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Kostandova N, Mutembo S, Prosperi C, Mwansa FD, Nakazwe C, Namukoko H, Nachinga B, Chongwe G, Chilumba I, Matakala KH, Musukwa G, Hamahuwa M, Mufwambi W, Matoba J, Situtu K, Mutale I, Kong AC, Simulundu E, Ndubani P, Hasan AZ, Truelove SA, Winter AK, Carcelen AC, Lau B, Moss WJ, Wesolowski A. Who is missed in a community-based survey: Assessment and implications of biases due to incomplete sampling frame in a community-based serosurvey, Choma and Ndola Districts, Zambia, 2022. PLOS Glob Public Health 2024; 4:e0003072. [PMID: 38683820 DOI: 10.1371/journal.pgph.0003072] [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] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 03/10/2024] [Indexed: 05/02/2024]
Abstract
Community-based serological studies are increasingly relied upon to measure disease burden, identify population immunity gaps, and guide control and elimination strategies; however, there is little understanding of the potential for and impact of sampling biases on outcomes of interest. As part of efforts to quantify measles immunity gaps in Zambia, a community-based serological survey using stratified multi-stage cluster sampling approach was conducted in Ndola and Choma districts in May-June 2022, enrolling 1245 individuals. We carried out a follow-up study among individuals missed from the sampling frame of the serosurvey in July-August 2022, enrolling 672 individuals. We assessed the potential for and impact of biases in the community-based serosurvey by i) estimating differences in characteristics of households and individuals included and excluded (77% vs 23% of households) from the sampling frame of the serosurvey and ii) evaluating the magnitude these differences make on healthcare-seeking behavior, vaccination coverage, and measles seroprevalence. We found that missed households were 20% smaller and 25% less likely to have children. Missed individuals resided in less wealthy households, had different distributions of sex and occupation, and were more likely to seek care at health facilities. Despite these differences, simulating a survey in which missed households were included in the sampling frame resulted in less than a 5% estimated bias in these outcomes. Although community-based studies are upheld as the gold standard study design in assessing immunity gaps and underlying community health characteristics, these findings underscore the fact that sampling biases can impact the results of even well-conducted community-based surveys. Results from these studies should be interpreted in the context of the study methodology and challenges faced during implementation, which include shortcomings in establishing accurate and up-to-date sampling frames. Failure to account for these shortcomings may result in biased estimates and detrimental effects on decision-making.
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Affiliation(s)
- Natalya Kostandova
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Simon Mutembo
- Department of International Health, International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Francis Dien Mwansa
- Department of Immunizations, Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia
| | - Chola Nakazwe
- Information, Research and Dissemination, Zambia Statistics Agency, Lusaka, Zambia
| | - Harriet Namukoko
- Population and Social Statistics, Zambia Statistics Agency, Lusaka, Zambia
| | - Bertha Nachinga
- Information, Research and Dissemination, Zambia Statistics Agency, Lusaka, Zambia
| | | | - Innocent Chilumba
- Biomedial Sciences Department, Tropical Diseases Research Centre, Ndola, Zambia
| | | | | | - Mutinta Hamahuwa
- Clinical Research Laboratory Department, Macha Research Trust, Macha, Zambia
| | - Webster Mufwambi
- Administration, Tropical Diseases Research Centre, Ndola, Zambia
| | - Japhet Matoba
- Molecular Biology Department, Macha Research Trust, Macha, Zambia
| | - Kenny Situtu
- Tropical Diseases Research Centre, Ndola, Zambia
| | - Irene Mutale
- Tropical Diseases Research Centre, Ndola, Zambia
| | - Alex C Kong
- Department of International Health, International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | - Alvira Z Hasan
- Department of International Health, International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Shaun A Truelove
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of International Health, International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Amy K Winter
- Department of International Health, International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, United States of America
| | - Andrea C Carcelen
- Department of International Health, International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - William J Moss
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of International Health, International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Amy Wesolowski
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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2
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Fola AA, He Q, Xie S, Thimmapuram J, Bhide KP, Dorman J, Ciubotariu II, Mwenda MC, Mambwe B, Mulube C, Hawela M, Norris DE, Moss WJ, Bridges DJ, Carpi G. Genomics reveals heterogeneous Plasmodium falciparum transmission and selection signals in Zambia. Commun Med (Lond) 2024; 4:67. [PMID: 38582941 PMCID: PMC10998850 DOI: 10.1038/s43856-024-00498-8] [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: 03/15/2023] [Accepted: 03/28/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Genomic surveillance is crucial for monitoring malaria transmission and understanding parasite adaptation to interventions. Zambia lacks prior nationwide efforts in malaria genomic surveillance among African countries. METHODS We conducted genomic surveillance of Plasmodium falciparum parasites from the 2018 Malaria Indicator Survey in Zambia, a nationally representative household survey of children under five years of age. We whole-genome sequenced and analyzed 241 P. falciparum genomes from regions with varying levels of malaria transmission across Zambia and estimated genetic metrics that are informative about transmission intensity, genetic relatedness between parasites, and selection. RESULTS We provide genomic evidence of widespread within-host polygenomic infections, regardless of epidemiological characteristics, underscoring the extensive and ongoing endemic malaria transmission in Zambia. Our analysis reveals country-level clustering of parasites from Zambia and neighboring regions, with distinct separation in West Africa. Within Zambia, identity by descent (IBD) relatedness analysis uncovers local spatial clustering and rare cases of long-distance sharing of closely related parasite pairs. Genomic regions with large shared IBD segments and strong positive selection signatures implicate genes involved in sulfadoxine-pyrimethamine and artemisinin combination therapies drug resistance, but no signature related to chloroquine resistance. Furthermore, differences in selection signatures, including drug resistance loci, are observed between eastern and western Zambian parasite populations, suggesting variable transmission intensity and ongoing drug pressure. CONCLUSIONS Our findings enhance our understanding of nationwide P. falciparum transmission in Zambia, establishing a baseline for analyzing parasite genetic metrics as they vary over time and space. These insights highlight the urgency of strengthening malaria control programs and surveillance of antimalarial drug resistance.
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Affiliation(s)
- Abebe A Fola
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI, USA
| | - Qixin He
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA
| | - Shaojun Xie
- Bioinformatics Core, Purdue University, Purdue University, West Lafayette, IN, USA
| | - Jyothi Thimmapuram
- Bioinformatics Core, Purdue University, Purdue University, West Lafayette, IN, USA
| | - Ketaki P Bhide
- Bioinformatics Core, Purdue University, Purdue University, West Lafayette, IN, USA
| | - Jack Dorman
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA
| | - Ilinca I Ciubotariu
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA
| | - Mulenga C Mwenda
- PATH-MACEPA, National Malaria Elimination Centre, Lusaka, Zambia
| | - Brenda Mambwe
- PATH-MACEPA, National Malaria Elimination Centre, Lusaka, Zambia
| | - Conceptor Mulube
- PATH-MACEPA, National Malaria Elimination Centre, Lusaka, Zambia
| | - Moonga Hawela
- PATH-MACEPA, National Malaria Elimination Centre, Lusaka, Zambia
| | - Douglas E Norris
- The Johns Hopkins Malaria Research Institute, W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - William J Moss
- The Johns Hopkins Malaria Research Institute, W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Giovanna Carpi
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA.
- The Johns Hopkins Malaria Research Institute, W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Purdue Institute for Inflammation, Immunology, & Infectious Disease, Purdue University, West Lafayette, IN, USA.
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3
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Thangaraj JWV, Prosperi C, Kumar MS, Hasan AZ, Kumar VS, Winter AK, Bansal AK, Chauhan SL, Grover GS, Jain AK, Kulkarni RN, Sharma SK, Soman B, Chaaithanya IK, Kharwal S, Mishra SK, Salvi NR, Sarmah NP, Sharma S, Varghese A, Sabarinathan R, Duraiswamy A, Rani DS, Kanagasabai K, Lachyan A, Gawali P, Kapoor M, Chonker SK, Sangal L, Mehendale SM, Sapkal GN, Gupta N, Hayford K, Moss WJ, Murherkar MV. Post-campaign coverage evaluation of a measles and rubella supplementary immunization activity in five districts in India, 2019-2020. PLoS One 2024; 19:e0297385. [PMID: 38551928 PMCID: PMC10980234 DOI: 10.1371/journal.pone.0297385] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 01/04/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND In alignment with the Measles and Rubella (MR) Strategic Elimination plan, India conducted a mass measles and rubella vaccination campaign across the country between 2017 and 2020 to provide a dose of MR containing vaccine to all children aged 9 months to 15 years. We estimated campaign vaccination coverage in five districts in India and assessed campaign awareness and factors associated with vaccination during the campaign to better understand reasons for not receiving the dose. METHODS AND FINDINGS Community-based cross-sectional serosurveys were conducted in five districts of India among children aged 9 months to 15 years after the vaccination campaign. Campaign coverage was estimated based on home-based immunization record or caregiver recall. Campaign coverage was stratified by child- and household-level risk factors and descriptive analyses were performed to assess reasons for not receiving the campaign dose. Three thousand three hundred and fifty-seven children aged 9 months to 15 years at the time of the campaign were enrolled. Campaign coverage among children aged 9 months to 5 years documented or by recall ranged from 74.2% in Kanpur Nagar District to 90.4% in Dibrugarh District, Assam. Similar coverage was observed for older children. Caregiver awareness of the campaign varied from 88.3% in Hoshiarpur District, Punjab to 97.6% in Dibrugarh District, Assam, although 8% of children whose caregivers were aware of the campaign were not vaccinated during the campaign. Failure to receive the campaign dose was associated with urban settings, low maternal education, and lack of school attendance although the associations varied by district. CONCLUSION Awareness of the MR vaccination campaign was high; however, campaign coverage varied by district and did not reach the elimination target of 95% coverage in any of the districts studied. Areas with lower coverage among younger children must be prioritized by strengthening the routine immunization programme and implementing strategies to identify and reach under-vaccinated children.
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Affiliation(s)
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Muthusamy Santhosh Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Epidemiology Chennai, Chennai, India
| | - Alvira Z. Hasan
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - V. Saravana Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Epidemiology Chennai, Chennai, India
| | - Amy K. Winter
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Avi Kumar Bansal
- ICMR-National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, India
| | - Sanjay L. Chauhan
- ICMR- National Institute for Research in Reproductive and Child Health, Mumbai, India
| | | | | | - Ragini N. Kulkarni
- ICMR- National Institute for Research in Reproductive and Child Health, Mumbai, India
| | | | - Biju Soman
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Achutha Menon Centre for Health Science Studies, Trivandrum, Kerala, India
| | - Itta K. Chaaithanya
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - Sanchit Kharwal
- Department of Health Research, Model Rural Health Research Unit-Hoshiarpur, Punjab, India
| | - Sunil K. Mishra
- Department of Health Research, Model Rural Health Research Unit-Hoshiarpur, Punjab, India
| | - Neha R. Salvi
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - Nilanju P. Sarmah
- Department of Health Research, Model Rural Health Research Unit-Chabua, Assam, India
| | - Sandeep Sharma
- ICMR-National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, India
| | - Adarsh Varghese
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Achutha Menon Centre for Health Science Studies, Trivandrum, Kerala, India
| | - R. Sabarinathan
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Epidemiology Chennai, Chennai, India
| | - Augustine Duraiswamy
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Epidemiology Chennai, Chennai, India
| | - D. Sudha Rani
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Epidemiology Chennai, Chennai, India
| | - K. Kanagasabai
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Epidemiology Chennai, Chennai, India
| | - Abhishek Lachyan
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - Poonam Gawali
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - Mitali Kapoor
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - Saurabh Kumar Chonker
- Department of Health Research, Model Rural Health Research Unit-Kanpur, Uttar Pradesh, India
| | - Lucky Sangal
- World Health Organization, Southeast Asia Region Office, New Delhi, India
| | | | | | - Nivedita Gupta
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Kyla Hayford
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - William J. Moss
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Manoj V. Murherkar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Epidemiology Chennai, Chennai, India
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Lambach P, Orenstein W, Silal S, Sbarra AN, Koh M, Aggarwal R, Hasan Farooqui H, Flasche S, Hogan A, Kim SY, Leask J, Luz PM, Lyimo DC, Moss WJ, Pitzer VE, Wang XY, Wu J. Report from the World Health Organization's immunization and vaccines related implementation research advisory committee (IVIR-AC) meeting, Geneva, 11-13 September 2023. Vaccine 2024; 42:1424-1434. [PMID: 38326131 PMCID: PMC10953699 DOI: 10.1016/j.vaccine.2024.02.014] [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: 01/25/2024] [Accepted: 02/02/2024] [Indexed: 02/09/2024]
Abstract
Evaluating vaccine-related research is critical to maximize the potential of vaccination programmes. The WHO Immunization and Vaccine-related Implementation Research Advisory Committee (IVIR-AC) provides an independent review of research that estimates the performance, impact and value of vaccines, with a particular focus on transmission and economic modelling. On 11-13 September 2023, IVIR-AC was convened for a bi-annual meeting where the committee reviewed research and presentations across eight different sessions. This report summarizes the background information, proceedings and recommendations from that meeting. Sessions ranged in topic from timing of measles supplementary immunization activities, analyses of conditions necessary to meet measles elimination in the South-East Asia region, translating modelled evidence into policy, a risk-benefit analysis of dengue vaccine, COVID-19 scenario modelling in the African region, therapeutic vaccination against human papilloma virus, the Vaccine Impact Modelling Consortium, and the Immunization Agenda 2030 vaccine impact estimates.
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Affiliation(s)
- Philipp Lambach
- Immunizations, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | | | - Sheetal Silal
- Modelling and Simulation Hub, Africa, University of Cape Town, Cape Town, South Africa; Centre for Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Alyssa N Sbarra
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Mitsuki Koh
- Immunizations, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Rakesh Aggarwal
- Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | | | - Stefan Flasche
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Julie Leask
- School of Public Health, University of Sydney Sydney, Australia
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - William J Moss
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Xian-Yi Wang
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Joseph Wu
- School of Public Health, The University of Hong Kong, Hong Kong
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5
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Moss WJ, Brusini L, Kuehnel R, Brochet M, Brown KM. Apicomplexan phosphodiesterases in cyclic nucleotide turnover: conservation, function, and therapeutic potential. mBio 2024; 15:e0305623. [PMID: 38132724 PMCID: PMC10865986 DOI: 10.1128/mbio.03056-23] [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] [Indexed: 12/23/2023] Open
Abstract
Apicomplexa encompasses a large number of intracellular parasites infecting a wide range of animals. Cyclic nucleotide signaling is crucial for a variety of apicomplexan life stages and cellular processes. The cyclases and kinases that synthesize and respond to cyclic nucleotides (i.e., 3',5'-cyclic guanosine monophosphate and 3',5'-cyclic adenosine monophosphate) are highly conserved and essential throughout the parasite phylum. Growing evidence indicates that phosphodiesterases (PDEs) are also critical for regulating cyclic nucleotide signaling via cyclic nucleotide hydrolysis. Here, we discuss recent advances in apicomplexan PDE biology and opportunities for therapeutic interventions, with special emphasis on the major human apicomplexan parasite genera Plasmodium, Toxoplasma, Cryptosporidium, and Babesia. In particular, we show a highly flexible repertoire of apicomplexan PDEs associated with a wide range of cellular requirements across parasites and lifecycle stages. Despite this phylogenetic diversity, cellular requirements of apicomplexan PDEs for motility, host cell egress, or invasion are conserved. However, the molecular wiring of associated PDEs is extremely malleable suggesting that PDE diversity and redundancy are key for the optimization of cyclic nucleotide turnover to respond to the various environments encountered by each parasite and life stage. Understanding how apicomplexan PDEs are regulated and integrating multiple signaling systems into a unified response represent an untapped avenue for future exploration.
