Hepatitis A vaccination coverage among adults aged 18–49 years in the United States

Background

Hepatitis A is the most common type of hepatitis reported in the United States. Prior to hepatitis A vaccine introduction in 1996, hepatitis A incidence followed a cyclic pattern with peak incidence occurring every 10–15 years. During 1980–1995, between 22,000 and 36,000 hepatitis A cases were reported annually. Since 1996, hepatitis A vaccination recommendations have included adults at risk for infection and children living in communities with the highest disease rates. This study provides the first national estimates of self-reported hepatitis A vaccination coverage among persons aged 18–49 years in the United States.

Methods

We analyzed the 2007 National Immunization Survey-Adult (NIS-Adult) data with restrictions to individuals aged 18–49 years. National estimates of hepatitis A vaccination coverage were calculated based on self-report and multivariable logistic regression analysis was used to identify factors independently associated with hepatitis A vaccination status.

Results

Among adults aged 18–49 years, 12.1% (95% confidence interval, CI = 9.9–14.8%) had received two or more doses of hepatitis A vaccine in 2007. Hepatitis A vaccination coverage was significantly higher among adults aged 18–29 years (15.6%) and adults aged 30–39 years (12.9%) compared with adults aged 40–49 years (8.3%). Coverage was significantly lower for Hispanics (7.1%) compared with non-Hispanic whites (12.5%). Characteristics independently associated with a higher likelihood of hepatitis A vaccination among persons aged 18–49 years included younger age groups, persons at or above poverty level, persons with public medical insurance, and persons who received influenza vaccination in the past season.

Conclusions

In 2007, self-reported hepatitis A vaccination coverage among adults aged 18–49 years was 12.1%. These data provide the first national hepatitis A vaccination coverage estimates among adults and are very important in planning and implementing strategies for increasing hepatitis A vaccination coverage among adults at risk for hepatitis A.     

Prevalence and predictors of physical inactivity levels among Kenyan adults (18–69 years): an analysis of STEPS survey 2015

Background

Physical inactivity accounts for more than 3 million deaths worldwide, and is implicated in causing 6% of coronary heart diseases, 7% of diabetes, and 10% of colon or breast cancer. Globally, research has shown that modifying four commonly shared risky behaviours, including poor nutrition, tobacco use, harmful use of alcohol, and physical inactivity, can reduce occurrence of non-communicable diseases (NCDs). Risk factor surveillance through population-based periodic surveys, has been identified as an effective strategy to inform public health interventions in NCD control. The stepwise approach to surveillance (STEPS) survey is one such initiative, and Kenya carried out its first survey in 2015. This study sought to describe the physical inactivity risk factors from the findings of the Kenya STEPS survey.

Methods

This study employed countrywide representative survey administered between April and June 2015. A three stage cluster sampling design was used to select clusters, households and eligible individuals. All adults between 18 and 69 years in selected households were eligible. Data on demographic, behavioural, and biochemical characteristics were collected. Prevalence of physical inactivity was computed. Logistic regression used to explore factors associated with physical inactivity.

Results

A total of 4500 individuals consented to participate from eligible 6000 households. The mean age was 40.5 (39.9–41.1) years, with 51.3% of the respondents being female. Overall 346 (7.7%) of respondents were classified as physically inactive. Physical inactivity was associated with female gender, middle age (30–49 years), and increasing level of education, increasing wealth index and low levels of High Density Lipoproteins (HDL).

Conclusion

A modest prevalence of physical inactivity slightly higher than in neighbouring countries was found in this study. Gender, age, education level and wealth index are evident areas that predict physical inactivity which can be focused on to develop programs that would work towards reducing physical inactivity among adults in Kenya.

     

Levels of physical activity among adults 18–64 years old in 28 European countries

BackgroundSedentary lifestyle is associated with more than three million deaths annually. Data from the 2013 Eurobarometer survey were analyzed to assess levels of physical activity across the European Union (EU) and to explore factors associated with adequate and high physical activity.MethodsA representative sample of n = 19,978 individuals aged 18–64 years from the 28 EU countries (sub-sample of the Eurobarometer survey, wave 80.2) was analyzed. Frequency and average duration of walking, moderate and vigorous physical activity was assessed with a self-reported questionnaire. Participants were then classified as physically inactive or adequately/highly active, based on the World Health Organization's (WHO) recommendations. The total amount of MET-minutes (MET-min) per week was also calculated for each respondent.ResultsThe proportion of physically inactive individuals was 28.6%, (12.4% in Sweden to 53.7% in Cyprus), while 59.1% of the respondents (37.9% in Portugal and Cyprus to 72.2% in Sweden) were classified as highly active. The mean total weekly physical activity was 2151 MET-min (95%CI: 2095–2206), of which 891 MET-min (95%CI: 858–924) were contributed by vigorous exercise, 559 MET-min (95%CI: 540–578) by moderate exercise (excluding walking) and 690 MET-min (95%CI: 673–706) by walking. Male gender, younger age, residence in rural areas and Northern Europe, higher education level and ability to pay bills were independently associated with higher physical activity.ConclusionOne fourth of the EU population did not meet the WHO's recommendations for physical activity, with wide inequalities between and within countries. Wide-reaching environmental approaches are required to promote physical activity and address these inequalities.     

