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Rajaonarifara E, Roche B, Chesnais CB, Rabenantoandro H, Evans M, Garchitorena A. Heterogeneity in elimination efforts could increase the risk of resurgence of lymphatic filariasis in Madagascar. Infect Genet Evol 2024; 120:105589. [PMID: 38548211 DOI: 10.1016/j.meegid.2024.105589] [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] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Progress in lymphatic filariasis (LF) elimination is spatially heterogeneous in many endemic countries, which may lead to resurgence in areas that have achieved elimination. Understanding the drivers and consequences of such heterogeneity could help inform strategies to reach global LF elimination goals by 2030. This study assesses whether differences in age-specific compliance with mass drug administration (MDA) could explain LF prevalence patterns in southeastern Madagascar and explores how spatial heterogeneity in prevalence and age-specific MDA compliance may affect the risk of LF resurgence after transmission interruption. METHODOLOGY We used LYMFASIM model with parameters in line with the context of southeastern Madagascar and explored a wide range of scenarios with different MDA compliance for adults and children (40-100%) to estimate the proportion of elimination, non-elimination and resurgence events associated with each scenario. Finally, we evaluated the risk of resurgence associated with different levels of migration (2-6%) from surrounding districts combined with varying levels of LF microfilaria (mf) prevalence (0-24%) during that same study period. RESULTS Differences in MDA compliance between adults and children better explained the observed heterogeneity in LF prevalence for these age groups than differences in exposure alone. The risk of resurgence associated with differences in MDA compliance scenarios ranged from 0 to 19% and was highest when compliance was high for children (e.g. 90%) and low for adults (e.g. 50%). The risk of resurgence associated with migration was generally higher, exceeding 60% risk for all the migration levels explored (2-6% per year) when mf prevalence in the source districts was between 9% and 20%. CONCLUSION Gaps in the implementation of LF elimination programme can increase the risk of resurgence and undermine elimination efforts. In Madagascar, districts that have not attained elimination pose a significant risk for those that have achieved it. More research is needed to help guide LF elimination programme on the optimal strategies for surveillance and control that maximize the chances to sustain elimination and avoid resurgence.
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Affiliation(s)
- Elinambinina Rajaonarifara
- UMR 224 MIVEGEC, Univ. Montpellier, IRD, CNRS, Montpellier, France; NGO Pivot, Ifanadiana, Madagascar; Sciences & Ingénierie, Sorbonne Université, Paris, France.
| | - Benjamin Roche
- UMR 224 MIVEGEC, Univ. Montpellier, IRD, CNRS, Montpellier, France
| | | | - Holivololona Rabenantoandro
- Service de Lutte contre les Maladies Epidémiques et Négligées - Ministère de la Santé Publique, Antananarivo, Madagascar
| | - Michelle Evans
- NGO Pivot, Ifanadiana, Madagascar; Departement of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, USA
| | - Andres Garchitorena
- UMR 224 MIVEGEC, Univ. Montpellier, IRD, CNRS, Montpellier, France; NGO Pivot, Ifanadiana, Madagascar
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Srivathsan A, Abdou A, Al-Khatib T, Apadinuwe SC, Badiane MD, Bucumi V, Chisenga T, Kabona G, Kabore M, Kanyi SK, Bella L, M’po N, Masika M, Minnih A, Sitoe HM, Mishra S, Olobio N, Omar FJ, Phiri I, Sanha S, Seife F, Sharma S, Tekeraoi R, Traore L, Watitu T, Bol YY, Borlase A, Deiner MS, Renneker KK, Hooper PJ, Emerson PM, Vasconcelos A, Arnold BF, Porco TC, Hollingsworth TD, Lietman TM, Blumberg S. District-Level Forecast of Achieving Trachoma Elimination as a Public Health Problem By 2030: An Ensemble Modelling Approach. Clin Infect Dis 2024; 78:S101-S107. [PMID: 38662700 PMCID: PMC11045026 DOI: 10.1093/cid/ciae031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Assessing the feasibility of 2030 as a target date for global elimination of trachoma, and identification of districts that may require enhanced treatment to meet World Health Organization (WHO) elimination criteria by this date are key challenges in operational planning for trachoma programmes. Here we address these challenges by prospectively evaluating forecasting models of trachomatous inflammation-follicular (TF) prevalence, leveraging ensemble-based approaches. Seven candidate probabilistic models were developed to forecast district-wise TF prevalence in 11 760 districts, trained using district-level data on the population prevalence of TF in children aged 1-9 years from 2004 to 2022. Geographical location, history of mass drug administration treatment, and previously measured prevalence data were included in these models as key predictors. The best-performing models were included in an ensemble, using weights derived from their relative likelihood scores. To incorporate the inherent stochasticity of disease transmission and challenges of population-level surveillance, we forecasted probability distributions for the TF prevalence in each geographic district, rather than predicting a single value. Based on our probabilistic forecasts, 1.46% (95% confidence interval [CI]: 1.43-1.48%) of all districts in trachoma-endemic countries, equivalent to 172 districts, will exceed the 5% TF control threshold in 2030 with the current interventions. Global elimination of trachoma as a public health problem by 2030 may require enhanced intervention and/or surveillance of high-risk districts.
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Affiliation(s)
- Ariktha Srivathsan
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Amza Abdou
- Programme National de Santé Oculaire, Ministère De La Santé Publique, Niamey, Niger
| | - Tawfik Al-Khatib
- Prevention of Blindness Program, Ministry of Public Health & Population, Sana'a, Yemen
| | | | - Mouctar D Badiane
- Programme National de Promotion de La Santé Oculaire, Ministère de la Santé et de L'Action sociale, Dakar, Sénégal
| | - Victor Bucumi
- Département En Charge des Maladies Tropicales Négligées, Ministère De La Santé Publique Et De La Lutte Contre Le Sida, Bujumbura, Burundi
| | - Tina Chisenga
- Ministry of Health Public Health Department, Lusaka, Zambia
| | - George Kabona
- Neglected Tropical Disease Control Program, Ministry of Health and Social Welfare, Dar Es Salaam, United Republic of Tanzania
| | - Martin Kabore
- Programme national de lutte contre les maladies tropicales négligées, Ministère de la santé et de l'hygiène publique, Ouagadougou, Burkina Faso
| | - Sarjo Kebba Kanyi
- The National Eye Health Programme, Ministry of Health and Social Welfare, Banjul, Kanifing, The Gambia
| | - Lucienne Bella
- Programme National De Lutte Contre La Cécité, Ministère De La Santé Publique, Yaoundé, Cameroon
| | - Nekoua M’po
- Programme National De Lutte Contre Les Maladies Transmissibles, Ministère De La Santé, Cotonou, Benin
| | - Michael Masika
- Department of Clinical Services, Ministry of Health, Lilongwe, Malawi
| | - Abdellahi Minnih
- Département Des Maladies Transmissibles, Ministère De La Santé Nouakchott, Nouakchott, Mauritania
| | - Henis Mior Sitoe
- Direcção Nacional De Saúde Pública Ministerio Da Saude, Maputo, Mozambique
| | | | - Nicholas Olobio
- National Trachoma Elimination Programme, Federal Ministry of Health, Abuja, Nigeria
| | | | - Isaac Phiri
- Department of Epidemiology and Disease Control, Ministry of Health & Child Welfare, Harare, Zimbabwe
| | - Salimato Sanha
- Programa Nacional De Saúde De Visão, Minsap, Bissau, Guinea-Bissau
| | - Fikre Seife
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Rabebe Tekeraoi
- Eye Department, Ministry of Health and Medical Services, South Tarawa, Kiribati
| | - Lamine Traore
- Programme National de la Santé Oculaire, Ministère de la Santé, Bamako, Mali
| | | | - Yak Yak Bol
- Neglected Tropical Diseases Programme, Ministry of Health, Juba, South Sudan
| | - Anna Borlase
- Department of Biology, University of Oxford, Oxford, United Kingdom
| | - Michael S Deiner
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Kristen K Renneker
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, USA
| | - P J Hooper
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, USA
| | - Paul M Emerson
- International Trachoma Initiative, The Task Force for Global Health, Decatur, Georgia, USA
| | - Andreia Vasconcelos
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - T Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Seth Blumberg
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Department of Medicine, University of California, San Francisco, California, USA
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Touloupou P, Fronterre C, Cano J, Prada JM, Smith M, Kontoroupis P, Brown P, Rivera RC, de Vlas SJ, Gunawardena S, Irvine MA, Njenga SM, Reimer L, Seife F, Sharma S, Michael E, Stolk WA, Pulan R, Spencer SEF, Hollingsworth TD. An Ensemble Framework for Projecting the Impact of Lymphatic Filariasis Interventions Across Sub-Saharan Africa at a Fine Spatial Scale. Clin Infect Dis 2024; 78:S108-S116. [PMID: 38662704 PMCID: PMC11045016 DOI: 10.1093/cid/ciae071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is a neglected tropical disease targeted for elimination as a public health problem by 2030. Although mass treatments have led to huge reductions in LF prevalence, some countries or regions may find it difficult to achieve elimination by 2030 owing to various factors, including local differences in transmission. Subnational projections of intervention impact are a useful tool in understanding these dynamics, but correctly characterizing their uncertainty is challenging. METHODS We developed a computationally feasible framework for providing subnational projections for LF across 44 sub-Saharan African countries using ensemble models, guided by historical control data, to allow assessment of the role of subnational heterogeneities in global goal achievement. Projected scenarios include ongoing annual treatment from 2018 to 2030, enhanced coverage, and biannual treatment. RESULTS Our projections suggest that progress is likely to continue well. However, highly endemic locations currently deploying strategies with the lower World Health Organization recommended coverage (65%) and frequency (annual) are expected to have slow decreases in prevalence. Increasing intervention frequency or coverage can accelerate progress by up to 5 or 6 years, respectively. CONCLUSIONS While projections based on baseline data have limitations, our methodological advancements provide assessments of potential bottlenecks for the global goals for LF arising from subnational heterogeneities. In particular, areas with high baseline prevalence may face challenges in achieving the 2030 goals, extending the "tail" of interventions. Enhancing intervention frequency and/or coverage will accelerate progress. Our approach facilitates preimplementation assessments of the impact of local interventions and is applicable to other regions and neglected tropical diseases.
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Affiliation(s)
| | | | - Jorge Cano
- Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN), WHO Regional Office for Africa, Brazzaville, Democratic Republic of the Congo
| | - Joaquin M Prada
- School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
| | - Morgan Smith
- Department of Biological Sciences, University of Notre Dame, Notre Dame, Indiana, USA
| | | | - Paul Brown
- Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, University of Warwick, Coventry, United Kingdom
| | - Rocio Caja Rivera
- Center for Global Health Infectious Disease Research, University of South Florida, Tampa, USA
| | - Sake J de Vlas
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Michael A Irvine
- Data and Analytic Services, British Columbia Centre for Disease Control, Vancouver, Canada
| | - Sammy M Njenga
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Lisa Reimer
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Fikre Seife
- Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Swarnali Sharma
- Department of Mathematics, Vijaygarh Jyotish Ray College, Kolkata, India
| | - Edwin Michael
- Center for Global Health Infectious Disease Research, University of South Florida, Tampa, USA
| | - Wilma A Stolk
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rachel Pulan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Simon E F Spencer
- Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, University of Warwick, Coventry, United Kingdom
| | - T Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
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Vasconcelos A, Nunes-Alves C, Hollingsworth TD. New Tools and Nuanced Interventions to Accelerate Achievement of the 2030 Roadmap for Neglected Tropical Diseases. Clin Infect Dis 2024; 78:S77-S82. [PMID: 38662694 PMCID: PMC11045012 DOI: 10.1093/cid/ciae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
The World Health Organization roadmap for neglected tropical diseases (NTDs) sets out ambitious targets for disease control and elimination by 2030, including 90% fewer people requiring interventions against NTDs and the elimination of at least 1 NTD in 100 countries. Mathematical models are an important tool for understanding NTD dynamics, optimizing interventions, assessing the efficacy of new tools, and estimating the economic costs associated with control programs. As NTD control shifts to increased country ownership and programs progress toward disease elimination, tailored models that better incorporate local context and can help to address questions that are important for decision-making at the national level are gaining importance. In this introduction to the supplement, New Tools and Nuanced Interventions to Accelerate Achievement of the 2030 Roadmap for Neglected Tropical Diseases, we discuss current challenges in generating more locally relevant models and summarize how the articles in this supplement present novel ways in which NTD modeling can help to accelerate achievement and sustainability of the 2030 targets.
