protein expression were significantly higher in the obese subjects and were related significantly to pro-inflammatory mediators but not to p-INSR-beta. SOCS3 mRNA expression was markedly elevated and positively related to pro-inflammatory mediators including IKBKB and PRKCB2 on the one hand and inversely related to p-INSR-beta on the other.

CONCLUSIONS/INTERPRETATION

We conclude that in obesity the MNC is characterised by reduced p-INSR-beta and increased inflammatory mediators including IKBKB, PRKCB2 and SOCS3. The increase in SOCS3 but not IKBKB or PRKCB2 is related inversely to p-INSR-beta and might mediate the inhibition of p-INSR-beta. These data elucidate the relationship between inflammation and insulin resistance using the MNC as a model.

A comparison of nerve stimulator guided paravertebral block and ilio-inguinal nerve block for analgesia after inguinal herniorrhaphy in children

The aim of this study was to compare the efficacy of nerve stimulator guided paravertebral block with ilio-inguinal nerve block in children undergoing inguinal herniorrhaphy. Eighty children were randomly allocated to receive either paravertebral block or ilio-inguinal nerve block. Each block was evaluated in terms of intra-operative haemodynamic stability, postoperative pain scores at rest, on movement and during activity, requirement for supplemental analgesia and parental satisfaction. Haemodynamic stability was maintained significantly better during sac traction in the paravertebral block group (p < 0.005). Pain scores and analgesic consumption were significantly lower in the paravertebral block group during the postoperative follow-up period (p < 0.05). Parental satisfaction (93%vs 69%) and surgeon satisfaction (93%vs 64%) were significantly higher in the paravertebral block group (p < 0.05). Paravertebral blockade improved and prolonged postoperative analgesia, and was associated with greater parental and surgeon satisfaction when compared to ilio-inguinal nerve block.

Evaluation of two D-Dimer assays in the diagnosis of venous thromboembolism

A qualitative (Instantia) and a quantitative (VIDAS D-Dimer) D-Dimer test have been evaluated and compared with an ELISA method (Asserachrom D-D) in a population of 74 patients suspected of presenting a deep vein thrombosis. Among the thirty-two patients presenting a deep vein thrombosis on phlebography, there were 16 (50%) proximal vein thrombosis and 16 (50%) distal vein thrombosis. Sensitivity and negative predictive value for proximal thrombosis were 100% in all three tests. For distal vein thrombosis, sensitivity and negative predictive value were respectively 81% and 81% for Asserachrom D-DI 75% and 76% for VIDAS D-Dimer and 63% and 82% for Instantia. In conclusion, this study shows that these D-Di assays are a useful tool to exclude proximal vein thrombosis, at least for patients who are not under anticoagulant therapy.

Corporeal veno-occlusive dysfunction: predominantly intracavernous muscular pathology

PURPOSE

We investigated whether a relationship exists between the flow to maintain an erection obtained at cavernosometry and the alteration of intracavernous structures in impotent patients with corporeal veno-occlusive dysfunction and normal arterial inflow.

MATERIALS AND METHODS

Computerized histomorphometric analysis of smooth muscle and elastic fibers, and endothelial cells was compared to the flow necessary to maintain erection after intracavernous vasoactive drug injection in 18 patients with corporeal veno-occlusive dysfunction.

RESULTS

A significant correlation between percentage of smooth muscle fibers and flow to maintain erection was observed, while no correlation was noted with elastic fibers and endothelial cells.

CONCLUSIONS

Corporeal veno-occlusive dysfunction seems to be due mainly to smooth muscular alterations. According to this observation treatment of impotent patients with this abnormality should not be restricted to the penile veins but should also include the intracavernous structures, predominantly the muscular component.

