Last data update: Nov 04, 2024. (Total: 48056 publications since 2009)
Records 1-30 (of 37 Records) |
Query Trace: McIntyre A[original query] |
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Farmworker mobility and COVID-19 vaccination strategies: Yuma County, Arizona, 2021
Franc KA , Phippard AE , Ruedas P , Pinto SJ , Mehta K , Montiel S , Contreras S , Katz H , McIntyre E , Lopez B , Kreutzberg-Martinez M , Steiner D , Gomez D , Merrill R . Am J Trop Med Hyg 2024 Farmworkers, a group of essential workers, experience a disproportionately high burden of COVID-19 due to their living and working conditions. This project characterized farmworker mobility in and around Yuma County, Arizona, to identify opportunities to improve farmworker access to COVID-19 vaccination. We collected qualitative and geospatial data through a series of in-person and virtual focus group discussions, key informant interviews, and intercept interviews with participatory mapping. Participants included farmworkers, employers, and representatives of local institutions who serve or interact with farmworkers. We identified participants through purposive and referential sampling and grouped people by sociodemographic characteristics for interviews. We used qualitative and geospatial analyses to identify common themes and mobility patterns. The team interviewed 136 people from February 26 to April 2, 2021. Common themes emerged about how farmworkers have little or no access to COVID-19 vaccination unless offered at their workplaces or at locations where they congregate at convenient times. Further, farmworkers described how their demanding work schedules, long commute times, and caretaker commitments make it challenging to access vaccination services. Geospatial analyses identified three geographic areas in Yuma County where farmworkers reported living and working that did not have a COVID-19 vaccine clinic within walking distance. Coordination between local public health authorities and key partners, including employers and trusted representatives from local community-based organizations or the Mexican consulate, to offer vaccination at worksites or other locations where farmworkers congregate can help improve access to COVID-19 vaccines and booster doses for this population. |
Triangulating truth and reaching consensus on population size, prevalence, and more: Modeling study
Fellows IE , Corcoran C , McIntyre AF . JMIR Public Health Surveill 2024 10 e48738 BACKGROUND: Population size, prevalence, and incidence are essential metrics that influence public health programming and policy. However, stakeholders are frequently tasked with setting performance targets, reporting global indicators, and designing policies based on multiple (often incongruous) estimates of these variables, and they often do so in the absence of a formal, transparent framework for reaching a consensus estimate. OBJECTIVE: This study aims to describe a model to synthesize multiple study estimates while incorporating stakeholder knowledge, introduce an R Shiny app to implement the model, and demonstrate the model and app using real data. METHODS: In this study, we developed a Bayesian hierarchical model to synthesize multiple study estimates that allow the user to incorporate the quality of each estimate as a confidence score. The model was implemented as a user-friendly R Shiny app aimed at practitioners of population size estimation. The underlying Bayesian model was programmed in Stan for efficient sampling and computation. RESULTS: The app was demonstrated using biobehavioral survey-based population size estimates (and accompanying confidence scores) of female sex workers and men who have sex with men from 3 survey locations in a country in sub-Saharan Africa. The consensus results incorporating confidence scores are compared with the case where they are absent, and the results with confidence scores are shown to perform better according to an app-supplied metric for unaccounted-for variation. CONCLUSIONS: The utility of the triangulator model, including the incorporation of confidence scores, as a user-friendly app is demonstrated using a use case example. Our results offer empirical evidence of the model's effectiveness in producing an accurate consensus estimate and emphasize the significant impact that the accessible model and app offer for public health. It offers a solution to the long-standing problem of synthesizing multiple estimates, potentially leading to more informed and evidence-based decision-making processes. The Triangulator has broad utility and flexibility to be adapted and used in various other contexts and regions to address similar challenges. |
Inter-species gene flow drives ongoing evolution of Streptococcus pyogenes and Streptococcus dysgalactiae subsp. equisimilis
Xie O , Morris JM , Hayes AJ , Towers RJ , Jespersen MG , Lees JA , Ben Zakour NL , Berking O , Baines SL , Carter GP , Tonkin-Hill G , Schrieber L , McIntyre L , Lacey JA , James TB , Sriprakash KS , Beatson SA , Hasegawa T , Giffard P , Steer AC , Batzloff MR , Beall BW , Pinho MD , Ramirez M , Bessen DE , Dougan G , Bentley SD , Walker MJ , Currie BJ , Tong SYC , McMillan DJ , Davies MR . Nat Commun 2024 15 (1) 2286 Streptococcus dysgalactiae subsp. equisimilis (SDSE) is an emerging cause of human infection with invasive disease incidence and clinical manifestations comparable to the closely related species, Streptococcus pyogenes. Through systematic genomic analyses of 501 disseminated SDSE strains, we demonstrate extensive overlap between the genomes of SDSE and S. pyogenes. More than 75% of core genes are shared between the two species with one third demonstrating evidence of cross-species recombination. Twenty-five percent of mobile genetic element (MGE) clusters and 16 of 55 SDSE MGE insertion regions were shared across species. Assessing potential cross-protection from leading S. pyogenes vaccine candidates on SDSE, 12/34 preclinical vaccine antigen genes were shown to be present in >99% of isolates of both species. Relevant to possible vaccine evasion, six vaccine candidate genes demonstrated evidence of inter-species recombination. These findings demonstrate previously unappreciated levels of genomic overlap between these closely related pathogens with implications for streptococcal pathobiology, disease surveillance and prevention. |
