Auswahl der wissenschaftlichen Literatur zum Thema „Measles vaccine – South Africa – Hammanskraal“

Abstract Background Measles morbidity and mortality rates are greatest in children <12 months old, with increased susceptibility in human immunodeficiency virus (HIV)–exposed children. We evaluated the immunogenicity and safety of an early 2-dose measles vaccine regimen administered at 6 and 12 months of age in South Africa. Methods HIV-unexposed (HU) (n = 212) and HIV-exposed, uninfected (HEU) (n = 71) children received measles vaccination (CAM-70) at 6 and 12 months of age. Measles immunoglobulin G titers were measured by means of enzyme-linked immunosorbent assay before and 1 month after each vaccine dose. Results The majority of children (88.2% HU and 95.8% HEU; P = .04) were seronegative (<150 mIU/mL) to measles at 4.2 months of age. This was particularly evident among infants of mothers born from 1992 onwards (year of public nationwide measles vaccine availability). One month after the first measles vaccine, 42.3% of HU and 46.4% of HEU children were seropositive (≥330 mIU/mL). After the second dose, the proportion seropositive increased to 99.0% in HU and 95.3% in HEU children. Safety profiles were similar between HU and HEU children. Conclusions Early 2-dose measles vaccination at 6 and 12 months of age was safe and induced antibody responses in HU and HEU children, which could partly offset the early loss of maternally derived antibodies in infants born to predominantly measles-vaccinated mothers. Clinical Trials Registration NCT03330171

Rubella is generally a mild childhood disease, but infection during early pregnancy may cause spontaneous abortion or congenital rubella syndrome (CRS), which may entail a variety of birth defects. Since vaccination at levels short of those necessary to achieve eradication may increase the average age of infection, and thus potentially the CRS burden, introduction of the vaccine has been limited to contexts where coverage is high. Recent work suggests that spatial heterogeneity in coverage should also be a focus of concern. Here, we use a detailed dataset from South Africa to explore the implications of heterogeneous vaccination for the burden of CRS, introducing realistic vaccination scenarios based on reported levels of measles vaccine coverage. Our results highlight the potential impact of country-wide reductions of incidence of rubella on the local CRS burdens in districts with small population sizes. However, simulations indicate that if rubella vaccination is introduced with coverage reflecting current estimates for measles coverage in South Africa, the burden of CRS is likely to be reduced overall over a 30 year time horizon by a factor of 3, despite the fact that this coverage is lower than the traditional 80 per cent rule of thumb for vaccine introduction, probably owing to a combination of relatively low birth and transmission rates. We conclude by discussing the likely impact of private-sector vaccination.

Background: age structured mathematical models have been used to evaluate the impact of rubella-containing vaccine (RCV) introduction into existing measles vaccination programs in several countries. South Africa has a well-established measles vaccination program and is considering RCV introduction. This study aimed to provide a comparison of different scenarios and their relative costs within the context of congenital rubella syndrome (CRS) reduction or elimination. Methods: we used a previously published age-structured deterministic discrete time rubella transmission model. We obtained estimates of vaccine costs from the South African medicines price registry and the World Health Organization. We simulated RCV introduction and extracted estimates of rubella incidence, CRS incidence and effective reproductive number over 30 years. Results: compared to scenarios without mass campaigns, scenarios including mass campaigns resulted in more rapid elimination of rubella and congenital rubella syndrome (CRS). Routine vaccination at 12 months of age coupled with vaccination of nine-year-old children was associated with the lowest RCV cost per CRS case averted for a similar percentage CRS reduction. Conclusion: At 80% RCV coverage, all vaccine introduction scenarios would achieve rubella and CRS elimination in South Africa. Any RCV introduction strategy should consider a combination of routine vaccination in the primary immunization series and additional vaccination of older children.