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Affiliation(s)
- Andreia Vasconcelos
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Cláudio Nunes-Alves
- Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Oxford, United Kingdom
| | - T Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
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Kura K, Stolk WA, Basáñez MG, Collyer BS, de Vlas SJ, Diggle PJ, Gass K, Graham M, Hollingsworth TD, King JD, Krentel A, Anderson RM, Coffeng LE. How Does the Proportion of Never Treatment Influence the Success of Mass Drug Administration Programs for the Elimination of Lymphatic Filariasis? Clin Infect Dis 2024; 78:S93-S100. [PMID: 38662701 PMCID: PMC11045024 DOI: 10.1093/cid/ciae021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Mass drug administration (MDA) is the cornerstone for the elimination of lymphatic filariasis (LF). The proportion of the population that is never treated (NT) is a crucial determinant of whether this goal is achieved within reasonable time frames. METHODS Using 2 individual-based stochastic LF transmission models, we assess the maximum permissible level of NT for which the 1% microfilaremia (mf) prevalence threshold can be achieved (with 90% probability) within 10 years under different scenarios of annual MDA coverage, drug combination and transmission setting. RESULTS For Anopheles-transmission settings, we find that treating 80% of the eligible population annually with ivermectin + albendazole (IA) can achieve the 1% mf prevalence threshold within 10 years of annual treatment when baseline mf prevalence is 10%, as long as NT <10%. Higher proportions of NT are acceptable when more efficacious treatment regimens are used. For Culex-transmission settings with a low (5%) baseline mf prevalence and diethylcarbamazine + albendazole (DA) or ivermectin + diethylcarbamazine + albendazole (IDA) treatment, elimination can be reached if treatment coverage among eligibles is 80% or higher. For 10% baseline mf prevalence, the target can be achieved when the annual coverage is 80% and NT ≤15%. Higher infection prevalence or levels of NT would make achieving the target more difficult. CONCLUSIONS The proportion of people never treated in MDA programmes for LF can strongly influence the achievement of elimination and the impact of NT is greater in high transmission areas. This study provides a starting point for further development of criteria for the evaluation of NT.
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Affiliation(s)
- Klodeta Kura
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
| | - Wilma A Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maria-Gloria Basáñez
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
| | - Benjamin S Collyer
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
| | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter J Diggle
- Centre for Health Informatics, Computing and Statistics, Lancaster University, Lancaster, United Kingdom
| | - Katherine Gass
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, Georgia, USA
| | - Matthew Graham
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - T Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Jonathan D King
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Alison Krentel
- Bruyère Research Institute, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Canada
| | - Roy M Anderson
- London Centre for Neglected Tropical Disease Research, London, United Kingdom
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
| | - Luc E Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Antony Oliver MC, Graham M, Gass KM, Medley GF, Clark J, Davis EL, Reimer LJ, King JD, Pouwels KB, Hollingsworth TD. Reducing the Antigen Prevalence Target Threshold for Stopping and Restarting Mass Drug Administration for Lymphatic Filariasis Elimination: A Model-Based Cost-effectiveness Simulation in Tanzania, India and Haiti. Clin Infect Dis 2024; 78:S160-S168. [PMID: 38662697 PMCID: PMC11045020 DOI: 10.1093/cid/ciae108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The Global Programme to Eliminate Lymphatic Filariasis (GPELF) aims to reduce and maintain infection levels through mass drug administration (MDA), but there is evidence of ongoing transmission after MDA in areas where Culex mosquitoes are the main transmission vector, suggesting that a more stringent criterion is required for MDA decision making in these settings. METHODS We use a transmission model to investigate how a lower prevalence threshold (<1% antigenemia [Ag] prevalence compared with <2% Ag prevalence) for MDA decision making would affect the probability of local elimination, health outcomes, the number of MDA rounds, including restarts, and program costs associated with MDA and surveys across different scenarios. To determine the cost-effectiveness of switching to a lower threshold, we simulated 65% and 80% MDA coverage of the total population for different willingness to pay per disability-adjusted life-year averted for India ($446.07), Tanzania ($389.83), and Haiti ($219.84). RESULTS Our results suggest that with a lower Ag threshold, there is a small proportion of simulations where extra rounds are required to reach the target, but this also reduces the need to restart MDA later in the program. For 80% coverage, the lower threshold is cost-effective across all baseline prevalences for India, Tanzania, and Haiti. For 65% MDA coverage, the lower threshold is not cost-effective due to additional MDA rounds, although it increases the probability of local elimination. Valuing the benefits of elimination to align with the GPELF goals, we find that a willingness to pay per capita government expenditure of approximately $1000-$4000 for 1% increase in the probability of local elimination would be required to make a lower threshold cost-effective. CONCLUSIONS Lower Ag thresholds for stopping MDAs generally mean a higher probability of local elimination, reducing long-term costs and health impacts. However, they may also lead to an increased number of MDA rounds required to reach the lower threshold and, therefore, increased short-term costs. Collectively, our analyses highlight that lower target Ag thresholds have the potential to assist programs in achieving lymphatic filariasis goals.
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Affiliation(s)
- Mary Chriselda Antony Oliver
- Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Cambridge, United Kingdom
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Matthew Graham
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Katherine M Gass
- Neglected Tropical Diseases Support Centre, The Task Force for Global Health, Decatur, Georgia, USA
| | - Graham F Medley
- Centre for Mathematical Modelling of Infectious Disease and Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jessica Clark
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Emma L Davis
- Mathematics Institute and the Zeeman Institute for Systems Biology and Infectious Disease Epidemiological Research, University of Warwick, Coventry, United Kingdom
| | - Lisa J Reimer
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jonathan D King
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Koen B Pouwels
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - T Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
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Fromsa A, Willgert K, Srinivasan S, Mekonnen G, Bedada W, Gumi B, Lakew M, Tadesse B, Bayissa B, Sirak A, Girma Abdela M, Gebre S, Chibssa T, Veerasami M, Vordermeier HM, Bakker D, Berg S, Ameni G, Juleff N, de Jong MCM, Wood J, Conlan A, Kapur V. BCG vaccination reduces bovine tuberculosis transmission, improving prospects for elimination. Science 2024; 383:eadl3962. [PMID: 38547287 DOI: 10.1126/science.adl3962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/24/2024] [Indexed: 04/02/2024]
Abstract
Bacillus Calmette-Guérin (BCG) is a routinely used vaccine for protecting children against Mycobacterium tuberculosis that comprises attenuated Mycobacterium bovis. BCG can also be used to protect livestock against M. bovis; however, its effectiveness has not been quantified for this use. We performed a natural transmission experiment to directly estimate the rate of transmission to and from vaccinated and unvaccinated calves over a 1-year exposure period. The results show a higher indirect efficacy of BCG to reduce transmission from vaccinated animals that subsequently become infected [74%; 95% credible interval (CrI): 46 to 98%] compared with direct protection against infection (58%; 95% CrI: 34 to 73%) and an estimated total efficacy of 89% (95% CrI: 74 to 96%). A mechanistic transmission model of bovine tuberculosis (bTB) spread within the Ethiopian dairy sector was developed and showed how the prospects for elimination may be enabled by routine BCG vaccination of cattle.
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Affiliation(s)
- Abebe Fromsa
- Aklilu Lemma Institutes of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- College of Veterinary Medicine and Agriculture, Addis Ababa University, Bishoftu, Ethiopia
| | - Katriina Willgert
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, UK
| | - Sreenidhi Srinivasan
- Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, USA
- Department of Animal Science, The Pennsylvania State University, University Park, PA, USA
- The Global Health Initiative, Henry Ford Health, Detroit, MI, USA
| | | | | | - Balako Gumi
- Aklilu Lemma Institutes of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Berecha Bayissa
- Aklilu Lemma Institutes of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Musse Girma Abdela
- Aklilu Lemma Institutes of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | | | | | - Douwe Bakker
- Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, USA
- Technical Consultant and Independent Researcher, Lelystad, Netherlands
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense, Madrid, Spain
| | - Stefan Berg
- Animal and Plant Health Agency, Weybridge, UK
| | - Gobena Ameni
- Aklilu Lemma Institutes of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, United Arab Emirates University, United Arab Emirates
| | - Nick Juleff
- The Bill & Melinda Gates Foundation Seattle, WA, USA
| | - Mart C M de Jong
- Quantitative Veterinary Epidemiology Group, Wageningen UR, The Netherlands
| | - James Wood
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, UK
| | - Andrew Conlan
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, UK
| | - Vivek Kapur
- Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, PA, USA
- Department of Animal Science, The Pennsylvania State University, University Park, PA, USA
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8
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Liu Y. Policy Evolution and Lessons Learned from China's Efforts to Eliminate Leprosy. J Epidemiol Glob Health 2024; 14:13-21. [PMID: 38300410 PMCID: PMC11043293 DOI: 10.1007/s44197-024-00188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/07/2024] [Indexed: 02/02/2024] Open
Abstract
The prevention and treatment of leprosy is a public health and social issue of global concern. China has become the first country in the world to put forward a proposal on the elimination of the harm caused by leprosy. This paper briefly introduces the status of the spread of leprosy in China, and systematically reviews the evolution of policies and measures at different stages of the disease in China, from the serious epidemic of leprosy to the control of the infection, to the basic elimination, and to the elimination of the hazards. On this basis, five main lessons learned from the control and elimination of leprosy in China were also summarized. These provide the basis for promoting the complete global elimination of leprosy and preventing its re-transmission, thereby benefiting all those who still suffer from the scourge of leprosy.
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Affiliation(s)
- Ying Liu
- School of Marxism, Fujian Normal University, Fuzhou, 350117, Fujian, China.
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9
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The Lancet Gastroenterology Hepatology. Hepatitis D: a neglected aspect of elimination efforts. Lancet Gastroenterol Hepatol 2023; 8:955. [PMID: 37837970 DOI: 10.1016/s2468-1253(23)00329-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
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10
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Irwin A. Polio is on the brink of eradication. Here's how to keep it from coming back. Nature 2023; 623:680-682. [PMID: 37989772 DOI: 10.1038/d41586-023-03602-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
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11
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Kerr L, Bourne A, Hill AO, McNair R, Wyatt K, Lyons A, Carman M, Amos N. Cervical screening among LGBTQ people: how affirming services may aid in achieving cervical cancer elimination targets. Women Health 2023; 63:736-746. [PMID: 37779316 DOI: 10.1080/03630242.2023.2263594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 09/17/2023] [Indexed: 10/03/2023]
Abstract
To reach cervical cancer elimination targets it is necessary to increase screening rates among underserved populations such as LGBTQ communities. This paper examines rates of attendance and associated factors of cervical screening in LGBTQ communities. Data from 2,424 people aged 25 to 74 years and assigned female at birth were drawn from an online national Australian survey of LGBTQ adults. Over half of the sample had accessed cervical screening in the past 2 years. Using a multivariable logistic regression analysis, significant associations were found between screening, sociodemographic traits and health-care access. Trans men were least likely to access cervical screening, while bisexual, pansexual and queer identified participants were most likely to access screening. People who lived outside inner-suburban areas and those who had a disability were less likely to have had screening. Evidence of trusting relationships with a general practitioner (having a regular GP and GP's knowledge of the individual's LGBTQ identity) increased the likelihood that participants had screened, as did recent access to a medical service that was LGBTQ-inclusive or catered specifically to LGBTQ communities. The findings suggest the importance of training health providers, as well as targeted public health messaging for increasing uptake of cervical screening among LGBTQ people.
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Affiliation(s)
- Lucille Kerr
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
- Department of Nursing Research, Cabrini Research, Malvern, Victoria, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Adam O Hill
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
- Graduate School of Public Health, St Luke's International University, Tokyo, Japan
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Parkville, Victoria, Australia
| | - Kerryann Wyatt
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Marina Carman
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
| | - Natalie Amos
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Victoria, Australia
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Hone J. Are predictions of bovine tuberculosis-infected herds unbiased and precise? Epidemiol Infect 2023; 151:e165. [PMID: 37726112 PMCID: PMC10600916 DOI: 10.1017/s0950268823001553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/06/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023] Open
Abstract
Bovine tuberculosis (bTB) is prevalent among livestock and wildlife in many countries including New Zealand (NZ), a country which aims to eradicate bTB by 2055. This study evaluates predictions related to the numbers of livestock herds with bTB in NZ from 2012 to 2021 inclusive using both statistical and mechanistic (causal) modelling. Additionally, this study made predictions for the numbers of infected herds between 2022 and 2059. This study introduces a new graphical method representing the causal criteria of strength of association, such as R2, and the consistency of predictions, such as mean squared error. Mechanistic modelling predictions were, on average, more frequently (3 of 4) unbiased than statistical modelling predictions (1 of 4). Additionally, power model predictions were, on average, more frequently (3 of 4) unbiased than exponential model predictions (1 of 4). The mechanistic power model, along with annual updating, had the highest R2 and the lowest mean squared error of predictions. It also exhibited the closest approximation to unbiased predictions. Notably, significantly biased predictions were all underestimates. Based on the mechanistic power model, the biological eradication of bTB from New Zealand is predicted to occur after 2055. Disease eradication planning will benefit from annual updating of future predictions.
