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Adekunle TB, Ringel JV, Williams MS, Faherty LJ. Continuity of Trust: Health Systems' Role in Advancing Health Equity Beyond the COVID-19 Pandemic. Community Health Equity Res Policy 2024; 44:323-329. [PMID: 37400357 PMCID: PMC10333557 DOI: 10.1177/2752535x231185221] [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] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Given COVID-19's disproportionate impact on populations that identify as Black, Indigenous, and People of Color (BIPOC) in the United States, researchers and advocates have recommended that health systems and institutions deepen their engagement with community-based organizations (CBOs) with longstanding relationships with these communities. However, even as CBOs leverage their earned trust to promote COVID-19 vaccination, health systems and institutions must also address underlying causes of health inequities more broadly. In this commentary, we discuss key lessons learned about trust from our participation in the U.S. Equity-First Vaccination Initiative, an effort funded by The Rockefeller Foundation to promote COVID-19 vaccination equity. The first lesson is that trust cannot be "surged" to meet the needs of the moment until it is no longer deemed important; rather, it must predate and outlast the crisis. Second, to generate long-term change, health systems cannot simply rely on CBOs to bridge the trust gap; instead, they must directly address the root causes of this gap among BIPOC populations.
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Affiliation(s)
| | | | | | - Laura J. Faherty
- RAND Corporation, Boston, MA, USA
- Department of Pediatrics, Maine Medical Center, Portland, ME, USA
- Tufts University School of Medicine, Boston, MA, USA
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Keshaviah A, Huff I, Hu XC, Guidry V, Christensen A, Berkowitz S, Reckling S, Noble RT, Clerkin T, Blackwood D, McLellan SL, Roguet A, Musse I. Separating signal from noise in wastewater data: An algorithm to identify community-level COVID-19 surges in real time. Proc Natl Acad Sci U S A 2023; 120:e2216021120. [PMID: 37490532 PMCID: PMC10401018 DOI: 10.1073/pnas.2216021120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 06/11/2023] [Indexed: 07/27/2023] Open
Abstract
Wastewater monitoring has provided health officials with early warnings for new COVID-19 outbreaks, but to date, no approach has been validated to distinguish signal (sustained surges) from noise (background variability) in wastewater data to alert officials to the need for heightened public health response. We analyzed 62 wk of data from 19 sites participating in the North Carolina Wastewater Monitoring Network to characterize wastewater metrics around the Delta and Omicron surges. We found that wastewater data identified outbreaks 4 to 5 d before case data (reported on the earlier of the symptom start date or test collection date), on average. At most sites, correlations between wastewater and case data were similar regardless of how wastewater concentrations were normalized and whether calculated with county-level or sewershed-level cases, suggesting that officials may not need to geospatially align case data with sewershed boundaries to gain insights into disease transmission. Although wastewater trend lines captured clear differences in the Delta versus Omicron surge trajectories, no single wastewater metric (detectability, percent change, or flow-population normalized viral concentrations) reliably signaled when these surges started. After iteratively examining different combinations of these three metrics, we developed the Covid-SURGE (Signaling Unprecedented Rises in Groupwide Exposure) algorithm, which identifies unprecedented signals in the wastewater data. With a true positive rate of 82%, a false positive rate of 7%, and strong performance during both surges and in small and large sites, our algorithm provides public health officials with an automated way to flag community-level COVID-19 surges in real time.