ABSTRACTHIV-exposed but uninfected (HEU) infants born to HIV-infected mothers from areas in the world with a high burden of infectious disease suffer higher infectious morbidity and mortality than their HIV unexposed uninfected (HUU) peers. Vaccination provides protection from infection. The possibility exists that altered response to vaccination contributes to the higher rate of infection in HEU than in HUU infants. While short-term, cross-sectional studies support this notion, it is unclear whether or not HEU infants develop long-term protective immune responses following the WHO extended program on immunization (EPI). Vaccine-specific antibody responses were compared between HEU and HUU infants from 2 weeks until 2 years of age in a longitudinal South African cohort. Total IgG and antibodies specific forBordetella pertussis,Haemophilus influenzaetype b (Hib), tetanus toxoid, hepatitis B virus (HepB), and measles virus were measured at multiple time points throughout the first 2 years of life. Prevaccine antibodies (maternal antibodies passively acquired) specific for tetanus were lower in HEU than in HUU infants, while prevaccine antibodies to HepB were higher in HEU than in HUU infants. Both groups responded similarly to tetanus, Hib, and HepB vaccination. HEU demonstrated stronger pertussis vaccine responses, developing protective titers 1 year earlier than HUU patients, and maintained higher anti-tetanus titers at 24 months of age. Vaccine-induced antibodies to measles virus were similar in both groups at all time points. Our results suggest that the current EPI vaccination program as practiced in South Africa leads to the development of vaccine-specific antibody responses that are equivalent in HEU and HUU infants. However, our data also suggest that a large fraction of both HEU and HUU South African infants have antibody titers for several infectious threats that remain below the level of protection for much of their first 2 years of life.

Background: Information on cost-effectiveness allows policy-makers to evaluate if they are using currently available resources effectively and efficiently. Our objective is to examine the cost-effectiveness of health interventions to improve maternal, newborn and child health (MNCH) outcomes, to provide global evidence relative to the context of two geographic regions. Methods: We consider interventions across the life course from adolescence to pregnancy and for children up to 5 years old. Interventions included are those that fall within the areas of immunization, child healthcare, nutrition, reproductive health, and maternal/newborn health, and for which it is possible to model impact on MNCH mortality outcomes using the Lives Saved Tool (LiST). Generalized cost-effectiveness analysis (GCEA) was used to derive average cost-effectiveness ratios (ACERs) for individual interventions and combinations (packages). Costs were assessed from the health system perspective and reported in international dollars. Health outcomes were estimated and reported as the gain in healthy life years (HLYs) due to the specific intervention or combination. The model was run for 2 regions: Eastern sub-Saharan Africa (SSA-E) and South-East Asia (SEA). Results: The World Health Organization (WHO) recommended interventions to improve MNCH are generally considered cost-effective, with the majority of interventions demonstrating ACERs below I$100/HLY saved in the chosen settings (low-and middle-income countries [LMICs]). Best performing interventions are consistent across the two regions, and include family planning, neonatal resuscitation, management of pneumonia and neonatal infection, vitamin A supplementation, and measles vaccine. ACERs below I$100 can be found across all delivery platforms, from community to hospital level. The combination of interventions into packages (such as antenatal care) produces favorable ACERs. Conclusion: Within each region there are interventions which represent very good value for money. There are opportunities to gear investments towards high-impact interventions and packages for MNCH outcomes. Cost-effectiveness tools can be used at national level to inform investment cases and overall priority setting processes.

ObjectiveThe mandate of establishing this DSS is to provide a research platform for both observational and interventional studies, with focus on maternal and child health, which could influence decision-making and planning for health strategies at local, national and international levels.IntroductionThe Karachi Health and Demographic Surveillance System was set up in year 2003 by the Department of Pediatrics and Child Health of the Aga Khan University, Karachi, Pakistan, in four peri-urban low socioeconomic communities of Karachi and covers an area of 17.6 square kilometers.(Figure 1)MethodsTotal population currently under surveillance is 299,009 for which a record of births, deaths, pregnancies and migration events is maintained by two monthly household visits. At each re-enumeration, Community Health Workers move through the area using GIS-derived maps and collect the information from households and conduct verbal autopsies for stillbirths and deaths of children under the age of five and adult female. Primary Health Care centre at each site provide free care to children under 5.ResultsThe demographic characteristics for the year 2016 are summarized in Table 1. The main demographic indicators for a period of five years enable us to study the trends of population dynamics and reasons for the change in the rates of stillbirth, under 5 children mortality and maternal mortality (Table 2). Under 5 mortality rates peaked in 2013 and 2016 due to measles epidemic. Within the time period of five years, a reduction in neonatal mortality rates is observed (Table 2).For over a decade, the KHDSS has been a platform for a variety of studies. At the outset, various epidemiological studies were conducted in the area of infectious diseases of children, identifying signs and symptoms in young infant requiring urgent referral, vaccine coverage and the impact of multiple interventions. The focus was on measuring burden of relevant and common childhood illnesses. Some of these projects include: calculation of the incidence of various infectious diseases like typhoid bacteremia, pneumonia and diarrhea, evaluation of effectiveness of various treatment regimens for neonatal sepsis, assessment of the acceptance of hospitalized care, determining etiology of moderate to severe diarrhea, assessment of burden and etiology of neonatal sepsis and a multi-center cohort measuring the burden of stillbirths, neonatal and maternal deaths. (1-5)ConclusionsAll the studies aim for improvement of public health policies and informed decision making at local and national levels. We have also established a bio-repository of a well-defined maternal and newborn cohort.References1. Group YICSS. Clinical signs that predict severe illness in children under age 2 months: a multicentre study. The Lancet. 2008;371(9607):135-42.2. Kotloff KL, Nataro JP, Blackwelder WC, Nasrin D, Farag TH, Panchalingam S, et al. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. The Lancet. 2013;382(9888):209-22.3. Mir F, Nisar I, Tikmani SS, Baloch B, Shakoor S, Jehan F, et al. Simplified antibiotic regimens for treatment of clinical severe infection in the outpatient setting when referral is not possible for young infants in Pakistan (Simplified Antibiotic Therapy Trial [SATT]): a randomised, open-label, equivalence trial. The Lancet Global Health. 2016.4. Shafiq Y, Nisar MI, Kazi AM, Ali M, Jamal S, Ilyas M, et al. Implementation of the ANISA Study in Karachi, Pakistan: Challenges and Solutions. The Pediatric infectious disease journal. 2016;35(5):S60-S4.5. group As. Burden, timing and causes of maternal and neonatal deaths and stillbirths in sub–Saharan Africa and South Asia: protocol for a prospective cohort study. Journal of Global Health. 2016;6(2).