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Affiliation(s)
- Jim Hone
- Institute for Applied Ecology, University of Canberra, Canberra, ACT, Australia
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Masresha BG, Hatcher C, Lebo E, Tanifum P, Bwaka AM, Minta AA, Antoni S, Grant GB, Perry RT, O’Connor P. Progress Toward Measles Elimination - African Region, 2017-2021. MMWR Morb Mortal Wkly Rep 2023; 72:985-991. [PMID: 37676836 PMCID: PMC10495184 DOI: 10.15585/mmwr.mm7236a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Worldwide, measles remains a major cause of disease and death; the highest incidence is in the World Health Organization African Region (AFR). In 2011, the 46 AFR member states established a goal of regional measles elimination by 2020; this report describes progress during 2017-2021. Regional coverage with a first dose of measles-containing vaccine (MCV) decreased from 70% in 2017 to 68% in 2021, and the number of countries with ≥95% coverage decreased from six (13%) to two (4%). The number of countries providing a second MCV dose increased from 27 (57%) to 38 (81%), and second-dose coverage increased from 25% to 41%. Approximately 341 million persons were vaccinated in supplementary immunization activities, and an estimated 4.5 million deaths were averted by vaccination. However, the number of countries meeting measles surveillance performance indicators declined from 26 (62%) to nine (22%). Measles incidence increased from 69.2 per 1 million population in 2017 to 81.9 in 2021. The number of estimated annual measles cases and deaths increased 22% and 8%, respectively. By December 2021, no country in AFR had received verification of measles elimination. To achieve a renewed regional goal of measles elimination in at least 80% of countries by 2030, intensified efforts are needed to recover and surpass levels of surveillance performance and coverage with 2 MCV doses achieved before the COVID-19 pandemic.
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Erbeto T, Bammeke P, Aregay A, Kamran Z, Ibrahim A, Usifoh N, Adamu U, Omotayo B, Braka F, Damisa E, Kazadi W, Shuaib F. Providing information for decision-making in the Nigerian Polio Eradication Program, 2016-2020. Pan Afr Med J 2023; 45:11. [PMID: 38370106 PMCID: PMC10874091 DOI: 10.11604/pamj.supp.2023.45.2.39489] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/07/2023] [Indexed: 02/20/2024] Open
Abstract
Nigeria made a coordinated effort to be certified by the World Health Organization's African Region for interrupting endemic transmission of wild poliovirus type-1 (WPV1) in August 2020 as a response to the resurgence of WPV1 cases in August 2016 after going two years without a case. The NEOC Data Working Group (DWG) was instrumental in providing quality and timely surveillance and campaign information for decision-making in order to interrupt WPV1 transmission and provide data toward documentation of its elimination for regional certification. The polio pre-campaign dashboard was used to assess the level of preparedness for Oral Poliovirus Vaccine (OPV) polio supplementary immunization activities (SIA) at three weeks, two weeks, one week, and three days to the start of each campaign implemented during 2016-2020. The administrative tally sheet, independent monitoring survey, and Lot Quality Assurance Sampling (LQAS) survey data collected and shared from the implementation level were analyzed by the EOC DWG to provide information by person, place, and time. Using a 90% threshold in LQAS surveys defining quality SIAs, the proportion of Local Government Areas (LGAs) in Nigeria's states in which post-SIA LQAS surveys were conducted that met this threshold were assessed over time. The highest level of preparedness attained by 3 days to a polio campaign during August 2016-February 2020 was 95% and the lowest attained was 77%. The admin, independent monitoring, and LQAS data analysis results were given to EOC working groups for assessing the performance and quality of each campaign. Twenty-twenty five percent of LGAs that failed LQAS were identified for repeat vaccination. Further, acute flaccid paralysis and environmental surveillance data and laboratory results were analyzed and shared with NEOC and partners. The government and partners used the information generated by the Data Working Group to take evidence-based action including determining the scope of the polio campaign, intensification of surveillance and routine immunization activities, and special intervention activities. On average, 12% of the 774 LGAs were identified as polio high risk LGAs for intervention using selected surveillance, routine immunization (RI), SIAs, and other relevant data sets. National Emergency Operation Centre Data Working Group provided quality and timely information that supported decision-making processes for the polio program in Nigeria. The quality and timely information enabled the NEOC to make evidence-based and timely decisions that contributed to gap identification and decision-making.
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Affiliation(s)
- Tesfaye Erbeto
- World Health Organization Country Office, Abuja, Nigeria
| | - Philip Bammeke
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Aron Aregay
- World Health Organization Country Office, Abuja, Nigeria
| | - Zabihullah Kamran
- United Nations Children’s Fund Nigeria Country Office, Copenhagen, Denmark
| | - Ahmed Ibrahim
- World Health Organization Country Office, Abuja, Nigeria
| | | | - Usman Adamu
- National Primary Healthcare Development Agency, Abuja, Nigeria
- National Emergency Operation Centre, Abuja, Nigeria
| | - Bolu Omotayo
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Fiona Braka
- World Health Organization Country Office, Abuja, Nigeria
| | - Eunice Damisa
- National Primary Healthcare Development Agency, Abuja, Nigeria
| | - Walter Kazadi
- World Health Organization Country Office, Abuja, Nigeria
| | - Faisal Shuaib
- National Primary Healthcare Development Agency, Abuja, Nigeria
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Prabhakar T, Kaushal K. Knowledge Dissemination for elimination Role of Academic Institutions in Eliminating Viral Hepatitis. J Assoc Physicians India 2023; 71:11-12. [PMID: 37651242 DOI: 10.59556/japi.71.0279] [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] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
INTRODUCTION India is looking to achieve hepatitis elimination status by 2030 through vaccination, diagnostic tests, medicines, and education campaigns. Awareness generation is essential to orient people regarding hepatitis B and C. The present study was done to assess the knowledge regarding hepatitis among students and staff of academic institutions and raise awareness through a series of webinars. MATERIALS AND METHODS A cross-sectional study was conducted in 12 academic institutes from across the country between February and March 2022. The study included the dissemination of knowledge in the form of a webinar and the administration of a pre and postwebinar survey to assess the difference in the knowledge levels. RESULTS A total of 914 individuals participated in the sessions. The mean baseline score for general epidemiology (max = 13 points), treatment and complications (max = 7 points), and prevention (max = 5 points) were 10.9 ± 2.1, 4.6 ± 1.3, and 3.2 ± 1.3, respectively. Overall, the mean score increased from 18.5 ± 3.6 to 20.4 ± 3.4 postwebinar, with an increase of +7.3%. CONCLUSION The study observed significant improvement in knowledge among the participants following a low-cost 1-day training in webinar mode. Such training programs can be upscaled and help in educating the general public on hepatitis.
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Affiliation(s)
| | - Kanica Kaushal
- Assistant Professor, Department of Clinical Research and Epidemiology, Institute of Liver and Biliary Sciences, Delhi, India
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So S, Terrault N, Conners EE. Universal Adult Hepatitis B Screening and Vaccination as the Path to Elimination. JAMA 2023; 329:1639-1640. [PMID: 36897598 PMCID: PMC10959250 DOI: 10.1001/jama.2023.2806] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
This Viewpoint describes new recommendations from the CDC regarding universal screening of adults for hepatitis B virus infection.
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Affiliation(s)
- Samuel So
- Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Norah Terrault
- Keck School of Medicine, University of Southern California, Los Angeles
| | - Erin E Conners
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
This Viewpoint introduces a proposed 5-year program from the Biden-Harris administration that would use direct-acting antivirals to eliminate hepatitis C in the United States.
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Abbasi J. Former NIH Director Francis S. Collins on the New White House Plan to Eliminate Hepatitis C. JAMA 2023; 329:1246-1247. [PMID: 36892977 DOI: 10.1001/jama.2023.3942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
This Medical News article is an interview with Francis S. Collins, MD, PhD, former National Institutes of Health director, and JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, about a historic Biden-Harris administration proposal to cure and prevent all hepatitis C infections in the US.
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Affiliation(s)
- Konstantin Chumakov
- From the Office of Vaccines Research and Review, Food and Drug Administration, Rockville (K.C.), and the Global Virus Network (C.B.) and the Institute of Human Virology, University of Maryland School of Medicine (R.C.G.), Baltimore - all in Maryland; and the University of Pennsylvania and Vaxconsult - both in Philadelphia (S.P.)
| | - Christian Brechot
- From the Office of Vaccines Research and Review, Food and Drug Administration, Rockville (K.C.), and the Global Virus Network (C.B.) and the Institute of Human Virology, University of Maryland School of Medicine (R.C.G.), Baltimore - all in Maryland; and the University of Pennsylvania and Vaxconsult - both in Philadelphia (S.P.)
| | - Robert C Gallo
- From the Office of Vaccines Research and Review, Food and Drug Administration, Rockville (K.C.), and the Global Virus Network (C.B.) and the Institute of Human Virology, University of Maryland School of Medicine (R.C.G.), Baltimore - all in Maryland; and the University of Pennsylvania and Vaxconsult - both in Philadelphia (S.P.)
| | - Stanley Plotkin
- From the Office of Vaccines Research and Review, Food and Drug Administration, Rockville (K.C.), and the Global Virus Network (C.B.) and the Institute of Human Virology, University of Maryland School of Medicine (R.C.G.), Baltimore - all in Maryland; and the University of Pennsylvania and Vaxconsult - both in Philadelphia (S.P.)
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Kanu FA, Yusuf N, Kassogue M, Ahmed B, Tohme RA. Progress Toward Achieving and Sustaining Maternal and Neonatal Tetanus Elimination — Worldwide, 2000–2020. MMWR Morb Mortal Wkly Rep 2022; 71:406-411. [PMID: 35298457 PMCID: PMC8942310 DOI: 10.15585/mmwr.mm7111a2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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21
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Chuchu VM, Kitala PM, Bichanga P, Ksee D, Muturi M, Mwatondo A, Nasimiyu C, Maritim M, Mutono N, Beyene TJ, Druelles S, Hampson K, Thumbi SM. Rabies Elimination in Rural Kenya: Need for Improved Availability of Human Vaccines, Awareness and Knowledge on Rabies and Its Management Among Healthcare Workers. Front Public Health 2022; 10:769898. [PMID: 35356016 PMCID: PMC8960031 DOI: 10.3389/fpubh.2022.769898] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/31/2022] [Indexed: 12/25/2022] Open
Abstract
BackgroundIn Africa, rabies causes an estimated 24,000 human deaths annually. Mass dog vaccinations coupled with timely post-exposure prophylaxis (PEP) for dog-bite patients are the main interventions to eliminate human rabies deaths. A well-informed healthcare workforce and the availability and accessibility of rabies biologicals at health facilities are critical in reducing rabies deaths. We assessed awareness and knowledge regarding rabies and the management of rabies among healthcare workers, and PEP availability in rural eastern Kenya.MethodologyWe interviewed 73 healthcare workers from 42 healthcare units in 13 wards in Makueni and Kibwezi West sub-counties, Makueni County, Kenya in November 2018. Data on demographics, years of work experience, knowledge of rabies, management of bite and rabies patients, and availability of rabies biologicals were collected and analyzed.ResultsRabies PEP vaccines were available in only 5 (12%) of 42 health facilities. None of the health facilities had rabies immunoglobulins in stock at the time of the study. PEP was primarily administered intramuscularly, with only 11% (n = 8) of the healthcare workers and 17% (7/42) healthcare facilities aware of the dose-sparing intradermal route. Less than a quarter of the healthcare workers were aware of the World Health Organization categorization of bite wounds that guides the use of PEP. Eighteen percent (n = 13) of healthcare workers reported they would administer PEP for category I exposures even though PEP is not recommended for this category of exposure. Only one of six respondents with acute encephalitis consultation considered rabies as a differential diagnosis highlighting the low index of suspicion for rabies.ConclusionThe availability and use of PEP for rabies was sub-optimal. We identified two urgent needs to support rabies elimination programmes: improving availability and access to PEP; and targeted training of the healthcare workers to improve awareness on bite wound management, judicious use of PEP including appropriate risk assessment following bites and the use of the dose-sparing intradermal route in facilities seeing multiple bite patients. Global and domestic funding plan that address these gaps in the human health sector is needed for efficient rabies elimination in Africa.