Population size, HIV prevalence, and antiretroviral therapy coverage among key populations in sub-Saharan Africa: collation and synthesis of survey data, 2010-23
Stevens O , Sabin K , Anderson RL , Garcia SA , Willis K , Rao A , McIntyre AF , Fearon E , Grard E , Stuart-Brown A , Cowan F , Degenhardt L , Stannah J , Zhao J , Hakim AJ , Rucinski K , Sathane I , Boothe M , Atuhaire L , Nyasulu PS , Maheu-Giroux M , Platt L , Rice B , Hladik W , Baral S , Mahy M , Imai-Eaton JW . Lancet Glob Health 2024 12 (9) e1400-e1412 BACKGROUND: Key population HIV programmes in sub-Saharan Africa require epidemiological information to ensure equitable and universal access to effective services. We aimed to consolidate and harmonise survey data among female sex workers, men who have sex with men, people who inject drugs, and transgender people to estimate key population size, HIV prevalence, and antiretroviral therapy (ART) coverage for countries in mainland sub-Saharan Africa. METHODS: Key population size estimates, HIV prevalence, and ART coverage data from 39 sub-Saharan Africa countries between 2010 and 2023 were collated from existing databases and verified against source documents. We used Bayesian mixed-effects spatial regression to model urban key population size estimates as a proportion of the gender-matched, year-matched, and area-matched population aged 15-49 years. We modelled subnational key population HIV prevalence and ART coverage with age-matched, gender-matched, year-matched, and province-matched total population estimates as predictors. FINDINGS: We extracted 2065 key population size data points, 1183 HIV prevalence data points, and 259 ART coverage data points. Across national urban populations, a median of 1·65% (IQR 1·35-1·91) of adult cisgender women were female sex workers, 0·89% (0·77-0·95) were men who have sex with men, 0·32% (0·31-0·34) were men who injected drugs, and 0·10% (0·06-0·12) were women who were transgender. HIV prevalence among key populations was, on average, four to six times higher than matched total population prevalence, and ART coverage was correlated with, but lower than, the total population ART coverage with wide heterogeneity in relative ART coverage across studies. Across sub-Saharan Africa, key populations were estimated as comprising 1·2% (95% credible interval 0·9-1·6) of the total population aged 15-49 years but 6·1% (4·5-8·2) of people living with HIV. INTERPRETATION: Key populations in sub-Saharan Africa experience higher HIV prevalence and lower ART coverage, underscoring the need for focused prevention and treatment services. In 2024, limited data availability and heterogeneity constrain precise estimates for programming and monitoring trends. Strengthening key population surveys and routine data within national HIV strategic information systems would support more precise estimates. FUNDING: UNAIDS, Bill & Melinda Gates Foundation, and US National Institutes of Health. |
Development of a standards-based city-wide health information exchange for public health in response to COVID-19 (preprint)
Hota B , Casey P , McIntyre AF , Khan J , Rab S , Chopra A , Lateef O , Layden JE . medRxiv 2020 2020.08.12.20173559 Background Disease surveillance is a critical function of public health, provides essential information about disease burden, clinical and epidemiologic parameters of disease, and is an important element to effective and timely case and contact tracing. The COVID-19 pandemic has demonstrated the essential role these functions have to preserve public health. Syndromic surveillance, electronic laboratory reporting in the meaningful use program, and the growth of the National Healthcare Safety Network (NHSN) have created linkages between hospitals, commercial labs, and public health that can collect and organize data, often through EHR and order workflows, to improve the timeliness and completeness of reporting. In theory, the standard data formats and exchange methods provided by meaningful use should enable rapid healthcare data exchange in the setting of disruptive healthcare events like a pandemic. In reality, access to data remains challenging, and even if available, often lack conformity to regulated standards.Objective We sought to use regulated interoperability standards already in production to generate regional bed capacity awareness, enhance the capture of epidemiological risk factors and clinical variables among COVID-19 tested patients, and reduce the administrative burden of reporting for stakeholders in a manner that could be replicated by other public health agencies.Methods Following a public health order mandating data submission, we developed technical infrastructure to combine multiple data feeds from electronic health record systems. We measured the completeness of each feed, and the match rate between feeds.Results A cloud-based environment was created that received data from electronic lab reporting, consolidated clinical data architecture, and bed capacity data feeds from sites. Data governance was planned from the project beginning to aid in consensus and principles for data use. 88,906 total persons from CCDA data among 14 facilities, and 408,741 persons from ELR records among 88 facilities, were submitted. Fields routinely absent from ELR feeds included travel histories, clinical symptoms, and comorbidities. CCDA data provided an improvement in the quality of data available for surveillance and was highly complete with <5% for all records types with the exception of patient cell phone. 