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Affiliation(s)
- William J. Moss
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lorenzo Brusini
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ronja Kuehnel
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mathieu Brochet
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Kevin M. Brown
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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6
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Fola AA, He Q, Xie S, Thimmapuram J, Bhide KP, Dorman J, Ciubotariu II, Mwenda MC, Mambwe B, Mulube C, Hawela M, Norris DE, Moss WJ, Bridges DJ, Carpi G. Genomics reveals heterogeneous Plasmodium falciparum transmission and population differentiation in Zambia and bordering countries. medRxiv 2024:2024.02.09.24302570. [PMID: 38370674 PMCID: PMC10871455 DOI: 10.1101/2024.02.09.24302570] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Genomic surveillance plays a critical role in monitoring malaria transmission and understanding how the parasite adapts in response to interventions. We conducted genomic surveillance of malaria by sequencing 241 Plasmodium falciparum genomes from regions with varying levels of malaria transmission across Zambia. We found genomic evidence of high levels of within-host polygenomic infections, regardless of epidemiological characteristics, underscoring the extensive and ongoing endemic malaria transmission in the country. We identified country-level clustering of parasites from Zambia and neighboring countries, and distinct clustering of parasites from West Africa. Within Zambia, our identity by descent (IBD) relatedness analysis uncovered spatial clustering of closely related parasite pairs at the local level and rare cases of long-distance sharing. Genomic regions with large shared IBD segments and strong positive selection signatures identified genes involved in sulfadoxine-pyrimethamine and artemisinin combination therapies drug resistance, but no signature related to chloroquine resistance. Together, our findings enhance our understanding of P. falciparum transmission nationwide in Zambia and highlight the urgency of strengthening malaria control programs and surveillance of antimalarial drug resistance.
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Affiliation(s)
- Abebe A. Fola
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA
| | - Qixin He
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA
| | - Shaojun Xie
- Bioinformatics Core, Purdue University, Purdue University, West Lafayette, IN, USA
| | - Jyothi Thimmapuram
- Bioinformatics Core, Purdue University, Purdue University, West Lafayette, IN, USA
| | - Ketaki P. Bhide
- Bioinformatics Core, Purdue University, Purdue University, West Lafayette, IN, USA
| | - Jack Dorman
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA
| | | | | | - Brenda Mambwe
- PATH-MACEPA, National Malaria Elimination Centre, Lusaka, Zambia
| | - Conceptor Mulube
- PATH-MACEPA, National Malaria Elimination Centre, Lusaka, Zambia
| | - Moonga Hawela
- PATH-MACEPA, National Malaria Elimination Centre, Lusaka, Zambia
| | - Douglas E. Norris
- The Johns Hopkins Malaria Research Institute, W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - William J. Moss
- The Johns Hopkins Malaria Research Institute, W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Giovanna Carpi
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA
- The Johns Hopkins Malaria Research Institute, W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Purdue Institute for Inflammation, Immunology, & Infectious Disease, Purdue University, West Lafayette, IN, USA
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7
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Goldin S, Moen A, Moss WJ, Nuzzo J. Assessing the relationship between existing childhood, adolescent and adult immunization programmes and national COVID-19 vaccination capacities in 2021. Vaccine 2024:S0264-410X(23)01484-6. [PMID: 38216440 DOI: 10.1016/j.vaccine.2023.12.038] [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: 07/10/2023] [Revised: 12/08/2023] [Accepted: 12/10/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND During the COVID-19 pandemic, nearly all countries introduced COVID-19 vaccination programmes. Yet, countries had a wide range of programmatic experiences. This analysis aims to identify national characteristics associated with COVID-19 vaccination programmatic success. METHODS We used the following outcome measures: the presence of national COVID-19 vaccination capacities and COVID-19 coverage as of December 2021, June 2022, and December 2022. We developed a standardized metric for assessing national COVID-19 vaccination capacities as a proxy for speed of introduction. We developed this metric through adaptation of the WHO Guide for Conducting an Expanded Programme on Immunization Review and consultations with technical experts specializing in vaccine introduction and emergency deployment; monitoring and data; childhood, adolescent and adult programmes; and COVID-19 vaccination roll-out. Through multivariable linear regressions, we evaluated whether having a mature immunization programme for children, adolescents and adults; recent use of emergency vaccination; World Bank income classification; past early adoption of new vaccines; density of the health workforce; and/or trust in science and government were associated with higher COVID-19 vaccination capacities and coverage. RESULTS The COVID-19 vaccination capacities scores ranged from 0 to 5 points with a global median score of 2 and an interquartile range of 1;4. After adjusting for World Bank income classifications, the presence of a mature influenza vaccination programme was independently correlated with statistically significant higher scores of national COVID-19 vaccination capacities and higher COVID-19 vaccination coverage in December 2021, June 2022, and December 2022. Trust in government was also associated with higher coverage for all three time stamps. CONCLUSIONS As countries consider how to prepare for and respond to future pandemics, having an adult seasonal influenza vaccination programme, building trust in government, and ensuring equitable access to vaccines supply emerged as key aspects that can benefit from additional national and global focus.
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Affiliation(s)
- Shoshanna Goldin
- Johns Hopkins University, Bloomberg School of Public Health, USA.
| | - Ann Moen
- Task Force for Global Health, Switzerland
| | - William J Moss
- Johns Hopkins University, Bloomberg School of Public Health, USA
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8
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Goldin S, Moen A, Moss WJ, Nuzzo J. The 2020 immunization programme landscape: Piloting an assessment metric to evaluate the maturity of national immunization programmes across the life course. Vaccine 2024:S0264-410X(23)01497-4. [PMID: 38212202 DOI: 10.1016/j.vaccine.2023.12.051] [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: 06/30/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND The World Health Organization (WHO) encourages countries to provide appropriate vaccinations for children, adolescents, and relevant adult populations. Childhood programme have been the focus of global investments, but recent pandemics have increasingly demonstrated the value of life course vaccination. Our objective is to compare national life course immunization programmatic maturity prior to mass COVID-19 vaccine introduction, the largest adult vaccination programme, globally. As coverage estimates (typically used to assess childhood programmes) are not available for adult vaccinations, this analysis pilots a standardized quantitative metric of programmatic maturity. METHODS Through consultation with vaccination experts, we developed a standardized approach to assess national immunization programme maturity across the life course. In accordance with expert input, five vaccines were selected to represent delivery across the life course: diphtheria tetanus toxoid and pertussis (DTP); measles (MCV) second dose; human papillomavirus (HPV) final dose; pneumococcal conjugate (PCV) final dose; and seasonal influenza annual dose. Experts recommended inclusion of the following indicators for each vaccine: a legal mandate (national policy), experience delivering the vaccine (programme duration), and vaccine use (uptake for relevant populations). We developed a metric accordingly that provides up to 5 points per vaccine ("vaccine specific maturity score") which when summed forms the "life course maturity score", with a maximum score of 25. We analysed the prevalence of national policies, experience, and use by region and World Bank income group. RESULTS More than 55% of the 194 WHO Member States had childhood vaccine policies for all three of the vaccines considered (DTP, MCV, and PCV) compared to 60% for HPV (proxy for adolescent vaccination programme) and 52% for seasonal influenza (proxy for adult vaccination programme). Childhood vaccination programmes (e.g., MCV and DTP) had the highest vaccine specific maturity scores, while seasonal influenza and HPV vaccination programmes had much lower scores. The national life course maturity scores ranged from 1 to 23, with a global median of 12 (IQR: 8; 16). DISCUSSION The piloted metric provides an overview of the maturity of life course immunization programmes. The metric is structured to be a flexible, rapid resource that can be used to assess other combinations of vaccines across the life course. The findings from this paper provide a baseline of immunization programme maturity for childhood, adolescent, and adult vaccination programmes immediately prior to the COVID-19 vaccine introduction. This maturity score, or adaptations of this approach, could be used to monitor the trajectory of national immunization programme maturity across the life course in the years ahead.
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Affiliation(s)
- Shoshanna Goldin
- Johns Hopkins University, Bloomberg School of Public Health, United States.
| | - Ann Moen
- Task Force for Global Health, United States
| | - William J Moss
- Johns Hopkins University, Bloomberg School of Public Health, United States
| | - Jennifer Nuzzo
- Brown University, Center for Pandemic Preparedness, United States
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Moss WJ, Kwon D, Wu N, Brett P. Complete clinicoradiographic remission following immunotherapy treatment for an unresectable, multiply-recurrent oral verrucous carcinoma: A letter to the editor. Oral Oncol 2023; 146:106567. [PMID: 37778230 DOI: 10.1016/j.oraloncology.2023.106567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023]
Affiliation(s)
- William J Moss
- Commonwealth Healthcare Corporation, Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, 1 Navy Hill Rd, Garapan, Saipan, MP 96950, USA; VinUniversity, Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, Vinhomes Ocean Park, Gia Lâm, Hanoi, Viet Nam.
| | - Daniel Kwon
- University of Southern California Keck School of Medicine, Department of Otolaryngology-Head and Neck Surgery, 1450 San Pablo Street, Suite 5800 Los Angeles, CA 90033, USA
| | - Nathaniel Wu
- University of Texas Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Peter Brett
- Commonwealth Healthcare Corporation, Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, 1 Navy Hill Rd, Garapan, Saipan, MP 96950, USA
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10
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Ferriss E, Chaponda M, Muleba M, Kabuya JB, Lupiya JS, Riley C, Winters A, Moulton LH, Mulenga M, Norris DE, Moss WJ. The Impact of Household and Community Indoor Residual Spray Coverage with Fludora Fusion in a High Malaria Transmission Setting in Northern Zambia. Am J Trop Med Hyg 2023; 109:248-257. [PMID: 37364860 PMCID: PMC10397455 DOI: 10.4269/ajtmh.22-0440] [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: 07/01/2022] [Accepted: 04/24/2023] [Indexed: 06/28/2023] Open
Abstract
Zambia's National Malaria Elimination Program transitioned to Fludora Fusion in 2019 for annual indoor residual spraying (IRS) in Nchelenge District, an area with holoendemic malaria transmission. Previously, IRS was associated with reductions in parasite prevalence during the rainy season only, presumably because of insufficient residual insecticide longevity. This study assessed the impact of transitioning from Actellic 300CS to long-acting Fludora Fusion using active surveillance data from 2014 through 2021. A difference-in-differences analysis estimated changes in rainy season parasite prevalence associated with living in a sprayed house, comparing insecticides. The change in the 2020 to 2021 dry season parasite prevalence associated with living in a house sprayed with Fludora Fusion was also estimated. Indoor residual spraying with Fludora Fusion was not associated with decreased rainy season parasite prevalence compared with IRS with Actellic 300CS (ratio of prevalence ratios [PRs], 1.09; 95% CI, 0.89-1.33). Moreover, living in a house sprayed with either insecticide was not associated with decreased malaria risk (Actellic 300CS: PR, 0.97; 95% CI, 0.86-1.10; Fludora Fusion: rainy season PR, 1.06; 95% CI, 0.89-1.25; dry season PR, 1.21; 95% CI, 0.99-1.48). In contrast, each 10% increase in community IRS coverage was associated with a 4% to 5% reduction in parasite prevalence (rainy season: PR, 0.95; 95% CI, 0.92-0.97; dry season: PR, 0.96; 95% CI, 0.94-0.99), suggesting a community-level protective effect, and corroborating the importance of high-intervention coverage.
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Affiliation(s)
- Ellen Ferriss
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | | | - Anna Winters
- Akros, Lusaka, Zambia
- University of Montana, Missoula, Montana
| | - Lawrence H. Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Pfizer Canada, Quebec, Canada
| | - Modest Mulenga
- Directorate of Research and Postgraduate Studies, Lusaka Apex Medical University, Lusaka, Zambia
| | - Douglas E. Norris
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - William J. Moss
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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11
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Bérubé S, Kobayashi T, Norris DE, Ruczinski I, Moss WJ, Wesolowski A, Louis TA. Novel bioinformatic methods and machine learning approaches reveal candidate biomarkers of the intensity and timing of past exposure to Plasmodium falciparum. PLOS Glob Public Health 2023; 3:e0001840. [PMID: 37531325 PMCID: PMC10395840 DOI: 10.1371/journal.pgph.0001840] [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: 12/07/2022] [Accepted: 06/28/2023] [Indexed: 08/04/2023]
Abstract
Accurately quantifying the burden of malaria over time is an important goal of malaria surveillance efforts and can enable effective targeting and evaluation of interventions. Malaria surveillance methods capture active or recent infections which poses several challenges to achieving malaria surveillance goals. In high transmission settings, asymptomatic infections are common and therefore accurate measurement of malaria burden demands active surveillance; in low transmission regions where infections are rare accurate surveillance requires sampling large subsets of the population; and in any context monitoring malaria burden over time necessitates serial sampling. Antibody responses to Plasmodium falciparum parasites persist after infection and therefore measuring antibodies has the potential to overcome several of the current obstacles to accurate malaria surveillance. Identifying which antibody responses are markers of the timing and intensity of past exposure to P. falciparum remains challenging, particularly among adults who tend to be re-exposed multiple times over the course of their lifetime and therefore have similarly high antibody responses to many Plasmodium antigens. A previous analysis of 479 serum samples from individuals in three regions in southern Africa with different historical levels of P. falciparum malaria transmission (high, intermediate, and low) revealed regional differences in antibody responses to P. falciparum antigens among children under 5 years of age. Using a novel bioinformatic pipeline optimized for protein microarrays that minimizes between-sample technical variation, we used antibody responses to Plasmodium antigens as predictors in random forest models to classify samples from adults into these three regions of differing historical malaria transmission with high accuracy (AUC = 0.99). Many of the most important antigens for classification in these models do not overlap with previously published results and are therefore novel candidate markers for the timing and intensity of past exposure to P. falciparum. Measuring antibody responses to these antigens could lead to improved malaria surveillance.
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Affiliation(s)
- Sophie Bérubé
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Tamaki Kobayashi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Douglas E. Norris
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Ingo Ruczinski
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - William J. Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Amy Wesolowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Thomas A. Louis
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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12
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Mak J, Sriudomporn S, Moss WJ, Patenaude BN. An Estimate Of The Return On Investment Of A Malaria Vaccine In 20 Sub-Saharan African Countries, 2021-30. Health Aff (Millwood) 2023; 42:1091-1099. [PMID: 37549331 DOI: 10.1377/hlthaff.2022.01328] [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] [Indexed: 08/09/2023]
Abstract
Malaria is a leading global health problem that was responsible for an estimated 619,000 deaths worldwide in 2021. We modeled the return on investment (ROI) for the introduction and continuation of a four-dose malaria vaccine, RTS,S/AS01, from 2021 to 2030 in twenty sub-Saharan African countries supported by Gavi, the Vaccine Alliance. We used the Decade of Vaccine Economics benefits and costing outputs to calculate an ROI using health impact data modeled by the Swiss Tropical and Public Health Institute (hereafter "Swiss") and Imperial College London (hereafter "Imperial"). The Swiss estimates with a base vaccine price of US$7.00 resulted in an ROI of 0.42, and the Imperial impact estimates with the same base vaccine price resulted in an ROI of 2.30. Inclusion of the fifth seasonal dose for ten countries exhibiting high seasonal disease burden increased the Swiss ROI by 143 percent, to 1.02, and the Imperial ROI by 23.5 percent, to 2.84. To improve ROI, decision makers should continue to improve delivery platforms, decrease vaccine delivery costs, deliver the malaria vaccine in fewer doses, and provide access to vaccine resources.