Metals in blood and urine,and thyroid function among adults in the United States 2007–2008

The thyroid is integral to regulation of development and metabolism. Certain metals have been shown to affect thyroid function in occupationally exposed persons, but few studies have been conducted in the general population. This study evaluates the association between biomarkers of metal exposure and thyroid hormones in the US population. Analyses included adults participating in the 2007–2008 National Health and Nutrition Examination Survey, with no history of thyroid disease or use of thyroid medications, and with data on metals in blood (lead, cadmium and mercury) and urine (lead, cadmium, mercury, barium, cobalt, cesium, molybdenum, antimony, thallium, tungsten and uranium), and thyroid hormones (TSH, free and total T₃ and T₄) in serum (N = 1587). Multivariate linear regression was used to model the association between thyroid hormone levels, and metals in either urine (creatinine-adjusted) or blood. Metal concentrations were considered as both continuous and categorical variables. Models were adjusted for: age, sex, race, BMI, serum lipids, serum cotinine, pregnancy and menopausal status, and use of selected medications. Few participants (<5%) had free T₃, free T₄, or TSH levels outside the reference range. However, 9.2% (SE = 1.2%) had low T₃ and 9.4% (SE = 1.1%) had low T₄. Metals were detected in nearly all blood and urine samples, with the highest levels seen for urinary molybdenum (median 42.5 μg/L). When including all blood metals, mercury was associated with decreases in T₃ and T₄, while cadmium was associated with decreased TSH. Urinary cadmium was associated with increases in both T₃ and T₄ (models including all metals measured in urine). Urinary thallium and barium were associated with decreased T₄ (both) and T₃ (barium). For TSH, cesium was associated with decreased, and tungsten with increased levels. Given the high prevalence of exposure to metals, associations of the size reported here could indicate an appreciable contribution of metals exposure to the prevalence of thyroid disorders. These findings indicate the importance of further research to further examine these relationships.     

Preventive behaviors,beliefs, and anxieties in relation to the swine flu outbreak among college students aged 18–24 years

Aim  

The objective of this study was to assess beliefs, misconception, and anxiety in relation to swine flu outbreak and whether perception of the outbreak predicted changes in behavior.     

Obesity and contraceptive use among women 20–44 years of age in the United States: results from the 2011–15 National Survey of Family Growth (NSFG)

Objective

Obesity has increased dramatically in the United States in recent decades. Our objective was to explore associations of contraceptive choices of US women, aged 20–44 years, with body mass index (BMI) and relevant covariates.

Acceptability of HPV vaccination among young adults aged 18–30 years–a population based survey in Sweden

Acceptability of human papillomavirus (HPV) vaccination seems to be high in the Western world but fewer data are available for men than for women. There are also concerns that HPV vaccination might lead young people to change their healthcare-related behaviours. We investigated these issues in a population-based survey performed in Sweden during January-May, 2007, just after HPV vaccination had been licensed. A total of 10 567 men and women aged 18 to 30 years participated. The intention to accept HPV vaccination among these young adults was relatively high but could likely be improved with higher awareness of HPV-related diseases as well as of the safety and efficacy of vaccines in general. Also, the cost of the vaccine needs to be affordable. Even though few young adults stated their healthcare-related behaviours would change after HPV vaccination, a significant number were uncertain, suggesting a need for continued educational efforts when HPV-vaccinating this group.     