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Affiliation(s)
- Veronicah Mbaire Chuchu
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi, Kenya
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Washington State University Global Health Program, Nairobi, Kenya
| | - Philip Mwanzia Kitala
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi, Kenya
| | - Philet Bichanga
- Government of Makueni County, Department of Health Services, Wote, Kenya
| | - Daniel Ksee
- Government of Makueni County, Department of Agriculture, Irrigation, Livestock, and Fisheries Development, Wote, Kenya
| | - Mathew Muturi
- Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Athman Mwatondo
- Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Carolyne Nasimiyu
- Washington State University Global Health Program, Nairobi, Kenya
- Zoonotic Disease Unit, Ministry of Health and Ministry of Agriculture, Livestock and Fisheries, Nairobi, Kenya
| | - Marybeth Maritim
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Nyamai Mutono
- Washington State University Global Health Program, Nairobi, Kenya
- Center for Epidemiological and Modelling Analysis, Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Tariku J. Beyene
- Center for Health Equity and Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Sophie Druelles
- Vaccine Epidemiology and Modeling, Sanofi Pasteur, Lyon, France
| | - Katie Hampson
- Institute of Biodiversity, Animal Health & Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - S. M. Thumbi
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
- Center for Epidemiological and Modelling Analysis, Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
- Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
- NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), The University of Edinburgh, Edinburgh, United Kingdom
- Paul G Allen School for Global Health, Washington State University, Pullman, WA, United States
- *Correspondence: S. M. Thumbi
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Macklin GR, Peak C, Eisenhawer M, Kurji F, Mach O, Konz J, Gast C, Bachtiar NS, Bandyopadhyay AS, Zipursky S. Enabling accelerated vaccine roll-out for Public Health Emergencies of International Concern (PHEICs): Novel Oral Polio Vaccine type 2 (nOPV2) experience. Vaccine 2022; 41 Suppl 1:A122-A127. [PMID: 35307230 PMCID: PMC10109087 DOI: 10.1016/j.vaccine.2022.02.050] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 08/24/2021] [Revised: 01/17/2022] [Accepted: 02/09/2022] [Indexed: 01/20/2023]
Abstract
To address the evolving risk of circulating vaccine-derived poliovirus type 2 (cVDPV2), Global Polio Eradication Initiative (GPEI) partners are working closely with countries to deploy an additional innovative tool for outbreak response - novel oral polio vaccine type 2 (nOPV2). The World Health Organization's (WHO) Prequalification program issued an Emergency Use Listing (EUL) recommendation for nOPV2 on 13 November 2020. The WHO's EUL procedure was created to assess and list unlicensed vaccines, therapeutics and diagnostics to enable their use in response to a Public Health Emergency of International Concern (PHEIC). nOPV2 was the first vaccine to receive an EUL, paving the way for other emergency vaccines. In this report, we summarise the pathway for nOPV2 roll-out under EUL.
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Affiliation(s)
- Grace R Macklin
- London School of Hygiene and Tropical Medicine, London, United Kingdom; Polio Eradication, World Health Organisation, Geneva, Switzerland
| | - Corey Peak
- Bill and Melinda Gates Foundation, Seattle, Washington, United States
| | | | - Feyrouz Kurji
- FDK Consulting LLC, Kirkland, Washington, United States
| | - Ondrej Mach
- Polio Eradication, World Health Organisation, Geneva, Switzerland
| | - John Konz
- PATH, Seattle, Washington, United States
| | - Chris Gast
- PATH, Seattle, Washington, United States
| | | | | | - Simona Zipursky
- Polio Eradication, World Health Organisation, Geneva, Switzerland
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Lupenza ET, Gasarasi DB, Minzi OM. Lymphatic filariasis elimination status: Wuchereria bancrofti infections in human populations and factors contributing to continued transmission after seven rounds of mass drug administration in Masasi District, Tanzania. PLoS One 2022; 17:e0262693. [PMID: 35045109 PMCID: PMC8769288 DOI: 10.1371/journal.pone.0262693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 01/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) affects more than 120 million people globally. In Tanzania, nearly six million people are estimated to live with clinical manifestations of the disease. The National LF control program was established in 2000 using Mass drug administration (MDA) of Ivermectin and Albendazole to individuals aged 5years and above. This study assessed the infection status in individuals aged 15 years and above who are eligible for participation in MDA. The level of compliance to MDA and the reasons for non-compliance to MDA were also assessed. METHODS A community based cross-sectional study was conducted in two villages of Masasi District. A total of 590 participants aged 15 years and above were screened for the circulating filarial antigen (CFA) using the rapid diagnostic test. Night blood samples from CFA positive individuals were further analyzed for detection and quantification of Wuchereria bancrofti microfilaria (Mf) using the counting chamber technique. A pre-tested questionnaire was administered to collect information on compliance to MDA and the factors affecting continued transmission. Data were analyzed using SPSS Version 20. Chi-square test was used to compare the prevalence of CFA by gender and village where a P-value ≤0.05 was considered statistically significant. RESULTS Out of 590 participants, 30 (5.1%) were positive for CFA and one (0.2%) was found positive for microfilaria of Wuchereria bancrofti. Compliance during the last round of MDA, in the year 2019 was 56% which is below the minimum coverage recommended by WHO. Absence from home during MDA and perceptions of being free from hydrocele or elephantiasis were the major reasons for non-compliance. CONCLUSION There is a significant decline in LF transmission in Masasi District after seven rounds of MDA. However, the presence of individuals who are persistently non-compliant may delay elimination of LF in the District.
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Affiliation(s)
- Eliza T. Lupenza
- Department of Parasitology and Medical Entomology, School of Public health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- * E-mail:
| | - Dinah B. Gasarasi
- Department of Parasitology and Medical Entomology, School of Public health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Omary M. Minzi
- Department of Clinical Pharmacy, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Ahmed MN, Jahan R, Nissapatorn V, Wilairatana P, Rahmatullah M. Plant lectins as prospective antiviral biomolecules in the search for COVID-19 eradication strategies. Biomed Pharmacother 2022; 146:112507. [PMID: 34891122 PMCID: PMC8648558 DOI: 10.1016/j.biopha.2021.112507] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 12/12/2022] Open
Abstract
Lectins or clusters of carbohydrate-binding proteins of non-immune origin are distributed chiefly in the Plantae. Lectins have potent anti-infectivity properties for several RNA viruses including SARS-CoV-2. The primary purpose of this review is to review the ability of lectins mediated potential biotherapeutic and bioprophylactic strategy against coronavirus causing COVID-19. Lectins have binding affinity to the glycans of SARS-COV-2 Spike glycoprotein that has N-glycosylation sites. Apart from this, the complement lectin pathway is a "first line host defense" against the viral infection that is activated by mannose-binding lectins. Mannose-binding lectins deficiency in serum influences innate immunity of the host and facilitates infectious diseases including COVID-19. Our accumulated evidence obtained from scientific databases particularly PubMed and Google Scholar databases indicate that mannose-specific/mannose-binding lectins (MBL) have potent efficacies like anti-infectivity, complement cascade induction, immunoadjuvants, DC-SIGN antagonists, or glycomimetic approach, which can prove useful in the strategy of COVID-19 combat along with the glycobiological aspects of SARS-CoV-2 infections and antiviral immunity. For example, plant-derived mannose-specific lectins BanLac, FRIL, Lentil, and GRFT from red algae can inhibit and neutralize SARS-CoV-2 infectivity, as confirmed with in-vitro, in-vivo, and in-silico assessments. Furthermore, Bangladesh has a noteworthy resource of antiviral medicinal plants as well as plant lectins. Intensifying research on the antiviral plant lectins, adopting a glyco-biotechnological approach, and with deeper insights into the "glycovirological" aspects may result in the designing of alternative and potent blueprints against the 21st century's biological pandemic of SARS-CoV-2 causing COVID-19.
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Affiliation(s)
- Md Nasir Ahmed
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Dhaka, Bangladesh; Biotechnology & Natural Medicine Division, TechB Nutrigenomics, Dhaka, Bangladesh.
| | - Rownak Jahan
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Dhaka, Bangladesh.
| | - Veeranoot Nissapatorn
- School of Allied Health Sciences and World Union for Herbal Drug Discovery (WUHeDD), Walailak University, Nakhon Si Thammarat, Thailand
| | - Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Mohammed Rahmatullah
- Department of Biotechnology & Genetic Engineering, University of Development Alternative, Dhaka, Bangladesh.
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Baker MG, Kvalsvig A, Crengle S, Harwood M, Tukuitonga C, Betty B, Bonning J, Wilson N. The next phase in Aotearoa New Zealand's COVID-19 response: a tight suppression strategy may be the best option. N Z Med J 2021; 134:8-16. [PMID: 34855729] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Michael G Baker
- Professor of Public Health, Director of CoSearch, Department of Public Health, University of Otago, Wellington
| | - Amanda Kvalsvig
- Senior Research Fellow, Co-Director of CoSearch, Department of Public Health, University of Otago Wellington
| | - Sue Crengle
- Professor in Māori Health, Department of Preventive and Social Medicine, University of Otago, Dunedin; Specialist General Practitioner, Invercargill
| | - Matire Harwood
- Associate Professor, Department of General Practice and Primary Care, University of Auckland; Specialist General Practitioner, Papakura Marae Health Clinic, Auckland
| | - Collin Tukuitonga
- Associate Dean (Pacific) and Associate Professor of Public Health, Faculty of Medical and Health Sciences, University of Auckland
| | - Bryan Betty
- Medical Director of the Royal New Zealand College of General Practitioners; Specialist General Practitioner, Cannons Creek, East Porirua
| | - John Bonning
- FACEM, Emergency Physician Waikato Hospital; Chair of the Council of Medical Colleges of Aotearoa NZ; Immediate Past president ACEM
| | - Nick Wilson
- Professor of Public Health, BODE3 Programme, Department of Public Health, University of Otago, Wellington
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Beaumont J, Nargesi MM, Smith S, Harte D, Smit E, Ussher J, McAuliffe G. Sensitivity and potential utility of SARS-CoV-2 rapid antigen and nucleic acid amplification tests in the context of an elimination approach. N Z Med J 2021; 134:28-37. [PMID: 34855731] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIM To assess the sensitivity and potential utility of five RATs and the IDNow, Liat and Oxsed nucleic acid amplification tests (NAATs) in our population. METHOD 39 retrospective and contrived SARS-CoV-2 positive samples were tested in parallel by standard RT-PCR and RAT. A second group of 44 samples was tested by standard RT-PCR, rapid RT-PCR and two isothermal NAAT assays. Limit of detection was compared at RT-PCR cycle thresholds for all assays. RESULTS We found that the Cobas Liat RT-PCR had 100% concordance with conventional RT-PCR, whereas the sensitivity of other rapid NAAT assays was less at lower viral loads indicated by Cts >30 (p=0.042) and the RATs at Cts >25 (p<0.001). When applied to New Zealand testing scenarios, IDNow or Oxsed NAAT could miss up to 12% and RATs up to 44.3% of COVID-19 cases compared with the RT-PCR currently used at our laboratory. CONCLUSION We found that the POC Cobas Liat, a platform that delivers a sample answer in 20 minutes, demonstrated equivalent performance to standard RT-PCR. However, the RATs and isothermal NAAT assays demonstrated reduced sensitivity, limiting their utility in New Zealand's currently very low prevalence setting.
