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MAHOMED, S., M. ARCHARY, P. MUTEVEDZI, Y. MAHABEER, P. GOVENDER, G. NTSHOE, W. KUHN, et al. "An isolated outbreak of diphtheria in South Africa, 2015." Epidemiology and Infection 145, no. 10 (May 8, 2017): 2100–2108. http://dx.doi.org/10.1017/s0950268817000851.
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SUMMARYAn outbreak of respiratory diphtheria occurred in two health districts in the province of KwaZulu-Natal in South Africa in 2015. A multidisciplinary outbreak response team was involved in the investigation and management of the outbreak. Fifteen cases of diphtheria were identified, with ages ranging from 4 to 41 years. Of the 12 cases that were under the age of 18 years, 9 (75%) were not fully immunized for diphtheria. The case fatality was 27%. Ninety-three household contacts, 981 school or work contacts and 595 healthcare worker contacts were identified and given prophylaxis against Corynebacterium diphtheriae infection. A targeted vaccination campaign for children aged 6–15 years was carried out at schools in the two districts. The outbreak highlighted the need to improve diphtheria vaccination coverage in the province and to investigate the feasibility of offering diphtheria vaccines to healthcare workers.
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Ndwandwe, Duduzile, Chukwudi A. Nnaji, and Charles S. Wiysonge. "The Magnitude and Determinants of Missed Opportunities for Childhood Vaccination in South Africa." Vaccines 8, no. 4 (November 25, 2020): 705. http://dx.doi.org/10.3390/vaccines8040705.
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Missed opportunities for vaccination (MOV) may be among the factors responsible for suboptimal vaccination coverage in South Africa. However, the magnitude and determinants of MOV in the country are not known. Thus, this study seeks to assess the prevalence and determinants of MOV in the country. South Africa is sub-divided into nine administrative provinces. We used nationally representative data from the 2016 South African Demographic and Health Survey. We considered MOV to have occurred if a child aged 12–23 months old had not taken all scheduled basic vaccine doses despite having any of the following contacts with health services: delivery in a health facility; postnatal clinic visit; receipt of vitamin A; and any child-related treatment at a health facility. Multilevel logistic regression was used to determine factors associated with MOV. The national prevalence of MOV among children aged 12–23 months was 40.1%. Children whose mothers attended facility-based antenatal care were considerably less likely to experience MOV than those whose mothers did not attend antenatal care: odds ratio (OR) 0.41, 95% confidence interval (CI) 0.19 to 0.88. Conversely, the independent predictor of an increased MOV among children was residence in either the Gauteng province (OR 2.97, 95% CI 1.29 to 6.81) or Mpumalanga province (OR 2.32, 95%CI 1.04 to 5.18); compared to residence in the Free State province. Our findings suggest a high burden of MOV among children in South Africa and that MOV may be associated with individual and contextual factors. The findings also underscore the need for further exploration of the contextual factors contributing to MOV in South Africa.
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Meiring, Susan, Gregory Hussey, Prakash Jeena, Salim Parker, and Anne Von Gottberg. "Recommendations for the use of meningococcal vaccines in South Africa." Southern African Journal of Infectious Diseases 32, no. 3 (October 1, 2017): 82–86. http://dx.doi.org/10.4102/sajid.v32i3.43.
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Background: Although meningococcal disease (MD) incidence in South Africa is low, Neisseria meningitidis (NM) causes severe disease that is often life-threatening and can cause long-term disabilities. A quadrivalent protein-conjugated meningococcal vaccine (MCV4) is available, and provides protection against 75% of disease causing serogroups in South Africa. Recommendations: We advise vaccination of persons at high risk of meningococcal disease including those with complement deficiency and asplenia; laboratory personnel from reference laboratories who work with NM; and travellers to Saudi Arabia. The need for routine vaccine against meningococcal disease in South Africa is controversial given the current burden of disease. However, due to the high morbidity/mortality of MD we recommend that clinicians consider vaccination of healthy infants and children; HIV-infected persons with a CD4 count 25%; students attending college /university /military academies; and miners.Conclusion: Protein-conjugated meningococcal vaccine is preferable to the polysaccharide vaccine given the ability of the protein-conjugated meningococcal vaccine to induce immune memory, allow for booster responses and eliminate carriage of the organism in the person vaccinated.
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Motaze, Nkengafac Villyen, Ijeoma Edoka, Charles S. Wiysonge, C. Jessica E. Metcalf, and Amy K. Winter. "Rubella Vaccine Introduction in the South African Public Vaccination Schedule: Mathematical Modelling for Decision Making." Vaccines 8, no. 3 (July 13, 2020): 383. http://dx.doi.org/10.3390/vaccines8030383.
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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.
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Groome, Michelle J., Jacqueline E. Tate, Marion Arnold, Milind Chitnis, Sharon Cox, Corné de Vos, Mari Kirsten, et al. "Evaluation of Intussusception After Oral Monovalent Rotavirus Vaccination in South Africa." Clinical Infectious Diseases 70, no. 8 (May 24, 2019): 1606–12. http://dx.doi.org/10.1093/cid/ciz431.
