Serogroup A meningococcal conjugate (PsA-TT) vaccine coverage and measles vaccine coverage in Burkina Faso—Implications for introduction of PsA-TT into the Expanded Programme on Immunization

BackgroundA new serogroup A meningococcal conjugate vaccine (PsA-TT, MenAfriVac™) has been developed to combat devastating serogroup A Neisseria meningitis (MenA) epidemics in Africa. A mass immunization campaign targeting 1–29 year olds was conducted in Burkina Faso in December 2010. Protection of subsequent infant cohorts will be necessary through either introduction of PsA-TT into the routine Expanded Programme on Immunization (EPI) or periodic repeat mass vaccination campaigns.ObjectivesTo inform future immunization policy for PsA-TT vaccination of infants through a comparison of PsA-TT campaign vaccination coverage and routine measles-containing vaccine (MCV) coverage in Burkina Faso.MethodsA national survey was conducted in Burkina Faso during December 17–27, 2011 using stratified cluster sampling to assess PsA-TT vaccine coverage achieved by the 2010 nationwide immunization campaign among 2–30 year olds and routine MCV coverage among 12–23 month olds. Coverage estimates and 95% Confidence Intervals (CI) were calculated, reasons for non-vaccination and methods of campaign communication were described, and a multivariable analysis for factors associated with vaccination was conducted.ResultsNational overall PsA-TT campaign coverage was 95.9% (95% CI: 95.0–96.7) with coverage greater than 90% all 13 regions of Burkina Faso. National overall routine MCV coverage was 92.5% (95% CI: 90.5–94.1), but ranged from 75.3% to 95.3% by region. The primary predictor for PsA-TT vaccination among all age groups was a head of household informed of the campaign. PsA-TT vaccination was more likely in residents of rural settings, whereas MCV vaccination was more likely in residents of urban settings.ConclusionOverall national vaccination rates in Burkina Faso were similar for PsA-TT and MCV vaccine. The regions with MCV coverage below targets may be at risk for sub-optimal vaccination coverage if PsA-TT is introduced in EPI. These results highlight the need for assessments of routine vaccination coverage to guide PsA-TT immunization policy in meningitis belt countries.     

Polymorphisms in genes involved in enamel development are associated with dental fluorosis

ObjectiveTo evaluate the association between polymorphisms in DLX1, DLX2, MMP13, TIMP1 and TIMP2 genes with dental fluorosis (DF) phenotype.DesignFour hundred and eighty one subjects (108 with DF and 373 DF free) from 6 to 18 years of age were recruited. This population lived in Rio de Janeiro, a city with fluoridation of public water supplies. DF was assessed using the Deańs index modified. Only erupted permanent teeth were assessed. Genetic polymorphisms in DLX1, DLX2, MMP13, TIMP1 and TIMP2 were analyzed by real-time PCR from genomic DNA. Association between DF, genotype, and allele distribution were evaluated using chi-square and logistic regression analyses with an alpha level of 5%.ResultsDF was more prevalent in Afro-descendants than in Caucasians (p = 0.08; OR = 1.83; CI 95% = 1.18–2.82). Logistic regression analysis adjusted by the ethnicity demonstrated a statistical difference for TIMP1 genotype (p = 0.033; OR = 2.93, 95%CI, 1.09–7.90). When only the severer cases of DF were analyzed, polymorphisms in DLX1 and DLX2 were associated with DF (p < 0.05).ConclusionOur results provided evidence that polymorphisms in TIMP1, DLX1 and DLX2 genes may be associated with DF phenotypes.     

Discourse on hygiene between hospitalized patients and health care workers as an accepted norm: Making it legitimate to remind health care workers about hand hygiene

BackgroundDespite World Health Organization recommendations that patients should play a role in encouraging hand hygiene (HH) as a means of preventing infection, patient engagement remains an underused method. From the perspectives of hospitalized patients (HPs) and health care workers (HCWs) at 2 major public hospitals in Haifa, Israel, this research investigated (1) HP barriers to reminding HCWs to maintain HH, (2) HCW barriers to giving HPs instruction on proper hygiene, (3) what could help HPs and HCWs overcome these barriers, and (4) how video clips can be used to devise tailored strategies governing discourse on HH between HCWs and HPs.MethodsIntervention type 2 design and examination of 2 population groups—HPs and HCWs—before and after intervention by means of mixed methods research.ResultsBoth HPs and HCWs reported partial knowledge, embarrassment, and fears regarding commenting to staff, as well as a lack of cultural adaptation. The interviewees indicated that the video clips granted legitimacy to reminding HCWs about hygiene through strategies designed to identify and solve barriers, authenticity, and cultural adaptation.ConclusionsTo overcome HP and HCW barriers to maintaining HH, tailored video clips on HH should specify barriers and solutions with which they can both identify, thus turning discourse on HH into an accepted norm.     