90.1% of records could be matched between CCDA and ELR feeds.Conclusions We describe the development of a city-wide public health data hub for the surveillance of COVID-19 infection. We were able to assess the completeness of existing ELR feeds, augment these feeds with CCDA documents, establish secure transfer methods for data exchange, develop cloud-based architecture to enable secure data storage and analytics, and produced meaningful dashboards for the monitoring of capacity and disease burden. We see this public health and clinical data registry as an informative example of the power of common standards across electronic records, and a potential template for future extension of the use of standards to improve public health surveillance.Competing Interest StatementThe authors have declared no competing interest.Funding StatementNo external funding was received for this work.Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:This work was conducted under a public health exemption through the Chicago Department of Public HealthAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectiv ly, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesThe data used for this study was reported to the health department and is not publicly available at this time. |
Key population size, HIV prevalence, and ART coverage in sub-Saharan Africa: systematic collation and synthesis of survey data (preprint)
Stevens O , Sabin K , Garcia SA , Anderson R , Willis K , Abdul-Quader A , McIntyre A , Fearon E , Grard E , Stewart-Brown A , Cowan F , Degenhardt L , Zhao J , Hakim A , Rucinski K , Sathane I , Boothe M , Atuhuire L , Nyasulu P , Platt L , Rice B , Hladik W , Baral S , Mahy M , Eaton JW . medRxiv 2022 29 Background: HIV programmes in sub-Saharan Africa (SSA) require information about HIV among key populations to ensure equitable and equal access to HIV prevention and treatment. Surveillance has been conducted among female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and transgender populations, but is not systematically included in national HIV estimates. We consolidated existing KP surveys to create national-level estimates of key population size, HIV prevalence, and ART coverage for mainland SSA. Method(s): Key population size estimates (KPSE), HIV prevalence, and ART coverage data from 38 countries from 2010-2021 were collated from existing databases, deduplicated, and verified against primary sources. We used Bayesian mixed-effects regression to spatially smooth KPSE, and regressed subnational key population HIV prevalence and ART coverage against age/sex/year/province-matched total population estimates. Finding(s): We extracted 1449 unique KPSE datapoints, 1181 HIV prevalence datapoints, and 242 ART coverage datapoints. Countries had data for a median of five of the twelve population/outcome stratifications. Across countries, a median of 1.44% of urban women were FSW (interquartile range [IQR] 0.83-1.89%); 0.60% of urban men were MSM; and 0.16% of urban adults injected drugs (IQR 0.14-0.24%). HIV prevalence in all key populations was higher than matched total population prevalence. ART coverage was correlated with, but lower than, total population ART coverage. Across SSA, key populations were estimated as 1.1% (95%CI 0.7-1.9%) of the population but 5.1% (95%CI 3.2-10.3%) of all PLHIV aged 15-49 years. Interpretation(s): Key populations in sub-Saharan experience disproportionate HIV burden and somewhat lower ART coverage, underscoring need for focused prevention and treatment services. However, large heterogeneity and incomplete data availability limit precise estimates for programming and monitoring trends. Future efforts should focus on integrating and strengthening key population surveys and routine data within national HIV strategic information systems. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license. |
Using population mobility patterns to adapt COVID-19 response strategies in 3 East Africa countries
Merrill RD , Kilamile F , White M , Eurien D , Mehta K , Ojwang J , Laurent-Comlan M , Babigumira PA , Nakiire L , Boos A , Gatei W , Harris JR , Magazani A , Ocom F , Ssekubugu R , Kigozi G , Senyana F , Iyese FB , Elyanu PJ , Ward S , Makumbi I , Muruta A , McIntyre E , Massa K , Ario AR , Mayinja H , Remidius K , Ndungi DN . Emerg Infect Dis 2022 28 (13) S105-s113 The COVID-19 pandemic spread between neighboring countries through land, water, and air travel. Since May 2020, ministries of health for the Democratic Republic of the Congo, Tanzania, and Uganda have sought to clarify population movement patterns to improve their disease surveillance and pandemic response efforts. Ministry of Health-led teams completed focus group discussions with participatory mapping using country-adapted Population Connectivity Across Borders toolkits. They analyzed the qualitative and spatial data to prioritize locations for enhanced COVID-19 surveillance, community outreach, and cross-border collaboration. Each country employed varying toolkit strategies, but all countries applied the results to adapt their national and binational communicable disease response strategies during the pandemic, although the Democratic Republic of the Congo used only the raw data rather than generating datasets and digitized products. This 3-country comparison highlights how governments create preparedness and response strategies adapted to their unique sociocultural and cross-border dynamics to strengthen global health security. |
Using spatial and population mobility models to inform outbreak response approaches in the Ebola affected area, Democratic Republic of the Congo, 2018-2020.