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Abstract Background Postlicensure studies have shown an association between rotavirus vaccination and intussusception. We assessed the risk of intussusception associated with Rotarix (RV1) administration, at 6 and 14 weeks of age, in an upper-middle-income country, South Africa. Methods Active prospective surveillance for intussusception was conducted in 8 hospitals from September 2013 through December 2017. Retrospective case enrollment was done at 1 hospital from July 2012 through August 2013. Demographic characteristics, symptom onset, and rotavirus vaccine status were ascertained. Using the self-controlled case-series method, we estimated age-adjusted incidence rate ratios within 1–7, 8–21, and 1–21 days of rotavirus vaccination in children aged 28–275 days at onset of symptoms. In addition, age-matched controls were enrolled for a subset of cases (n = 169), and a secondary analysis was performed. Results Three hundred forty-six cases were included in the case-series analysis. Post–dose 1, there were zero intussusception cases within 1–7 days, and 5 cases within 8–21 days of vaccination. Post–dose 2, 15 cases occurred within 1–7 days, and 18 cases within 8–21 days of vaccination. There was no increased risk of intussusception 1–7 days after dose 1 (no cases observed) or dose 2 (relative incidence [RI], 1.71 [95% confidence interval {CI} .83–3.01]). Similarly, there was no increased risk 8–21 days after the first (RI, 4.01 [95% CI, .87–10.56]) or second dose (RI, .96 [95% CI, .52–1.60]). Results were similar for the case-control analysis. Conclusions The risk of intussusception in the 21 days after the first or second dose of RV1 was not higher than the background risk among South Africa infants. Clinical Trials Registration South African National Clinical Trial Register (DOH-27-0913-4183).
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Chandrakantan, A. J. V. "PROCLAIMING THE CRUCIFIED CHRIST IN A BROKEN WORLD: An Asian Perspective." Mission Studies 17, no. 1 (2000): 59–67. http://dx.doi.org/10.1163/157338300x00082.
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AbstractThis article originally delivered as a keynote address at the IAMS Tenth International Conference in Hammanskraal, South Africa, is a passionate call to attend to the atrocities being committed against Tamils in the "broken world" of contemporary Sri Lanka. As the author puts it: "Disbelief and forgetfulness are the weapons of those who are opposed to humanity therefore to God. Forgetfulness is the antidote to truth and truthfulness of memory. Looking at this indescribable suffering of the innocent I have often felt that we all live in a world that has become unresponsive to the cries of the poor and under privileged. Such an attitude calls for solidarity among the victims and the oppressed. We also live in a world where a common agenda seems to unite all those who have chosen to be the enemies of humanity. It is our duty to fight this mute silence of the world with the power of the WORD. We should allow the word of Truth about the poor and innocent about voiceless women, men and children, to seek refuge and self-exile. Let us speak this word to the powers that be. All that we carry with us now is the memory of our life and that of the death of our fellow Tamils."
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Ewang, Bestina Forkwa, Mathias Esum Eyong, Samuel Nambile Cumber, Claude Ngwayu Nkfusai, Brenda Mbouamba Yankam, Cho Sabastine Anye, Jacintha Rebang Achu, et al. "Vaccination Coverage Under the Expanded Program on Immunization in South West Cameroon." International Journal of Maternal and Child Health and AIDS (IJMA) 9, no. 2 (July 9, 2020): 242–51. http://dx.doi.org/10.21106/ijma.308.
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Background: Inadequate vaccination coverage with increased risk of vaccine preventable disease outbreaks remain a problem in Africa. The aim of this study was to assess the vaccination coverage levels under the Expanded Program on Immunization (EPI) in a health area and to identify factors that affect vaccination coverage in view of providing valuable data for disease prevention.
Methods: A cross-sectional household survey was conducted in August 2017 in the Mbonge health area, Southwest Cameroon. Clustered sampling technique was used to select study communities and a purposive sampling design was used to select households. An interviewer-administered questionnaire was used to obtain information from consenting caregivers of children aged 9–23 months. Vaccination coverage was assessed by consulting the vaccination cards and parents’ recall. In households with more than one child aged 9-23months, the youngest was chosen.
Results: Overall, 300 caregivers were enrolled into the study. The average vaccination coverage for the past three years (2014-2016) was 34.0%. Two hundred and fifty-five (85%) children had vaccination cards. Amongst the children, 143 (47.7%) had taken all vaccines as recommended while 30 (10%) had not received a single dose. Factors significantly associated with incomplete vaccination status included: occupation (being a farmer) (p-value=0.011), marital status (married) (p-value=0.048), caregiver’s utilization of health facility (p-value=0.003), low levels of mothers’ utilization of antenatal care (ANC) services (p-value=0.000), and low knowledge on vaccination (p-value=0.000).
Conclusion and Global Health Implications: Adequate vaccination coverage can be attained through good sensitization and health education for primary caregivers. Targeting families living far away from vaccination centers, using appropriate communication and vaccination strategies may improve vaccination coverage in the Mbonge Health Area of South West Region, Cameroon.
Key words: • Assessment • Vaccination Coverage Expanded Program on Immunization • Mbonge Health Area • Cameroon • EPI
Copyright © 2020 Ewang et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.
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Chopra, M. "Brief report. Vaccination coverage is higher in children living in areas with community health workers in rural South Africa." Journal of Tropical Pediatrics 43, no. 6 (December 1, 1997): 372–74. http://dx.doi.org/10.1093/tropej/43.6.372.
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Kleynhans, Jackie, Stefano Tempia, Kayoko Shioda, Anne von Gottberg, Daniel M. Weinberger, and Cheryl Cohen. "Estimated impact of the pneumococcal conjugate vaccine on pneumonia mortality in South Africa, 1999 through 2016: An ecological modelling study." PLOS Medicine 18, no. 2 (February 16, 2021): e1003537. http://dx.doi.org/10.1371/journal.pmed.1003537.