装修所致室内空气污染对健康的影响

目的通过对新装修住宅的室内空气质量检测和居民健康状况调查,研究室内空气污染物对居民健康的危害。方法检测159户新装修6月～1年的居室室内空气中甲醛、总挥发性有机物(TVOC)、氨和放射性氡的浓度,并用问卷调查居民的健康状况。以各个污染物浓度是否超过国家标准分组分析其对居民健康的影响。结果超标组和达标组室内空气中甲醛浓度分别为(0.170±0.075)mg m3,(0.064±0.022)mg m3;TVOC超标组和TVOC达标组室内空气中TVOC浓度分别为(2.033±1.161)mg m3,(0.271±0.142)mg m3。甲醛超标组居民疲劳、恶心、眼部刺激症状、鼻部刺激症状、喉咙干燥、皮肤干燥、皮肤骚痒、皮肤红肿的阳性率均明显高于甲醛达标组(均P<0.05)。TVOC超标组居民恶心、皮肤骚痒、胸闷气短3个指标阳性率明显高于TVOC达标组(均P<0.05)。结论装修可致室内空气中甲醛和TVOC超标,并可引起明显居民恶心、眼部刺激症状和皮肤刺激等症状,严重损害了居民健康。     

An economic evaluation of the current measles vaccination program: A case study in Zhejiang Province,east China

ObjectiveTo evaluate the economic impact of the current measles vaccination program in Zhejiang Province, east China.MethodsA decision tree-Markov model with parameters from published literatures, government documents and surveys was developed and used to simulate over 40 years of a birth cohort in Zhejiang Province during the year 2014. The expected cost and effectiveness of the current measles vaccination program was compared against no vaccination. Costs were assessed from the payer's perspective. Benefits were defined as savings on the direct cost of measles treatment, and the effectiveness was measured according to the number of measles cases and deaths averted. The net present value (NPV), benefit-cost ratio (BCR) and incremental cost-effectiveness ratio (ICER) were also calculated. A threshold for cost-effectiveness of less than 3 times the Gross Domestic Product (GDP) per capita was used. One-way sensitivity analysis was performed to assess parameter uncertainties.ResultsThe total vaccination cost was estimated to be $2.52 million. The BCR of the current measles program was found to be 6.06 with a NPV of $73.38 million. It was also calculated that a total of 195,165 measles cases and 191 measles-related deaths would be prevented by vaccination. The ICER was approximately $12.91 per case averted and $13,213.43 per death averted, respectively, which was cost-effective. The models were proven to be robust.ConclusionsThe current measles vaccination program appeared to be cost-effective and to offer substantial benefits. The results of this analysis sought to contribute to the justification of future investments to achieve the goal of measles elimination.     

A nested case-control study measuring pertussis vaccine effectiveness and duration of protection in Manitoba,Canada, 1992–2015: A Canadian Immunization Research Network Study

BackgroundPertussis persists in Manitoba despite the universal availability of pertussis vaccines. Recent cases have included previously vaccinated individuals, raising concerns about declining vaccine effectiveness (VE). We measured pertussis VE and duration of protection using Manitoba’s provincial immunization and communicable disease registries.MethodsUsing a nested case-control design, individuals with laboratory-confirmed pertussis in Manitoba diagnosed between April 1, 1992, and March 31, 2015, were matched to up to five population-based controls on age, gender, geography, and case physician or number of physician visits. Conditional logistic regression was used to estimate VE against pertussis for both the whole-cell (wP) and acellular (aP) pertussis vaccines. Duration of protection was assessed using time since last dose.ResultsData on 534 eligible cases and 2614 controls were available for analysis. The adjusted VE estimate for aP-containing vaccines was 85% (95%CI: 74–91%); VE was 89% (66–96%) one to three years after the last vaccination. The adjusted VE of wP-containing vaccines was –15% (–91–31%) during a large outbreak in 1994 and 1995 compared to 35% (–26–66%) during non-outbreak years.ConclusionsOur estimates suggest that the aP vaccine was effective in preventing pertussis since its introduction in Manitoba. VE was lower during a large outbreak, highlighting the importance of separately analyzing outbreak periods when estimating pertussis VE over time.     