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Affiliation(s)
- Jenna Beaumont
- Virology and Immunology Department, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Mirsaed Miri Nargesi
- Virology and Immunology Department, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | | | - David Harte
- Institute of Environmental Science and Research Ltd, Kenepuru Science Centre, Porirua, New Zealand
| | - Erasmus Smit
- Institute of Environmental Science and Research Ltd, Kenepuru Science Centre, Porirua, New Zealand
| | - James Ussher
- Southern Community Laboratories, Dunedin, New Zealand
| | - Gary McAuliffe
- Virology and Immunology Department, LabPLUS, Auckland City Hospital, Auckland, New Zealand
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Niles RA, Thickstun CR, Cox H, Dilliott D, Burgert-Brucker CR, Harding-Esch EM, Clementson N, Sampson A, Alexandre JS, Morice Trejos AC, Scholte RGC, Krentel A. Assessing factors influencing communities' acceptability of mass drug administration for the elimination of lymphatic filariasis in Guyana. PLoS Negl Trop Dis 2021; 15:e0009596. [PMID: 34543269 PMCID: PMC8452018 DOI: 10.1371/journal.pntd.0009596] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Guyana is one of four countries in the Latin American Region where lymphatic filariasis (LF) remains endemic. In preparation for the introduction of a new triple drug therapy regimen (ivermectin, diethylcarbamazine, and albendazole (IDA)) in 2019, an acceptability study was embedded within sentinel site mapping in four regions to assess mass drug administration (MDA) coverage and compliance, acceptability, and perceptions about treatment and disease. The results from this survey would inform the rollout of IDA in Guyana in 2019. METHODS Data collection for the study occurred in August 2019, using a validated questionnaire administered by trained enumerators. Across all regions, a total of 1,248 participants were sampled by the Filarial Mapping team. Four-hundred and fifty-one participants aged over 18 years were randomly selected for participation in an expanded acceptability questionnaire. All data were captured in Secure Data Kit (SDK). RESULTS Acceptability was measured using a mean acceptability score. Unadjusted mean scores ranged from 24.6 to 29.3, with 22.5 as the threshold of acceptability. Regional variation occurred across many indicators of interest: self-rated understanding about LF, mechanisms of LF transmission, LF drug safety and history of treatment during MDA. Region IV (Georgetown) recorded higher knowledge about LF, but lower compliance and acceptability. Number of pills was not perceived as a concern. CONCLUSION Acceptability of MDA was good across all four regions under study. Results from this study set a baseline level for key indicators and acceptability, from which the acceptability of IDA can be measured. Regional variations across indicators suggest that localized approaches should be considered for social mobilization and MDA delivery to capture these contextual differences.
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Affiliation(s)
- Reza A. Niles
- Neglected Tropical Diseases Programme, Ministry of Health, Georgetown, Guyana
| | - Charles R. Thickstun
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Horace Cox
- Neglected Tropical Diseases Programme, Ministry of Health, Georgetown, Guyana
| | | | | | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nikita Clementson
- Neglected Tropical Diseases Programme, Ministry of Health, Georgetown, Guyana
| | - Annastacia Sampson
- Neglected Tropical Diseases Programme, Ministry of Health, Georgetown, Guyana
| | - Jean Seme Alexandre
- Neglected, Tropical, and Vector Borne Diseases, Pan American Health Organization, Washington DC, United States of America
| | - Ana C. Morice Trejos
- Neglected, Tropical, and Vector Borne Diseases, Pan American Health Organization, Washington DC, United States of America
| | - Ronaldo G. Carvalho Scholte
- Neglected, Tropical, and Vector Borne Diseases, Pan American Health Organization, Washington DC, United States of America
| | - Alison Krentel
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
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Glenn J, Adams AB, Sankar G, Henry C, Palacio K, Thuo W, Williams K. Towards a shared understanding of sustainability for neglected tropical disease programs. PLoS Negl Trop Dis 2021; 15:e0009595. [PMID: 34415903 PMCID: PMC8378706 DOI: 10.1371/journal.pntd.0009595] [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: 03/26/2021] [Accepted: 06/24/2021] [Indexed: 11/22/2022] Open
Abstract
Background Sustainability within neglected tropical disease (NTD) programs is a complex and challenging issue. The need for a shared understanding about what sustainability means for NTD programs is more important than ever as stakeholders are currently realigning for the next decade of NTD programming with the launch of WHO’s new NTD roadmap for 2012–2030. The aim of this paper is to assess different perspectives to generate a working definition of sustainability for NTD programs. Methodology/Principal findings This study surveyed affiliates of the NTD NGO Network (NNN) about their definitions of sustainability and then analyzed the data using an inductive and deductive process. The research team drafted a sustainability statement based on the survey findings and then solicited and incorporated feedback on the statement from a diverse group of expert reviewers. The final statement includes a working definition of sustainability for NTD programs that highlights three key essential components to sustainability: domestic commitment, responsive resource mobilization, and accountability. Conclusions/Significance This research resulted in a sustainability statement, based on a survey and extensive consultation with stakeholders, that represents a starting point for shared understanding around the concept of sustainability for NTD programs. Future collaborative work should build off this definition and seek to incorporate indicators for sustainability into programmatic decision-making. The question of whether a global public health program can be sustainable is as important as whether that program is effective. While neglected tropical disease (NTD) programs have achieved tangible success in reducing the burden of NTDs over the past decade through a massive collaboration between global and local stakeholders, the achievement of global NTD control and elimination goals will depend in large part on whether these efforts are sustained. This study seeks to encourage more and better dialogue around NTD program sustainability by incorporating a wide variety of expert perspectives to create and propose a shared definition of sustainability upon which future NTD programming decisions can be made. The sustainability statement based on the findings from this study suggests that three essential components to NTD program sustainability are commitment from decision-makers within NTD-endemic countries, resource mobilization that is responsive to local needs, and enhanced mechanisms for accountability.
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Affiliation(s)
- Jeffrey Glenn
- Sustainable Systems Cross-Cutting Group, Neglected Tropical Disease NGO Network, London, United Kingdom
- Department of Public Health, College of Life Sciences, Brigham Young University, Provo, Utah, United States of America
- * E-mail:
| | - Aparna Barua Adams
- Sustainable Systems Cross-Cutting Group, Neglected Tropical Disease NGO Network, London, United Kingdom
- International Coalition for Trachoma Control, London, United Kingdom
| | - Girija Sankar
- Sustainable Systems Cross-Cutting Group, Neglected Tropical Disease NGO Network, London, United Kingdom
- CBM International, Bensheim, Germany
| | - Carolyn Henry
- Sustainable Systems Cross-Cutting Group, Neglected Tropical Disease NGO Network, London, United Kingdom
- SCI Foundation, London, United Kingdom
| | - Karen Palacio
- Sustainable Systems Cross-Cutting Group, Neglected Tropical Disease NGO Network, London, United Kingdom
- The END Fund, New York City, New York, United States of America
| | - Wangeci Thuo
- Sustainable Systems Cross-Cutting Group, Neglected Tropical Disease NGO Network, London, United Kingdom
- RTI International, Washington, DC, United States of America
| | - Katherine Williams
- Sustainable Systems Cross-Cutting Group, Neglected Tropical Disease NGO Network, London, United Kingdom
- The END Fund, New York City, New York, United States of America
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Loeb J. New approach for bTB in Northern Ireland. Vet Rec 2021; 189:94. [PMID: 34357622 DOI: 10.1002/vetr.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Importance The success of direct-acting antiviral therapies for chronic hepatitis C virus (HCV) infection led the World Health Organization to set elimination targets by 2030. For the United States to achieve these benchmarks, public health responses must target high-risk populations, such as people who inject drugs (PWID), a group with high rates of HCV incidence and low rates of treatment uptake. Objective To evaluate potential improvements in the HCV care cascade among PWID, focusing on improved testing, treatment uptake, and access to harm reduction. Design, Setting, and Participants This decision analytic model used a differential equation-based dynamic transmission model based on data from New Hampshire, an illustrative state with a large number of PWID and limited HCV treatment infrastructure. Surveillance data through 2020 was used for model parameterization, and the final analysis was conducted in May 2021. Main Outcomes and Measures Model forecasts of chronic HCV cases and advanced-stage HCV outcomes from 2022 to 2045. Results A total of 6 scenarios were tested: (1) the base case, (2) improved harm reduction, (3) improved testing, (4) improved treatment, (5) improved testing and treatment, and (6) improved testing, treatment, and harm reduction. All scenarios with improved testing, treatment uptake, and/or access to harm reduction were associated with decreases in forecasted HCV prevalence and HCV-associated mortality compared with the base case. Improving harm reduction, testing, and treatment individually were forecast to reduce prevalence of HCV in 2045 from 69.7% in the base case to 62.8%, 45.7%, and 35.5%, respectively. Combining treatment and testing improvements was associated with a 2045 prevalence of 0.3%; adding harm reduction improvements was associated with further reductions in prevalence forecasts (to 0.2%), with fewer total treatments (10 960 vs 13 219 from 2022-2045). Conclusions and Relevance In this modeling study, no single intervention was projected to achieve World Health Organization HCV elimination targets. Scenarios with improvements in both testing and treatment were associated with a prevalence of less than 3% by 2030 and achieved elimination targets. Adding improvements in harm reduction was associated with faster reductions in prevalence and fewer treatments.
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Affiliation(s)
- Andrew Blake
- Brigham and Women's Hospital, Boston, Massachusetts
| | - James E. Smith
- Tuck School of Business at Dartmouth, Hanover, New Hampshire
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Jangjou A, Meisami AH, Jamali K, Niakan MH, Abbasi M, Shafiee M, Salehi M, Hosseinzadeh A, Amani AM, Vaez A. The promising shadow of microbubble over medical sciences: from fighting wide scope of prevalence disease to cancer eradication. J Biomed Sci 2021; 28:49. [PMID: 34154581 PMCID: PMC8215828 DOI: 10.1186/s12929-021-00744-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/10/2021] [Indexed: 12/29/2022] Open
Abstract
Microbubbles are typically 0.5-10 μm in size. Their size tends to make it easier for medication delivery mechanisms to navigate the body by allowing them to be swallowed more easily. The gas included in the microbubble is surrounded by a membrane that may consist of biocompatible biopolymers, polymers, surfactants, proteins, lipids, or a combination thereof. One of the most effective implementation techniques for tiny bubbles is to apply them as a drug carrier that has the potential to activate ultrasound (US); this allows the drug to be released by US. Microbubbles are often designed to preserve and secure medicines or substances before they have reached a certain area of concern and, finally, US is used to disintegrate microbubbles, triggering site-specific leakage/release of biologically active drugs. They have excellent therapeutic potential in a wide range of common diseases. In this article, we discussed microbubbles and their advantageous medicinal uses in the treatment of certain prevalent disorders, including Parkinson's disease, Alzheimer's disease, cardiovascular disease, diabetic condition, renal defects, and finally, their use in the treatment of various forms of cancer as well as their incorporation with nanoparticles. Using microbubble technology as a novel carrier, the ability to prevent and eradicate prevalent diseases has strengthened the promise of effective care to improve patient well-being and life expectancy.
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Affiliation(s)
- Ali Jangjou
- Department of Emergency Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Hossein Meisami
- Department of Emergency Medicine, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kazem Jamali
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hadi Niakan
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Milad Abbasi
- Department of Medical Nanotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Shafiee
- Department of Medical Nanotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Salehi
- Department of Tissue Engineering, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
- Tissue Engineering and Stem Cells Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Ahmad Hosseinzadeh
- Thoracic and Vascular Surgery Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Mohammad Amani
- Department of Medical Nanotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Vaez
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
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Palmer BS. Covid-19 eradication: stopping transmission between countries. BMJ 2021; 373:n1425. [PMID: 34099495 DOI: 10.1136/bmj.n1425] [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: 11/04/2022]
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Solitano V, Plaz Torres MC, Pugliese N, Aghemo A. Management and Treatment of Hepatitis C: Are There Still Unsolved Problems and Unique Populations? Viruses 2021; 13:1048. [PMID: 34205966 PMCID: PMC8228389 DOI: 10.3390/v13061048] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023] Open
Abstract
Direct-acting antivirals (DAA) have revolutionized the treatment of patients with chronic hepatitis C virus (HCV) infection, possibly leading to HCV elimination by 2030 as endorsed by the World Health Organization (WHO). However, some patients belonging to the so-called unique or special populations are referred to as difficult-to-treat due to unreached sustained virological response, potential drug side effects or interactions or co-morbidities. Several years after the DAA introduction and on the basis of excellent findings in terms of efficacy and safety, some doubts arise around the exact meaning of the special population designation and whether this group of patients actually exists. The aim of this review is to discuss and analyze current evidence on the management and treatment of the so-called "unique populations". We placed particular emphasis on patients with decompensated cirrhosis, chronic kidney disease (CKD), coinfections, rare genotypes, and previous treatment failure, in order to provide physicians with an updated overview of the actual problems and needs in the current scenario.
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Affiliation(s)
- Virginia Solitano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20082 Milan, Italy; (V.S.); (N.P.)
- Division of Internal Medicine and Hepatology, Humanitas Research Hospital IRCCS, Rozzano, 20089 Milan, Italy;
| | - Maria Corina Plaz Torres
- Division of Internal Medicine and Hepatology, Humanitas Research Hospital IRCCS, Rozzano, 20089 Milan, Italy;
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS-Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Nicola Pugliese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20082 Milan, Italy; (V.S.); (N.P.)
- Division of Internal Medicine and Hepatology, Humanitas Research Hospital IRCCS, Rozzano, 20089 Milan, Italy;
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20082 Milan, Italy; (V.S.); (N.P.)