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Background Data on the national-level impact of pneumococcal conjugate vaccine (PCV) introduction on mortality are lacking from Africa. PCV was introduced in South Africa in 2009. We estimated the impact of PCV introduction on all-cause pneumonia mortality in South Africa, while controlling for changes in mortality due to other interventions. Methods and findings We used national death registration data in South Africa from 1999 to 2016 to assess the impact of PCV introduction on all-cause pneumonia mortality in all ages, with the exclusion of infants aged <1 month. We created a composite (synthetic) control using Bayesian variable selection of nondiarrheal, nonpneumonia, and nonpneumococcal deaths to estimate the number of expected all-cause pneumonia deaths in the absence of PCV introduction post 2009. We compared all-cause pneumonia deaths from the death registry to the expected deaths in 2012 to 2016. We also estimated the number of prevented deaths during 2009 to 2016. Of the 9,324,638 deaths reported in South Africa from 1999 to 2016, 12·6% were pneumonia-related. Compared to number of deaths expected, we estimated a 33% (95% credible interval (CrI) 26% to 43%), 23% (95%CrI 17% to 29%), 25% (95%CrI 19% to 32%), and 23% (95%CrI 11% to 32%) reduction in pneumonia mortality in children aged 1 to 11 months, 1 to 4 years, 5 to 7 years, and 8 to 18 years in 2012 to 2016, respectively. In total, an estimated 18,422 (95%CrI 12,388 to 26,978) pneumonia-related deaths were prevented from 2009 to 2016 in children aged <19 years. No declines were estimated observed among adults following PCV introduction. This study was mainly limited by coding errors in original data that could have led to a lower impact estimate, and unmeasured factors could also have confounded estimates. Conclusions This study found that the introduction of PCV was associated with substantial reduction in all-cause pneumonia deaths in children aged 1 month to <19 years. The model predicted an effect of PCV in age groups who were eligible for vaccination (1 months to 4 years), and an indirect effect in those too old (8 to 18 years) to be vaccinated. These findings support sustaining pneumococcal vaccination to reduce pneumonia-related mortality in children.
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Wolter, Nicole, Cheryl Cohen, Stefano Tempia, Sibongile Walaza, Fahima Moosa, Mignon du Plessis, Meredith L. McMorrow, et al. "Epidemiology of Pertussis in Individuals of All Ages Hospitalized With Respiratory Illness in South Africa, January 2013—December 2018." Clinical Infectious Diseases 73, no. 3 (February 2, 2021): e745-e753. http://dx.doi.org/10.1093/cid/ciab089.
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Abstract Background Policy recommendations on pertussis vaccination need to be guided by data, which are limited from low- and middle-income countries. We aimed to describe the epidemiology of pertussis in South Africa, a country with high human immunodeficiency virus (HIV) prevalence and routine pertussis vaccination for 6 decades including the acellular vaccine since 2009. Methods Hospitalized patients of all ages were enrolled at 5 sentinel sites as part of a pneumonia surveillance program from January 2013 through December 2018. Nasopharyngeal specimens and induced sputum were tested by polymerase chain reaction (PCR) for Bordetella pertussis. In addition, demographic and clinical information were collected. Incidence rates were calculated for 2013–2016, and multivariable logistic regression performed to identify factors associated with pertussis. Results Over the 6-year period 19 429 individuals were enrolled, of which 239 (1.2%) tested positive for B. pertussis. Detection rate was highest in infants aged <6 months (2.8%, 155/5524). Mean annual incidence was 17 cases per 100 000 population, with the highest incidence in children <1 year of age (228 per 100 000). Age-adjusted incidence was 65.9 per 100 000 in HIV-infected individuals compared to 8.5 per 100 000 in HIV-uninfected individuals (risk ratio 30.4, 95% confidence interval: 23.0–40.2). Ten individuals (4.2%) with pertussis died; of which 7 were infants aged <6 months and 3 were immunocompromised adults. Conclusions Pertussis continues to be a significant cause of illness and hospitalization in South Africa, despite routine vaccination. The highest burden of disease and death occurred in infants; however, HIV-infected adults were also identified as an important group at risk of B. pertussis infection.
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Mthiyane, T. N., C. Cohen, S. A. Norris, S. Walaza, S. Tempia, A. L. Cohen, A. Von Gottberg, and C. Von Mollendorf. "Factors associated with missed and delayed DTP3 vaccination in children aged 12 - 59 months in two communities in South Africa, 2012 - 2013." South African Medical Journal 109, no. 8 (July 26, 2019): 562. http://dx.doi.org/10.7196/samj.2019.v109i8.13244.
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Mutsaerts, Eleonora A. M. L., Marta C. Nunes, Sutika Bhikha, Benit T. Ikulinda, Welekazi Boyce, Lisa Jose, Anthonet Koen, et al. "Immunogenicity and Safety of an Early Measles Vaccination Schedule at 6 and 12 Months of Age in Human Immunodeficiency Virus (HIV)–Unexposed and HIV-Exposed, Uninfected South African Children." Journal of Infectious Diseases 220, no. 9 (July 6, 2019): 1529–38. http://dx.doi.org/10.1093/infdis/jiz348.
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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
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Chonco, F. M., and S. Rangiah. "Susceptibility to hepatitis B infection, hepatitis B/HIV co-infections and hepatitis B immunity in HIV-positive patients starting HAART in Durban, South Africa." South African Family Practice 61, no. 2 (April 29, 2019): 51. http://dx.doi.org/10.4102/safp.v61i2.5004.