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Affiliation(s)
| | - Ian Huff
- Mathematica, Inc., Princeton, NJ 08543
| | | | - Virginia Guidry
- North Carolina Department of Health and Human Services, Division of Public Health, Raleigh, NC 27609
| | - Ariel Christensen
- North Carolina Department of Health and Human Services, Division of Public Health, Raleigh, NC 27609
| | - Steven Berkowitz
- North Carolina Department of Health and Human Services, Division of Public Health, Raleigh, NC 27609
| | - Stacie Reckling
- North Carolina Department of Health and Human Services, Division of Public Health, Raleigh, NC 27609
| | - Rachel T Noble
- Institute of Marine Sciences, University of North Carolina-Chapel Hill, Morehead City, NC 28557
| | - Thomas Clerkin
- Institute of Marine Sciences, University of North Carolina-Chapel Hill, Morehead City, NC 28557
| | - Denene Blackwood
- Institute of Marine Sciences, University of North Carolina-Chapel Hill, Morehead City, NC 28557
| | - Sandra L McLellan
- School of Freshwater Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI 53204
| | - Adélaïde Roguet
- School of Freshwater Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI 53204
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Kangas ST, Coulibaly IN, Tausanovitch Z, Ouologuem B, Marron B, Radin E, Ritz C, Dembele S, Ouédraogo CT, Bailey J. Post-Recovery Relapse of Children Treated with a Simplified, Combined Nutrition Treatment Protocol in Mali: A Prospective Cohort Study. Nutrients 2023; 15:nu15112636. [PMID: 37299599 DOI: 10.3390/nu15112636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
The present study aimed to determine the 6-month incidence of relapse and associated factors among children who recovered from acute malnutrition (AM) following mid-upper arm circumference (MUAC)-based simplified combined treatment using the ComPAS protocol. A prospective cohort of 420 children who had reached a MUAC ≥ 125 mm for two consecutive measures was monitored between December 2020 and October 2021. Children were seen at home fortnightly for 6 months. The overall 6-month cumulative incidence of relapse [95%CI] into MUAC < 125 mm and/or edema was 26.1% [21.7; 30.8] and 1.7% [0.6; 3.6] to MUAC < 115 mm and/or edema. Relapse was similar among children initially admitted to treatment with a MUAC < 115 mm and/or oedema and among those with a MUAC ≥ 115 mm but <125 mm. Relapse was predicted by lower anthropometry both at admission to and discharge from treatment, and a higher number of illness episodes per month of follow-up. Having a vaccination card, using an improved water source, having agriculture as the main source of income, and increases in caregiver workload during follow-up all protected from relapse. Children discharged as recovered from AM remain at risk of relapsing into AM. To achieve reduction in relapse, recovery criteria may need to be revised and post-discharge strategies tested.
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Affiliation(s)
| | | | | | | | | | | | - Christian Ritz
- National Institute of Public Health, Copenhagen, Denmark
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Faherty LJ, Schulson L, Gandhi P, Howell K, Wolfe R, Ringel JS. Promising Practices for Ensuring Equity in COVID-19 Vaccination: The Devil's in the Details. Public Health Rep 2022; 137:630-636. [PMID: 35499111 PMCID: PMC9066272 DOI: 10.1177/00333549221086579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Laura J. Faherty
- RAND Corporation, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Lucy Schulson
- RAND Corporation, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
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Li SL, Acosta AL, Hill SC, Brady OJ, de Almeida MAB, Cardoso JDC, Hamlet A, Mucci LF, Telles de Deus J, Iani FCM, Alexander NS, Wint GRW, Pybus OG, Kraemer MUG, Faria NR, Messina JP. Mapping environmental suitability of Haemagogus and Sabethes spp. mosquitoes to understand sylvatic transmission risk of yellow fever virus in Brazil. PLoS Negl Trop Dis 2022; 16:e0010019. [PMID: 34995277 PMCID: PMC8797211 DOI: 10.1371/journal.pntd.0010019] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 04/15/2021] [Revised: 01/28/2022] [Accepted: 11/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Yellow fever (YF) is an arboviral disease which is endemic to Brazil due to a sylvatic transmission cycle maintained by infected mosquito vectors, non-human primate (NHP) hosts, and humans. Despite the existence of an effective vaccine, recent sporadic YF epidemics have underscored concerns about sylvatic vector surveillance, as very little is known about their spatial distribution. Here, we model and map the environmental suitability of YF's main vectors in Brazil, Haemagogus spp. and Sabethes spp., and use human population and NHP data to identify locations prone to transmission and spillover risk. METHODOLOGY/PRINCIPAL FINDINGS We compiled a comprehensive set of occurrence records on Hg. janthinomys, Hg. leucocelaenus, and Sabethes spp. from 1991-2019 using primary and secondary data sources. Linking these data with selected environmental and land-cover variables, we adopted a stacked regression ensemble modelling approach (elastic-net regularized GLM, extreme gradient boosted regression trees, and random forest) to predict the environmental suitability of these species across Brazil at a 1 km x 1 km resolution. We show that while suitability for each species varies spatially, high suitability for all species was predicted in the Southeastern region where recent outbreaks have occurred. By integrating data on NHP host reservoirs and human populations, our risk maps further highlight municipalities within the region that are prone to transmission and spillover. CONCLUSIONS/SIGNIFICANCE Our maps of sylvatic vector suitability can help elucidate potential locations of sylvatic reservoirs and be used as a tool to help mitigate risk of future YF outbreaks and assist in vector surveillance. Furthermore, at-risk regions identified from our work could help disease control and elucidate gaps in vaccination coverage and NHP host surveillance.
