Last data update: Nov 04, 2024. (Total: 48056 publications since 2009)
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Query Trace: Fitter DL[original query] |
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Perceptions toward Ebola vaccination and correlates of vaccine uptake among high-risk community members in North Kivu, Democratic Republic of the Congo
Perera SM , Garbern SC , Mbong EN , Fleming MK , Muhayangabo RF , Ombeni AB , Kulkarni S , Tchoualeu DD , Kallay R , Song E , Powell J , Gainey M , Glenn B , Mutumwa RM , Mustafa SHB , Earle-Richardson G , Fukunaga R , Abad N , Soke GN , Prybylski D , Fitter DL , Levine AC , Doshi RH . PLOS Glob Public Health 2024 4 (1) e0002566 The tenth Ebola Virus Disease (EVD) outbreak (2018-2020, North Kivu, Ituri, South Kivu) in the Democratic Republic of the Congo (DRC) was the second-largest EVD outbreak in history. During this outbreak, Ebola vaccination was an integral part of the EVD response. We evaluated community perceptions toward Ebola vaccination and identified correlates of Ebola vaccine uptake among high-risk community members in North Kivu, DRC. In March 2021, a cross-sectional survey among adults was implemented in three health zones. We employed a sampling approach mimicking ring vaccination, targeting EVD survivors, their household members, and their neighbors. Outbreak experiences and perceptions toward the Ebola vaccine were assessed, and modified Poisson regression was used to identify correlates of Ebola vaccine uptake among those offered vaccination. Among the 631 individuals surveyed, most (90.2%) reported a high perceived risk of EVD and 71.6% believed that the vaccine could reduce EVD severity; however, 63.7% believed the vaccine had serious side effects. Among the 474 individuals who had been offered vaccination, 397 (83.8%) received the vaccine, 180 (45.3%) of those vaccinated received the vaccine after two or more offers. Correlates positively associated with vaccine uptake included having heard positive information about the vaccine (RR 1.30, 95% CI 1.06-1.60), the belief that the vaccine could prevent EVD (RR 1.23, 95% CI 1.09-1.39), and reporting that religion influenced all decisions (RR 1.13, 95% CI 1.02-1.25). Ebola vaccine uptake was high in this population, although mixed attitudes and vaccine delays were common. Communicating positive vaccine information, emphasizing the efficacy of the Ebola vaccine, and engaging religious leaders to promote vaccination may aid in increasing Ebola vaccine uptake during future outbreaks. |
Ebola vaccine uptake and attitudes among healthcare workers in North Kivu, Democratic Republic of the Congo, 2021
Doshi RH , Garbern SC , Kulkarni S , Perera SM , Fleming MK , Muhayangabo RF , Ombeni AB , Tchoualeu DD , Kallay R , Song E , Powell J , Gainey M , Glenn B , Mutumwa RM , Hans Bateyi Mustafa S , Earle-Richardson G , Gao H , Abad N , Soke GN , Fitter DL , Hyde TB , Prybylski D , Levine AC , Jalloh MF , Mbong EN . Front Public Health 2023 11 1080700 INTRODUCTION: During the 2018-2020 Ebola virus disease (EVD) outbreak in the eastern part of the Democratic Republic of the Congo (DRC), prevention and control measures, such as Ebola vaccination were challenging by community mistrust. We aimed to understand perceptions regarding Ebola vaccination and identify determinants of Ebola vaccine uptake among HCWs. METHODS: In March 2021, we conducted a cross-sectional survey among 438 HCWs from 100 randomly selected health facilities in three health zones (Butembo, Beni, Mabalako) affected by the 10th EVD outbreak in North Kivu, DRC. HCWs were eligible if they were ≥ 18 years and were working in a health facility during the outbreak. We used survey logistic regression to assess correlates of first-offer uptake (i.e., having received the vaccine the first time it was offered vs. after subsequent offers). RESULTS: Of the 438 HCWs enrolled in the study, 420 (95.8%) reported that they were eligible and offered an Ebola vaccine. Among those offered vaccination, self-reported uptake of the Ebola vaccine was 99.0% (95% confidence interval (CI) [98.5-99.4]), but