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Background: HIV/HBV co-infection remains a global threat to HIV management despite the available effective hepatitis B vaccine and hepatitis B covering antiretroviral therapy. Many studies done in South Africa and internationally showed high prevalence of HIV/hepatitis B co-infection, which mandated routine screening for both infections before initiating HAART. Fewer studies have highlighted the prevalence of hepatitis B susceptibility in the general population starting HAART and most of them were limited to children and high-risk groups. The aim of this study was to demonstrate the extent of hepatitis B susceptibility, hepatitis B/HIV co-infections and hepatitis B immunity in general HIV-infected patients.Method: This was a retrospective review of 1 066 randomly sampled files of patients initiated on HAART between January 2012 and December 2014 at two Durban hospitals. Data collection included demographic characteristic, CD4 counts and hepatitis B serology. Data were analysed for the prevalence of hepatitis B susceptibility, HIV/HBV co-infection and hepatitis B immunity, while correlations between age, CD4 count and these three groups were demonstrated. Statistical analysis was performed using SAS version 9.3.Results: Total prevalence of HBV susceptibility was 69.7%, HBV immunity was 26.9% and true chronic HIV/HBV co-infection was 3.4%, while HBVsAg positivity accounted for 8.4% of the participants. Adults were more susceptible to HBV than children, with a median age of 36 years. Stratified for age, children were more immune (90%) to HBV than adults.Conclusion: This study demonstrated a significantly high number of HIV-infected persons who were susceptible to hepatitis B infection in Durban, South Africa, where both HIV and HBV are endemic, co-infection is high, and safe and effective HBV vaccine is available. Hepatitis B vaccination of the hepatitis B susceptible patients initiating HAART in South Africa is recommended to prevent further HIV/HBV co-infection.
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Nguyen, Thi Yen Chi, Bamidele Oladapo Fagbayigbo, Guéladio Cissé, Nesre Redi, Samuel Fuhrimann, John Okedi, Christian Schindler, et al. "Diarrhoea among Children Aged under Five Years and Risk Factors in Informal Settlements: A Cross-Sectional Study in Cape Town, South Africa." International Journal of Environmental Research and Public Health 18, no. 11 (June 4, 2021): 6043. http://dx.doi.org/10.3390/ijerph18116043.
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Background: There is limited data on the association between diarrhoea among children aged under five years (U5D) and water use, sanitation, hygiene, and socio-economics factors in low-income communities. The study investigated U5D and the associated risk factors in the Zeekoe catchment in Cape Town, South Africa. Methods: A cross-sectional study was conducted in 707 households in six informal settlements (IS) two formal settlements (FS) (March–June 2017). Results: Most IS households used public taps (74.4%) and shared toilets (93.0%), while FS households used piped water on premises (89.6%) and private toilets (98.3%). IS respondents had higher average hand-washing scores than those of FS (0.04 vs. −0.14, p = 0.02). The overall U5D prevalence was 15.3% (range: 8.6%–24.2%) and was higher in FS than in IS (21.2% vs. 13.4%, respectively, p = 0.01). Water storage >12 h was associated with increasing U5D (OR = 1.88, 95% CI 1.00–3.55, p = 0.05). Water treatment (OR = 0.57, 95%CI 0.34–0.97, p = 0.04), good hand-washing practices (OR = 0.59, 95%CI 0.42–0.82, p = 0.002) and Hepatitis A vaccination (OR = 0.51, 95%CI 0.28–0.9, p = 0.02) had significant preventing effects on U5D. Conclusions: The study highlights that good hygiene practice is a key intervention against U5D in informal settlements. The promotion of hand-washing, proper water storage, and hygienic breastfeeding is highly recommended.
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Casale, Daniela, Gabriel Espi, and Shane A. Norris. "Estimating the pathways through which maternal education affects stunting: evidence from an urban cohort in South Africa." Public Health Nutrition 21, no. 10 (February 19, 2018): 1810–18. http://dx.doi.org/10.1017/s1368980018000125.
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AbstractObjectiveTo estimate the determinants of stunting using rich data from a birth cohort study from urban South Africa and to examine the various mechanisms, both proximate and distal, through which maternal education affects stunting.DesignMultivariate regression analysis using birth cohort data, where the outcome variable was stunting at age 2 years, and multiple mediator analysis to identify pathways from maternal education to stunting.SettingSouth Africa’s largest metropolitan area, Soweto-Johannesburg.SubjectsParticipants of Birth to Twenty Plus, a longitudinal cohort study of children born in 1990 (n 691).ResultsIn multivariate analysis, the birth weight Z-score (−0·084; P<0·001; 95 % CI −0·11, −0·06), the mother’s openness towards modern health care, captured by a vaccination score (−0·05; P=0·04; 95 % CI −0·10, −0·00), and a better-quality care environment (−0·015; P=0·04; 95 % CI −0·03, −0·00) were found to be negatively associated with stunting. Having experienced symptoms of illness related to ears and eyes increased the risk of stunting (0·038; P=0·01; 95 % CI 0·01, 0·07). Results of the mediation analysis showed that maternal education had an indirect effect on stunting largely through socio-economic status and the antenatal environment (measured by the birth weight Z-score).ConclusionsOverall, many of the factors that were protective against stunting in the final analysis, whether they operated through maternal education or not, were related to the mother’s contribution to the child’s life. This reinforces the idea that to minimise stunting, enhanced antenatal and postnatal services to better support and empower mothers may be important.
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Nnaji, Chukwudi A., Charles S. Wiysonge, Maia Lesosky, Hassan Mahomed, and Duduzile Ndwandwe. "COVID-19 and the Gaping Wounds of South Africa’s Suboptimal Immunisation Coverage: An Implementation Research Imperative for Assessing and Addressing Missed Opportunities for Vaccination." Vaccines 9, no. 7 (June 23, 2021): 691. http://dx.doi.org/10.3390/vaccines9070691.
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Despite South Africa’s substantial investments in and efforts at ensuring universal access to immunisation services, progress has stalled and remains suboptimal across provinces and districts. An additional challenge is posed by the ongoing coronavirus disease 2019 (COVID-19) pandemic, which has disrupted immunisation services globally, including in South Africa. While there is growing evidence that missed opportunities for vaccination (MOV) are a major contributor to suboptimal immunisation progress globally, not much is known about the burden and determinants of MOV in the South African context. Herein, we make a case for assessing MOV as a strategy to address current immunisation coverage gaps while mitigating the adverse impacts of the COVID-19 pandemic on immunisation services. We illustrate a practical implementation research approach to assessing the burden of MOV among children in primary care settings; for understanding the factors associated with MOV; and for designing, implementing, and evaluating context-appropriate quality improvement interventions for addressing missed opportunities. Such efforts are vital for building health system resilience and maintaining immunisation programme capacity to optimally deliver essential health services such as routine childhood immunisation, even during pandemics.