Huber C , Watts A , Thomas-Bachli A , McIntyre E , Tuite A , Khan K , Cetron M , Merrill RD . Spat Spatiotemporal Epidemiol 2023 44 100558 The Democratic Republic of the Congo's (DRC) 10th known Ebola virus disease (EVD) outbreak occurred between August 1, 2018 and June 25, 2020, and was the largest EVD outbreak in the country's history. During this outbreak, the DRC Ministry of Health initiated traveller health screening at points of control (POC, locations not on the border) and points of entry (POE) to minimize disease translocation via ground and air travel. We sought to develop a model-based approach that could be applied in future outbreaks to inform decisions for optimizing POC and POE placement, and allocation of resources more broadly, to mitigate the risk of disease translocation associated with ground-level population mobility. We applied a parameter-free mobility model, the radiation model, to estimate likelihood of ground travel between selected origin locations (including Beni, DRC) and surrounding population centres, based on population size and drive-time. We then performed a road network route analysis and included estimated population movement results to calculate the proportionate volume of travellers who would move along each road segment; this reflects the proportion of travellers that could be screened at a POC or POE. For Beni, the road segments estimated to have the highest proportion of travellers that could be screened were part of routes into Uganda and Rwanda. Conversely, road segments that were part of routes to other population centres within the DRC were estimated to have relatively lower proportions. We observed a posteriori that, in many instances, our results aligned with locations that were selected for actual POC or POE placement through more time-consuming methods. This study has demonstrated that mobility models and simple spatial techniques can help identify potential locations for health screening at newly placed POC or existing POE during public health emergencies based on expected movement patterns. Importantly, we have provided methods to estimate the proportionate volume of travellers that POC or POE screening measures would assess based on their location. This is critical information in outbreak situations when timely decisions must be made to implement public health interventions that reach the most individuals across a network. © 2022 Elsevier Ltd |
Key population size estimation to guide HIV epidemic responses in Nigeria: Bayesian analysis of 3-source capture-recapture data
McIntyre AF , Mitchell A , Stafford KA , Nwafor SU , Lo J , Sebastian V , Schwitters A , Swaminathan M , Dalhatu I , Charurat M . JMIR Public Health Surveill 2022 8 (10) e34555 BACKGROUND: Nigeria has the fourth largest burden of HIV globally. Key populations, including female sex workers, men who have sex with men, and people who inject drugs, are more vulnerable to HIV than the general population due to stigmatized and criminalized behaviors. Reliable key population size estimates are needed to guide HIV epidemic response efforts. OBJECTIVE: The objective of our study was to use empirical methods for sampling and analysis to improve the quality of population size estimates of female sex workers, men who have sex with men, and people who inject drugs in 7 states (Akwa Ibom, Benue, Cross River, Lagos, Nasarawa, Rivers, and the Federal Capital Territory) of Nigeria for program planning and to demonstrate improved statistical estimation methods. METHODS: From October to December 2018, we used 3-source capture-recapture to produce population size estimates in 7 states in Nigeria. Hotspots were mapped before 3-source capture-recapture started. We sampled female sex workers, men who have sex with men, and people who inject drugs during 3 independent captures about one week apart. During hotspot encounters, key population members were offered inexpensive, memorable objects unique to each capture round. In subsequent rounds, key population members were offered an object and asked to identify objects received during previous rounds (if any). Correct responses were tallied and recorded on tablets. Data were aggregated by key population and state for analysis. Median population size estimates were derived using Bayesian nonparametric latent-class models with 80% highest density intervals. RESULTS: Overall, we sampled approximately 310,000 persons at 9015 hotspots during 3 independent captures. Population size estimates for female sex workers ranged from 14,500 to 64,300; population size estimates for men who have sex with men ranged from 3200 to 41,400; and population size estimates for people who inject drugs ranged from 3400 to 30,400. CONCLUSIONS: This was the first implementation of these 3-source capture-recapture methods in Nigeria. Our population size estimates were larger than previously documented for each key population in all states. The Bayesian models account for factors, such as social visibility, that influence heterogeneous capture probabilities, resulting in more reliable population size estimates. The larger population size estimates suggest a need for programmatic scale-up to reach these populations, which are at highest risk for HIV. |
Thinking about differences in the worldwide prevalence of cerebral palsy
Paneth N , Yeargin-Allsopp M . Dev Med Child Neurol 2022 64 (12) 1436-1437 This commentary is on the original article by McIntyre et al. on pages 1494-1506 of this issue. |
Development of a standards-based city-wide health information exchange for public health in response to COVID-19.
Hota B , Casey P , McIntyre AF , Khan J , Rab S , Chopra A , Lateef O , Layden JE . JMIR Public Health Surveill 2022 8 (9) e35973 BACKGROUND: Disease surveillance is a critical function of public health, provides essential information about disease burden, clinical and epidemiologic parameters of disease, and is an important element of effective and timely case and contact tracing. The COVID-19 pandemic demonstrates the essential role of disease surveillance in preserving public health. In theory, the standard data formats and exchange methods provided by EHR meaningful use should enable rapid healthcare data exchange in the setting of disruptive healthcare events like a pandemic. In reality, access to data remains challenging, and, even if available, often lacks conformity to regulated standards. As a result of the COVID-19 pandemic, we developed a regional data hub to enhance public health surveillance. OBJECTIVE: We sought to use regulated interoperability standards already in production to generate awareness of regional bed capacity and enhance the capture of epidemiological risk factors and clinical variables among patients tested for SARS-CoV-2. We describe the technical and operational components, governance model, and timelines required to implement the public health order which mandated electronic reporting of data from EHRs among hospitals in the Chicago jurisdiction. We also evaluate the data sources, infrastructure requirements and the completeness of data supplied to the platform and the capacity to link these sources. METHODS: Following a public health order mandating data submission by all acute care hospitals in Chicago, we developed the technical infrastructure to combine multiple data feeds from those EHR systems. We measured the completeness of each feed and the match rate between feeds. RESULTS: A cloud-based environment was created that received ELR, consolidated clinical data architecture, and bed capacity data feeds from sites. Data governance was planned from the project initiation to aid in consensus and principles for data use. Data from 88,906 persons from consolidated clinical data architecture (CCDA) records among 14 facilities, and 408,741 persons from ELR records among 88 facilities, were submitted. Most (90.1%) records could be matched between CCDA and ELR feeds. Data fields absent from ELR feeds included travel histories, clinical symptoms, and comorbidities. Less than 5% of CCDA data fields were empty. Merging CCDA with ELR data improved race, ethnicity, comorbidity, and hospitalization information data availability. CONCLUSIONS: We describe the development of a city-wide public health data hub for the surveillance of SARS-CoV-2 infection. We were able to assess the completeness of existing ELR feeds, augment these feeds with CCDA documents, establish secure transfer methods for data exchange, develop cloud-based architecture to enable secure data storage and analytics, and produce dashboards for monitoring of capacity and disease burden. We consider this public health and clinical data registry as an informative example of the power of common standards across EHR and a potential template for future use of standards to improve public health surveillance. |
Population Size Estimation From Capture-Recapture Studies Using shinyrecap: Design and Implementation of a Web-Based Graphical User Interface.