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Affiliation(s)
- Sabrina L. Li
- School of Geography and the Environment, University of Oxford, Oxford, United Kingdom
- * E-mail: (SLL); (JPM)
| | - André L. Acosta
- Departamento de Ecologia, Instituto de Biociências, Laboratório de Ecologia de Paisagens e Conservação—LEPAC, Universidade de São Paulo, São Paulo, Brazil
| | - Sarah C. Hill
- Department of Pathobiology and Population Sciences, Royal Veterinary College London, London, United Kingdom
| | - Oliver J. Brady
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Marco A. B. de Almeida
- State Centre of Health Surveillance, Rio Grande do Sul State Health Secretariat, Rio Grande do Sul, Brazil
| | - Jader da C. Cardoso
- State Centre of Health Surveillance, Rio Grande do Sul State Health Secretariat, Rio Grande do Sul, Brazil
| | - Arran Hamlet
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Luis F. Mucci
- Superintendence for Endemic Diseases Control, São Paulo State Health Secretariat, São Paulo, Brazil
| | - Juliana Telles de Deus
- Superintendence for Endemic Diseases Control, São Paulo State Health Secretariat, São Paulo, Brazil
| | | | - Neil S. Alexander
- Environmental Research Group Oxford, c/o Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - G. R. William Wint
- Environmental Research Group Oxford, c/o Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Oliver G. Pybus
- Department of Pathobiology and Population Sciences, Royal Veterinary College London, London, United Kingdom
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | | | - Nuno R. Faria
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
- Department of Zoology, University of Oxford, Oxford, United Kingdom
- Departamento de Molestias Infecciosas e Parasitarias & Instituto de Medicina Tropical da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Jane P. Messina
- School of Geography and the Environment, University of Oxford, Oxford, United Kingdom
- Oxford School of Global and Area Studies, University of Oxford, Oxford, United Kingdom
- * E-mail: (SLL); (JPM)
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Rice BL, Golden CD, Anjaranirina EJG, Botelho CM, Volkman SK, Hartl DL. Genetic evidence that the Makira region in northeastern Madagascar is a hotspot of malaria transmission. Malar J 2016; 15:596. [PMID: 27998292 PMCID: PMC5175380 DOI: 10.1186/s12936-016-1644-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 08/30/2016] [Accepted: 12/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Encouraging advances in the control of Plasmodium falciparum malaria have been observed across much of Africa in the past decade. However, regions of high relative prevalence and transmission that remain unaddressed or unrecognized provide a threat to this progress. Difficulties in identifying such localized hotspots include inadequate surveillance, especially in remote regions, and the cost and labor needed to produce direct estimates of transmission. Genetic data can provide a much-needed alternative to such empirical estimates, as the pattern of genetic variation within malaria parasite populations is indicative of the level of local transmission. Here, genetic data were used to provide the first empirical estimates of P. falciparum malaria prevalence and transmission dynamics for the rural, remote Makira region of northeastern Madagascar. METHODS Longitudinal surveys of a cohort of 698 total individuals (both sexes, 0-74 years of age) were performed in two communities bordering the Makira Natural Park protected area. Rapid diagnostic tests, with confirmation by molecular methods, were used to estimate P. falciparum prevalence at three seasonal time points separated by 4-month intervals. Genomic loci in a panel of polymorphic, putatively neutral markers were genotyped for 94 P. falciparum infections and used to characterize genetic parameters known to correlate with transmission levels. RESULTS Overall, 27.8% of individuals tested positive for P. falciparum over the 10-month course of the study, a rate approximately sevenfold higher than the countrywide average for Madagascar. Among those P. falciparum infections, a high level of genotypic diversity and a high frequency of polygenomic infections (68.1%) were observed, providing a pattern consistent with high and stable transmission. CONCLUSIONS Prevalence and genetic diversity data indicate that the Makira region is a hotspot of P. falciparum transmission in Madagascar. This suggests that the area should be highlighted for future interventions and that additional areas of high transmission may be present in ecologically similar regions nearby.
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Affiliation(s)
- Benjamin L. Rice
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA USA
| | - Christopher D. Golden
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Harvard University Center for the Environment, Cambridge, MA USA
- Madagascar Health and Environmental Research (MAHERY), Maroantsetra, Madagascar
| | | | | | - Sarah K. Volkman
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Daniel L. Hartl
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA USA
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