Pneumococcal carriage among adults aged 50 years and older with co-morbidities attending medical practices in Rome,Italy

BackgroundData on Streptococcus pneumoniae carriage in adults with co-morbidities are limited. In this study we estimated the pneumococcal carriage among adults with co-morbidities and evaluated socio-demographic and clinical risk factors. The potential coverage of the current pneumococcal vaccines recommended for adults (PCV13 and PPV23) was also investigated.MethodsA cross-sectional study on S. pneumoniae carriage among unvaccinated adults ≥50 years with co-morbidities, presenting with or without acute respiratory symptoms at general practitioners in Rome, Italy, between October 2015 and July 2016 was conducted. Pneumococcal carriage was investigated by both cultural and molecular methods. Socio-demographic variables and co-morbidities were evaluated by logistic models as possible risk factors for pneumococcal carriage.ResultsOut of 248 patients (median age: 73 yrs; IQR: 65–79), 12 (4.8%) and 83 (33.5%) individuals were found colonized using cultural or molecular methods, respectively. Potential risk factors for pneumococcal colonization as ascertained by molecular methods were: low level of education (adjusted OR = 3.71, 95% CI: 1.62–9.40), winter months (December-March vs other months, adjusted OR = 2.56, 95% CI: 1.29–5.14), and presence of chronic lung diseases (adjusted OR = 2.18, 95% CI: 1.15–4.16). The combination of serotype-specific multiplex RT-PCR and conventional PCR allowed to identify 22 serotypes/group of serotypes, of which the most common were: 24F/24A/24B, 12F/12A/12B/44/46, 6A/6B, 14, 15B/15C, and 22F/22A. Prevalence of pneumococcal carriage due to PCV13 serotypes and non-PCV13 serotypes was 23.6% and 67.3%, respectively. Prevalence of colonization due to PPV23 serotypes was estimated to be 54.6%.ConclusionsA high prevalence of S. pneumoniae carriage was observed among adults with co-morbidities, especially among individuals affected by chronic lung diseases. These results support vaccine strategies based on the sequential administration of PCV13 and PPV23 to control potentially invasive pneumococcal strains in adults, especially in subjects with co-morbidities.     

Surveillance of perceptions,knowledge, attitudes and behaviors of the Italian adult population (18–69 years) during the 2009–2010 A/H1N1 influenza pandemic

Monitoring perceptions, knowledge, attitudes and behaviors of populations during pandemic flu outbreaks is important as it allows communication strategies to be adjusted to meet emerging needs and assessment to be made of the effects of recommendations for prevention. The ongoing Italian Behavioral Risk Factor Surveillance System (PASSI) offered the setting for investigating people’s opinions and behaviors regarding the A/H1N1 pandemic. PASSI surveillance is carried out in 126/148 Italian Local Health Units (LHU) through monthly telephone interviews administered by public health staff to a random sample of the resident population 18–69 years. In fall 2009 additional questions exploring issues related to the A/H1N1 flu were added to the standard questionnaire. The pandemic module was administered on a voluntary basis by the 70 participating LHUs from November 2nd, 2009 to February 7th, 2010; 4 047 interviews were collected. Overall 33% of respondents considered it likely that they would catch flu, 26% stated they were worried, 16% reported having limited some daily activities out of home and 22% said they would accept vaccination if offered. All these indicators showed a decreasing trend across the four-month period of observation. The most trusted sources of information were family doctors (81%). Willingness to be vaccinated was associated with worry about pandemic, age, sex, having a chronic disease and timing of the interview. The surveillance allowed us to gather relevant information, crucial for devising appropriate public health interventions. In future disease outbreaks, systems monitoring people’s perceptions and behaviors should be included in the preparedness and response plans.     

Use of contraception among US women reporting postpartum depressive symptoms,pregnancy risk assessment monitoring system 2009–2011

Objective

We sought to determine the prevalence of postpartum contraceptive use among women with postpartum depressive symptoms (PDS) and examine the association between PDS and contraceptive method.

Association of hemoglobin concentration with handgrip strength in relation to hepatocyte growth factor levels among elderly Japanese men aged 60–69 years: a cross-sectional study

Background

Hemoglobin concentration reportedly is positively associated with muscle strength, for example, handgrip strength. However, hemoglobin cannot repair muscle directly, but is beneficial only in a supportive role. Since hepatocyte growth factor (HGF) regulates muscle satellite cell production and differentiation, which is stimulated by organ injury, the supportive effect of hemoglobin should thus be stronger for participants with high HGF than for those with low HGF. However, the association between hemoglobin concentration and handgrip strength in relation to HGF levels remains unknown.

Methods

We conducted a cross-sectional study of 255 Japanese elderly men aged 60–69 years who participated in annual health check-ups in 2014–2015. The study population was categorized on the basis of a median value of HGF of 300.6 pg/mL.

Results

Among present study population, 128 participants showed low HGF. For participants with low HGF, hemoglobin concentration showed no significant association with handgrip strength (standardized parameter estimate (β)?=?0.03, p?=?0.767), but for those with high HGF, hemoglobin concentration was significantly positively associated with handgrip strength (β?=?0.23, p?=?0.014).