first-offer uptake was 70.2% (95% CI [67.1, 73.5]). Nearly all HCWs (94.3%; 95% CI [92.7-95.5]) perceived themselves to be at risk of contracting EVD. The most common concern was that the vaccine would cause side effects (65.7%; 95% CI [61.4-69.7]). In the multivariable analysis, mistrust of the vaccine source or how the vaccine was produced decreased the odds of first-time uptake. DISCUSSION: Overall uptake of the Ebola vaccine was high among HCWs, but uptake at the first offer was substantially lower, which was associated with mistrust of the vaccine source. Future Ebola vaccination efforts should plan to make repeated vaccination offers to HCWs and address their underlying mistrust in the vaccines, which can, in turn, improve community uptake. |
CDC's COVID-19 international vaccine implementation and evaluation program and lessons from earlier vaccine introductions
Soeters HM , Doshi RH , Fleming M , Adegoke OJ , Ajene U , Aksnes BN , Bennett S , Blau EF , Carlton JG , Clements S , Conklin L , Dahlke M , Duca LM , Feldstein LR , Gidudu JF , Grant G , Hercules M , Igboh LS , Ishizumi A , Jacenko S , Kerr Y , Konne NM , Kulkarni S , Kumar A , Lafond KE , Lam E , Longley AT , McCarron M , Namageyo-Funa A , Ortiz N , Patel JC , Perry RT , Prybylski D , Reddi P , Salman O , Sciarratta CN , Shragai T , Siddula A , Sikare E , Tchoualeu DD , Traicoff D , Tuttle A , Victory KR , Wallace A , Ward K , Wong MKA , Zhou W , Schluter WW , Fitter DL , Mounts A , Bresee JS , Hyde TB . Emerg Infect Dis 2022 28 (13) S208-s216 The US Centers for Disease Control and Prevention (CDC) supports international partners in introducing vaccines, including those against SARS-CoV-2 virus. CDC contributes to the development of global technical tools, guidance, and policy for COVID-19 vaccination and has established its COVID-19 International Vaccine Implementation and Evaluation (CIVIE) program. CIVIE supports ministries of health and their partner organizations in developing or strengthening their national capacities for the planning, implementation, and evaluation of COVID-19 vaccination programs. CIVIE's 7 priority areas for country-specific technical assistance are vaccine policy development, program planning, vaccine confidence and demand, data management and use, workforce development, vaccine safety, and evaluation. We discuss CDC's work on global COVID-19 vaccine implementation, including priorities, challenges, opportunities, and applicable lessons learned from prior experiences with Ebola, influenza, and meningococcal serogroup A conjugate vaccine introductions. |
Diversity of rotavirus strains circulating in Haiti before and after introduction of monovalent vaccine.
Lucien MAB , Esona MD , Pierre M , Joseph G , Rivire C , Leshem E , Aliabadi N , Desormeaux AM , Andre-Alboth J , Fitter DL , Grant-Greene Y , Tate J , Boncy J , Patel R , Burnett E , Juin S , Parashar UD , Bowen MD . IJID Reg 2022 4 146-151 BACKGROUND: Haiti introduced a monovalent human group A rotavirus (RVA) vaccine (Rotarix) into its routine infant immunization program in April 2014. The goal of the surveillance program was to characterize RVA strains circulating in Haiti before and after RVA vaccine introduction. METHODS: Stool samples were collected from children <5 years old presenting with acute gastroenteritis at 16 hospitals in Haiti. RVA antigen enzyme immunoassay (EIA) testing was performed, and G and P genotypes were determined for positive specimens. In this study, genotype data for samples collected from May 2012 through April 2014 (the pre-vaccine introduction era) and May 2014 through July 2019 (post-vaccine introduction era) were analyzed. RESULTS: A total of 809 specimens were tested by the Centers for Disease Control and Prevention. During the pre-vaccine introduction era (May 2012 through April 2014), G12P[8] was the predominant genotype, detected in 88-94% of specimens. There was a high prevalence of the equine-like G3P[8] genotype among Haitian children with RVA after vaccine introduction. CONCLUSIONS: The predominance of equine-like G3P[8] in three of five RVA seasons post-vaccine introduction suggests possible vaccine-specific selection pressure in Haiti. These temporal variations in RVA genotype predominance will require continued monitoring in Haiti as the vaccination program continues. |