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le Roux, David M., Mark P. Nicol, Landon Myer, Aneesa Vanker, Jacob A. M. Stadler, Eckart von Delft, and Heather J. Zar. "Lower Respiratory Tract Infections in Children in a Well-vaccinated South African Birth Cohort: Spectrum of Disease and Risk Factors." Clinical Infectious Diseases 69, no. 9 (March 29, 2019): 1588–96. http://dx.doi.org/10.1093/cid/ciz017.
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Abstract Background Childhood lower respiratory tract infections (LRTIs) cause substantial morbidity and under-5 child mortality. The epidemiology of LRTI is changing in low- and middle-income countries with expanding access to conjugate vaccines, yet there are few data on the incidence and risk factors for LRTI in these settings. Methods A prospective birth cohort enrolled mother–infant pairs in 2 communities near Cape Town, South Africa. Active surveillance for LRTI was performed for the first 2 years of life over 4 respiratory seasons. Comprehensive data collection of risk factors was done through 2 years of life. World Health Organization definitions were used to classify clinical LRTI and chest radiographs. Results From March 2012 to February 2017, 1143 children were enrolled and followed until 2 years of age. Thirty-two percent of children were exposed to antenatal maternal smoking; 15% were born at low birth weights. Seven hundred ninety-five LRTI events occurred in 429 children by February 2017; incidence of LRTI was 0.51 and 0.25 episodes per child-year in the first and second years of life, respectively. Human immunodeficiency virus (HIV)–exposed, uninfected infants (vs HIV-unexposed infants) were at increased risk of hospitalized LRTI in the first 6 months of life. In regression models, male sex, low birth weight, and maternal smoking were independent risk factors for both ambulatory and hospitalized LRTI; delayed or incomplete vaccination was associated with hospitalized LRTI. Conclusions LRTI incidence was high in the first year of life, with substantial morbidity. Strategies to ameliorate harmful exposures are needed to reduce LRTI burden in vulnerable populations.
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Mwenda, Jason M., Elizabeth Soda, Goitom Weldegebriel, Regis Katsande, Joseph Nsiari-Muzeyi Biey, Tieble Traore, Linda de Gouveia, et al. "Pediatric Bacterial Meningitis Surveillance in the World Health Organization African Region Using the Invasive Bacterial Vaccine-Preventable Disease Surveillance Network, 2011–2016." Clinical Infectious Diseases 69, Supplement_2 (August 31, 2019): S49—S57. http://dx.doi.org/10.1093/cid/ciz472.
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Abstract Background Bacterial meningitis is a major cause of morbidity and mortality in sub-Saharan Africa. We analyzed data from the World Health Organization’s (WHO) Invasive Bacterial Vaccine-preventable Diseases Surveillance Network (2011–2016) to describe the epidemiology of laboratory-confirmed Streptococcus pneumoniae (Spn), Neisseria meningitidis, and Haemophilus influenzae meningitis within the WHO African Region. We also evaluated declines in vaccine-type pneumococcal meningitis following pneumococcal conjugate vaccine (PCV) introduction. Methods Reports of meningitis in children <5 years old from sentinel surveillance hospitals in 26 countries were classified as suspected, probable, or confirmed. Confirmed meningitis cases were analyzed by age group and subregion (South-East and West-Central). We described case fatality ratios (CFRs), pathogen distribution, and annual changes in serotype and serogroup, including changes in vaccine-type Spn meningitis following PCV introduction. Results Among 49 844 reported meningitis cases, 1670 (3.3%) were laboratory-confirmed. Spn (1007/1670 [60.3%]) was the most commonly detected pathogen; vaccine-type Spn meningitis cases declined over time. CFR was the highest for Spn meningitis: 12.9% (46/357) in the South-East subregion and 30.9% (89/288) in the West-Central subregion. Meningitis caused by N. meningitidis was more common in West-Central than South-East Africa (321/954 [33.6%] vs 110/716 [15.4%]; P < .0001). Haemophilus influenzae (232/1670 [13.9%]) was the least prevalent organism. Conclusions Spn was the most common cause of pediatric bacterial meningitis in the African region even after reported cases declined following PCV introduction. Sustaining robust surveillance is essential to monitor changes in pathogen distribution and to inform and guide vaccination policies.
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Brown, Nick, Antti Juhani Kukka, and Andreas Mårtensson. "Efficacy of zinc as adjunctive pneumonia treatment in children aged 2 to 60 months in low-income and middle-income countries: a systematic review and meta-analysis." BMJ Paediatrics Open 4, no. 1 (July 2020): e000662. http://dx.doi.org/10.1136/bmjpo-2020-000662.