McIntyre AF , Fellows IE , Gutreuter S , Hladik W . JMIR Public Health Surveill 2022 8 (4) e32645 BACKGROUND: Population size estimates (PSE) provide critical information in determining resource allocation for HIV services geared toward those at high risk of HIV, including female sex workers, men who have sex with men, and people who inject drugs. Capture-recapture (CRC) is often used to estimate the size of these often-hidden populations. Compared with the commonly used 2-source CRC, CRC relying on 3 (or more) samples (3S-CRC) can provide more robust PSE but involve far more complex statistical analysis. OBJECTIVE: This study aims to design and describe the Shiny application (shinyrecap), a user-friendly interface that can be used by field epidemiologists to produce PSE. METHODS: shinyrecap is built on the Shiny web application framework for R. This allows it to seamlessly integrate with the sophisticated CRC statistical packages (eg, Rcapture, dga, LCMCR). Additionally, the application may be accessed online or run locally on the user's machine. RESULTS: The application enables users to engage in sample size calculation based on a simulation framework. It assists in the proper formatting of collected data by providing a tool to convert commonly used formats to that used by the analysis software. A wide variety of methodologies are supported by the analysis tool, including log-linear, Bayesian model averaging, and Bayesian latent class models. For each methodology, diagnostics and model checking interfaces are provided. CONCLUSIONS: Through a use case, we demonstrated the broad utility of this powerful tool with 3S-CRC data to produce PSE for female sex workers in a subnational unit of a country in sub-Saharan Africa. |
Pneumococcal Disease Outbreak at a State Prison, Alabama, USA, September 1-October 10, 2018(1)
Sanchez GV , Bourne CL , Davidson SL , Ellis M , Feldstein LR , Fay K , Brown NE , Geeter EF , Foster LL , Gilmore C , McIntyre MG , Taylor B , Velusamy S , Chochua S , Matanock AM . Emerg Infect Dis 2021 27 (7) 1949-1952 A pneumococcal disease outbreak caused by Streptococcus pneumoniae serotype 12F occurred in a state prison in Alabama, USA. Among 1,276 inmates, 40 cases were identified (3 confirmed, 2 probable, 35 suspected). Close living quarters, substance use, and underlying conditions likely contributed to disease risk. Prophylaxis for close contacts included azithromycin and 23-valent pneumococcal polysaccharide vaccine. |
Preventing the cross-border spread of zoonotic diseases: Multisectoral community engagement to characterize animal mobility-Uganda, 2020
Medley AM , Gasanani J , Nyolimati CA , McIntyre E , Ward S , Okuyo B , Kabiito D , Bender C , Jafari Z , LaMorde M , Babigumira PA , Nakiire L , Agwang C , Merrill R , Ndumu D , Doris K . Zoonoses Public Health 2021 68 (7) 747-759 In Uganda, the borders are highly porous to animal movement, which may contribute to zoonotic disease spread. We piloted an animal adaptation of an existing human-focused toolkit to collect data on animal movement patterns and interactions to inform One Health programs. During January 2020, we conducted focus group discussions and key informant interviews with participatory mapping of 2 national-level One Health stakeholders and 2 local-level abattoir representatives from Kampala. Zoonotic disease hotspots changed in 2020 compared with reports from 2017-2019. In contrast to local-level participants, national-level participants highlighted districts rather than specific locations. Everyone discussed livestock species; only national-level participants mentioned wildlife. Participants described seasonality differently. Stakeholders used the results to identify locations for zoonotic disease interventions and sites for future data collection. This implementation of an animal-adapted population mobility mapping exercise highlights the importance of multisectoral initiatives to promote One Health border health approaches. |
Key population hotspots in Nigeria for targeted HIV program planning: Mapping, validation, and reconciliation
Lo J , Nwafor SU , Schwitters AM , Mitchell A , Sebastian V , Stafford KA , Ezirim I , Charurat M , McIntyre AF . JMIR Public Health Surveill 2021 7 (2) e25623 BACKGROUND: With the fourth highest HIV burden globally, Nigeria is characterized as having a mixed HIV epidemic with high HIV prevalence among key populations, including female sex workers, men who have sex with men, and people who inject drugs. Reliable and accurate mapping of key population hotspots is necessary for strategic placement of services and allocation of limited resources for targeted interventions. OBJECTIVE: We aimed to map and develop a profile for the hotspots of female sex workers, men who have sex with men, and people who inject drugs in 7 states of Nigeria to inform HIV prevention and service programs and in preparation for a multiple-source capture-recapture population size estimation effort. METHODS: In August 2018, 261 trained data collectors from 36 key population-led community-based organizations mapped, validated, and profiled hotspots identified during the formative assessment in 7 priority states in Nigeria designated by the United States President's Emergency Plan for AIDS Relief. Hotspots were defined as physical venues wherein key population members frequent to socialize, seek clients, or engage in key population-defining behaviors. Hotspots were visited by data collectors, and each hotspot's name, local government area, address, type, geographic coordinates, peak times of activity, and estimated number of key population members was recorded. The number of key population hotspots per local government area was tabulated from the final list of hotspots. RESULTS: A total of 13,899 key population hotspots were identified and mapped in the 7 states, that is, 1297 in Akwa Ibom, 1714 in