Identification of TB space-time clusters and hotspots in Ouest dpartement, Haiti, 2011-2016
Dismer AM , Charles M , Dear N , Louis-Jean JM , Barthelemy N , Richard M , Morose W , Fitter DL . Public Health Action 2021 11 (2) 101-107 BACKGROUND: Haiti has the highest incidence rate of TB in the Western Hemisphere, with an estimated 170 cases per 100,000 in 2019. Since 2010, control efforts have focused on targeted case-finding activities in urban areas, implementation of rapid molecular diagnostics at high-volume TB centers, and improved reporting. TB analyses are rarely focused on lower geographic units; thus, the major goal was to determine if there were focal areas of TB transmission from 2011 to 2016 at operational geographic levels useful for the National TB Control Program (PNLT). METHODS: We created a geocoder to locate TB cases at the smallest geographic level. Kulldorff's space-time permutation scan, Anselin Moran's I, and Getis-Ord Gi* statistics were used to determine the spatial distribution and clusters of TB. RESULTS: With 91% of cases linked using the geocoder, TB clusters were identified each year. Getis-Ord Gi* analysis revealed 14 distinct spatial clusters of high incidences in the Port-au-Prince metropolitan area. One hundred retrospective space-time clusters were detected. CONCLUSION: Our study confirms the presence of TB hotspots in the Ouest département, with most clusters in the Port-au-Prince metropolitan area. Results will help the PNLT and its partners better design case-finding strategies for these areas. |
Treatment success for patients with tuberculosis receiving care in areas severely affected by Hurricane Matthew - Haiti, 2016
Charles M , Richard M , Reichler MR , Koama JB , Morose W , Fitter DL . PLoS One 2021 16 (3) e0247750 BACKGROUND: On October 4, 2016, Hurricane Matthew struck southwest Haiti as a category 4 storm. The goal of this study was to evaluate the impact of the hurricane on tuberculosis (TB) services and patient outcomes in the three severely affected departments-Sud, Grand'Anse, and Nippes-of southwest Haiti. METHODS: We developed a standard questionnaire to assess a convenience sample of health facilities in the affected areas, a patient tracking form, and a line list for tracking all patients with drug-susceptible TB registered in care six months before the hurricane. We analyzed data from the national TB electronic surveillance system to determine outcomes for all patients receiving anti-TB treatment in the affected areas. We used logistic regression analysis to determine factors associated with treatment success. RESULTS: Of the 66 health facilities in the three affected departments, we assessed 31, accounting for 536 (45.7%) of 1,174 TB patients registered in care when Hurricane Matthew made landfall in Haiti. Three (9.7%) health facilities sustained moderate to severe damage, whereas 18 (58.1%) were closed for <1 week, and five (16.1%) for ≥1 week. Four weeks after the hurricane, 398 (73.1%) of the 536 patients in the assessed facilities were located. Treatment success in the affected departments one year after the hurricane was 81.4%. Receiving care outside the municipality of residence (adjusted odds ratio [aOR]: 0.46, 95% confidence interval [CI]: 0.27-0.80) and HIV positivity (aOR: 0.31, 95% CI: 0.19-0.51) or unknown HIV status (aOR: 0.49, 95% CI: 0.33-0.74) were associated with significantly lower rates of treatment success. CONCLUSIONS: Despite major challenges, a high percentage of patients receiving anti-TB treatment before the hurricane were located and successfully treated in southwest Haiti. The lessons learned and results presented here may help inform policies and guidelines in similar settings for effective TB control after a natural disaster. |
COVID-19 Vaccine Second-Dose Completion and Interval Between First and Second Doses Among Vaccinated Persons - United States, December 14, 2020-February 14, 2021.