Alzheimer's disease: preliminary study of spatial distribution at birth place

Alzheimer's disease (AD) is a neurodegenerative disorder which is characterized by a progressive loss of memory and the alteration of cognitive functions. At least three chromosomal segments have been associated with early-onset AD in genetic linkage studies. These results argue for a certain degree of heterogeneity in the genetic origin of some forms of AD, although environmental risk factors cannot be ruled out in late-onset AD. In this preliminary study, we analyzed the geographical distribution of the birth places of a sample of 235 AD cases born in a defined region of Quebec (Canada), between 1895 and 1935. We wished to test the hypothesis that risk factors acting at, or around birth place and time play a role in the etiology of AD. The field of study was divided into rural and urban areas. A reference population of live births was used to compute a measure of odds ratio (OR). The OR results showed a statistically significant excess of AD cases in the rural area as compared to the reference population. When stratified for sex, the OR results showed a global excess of female AD cases in both the rural and the urban areas. For men, only the urban area presented a statistically significant deficit. We also analyzed the structures of the genealogical kinships of the rural and urban sub-groups. Although AD cases from the rural sub-group were more closely related to each other than those from the urban one, removal of the kin pairs from the OR analysis seemed to have little effect on the rural/urban distribution of cases. Therefore, the OR results would not appear to be due primarily to a difference in the kinship structures of the two sub-groups. This could mean that some risk factors for AD afflict women more strongly than men, the effect being different depending on the urban or rural origin. However, potential biases such as a higher rate of report for women, differential migration between birth places or a differential mortality ratio between sexes could produce spurious results in the direction of what we have observed in this preliminary study.

Season of birth and Alzheimer's disease: a population-based study in Saguenay-Lac-St-Jean/Québec (IMAGE Project)

The birth distribution of 399 cases of Alzheimer's disease (AD) identified in the region of Saguenay-Lac-St-Jean (Québec) was compared with that of: (a) the population currently living in the area; and (b) the population born during the same period in the same area. AD cases have been recruited since 1986 by the IMAGE Project. Cases and controls were grouped according to the month of birth and according to the day of birth using density estimation. Analyses showed a significant deficit of births in the month of May. We believe these preliminary results deserve further attention and we suggest two possible explanations that could lead to a deficit of AD births at specific periods during the year.

Laparoscopic appendectomy in children: report of 465 cases

The authors present a retrospective analysis of 465 pediatric laparoscopic appendectomies. The ages of these patients ranged from 3 to 16 years, with a mean age of 10 years. The diagnosis of acute appendicitis was based on one or more of the following: the initial or repeated physical examination, abdominal radiographs, leukocyte blood count, and ultrasonography. On gross examination, 90% of appendices appeared inflamed, while on microscopic examination, 93% showed evidence of acute inflammation. There was a 3.6% incidence of minor intraoperative incidents and a 3.0% postoperative complication rate with 1.3% of patients requiring a subsequent laparotomy or repeat laparoscopic procedure. There were no deaths. The advantages of laparoscopic appendectomy include easy and rapid localization of the appendix, regardless of its location, the ability to explore the entire abdominal cavity through the same laparoscopic portals used for appendix removal, the ability to lavage completely the contaminated peritoneal cavity, a reduction in the incidence of intraperitoneal abscesses, and a probable reduction in postoperative adhesions. In addition, laparoscopic appendectomy is associated with less cutaneous scarring and a more rapid return of intestinal function and normal activities. In our experience, these results are better than those obtained with classical surgery.

[Appendectomy with intraoperative celioscopy in children. 465 cases]

The authors report a retrospective series of 465 appendectomies with intraoperative celioscopy in children under age 16. The technical issues and the indications are discussed. The results are the following: No death, 3.6% intraoperative incidents of no consequence, 3% postoperative complications, including 1.3% requiring second surgery or celioscopy. These results are better than those obtained with conventional surgery. The advantages of appendicectomy with intraoperative celioscopy are the following: easy, quick search for the appendix, whatever its location, exploration of the entire abdominal cavity, possibility to perform a complete peritoneal washing, suppression of parietal complications, and almost no skin scar, definite reduction in the number of intraperitoneal residual abscesses, and likely reduction of postoperative adhesions, which are a cause of obstruction, of chronic pain and of infertility in girls, rapid resumption of transit and of all activities, including sports.