天津市新型冠状病毒肺炎聚集性疫情病例分析

目的 分析天津市新型冠状病毒肺炎（COVID-19）聚集性疫情病例情况,掌握不同类型聚集性病例发病特征,为COVID-19防控提供流行病学证据和经验。方法 收集截至2020年2月22日天津市全部COVID-19确诊病例的聚集性资料,梳理和分析不同类型聚集性疫情发病特点。结果 截至2月22日,天津市共报告COVID-19聚集性疫情33起,涉及病例115例。聚集性病例分为4类：家庭聚集（28起,71例）、单位聚集（1起,10例）、交通工具（3起,8例）和公共场所（1起,26例）,其中单位和公共场所聚集性疫情中的病例又导致了14起家庭聚集性疫情。家庭聚集的续发病例1~7例,中位数为2例。家庭首发病例发病到确诊时间长于续发病例（Z=-2.406,P=0.016）。公共场所聚集的潜伏期中位数为7 d。家庭、单位和公共场所3类聚集性疫情相比较,病例发病到确诊时间差异有统计学意义（H=8.843,P=0.012）,续发病例发病时间差异有统计学意义（H=16.607,P=0.000）。结论 COVID-19疫情监测应特别关注容易发生聚集性疫情场所,及时开展细致的流行病学调查和排查。出现聚集性疫情的场所内部,应及时将密切接触者转至统一的隔离观察点,严格单间管理,避免疫情扩散。部分农村地区防疫意识不强,聚集活动较多,且发病后就诊不及时,在疫情初期应该加强防控的宣传和控制措施。     

天津市1999－2015年慢性非传染性疾病过早死亡趋势分析

目的 分析1999-2015年天津市30~69岁居民心脑血管疾病、肿瘤、糖尿病和慢性呼吸系统疾病过早死亡及其变动趋势,探讨其在不同特征人群中的特点并评价危害程度。方法 采用天津市CDC收集的居民全死因监测数据,户籍人口信息源自天津市公安局。以2000年世界标准人口计算年龄别、性别标化死亡率,根据WHO推荐的早死概率计算方法统计居民过早死亡概率,采用Joinpoint回归和Cochran-Armitage趋势检验分析17年的变化趋势以及在不同年龄、性别以及城乡之间分布差异。结果 1999-2015年天津市慢性非传染性疾病（慢性病）过早死亡标化死亡率为382.38/10万至250.95/10万,呈逐年下降趋势[年度变化百分比（APC）=-2.41%,P<0.001],过早死亡概率为19.67%~12.85%,呈逐年下降趋势（APC=-2.49%,P<0.001）。心脑血管疾病、恶性肿瘤、慢性呼吸系统疾病和糖尿病过早死亡概率均呈下降趋势（APC分别为-2.92%、-1.13%、-9.51%和-3.39%,均P<0.001）。男性慢性病过早死亡呈逐年下降趋势,过早死亡概率为22.27%~16.47%（APC=-1.59%,P<0.001）。女性慢性病过早死亡低于男性,过早死亡概率为17.02%~9.17%,也呈逐年下降趋势（APC=-3.84%,P<0.001）,下降趋势快于男性。城市居民慢性病过早死亡概率为21.04%~12.34%（APC=-3.26%,P<0.001）;农村居民慢性病过早死亡概率为17.80%~13.54%（APC=-1.54%,P<0.001）。农村居民慢性病过早死亡由原先低于城市逐渐高于城市。结论 1999-2015年天津市居民慢性病过早死亡呈下降趋势,男性、农村居民为过早死亡高发人群。     

Severe underestimation of pertussis related hospitalizations and deaths in the Netherlands: A capture-recapture analysis

OjectiveDespite vaccination, pertussis has remained endemic, sometimes leading to severe disease. We aimed to quantify the completeness of reporting (CoR) of pertussis hospitalizations and deaths in the Netherlands.Study designCoR was estimated using capture-recapture analyses. Hospitalizations (2007–2014) from the National Registration Hospital Care (hospital data) were matched to the notifiable Infectious Disease case registry (notifications) providing (month and) year of birth, gender and postal code. Deaths (1996–2014) from Statistics Netherlands (death registry) were matched to notifications using gender, age, year of death and notification date. Cases <2 years (y) and ≥2y were analysed separately. Chao’s estimator estimated the total population, which was used to calculate CoR.ResultsUsing strict matching criteria, we found 461 matches among 876 (hospital data) and 757 (notifications) hospitalizations <2y. The population estimate of hospitalized infants was 1446, resulting in CoR between 52% and 61%. For hospitalizations ≥2y (246; hospital data and 264; notifications) 43 matches were found, with a population estimate of 1512 and CoR between 16.5% and 22%.Among thirteen (death registry) and eight (notifications) deaths <2y, seven cases overlapped. The population estimate was 16. CoR of the two sources was 50–81%. With two (death registry) and eight (notifications) deaths ≥2y without overlap, the population estimate was 26 and CoR 8–31%.ConclusionResults showed substantial underestimation of pertussis hospitalizations and deaths. This has to be taken into account in evaluation of current and future immunization programs.