Kriss JL , Reynolds LE , Wang A , Stokley S , Cole MM , Harris LQ , Shaw LK , Black CL , Singleton JA , Fitter DL , Rose DA , Ritchey MD , Toblin RL . MMWR Morb Mortal Wkly Rep 2021 70 (11) 389-395 In December 2020, two COVID-19 vaccines (Pfizer-BioNTech and Moderna) received Emergency Use Authorization from the Food and Drug Administration.*(,)(†) Both vaccines require 2 doses for a completed series. The recommended interval between doses is 21 days for Pfizer-BioNTech and 28 days for Moderna; however, up to 42 days between doses is permissible when a delay is unavoidable.(§) Two analyses of COVID-19 vaccine administration data were conducted among persons who initiated the vaccination series during December 14, 2020-February 14, 2021, and whose doses were reported to CDC through February 20, 2021. The first analysis was conducted to determine whether persons who received a first dose and had sufficient time to receive the second dose (i.e., as of February 14, 2021, >25 days from receipt of Pfizer-BioNTech vaccine or >32 days from receipt of Moderna vaccine had elapsed) had received the second dose. A second analysis was conducted among persons who received a second COVID-19 dose by February 14, 2021, to determine whether the dose was received during the recommended dosing interval, which in this study was defined as 17-25 days (Pfizer-BioNTech) and 24-32 days (Moderna) after the first dose. Analyses were stratified by jurisdiction and by demographic characteristics. In the first analysis, among 12,496,258 persons who received the first vaccine dose and for whom sufficient time had elapsed to receive the second dose, 88.0% had completed the series, 8.6% had not received the second dose but remained within the allowable interval (≤42 days since the first dose), and 3.4% had missed the second dose (outside the allowable interval, >42 days since the first dose). The percentage of persons who missed the second dose varied by jurisdiction (range = 0.0%-9.1%) and among demographic groups was highest among non-Hispanic American Indian/Alaska Native (AI/AN) persons (5.1%) and persons aged 16-44 years (4.0%). In the second analysis, among 14,205,768 persons who received a second dose, 95.6% received the dose within the recommended interval, although percentages varied by jurisdiction (range = 79.0%-99.9%). Public health officials should identify and address possible barriers to completing the COVID-19 vaccination series to ensure equitable coverage across communities and maximum health benefits for recipients. Strategies to ensure series completion could include scheduling second-dose appointments at the first-dose administration and sending reminders for second-dose visits. |
Vaccination of contacts of Ebola virus disease survivors to prevent further transmission.
Doshi RH , Fleming M , Mukoka AK , Carter RJ , Hyde TB , Choi M , Nzaji MK , Bateyi SH , Christie A , Nichol ST , Damon IK , Beach M , Musenga EM , Fitter DL . Lancet Glob Health 2020 8 (12) e1455-e1456 On April 10, 2020, just 2 days before the anticipated declaration of the end of the North Kivu and Ituri Ebola virus disease (EVD) outbreak in DR Congo, and 53 days after the last confirmed case of EVD had been reported, a new case was confirmed. Sequencing of patient samples from the case in April and six others that followed indicated that these cases were likely to have come from a reintroduction of the virus from a persistently infected survivor.1 This group of cases marked the second flare-up linked to an EVD survivor during this outbreak. In November, 2019, a relapse case in North Kivu resulted in widespread transmission across multiple health zones, helping to extend the outbreak by at least 3 months. |
Loss to follow-up among patients receiving anti-tuberculosis treatment, Haiti, 2011-2015
Schnaubelt ER , Charles M , Richard M , Fitter DL , Morose W , Cegielski JP . Public Health Action 2018 8 (4) 154-161 Setting: Tuberculosis (TB) treatment facilities in Haiti. Objective: To assess factors associated with loss to follow-up (LTFU) among patients receiving treatment for tuberculosis (TB) in Haiti. Design: We analyzed Haiti's national surveillance data for patients started on anti-tuberculosis treatment from 2011 to 2015 to determine factors associated with LTFU using multivariable logistic regression and describe LTFU in terms of subnational units to target future intervention strategies. We also conducted a survival analysis to estimate hazard ratios of factors associated with time to LTFU. Results: Of 81 490 TB cases reported, 7423 (9.1%) were LTFU during anti-tuberculosis treatment, increasing from 7.1% in 2011 to 10.3% in 2015. Six high-volume facilities had significantly higher rates of LTFU (14.3-31.9%) than the rest of the country, accounting for 18.8% of all TB cases reported, but 41.7% of all LTFU patients. Male sex, previous treatment history, and human immunodeficiency virus infection were associated with higher rates of LTFU. The median time to LTFU was 94 days. Conclusion: A small number of facilities accounted for disproportionately high rates of LTFU. These results identify characteristics of facilities and individuals leading to concentrated interventions to reduce LTFU and improve treatment success. |