Benue, 2666 in Cross River, 2974 in Lagos, 1550 in Nasarawa, 2494 in Rivers, and 1204 in Federal Capital Territory. The most common hotspots were those frequented by female sex workers (9593/13,899, 69.0%), followed by people who inject drugs (2729/13,899, 19.6%) and men who have sex with men (1577/13,899, 11.3%). Although hotspots were identified in all local government areas visited, more hotspots were found in metropolitan local government areas and state capitals. CONCLUSIONS: The number of key population hotspots identified in this study is more than that previously reported in similar studies in Nigeria. Close collaboration with key population-led community-based organizations facilitated identification of many new and previously undocumented key population hotspots in the 7 states. The smaller number of hotspots of men who have sex with men than that of female sex workers and that of people who inject drugs may reflect the social pressure and stigma faced by this population since the enforcement of the 2014 Same Sex Marriage (Prohibition) Act, which prohibits engaging in intimate same-sex relationships, organizing meetings of gays, or patronizing gay businesses. |
An approach to integrate population mobility patterns and sociocultural factors in communicable disease preparedness and response
Merrill RD , Chabi AIB , McIntyre E , Kouassi JV , Alleby MM , Codja C , Tante O , Martial GTP , Kone I , Ward S , Agbeko TT , Kakaı CG . Hum Soc Sci Comm 2021 8 (1) Complex human movement patterns driven by a range of economic, health, social, and environmental factors influence communicable disease spread. Further, cross-border movement impacts disparate public health systems of neighboring countries, making an effective response to disease importation or exportation more challenging. Despite the array of quantitative techniques and social science approaches available to analyze movement patterns, there continues to be a dearth of methods within the applied public health setting to gather and use information about community-level mobility dynamics. Population Connectivity Across Borders (PopCAB) is a rapidly-deployable toolkit to characterize multisectoral movement patterns through community engagement using focus group discussions or key informant interviews, each with participatory mapping, and apply the results to tailor preparedness and response strategies. The Togo and Benin Ministries of Health (MOH), in collaboration with the Abidjan Lagos Corridor Organization and the US Centers for Disease Control and Prevention, adapted and applied PopCAB to inform cross-border preparedness and response strategies for multinational Lassa fever outbreaks. Initially, the team implemented binational, national-level PopCAB activities in March 2017, highlighting details about a circular migration pathway across northern Togo, Benin, and Nigeria. After applying those results to respond to a cross-border Lassa fever outbreak in February 2018, the team designed an expanded PopCAB initiative in April 2018. In eight days, they trained 54 MOH staff who implemented 21 PopCAB focus group discussions in 14 cities with 224 community-level participants representing six stakeholder groups. Using the newly-identified 167 points of interest and 176 routes associated with a circular migration pathway across Togo, Benin, and Nigeria, the Togo and Benin MOH refined their cross-border information sharing and collaboration processes for Lassa fever and other communicable diseases, selected health facilities with increased community connectivity for enhanced training, and identified techniques to better integrate traditional healers in surveillance and community education strategies. They also integrated the final toolkit in national- and district-level public health preparedness plans. Integrating PopCAB in public health practice to better understand and accommodate population movement patterns can help countries mitigate the international spread of disease in support of improved global health security and International Health Regulations requirements. |
Identification of presymptomatic and asymptomatic cases using cohort-based testing approaches at a large correctional facility - Chicago, Illinois, USA, May 2020.
Wadhwa A , Fisher KA , Silver R , Koh M , Arons MM , Miller DA , McIntyre AF , Vuong JT , Kim K , Takamiya M , Binder AM , Tate JE , Armstrong PA , Black SR , Mennella CC , Levin R , Gubser J , Jones B , Welbel SF , Moonan PK , Curran K , Ghinai I , Doshi R , Zawitz CJ . Clin Infect Dis 2020 72 (5) e128-e135 BACKGROUND: COVID-19 continues to cause significant morbidity and mortality worldwide. Correctional and detention facilities are at high risk of experiencing outbreaks. We aimed to evaluate cohort-based testing among detained persons exposed to laboratory-confirmed cases of SARS-CoV-2 in order to identify presymptomatic and asymptomatic cases. METHODS: During May 1-19, 2020, two testing strategies were implemented in 12 tiers or housing units of the Cook County Jail in Chicago, Illinois. Detained persons were approached to participate in serial testing (n=137) tests at 3 time points over 14 days (day 1, day 3-5, and day 13-14). The second group was offered a single test and interview at the end of a 14-day quarantine period (day 14 group) (n=87). RESULTS: A total of 224 detained persons were approached for participation and of these 194 (87%) participated in at least one interview, and 172 (77%) had at least one test. Of the 172 tested, 19 were positive for SARS-CoV-2. In the serial testing group, 17 (89%) new cases were detected, sixteen (84%) on day 1, one (5%) on days 3-5, and none on days 13-14; and, in day 14 group, two (11%) cases were identified. More than half (12/19; 63%) of the newly identified cases were pre-symptomatic or asymptomatic. CONCLUSION: Our findings highlight the utility of cohort-based testing promptly after initiating quarantine within a housing tier. Cohort-based testing efforts identified new SARS-CoV-2 asymptomatic and presymptomatic infections that may have been missed by symptom screening alone. |