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Affiliation(s)
- Joshua Mak
- Joshua Mak , Johns Hopkins University, Baltimore, Maryland
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13
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Fola AA, Moser KA, Aydemir O, Hennelly C, Kobayashi T, Shields T, Hamapumbu H, Musonda M, Katowa B, Matoba J, Stevenson JC, Norris DE, Thuma PE, Wesolowski A, Moss WJ, Bailey JA, Juliano JJ. Temporal and spatial analysis of Plasmodium falciparum genomics reveals patterns of parasite connectivity in a low-transmission district in Southern Province, Zambia. Malar J 2023; 22:208. [PMID: 37420265 PMCID: PMC10327325 DOI: 10.1186/s12936-023-04637-9] [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: 04/20/2023] [Accepted: 06/30/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Understanding temporal and spatial dynamics of malaria transmission will help to inform effective interventions and strategies in regions approaching elimination. Parasite genomics are increasingly used to monitor epidemiologic trends, including assessing residual transmission across seasons and importation of malaria into these regions. METHODS In a low and seasonal transmission setting of southern Zambia, a total of 441 Plasmodium falciparum samples collected from 8 neighbouring health centres between 2012 and 2018 were genotyped using molecular inversion probes (MIPs n = 1793) targeting a total of 1832 neutral and geographically informative SNPs distributed across the parasite genome. After filtering for quality and missingness, 302 samples and 1410 SNPs were retained and used for downstream population genomic analyses. RESULTS The analyses revealed most (67%, n = 202) infections harboured one clone (monogenomic) with some variation at local level suggesting low, but heterogenous malaria transmission. Relatedness identity-by-descent (IBD) analysis revealed variable distribution of IBD segments across the genome and 6% of pairs were highly-related (IBD ≥ 0.25). Some of the highly-related parasite populations persisted across multiple seasons, suggesting that persistence of malaria in this low-transmission region is fueled by parasites "seeding" across the dry season. For recent years, clusters of clonal parasites were identified that were dissimilar to the general parasite population, suggesting parasite populations were increasingly fragmented at small spatial scales due to intensified control efforts. Clustering analysis using PCA and t-SNE showed a lack of substantial parasite population structure. CONCLUSION Leveraging both genomic and epidemiological data provided comprehensive picture of fluctuations in parasite populations in this pre-elimination setting of southern Zambia over 7 years.
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Affiliation(s)
- Abebe A. Fola
- Department of Pathology and Laboratory Medicine, Brown University, 55 Claverick Street, Providence, RI 02906 USA
| | - Kara A. Moser
- University of North Carolina Institute for Global Health and Infectious Diseases, University of North Carolina Chapel Hill, Chapel Hill, NC 27599 USA
| | - Ozkan Aydemir
- Department of Pathology and Laboratory Medicine, Brown University, 55 Claverick Street, Providence, RI 02906 USA
| | - Chris Hennelly
- University of North Carolina Institute for Global Health and Infectious Diseases, University of North Carolina Chapel Hill, Chapel Hill, NC 27599 USA
| | - Tamaki Kobayashi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205 USA
| | - Timothy Shields
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205 USA
| | | | | | - Ben Katowa
- Macha Research Trust, Choma District, Choma, Zambia
| | | | | | - Douglas E. Norris
- Department of Molecular Microbiology and Immunology, The Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205 USA
| | | | - Amy Wesolowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205 USA
| | - William J. Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205 USA
- Department of Molecular Microbiology and Immunology, The Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205 USA
| | - Jeffrey A. Bailey
- Department of Pathology and Laboratory Medicine, Brown University, 55 Claverick Street, Providence, RI 02906 USA
| | - Jonathan J. Juliano
- University of North Carolina Institute for Global Health and Infectious Diseases, University of North Carolina Chapel Hill, Chapel Hill, NC 27599 USA
- Division of Infectious Diseases, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC 27599 USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC 27599 USA
- Curriculum in Genetics and Molecular Biology, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC 27599 USA
| | - the Southern, Central Africa International Center of Excellence for Malaria Research (ICEMR)
- Department of Pathology and Laboratory Medicine, Brown University, 55 Claverick Street, Providence, RI 02906 USA
- University of North Carolina Institute for Global Health and Infectious Diseases, University of North Carolina Chapel Hill, Chapel Hill, NC 27599 USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205 USA
- Macha Research Trust, Choma District, Choma, Zambia
- Department of Molecular Microbiology and Immunology, The Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205 USA
- Division of Infectious Diseases, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC 27599 USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC 27599 USA
- Curriculum in Genetics and Molecular Biology, School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC 27599 USA
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14
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Sutcliffe CG, Moyo N, Hamahuwa M, Mutanga JN, van Dijk JH, Hamangaba F, Schue JL, Thuma PE, Moss WJ. The Evolving Pediatric HIV Epidemic in Rural Southern Zambia: The Beneficial Impact of Advances in Prevention and Treatment at a District Hospital From 2007 to 2019. Pediatr Infect Dis J 2023; 42:489-495. [PMID: 36795584 PMCID: PMC10360039 DOI: 10.1097/inf.0000000000003873] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Remarkable progress has been made in expanding access to services addressing the pediatric HIV epidemic, including programs to prevent mother-to-child transmission, early diagnosis and treatment for children living with HIV. Few long-term data are available from rural sub-Saharan Africa to assess implementation and impact of national guidelines. METHODS Results from 3 cross-sectional studies and 1 cohort study conducted at Macha Hospital in Southern Province, Zambia from 2007 to 2019 were summarized. For infant diagnosis, maternal antiretroviral treatment, infant test results and turnaround times for results were evaluated by year. For pediatric HIV care, the number and age of children initiating care and treatment, and treatment outcomes within 12 months were evaluated by year. RESULTS Receipt of maternal combination antiretroviral treatment increased from 51.6% in 2010-2012 to 93.4% in 2019, and the proportion of infants testing positive decreased from 12.4% to 4.0%. Turnaround times for results returning to clinic varied but were shorter when labs consistently used a text messaging system. The proportion of mothers receiving results was higher when a text message intervention was piloted. The number of children living with HIV enrolled into care and the proportion initiating treatment with severe immunosuppression and dying within 12 months decreased over time. CONCLUSIONS These studies demonstrate the long-term beneficial impact of implementing a strong HIV prevention and treatment program. While expansion and decentralization brought challenges, the program succeeded in decreasing the rate of mother-to-child transmission and ensuring that children living with HIV benefit from access to life-saving treatment.
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Affiliation(s)
- Catherine G. Sutcliffe
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, Maryland, USA
| | | | | | | | | | | | - Jessica L. Schue
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, Maryland, USA
| | - Philip E. Thuma
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, Maryland, USA
- Macha Research Trust, Choma, Zambia
| | - William J. Moss
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, Maryland, USA
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15
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Lutz CS, Hasan AZ, Bolotin S, Crowcroft NS, Cutts FT, Joh E, Loisate S, Moss WJ, Osman S, Hayford K. Comparison of measles IgG enzyme immunoassays (EIA) versus plaque reduction neutralization test (PRNT) for measuring measles serostatus: a systematic review of head-to-head analyses of measles IgG EIA and PRNT. BMC Infect Dis 2023; 23:367. [PMID: 37259032 PMCID: PMC10231861 DOI: 10.1186/s12879-023-08199-8] [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: 08/08/2022] [Accepted: 03/26/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND As countries move towards or achieve measles elimination status, serosurveillance is an important public health tool. However, a major challenge of serosurveillance is finding a feasible, accurate, cost-effective, and high throughput assay to measure measles antibody concentrations and estimate susceptibility in a population. We conducted a systematic review to assess, characterize, and - to the extent possible - quantify the performance of measles IgG enzyme-linked assays (EIAs) compared to the gold standard, plaque reduction neutralization tests (PRNT). METHODS We followed the PRISMA statement for a systematic literature search and methods for conducting and reporting systematic reviews and meta-analyses recommended by the Cochrane Screening and Diagnostic Tests Methods Group. We identified studies through PubMed and Embase electronic databases and included serologic studies detecting measles virus IgG antibodies among participants of any age from the same source population that reported an index (any EIA or multiple bead-based assays, MBA) and reference test (PRNT) using sera, whole blood, or plasma. Measures of diagnostic accuracy with 95% confidence intervals (CI) were abstracted for each study result, where reported. RESULTS We identified 550 unique publications and identified 36 eligible studies for analysis. We classified studies as high, medium, or low quality; results from high quality studies are reported. Because most high quality studies used the Siemens Enzygnost EIA kit, we generate individual and pooled diagnostic accuracy estimates for this assay separately. Median sensitivity of the Enzygnost EIA was 92.1% [IQR = 82.3, 95.7]; median specificity was 96.9 [93.0, 100.0]. Pooled sensitivity and specificity from studies using the Enzygnost kit were 91.6 (95%CI: 80.7,96.6) and 96.0 (95%CI: 90.9,98.3), respectively. The sensitivity of all other EIA kits across high quality studies ranged from 0% to 98.9% with median (IQR) = 90.6 [86.6, 95.2]; specificity ranged from 58.8% to 100.0% with median (IQR) = 100.0 [88.7, 100.0]. CONCLUSIONS Evidence on the diagnostic accuracy of currently available measles IgG EIAs is variable, insufficient, and may not be fit for purpose for serosurveillance goals. Additional studies evaluating the diagnostic accuracy of measles EIAs, including MBAs, should be conducted among diverse populations and settings (e.g., vaccination status, elimination/endemic status, age groups).
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Affiliation(s)
- Chelsea S Lutz
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alvira Z Hasan
- International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shelly Bolotin
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Natasha S Crowcroft
- Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Immunisation, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Felicity T Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - Eugene Joh
- Public Health Ontario, Toronto, ON, Canada
| | - Stacie Loisate
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - William J Moss
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kyla Hayford
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
- Pfizer Vaccines, Inc., New York City, NY, USA.
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16
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Katowa B, Hamapumbu H, Thuma PE, Bérubé S, Wesolowski A, Moss WJ, Kobayashi T. Declining Age-Specific Seroprevalence and Seroconversion Rates in Plasmodium falciparum from 2009 to 2018 Documents Progress toward Malaria Elimination in Southern Zambia. Am J Trop Med Hyg 2023:ajtmh.22-0401. [PMID: 37127270 DOI: 10.4269/ajtmh.22-0401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/15/2023] [Indexed: 05/03/2023] Open
Abstract
Obtaining accurate malaria surveillance data is challenging in low-transmission settings because large sample sizes are required to estimate incidence and prevalence precisely. Serology is an additional tool to document progress toward malaria elimination. An enzyme immunoassay to Plasmodium falciparum lysate was used to estimate age-specific seroprevalence among residents of southern Zambia, where malaria transmission has declined to pre-elimination levels during the past two decades. Plasma was eluted from 3,362 dried blood spots collected during five cross-sectional surveys conducted between 2009 and 2012, and again in 2018. Annual seroconversion rates (SCRs), an estimate of the force of infection, were calculated using a reversible catalytic model. The SCR decreased by two thirds from a level of approximately 0.15/year in 2009 and 2010 to approximately 0.05/year in 2011 and 2012, and then decreased 5-fold to 0.01/year by 2018, demonstrating the utility of serology in documenting progress toward elimination.
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Bérubé S, Kobayashi T, Wesolowski A, Norris DE, Ruczinski I, Moss WJ, Louis TA. A Bayesian hierarchical model for signal extraction from protein microarrays. Stat Med 2023; 42:1445-1460. [PMID: 36872556 DOI: 10.1002/sim.9680] [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: 03/03/2022] [Revised: 11/09/2022] [Accepted: 01/30/2023] [Indexed: 03/07/2023]
Abstract
Protein microarrays are a promising technology that measure protein levels in serum or plasma samples. Due to their high technical variability and high variation in protein levels across serum samples in any population, directly answering biological questions of interest using protein microarray measurements is challenging. Analyzing preprocessed data and within-sample ranks of protein levels can mitigate the impact of between-sample variation. As for any analysis, ranks are sensitive to preprocessing, but loss function based ranks that accommodate major structural relations and components of uncertainty are very effective. Bayesian modeling with full posterior distributions for quantities of interest produce the most effective ranks. Such Bayesian models have been developed for other assays, for example, DNA microarrays, but modeling assumptions for these assays are not appropriate for protein microarrays. Consequently, we develop and evaluate a Bayesian model to extract the full posterior distribution of normalized protein levels and associated ranks for protein microarrays, and show that it fits well to data from two studies that use protein microarrays produced by different manufacturing processes. We validate the model via simulation and demonstrate the downstream impact of using estimates from this model to obtain optimal ranks.
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Affiliation(s)
- Sophie Bérubé
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tamaki Kobayashi
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amy Wesolowski
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Douglas E Norris
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ingo Ruczinski
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - William J Moss
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Thomas A Louis
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Yang Y, Kostandova N, Mwansa FD, Nakazwe C, Namukoko H, Sakala C, Bobo P, Masumbu PK, Nachinga B, Ngula D, Carcelen AC, Prosperi C, Winter AK, Moss WJ, Mutembo S. Challenges Addressing Inequalities in Measles Vaccine Coverage in Zambia through a Measles-Rubella Supplementary Immunization Activity during the COVID-19 Pandemic. Vaccines (Basel) 2023; 11:608. [PMID: 36992192 PMCID: PMC10059977 DOI: 10.3390/vaccines11030608] [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: 02/14/2023] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Measles-rubella supplementary immunization activities (MR-SIAs) are conducted to address inequalities in coverage and fill population immunity gaps when routine immunization services fail to reach all children with two doses of a measles-containing vaccine (MCV). We used data from a post-campaign coverage survey in Zambia to measure the proportion of measles zero-dose and under-immunized children who were reached by the 2020 MR-SIA and identified reasons associated with persistent inequalities following the MR-SIA. METHODS Children between 9 and 59 months were enrolled in a nationally representative, cross-sectional, multistage stratified cluster survey in October 2021 to estimate vaccination coverage during the November 2020 MR-SIA. Vaccination status was determined by immunization card or through caregivers' recall. MR-SIA coverage and the proportion of measles zero-dose and under-immunized children reached by MR-SIA were estimated. Log-binomial models were used to assess risk factors for missing the MR-SIA dose. RESULTS Overall, 4640 children were enrolled in the nationwide coverage survey. Only 68.6% (95% CI: 66.7%, 70.6%) received MCV during the MR-SIA. The MR-SIA provided MCV1 to 4.2% (95% CI: 0.9%, 4.6%) and MCV2 to 6.3% (95% CI: 5.6%, 7.1%) of enrolled children, but 58.1% (95% CI: 59.8%, 62.8%) of children receiving the MR-SIA dose had received at least two prior MCV doses. Furthermore, 27.8% of measles zero-dose children were vaccinated through the MR-SIA. The MR-SIA reduced the proportion of measles zero-dose children from 15.1% (95% CI: 13.6%, 16.7%) to 10.9% (95% CI: 9.7%, 12.3%). Zero-dose and under-immunized children were more likely to miss MR-SIA doses (prevalence ratio (PR): 2.81; 95% CI: 1.80, 4.41 and 2.22; 95% CI: 1.21 and 4.07) compared to fully vaccinated children. CONCLUSIONS The MR-SIA reached more under-immunized children with MCV2 than measles zero-dose children with MCV1. However, improvement is needed to reach the remaining measles zero-dose children after SIA. One possible solution to address the inequalities in vaccination is to transition from nationwide non-selective SIAs to more targeted and selective strategies.