Strengthening national disease surveillance and response-Haiti, 2010-2015
Juin S , Schaad N , Lafontant D , Joseph GA , Barzilay E , Boncy J , Barrais R , Louis FJ , Jean Charles NL , Corvil S , Barthelemy N , Dismer A , Pierre JS , Archer RW , Antoine M , Marston B , Katz M , Dely P , Adrien P , Fitter DL , Lowrance D , Patel R . Am J Trop Med Hyg 2017 97 12-20 Haiti's health system has faced many challenges over the years, with competing health priorities in the context of chronic financial and human resource limitations. As a result, the existing notifiable disease surveillance system was unable to provide the most basic epidemiologic data for public health decision-making and action. In the wake of the January 2010 earthquake, the Haitian Ministry of Public Health and Population collaborated with the U.S. Centers for Disease Control and Prevention, the Pan American Health Organization, and other local and international partners to implement a functional national surveillance system. More than 7 years later, it is important to take the opportunity to reflect on progress made on surveillance and response in Haiti, including disease detection, reporting, outbreak investigation, and response. The national epidemiologic surveillance network that started with 51 sites in 2010 has been expanded to 357 sites as of December 2015. Disease outbreaks identified via the surveillance system, or other surveillance approaches, are investigated by epidemiologists trained by the Ministry of Health's Field Epidemiology Training Program. Other related surveillance modules have been developed on the same model and electronic platform, allowing the country to document the impact of interventions, track progress, and monitor health problems. Sustainability remains the greatest challenge since most of the funding for surveillance come from external sources. |
Trends in tuberculosis case notification and treatment success, Haiti, 2010-2015
Charles M , Richard M , Joseph P , Bury MR , Perrin G , Louis FJ , Fitter DL , Marston BJ , Deyde V , Boncy J , Morose W , Pape JW , Lowrance DW . Am J Trop Med Hyg 2017 97 49-56 Since the 2010 earthquake, tuberculosis (TB) control has been a major priority for health sector response and recovery efforts in Haiti. The goal of this study was to analyze trends in TB case notification in Haiti from the aggregate data reported by the National TB Control Program to understand the effects of such efforts. A total of 95,745 TB patients were registered for treatment in Haiti between 2010 and 2015. Three regions, the West, Artibonite, and North departments accounted for 68% of the TB cases notified during the period. Patients in the 15-34 age groups represented 53% (50,560) of all cases. Case notification rates of all forms of TB increased from 142.7/100,000 in 2010 to 153.4 in 2015, peaking at 163.4 cases/100,000 in 2013. Case notification for smear-positive pulmonary TB increased from 85.5 cases/100,000 to 105.7 cases/100,000, whereas treatment success rates remained stable at 79-80% during the period. Active TB case finding efforts in high-risk communities and the introduction of new diagnostics have contributed to increasing TB case notification trends in Haiti from 2010 to 2015. Targeted interventions and novel strategies are being implemented to reach high-risk populations and underserved communities. |
Applying a new framework for public health systems recovery following emergencies and disasters: The example of Haiti following a major earthquake and cholera outbreak