- Division of Internal Medicine and Hepatology, Humanitas Research Hospital IRCCS, Rozzano, 20089 Milan, Italy;
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Nji TM, Piotrowski H, Dum-Buo N, Fung EG, Dean L, Theobald S, Thomson R, Wanji S, Ozano K. Eliminating onchocerciasis within the Meme River Basin of Cameroon: A social-ecological approach to understanding everyday realities and health systems. PLoS Negl Trop Dis 2021; 15:e0009433. [PMID: 34077416 PMCID: PMC8202923 DOI: 10.1371/journal.pntd.0009433] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 06/14/2021] [Accepted: 05/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Onchocerciasis affects some of the world's most marginalized people, perpetuating poverty and inequalities. Mass Drug Administration (MDA) with Ivermectin has taken place within the Meme River basin region in Cameroon for over 15 years. Despite this, onchocerciasis is still prevalent in the region due to existing and emerging contextual challenges. Using a social-ecological approach we explore the everyday realities of communities, highlighting the challenges and potential solutions that could support Neglected Tropical Disease (NTD) programmes when transitioning from control to elimination of onchocerciasis in this highly endemic area and other similar communities. METHODOLOGY/PRINCIPAL FINDING In-depth interviews (71) with community members and Community Drug Distributors (CDDs) were conducted to understand current knowledge, attitudes, and behaviours in relation to transmission, prevention and treatment of onchocerciasis. Through application of the social-ecological model, four key themes were identified: 1. Contextual factors on health promotion interventions (Onchocerciasis history and understanding of the disease, prevention and mitigation strategies and MDA experience); 2. Social determinants (poverty and livelihoods, economic and social impacts on CDD volunteers and stigma); 3. Environmental determinants (exposure, housing, occupation and poverty); and 4. health seeking pathways and decision making for treatment (access, cost and preferable treatment routes). We discuss these core and cross cutting themes (gender differences and community participation/ownership) in relation to intersectoral collaboration, gender equity and health systems support, making recommendations for NTD programmes within the context of integrated and interdisciplinary approaches. These include the need for; intersectional and gender analysis at the local level, addressing environmental dimensions of onchocerciasis through integrated and regular health promotion, vector control strategies and access to safe water sources; reflection and action that embeds responses to social and economic barriers to MDA; integrated case detection and management that is responsive to onchocerciasis symptoms and related stigma and a fair and just support network for CDDs. CONCLUSION/SIGNIFICANCE NTD programmes need to respond to diverse community circumstances and behaviours. Communities are not a homogeneous risk group and treating them in this way will delay elimination. A deeper understanding of individual needs and their capacity to seek prevention and treatment must be considered if onchocerciasis is to be eliminated and the remaining impacts managed.
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Affiliation(s)
- Theobald Mue Nji
- Department of Sociology and Anthropology, Faculty of Social and Management Sciences, University of Buea, Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | - Helen Piotrowski
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Nnamdi Dum-Buo
- Department of Sociology and Anthropology, Faculty of Social and Management Sciences, University of Buea, Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | - Ebua Gallus Fung
- Department of Sociology and Anthropology, Faculty of Social and Management Sciences, University of Buea, Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Rachael Thomson
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Samuel Wanji
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | - Kim Ozano
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Wingfield T, Karmadwala F, MacPherson P, Millington KA, Walker NF, Cuevas LE, Squire SB. Challenges and opportunities to end tuberculosis in the COVID-19 era. Lancet Respir Med 2021; 9:556-558. [PMID: 33773121 PMCID: PMC7988354 DOI: 10.1016/s2213-2600(21)00161-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Tom Wingfield
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; Social Medicine, Infectious diseases, and Migration Group, Department of Global Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
| | - Fatima Karmadwala
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Peter MacPherson
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Kerry A Millington
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Naomi F Walker
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Luis E Cuevas
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; Zankli Research Centre, Bingham University, Nasarawa State, Nigeria
| | - S Bertel Squire
- Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Oteri AJ, Adamu U, Dieng B, Bawa S, Terna N, Nsubuga P, Owoaje ET, Kassogue M, Jean Baptiste AE, Braka F, Shuaib F. Nigeria experience on the use of polio assets for the 2017/18 measles vaccination campaign follow-up. Vaccine 2021; 39 Suppl 3:C3-C11. [PMID: 33962837 DOI: 10.1016/j.vaccine.2021.04.040] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/05/2021] [Accepted: 04/20/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The global polio eradication initiative has made giant stride by achieving a 99% reduction in Wild poliovirus (WPV) cases, with Nigeria on the verge of being declared polio-free following over 36 months without a WPV. The initiative has provided multiple resources, assets and lessons learnt that could be transitioned to other public health challenges, including improving the quality and vaccination coverage of measles campaigns in order to reduce the incidences of measles in Nigeria. We documented the polio legacy and assets used to support the national measles campaign in 2017/2018. METHODS We documented the integration of the measles campaign coordination with the Polio Emergency Operation Centre (EOC) at national and state levels for planning and implementing the measles SIA. Specific polio strategies and assets, such as the EOC incident command framework and facilities, human resource surge capacity, polio GIS resource These strategies were adapted and adopted for the MVC implementation overcome challenges and improve vaccination coverage. We evaluated the performance through a set process and outcome indicators. RESULTS All the 36 states and Federal Capital Territory used the structure and resources in Nigeria and provided counterpart financing for the MVC 2017/ 2018. The 11 polio high-risk states deployed the use of GIS for microplanning process, while daily call-in data were tracked in 99.7% of the LGAs and 70,846 reports were submitted real-time by supervisors using Open data kit (ODK). The national coverage achieved was 87.5% by the post-campaign survey with 65% of states reporting higher coverage in 2018 compared to 2015. CONCLUSION Polio eradication assets and lessons learned can be applied to measles elimination efforts as the eradication and elimination efforts have similar strategies and programme implementation infrastructure needs. Leveraging these strategies and resources to support MVC planning and implementation resulted in more realistic planning, improved accountability and availability of human and fiscal resources. This approach may have resulted in better MVC outcomes and contributed to Nigeria's efforts in measles control and elimination.
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Affiliation(s)
| | - Usman Adamu
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Boubacar Dieng
- Technical Assistance Consultant, Global Alliance for Vaccines and Immunisations, Nigeria
| | - Samuel Bawa
- World Health Organisation, Country Office, Abuja, Nigeria.
| | | | | | - Eme T Owoaje
- College of Medicine, University of Ibadan. Nigeria
| | - Modibo Kassogue
- United Nations Children's Fund, Country Office, Abuja, Nigeria
| | | | - Fiona Braka
- World Health Organisation, Country Office, Abuja, Nigeria
| | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
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Standley CJ, Schermerhorn J. Reaching the "Last Mile": Fresh Approaches Needed for Guinea Worm Eradication. Am J Trop Med Hyg 2021; 105:1-2. [PMID: 33909595 PMCID: PMC8274775 DOI: 10.4269/ajtmh.21-0433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 01/23/2023] Open
Affiliation(s)
- Claire J. Standley
- Address correspondence to Claire J. Standley, Center for Global Health Science and Security, Georgetown University, 3900 Reservoir Road NW, Washington, DC 20057. E-mail:
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Abstract
Two recent initiatives, the World Health Organization (WHO) Strategic Advisory Group on Malaria Eradication and the Lancet Commission on Malaria Eradication, have assessed the feasibility of achieving global malaria eradication and proposed strategies to achieve it. Both reports rely on a climate-driven model of malaria transmission to conclude that long-term trends in climate will assist eradication efforts overall and, consequently, neither prioritize strategies to manage the effects of climate variability and change on malaria programming. This review discusses the pathways via which climate affects malaria and reviews the suitability of climate-driven models of malaria transmission to inform long-term strategies such as an eradication programme. Climate can influence malaria directly, through transmission dynamics, or indirectly, through myriad pathways including the many socioeconomic factors that underpin malaria risk. These indirect effects are largely unpredictable and so are not included in climate-driven disease models. Such models have been effective at predicting transmission from weeks to months ahead. However, due to several well-documented limitations, climate projections cannot accurately predict the medium- or long-term effects of climate change on malaria, especially on local scales. Long-term climate trends are shifting disease patterns, but climate shocks (extreme weather and climate events) and variability from sub-seasonal to decadal timeframes have a much greater influence than trends and are also more easily integrated into control programmes. In light of these conclusions, a pragmatic approach is proposed to assessing and managing the effects of climate variability and change on long-term malaria risk and on programmes to control, eliminate and ultimately eradicate the disease. A range of practical measures are proposed to climate-proof a malaria eradication strategy, which can be implemented today and will ensure that climate variability and change do not derail progress towards eradication.
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Affiliation(s)
- Hannah Nissan
- Grantham Research Institute for Climate Change and the Environment, London School of Economics and Political Science, London, UK.
- International Research Institute for Climate and Society, Columbia University, Palisades, NY, USA.
| | - Israel Ukawuba
- Mailman School for Public Health, Columbia University, New York, NY, USA
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van den Hoogen LL, Herman C, Présumé J, Romilus I, Existe A, Boncy J, Joseph V, Stresman G, Tetteh KKA, Drakeley C, Chang MA, Lemoine JF, Eisele TP, Rogier E, Ashton RA. Rapid Screening for Non-falciparum Malaria in Elimination Settings Using Multiplex Antigen and Antibody Detection: Post Hoc Identification of Plasmodium malariae in an Infant in Haiti. Am J Trop Med Hyg 2021; 104:2139-2145. [PMID: 33819177 PMCID: PMC8176464 DOI: 10.4269/ajtmh.20-1450] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/24/2020] [Indexed: 01/24/2023] Open
Abstract
Haiti is targeting malaria elimination by 2025. The Grand'Anse department in southwestern Haiti experiences one-third to half of all nationally reported Plasmodium falciparum cases. Although there are historical reports of Plasmodium vivax and Plasmodium malariae, today, non-falciparum infections would remain undetected because of extensive use of falciparum-specific histidine-rich protein 2 (HRP2) rapid diagnostic tests (RDT) at health facilities. A recent case-control study was conducted in Grand'Anse to identify risk factors for P. falciparum infection using HRP2-based RDTs (n = 1,107). Post hoc multiplex Plasmodium antigenemia and antibody (IgG) detection by multiplex bead assay revealed one blood sample positive for pan-Plasmodium aldolase, negative for P. falciparum HRP2, and positive for IgG antibodies to P. malariae. Based on this finding, we selected 52 samples with possible P. malariae infection using IgG and antigenemia data and confirmed infection status by species-specific PCR. We confirmed one P. malariae infection in a 6-month-old infant without travel history. Congenital P. malariae could not be excluded. However, our finding-in combination with historical reports of P. malariae-warrants further investigation into the presence and possible extent of non-falciparum malaria in Haiti. Furthermore, we showed the use of multiplex Plasmodium antigen and IgG detection in selecting samples of interest for subsequent PCR analysis, thereby reducing costs as opposed to testing all available samples by PCR. This is of specific use in low-transmission or eliminating settings where infections are rare.
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Affiliation(s)
- Lotus L. van den Hoogen
- Center for Applied Malaria Research and Evaluation, Tropical Medicine Department, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | | | | | | | - Jacques Boncy
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | - Vena Joseph
- Center for Applied Malaria Research and Evaluation, Tropical Medicine Department, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Gillian Stresman
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kevin K. A. Tetteh
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chris Drakeley
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michelle A. Chang
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jean F. Lemoine
- Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Thomas P. Eisele
- Center for Applied Malaria Research and Evaluation, Tropical Medicine Department, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Eric Rogier
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ruth A. Ashton
- Center for Applied Malaria Research and Evaluation, Tropical Medicine Department, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
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Nekkab N, Lana R, Lacerda M, Obadia T, Siqueira A, Monteiro W, Villela D, Mueller I, White M. Estimated impact of tafenoquine for Plasmodium vivax control and elimination in Brazil: A modelling study. PLoS Med 2021; 18:e1003535. [PMID: 33891582 PMCID: PMC8064585 DOI: 10.1371/journal.pmed.1003535] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite recent intensification of control measures, Plasmodium vivax poses a major challenge for malaria elimination efforts. Liver-stage hypnozoite parasites that cause relapsing infections can be cleared with primaquine; however, poor treatment adherence undermines drug effectiveness. Tafenoquine, a new single-dose treatment, offers an alternative option for preventing relapses and reducing transmission. In 2018, over 237,000 cases of malaria were reported to the Brazilian health system, of which 91.5% were due to P. vivax. METHODS AND FINDINGS We evaluated the impact of introducing tafenoquine into case management practices on population-level transmission dynamics using a mathematical model of P. vivax transmission. The model was calibrated to reflect the transmission dynamics of P. vivax endemic settings in Brazil in 2018, informed by nationwide malaria case reporting data. Parameters for treatment pathways with chloroquine, primaquine, and tafenoquine with glucose-6-phosphate dehydrogenase deficiency (G6PDd) testing were informed by clinical trial data and the literature. We assumed 71.3% efficacy for primaquine and tafenoquine, a 66.7% adherence rate to the 7-day primaquine regimen, a mean 5.5% G6PDd prevalence, and 8.1% low metaboliser prevalence. The introduction of tafenoquine is predicted to improve effective hypnozoite clearance among P. vivax cases and reduce population-level transmission over time, with heterogeneous levels of impact across different transmission settings. According to the model, while achieving elimination in only few settings in Brazil, tafenoquine rollout in 2021 is estimated to improve the mean effective radical cure rate from 42% (95% uncertainty interval [UI] 41%-44%) to 62% (95% UI 54%-68%) among clinical cases, leading to a predicted 38% (95% UI 7%-99%) reduction in transmission and over 214,000 cumulative averted cases between 2021 and 2025. Higher impact is predicted in settings with low transmission, low pre-existing primaquine adherence, and a high proportion of cases in working-aged males. High-transmission settings with a high proportion of cases in children would benefit from a safe high-efficacy tafenoquine dose for children. Our methodological limitations include not accounting for the role of imported cases from outside the transmission setting, relying on reported clinical cases as a measurement of community-level transmission, and implementing treatment efficacy as a binary condition. CONCLUSIONS In our modelling study, we predicted that, provided there is concurrent rollout of G6PDd diagnostics, tafenoquine has the potential to reduce P. vivax transmission by improving effective radical cure through increased adherence and increased protection from new infections. While tafenoquine alone may not be sufficient for P. vivax elimination, its introduction will improve case management, prevent a substantial number of cases, and bring countries closer to achieving malaria elimination goals.