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Affiliation(s)
- Yangyupei Yang
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA
| | - Natalya Kostandova
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA
| | - Francis Dien Mwansa
- Ministry of Health, Government of the Republic of Zambia, Lusaka 10101, Zambia
| | | | | | - Constance Sakala
- Ministry of Health, Government of the Republic of Zambia, Lusaka 10101, Zambia
| | - Patricia Bobo
- Ministry of Health, Government of the Republic of Zambia, Lusaka 10101, Zambia
| | | | | | - David Ngula
- Ministry of Health, Government of the Republic of Zambia, Lusaka 10101, Zambia
| | - Andrea C. Carcelen
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA
| | - Amy K. Winter
- Department of Epidemiology, University of Georgia, Athens, GA 30602, USA
| | - William J. Moss
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA
- W Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA
| | - Simon Mutembo
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA
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19
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Hauser M, Kabuya JBB, Mantus M, Kamavu LK, Sichivula JL, Matende WM, Fritschi N, Shields T, Curriero F, Kvit A, Chongwe G, Moss WJ, Ritz N, Ippolito MM. Malaria in Refugee Children Resettled to a Holoendemic Area of Sub-Saharan Africa. Clin Infect Dis 2023; 76:e1104-e1113. [PMID: 35640824 PMCID: PMC10169438 DOI: 10.1093/cid/ciac417] [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: 01/14/2022] [Revised: 05/06/2022] [Accepted: 05/20/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Malaria is a leading cause of morbidity and mortality in refugee children in high-transmission parts of Africa. Characterizing the clinical features of malaria in refugees can inform approaches to reduce its burden. METHODS The study was conducted in a high-transmission region of northern Zambia hosting Congolese refugees. We analyzed surveillance data and hospital records of children with severe malaria from refugee and local sites using multivariable regression models and geospatial visualization. RESULTS Malaria prevalence in the refugee settlement was similar to the highest burden areas in the district, consistent with the local ecology and leading to frequent rapid diagnostic test stockouts. We identified 2197 children hospitalized for severe malaria during the refugee crisis in 2017 and 2018. Refugee children referred from a refugee transit center (n = 63) experienced similar in-hospital mortality to local children and presented with less advanced infection. However, refugee children from a permanent refugee settlement (n = 110) had more than double the mortality of local children (P < .001), had lower referral rates, and presented more frequently with advanced infection and malnutrition. Distance from the hospital was an important mediator of the association between refugee status and mortality but did not account for all of the increased risk. CONCLUSIONS Malaria outcomes were more favorable in refugee children referred from a highly outfitted refugee transit center than those referred later from a permanent refugee settlement. Refugee children experienced higher in-hospital malaria mortality due in part to delayed presentation and higher rates of malnutrition. Interventions tailored to the refugee context are required to ensure capacity for rapid diagnosis and referral to reduce malaria mortality.
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Affiliation(s)
- Manuela Hauser
- Faculty of Medicine, University of Basel, Basel, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Jean-Bertin B Kabuya
- Department of Clinical Sciences, Tropical Diseases Research Centre, Ndola, Zambia
| | - Molly Mantus
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Luc K Kamavu
- Office of Hospital Administration, Saint Paul's General Hospital, Nchelenge, Zambia
| | - James L Sichivula
- Department of Clinical Sciences, Tropical Diseases Research Centre, Ndola, Zambia
| | - Wycliffe M Matende
- United Nations High Commissioner for Refugees, Country Representation Office, Lusaka, Zambia
| | - Nora Fritschi
- Mycobacterial and Migrant Health Research Group, University of Basel Children's Hospital, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Timothy Shields
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Frank Curriero
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anton Kvit
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Gershom Chongwe
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - William J Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nicole Ritz
- Mycobacterial and Migrant Health Research Group, University of Basel Children's Hospital, Basel, Switzerland.,Infectious Disease and Vaccinology Unit, University Children's Hospital Basel, University of Basel, Basel, Switzerland.,Department of Pediatrics, The Royal Children's Hospital Melbourne, The University of Melbourne, Melbourne, Australia.,Department of Paediatrics and Paediatric Infectious Diseases, Children's Hospital, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Matthew M Ippolito
- Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Division of Clinical Pharmacology and Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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20
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Winter AK, Takahashi S, Carcelen AC, Hayford K, Mutale W, Mwansa FD, Sinyange N, Ngula D, Moss WJ, Mutembo S. An evaluation of the early impact of the COVID-19 pandemic on Zambia's routine immunization program. PLOS Glob Public Health 2023; 3:e0000554. [PMID: 37130089 PMCID: PMC10153718 DOI: 10.1371/journal.pgph.0000554] [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] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 03/31/2023] [Indexed: 05/03/2023]
Abstract
Implications of the COVID-19 pandemic for both populations and healthcare systems are vast. In addition to morbidity and mortality from COVID-19, the pandemic also disrupted local health systems, including reductions or delays in routine vaccination services and catch-up vaccination campaigns. These disruptions could lead to outbreaks of other infectious diseases that result in an additional burden of disease and strain on the healthcare system. We evaluated the impact of the COVID-19 pandemic on Zambia's routine childhood immunization program in 2020 using multiple sources of data. We relied on administrative vaccination data and Zambia's 2018 Demographic and Health Survey to project national disruptions to district-specific routine childhood vaccination coverage within the pandemic year 2020. Next, we leveraged a 2016 population-based serological survey to predict age-specific measles seroprevalence and assessed the impact of changes in vaccination coverage on measles outbreak risk in each district. We found minor disruptions to routine administration of measles-rubella and pentavalent vaccines in 2020. This was in part due to Zambia's Child Health Week held in June of 2020 which helped to reach children missed during the first six months of the year. We estimated that the two-month delay in a measles-rubella vaccination campaign, originally planned for September of 2020 but conducted in November of 2020 as a result of the pandemic, had little impact on modeled district-specific measles outbreak risks. This study estimated minimal increases in the number of children missed by vaccination services in Zambia during 2020. However, the ongoing SARS-CoV-2 transmission since our analysis concluded means efforts to maintain routine immunization services and minimize the risk of measles outbreaks will continue to be critical. The methodological framework developed in this analysis relied on routinely collected data to estimate disruptions of the COVID-19 pandemic to national routine vaccination program performance and its impact on children missed at the subnational level can be deployed in other countries or for other vaccines.
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Affiliation(s)
- Amy K Winter
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, United States of America
| | - Saki Takahashi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Andrea C Carcelen
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kyla Hayford
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Wilbroad Mutale
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Francis D Mwansa
- Child Health Unit, Directorate of Public Health and Research, Ministry of Health, Lusaka, Zambia
| | - Nyambe Sinyange
- Field Epidemiology Training Program, Zambia National Public Health Institute, Lusaka, Zambia
| | - David Ngula
- Child Health Unit, Directorate of Public Health and Research, Ministry of Health, Lusaka, Zambia
| | - William J Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Simon Mutembo
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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21
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Carcelen AC, Limaye RJ, Mutembo S, Hamahuwa M, Thuma PE, Moss WJ, Hayford K. Acceptability of serosurveys in southern Zambia: data collector and caregiver perspectives. Discov Soc Sci Health 2023; 3:3. [PMID: 36824432 PMCID: PMC9940080 DOI: 10.1007/s44155-023-00032-6] [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: 11/21/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
Background Factors associated with whether individuals choose to participate in serosurveys are not well understood. Understanding perceptions from multiple perspectives, including the perspectives of both data collectors and participants, through a holistic model such as the socio-ecological model contextualizes individual, interpersonal, and structural level influences on survey research participation. We used a multiple methods approach to characterize reasons for serosurvey participation in communities in Southern Province, Zambia where a serosurvey was conducted in 2016. Methods The first phase conducted focus group discussions and in-depth interviews with 24 data collectors who participated in a measles-rubella serosurvey in 2016. The second phase surveyed 34 caregivers at health facilities to identify barriers and facilitators to serosurvey participation. Emergent themes were then classified into a socio-ecological model using individual, interpersonal, and structural level constructs. Results Common themes emerged from data collectors as well as caregivers surveyed. At the individual level, providing incentives was a facilitator, and some religious beliefs were described as a barrier to serosurvey participation. At the interpersonal level, family dynamics and community peer influences could help or hinder serosurvey participation. Community health workers were consistently named as facilitators of participation. At the structural level, concerns about specimen collection, who was selected for serosurveys, and not receiving test results arose as potential barriers. The most frequently reported facilitator was provision of information about the purpose of the serosurvey (85% of respondents). The most frequently reported barrier was lack of clarity regarding use of their blood specimen (53% of respondents). For specimen collection type, caregivers consistently preferred finger prick blood collection over both venous blood draw and oral swabs. Conclusion Serosurvey participation was deemed acceptable to most study participants. The socio-ecological model revealed barriers and facilitators for participation to guide strategies to improve participation which can be applied to ongoing serosurveys for SARS-CoV-2. Serosurveys should continue to develop engagement plans to provide information about blood collection ahead of the serosurvey and communicate the objectives of such studies through trusted sources such as community health workers and traditional leaders.
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Affiliation(s)
- Andrea C. Carcelen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, Floor 5, Baltimore, MD 21231 USA
| | - Rupali J. Limaye
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, Floor 5, Baltimore, MD 21231 USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Simon Mutembo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, Floor 5, Baltimore, MD 21231 USA
- Government of the Republic of Zambia, Ministry of Health, Lusaka, Zambia
| | | | | | - William J. Moss
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, Floor 5, Baltimore, MD 21231 USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Kyla Hayford
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, Floor 5, Baltimore, MD 21231 USA
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22
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Hast M, Mharakurwa S, Shields TM, Lubinda J, Searle K, Gwanzura L, Munyati S, Moss WJ. Characterizing human movement patterns using GPS data loggers in an area of persistent malaria in Zimbabwe along the Mozambique border. BMC Infect Dis 2022; 22:942. [PMID: 36522643 PMCID: PMC9756631 DOI: 10.1186/s12879-022-07903-4] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Human mobility is a driver for the reemergence or resurgence of malaria and has been identified as a source of cross-border transmission. However, movement patterns are difficult to measure in rural areas where malaria risk is high. In countries with malaria elimination goals, it is essential to determine the role of mobility on malaria transmission to implement appropriate interventions. METHODS A study was conducted in Mutasa District, Zimbabwe, to investigate human movement patterns in an area of persistent transmission along the Mozambique border. Over 1 year, a convenience sample of 20 participants/month was recruited from active malaria surveillance cohorts to carry an IgotU® GT-600 global positioning system (GPS) data logger during all daily activities. Consenting participants were tested for malaria at data logger distribution using rapid antigen diagnostic tests and completed a survey questionnaire. GPS data were analyzed using a trajectory analysis tool, and participant movement patterns were characterized throughout the study area and across the border into Mozambique using movement intensity maps, activity space plots, and statistical analyses. RESULTS From June 2016-May 2017, 184 participants provided movement tracks encompassing > 350,000 data points and nearly 8000 person-days. Malaria prevalence at logger distribution was 3.7%. Participants traveled a median of 2.8 km/day and spent a median of 4.6 h/day away from home. Movement was widespread within and outside the study area, with participants traveling up to 500 km from their homes. Indices of mobility were higher in the dry season than the rainy season (median km traveled/day = 3.5 vs. 2.2, P = 0.03), among male compared to female participants (median km traveled/day = 3.8 vs. 2.0, P = 0.0008), and among adults compared to adolescents (median total km traveled = 104.6 vs. 59.5, P = 0.05). Half of participants traveled outside the study area, and 30% traveled into Mozambique, including 15 who stayed in Mozambique overnight. CONCLUSIONS Study participants in Mutasa District, Zimbabwe, were highly mobile throughout the year. Many participants traveled long distances from home, including overnight trips into Mozambique, with clear implications for malaria control. Interventions targeted at mobile populations and cross-border transmission may be effective in preventing malaria introductions in this region.
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Affiliation(s)
- Marisa Hast
- grid.21107.350000 0001 2171 9311Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Sungano Mharakurwa
- grid.418347.d0000 0004 8265 7435Biomedical Research and Training Institute, Harare, Zimbabwe ,grid.442719.d0000 0000 8930 0245Africa University, Old Mutare, Mutare, Zimbabwe
| | - Timothy M. Shields
- grid.21107.350000 0001 2171 9311Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Jailos Lubinda
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Malaria Atlas Project, Nedlands, WA Australia
| | - Kelly Searle
- grid.17635.360000000419368657School of Public Health, University of Minnesota, Minneapolis, MN USA
| | - Lovemore Gwanzura
- grid.418347.d0000 0004 8265 7435Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Shungu Munyati
- grid.418347.d0000 0004 8265 7435Biomedical Research and Training Institute, Harare, Zimbabwe
| | - William J. Moss
- grid.21107.350000 0001 2171 9311Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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23
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Kostandova N, Loisate S, Winter A, Moss WJ, Giles JR, Metcalf C, Mutembo S, Wesolowski A. Impact of disruptions to routine vaccination programs, quantifying burden of measles, and mapping targeted supplementary immunization activities. Epidemics 2022; 41:100647. [PMID: 36343498 PMCID: PMC9742850 DOI: 10.1016/j.epidem.2022.100647] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 09/27/2022] [Accepted: 10/21/2022] [Indexed: 12/29/2022] Open
Abstract
Measles is a highly transmissible disease that requires high levels of vaccination coverage for control and elimination. Areas that are unable to achieve and maintain high coverage levels are at risk for measles outbreaks resulting in increased morbidity and mortality. Public health emergencies, such as the current COVID-19 pandemic, pose a threat to the functioning of health systems by disrupting immunization services which can derail measles vaccination efforts. Efforts to bridge coverage gaps in immunization include the rapid return to fully functioning services as well as deploying supplementary immunization activities (SIAs), which are additional vaccination campaigns intended to catch-up children who have missed routine services. However, SIAs, which to date tend to be national efforts, can be difficult to mobilize quickly, resource-intensive, and even more challenging to deploy during a public health crisis. By mapping expected burden of measles, more effective SIAs that are setting-specific and resource-efficient can be planned and mobilized. Using a spatial transmission model of measles dynamics, we projected and estimated the expected burden of national and local measles outbreaks in Zambia with the current COVID-19 pandemic as a framework to inform disruptions to routine vaccination. We characterize the impact of disruptions to routine immunization services on measles incidence, map expected case burden, and explore SIA strategies to mitigate measles outbreaks. We find that disruptions lasting six months or longer as well as having low MCV1 coverage prior to disruptions resulted in an observable increase of measles cases across provinces. Targeting provinces at higher risk of measles outbreaks for SIAs is an effective strategy to curb measles virus incidence following disruptions to routine immunization services.