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BackgroundDespite advances in vaccination and case management, pneumonia remains the single largest contributor to early child mortality worldwide. Zinc has immune-enhancing properties, but its role in adjunctive treatment of pneumonia in low-income and middle-income countries (LMICs) is controversial and research still active.MethodsSystematic review and meta-analysis of randomised controlled trials of zinc and placebo in pneumonia in children aged 2 to 60 months in LMICs. Databases included MEDLINE, the Cochrane Library, EMBASE, LILACS, SciELO, the WHO portal, Scopus, Google Scholar and ClinicalTrials.gov. Inclusion criteria included accepted signs of pneumonia and clear measure of outcome. Risk of bias was independently assessed by two authors. ORs with 95% CI were used for calculating the pooled estimate of dichotomous outcomes including treatment failure and mortality. Time to recovery was expressed as HRs. Sensitivity analyses considering risk of bias and subgroup analyses for pneumonia severity were performed.ResultsWe identified 11 trials published between 2004 and 2019 fulfilling the a priori defined criteria, 7 from South Asia and 3 from Africa and 1 from South America. Proportional treatment failure was comparable in both zinc and placebo groups when analysed for all patients (OR 0.95 (95% CI 0.80 to 1.14)) and only for those with severe pneumonia (OR 0.93 (95% CI 0.75 to 1.14)). No difference was seen in mortality between zinc and placebo groups (OR 0.64 (95% CI 0.31 to 1.31)). Time to recovery from severe pneumonia did not differ between the treatment and control groups for patients with severe pneumonia (HR 1.01 (95% CI 0.89 to 1.14)). Removal of four studies with high risk of bias made no difference to the conclusions.ConclusionThere is no evidence that adjunctive zinc treatment improves recovery from pneumonia in children in LMICs.Trial registration numberCRD42019141602.
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Dye, Christopher. "Making wider use of the world's most widely used vaccine: Bacille Calmette–Guérin revaccination reconsidered." Journal of The Royal Society Interface 10, no. 87 (October 6, 2013): 20130365. http://dx.doi.org/10.1098/rsif.2013.0365.
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Approximately 100 million newborn children receive Bacille Calmette–Guérin (BCG) annually, because vaccination is consistently protective against childhood tuberculous meningitis and miliary TB. By contrast, BCG efficacy against pulmonary TB in children and adults is highly variable, ranging from 0% to 80%, though it tends to be higher in individuals who have no detectable prior exposure to mycobacterial infections, as judged by the absence of delayed-type hypersensitivity response (a negative tuberculin skin test, TST). The duration of protection against pulmonary TB is also variable, but lasts about 10 years on average. These observations raise the possibility that BCG revaccination, following primary vaccination in infancy, could be efficacious among TST-negative adolescents as they move into adulthood, the period of highest risk for pulmonary disease. To inform continuing debate about revaccination, this paper assesses the effectiveness and cost-effectiveness of revaccinating adolescents in a setting with intense transmission—Cape Town, South Africa. For a cost of revaccination in the range US$1–10 per person, and vaccine efficacy between 10% and 80% with protection for 10 years, the incremental cost per year of healthy life recovered (disability-adjusted life years, DALY) in the vaccinated population lies between US$116 and US$9237. The intervention is about twice as cost-effective when allowing for the extra benefits of preventing transmission, with costs per DALY recovered in the range US$52–$4540. At 80% efficacy, revaccination averted 17% of cases. Under the scenarios investigated, BCG revaccination is cost-effective against international benchmarks, though not highly effective. Cost-effectiveness ratios would be more favourable if we also allow for TB cases averted by preventing transmission to HIV-positive people, for the protection of HIV-negative people who later acquire HIV infection, for the possible non-specific benefits of BCG, for the fact that some adolescents would receive BCG for the first time, and for cost sharing when BCG is integrated into an adolescent immunization programme. These findings suggest, subject to further evaluation, that BCG revaccination could be cost-effective in some settings.
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Zancan, L. "Pediatric Hepatology: Present and Future." Acta geneticae medicae et gemellologiae: twin research 45, no. 3 (July 1996): 377–82. http://dx.doi.org/10.1017/s0001566000000970.
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Pediatric Gastroenterology was born as specialism within Pediatrics during the 1960s, and its younger sister, Hepatology, gradually acquired respect as an autonomous field early in the 1970s, with the formation of the Pediatric group for Gastroenterology, and more recently in 1992 with the creation of the Italian Society for Pediatric Gastroenterology and Hepatology in the Italian Society of Pediatrics. My aim in this paper is to review the most significant developments that have taken place in Pediatric Hepatology over the past decade, and to indicate how the field is likely to develop in the future. I will make particular reference here to HBV infection, cholelithiasis, extrahepatic biliary atresia, and liver transplants.In Italy, this remains one of the most common causes of chronic hepatitis in children. (HCV infection in children without an underlying illness is still uncommon). Since the 1960s, we have gained an understanding of the risk factors, pathogenesis and natural history of infection, and an awareness of the strong tendency for the condition to become chronic in children. Moreover, with the increase in knowledge of the biology of the virus, an efficacious programme of preventive medicine has been implemented, which 3 years ago culminated in obligatory vaccination for newborns and 12-year-old children. These measures have resulted in a change in the epidemiology of the infection, which is now found above all in foreign children residing in Italy, who have been usually adopted.Over the last 10 years, the phenomenon of international adoption represents a new socio-sanitary reality in the industrialized countries. A number of important studies report that, more than 50 percent of foreign children adopted present serious medical condition (irrespective of the area of the world from which they come, be it Asia, Africa, South America, or Eastern Europe). If routine screening is not carried out, these disorders go undetected by medical tests performed in the children's countries of origin, as well as by medical examinations carried out in their adoptive countries [4]. The most frequent diseases are infections, and amongst these HBV infection, besides TBC and CMV infection, making those children in whom such infections go undetected veritable spring of disease [3].
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Mandalakas, Anna M., Anneke C. Hesseling, Alexander Kay, Karen Du Preez, Leonardo Martinez, Lena Ronge, Andrew DiNardo, Christoph Lange, and H. Lester Kirchner. "Tuberculosis prevention in children: A prospective community based study in South Africa." European Respiratory Journal, October 29, 2020, 2003028. http://dx.doi.org/10.1183/13993003.03028-2020.