Prospective study of diarrheal diseases in Venezuelan children to evaluate the efficacy of rhesus rotavirus vaccine

The efficacy of a rhesus rotavirus vaccine (MMU 18006, serotype 3) against infantile diarrhea was evaluated by active home surveillance of a group of 320 children 1-10 months of age in Caracas, Venezuela. During a 1 year period following oral administration of vaccine or placebo under a double-masked code, over 600 diarrheal episodes were detected. Etiologic studies revealed that heat-stable toxin (ST) producing enterotoxigenic E. coli (ETEC) was the most common diarrheal agent detected (34%) followed by enteropathogenic E. coli (EPEC, 10.9%), heat-labile toxin (LT) producing ETEC (7.6%), rotavirus (6.9%), Cryptosporidium (4.8%) and Campylobacter (1.3%). ST-producing ETEC were also recovered from over 20% of control stool specimens obtained during diarrhea-free periods, whereas EPEC, rotavirus, Cryptosporidium, and Campylobacter were rarely detected in such control specimens. Rotavirus was responsible for about one-half of the more severe cases of diarrhea. Twenty-two of 151 infants who received placebo (14.6%) and eight of 151 receiving a 10(4) PFU dose of vaccine (5.3%) had rotavirus diarrhea during the follow-up period for an efficacy level of 64% against any rotavirus diarrhea. However, vaccine efficacy reached 90% against the more severe cases of rotavirus diarrhea and was noticeably high in the 1-4 month age group. Serotypic analysis of the rotaviruses detected suggests that the resistance induced by the vaccine was type specific since significant protection was only evident against serotype 3 rotaviruses. A 10(3) PFU dose tested initially in 18 children did not appear to protect against rotavirus diarrhea.

Reactions to and antigenicity of two human-rhesus rotavirus reassortant vaccine candidates of serotypes 1 and 2 in Venezuelan infants

The reactions to and antigenicity of two human-rhesus rotavirus (RRV) reassortants (human rotavirus strain D x RRV and human rotavirus strain DS1 x RRV) with the VP7 neutralization specificity of a serotype 1 or serotype 2 rotavirus were evaluated in a placebo-controlled double-blind trial in 116 1- to 5-month-old infants in Caracas, Venezuela. The children were randomly divided into five groups to receive orally the following inocula: (i) 10(4) PFU of D x RRV reassortant; (ii) 10(4) PFU of DS1 x RRV reassortant; (iii) 10(4) PFU of RRV; (iv) 5 x 10(3) PFU of D x RRV and 5 x 10(3) PFU of RRV; and (v) placebo. The children were examined daily for 7 days following vaccine administration; 8 to 26% of the vaccinated infants developed a mild febrile reaction which in most cases lasted only 1 day. Seroresponses to rotavirus were observed in 39 to 65% of the vaccinees by plaque neutralization assay and in 57 to 88% by an immunoglobulin A enzyme-linked immunosorbent assay. Vaccine shedding was detected in 53 to 86% of the vaccinees. Analysis of neutralization antibody responses indicates that the VP4 protein represents an important component of the response induced by the vaccines.

Reactogenicity and antigenicity of rhesus rotavirus vaccine (MMU-18006) in newborn infants in Venezuela

The reactogenicity and antigenicity of the rhesus rotavirus vaccine, strain MMU18006, developed at the Laboratory of Infectious Diseases (National Institute of Allergy and Infectious Diseases, National Institutes of Health) were examined in a double blind, placebo-controlled study of 40 newborn infants in Caracas, Venezuela. The children were observed for the first few days after birth in the hospital nursery and by home visits for 10 days after vaccination to detect any adverse reactions. No reactions could be attributed to the vaccine. Serologic responses to the vaccine were evaluated in paired sera obtained at birth (cord blood) and 4 weeks after vaccination. Serologic responses to the vaccine were not observed by complement fixation, neutralization or a rhesus rotavirus VP7 epitope-specific competition assay. However, such responses were found in 9 of 14 tested infants by an immunoglobulin A-specific enzyme-linked immunosorbent assay. Seventeen of the 20 vaccinees also shed rhesus rotavirus vaccine in stool during the postvaccination period.