Fitter DL , Delson DB , Guillaume FD , Schaad AW , Moffett DB , Poncelet JL , Lowrance D , Gelting R . Am J Trop Med Hyg 2017 97 4-11 Emergencies can often directly impact health systems of an affected region or country, especially in resource-constrained areas. Health system recovery following an emergency is a complex and dynamic process. Health system recovery efforts have often been structured around the World Health Organization's health systems building blocks as demonstrated by the Post-Disaster Needs Assessment. Although this structure is valuable and well known, it can overlook the intricacies of public health systems. We retrospectively examine public health systems recovery, a subset of the larger health system, following the 2010 Haiti earthquake and cholera outbreak, through the lens of the 10 essential public health services. This framework illustrates the comprehensive nature of and helps categorize the activities necessary for a well-functioning public health system and can complement other assessments. Outlining the features of a public health system for recovery in structured manner can also help lay the foundation for sustainable long-term development leading to a more robust and resilient health system. |
Implementation of broad screening with Ebola rapid diagnostic tests in Forecariah, Guinea
Louis FJ , Huang JY , Nebie YK , Koivogui L , Jayaraman G , Abiola N , Vansteelandt A , Worrel MC , Shang J , Murphy LB , Fitter DL , Marston BJ , Martel L . Afr J Lab Med 2017 6 (1) 484 Background: Laboratory-enhanced surveillance is critical for rapidly detecting the potential re-emergence of Ebola virus disease. Rapid diagnostic tests (RDT) for Ebola antigens could expand diagnostic capacity for Ebola virus disease. Objectives: The Guinean National Coordination for Ebola Response conducted a pilot implementation to determine the feasibility of broad screening of patients and corpses with the OraQuick Ebola RDT. Methods: The implementation team developed protocols and trained healthcare workers to screen patients and corpses in Forecariah prefecture, Guinea, from 15 October to 30 November 2015. Data collected included number of consultations, number of fevers reported or measured, number of tests performed for patients or corpses and results of confirmatory RT-PCR testing. Data on malaria RDT results were collected for comparison. Feedback from Ebola RDT users was collected informally during supervision visits and forums. Results: There were 3738 consultations at the 15 selected healthcare facilities; 74.6% of consultations were for febrile illness. Among 2787 eligible febrile patients, 2633 were tested for malaria and 1628 OraQuick Ebola RDTs were performed. A total of 322 OraQuick Ebola RDTs were conducted on corpses. All Ebola tests on eligible patients were negative. Conclusions: Access to Ebola testing was expanded by the implementation of RDTs in an emergency situation. Feedback from Ebola RDT users and lessons learned will contribute to improving quality for RDT expansion. |
Transmission of Zika Virus - Haiti, October 12, 2015-September 10, 2016
Journel I , Andrecy LL , Metellus D , Pierre JS , Faublas RM , Juin S , Dismer AM , Fitter DL , Neptune D , Laraque MJ , Corvil S , Pierre M , Buteau J , Lafontant D , Patel R , Lemoine JF , Lowrance DW , Charles M , Boncy J , Adrien P . MMWR Morb Mortal Wkly Rep 2017 66 (6) 172-176 Zika virus disease is caused by infection with a flavivirus with broad geographic distribution and is most frequently transmitted by the bite of an infected mosquito. The disease was first identified in the World Health Organization's Region of the Americas in 2015 and was followed by a surge in reported cases of congenital microcephaly in Brazil; Zika virus disease rapidly spread to the rest of the region and the Caribbean, including Haiti. Infection with the virus is associated with adverse fetal outcomes and rare neurologic complications in adults. The magnitude of public health issues associated with Zika virus led the World Health Organization to declare the Zika virus outbreak a Public Health Emergency of International Concern on February 1, 2016 (2). Because many persons with mild Zika virus disease are asymptomatic and might not seek care, it is difficult to estimate the actual incidence of Zika virus infection. During October 12, 2015-September 10, 2016, the Haitian Ministry of Public Health and Population (Ministere de la Sante Publique et de la Population [MSPP]) detected 3,036 suspected cases of Zika virus infection in the general population, 22 suspected cases of Zika virus disease among pregnant women, 13 suspected cases of Guillain-Barre syndrome (GBS), and 29 suspected cases of Zika-associated congenital microcephaly. Nineteen (0.6%) patients with suspected Zika virus disease, residing in Ouest (10 patients), Artibonite (six), and Centre (three) administrative departments, have been confirmed by laboratory testing, including two among pregnant women and 17 in the general population. Ongoing laboratory-enhanced surveillance to monitor Zika virus disease in Haiti is important to understanding the outbreak and ensuring effective response activities. |
Ebola virus persistence in breast milk after no reported illness: a likely source of virus transmission from mother to child.