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Affiliation(s)
- Narimane Nekkab
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
| | - Raquel Lana
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Marcus Lacerda
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil
| | - Thomas Obadia
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
| | - André Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Wuelton Monteiro
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Daniel Villela
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ivo Mueller
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
- Population Health & Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael White
- Malaria: Parasites and Hosts, Department of Parasites and Insect Vectors, Institut Pasteur, Paris, France
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Alleman MM, Coulliette-Salmond AD, Wilnique P, Belgasmi-Wright H, Sayyad L, Wong K, Gue E, Barrais R, Rey-Benito G, Burns CC, Vega E. Environmental Surveillance for Polioviruses in Haïti (2017-2019): The Dynamic Process for the Establishment and Monitoring of Sampling Sites. Viruses 2021; 13:v13030505. [PMID: 33803868 PMCID: PMC8003210 DOI: 10.3390/v13030505] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023] Open
Abstract
Haïti is at risk for wild poliovirus (WPV) importation and circulation, as well as vaccine-derived poliovirus (VDPV) emergence. Environmental surveillance (ES) for polioviruses was established in Port au Prince and Gonaïves in 2016. During 2017–2019, initial ES sites were re-evaluated, and ES was expanded into Cap Haïtien and Saint Marc. Wastewater samples and data on weather, hour of collection, and sample temperature and pH were collected every 4 weeks during March 2017–December 2019 (272 sampling events) from 21 sites in Cap Haïtien, Gonaïves, Port au Prince, and Saint Marc. Samples were processed for the detection of polio and non-polio enteroviruses using the two-phase and “Concentration and Filter Elution” methodologies. Polioviruses were serotyped and underwent intra-typic characterization. No WPV or VDPVs were isolated. Sabin-like polioviruses (oral vaccine strain) of serotypes 1 and 3 were sporadically detected. Five of six (83%), one of six (17%), five of six (83%), and two of three (67%) sites evaluated in Cap Haïtien, Gonaïves, Port au Prince, and Saint Marc, respectively, had enterovirus isolation from >50% of sampling events; these results and considerations, such as watershed population size and overlap, influence of sea water, and excessive particulates in samples, were factors in site retention or termination. The evaluation of 21 ES sampling sites in four Haïtian cities led to the termination of 11 sites. Every-four-weekly sampling continues at the remaining 10 sites across the four cities as a core Global Polio Eradication Initiative activity.
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Affiliation(s)
- Mary M. Alleman
- Polio Eradication Branch, Centers for Disease Control and Prevention, Global Immunization Division, Atlanta, GA 30329, USA
- Correspondence: ; Tel.: +1-404-639-8703
| | - Angela D. Coulliette-Salmond
- Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA 30329, USA; (A.D.C.-S.); (C.C.B.); (E.V.)
- United States Public Health Service, Rockville, MD 20852, USA
| | - Pierre Wilnique
- Laboratory and Research, Division of Epidemiology, Ministère de la Santé Publique et de la Population (Ministry of Public Health and Population (MSPP)), Port au Prince HT6110, Haiti; (P.W.); (R.B.)
| | | | | | - Kimberly Wong
- IHRC, Inc., Atlanta, GA 30346, USA; (H.B.-W.); (K.W.)
- Cherokee Nation Assurance, Catoosa, OK 74015, USA;
| | - Edmund Gue
- Pan American Health Organization, World Health Organization, Region of the Americas, Port au Prince HT6110, Haiti;
| | - Robert Barrais
- Laboratory and Research, Division of Epidemiology, Ministère de la Santé Publique et de la Population (Ministry of Public Health and Population (MSPP)), Port au Prince HT6110, Haiti; (P.W.); (R.B.)
| | - Gloria Rey-Benito
- Pan American Health Organization, World Health Organization, Washington, DC 20037, USA;
| | - Cara C. Burns
- Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA 30329, USA; (A.D.C.-S.); (C.C.B.); (E.V.)
| | - Everardo Vega
- Polio and Picornavirus Laboratory Branch, Centers for Disease Control and Prevention, Division of Viral Diseases, Atlanta, GA 30329, USA; (A.D.C.-S.); (C.C.B.); (E.V.)
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Kotzé JL, Duncan Grewar J, Anderson A. Modelling the factors affecting the probability for local rabies elimination by strategic control. PLoS Negl Trop Dis 2021; 15:e0009236. [PMID: 33661893 PMCID: PMC7963038 DOI: 10.1371/journal.pntd.0009236] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/16/2021] [Accepted: 02/11/2021] [Indexed: 11/18/2022] Open
Abstract
Dog rabies has been recognized from ancient times and remains widespread across the developing world with an estimated 59,000 people dying annually from the disease. In 2011 a tri-partite alliance consisting of the OIE, the WHO and the FAO committed to globally eliminating dog-mediated human rabies by 2030. Regardless of global support, the responsibility remains with local program managers to implement successful elimination programs. It is well known that vaccination programs have a high probability of successful elimination if they achieve a population-coverage of 70%. It is often quoted that reducing population turnover (typically through sterilizations) raises the probability for local elimination by maintaining herd immunity for longer. Besides this, other factors that affect rabies elimination are rarely mentioned. This paper investigates the probability for local elimination as it relates to immunity, fecundity, dog population size, infectivity (bite rates), in-migration of immune-naïve dogs, and the initial incidence. To achieve this, an individual-based, stochastic, transmission model was manipulated to create a dataset covering combinations of factors that may affect elimination. The results thereof were analysed using a logistic regression model with elimination as the dependent variable. Our results suggest that smaller dog populations, lower infectivity and lower incidence (such as when epidemics start with single introductions) strongly increased the probability for elimination at wide ranges of vaccination levels. Lower fecundity and lower in-migration had weak effects. We discuss the importance of these findings in terms of their impact and their practical application in the design of dog-mediated rabies control programs. Most guidelines for rabies control call for at least 70% vaccination coverage of dogs. This level of immunity has a very high probability for the local elimination of rabies, but it is often not an achievable ideal due to resource constraints. Campaign managers can be strategic on how they allocate their resources. Lower infectivity rates are present in areas with more restricted dog movements and have higher probabilities for elimination at lower vaccination rates. Smaller sub-populations have higher probabilities for elimination at the same vaccination coverage levels compared to larger sub-populations. Vaccinating immune corridors can divide meta-populations into smaller sub-populations that are likely to result in elimination either due to their small size or due to the local low infectivity. Areas already free of rabies require lower vaccination levels to maintain freedom compared to endemic areas. Where donors do not specifically require sterilization campaigns, funds meant for rabies control should not be diverted to sterilizations.
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Affiliation(s)
- Johann L. Kotzé
- Department of Production Animal Studies, University of Pretoria, Onderstepoort, South Africa
- * E-mail:
| | - John Duncan Grewar
- Department of Production Animal Studies, University of Pretoria, Onderstepoort, South Africa
- jDATA (Pty) Ltd, Sandbaai, South Africa
| | - Aaron Anderson
- USDA National Wildlife Research Centre, Fort Collins, Colorado, United States of America
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Černe D, Hostnik P, Toplak I. The Successful Elimination of Sylvatic Rabies Using Oral Vaccination of Foxes in Slovenia. Viruses 2021; 13:405. [PMID: 33806582 PMCID: PMC8001208 DOI: 10.3390/v13030405] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 01/21/2023] Open
Abstract
Sylvatic rabies was present in Slovenia between 1973 and 2013, with the red fox as the main reservoir of the rabies virus. The first oral rabies vaccination (ORV) control program in foxes started in 1988, using the manual distribution of baits. Significant improvement of fox vaccination was achieved with the aerial distribution of baits, starting in 1995 and successfully finished with the final, fifty-ninth vaccination campaign in 2019. Between 1979 and 2019, a total of 86,471 samples were tested, and 10,975 (12.69%) rabies-positive animals were identified. Within the ORV, two different vaccines were used, containing modified live virus strain Street Alabama Dufferin (SAD) B19 and SAD Bern, while the last ORV campaigns were completed in 2019, with a vaccine containing a genetically modified strain of SPBN GASGAS. Molecular epidemiological studies of 95 rabies-positive samples, originating from red foxes, badgers, cattle, dogs, martens, cats, and horses, revealed a low genetic diversity of circulating strains and high similarity to strains from neighboring countries. During the elimination program, few vaccine-induced rabies cases were detected: three in red foxes and one case in a marten, with no epidemiological relevance. Slovenia has been officially declared a country free of rabies since 2016.
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Affiliation(s)
- Danijela Černe
- Institute of Microbiology and Parasitology, Virology Unit, Veterinary Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia; (P.H.); (I.T.)
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Patel AA, Bui A, Prohl E, Bhattacharya D, Wang S, Branch AD, Perumalswami PV. Innovations in Hepatitis C Screening and Treatment. Hepatol Commun 2021; 5:371-386. [PMID: 33681673 PMCID: PMC7917266 DOI: 10.1002/hep4.1646] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/20/2020] [Accepted: 11/01/2020] [Indexed: 12/11/2022] Open
Abstract
New therapies offer hope for a cure to millions of persons living with hepatitis C virus (HCV) infection. HCV elimination is a global goal that will be difficult to achieve using the traditional paradigms of diagnosis and care. The current standard has evolved toward universal HCV screening and treatment, to achieve elimination goals. There are several steps between HCV diagnosis and cure with major barriers along the way. Innovative models of care can address barriers to better serve hardly reached populations and scale national efforts in the United States and abroad. Herein, we highlight innovative models of HCV care that aid in our progress toward HCV elimination.