Measles is a highly contagious virus that can affect the entire population if an effective immunisation programme is not in place. This study was aimed at determining the measles immunisation coverage and the dropout rate among children aged between 6 months and 14 years and at assessing factors associated with caregivers’ knowledge and perception of, and attitude towards the measles immunisation programme. Between 14 May 2018 and 31 July 2018, a descriptive, cross-sectional study design was conducted using simple random sampling to sample 381 caregivers of children at nine public health facilities at Tshwane Sub-district 2, Hammanskraal town. Data were collected by means of a structured questionnaire and observational checklist, and analysed using IBM SPSS version 23.0. Overall, the measles immunization coverage was 95.8% (365/381) and the MCV1-MCV2 dropout rate was 4.1%. The association between educational level and employment status (correlation coefficient=0.157**, p=0.0002), measles knowledge (correlation coefficient=-0.244**, p=0.000), immunization importance (correlation coefficient=-0.194**, p=0.000) and measles vaccine schedule (correlation coefficient=-0.138**, p=0.007) were found to be significant at p<0.05. The findings in this study revealed that caregivers’ positive attitude towards, and knowledge of measles immunisation programme resulted in high measles immunisation coverage and low dropout rate. It is recommended that continuous positive immunisation education about the benefits and importance be emphasized in order to increase immunisation uptake.
Health Studies
M. P. H.

ABSTRACT Background: Among the leading causes of global child morbidity and mortality are vaccine-preventable diseases, especially in low-and middle-income countries (LMICs). A complete basic immunization for children contains one BCG, three DPT-HB-Hib immunizations, four polio immunizations, and one measles immunizations. Antenatal care visit contributes an important to complete the basic immunization. This study aimed to estimate the effect of antenatal care on the completeness of basic immunization in children aged 12-23 months in Africa using meta-analysis. Subjects and Method: A meta-analysis and systematic review was conducted to examine the effect of antenatal care on the basic immunization completeness in children aged 12-23 months. Published articles in 2015-2020 were collected from PubMed and Google Scholar databases. Keywords used “immunization coverage” OR “vaccination coverage” OR “complete immunization” OR “complete vaccination” OR “full immunization” OR “full vaccination” AND children OR “child immunization” OR “child immunization coverage” NOT “incomplete immunization” OR “incomplete vaccination”. The inclusion criteria were full text, in English language, and using cross-sectional study design. The selected articles were analyzed by Revman 5.3. Results:6 studies from Senegal, Nigeria, Ethiopia, and South Africa showed that antenatal care increased basic immunization completeness in children aged 12-23 months (aOR=1.19; 95% CI= 1.06 to 1.36; p<0.001) with I2 = 95%). Conclusion: Antenatal care increases basic immunization completeness in children aged 12-23 months. Keywords: basic immunization, antenatal care, children aged 12-23 months Correspondence: Farida. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutarmi 36A, Surakarta 57126, Central Java. Email: faridariza9232@gmail.com. Mobile: 085654415292 DOI: https://doi.org/10.26911/the7thicph.03.125