Planning and implementing a targeted polio vaccination campaign for Somali mobile populations in Northeastern Kenya based on migration and settlement patterns
Harvey B , Dalal W , Amin F , McIntyre E , Ward S , Merrill RD , Mohamed A , Hsu CH . Ethn Health 2020 27 (4) 1-16 Supporting the global eradication of wildpoliovrisu (WPV), this project aimed to provide polio and measles vaccines to a population frequenty missed by immunization services and campaigns, ethnic Somali children living among mobile populations within Kenya's Northeastern Region. Additionally, nutritional support, albendazole (for treatment of intestinal parasites) and vitamin A were provided to improve children's health and in accordance with regional vaccination campaign practices. To better understand movement patterns and healthcare-seeking behaviors within this population, we trained community-based data collectors in qualitative and geospatial data collection methods. Data collectors conducted focus group and participatory mapping discussions with ethnic Somalis living in the region. Qualitative and geospatial data indicated movement patterns that followed partially definable routes and temporary settlement patterns with an influx of ethnic Somali migrants into Kenya at the start of the long rainy season (April-June). Community members also reported concerns about receiving healthcare services in regional health facilities. Using these data, an 8-week vaccination campaign was planned and implemented: 2196 children aged 0-59 months received polio vaccine (9% had not previously received polio vaccine), 2524 children aged 9-59 months received measles vaccine (27% had not previously received measles vaccine), 113 were referred for the treatment of severe acute malnourishment, 150 were referred to a supplementary feeding program due to moderate acute malnourishment, 1636 children aged 12-59 months were provided albendazole and 2008 children aged 6-59 months were provided with vitamin A. This project serves as an example for how community-based data collectors and local knowledge can help adapt public health programming to the local context and could aid disease eradication in at-risk populations. |
Incorporating stakeholder feedback in guidelines development for the management of abnormal cervical cancer screening tests
Perkins RB , Fuzzell LN , Lake P , McIntyre M , Nayar R , Saraiya M , Loukissas J , Felder T , Guido RS , Vadaparampil ST . J Low Genit Tract Dis 2020 24 (2) 167-177 OBJECTIVE: The 2019 ASCCP Risk-Based Management Consensus Guidelines present a paradigm shift from results- to risk-based management. Patient and provider factors can affect guideline adoption. We sought feedback from stakeholders to inform guideline development. MATERIALS AND METHODS: To solicit provider feedback, we surveyed attendees at the 2019 ASCCP annual meeting regarding readiness to adopt proposed changes and used a web-based public comment period to gauge agreement/disagreement with preliminary guidelines. We elicited patient feedback via a brief survey on preferences around proposed recommendations for treatment without biopsy. Surveys and public comment included both closed-ended and free-text items. Quantitative results were analyzed using descriptive statistics; qualitative results were analyzed using content analysis. Results were incorporated into guideline development in real time. RESULTS: Surveys indicated that 98% of providers currently evaluate their patients' past results to determine management; 88% felt formally incorporating history into management would represent an improvement in care. Most providers supported expedited treatment without biopsy: 22% currently perform expedited treatment and 60% were willing to do so. Among patients, 41% preferred expedited treatment, 32% preferred biopsy before treatment, and the remainder were undecided. Responses from the public comment period included agreement/disagreement with preliminary guidelines, reasons for disagreement, and suggestions for improvement. CONCLUSIONS: Stakeholder feedback was incorporated into the development of the 2019 ASCCP Risk-Based Management Consensus Guidelines. Proposed recommendations with less than two-thirds agreement in the public comment period were considered for revision. Findings underscore the importance of stakeholder feedback in developing guidelines that meet the needs of patients and providers. |
Estimating the size of key populations in Kampala, Uganda: 3-source capture-recapture study
Doshi RH , Apodaca K , Ogwal M , Bain R , Amene E , Kiyingi H , Aluzimbi G , Musinguzi G , Serwadda D , McIntyre AF , Hladik W . JMIR Public Health Surveill 2019 5 (3) e12118 BACKGROUND: Key populations, including people who inject drugs (PWID), men who have sex with men (MSM), and female sex workers (FSW), are disproportionately affected by the HIV epidemic. Understanding the magnitude of, and informing the public health response to, the HIV epidemic among these populations requires accurate size estimates. However, low social visibility poses challenges to these efforts. OBJECTIVE: The objective of this study was to derive population size estimates of PWID, MSM, and FSW in Kampala using capture-recapture. METHODS: Between June and October 2017, unique objects were distributed to the PWID, MSM, and FSW populations in Kampala. PWID, MSM, and FSW were each sampled during 3 independent captures; unique objects were offered in captures 1 and 2. PWID, MSM, and FSW sampled during captures 2 and 3 were asked if they had received either or both of the distributed objects. All captures were completed 1 week apart. The numbers of PWID, MSM, and