Conclusions

A significant positive association between hemoglobin level and handgrip strength was established for elderly Japanese men aged 60–69 years with high HGF but not for participants with low HGF. Our finding indicates that HGF levels could determine the relationship of hemoglobin concentration with handgrip strength in elderly Japanese men aged 60–69 years. This result can be expected to serve as an effective tool for the clarification of the roles played by HGF and hemoglobin concentration in maintenance of muscle strength.

     

Vitamin D deficiency is an independent risk factor for cardiovascular disease in Koreans aged �� 50 years: results from the Korean National Health and Nutrition Examination Survey

Vitamin D deficiency is a risk factor for metabolic syndromes. We examined whether vitamin D deficiency altered the prevalence of cardiovascular disease (CVD) in older Koreans. Cross-sectional analysis of data from the Korean National Health and Nutrition Examination Survey IV 2008-2009 was used to examine the association between serum 25-hydroxyvitamin D (25(OH)D) levels and the prevalence of CVD in a representative population-based sample of 5,559 men and women aged ≥ 50 years. CVD was defined as angina pectoris, myocardial infarction, or stroke. The prevalence of CVD (7.0%) in the older Korean population was lower than that in the older US population, although average serum 25(OH)D levels were much lower in the Korean population. Additionally, serum 25(OH)D levels did not differ significantly between the CVD and non-CVD groups. However, subjects in the lowest category (< 25 nmol/l) of serum 25(OH)D level had the greatest prevalence of CVD, about two-fold higher than subjects in the highest category (> 75 nmol/l), after adjusting for age, gender, body mass index, education level, residence location, and region. The prevalence of other risk factors for CVD, including higher waist circumference, fasting glucose, low-density lipoprotein (LDL) cholesterol, and triglyceride levels and lower high-density lipoprotein (HDL) cholesterol levels, was also higher among subjects in the lowest category than among those in the highest category. In conclusion, low serum 25(OH)D may be an independent risk factor for CVD in older Koreans.     

Vaccination coverage among school children aged 14–15 years in the French department of Sarthe

Objectives

Vaccinations are the main pillar of primary prevention for infectious diseases. To guide and prioritize public health interventions, the Regional Health Agency has asked the Prevention, Vaccination, and Screening Center of the Sarthe department to assess vaccination coverage (VC) at the sub-departmental level. The main objective was to measure the VC among school children aged 14–15 years in Sarthe at the sub-departmental level.

Health-related quality of life among adults 65 years and older in the United States, 2011–2012: a multilevel small area estimation approach

PurposeThe purpose of this study was to develop county-level estimates of poor health-related quality of life (HRQOL) among aged 65 years and older U.S. adults and to identify spatial clusters of poor HRQOL using a multilevel, poststratification approach.MethodsMultilevel, random-intercept models were fit to HRQOL data (two domains: physical health and mental health) from the 2011–2012 Behavioral Risk Factor Surveillance System. Using a poststratification, small area estimation approach, we generated county-level probabilities of having poor HRQOL for each domain in U.S. adults aged 65 and older, and validated our model-based estimates against state and county direct estimates.ResultsCounty-level estimates of poor HRQOL in the United States ranged from 18.07% to 44.81% for physical health and 14.77% to 37.86% for mental health. Correlations between model-based and direct estimates were higher for physical than mental HRQOL. Counties located in the Arkansas, Kentucky, and Mississippi exhibited the worst physical HRQOL scores, but this pattern did not hold for mental HRQOL, which had the highest probability of mentally unhealthy days in Illinois, Indiana, and Vermont.ConclusionsSubstantial geographic variation in physical and mental HRQOL scores exists among older U.S. adults. State and local policy makers should consider these local conditions in targeting interventions and policies to counties with high levels of poor HRQOL scores.     