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Affiliation(s)
- Arpan A. Patel
- Division of Digestive DiseasesDavid Geffen School of Medicine at UCLALos AngelesCAUSA
- Greater Los Angeles Veterans Affairs Medical CenterLos AngelesCAUSA
| | - Aileen Bui
- Division of General Internal MedicineDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Eian Prohl
- Division of General Internal MedicineDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Debika Bhattacharya
- Greater Los Angeles Veterans Affairs Medical CenterLos AngelesCAUSA
- Division of Infectious DiseasesDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Su Wang
- Saint Barnabas Medical CenterLivingstonNJUSA
- World Hepatitis AllianceLondonUnited Kingdom
| | - Andrea D. Branch
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Ponni V. Perumalswami
- Division of Liver DiseasesIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Division of Gastroenterology and HepatologyUniversity of MichiganAnn ArborMichiganUSA
- Veterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
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Rajvanshi H, Jain Y, Kaintura N, Soni C, Chandramohan R, Srinivasan R, Telasey V, Bharti PK, Jain D, Surve M, Saxena S, Gangamwar V, Anand MS, Lal AA. A comprehensive mobile application tool for disease surveillance, workforce management and supply chain management for Malaria Elimination Demonstration Project. Malar J 2021; 20:91. [PMID: 33593359 PMCID: PMC7885520 DOI: 10.1186/s12936-021-03623-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 03/27/2020] [Accepted: 02/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health care technologies are now offering accountability, quality, robustness, and accuracy in disease surveillance and health care delivery programmes. With the advent of mobile hand-held devices, these technologies have become more accessible and adaptable for use by field staff working in remote areas. The Malaria Elimination Demonstration Project started collection of data and conduct of routine operations using paper-based reporting systems. Observing the need for a robust and quality digital mobile application, a comprehensive mobile application tool was developed that allowed the project to conduct disease surveillance, workforce management and supply chain management. METHODS In June 2017, the project conceptualized a comprehensive mobile application tool in the local language (Hindi) for disease surveillance, human resources management, and supply chain management. The tool is also available in English. Solution for Community Health-workers (SOCH) mobile app is an android native application developed using android SDK and web-based tool using MVC.net framework. Construction of the application started in November 2017 and rolled out its pilot in April 2018, followed by pan-district roll out in July 2018. The application uses self-validation tools to ensure high level of data quality and integrity. RESULTS The software is available in android based hand-held devices and web-screens with built-in data analytical capabilities. Using SOCH, the project has now successfully digitized its routine surveillance, attendance, tour plans, supply chain management components. The project has documented a reduction in 91% indigenous cases in the district, 60% improvement in stock accountability, and 99.6% accuracy in data collected through the mobile application. CONCLUSION SOCH is an excellent and user-friendly tool, which can be customized for any public health management programme. The system ensures accountability and data robustness, which is needed for malaria elimination efforts throughout the country. The mobile application can be adapted for English or any other Indian or international language for use for malaria or any other disease surveillance and control programme. Another expansion feature of this mobile application is incorporation of indicators for Indoor Residual Spraying (IRS), Long-Lasting Insecticidal Nets (LLINs), and minor engineering by the residents of community under surveillance. The authors believe that it would be highly desirable and appropriate for an international organization, such as the World Health Organization (WHO), to conduct an independent comparison of all available mobile e-surveillance tools, so that a high-performing and globally suitable system can be selected for use in malaria elimination programmes. The Foundation of Disease Elimination and Controlof India has decided to make the SOCH mobile application available to anyone who would like to use it for disease surveillance and health care programmes.
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Affiliation(s)
- Harsh Rajvanshi
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India.
| | | | | | - Chaitanya Soni
- Information Technology, Sun Pharmaceutical Industries Ltd, Mumbai, Maharashtra, India
| | | | | | - Vinay Telasey
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
| | - Praveen K Bharti
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Deepak Jain
- Information Technology, Sun Pharmaceutical Industries Ltd, Mumbai, Maharashtra, India
| | - Mangeshi Surve
- Information Technology, Sun Pharmaceutical Industries Ltd, Mumbai, Maharashtra, India
| | | | - Vilas Gangamwar
- Information Technology, Sun Pharmaceutical Industries Ltd, Mumbai, Maharashtra, India
| | - M S Anand
- Swaas Systems Pvt Ltd, Chennai, Tamil Nadu, India
| | - Altaf A Lal
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
- Foundation for Disease Elimination and Control of India, Mumbai, Maharashtra, India
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Thompson KM, Kalkowska DA. An Updated Economic Analysis of the Global Polio Eradication Initiative. Risk Anal 2021; 41:393-406. [PMID: 33590521 PMCID: PMC7894996 DOI: 10.1111/risa.13665] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 05/20/2023]
Abstract
Despite a strong global commitment, polio eradication efforts continue now more than 30 years after the 1988 World Health Assembly resolution that established the Global Polio Eradication Initiative (GPEI), and 20 years after the original target of the year 2000. Prior health economic analyses estimated incremental net benefits of the GPEI of 40-50 billion in 2008 U.S. dollars (US$2008, equivalent to 48-59 billion US$2019), assuming the achievement of polio eradication by 2012. Given the delays in achieving polio eradication and increased costs, we performed an updated economic analysis of the GPEI using an updated integrated global model, and considering the GPEI trajectory as of the beginning of 2020. Applying similar methods and assuming eradication achievement in 2023, we estimate incremental net benefits of the GPEI of 28 billion US$2019, which falls below the prior estimate. Delays in achieving polio eradication combined with the widescale introduction of relatively expensive inactivated poliovirus vaccine significantly increased the costs of the GPEI and make it less cost-effective, although the GPEI continues to yield expected incremental net benefits at the global level when considered over the time horizon of 1988-2029. The overall health and financial benefits of the GPEI will depend on whether and when the GPEI can achieve its goals, when eradication occurs, the valuation method applied, and the path dependence of the actions taken. Reduced expected incremental net benefits of the GPEI and the substantial economic impacts of the COVID-19 pandemic pose large financial risks for the GPEI.
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Scott RP, Cullen AC, Chabot‐Couture G. Disease Surveillance Investments and Administration: Limits to Information Value in Pakistan Polio Eradication. Risk Anal 2021; 41:273-288. [PMID: 32822075 PMCID: PMC7984073 DOI: 10.1111/risa.13580] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 07/28/2020] [Accepted: 08/01/2020] [Indexed: 05/04/2023]
Abstract
In Pakistan, annual poliovirus investment decisions drive quantities of supplemental immunization campaigns districts receive. In this article, we assess whether increased spending on poliovirus surveillance is associated with greater likelihood of correctly identifying districts at high risk of polio with assignment of an elevated "risk ranking." We reviewed programmatic documents from Pakistan for the period from 2012-2017, recording whether districts had been classified as "high risk" or "low risk" in each year. Through document review, we developed a decision tree to describe the ranking decisions. Then, integrating data from the World Health Organization and Global Polio Eradication Initiative, we constructed a Bayesian decision network reflecting investments in polio surveillance and immunization campaigns, surveillance metrics, disease incidence, immunization rates, and occurrence of polio cases. We test these factors for statistical association with the outcome of interest-a change in risk rank between the beginning and the end of the one-year time period. We simulate different spending scenarios and predict their impact on district risk ranking in future time periods. We find that per district spending increases are associated with increased identification of cases of acute flaccid paralysis (AFP). However, the low specificity of AFP investment and the largely invariant ranking of district risk means that even large increases in surveillance spending are unlikely to promote major changes in risk rankings at the current stage of the Pakistan polio eradication campaign.
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Affiliation(s)
- Ryan P. Scott
- Daniel J. Evans School of Public Policy and GovernanceUniversity of WashingtonSeattleWAUSA
- Political ScienceColorado State UniversityFort CollinsCOUSA
| | - Alison C. Cullen
- Daniel J. Evans School of Public Policy and GovernanceUniversity of WashingtonSeattleWAUSA
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Kalkowska DA, Pallansch MA, Wilkinson A, Bandyopadhyay AS, Konopka-Anstadt JL, Burns CC, Oberste MS, Wassilak SGF, Badizadegan K, Thompson KM. Updated Characterization of Outbreak Response Strategies for 2019-2029: Impacts of Using a Novel Type 2 Oral Poliovirus Vaccine Strain. Risk Anal 2021; 41:329-348. [PMID: 33174263 PMCID: PMC7887065 DOI: 10.1111/risa.13622] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/08/2020] [Accepted: 10/16/2020] [Indexed: 05/06/2023]
Abstract
Delays in achieving the global eradication of wild poliovirus transmission continue to postpone subsequent cessation of all oral poliovirus vaccine (OPV) use. Countries must stop OPV use to end all cases of poliomyelitis, including vaccine-associated paralytic polio (VAPP) and cases caused by vaccine-derived polioviruses (VDPVs). The Global Polio Eradication Initiative (GPEI) coordinated global cessation of all type 2 OPV (OPV2) use in routine immunization in 2016 but did not successfully end the transmission of type 2 VDPVs (VDPV2s), and consequently continues to use type 2 OPV (OPV2) for outbreak response activities. Using an updated global poliovirus transmission and OPV evolution model, we characterize outbreak response options for 2019-2029 related to responding to VDPV2 outbreaks with a genetically stabilized novel OPV (nOPV2) strain or with the currently licensed monovalent OPV2 (mOPV2). Given uncertainties about the properties of nOPV2, we model different assumptions that appear consistent with the evidence on nOPV2 to date. Using nOPV2 to respond to detected cases may reduce the expected VDPV and VAPP cases and the risk of needing to restart OPV2 use in routine immunization compared to mOPV2 use for outbreak response. The actual properties, availability, and use of nOPV2 will determine its effects on type 2 poliovirus transmission in populations. Even with optimal nOPV2 performance, countries and the GPEI would still likely need to restart OPV2 use in routine immunization in OPV-using countries if operational improvements in outbreak response to stop the transmission of cVDPV2s are not implemented effectively.
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Affiliation(s)
| | - Mark A. Pallansch
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amanda Wilkinson
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jennifer L. Konopka-Anstadt
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cara C. Burns
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M. Steven Oberste
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Steven G. F. Wassilak
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Kimberly M. Thompson
- Kid Risk, Inc., Orlando, FL, USA
- Correspondence to: Kimberly Thompson, Kid Risk, Inc., 7512 Dr. Phillips Blvd. #50-523, Orlando, FL 32819, USA,
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Kalkowska DA, Pallansch MA, Cochi SL, Kovacs SD, Wassilak SGF, Thompson KM. Updated Characterization of Post-OPV Cessation Risks: Lessons from 2019 Serotype 2 Outbreaks and Implications for the Probability of OPV Restart. Risk Anal 2021; 41:320-328. [PMID: 32632925 PMCID: PMC7814395 DOI: 10.1111/risa.13555] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/15/2020] [Accepted: 06/22/2020] [Indexed: 05/06/2023]
Abstract
After the globally coordinated cessation of any serotype of oral poliovirus vaccine (OPV), some risks remain from undetected, existing homotypic OPV-related transmission and/or restarting transmission due to several possible reintroduction risks. The Global Polio Eradication Initiative (GPEI) coordinated global cessation of serotype 2-containing OPV (OPV2) in 2016. Following OPV2 cessation, the GPEI and countries implemented activities to withdraw all the remaining trivalent OPV, which contains all three poliovirus serotypes (i.e., 1, 2, and 3), from the supply chain and replace it with bivalent OPV (containing only serotypes 1 and 3). However, as of early 2020, monovalent OPV2 use for outbreak response continues in many countries. In addition, outbreaks observed in 2019 demonstrated evidence of different types of risks than previously modeled. We briefly review the 2019 epidemiological experience with serotype 2 live poliovirus outbreaks and propose a new risk for unexpected OPV introduction for inclusion in global modeling of OPV cessation. Using an updated model of global poliovirus transmission and OPV evolution with and without consideration of this new risk, we explore the implications of the current global situation with respect to the likely need to restart preventive use of OPV2 in OPV-using countries. Simulation results without this new risk suggest OPV2 restart will likely need to occur (81% of 100 iterations) to manage the polio endgame based on the GPEI performance to date with existing vaccine tools, and with the new risk of unexpected OPV introduction the expected OPV2 restart probability increases to 89%. Contingency planning requires new OPV2 bulk production, including genetically stabilized OPV2 strains.
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Affiliation(s)
| | - Mark A. Pallansch
- National Center for Immunization and Respiratory, Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephen L. Cochi
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephanie D. Kovacs
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Steven G. F. Wassilak
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Thompson KM, Kalkowska DA. Reflections on Modeling Poliovirus Transmission and the Polio Eradication Endgame. Risk Anal 2021; 41:229-247. [PMID: 32339327 PMCID: PMC7983882 DOI: 10.1111/risa.13484] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 05/06/2023]
Abstract
The Global Polio Eradication Initiative (GPEI) partners engaged modelers during the past nearly 20 years to support strategy and policy discussions and decisions, and to provide estimates of the risks, costs, and benefits of different options for managing the polio endgame. Limited efforts to date provided insights related to the validation of the models used for GPEI strategy and policy decisions. However, modeling results only influenced decisions in some cases, with other factors carrying more weight in many key decisions. In addition, the results from multiple modeling groups do not always agree, which supports selection of some strategies and/or policies counter to the recommendations from some modelers but not others. This analysis reflects on our modeling, and summarizes our premises and recommendations, the outcomes of these recommendations, and the implications of key limitations of models with respect to polio endgame strategy. We briefly review the current state of the GPEI given epidemiological experience as of early 2020, which includes failure of the GPEI to deliver on the objectives of its 2013-2018 strategic plan despite full financial support. Looking ahead, we provide context for why the GPEI strategy of global oral poliovirus vaccine (OPV) cessation to end all cases of poliomyelitis looks infeasible given the current state of the GPEI and the failure to successfully stop all transmission of serotype 2 live polioviruses within four years of the April-May 2016 coordinated cessation of serotype 2 OPV use in routine immunization.
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