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Tuberculosis preventive therapy reduces tuberculosis risk in children. However, the effectiveness of tuberculosis preventive therapy in children living in high burden settings is unclear.In a prospective observational community-based cohort study in Cape Town, South Africa, we assessed the effectiveness of routine tuberculosis preventive therapy in children ≤15 years of age in a tuberculosis and HIV high-prevalence setting.Among 966 children (median age 5.07 years; inter-quartile range [IQR] 2.52,8.72), 676 (70%) reported exposure to an adult with tuberculosis in the past 3 months and 240/326 (74%) of eligible children initiated isoniazid preventive therapy (IPT) under programmatic guidelines. Prevalent (n=73) and incident (n=27) tuberculosis were diagnosed among 100/966 (10%) of children. Children who initiated IPT were 82% less likely to develop incident tuberculosis than children who did not (aOR=0.18; 95% confidence-interval [CI] 0.06,0.52; p=0.0014). Children's risk of incident tuberculosis increased if they were younger than 5 years, living with HIV, had a positive M.tuberculosis specific immune response, or recent tuberculosis exposure. The risk of incident tuberculosis was not associated with gender or M. bovis-BCG vaccination status. Number needed to treat (NNT) was lowest in children living with HIV (NNT=15) and children less than 5 years of age (NNT=19) compared to children of all ages (NNT=82).In communities with high tuberculosis prevalence, tuberculosis preventive therapy substantially reduces the risk of tuberculosis among children who are younger than 5 years or living with HIV, especially those with recent tuberculosis exposure or a positive M.tuberculosis specific immune response in the absence of disease (Mtb-sir-nodis).
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Asowata, Osaretin E., Olubisi T. Ashiru, Saajida Mahomed, A. Willem Sturm, and Prashini Moodley. "Influence of vaccination status and clinical, seasonal and sociodemographic factors on rotavirus prevalence in KwaZulu-Natal, South Africa." Southern African Journal of Infectious Diseases 33, no. 5 (December 12, 2018). http://dx.doi.org/10.4102/sajid.v33i5.152.
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Human rotavirus infection is the leading cause of diarrhoea in infants and young children worldwide. In South Africa, diarrhoea is a major cause of childhood morbidity and mortality in children less than five years old, and before the vaccine was introduced rotavirus had been reported as causing one-third of all diarrhoeal related hospital admissions. This study assessed factors influencing the prevalence of rotavirus in children aged five years and under in KwaZulu-Natal, South Africa between June 2014 and June 2015. In addition, genotypes of the rotaviruses were determined. A stool specimen was collected from children presenting with diarrhoea to a regional hospital. Clinical, vaccination status, seasonal and sociodemographic information was collected using a structured questionnaire. ELISA (enzyme linked immunosorbent assay) was performed to detect rotavirus antigen in the stool. Rotavirus from selected positives specimens were genotyped using RT–PCR (reverse transcriptase polymerase chain reaction). The data were analysed using SPSS. In total, 365 stool specimens were collected. Rotavirus antigen was detected in 83 (23%) patients. The prevalence of rotavirus was not affected by vaccination status (p = 0.3; OR 1.5; CI 0.7–3.1), HIV status (p = 0.2; OR 0.6; CI 0.2–1.5), breastfeeding (p = 0.9; OR 1.1; CI 0.5–2.5) and administration of anti-helminth treatment (p = 0.6; OR 0.8; CI 0.3–1.9). The highest rotavirus prevalence was observed in the winter season (p 0.001; OR 43.3; CI 14.9–125.0). The G9P[8] was the most prevalent genotype (21%) followed by G9P[4] (14%). Rotavirus remains a major contributor to childhood diarrhoeal aetiology and hospitalisation in KwaZulu-Natal. Further investigation is needed to better understand the key drivers of rotavirus infection despite a successful vaccination programme in South Africa.
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Ndwandwe, Duduzile, Chukwudi A. Nnaji, Thandiwe Mashunye, Olalekan A. Uthman, and Charles S. Wiysonge. "Incomplete vaccination and associated factors among children aged 12–23 months in South Africa: an analysis of the South African demographic and health survey 2016." Human Vaccines & Immunotherapeutics, July 23, 2020, 1–8. http://dx.doi.org/10.1080/21645515.2020.1791509.
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Tempia, Stefano, Sibongile Walaza, Jocelyn Moyes, Adam L. Cohen, Claire von Mollendorf, Florette K. Treurnicht, Marietjie Venter, et al. "Risk Factors for Influenza-Associated Severe Acute Respiratory Illness Hospitalization in South Africa, 2012–2015." Open Forum Infectious Diseases 4, no. 1 (January 1, 2017). http://dx.doi.org/10.1093/ofid/ofw262.
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Abstract Background Data on risk factors for influenza-associated hospitalizations in low- and middle-income countries are limited. Methods We conducted active syndromic surveillance for hospitalized severe acute respiratory illness (SARI) and outpatient influenza-like illness (ILI) in 2 provinces of South Africa during 2012–2015. We compared the characteristics of influenza-positive patients with SARI to those with ILI to identify factors associated with severe disease requiring hospitalization, using unconditional logistic regression. Results During the study period, influenza virus was detected in 5.9% (110 of 1861) and 15.8% (577 of 3652) of SARI and ILI cases, respectively. On multivariable analysis factors significantly associated with increased risk of influenza-associated SARI hospitalization were as follows: younger and older age (<6 months [adjusted odds ratio {aOR}, 37.6], 6–11 months [aOR, 31.9], 12–23 months [aOR, 22.1], 24–59 months [aOR, 7.1], and ≥65 years [aOR, 40.7] compared with 5–24 years of age), underlying medical conditions (aOR, 4.5), human immunodeficiency virus infection (aOR, 4.3), and Streptococcus pneumoniae colonization density ≥1000 deoxyribonucleic acid copies/mL (aOR, 4.8). Underlying medical conditions in children aged <5 years included asthma (aOR, 22.7), malnutrition (aOR, 2.4), and prematurity (aOR, 4.8); in persons aged ≥5 years, conditions included asthma (aOR, 3.6), diabetes (aOR, 7.1), chronic lung diseases (aOR, 10.7), chronic heart diseases (aOR, 9.6), and obesity (aOR, 21.3). Mine workers (aOR, 13.8) and pregnant women (aOR, 12.5) were also at increased risk for influenza-associated hospitalization. Conclusions The risk groups identified in this study may benefit most from annual influenza immunization, and children <6 months of age may be protected through vaccination of their mothers during pregnancy.