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Affiliation(s)
- Natalya Kostandova
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Stacie Loisate
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy Winter
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | - William J. Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John R. Giles
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - C.J.E. Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA,Princeton School of Public and International Affairs, Princeton University, Princeton, NJ, USA
| | - Simon Mutembo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia
| | - Amy Wesolowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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24
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Ippolito MM, Kabuya JBB, Hauser M, Kamavu LK, Banda PM, Yanek LR, Malik R, Mulenga M, Bailey JA, Chongwe G, Louis TA, Shapiro TA, Moss WJ. Whole Blood Transfusion for Severe Malarial Anemia in a High Plasmodium falciparum Transmission Setting. Clin Infect Dis 2022; 75:1893-1902. [PMID: 35439307 PMCID: PMC10200327 DOI: 10.1093/cid/ciac304] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Severe malaria resulting from Plasmodium falciparum infection is the leading parasitic cause of death in children worldwide, and severe malarial anemia (SMA) is the most common clinical presentation. The evidence in support of current blood transfusion guidelines for patients with SMA is limited. METHODS We conducted a retrospective cohort study of 911 hospitalized children with SMA in a holoendemic region of Zambia to examine the association of whole blood transfusion with in-hospital survival. Data were analyzed in adjusted logistic regression models using multiple imputation for missing data. RESULTS The median age of patients was 24 months (interquartile range, 16-30) and overall case fatality was 16%. Blood transfusion was associated with 35% reduced odds of death in children with SMA (odds ratio, 0.65; 95% confidence interval, .52-.81; P = .0002) corresponding to a number-needed-to-treat (NNT) of 14 patients. Children with SMA complicated by thrombocytopenia were more likely to benefit from transfusion than those without thrombocytopenia (NNT = 5). Longer storage time of whole blood was negatively associated with survival and with the posttransfusion rise in the platelet count but was not associated with the posttransfusion change in hemoglobin concentration. CONCLUSIONS Whole blood given to pediatric patients with SMA was associated with improved survival, mainly among those with thrombocytopenia who received whole blood stored for <4 weeks. These findings point to a potential use for incorporating thrombocytopenia into clinical decision making and management of severe malaria, which can be further assessed in prospective studies, and underline the importance of maintaining reliable blood donation networks in areas of high malaria transmission.
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Affiliation(s)
- Matthew M Ippolito
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- The Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jean-Bertin B Kabuya
- Department of Clinical Sciences, Tropical Diseases Research Centre, Ndola, Zambia
| | - Manuela Hauser
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Children’s Research Center, University Children’s Hospital, Zurich, Switzerland
| | - Luc K Kamavu
- Saint Paul’s General Hospital, Nchelenge, Luapula Province, Zambia
| | | | - Lisa R Yanek
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rubab Malik
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Modest Mulenga
- Directorate of Research and Postgraduate Studies, Lusaka Apex Medical University, Lusaka, Zambia
| | - Jeffrey A Bailey
- Department of Pathology and Laboratory Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Gershom Chongwe
- Department of Clinical Sciences, Tropical Diseases Research Centre, Ndola, Zambia
| | - Thomas A Louis
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Theresa A Shapiro
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- The Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - William J Moss
- The Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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25
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Schaber KL, Kobayashi T, Hast M, Searle KM, Shields TM, Hamapumbu H, Lubinda J, Thuma PE, Lupiya J, Chaponda M, Munyati S, Gwanzura L, Mharakurwa S, Moss WJ, Wesolowski A. What Heterogeneities in Individual-level Mobility Are Lost During Aggregation? Leveraging GPS Logger Data to Understand Fine-scale and Aggregated Patterns of Mobility. Am J Trop Med Hyg 2022; 107:1145-1153. [PMID: 36252797 PMCID: PMC9709031 DOI: 10.4269/ajtmh.22-0202] [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: 03/14/2022] [Accepted: 08/18/2022] [Indexed: 01/25/2023] Open
Abstract
Human movement drives spatial transmission patterns of infectious diseases. Population-level mobility patterns are often quantified using aggregated data sets, such as census migration surveys or mobile phone data. These data are often unable to quantify individual-level travel patterns and lack the information needed to discern how mobility varies by demographic groups. Individual-level datasets can capture additional, more precise, aspects of mobility that may impact disease risk or transmission patterns and determine how mobility differs across cohorts; however, these data are rare, particularly in locations such as sub-Saharan Africa. Using detailed GPS logger data collected from three sites in southern Africa, we explore metrics of mobility such as percent time spent outside home, number of locations visited, distance of locations, and time spent at locations to determine whether they vary by demographic, geographic, or temporal factors. We further create a composite mobility score to identify how well aggregated summary measures would capture the full extent of mobility patterns. Although sites had significant differences in all mobility metrics, no site had the highest mobility for every metric, a distinction that was not captured by the composite mobility score. Further, the effects of sex, age, and season on mobility were all dependent on site. No factor significantly influenced the number of trips to locations, a common way to aggregate datasets. When collecting and analyzing human mobility data, it is difficult to account for all the nuances; however, these analyses can help determine which metrics are most helpful and what underlying differences may be present.
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Affiliation(s)
- Kathryn L. Schaber
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tamaki Kobayashi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Marisa Hast
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kelly M. Searle
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Timothy M. Shields
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Jailos Lubinda
- Telethon Kids Institute, Malaria Atlas Project, Nedlands, Australia
| | - Philip E. Thuma
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - James Lupiya
- The Tropical Diseases Research Centre, Ndola, Zambia
| | - Mike Chaponda
- The Tropical Diseases Research Centre, Ndola, Zambia
| | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Lovemore Gwanzura
- Biomedical Research and Training Institute, Harare, Zimbabwe
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Sungano Mharakurwa
- Biomedical Research and Training Institute, Harare, Zimbabwe
- College of Health, Agriculture and Natural Sciences, Africa University, Mutare, Zimbabwe
| | - William J. Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Amy Wesolowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Wesolowski A, Ippolito MM, Gebhardt ME, Ferriss E, Schue JL, Kobayashi T, Chaponda M, Kabuya JB, Muleba M, Mburu M, Matoba J, Musonda M, Katowa B, Lubinda M, Hamapumbu H, Simubali L, Mudenda T, Shields TM, Hackman A, Shiff C, Coetzee M, Koekemoer LL, Munyati S, Gwanzura L, Mutambu S, Stevenson JC, Thuma PE, Norris DE, Bailey JA, Juliano JJ, Chongwe G, Mulenga M, Simulundu E, Mharakurwa S, Agre P, Moss WJ. Policy Implications of the Southern and Central Africa International Center of Excellence for Malaria Research: Ten Years of Malaria Control Impact Assessments in Hypo-, Meso-, and Holoendemic Transmission Zones in Zambia and Zimbabwe. Am J Trop Med Hyg 2022; 107:68-74. [PMID: 36228913 PMCID: PMC9662215 DOI: 10.4269/ajtmh.21-1288] [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: 12/13/2021] [Accepted: 05/28/2022] [Indexed: 11/07/2022] Open
Abstract
The International Centers of Excellence for Malaria Research (ICEMR) were established by the National Institute of Allergy and Infectious Diseases more than a decade ago to provide multidisciplinary research support to malaria control programs worldwide, operating in endemic areas and contributing technology, expertise, and ultimately policy guidance for malaria control and elimination. The Southern and Central Africa ICEMR has conducted research across three main sites in Zambia and Zimbabwe that differ in ecology, entomology, transmission intensity, and control strategies. Scientific findings led to new policies and action by the national malaria control programs and their partners in the selection of methods, materials, timing, and locations of case management and vector control. Malaria risk maps and predictive models of case detection furnished by the ICEMR informed malaria elimination programming in southern Zambia, and time series analyses of entomological and parasitological data motivated several major changes to indoor residual spray campaigns in northern Zambia. Along the Zimbabwe-Mozambique border, temporal and geospatial data are currently informing investigations into a recent resurgence of malaria. Other ICEMR findings pertaining to parasite and mosquito genetics, human behavior, and clinical epidemiology have similarly yielded immediate and long-term policy implications at each of the sites, often with generalizable conclusions. The ICEMR programs thereby provide rigorous scientific investigations and analyses to national control and elimination programs, without which the impediments to malaria control and their potential solutions would remain understudied.
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Affiliation(s)
- Amy Wesolowski
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Matthew M. Ippolito
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary E. Gebhardt
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ellen Ferriss
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jessica L. Schue
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tamaki Kobayashi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | | | | | | | | | | | | | | | | | - Andre Hackman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Clive Shiff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maureen Coetzee
- Wits Research Institute for Malaria, Faculty of Health Sciences, University of the Witwatersrand and National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Lizette L. Koekemoer
- Wits Research Institute for Malaria, Faculty of Health Sciences, University of the Witwatersrand and National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Lovemore Gwanzura
- Biomedical Research and Training Institute, Harare, Zimbabwe
- University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | | | - Jennifer C. Stevenson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Macha Research Trust, Choma, Zambia
| | - Philip E. Thuma
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Macha Research Trust, Choma, Zambia
| | - Douglas E. Norris
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Jonathan J. Juliano
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Modest Mulenga
- Directorate of Research and Postgraduate Studies, Lusaka Apex Medical University, Lusaka, Zambia
| | | | - Sungano Mharakurwa
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Africa University, Mutare, Zimbabwe
| | - Peter Agre
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - William J. Moss
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Ippolito MM, Gebhardt ME, Ferriss E, Schue JL, Kobayashi T, Chaponda M, Kabuya JB, Muleba M, Mburu M, Matoba J, Musonda M, Katowa B, Lubinda M, Hamapumbu H, Simubali L, Mudenda T, Wesolowski A, Shields TM, Hackman A, Shiff C, Coetzee M, Koekemoer LL, Munyati S, Gwanzura L, Mutambu S, Stevenson JC, Thuma PE, Norris DE, Bailey JA, Juliano JJ, Chongwe G, Mulenga M, Simulundu E, Mharakurwa S, Agre PC, Moss WJ. Scientific Findings of the Southern and Central Africa International Center of Excellence for Malaria Research: Ten Years of Malaria Control Impact Assessments in Hypo-, Meso-, and Holoendemic Transmission Zones in Zambia and Zimbabwe. Am J Trop Med Hyg 2022; 107:55-67. [PMID: 36228903 PMCID: PMC9662223 DOI: 10.4269/ajtmh.21-1287] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 12/13/2021] [Accepted: 04/08/2022] [Indexed: 11/07/2022] Open
Abstract
For a decade, the Southern and Central Africa International Center of Excellence for Malaria Research has operated with local partners across study sites in Zambia and Zimbabwe that range from hypo- to holoendemic and vary ecologically and entomologically. The burden of malaria and the impact of control measures were assessed in longitudinal cohorts, cross-sectional surveys, passive and reactive case detection, and other observational designs that incorporated multidisciplinary scientific approaches: classical epidemiology, geospatial science, serosurveillance, parasite and mosquito genetics, and vector bionomics. Findings to date have helped elaborate the patterns and possible causes of sustained low-to-moderate transmission in southern Zambia and eastern Zimbabwe and recalcitrant high transmission and fatality in northern Zambia. Cryptic and novel mosquito vectors, asymptomatic parasite reservoirs in older children, residual parasitemia and gametocytemia after treatment, indoor residual spraying timed dyssynchronously to vector abundance, and stockouts of essential malaria commodities, all in the context of intractable rural poverty, appear to explain the persistent malaria burden despite current interventions. Ongoing studies of high-resolution transmission chains, parasite population structures, long-term malaria periodicity, and molecular entomology are further helping to lay new avenues for malaria control in southern and central Africa and similar settings.
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Affiliation(s)
- Matthew M. Ippolito
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary E. Gebhardt
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ellen Ferriss
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jessica L. Schue
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tamaki Kobayashi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | | | | | | | | | | | | | | | - Amy Wesolowski
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Andre Hackman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Clive Shiff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maureen Coetzee
- Wits Research Institute for Malaria, Faculty of Health Sciences, University of the Witwatersrand and National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Lizette L. Koekemoer
- Wits Research Institute for Malaria, Faculty of Health Sciences, University of the Witwatersrand and National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Lovemore Gwanzura
- Biomedical Research and Training Institute, Harare, Zimbabwe
- University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | | | - Jennifer C. Stevenson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Macha Research Trust, Choma, Zambia
| | | | - Douglas E. Norris
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Jonathan J. Juliano
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Modest Mulenga
- Directorate of Research and Postgraduate Studies, Lusaka Apex Medical University, Lusaka, Zambia
| | | | - Sungano Mharakurwa
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Africa University, Mutare, Zimbabwe
| | - Peter C. Agre
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - William J. Moss
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Murhekar MV, Gupta N, Hasan AZ, Kumar MS, Kumar VS, Prosperi C, Sapkal GN, Thangaraj JWV, Kaduskar O, Bhatt V, Deshpande GR, Thankappan UP, Bansal AK, Chauhan SL, Grover GS, Jain AK, Kulkarni RN, Sharma SK, Chaaithanya IK, Kharwal S, Mishra SK, Salvi NR, Sharma S, Sarmah NP, Sabarinathan R, Duraiswamy A, Rani DS, Kanagasabai K, Lachyan A, Gawali P, Kapoor M, Shrivastava AK, Chonker SK, Tilekar B, Tandale BV, Ahmad M, Sangal L, Winter A, Mehendale SM, Moss WJ, Hayford K. Evaluating the effect of measles and rubella mass vaccination campaigns on seroprevalence in India: a before-and-after cross-sectional household serosurvey in four districts, 2018-2020. Lancet Glob Health 2022; 10:e1655-e1664. [PMID: 36240831 PMCID: PMC9579355 DOI: 10.1016/s2214-109x(22)00379-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/14/2022] [Accepted: 08/19/2022] [Indexed: 11/07/2022]
Abstract
Background India did phased measles–rubella supplementary immunisation activities (MR-SIAs; ie, mass-immunisation campaigns) targeting children aged 9 months to less than 15 years. We estimated measles–rubella seroprevalence before and after the MR-SIAs to quantify the effect on population immunity and identify remaining immunity gaps. Methods Between March 9, 2018 and March 19, 2020 we did community-based, cross-sectional serosurveys in four districts in India before and after MR-SIAs. 30 villages or wards were selected within each district, and one census enumeration block from each was selected as the survey cluster. Households were enumerated and 13 children in the younger age group (9 months to <5 years) and 13 children in the older ager group (5 to <15 years) were randomly selected by use of computer-generated random numbers. Serum samples were tested for IgG antibodies to measles and rubella viruses by enzyme immunoassay. Findings Specimens were collected from 2570 children before the MR-SIA and from 2619 children afterwards. The weighted MR-SIA coverage ranged from 73·7% to 90·5% in younger children and from 73·6% to 93·6% in older children. Before the MR-SIA, district-level measles seroprevalence was between 80·7% and 88·5% among younger children in all districts, and between 63·4% and 84·5% among older children. After the MR-SIA, measles seroprevalence among younger children increased to more than 90% (range 91·5 to 96·0) in all districts except Kanpur Nagar, in which it remained unchanged 80·4%. Among older children, measles seroprevalence increased to more than 90·0% (range 93·7% to 96·5%) in all districts except Hoshiarpur (88·7%). A significant increase in rubella seroprevalence was observed in all districts in both age groups, with the largest effect in Dibrugarh, where rubella seroprevalence increased from 10·6% to 96·5% among younger children. Interpretation Measles–rubella seroprevalence increased substantially after the MR-SIAs but the serosurvey also identified remaining gaps in population immunity. Funding The Bill & Melinda Gates Foundation and Indian Council of Medical Research.