Sissoko D , Keita M , Diallo B , Aliabadi N , Fitter DL , Dahl BA , Bore JA , Koundouno FR , Singethan K , Meisel S , Enkirch T , Mazzarelli A , Amburgey V , Faye O , Sall AA , Magassouba N , Carroll MW , Anglaret X , Malvy D , Formenty P , Aylward RB , Keita S , Djingarey MH , Loman NJ , Gunther S , Duraffour S . Clin Infect Dis 2016 64 (4) 513-516 A nine-month-old infant died from Ebola virus (EBOV) disease with unknown epidemiological link. While her parents did not report previous illness, laboratory investigations revealed persisting EBOV RNA in the mother's breast milk and the father's seminal fluid. Genomic analysis strongly suggests EBOV transmission to the child through breastfeeding. |
Evaluation of the national tuberculosis surveillance program in Haiti
Salyer SJ , Fitter DL , Milo R , Blanton C , Ho JL , Geffrard H , Morose W , Marston BJ . Int J Tuberc Lung Dis 2015 19 (9) 1045-50 OBJECTIVE: To assess the quality of tuberculosis (TB) surveillance in Haiti, including whether underreporting from facilities to the national level contributes to low national case registration. METHODS: We collected 2010 and 2012 TB case totals, reviewed laboratory registries, and abstracted individual TB case reports from 32 of 263 anti-tuberculosis treatment facilities randomly selected after stratification/weighting toward higher-volume facilities. We compared site results to national databases maintained by a non-governmental organization partner (International Child Care [ICC]) for 2010 and 2012, and the National TB Program (Programme National de Lutte contre la Tuberculose, PNLT) for 2012 only. RESULTS: Case registries were available at 30/32 facilities for 2010 and all 32 for 2012. Totals of 3711 (2010) and 4143 (2012) cases were reported at the facilities. Case totals per site were higher in site registries than in the national databases by 361 (9.7%) (ICC 2010), 28 (0.8%) (ICC 2012), and 31 (0.8%) cases (PNLT 2012). Of abstracted individual cases, respectively 11.8% and 6.8% were not recorded in national databases for 2010 (n = 323) and 2012 (n = 351). CONCLUSIONS: The evaluation demonstrated an improvement in reporting registered TB cases to the PNLT in Haiti between 2010 and 2012. Further improvement in case notification will require enhanced case detection and diagnosis. |
Measles and rubella vaccination coverage in Haiti, 2012: progress towards verifying and challenges to maintaining measles and rubella elimination
Tohme RA , Francois J , Wannemuehler K , Magloire R , Carolina Danovaro-Holliday M , Flannery B , Cavallaro KF , Fitter DL , Purcell N , Dismer A , Tappero JW , Vertefeuille JF , Hyde TB . Trop Med Int Health 2014 19 (9) 1105-15 OBJECTIVES: We conducted a nationwide survey to assess measles containing vaccine (MCV) coverage among children aged 1-9 years in Haiti and identify factors associated with vaccination before and during the 2012 nationwide supplementary immunisation activities (SIA). METHODS: Haiti was stratified into five geographic regions (Metropolitan Port-au-Prince, North, Centre, South and West), 40 clusters were randomly selected in each region, and 35 households were selected per cluster. RESULTS: Among the 7000 visited households, 75.8% had at least one child aged 1-9 years; of these, 5279 (99.5%) households consented to participate in the survey. Of 9883 children enrolled, 91% received MCV before and/or during the SIA; 31% received MR for the first time during the SIA, and 50.7% received two doses of MCV (one before and one during the 2012 SIA). Among the 1685 unvaccinated children during the SIA, the primary reason of non-vaccination was caregivers not being aware of the SIA (31.0%). Children aged 1-4 years had significantly lower MR SIA coverage than those aged 5-9 years (79.5% vs. 84.8%) (P < 0.0001). A higher proportion of children living in the West (12.3%) and Centre (11.2%) regions had never been vaccinated than in other regions (4.8-9.1%). Awareness, educational level of the mother and region were significantly associated with MR vaccination during and before the SIA (P < 0.001). CONCLUSIONS: The 2012 SIA successfully increased MR coverage; however, to maintain measles and rubella elimination, coverage needs to be further increased among children aged 1-4 years and in regions with lower coverage. |
Seroprevalence of measles and rubella antibodies in pregnant women Haiti, 2012