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Moffatt, M., and M. Wasserman. "Modelling the global impact of the 13-valent pneumococcal vaccine on antibiotic use for otitis media." European Journal of Public Health 30, Supplement_5 (September 1, 2020). http://dx.doi.org/10.1093/eurpub/ckaa166.1423.
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Abstract Background Antimicrobial resistance (AMR) is a critical issue in global health causing approximately 1 million annual deaths. Vaccines are essential in addressing AMR as they reduce resistant strains and prevent development of resistance by preventing spread of disease and resulting antimicrobial use. This analysis evaluates the impact the 13-valent pneumococcal conjugate vaccine (PCV13) has had on dispensed antibiotic prescriptions (DAP) due to otitis media (OM), one of the largest drivers of DAP globally. Methods An Excel-based model was developed to estimate number of infants vaccinated with PCV13, and the associated reduction in OM cases in children <5 since 2010. OM cases averted were based on a global meta-analysis and estimated cases averted were applied to infants vaccinated by country. DAP avoided were estimated assuming 90% of OM cases were prescribed an antibiotic. We then compared our modelled estimates to metrics measuring number needed to vaccinate to prevent DAP from any outcome. Results Over the past 10 years, we estimated 286,54m infants were vaccinated with PCV13, with 158,33m OM cases and as many as 142,49m DAP avoided globally. By WHO region, reductions in OM rates and DAP respectively are estimated to have been; Africa and Eastern Mediterranean (103,05m; 92,74m), South-East Asia and Western Pacific (8,82m; 7,94m), Europe (20,70m; 18,63m) and Americas (25,76m; 23,18m). Using rates from the literature of 0,20 to 1,79 total DAP avoided per child vaccinated, results ranged from to 71,63m to 511,68m. Conclusions PCV13 use has resulted in substantial reductions in OM and DAP. As we focus on OM in children <5, results underestimate the full impact of PCV13 on DAP as vaccine impact on other pneumococcal diseases and adults through herd effect are not included. Recognition of the role of vaccination in addressing AMR burden is an opportunity to encourage patients, providers and healthcare systems to continually prioritize vaccination in public health efforts. Key messages Over the past 10 years, PCV13 has led to considerable reductions in dispensed antibiotic prescriptions globally, highlighting the importance of prioritizing vaccination in global healthcare systems. Our findings illustrate how vaccines can play an essential role in reducing the global burden of antimicrobial resistance through reduction of antibiotic use.
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Fattorini, M., G. Raguzzoni, C. Cuccaro, N. Nante, C. Quercioli, J. M. N. Ndilimondjo, C. Caresia, and G. Putoto. "Multiple interventions to strengthen immunization services in an Angolan district." European Journal of Public Health 29, Supplement_4 (November 1, 2019). http://dx.doi.org/10.1093/eurpub/ckz185.593.
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Abstract Background Immunization represents one of the most effective intervention in public health. In the Sustainable Development Goals era, adequate vaccination services are still crucial for the prevention of infectious diseases and the reduction of under-5 mortality. However, in 2017 WHO estimated that children <1 year who did not receive the third dose of Diphtheria-Tetanus-Pertussis (DTP3) vaccine were 19.2 million globally, and 600000 of these were located in Angola, a Sub-Saharan country with an estimated DTP3 coverage of 52%. Since 2000, Italian Non-Governmental Organization (NGO) Doctors with Africa CUAMM supports the activity of the hospital of Chiulo in the commune of Mucope (district of Ombadja, south of Angola). Aim of the study is to describe the interventions implemented to strengthen the immunization services performed by the hospital Public Health Staff (PHS). Methods In May 2018 the NGO started to implement multiple interventions to enhance the number of vaccine doses administered. Firstly, outreach immunization sessions were reorganized and reinforced, for example involving local Community Health Workers in the identification of villages with a high burden of unvaccinated children. Other actions were the continuous training of the PHS in data collection and the increased collaboration with the Ombadja District Health Department in order to develop a more efficient vaccine supply chain at local level. Results In 2018, among children <1 year the PHS administered 19746 doses, with a 22.3% growth compared to 2017 (15349 doses). Doses administered during outreach sessions increased by 35.4% (6597 versus 4259 doses). Estimated DTP3 coverage in Mucope commune was 71% (2017, 59%). Conclusions The WHO “Reaching Every Community” strategy emphasizes the importance of high quality immunization services in hard-to-reach areas. The organisation of well-functioning immunization services requires a multifaceted approach by the involved stakeholders. Key messages In 2017, globally 19.2 million of children <1 year did not receive the recommended three DTP doses. Six-hundred thousand were located in Angola. To obtain and sustain an adequate vaccination coverage, especially in hard-to-reach areas, multiple and well-coordinated actions should be implemented by all the involved stakeholders.
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"Study to Evaluate the Immune Response After Booster Vaccination With Tdap-IPV Vaccine (Against Tetanus, Diphtheria, Pertussis and Poliomyelitis) in Children 9-13 Years Who Received Different Pertussis Primary Vaccine Regimens in Republic of South Africa." Case Medical Research, March 9, 2020. http://dx.doi.org/10.31525/ct1-nct04300192.
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