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Affiliation(s)
- Manoj V Murhekar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India,Correspondence to: Dr Manoj V Murhekar, ICMR-National Institute of Epidemiology, Tamil Nadu Housing Board, Ayapakkam, Ambattur, Chennai 600 070, India
| | - Nivedita Gupta
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Alvira Z Hasan
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - V Saravana Kumar
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - Christine Prosperi
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | | | - Avi Kumar Bansal
- ICMR-National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, India
| | - Sanjay L Chauhan
- ICMR- National Institute for Research in Reproductive and Child Health, Mumbai, India
| | | | | | - Ragini N Kulkarni
- ICMR- National Institute for Research in Reproductive and Child Health, Mumbai, India
| | | | - Itta K Chaaithanya
- ICMR- National Institute for Research in Reproductive and Child Health, Mumbai, India,Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - Sanchit Kharwal
- Department of Health Research, Model Rural Health Research Unit-Hoshiarpur, Punjab, India
| | - Sunil K Mishra
- Department of Health Research, Model Rural Health Research Unit-Hoshiarpur, Punjab, India
| | - Neha R Salvi
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - Sandeep Sharma
- ICMR-National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, India
| | - Nilanju P Sarmah
- Department of Health Research, Model Rural Health Research Unit-Chabua, Assam, India
| | - R Sabarinathan
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - Augustine Duraiswamy
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - D Sudha Rani
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - K Kanagasabai
- Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India
| | - Abhishek Lachyan
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - Poonam Gawali
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | - Mitali Kapoor
- Department of Health Research, Model Rural Health Research Unit-Dahanu, Maharashtra, India
| | | | - Saurabh Kumar Chonker
- ICMR-National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, India
| | | | | | | | - Lucky Sangal
- WHO, Southeast Asia Region Office, New Delhi, India
| | - Amy Winter
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Epidemiology and Statistics, University of Georgia, Athens, GA, USA
| | | | - William J Moss
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kyla Hayford
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Morales JA, Hamahuwa M, Moyo N, Mutanga JN, Schue JL, Maunga S, Thuma PE, Moss WJ, Sutcliffe CG. Factors associated with antiretroviral therapy use among pregnant women in rural and urban settings in Southern Province, Zambia: 2016-2019. Trop Med Int Health 2022; 27:902-912. [PMID: 36127148 PMCID: PMC10375440 DOI: 10.1111/tmi.13816] [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] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To assess antiretroviral therapy (ART) coverage among pregnant women living with HIV and compare the characteristics of women who received and did not receive ART during pregnancy in Zambia. METHODS A cross-sectional study was conducted at urban and rural health facilities in Southern Province, Zambia, from 2016 to 2019. Pregnant women living with HIV delivering at study sites were enrolled and administered a questionnaire, and the results of infant diagnostic testing for HIV at birth was documented. RESULTS About 1184 mother/infant pairs were enrolled. ART coverage was 93.7%. Most women who did not receive ART during pregnancy reported HIV diagnosis at delivery (18.0%) or during pregnancy (57.7%). The primary reported reason for not receiving ART was not wanting to take the drugs. Women who did not receive ART during pregnancy were significantly younger, less likely to have disclosed their HIV-infection status to others, and less likely to have received antenatal care than women who received ART. ART use correlated with higher levels of education in urban but not rural sites. Overall, 1.0% of infants were infected with HIV at birth, including 0.8% of infants born to women who received ART and 4.1% of infants born to women who did not. CONCLUSIONS Most women received ART according to guidelines, resulting in low perinatal transmission rates of HIV to infants. Efforts to increase ART coverage and prevent vertical transmission should focus on identifying incident HIV infections during pregnancy and strengthening counselling for newly diagnosed pregnant women.
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Affiliation(s)
- Juliet A Morales
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | | | - Jane N Mutanga
- Department of Paediatrics and Child Health, Livingstone Central Hospital, Livingstone, Zambia
| | - Jessica L Schue
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | - Philip E Thuma
- Macha Research Trust, Zambia.,Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - William J Moss
- Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Moss WJ. The Seeds of Ignorance - Consequences of a Booming Betel-Nut Economy. N Engl J Med 2022; 387:1059-1061. [PMID: 36121043 DOI: 10.1056/nejmp2203571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- William J Moss
- From the Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, Commonwealth Healthcare Corporation, Garapan, Saipan
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Duncan SG, Fernandez-Criado RM, Narayanan A, Mary P. C, Moss WJ. Characterization of Otolaryngology Referrals among Pacific Islanders in the Commonwealth of the Northern Mariana Islands. Hawaii J Health Soc Welf 2022; 81:253-258. [PMID: 36118152 PMCID: PMC9460761] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The burden of otolaryngology disease in Pacific Islander populations is relatively uncharacterized. A single-institution retrospective review was undertaken at the Commonwealth Healthcare Corporation in Saipan, the only hospital in the Commonwealth of the Northern Mariana Islands. Demographic, diagnostic, and treatment data were compiled from the clinical charts of all patients seen by an otolaryngologist between January 2015 and April 2020. For all Pacific Islanders in the sample (N=674), the average age was 40.2 (SD 22.4) years and ages ranged from 10 months to 89 years. Patients were 50.7% male and 49.3% female. The most common diagnoses affected the ear (40.8%), followed by the oral cavity/pharynx (23.2%), and nose (14.0%). Middle ear disease comprised 41.7% of reported ear disorders; the most common problem was otitis media (19.4%, n=68) followed by tympanic membrane perforation (14.0%, n=49). Head and neck cancers comprised 8.6% of all diagnoses. Most (77.8%) malignant neoplasms were oral cavity carcinomas. The average age at diagnosis for oral cancer was 46.6 years with a 1.8:1 male-to-female predominance. Patients with cancer of the oral cavity (n=56) chewed betel nut at higher rates (94.6%) compared with other adults in the sample (P<.001). Adult patients reported alcohol use, smoking, and chewing betel quid at rates of 26.5%, 39.9%, and 52.2% respectively. Otolaryngology referrals among Pacific Islanders in this sample were dominated by ear disease and included betel nut-related oral cavity disease.
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Affiliation(s)
- Steven G. Duncan
- University of Texas Southwestern Medical School, Dallas, TX (SGD, RMF, AN, MPC)
| | | | - Ajay Narayanan
- University of Texas Southwestern Medical School, Dallas, TX (SGD, RMF, AN, MPC)
| | - Chang Mary P.
- University of Texas Southwestern Medical School, Dallas, TX (SGD, RMF, AN, MPC)
| | - William J. Moss
- Commonwealth Health Center, Saipan, Northern Mariana Islands (WJM)
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Gebhardt ME, Krizek RS, Coetzee M, Koekemoer LL, Dahan-Moss Y, Mbewe D, Lupiya JS, Muleba M, Stevenson JC, Moss WJ, Norris DE. Expanded geographic distribution and host preference of Anopheles gibbinsi (Anopheles species 6) in northern Zambia. Malar J 2022; 21:211. [PMID: 35780113 PMCID: PMC9250713 DOI: 10.1186/s12936-022-04231-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Nchelenge District in northern Zambia suffers from holoendemic malaria transmission despite a decade of yearly indoor residual spraying (IRS) and insecticide-treated net (ITN) distributions. One hypothesis for this lack of impact is that some vectors in the area may forage in the early evening or outdoors. Anopheles gibbinsi specimens were identified in early evening mosquito collections performed in this study area, and further insight was gleaned into this taxon, including characterizing its genetic identity, feeding preferences, and potential role as a malaria vector. Methods Mosquitoes were collected in July and August 2019 by CDC light traps in Nchelenge District in indoor sitting rooms, outdoor gathering spaces, and animal pens from 16:00–22:00. Host detection by PCR, COI and ITS2 PCR, and circumsporozoite (CSP) ELISA were performed on all samples morphologically identified as An. gibbinsi, and a subset of specimens were selected for COI and ITS2 sequencing. To determine risk factors for increased abundance of An. gibbinsi, a negative binomial generalized linear mixed-effects model was performed with household-level variables of interest. Results Comparison of COI and ITS2 An. gibbinsi reference sequences to the NCBI database revealed > 99% identity to “Anopheles sp. 6” from Kenya. More than 97% of specimens were morphologically and molecularly consistent with An. gibbinsi. Specimens were primarily collected in animal pen traps (59.2%), followed by traps outdoors near where humans gather (24.3%), and traps set indoors (16.5%). Host DNA detection revealed a high propensity for goats, but 5% of specimens with detected host DNA had fed on humans. No specimens were positive for Plasmodium falciparum sporozoites. Animal pens and inland households > 3 km from Lake Mweru were both associated with increased An. gibbinsi abundance. Conclusions This is the first report of An. gibbinsi in Nchelenge District, Zambia. This study provided a species identity for unknown “An. sp. 6” in the NCBI database, which has been implicated in malaria transmission in Kenya. Composite data suggest that this species is largely zoophilic and exophilic, but comes into contact with humans and the malaria parasites they carry. This species should continue to be monitored in Zambia and neighbouring countries as a potential malaria vector. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04231-5.
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Affiliation(s)
- Mary E Gebhardt
- The W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Rachel S Krizek
- The W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maureen Coetzee
- Wits Research Institute for Malaria, Faculty of Health Sciences, University of the Witwatersrand, and the Centre for Emerging Zoonotic & Parasitic Diseases, Vector Control Reference Laboratory, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Lizette L Koekemoer
- Wits Research Institute for Malaria, Faculty of Health Sciences, University of the Witwatersrand, and the Centre for Emerging Zoonotic & Parasitic Diseases, Vector Control Reference Laboratory, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - Yael Dahan-Moss
- Wits Research Institute for Malaria, Faculty of Health Sciences, University of the Witwatersrand, and the Centre for Emerging Zoonotic & Parasitic Diseases, Vector Control Reference Laboratory, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
| | - David Mbewe
- Tropical Diseases Research Centre, Ndola, Zambia
| | | | | | - Jennifer C Stevenson
- The W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Macha Research Trust, Choma, Zambia
| | - William J Moss
- The W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Douglas E Norris
- The W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Mueller AK, Matoba J, Schue JL, Hamapumbu H, Kobayashi T, Stevenson JC, Thuma PE, Wesolowski A, Moss WJ, _ _. The Unmeasured Burden of Febrile, Respiratory, and Diarrheal Illnesses Identified Through Active Household Surveillance in a Low Malaria Transmission Setting in Southern Zambia. Am J Trop Med Hyg 2022; 106:1791-1799. [PMID: 35895429 PMCID: PMC9209922 DOI: 10.4269/ajtmh.21-1253] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/07/2022] [Indexed: 01/25/2023] Open
Abstract
Malaria incidence has declined in southern Zambia over recent decades, leading to efforts to achieve and sustain malaria elimination. Understanding the remaining disease burden is key to providing optimal health care. A longitudinal study conducted in a rural area of Choma District, Southern Province, Zambia, assessed the prevalence of and factors associated with symptoms of non-malarial illnesses and treatment-seeking behavior. We analyzed data collected monthly between October 2018 through September 2020 from 1,174 individuals from 189 households. No incident malaria cases were detected by rapid diagnostic tests among febrile participants. Mixed-effects logistic regression identified factors associated with cough, fever, diarrhea, and treatment-seeking. Incidence rates of cough (192 of 1,000 person-months), fever (87 of 1,000 person-months), and fever with cough (37 of 1,000 person-months) were highest among adults older than 65 years. Diarrhea incidence (37 of 1,000 person-months) was highest among children younger than 5 years. For every additional symptomatic household member, one's odds of experiencing symptoms increased: cough by 47% (95% CI, 40-55), fever by 31% (95% CI, 23-40), diarrhea by 31% (95% CI, 17-46), and fever with cough by 112% (95% CI, 90-137), consistent with household clustering of illnesses. However, between 35% and 75% of participants did not seek treatment for their symptoms. Treatment-seeking was most common for children 5 to 9 years old experiencing diarrhea (adjusted odds ratio, 3.61; 95% CI, 1.42-9.18). As malaria prevalence reduces, respiratory and diarrheal infections persist, particularly among young children but, notably, also among adults older than 65 years. Increasing awareness of the disease burden and treatment-seeking behavior are important for guiding resource re-allocation as malaria prevalence declines in this region.
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Affiliation(s)
- Alexandra K. Mueller
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland;,Address correspondence to Alexandra K. Mueller, Johns Hopkins School of Medicine, 5200 Eastern Ave., Baltimore, MD 21224. E-mail:
| | | | - Jessica L. Schue
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Tamaki Kobayashi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Amy Wesolowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - William J. Moss
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;,W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Abstract
Rubella is an acute illness caused by rubella virus and characterised by fever and rash. Although rubella is a clinically mild illness, primary rubella virus infection in early pregnancy can result in congenital rubella syndrome, which has serious medical and public health consequences. WHO estimates that approximately 100 000 congenital rubella syndrome cases occur per year. Rubella virus is transmitted through respiratory droplets and direct contact. 25-50% of people infected with rubella virus are asymptomatic. Clinical disease often results in mild, self-limited illness characterised by fever, a generalised erythematous maculopapular rash, and lymphadenopathy. Complications include arthralgia, arthritis, thrombocytopenic purpura, and encephalitis. Common presenting signs and symptoms of congenital rubella syndrome include cataracts, sensorineural hearing impairment, congenital heart disease, jaundice, purpura, hepatosplenomegaly, and microcephaly. Rubella and congenital rubella syndrome can be prevented by rubella-containing vaccines, which are commonly administered in combination with measles vaccine. Although global rubella vaccine coverage reached only 70% in 2020 global rubella eradiation remains an ambitious but achievable goal.
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Affiliation(s)
- Amy K Winter
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens GA, USA
| | - William J Moss
- International Vaccine Access Center, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
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Gebhardt ME, Searle KM, Kobayashi T, Shields TM, Hamapumbu H, Simubali L, Mudenda T, Thuma PE, Stevenson JC, Moss WJ, Norris DE. Understudied Anophelines Contribute to Malaria Transmission in a Low-Transmission Setting in the Choma District, Southern Province, Zambia. Am J Trop Med Hyg 2022; 106:tpmd210989. [PMID: 35344932 PMCID: PMC9128685 DOI: 10.4269/ajtmh.21-0989] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 09/14/2021] [Accepted: 10/29/2021] [Indexed: 11/11/2022] Open
Abstract
Malaria transmission has declined substantially in Southern Province, Zambia, which is considered a low-transmission setting. The Zambian government introduced a reactive test-and-treat strategy to identify active zones of transmission and treat parasitemic residents. This study was conducted in the Choma District, Southern Province, Zambia, concurrently with an evaluation of this strategy to identify vectors responsible for sustaining transmission, and to identify entomological, spatial, and ecological risk factors associated with increased densities of mosquitoes. Anophelines were collected with CDC light traps indoors and near animal pens in index cases and neighboring households. Outdoor collections captured significantly more anophelines than indoor traps, and 10 different anopheline species were identified. Four species (Anopheles arabiensis, An. rufipes, An. squamosus, and An. coustani) were positive for Plasmodium falciparum circumsporozoite protein by ELISA, and 61% of these 26 anophelines were captured outdoors. Bloodmeal assays confirm plasticity in An. arabiensis foraging, feeding both on humans and animals, whereas An. rufipes, An. squamosus, and An. coustani were largely zoophilic and exophilic. Linear regression of count data for indoor traps revealed that households with at least one parasitemic resident by polymerase chain reaction testing was associated with higher female anopheline counts. This suggests that targeting households with parasitemic individuals for vector interventions may reduce indoor anopheline populations. However, many vectors species responsible for transmission may not be affected by indoor interventions because they are primarily exophilic and forage opportunistically. These data underscore the necessity for further evaluation of vector surveillance and control tools that are effective outdoors, in conjunction with current indoor-based interventions.