Fitter DL , Anselme R , Paluku G , Rey G , Flannery B , Tohme RA , Marston BJ , Griswold M , Boncy J , Vertefeuille JF . Vaccine 2013 32 (1) 69-73 BACKGROUND: Haiti had set a national goal to eliminate measles and rubella, as well as congenital rubella syndrome (CRS) by 2010. A 2007-2008 nationwide measles and rubella vaccination campaign targeting 1-19 years, however, reached only 79% of the target population. To assess whether population immunity was adequate to support elimination, we conducted a national serosurvey. METHODS: We systematically selected 740 serum specimens collected from pregnant women in a 2012 national antenatal HIV sentinel serosurvey across four age strata: 15-19, 20-24, 25-29 and 30-39 years. Sera were tested for measles and rubella specific immunoglobulin G antibodies (IgG) using commercial immunoassays. We classified sera as seropositive, seronegative or indeterminate per manufacturer's instructions, and analyzed seroprevalence according to age strata, and rural or urban residence. We assessed immunity by estimating antibody concentrations in international units per milliliter (IU/mL) for seropositive and indeterminate sera. Measles IgG concentrations >0.12IU/mL and rubella IgG concentrations >10IU/mL were considered clinically protective. RESULTS: Of 740 sera, 696 (94.1%) were seropositive and 20 (2.7%) were indeterminate for measles IgG; overall 716 (96.8%) sera had IgG concentrations >0.12IU/mL. For rubella IgG, 691 (93.4%) sera were seropositive and 1 (0.1%) was indeterminate; a total of 687 (92.8%) had IgG concentrations >10IU/mL. Measles seropositivity varied across age strata (p=0.003); seropositivity increased from 88.6% among 15-19 year olds to 98.4% among 30-39 year olds (Cochran-Armitage trend test≤0.0001). Rubella seropositivity did not differ across age strata. There were no statistically significant differences in measles or rubella seropositivity by urban versus rural residence. CONCLUSION: Despite previous low vaccination coverage for measles, results from this serosurvey indicate high levels of measles and rubella seropositivity in pregnant women, and contribute to the evidence for measles, rubella and CRS elimination from Haiti by the target date. |
Modeling the effect of water, sanitation, and hygiene and oral cholera vaccine implementation in Haiti
Fung IC , Fitter DL , Borse RH , Meltzer MI , Tappero JW . Am J Trop Med Hyg 2013 89 (4) 633-40 In 2010, toxigenic Vibrio cholerae was newly introduced to Haiti. Because resources are limited, decision-makers need to understand the effect of different preventive interventions. We built a static model to estimate the potential number of cholera cases averted through improvements in coverage in water, sanitation and hygiene (WASH) (i.e., latrines, point-of-use chlorination, and piped water), oral cholera vaccine (OCV), or a combination of both. We allowed indirect effects and non-linear relationships between effect and population coverage. Because there are limited incidence data for endemic cholera in Haiti, we estimated the incidence of cholera over 20 years in Haiti by using data from Malawi. Over the next two decades, scalable WASH interventions could avert 57,949-78,567 cholera cases, OCV could avert 38,569-77,636 cases, and interventions that combined WASH and OCV could avert 71,586-88,974 cases. Rate of implementation is the most influential variable, and combined approaches maximized the effect. |
Pandemic H1N1 influenza surveillance in Haiti, July-December 2009
Fitter DL , Freeman NM , Buteau J , Magloire R , Sessions WM , Guo L , Katz MA , Boncy J . Influenza Other Respir Viruses 2012 7 (5) 772-5 From June 2009 through December 2009, Haiti conducted sentinel surveillance for influenza. 499 samples were collected and tested using real-time RT-PCR. 197 (39.5%) were positive for influenza, including 95 (48%) pandemic (H1N1) 2009, 57 (29%) seasonal influenza A and 45 (23%) influenza B. The median age of pandemic (H1N1) 2009 cases was 21.7; two-thirds of pandemic (H1N1) 2009 cases were in patients aged 6 years - 35 years. Pandemic activity peaked in September and co-circulated with other influenza subtypes. The age distribution and seasonality of pandemic (H1N1) 2009 in Haiti were similar to other countries in the Caribbean region. |
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