Prevalence of smear-positive tuberculosis in persons aged ≥ 15 years in Bangladesh: results from a national survey, 2007-2009

The aim of this study was to determine the nationwide prevalence of smear-positive tuberculosis (TB) in Bangladesh. A multi-stage cluster survey of a random sample of persons aged ≥ 15 years was included in 40 clusters (20 urban, 20 rural). Two sputum samples were collected from study participants and tested initially by fluorescence microscopy and confirmed by the Ziehl-Neelsen method. The crude and adjusted prevalence rates and 95% confidence intervals (CIs) were calculated using standard methods. A total of 33 new smear-positive TB cases were detected among 52 098 individuals who participated in the study. The average participation rate was over 80%. The overall crude prevalence of new smear-positive TB in persons aged ≥ 15 years was estimated as 63.3/100 000 (95% CI 43.6-88.9) and the adjusted prevalence was 79.4/100 000 (95% CI 47.1-133.8). TB prevalence was higher in males (n = 24) and in rural areas (n = 20). The prevalence was highest in the 55-64 years age group (201/100 000) and lowest in 15-24 years age group (43.0/100 000). The prevalence was higher in persons with no education (138.6/100 000, 95% CI 78.4-245.0). The overall prevalence of smear-positive TB was significantly lower than the prevalence estimate of the previous nationwide survey in Bangladesh in 1987-1988 (870/100 000).     

Epidemiology of childhood intussusception in Bangladesh: Findings from an active national hospital based surveillance system, 2012–2016

IntroductionRotavirus vaccines have significantly decreased the burden of diarrheal diseases in countries that have introduced them into their immunization programs. In some studies, there has been a small association between rotavirus vaccines and intussusception in post-marketing surveillance, highlighting the importance of tracking incidence before and after vaccine introduction. The objective of this study was to describe the epidemiology of intussusception among Bangladeshi children pre-vaccine introduction.MethodsWe conducted active, hospital-based surveillance for intussusception at 7 tertiary care hospitals with pediatric surgical facilities during July 2012 to September 2016. Hospitalized children under 2 years of age were identified according to Brighton Collaboration level 1 criteria for intussusception. The frequency and proportion of intussusception among overall surgical admissions, as well as the demographic and clinical information of the cases is described.ResultsOverall 153 cases of intussusception among children <2 years-old were identified at participating sites over the enrolment period, confirmed by Level 1 Brighton criteria. These cases represented 2% of all surgical admissions under 2 years of age. One hundred twelve cases (73%) were male; the median age was 7 months; and the median duration of hospitalization was 7 days. One hundred forty-six (95%) children with intussusception required surgery, and 11 (7%) died.ConclusionsConfirmed cases of intussusception represented nearly 2% of pediatric surgical admissions at tertiary referral centers in Bangladesh during the study period and 7% of children with intussusception died. Given the high burden of rotavirus disease in Bangladesh, vaccine introduction is warranted, however, further studies after introduction of rotavirus vaccine are necessary to determine any association between vaccine and intussusception in this setting.     

Pediatric hospitalizations attributable to rotavirus gastroenteritis among Cambodian children: Seven years of active surveillance, 2010–2016

BackgroundEach year, approximately 1,066 Cambodian children under five years old die of diarrhea, and 51% of these deaths are due to rotavirus gastroenteritis. Quantifying childhood hospitalizations caused by severe rotavirus infections is also important in demonstrating disease burden caused by this virus. The objective of this study is to update and confirm the current burden of pediatric hospitalizations attributable to rotavirus gastroenteritis among Cambodian children using seven years of continuous active, prospective surveillance from 2010 to 2016. We also characterize the circulating rotavirus genotypic strains during this period.MethodsActive surveillance for rotavirus gastroenteritis was conducted from January 2010 through December 2016 at a national hospital in Phnom Penh, Cambodia. Children <60 months of age who were hospitalized for acute gastroenteritis (AGE) were consented and enrolled. Information on gender, age, clinical characteristics, and month of onset were collected. Stool specimens were collected and tested by enzyme immunoassay for the presence of rotavirus antigen, and genotyping was performed on rotavirus test-positive specimens to characterize predominant rotavirus strains during the surveillance period.ResultsOf 7007 children enrolled with AGE and having specimens collected, 3473 (50%) were attributed to rotavirus gastroenteritis. The majority of rotavirus hospitalizations occurred in children younger than two years old (92%). Year-round rotavirus transmission was observed, with seasonal peaks during the cooler, dry months between November and May. Genotypic trends in rotavirus were observed over the surveillance period; the predominant rotavirus strains changed from G1P[8] (2010–2012), to G2P[4] (2013–2014), the emergence of genotype G8P[8] in 2015, and G3P[8] in 2016.ConclusionsRotavirus is the leading cause of severe acute gastroenteritis hospitalizations in Cambodian children under five years old, with 50% of such hospitalizations attributable to rotavirus. Over 90% of rotavirus hospitalizations occurred in children under 2 years of age. Changes in the predominant rotavirus strains occurred over time among these unvaccinated children. This information is important to understand and prioritize the current potential impacts upon child health that could be achieved through the introduction of rotavirus vaccines in Cambodia.