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Affiliation(s)
- Mary E. Gebhardt
- Johns Hopkins Malaria Research Institute, The W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kelly M. Searle
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Tamaki Kobayashi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Timothy M. Shields
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | - Jennifer C. Stevenson
- Johns Hopkins Malaria Research Institute, The W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Macha Research Trust, Choma, Zambia
| | - William J. Moss
- Johns Hopkins Malaria Research Institute, The W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Douglas E. Norris
- Johns Hopkins Malaria Research Institute, The W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Affiliation(s)
- William J Moss
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC
| | - Jennifer B Nuzzo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Yang Y, Mutembo S, Carcelen A, Hayford K, Mwansa F, Moss WJ. 1171. Measles and Rubella Seroprevalence among HIV-infected and uninfected Children and Adults in Zambia. Open Forum Infect Dis 2021. [PMCID: PMC8643959 DOI: 10.1093/ofid/ofab466.1364] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Despite the availability of safe and effective vaccines, measles and congenital rubella syndrome remain important causes of morbidity and mortality. HIV-infected individuals may be more vulnerable to measles because of poor immune responses to vaccination. Population-level estimates and comparisons of measles and rubella seroprevalence between HIV-infected and uninfected children and adults in sub-Saharan Africa are needed to guide vaccination policy and control strategies. Methods This cross-sectional study was performed by analysing a selected and weighted subsample from the Zambia Population HIV Impact Assessment survey (ZAMPHIA). ZAMPHIA was conducted in 2016 to estimate national HIV incidence and prevalence in Zambia. Dried blood spots and plasma samples were tested for IgG antibodies to measles and rubella viruses using a commercial enzyme immunoassay. We estimated national age-specific measles and rubella seroprevalence by HIV infection status using hierarchical generalized additive models. Results Specimens from 9521 HIV-uninfected (3840 children age under 10 years, 3981 youth age 10-19 years, and 1700 adults age 20-49 years) and 331 HIV-infected (53, 107, and 171 respectively) individuals were included in the study. Measles seroprevalence was lower among HIV-infected children (46.4%) compared to HIV-uninfected children (76.4%, p < 0.001). In both HIV-uninfected and HIV-infected individuals, measles seroprevalence increased steadily with age but more rapidly in the HIV-infected until about the age of 20 years when the seroprevalence was similar between the two groups. Above 20 years, measles seroprevalence was similar between HIV-infected and uninfected adults. There was no significant difference in rubella seroprevalence between HIV-infected and HIV-uninfected individuals. Figure 1. Measles and Rubella Age-specific Seroprevalence ![]()
The lines represent generalized additive model fits for the mean (solid) and 95% confidence intervals (dashed). Data are grouped by age in years and year 0 includes only specimens from children 9-11 months. Rubella-containing vaccine was not available in the public sector prior to the serosurvey. Conclusion Measles seroprevalence was lower among HIV-infected than uninfected children and youth. HIV-infected children would likely benefit from revaccination. Many children were susceptible to rubella before the introduction of the combined measles and rubella vaccine in Zambia. Disclosures Kyla Hayford, PhD, MA, Pfizer, Inc. (Other Financial or Material Support, KH conducted the study and analyses while working at the Johns Hopkins School of Public Health but is an employee at Pfizer, Inc. as of 26 October 2020.)
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Affiliation(s)
- Yangyupei Yang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Simon Mutembo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrea Carcelen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kyla Hayford
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - William J Moss
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Holroyd TA, Schiaffino F, Chang RH, Wanyiri JW, Saldanha IJ, Gross M, Moss WJ, Hayford K. Diagnostic accuracy of dried blood spots for serology of vaccine-preventable diseases: a systematic review. Expert Rev Vaccines 2021; 21:185-200. [PMID: 34852211 DOI: 10.1080/14760584.2022.2013821] [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: 01/27/2023]
Abstract
INTRODUCTION Venous serum and plasma are optimal specimens for serological testing but may be logistically infeasible. Dried blood spots (DBS) are a feasible alternative, provided results are adequately sensitive and specific. We aimed to assess the diagnostic accuracy of DBS to measure IgG and IgM antibodies for vaccine-preventable diseases and compare test validity of DBS with venous blood. AREAS COVERED In October 2020, we searched seven databases for peer-reviewed studies assessing the diagnostic accuracy of DBS specimens compared with serum in detecting antibodies to VPDs in humans. We extracted data and assessed risk of bias in all included studies. We calculated sensitivity and specificity with 95% confidence intervals for each index-reference test comparison. We narratively synthesized the identified evidence on diagnostic accuracy and blood collection and processing methods for DBS. Studies on measles and rubella IgG and IgM were the most frequently identified and reported generally high sensitivity and specificity. EXPERT OPINION Lack of standardization in collection, storage, and testing methods limited systematic comparison across studies. Our findings indicate a need for additional validation studies on the diagnostic accuracy of DBS to expand their use in serological surveillance. We recommend practical considerations to improve standardized reporting for DBS validation studies.
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Affiliation(s)
- Taylor A Holroyd
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Francesca Schiaffino
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rachel H Chang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jane W Wanyiri
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ian J Saldanha
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Margaret Gross
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - William J Moss
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kyla Hayford
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Bérubé S, Kobayashi T, Wesolowski A, Norris DE, Ruczinski I, Moss WJ, Louis TA. A pre-processing pipeline to quantify, visualize, and reduce technical variation in protein microarray studies. Proteomics 2021; 22:e2100033. [PMID: 34668656 DOI: 10.1002/pmic.202100033] [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: 02/05/2021] [Revised: 07/13/2021] [Accepted: 10/07/2021] [Indexed: 11/07/2022]
Abstract
Technical variation, or variation from non-biological sources, is present in most laboratory assays. Correcting for this variation enables analysts to extract a biological signal that informs questions of interest. However, each assay has different sources and levels of technical variation, and the choice of correction methods can impact downstream analyses. Compared to similar assays such as DNA microarrays, relatively few methods have been developed and evaluated for protein microarrays, a versatile tool for measuring levels of various proteins in serum samples. Here, we propose a pre-processing pipeline to correct for some common sources of technical variation in protein microarrays. The pipeline builds upon an existing normalization method by using controls to reduce technical variation. We evaluate our method using data from two protein microarray studies and by simulation. We demonstrate that pre-processing choices impact the fluorescent-intensity based ranks of proteins, which in turn, impact downstream analysis.
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Affiliation(s)
- Sophie Bérubé
- Department of Biostatistics, Johns Hopkins University Bloomberg, School of Public Health, Baltimore, MD, USA
| | - Tamaki Kobayashi
- Department of Epidemiology, Johns Hopkins University Bloomberg, School of Public Health, Baltimore, MD, USA
| | - Amy Wesolowski
- Department of Epidemiology, Johns Hopkins University Bloomberg, School of Public Health, Baltimore, MD, USA
| | - Douglas E Norris
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg, School of Public Health, Baltimore, MD, USA
| | - Ingo Ruczinski
- Department of Biostatistics, Johns Hopkins University Bloomberg, School of Public Health, Baltimore, MD, USA
| | - William J Moss
- Department of Epidemiology, Johns Hopkins University Bloomberg, School of Public Health, Baltimore, MD, USA.,W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg, School of Public Health, Baltimore, MD, USA
| | - Thomas A Louis
- Department of Biostatistics, Johns Hopkins University Bloomberg, School of Public Health, Baltimore, MD, USA
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Hasan AZ, Kumar MS, Prosperi C, Thangaraj JWV, Sabarinathan R, Saravanakumar V, Duraiswamy A, Kaduskar O, Bhatt V, Deshpande GR, Ullas PT, Sapkal GN, Sangal L, Mehendale SM, Gupta N, Moss WJ, Hayford K, Murhekar MV. Implementing Serosurveys in India: Experiences, Lessons Learned, and Recommendations. Am J Trop Med Hyg 2021; 105:1608-1617. [PMID: 34607310 PMCID: PMC8641364 DOI: 10.4269/ajtmh.21-0401] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/27/2021] [Indexed: 11/07/2022] Open
Abstract
Serological surveillance for vaccine-preventable diseases, such as measles and rubella, can provide direct measures of population immunity across age groups, identify gaps in immunity, and document changes in immunity over time. Rigorously conducted, representative household serosurveys provide high-quality estimates with minimal bias. However, they can be logistically challenging, expensive, and have higher refusal rates than vaccine coverage surveys. This article shares lessons learned through implementing nine measles and rubella household serosurveys in five districts in India—the challenges faced, the potential impact on results, and recommendations to facilitate the conduct of serosurveys. Specific lessons learned arose from challenges related to community mobilization owing to lack of cooperation in certain settings and populations, limitations of outdated census information, nonresponse due to refusal or unavailability during survey enumeration and enrollment, data collection issues, and specimen collection and handling issues. Although some experiences are specific to serosurveys in India, these lessons are generalizable to other household surveys, particularly vaccination coverage and serosurveys conducted in low- and middle-income settings.
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Affiliation(s)
- Alvira Z. Hasan
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Christine Prosperi
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | - Ojas Kaduskar
- Diagnostic Virology Group, Indian Council of Medical Research (ICMR)–National Institute of Virology, Pune, Maharashtra, India
| | - Vaishali Bhatt
- Diagnostic Virology Group, Indian Council of Medical Research (ICMR)–National Institute of Virology, Pune, Maharashtra, India
| | - Gururaj Rao Deshpande
- Diagnostic Virology Group, Indian Council of Medical Research (ICMR)–National Institute of Virology, Pune, Maharashtra, India
| | | | - Gajanan N. Sapkal
- Diagnostic Virology Group, Indian Council of Medical Research (ICMR)–National Institute of Virology, Pune, Maharashtra, India
| | - Lucky Sangal
- World Health Organization, Southeast Asia Region Office, New Delhi, India
| | - Sanjay M. Mehendale
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Nivedita Gupta
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - William J. Moss
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Kyla Hayford
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Manoj V. Murhekar
- ICMR-National Institute of Epidemiology, Chennai, India
- Address correspondence to Manoj V. Murhekar, National Institute of Epidemiology, Indian Council of Medical Research, R-127, Tamil Nadu Housing Board, Ayapakkam, Ambattur, Chennai 600 070, India. E-mail: † Cosenior authors. The order was mutually agreed on accounting for equal roles in multiple manuscripts and final editorial responsibilities. ‡ These authors contributed equally to this work. The order was mutually agreed on accounting for equal roles in multiple manuscripts and final editorial responsibilities
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Mharakurwa S, Matsena-Zingoni Z, Mudare N, Matimba C, Gara TX, Makuwaza A, Maponga G, Munyati S, Gwanzura L, Mutambu SL, Mason P, Kobayashi T, Midzi N, Moss WJ, Ippolito MM. Steep Rebound of Chloroquine-Sensitive Plasmodium falciparum in Zimbabwe. J Infect Dis 2021; 223:306-309. [PMID: 32594154 DOI: 10.1093/infdis/jiaa368] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/12/2020] [Accepted: 06/19/2020] [Indexed: 11/13/2022] Open
Abstract
Removal of chloroquine from national malaria formularies can lead to the reversion of resistant Plasmodium falciparum to wild-type. We report a steep decline in chloroquine-resistant P falciparum within 10 years of national discontinuation of chloroquine monotherapy in Zimbabwe. Drug resistance surveillance is a vital component of malaria control programs, and the experience with chloroquine in Zimbabwe and elsewhere in sub-Saharan Africa is illustrative of the potentially rapid and dramatic impact of drug policy on antimalarial resistance.
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Affiliation(s)
| | | | - Nobert Mudare
- Department of Health Sciences, Africa University, Mutare, Zimbabwe
| | | | | | - Aramu Makuwaza
- National Institute of Health Research Malaria Section, Harare, Zimbabwe
| | - Gladys Maponga
- National Institute of Health Research Malaria Section, Harare, Zimbabwe
| | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Lovemore Gwanzura
- Biomedical Research and Training Institute, Harare, Zimbabwe.,College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Susan L Mutambu
- Department of Health Sciences, Africa University, Mutare, Zimbabwe
| | - Peter Mason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tamaki Kobayashi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nicholas Midzi
- National Institute of Health Research Malaria Section, Harare, Zimbabwe
| | - William J Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Matthew M Ippolito
- Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Division of Clinical Pharmacology and Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Schue JL, van Dijk JH, Hamangaba F, Hamahuwa M, Moyo N, Thuma PE, Moss WJ, Sutcliffe CG. Treatment outcomes among children younger than five years living with HIV in rural Zambia, 2008-2018: a cohort study. BMC Pediatr 2021; 21:315. [PMID: 34261465 PMCID: PMC8278691 DOI: 10.1186/s12887-021-02793-y] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/30/2021] [Indexed: 12/01/2022] Open
Abstract
Background HIV testing and treatment guidelines for children in sub-Saharan Africa have evolved over time, such that children are now treated at younger ages. The objective of this study was to describe the treatment experience for immunologic, virologic, and growth outcomes among HIV-infected Zambian children younger than 5 years of age from 2008 to 2018. Methods Participants enrolled in a clinical cohort study in Macha, Zambia and initiating antiretroviral treatment before 5 years of age between 2008 and 2015 were included in the analysis and followed up to the end of 2018. Outcomes, including growth, CD4+ T-cell percentage, viral suppression, and mortality, were evaluated among all children using longitudinal and survival analyses. Comparisons by age at treatment initiation (< 1, 1 to < 2, and 2 to < 5 years) were also evaluated. Results Three hundred eighty-one children initiating treatment before 5 years of age between 2008 and 2015 were included in the analysis. Growth metrics and CD4+ T-cell percentage improved over time after treatment initiation. However, 20% of children remained underweight and 40% of children remained stunted after the first 36 months of treatment. 85% of children had a viral load < 400 copies/mL after 12 months of treatment. However, children < 1 year at treatment initiation were more likely to have a detectable viral load in the first 12 months of treatment and less likely to achieve viral suppression compared to older children. Mortality was highest in the first 12 months of treatment, among underweight children, and among children initiating treatment in 2008–2010 compared to 2011–2015. Conclusions Most children initiating antiretroviral treatment from 2008 to 2015 in rural Zambia responded well to treatment. However, many children remained underweight and stunted, and experienced high mortality rates during the first few months of treatment. This supports continued efforts to improve early infant diagnosis, nutritional support, and pediatric drug formulations. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02793-y.
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Affiliation(s)
- Jessica L Schue
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, USA
| | - Janneke H van Dijk
- Erasmus University, Burgemeester Oudlaan 50, 3062, PA, Rotterdam, Netherlands
| | | | | | | | - Philip E Thuma
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, USA.,Macha Research Trust, Choma, Zambia
| | - William J Moss
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, USA
| | - Catherine G Sutcliffe
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, USA.
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Carcelen AC, Prosperi C, Mutembo S, Chongwe G, Mwansa FD, Ndubani P, Simulundu E, Chilumba I, Musukwa G, Thuma P, Kapungu K, Hamahuwa M, Mutale I, Winter A, Moss WJ, Truelove SA. COVID-19 vaccine hesitancy in Zambia: a glimpse at the possible challenges ahead for COVID-19 vaccination rollout in sub-Saharan Africa. Hum Vaccin Immunother 2021; 18:1-6. [PMID: 34227914 PMCID: PMC8920139 DOI: 10.1080/21645515.2021.1948784] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [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: 12/17/2022] Open
Abstract
With unprecedented speed, multiple vaccines against SARS-CoV-2 are available 1 year after the COVID-19 pandemic was first identified. As we push to achieve global control through these new vaccines, old challenges present themselves, including cold-chain storage, the logistics of mass vaccination, and vaccine hesitancy. Understanding how much hesitancy toward COVID-19 vaccines might occur and what factors may be driving these concerns can improve the ability of public health workers and communicators to maximize vaccine uptake. We nested a survey within a measles-rubella mass vaccination campaign in Zambia in November 2020 and asked about sentiments and beliefs toward COVID-19 and COVID-19 vaccines. Among parents bringing their children to receive a measles-rubella vaccine, we found high acceptability of COVID-19 vaccination of their children, but substantial uncertainty and hesitancy about receiving the vaccine themselves. COVID-19 vaccination hesitancy was correlated with beliefs around COVID-19 severity and risk, as well as vaccine safety and effectiveness.
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Affiliation(s)
- Andrea C Carcelen
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Simon Mutembo
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Laboratory Science, Macha Research Trust, Choma, Zambia
| | - Gershom Chongwe
- Department of Immunology, Tropical Diseases Research Center, Ndola, Zambia
| | - Francis D Mwansa
- Ministry of the Health, Government of the Republic of Zambia, Lusaka, Zambia
| | | | | | - Innocent Chilumba
- Department of Immunology, Tropical Diseases Research Center, Ndola, Zambia
| | | | - Phil Thuma
- Laboratory Science, Macha Research Trust, Choma, Zambia
| | - Kelvin Kapungu
- Department of Immunology, Tropical Diseases Research Center, Ndola, Zambia
| | | | - Irene Mutale
- Department of Immunology, Tropical Diseases Research Center, Ndola, Zambia
| | - Amy Winter
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - William J Moss
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,W Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shaun A Truelove
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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44
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Sutcliffe CG, Moyo N, Schue JL, Mutanga JN, Hamahuwa M, Munachoonga P, Maunga S, Thuma PE, Moss WJ. The NSEBA Demonstration Project: implementation of a point-of-care platform for early infant diagnosis of HIV in rural Zambia. Trop Med Int Health 2021; 26:1036-1046. [PMID: 33999480 PMCID: PMC8416694 DOI: 10.1111/tmi.13627] [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: 11/29/2022]
Abstract
OBJECTIVES To describe the experience and resource requirements of implementing point-of-care testing for early infant diagnosis of HIV in rural Zambia. METHODS A demonstration project was conducted using a hub-and-spoke model in 2018-2019 at five clinics in rural Zambia. Two testing hubs were established, and all HIV-exposed infants were tested with the GeneXpert system. Data on costs, turnaround times and test results were collected. RESULTS Seven hundred and eighty six tests were conducted. At the hubs, results were available a median of 2.4 (IQR: 2.1, 2.8) hours after sample collection and most mothers (84%) received same-day results. At the spoke facilities, results were available a median of 9 days (IQR: 7, 12) after sample collection and provided to the mother a median of 16 days (IQR: 10, 28) after sample collection. Eleven children tested positive, and 9 (82%) started treatment a median of 13 days (IQR: 7, 21) after sample collection and on the day mothers received results. In contrast, results from matching samples sent for routine testing were available a median of 38 days (IQR: 27, 61) after sample collection and provided to the mother a median of 91 days (IQR: 47, 135) after sample collection. CONCLUSIONS Implementing point-of-care testing in a network of rural health centres in Zambia required significant initial and ongoing investment in infrastructure, training and supervision. However, point-of-care testing can rapidly diagnose HIV-infected infants, so they can benefit from early treatment.
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Affiliation(s)
| | | | - Jessica L Schue
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | - Philip E Thuma
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Macha Research Trust, Choma, Zambia
| | - William J Moss
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Moss WJ, Shendale S, Lindstrand A, O'Brien KL, Turner N, Goodman T, Kretsinger K. Feasibility assessment of measles and rubella eradication. Vaccine 2021; 39:3544-3559. [PMID: 34045102 DOI: 10.1016/j.vaccine.2021.04.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 04/05/2021] [Accepted: 04/14/2021] [Indexed: 12/28/2022]
Abstract
This report addresses the epidemiological aspects and feasibility of measles and rubella eradication and the potential resource requirements in response to the request of the Director-General at the Seventieth World Health Assembly held on May 31, 2017. A guiding principle is that the path toward measles and rubella eradication should serve to strengthen primary health care, promote universal health coverage, and be a pathfinder for new vision and strategy for immunization over the next decade as laid out in the Immunization Agenda 2030. Specifically, this report: 1) highlights the importance of measles and rubella as global health priorities; 2) reviews the current global measles and rubella situation; 3) summarizes prior assessments of the feasibility of measles and rubella eradication; 4) assesses the progress and challenges in achieving regional measles and rubella elimination; 5) assesses additional considerations for measles and rubella eradication, including the results of modelling and economic analyses; 6) assesses the implications of establishing a measles and rubella eradication goal and the process for setting an eradication target date; 7) proposes a framework for determining preconditions for setting a target date for measles and rubella eradication and how these preconditions should be understood and used; and 8) concludes with recommendations endorsed by SAGE.
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Affiliation(s)
- William J Moss
- International Vaccine Access Center, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Stephanie Shendale
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Ann Lindstrand
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Katherine L O'Brien
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Nikki Turner
- Division of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Tracey Goodman
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Katrina Kretsinger
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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46
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Carcelen AC, Mutembo S, Matakala KH, Chilumba I, Mulundu G, Monze M, Mwansa FD, Moss WJ, Hayford K. Impact of a Measles and Rubella Vaccination Campaign on Seroprevalence in Southern Province, Zambia. Am J Trop Med Hyg 2021; 104:2229-2232. [PMID: 33939639 PMCID: PMC8176503 DOI: 10.4269/ajtmh.20-1669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/05/2021] [Indexed: 11/07/2022] Open
Abstract
Zambia conducted a measles and rubella (MR) vaccination campaign targeting children 9 months to younger than 15 years of age in 2016. This campaign was the first introduction of a rubella-containing vaccine in Zambia. To evaluate the impact of the campaign, we compared the MR seroprevalence estimates from serosurveys conducted before and after the campaign in Southern Province, Zambia. The measles seroprevalence increased from 77.8% (95% confidence interval [CI], 73.2-81.9) to 96.4% (95% CI, 91.7-98.5) among children younger than 15 years. The rubella seroprevalence increased from 51.3% (95% CI, 45.6-57.0) to 98.3% (95% CI, 95.5-99.4). After the campaign, slightly lower seroprevalence remained for young adults 15 to 19 years old, who were not included in the campaign because of their age. These serosurveys highlighted the significant impact of the vaccination campaign and identified immunity gaps for those beyond the targeted vaccination age. Continued monitoring of population immunity can signal the need for future targeted vaccination strategies.
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Affiliation(s)
- Andrea C Carcelen
- 1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Simon Mutembo
- 1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,2Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia
| | | | | | - Gina Mulundu
- 5University of Zambia School of Medicine, Lusaka, Zambia.,6University Teaching Hospital, Lusaka, Zambia
| | - Mwaka Monze
- 5University of Zambia School of Medicine, Lusaka, Zambia
| | - Francis D Mwansa
- 2Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia
| | - William J Moss
- 1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,7Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kyla Hayford
- 1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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47
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Sikalima J, Schue JL, Hill SE, Mulenga M, Handema R, Daka V, Chileshe J, Kasongo W, Chaponda M, Bukasa Kabuya JB, Moss WJ, Ippolito MM. House Structure Is Associated with Malaria among Febrile Patients in a High-Transmission Region of Zambia. Am J Trop Med Hyg 2021; 104:2131-2138. [PMID: 33844650 DOI: 10.4269/ajtmh.20-1378] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/10/2021] [Indexed: 11/07/2022] Open
Abstract
Since the late nineteenth century, the importance of house structure as a determinant of malaria risk has been recognized. Few studies to date have examined the association of housing and malaria in clinical populations. We conducted a cross-sectional study of febrile patients (n = 282) at two rural health clinics in a high malaria-transmission area of northern Zambia. Participants underwent testing for Plasmodium falciparum infection by PCR. Demographic and other risk factors including house structure, indoor residual spraying (IRS), bed net use, education level, and household income were collected. Data were fitted to logistic regression models for relational and mediation analyses. Residing in a house with a thatch roof was associated with higher odds of malaria than residing in a house with corrugated metal (odds ratio: 2.6; 95% CI: 1.0-6.3, P = 0.04). Lower income and educational attainment were also associated with greater odds of malaria. Living under a thatch roof accounted for 24% (95% CI: 14-82) of the effect of household income on malaria risk, and income accounted for 11% (95% CI: 8-19) of the effect of education. Neither IRS nor bed net use was associated with malaria risk despite large, local investments in these vector control interventions. The findings testify to malaria as a disease of rural poverty and contribute further evidence to the utility of housing improvements in vector control programs.
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Affiliation(s)
- Jay Sikalima
- 1Tropical Diseases Research Centre, Ndola, Zambia
| | - Jessica L Schue
- 2Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,3Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah E Hill
- 4Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Modest Mulenga
- 5Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, Kitwe, Zambia
| | - Ray Handema
- 1Tropical Diseases Research Centre, Ndola, Zambia
| | - Victor Daka
- 5Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, Kitwe, Zambia
| | | | | | | | | | - William J Moss
- 3Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Matthew M Ippolito
- 3Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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48
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De Broucker G, Salvatore PP, Mutembo S, Moyo N, Mutanga JN, Thuma PE, Moss WJ, Sutcliffe CG. The cost-effectiveness of scaling-up rapid point-of-care testing for early infant diagnosis of HIV in southern Zambia. PLoS One 2021; 16:e0248217. [PMID: 33690733 PMCID: PMC7943017 DOI: 10.1371/journal.pone.0248217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/22/2021] [Indexed: 01/06/2023] Open
Abstract
Introduction Early infant diagnosis (EID) and treatment can prevent much of the HIV-related morbidity and mortality experienced by children but is challenging to implement in sub-Saharan Africa. Point-of-care (PoC) testing would decentralize testing and increase access to rapid diagnosis. The objective of this study was to determine the cost-effectiveness of PoC testing in Southern Province, Zambia. Methods A decision tree model was developed to compare health outcomes and costs between the standard of care (SoC) and PoC testing using GeneXpert and m-PIMA platforms. The primary health outcome was antiretroviral treatment (ART) initiation within 60 days of sample collection. Additional outcomes included ART initiation by 12 months of age and death prior to ART initiation. Costs included both capital and recurrent costs. Health outcomes and costs were combined to create incremental cost effectiveness ratios (ICERs). Results The proportion of children initiating ART within 60 days increased from 27.8% with SoC to 79.8–82.8% with PoC testing depending on the algorithm and platform. The proportion of children initiating ART by 12 months of age increased from 50.9% with SoC to 84.0–86.5% with PoC testing. The proportion of HIV-infected children dying prior to ART initiation decreased from 18.1% with SoC to 3.8–4.6% with PoC testing. Total program costs were similar for the SoC and GeneXpert but higher for m-PIMA. ICERs for PoC testing were favorable, ranging from $23–1,609 for ART initiation within 60 days, $37–2,491 for ART initiation by 12 months of age, and $90–6,188 for deaths prior to ART initiation. Factors impacting the costs of PoC testing, including the lifespan of the testing instruments and integrated utilization of PoC platforms, had the biggest impact on the ICERs. Integrating utilization across programs decreased costs for the EID program, such that PoC testing was cost-saving in some situations. Conclusion PoC testing has the potential to improve linkage to care and ART initiation for HIV-infected infants and should be considered for implementation within EID programs to achieve equity in access to HIV services and reduce HIV-related pediatric morbidity and mortality.
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Affiliation(s)
- Gatien De Broucker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Phillip P. Salvatore
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | | | | | | | | | - William J. Moss
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Catherine G. Sutcliffe
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- * E-mail:
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Hoffman JE, Ciubotariu II, Simubali L, Mudenda T, Moss WJ, Carpi G, Norris DE, Stevenson JC. Phylogenetic Complexity of Morphologically Identified Anopheles squamosus in Southern Zambia. Insects 2021; 12:insects12020146. [PMID: 33567609 PMCID: PMC7915044 DOI: 10.3390/insects12020146] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/16/2022]
Abstract
Despite dramatic reductions in malaria cases in the catchment area of Macha Hospital, Choma District, Southern Province in Zambia, prevalence has remained near 1-2% by RDT for the past several years. To investigate residual malaria transmission in the area, this study focuses on the relative abundance, foraging behavior, and phylogenetic relationships of Anopheles squamosus specimens. In 2011, higher than expected rates of anthropophily were observed among "zoophilic" An. squamosus, a species that had sporadically been found to contain Plasmodium falciparum sporozoites. The importance of An. squamosus in the region was reaffirmed in 2016 when P. falciparum sporozoites were detected in numerous An. squamosus specimens. This study analyzed Centers for Disease Control (CDC) light trap collections of adult mosquitoes from two collection schemes: one performed as part of a reactive-test-and-treat program and the second performed along a geographical transect. Morphological identification, molecular verification of anopheline species, and blood meal source were determined on individual samples. Data from these collections supported earlier studies demonstrating An. squamosus to be primarily exophagic and zoophilic, allowing them to evade current control measures. The phylogenetic relationships generated from the specimens in this study illustrate the existence of well supported clade structure among An. squamosus specimens, which further emphasizes the importance of molecular identification of vectors. The primarily exophagic behavior of An. squamosus in these collections also highlights that indoor vector control strategies will not be sufficient for elimination of malaria in southern Zambia.
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Affiliation(s)
- Jordan E. Hoffman
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80523, USA;
| | - Ilinca I. Ciubotariu
- Department of Biological Sciences, Purdue University, West Lafayette, IN 47907, USA; (I.I.C.); (G.C.)
| | | | - Twig Mudenda
- Macha Research Trust, Choma, Zambia; (L.S.); (T.M.); (J.C.S.)
| | - William J. Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
- The W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Giovanna Carpi
- Department of Biological Sciences, Purdue University, West Lafayette, IN 47907, USA; (I.I.C.); (G.C.)
| | - Douglas E. Norris
- The W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Correspondence: ; Tel.: +1-410-614-2710
| | - Jennifer C. Stevenson
- Macha Research Trust, Choma, Zambia; (L.S.); (T.M.); (J.C.S.)
- The W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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50
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Bolotin S, Hughes SL, Gul N, Khan S, Rota PA, Severini A, Hahné S, Tricco A, Moss WJ, Orenstein W, Turner N, Durrheim D, Heffernan JM, Crowcroft N. What Is the Evidence to Support a Correlate of Protection for Measles? A Systematic Review. J Infect Dis 2021; 221:1576-1583. [PMID: 31674648 DOI: 10.1093/infdis/jiz380] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 04/05/2019] [Accepted: 07/22/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many studies assume that the serologic correlate of protection from measles disease is 120 mIU/mL. We systematically reviewed the literature to examine the evidence supporting this correlate of protection. METHODS We searched peer-reviewed and gray literature for articles reporting a measles correlate of protection. We excluded studies focusing on special populations, infants aged <9 months, and those using animal models or nonstandard vaccines or administration routes. We extracted and synthesized data from full-text articles that met inclusion criteria. RESULTS We screened 14 778 articles and included 5 studies in our review. The studies reported either preexposure antibody concentrations of individuals along with a description of symptoms postexposure, or the proportion of measles cases that had preexposure antibody concentrations above a threshold of immunity specified by the authors. Some studies also described secondary antibody responses upon exposure. The variation in laboratory methods between studies made comparisons difficult. Some of the studies that assumed 120 mIU/mL as a correlate of protection identified symptomatic individuals with preexposure titers exceeding this threshold. CONCLUSIONS Our findings underscore the scant data upon which the commonly used 120 mIU/mL measles threshold of protection is based, suggesting that further work is required to characterize the measles immunity threshold.
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Affiliation(s)
- Shelly Bolotin
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | | | - Nazish Gul
- Public Health Ontario, Toronto, Ontario, Canada
| | | | - Paul A Rota
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alberto Severini
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Susan Hahné
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Andrea Tricco
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - William J Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Walter Orenstein
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nikki Turner
- Department of General Practice and Primary Health Care, Faculty of Medicine and Health Science, University of Auckland, Tamaki Campus, Auckland, New Zealand
| | | | - Jane M Heffernan
- Centre for Disease Modelling, Mathematics and Statistics, York University,, Toronto, Ontario, Canada
| | - Natasha Crowcroft
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
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