FSW receiving one or both objects were determined. Population size estimates were derived using the Lincoln-Petersen method for 2-source capture-recapture (PWID) and Bayesian nonparametric latent-class model for 3-source capture-recapture (MSM and FSW). RESULTS: We sampled 467 PWID in capture 1 and 450 in capture 2; a total of 54 PWID were captured in both. We sampled 542, 574, and 598 MSM in captures 1, 2, and 3, respectively. There were 70 recaptures between captures 1 and 2, 103 recaptures between captures 2 and 3, and 155 recaptures between captures 1 and 3. There were 57 MSM captured in all 3 captures. We sampled 962, 965, and 1417 FSW in captures 1, 2, and 3, respectively. There were 316 recaptures between captures 1 and 2, 214 recaptures between captures 2 and 3, and 235 recaptures between captures 1 and 3. There were 109 FSW captured in all 3 rounds. The estimated number of PWID was 3892 (3090-5126), the estimated number of MSM was 14,019 (95% credible interval (CI) 4995-40,949), and the estimated number of FSW was 8848 (95% CI 6337-17,470). CONCLUSIONS: Our population size estimates for PWID, MSM, and FSW in Kampala provide critical population denominator data to inform HIV prevention and treatment programs. The 3-source capture-recapture is a feasible method to advance key population size estimation. |
Outcomes of infants born to women with influenza A(H1N1)pdm09
Newsome K , Alverson CJ , Williams J , McIntyre AF , Fine AD , Wasserman C , Lofy KH , Acosta M , Louie JK , Jones-Vessey K , Stanfield V , Yeung A , Rasmussen SA . Birth Defects Res 2019 111 (2) 88-95 BACKGROUND: Pregnant women with influenza are more likely to have complications, but information on infant outcomes is limited. METHODS: Five state/local health departments collected data on outcomes of infants born to pregnant women with 2009 H1N1 influenza reported to the Centers for Disease Control and Prevention from April to December 2009. Collaborating sites linked information on pregnant women with confirmed 2009 H1N1 influenza, many who were severely ill, to their infants' birth certificates. Collaborators also collected birth certificate data from two comparison groups that were matched with H1N1-affected pregnancies on month of conception, sex, and county of residence. RESULTS: 490 pregnant women with influenza, 1,451 women without reported influenza with pregnancies in the same year, and 1,446 pregnant women without reported influenza with prior year pregnancies were included. Women with 2009 H1N1 influenza admitted to an intensive care unit (ICU; n = 64) were more likely to deliver preterm infants (<37 weeks), low birth weight infants, and infants with Apgar scores <=6 at 5 min than women in comparison groups (adjusted relative risk, aRR = 3.9 [2.7, 5.6], aRR = 4.6 [2.9, 7.5], and aRR = 8.7 [3.6, 21.2], for same year comparisons, respectively). Women with influenza who were not hospitalized and hospitalized women not admitted to the ICU did not have significantly elevated risks for adverse infant outcomes. CONCLUSIONS: Severely ill women with 2009 H1N1 influenza during pregnancy were more likely to have adverse birth outcomes than women without influenza, providing more support for influenza vaccination during pregnancy. |
Progress toward UNAIDS 90-90-90 targets: A respondent-driven survey among female sex workers in Kampala, Uganda
Doshi RH , Sande E , Ogwal M , Kiyingi H , McIntyre A , Kusiima J , Musinguzi G , Serwadda D , Hladik W . PLoS One 2018 13 (9) e0201352 BACKGROUND: We investigated progress towards UNAIDS 90-90-90 targets among female sex workers in Kampala, Uganda, who bear a disproportionate burden of HIV. METHODS: Between April and December 2012, 1,487 female sex workers, defined as women, 15-49 years, residing in greater Kampala, and selling sex for money in the last 6 months, were recruited using respondent-driven sampling. Venous blood was collected for HIV and viral load testing [viral load suppression (VLS) defined as <1,000 copies/mL]. We collected data using audio computer-assisted self-interviews and calculated weighted population-level estimates. RESULTS: The median age was 27 years (interquartile range: 23 to 32). HIV seroprevalence was 31.4% (95% confidence interval [CI]: 29.0, 33.7%). Among all female sex workers who tested HIV-positive in the survey (population-level targets), 45.5% (95% CI: 40.1, 51.0) had knowledge of their serostatus (population-level target: 90%), 37.8% (95% CI: 32.2, 42.8) self-reported to be on ART (population-level target: 81%), and 35.2% (95% CI: 20.7, 30.4) were virally suppressed (population-level target: 73%). CONCLUSIONS: HIV prevalence among Kampala female sex workers is high, whereas serostatus knowledge and VLS are far below UNAIDS targets. Kampala female sex workers are in need of intensified and targeted HIV prevention and control efforts. |
Multistate epidemiology of histoplasmosis, United States, 2011-2014
Armstrong PA , Jackson BR , Haselow D , Fields V , Ireland M , Austin C , Signs K , Fialkowski V , Patel R , Ellis P , Iwen PC , Pedati C , Gibbons-Burgener S , Anderson J , Dobbs T , Davidson S , McIntyre M , Warren K , Midla J , Luong N , Benedict K . Emerg Infect Dis 2018 24 (3) 425-431 Histoplasmosis is one of the most common mycoses endemic to the United States, but it was reportable in only 10 states during 2016, when a national case definition was approved. To better characterize the epidemiologic features of histoplasmosis, we analyzed deidentified surveillance data for 2011-2014 from the following 12 states: Alabama, Arkansas, Delaware, Illinois, Indiana, Kentucky, Michigan, Minnesota, Mississippi, Nebraska, Pennsylvania, and Wisconsin. We examined epidemiologic and laboratory features and calculated state-specific annual and county-specific mean annual incidence rates. A total of 3,409 cases were reported. Median patient age was 49 (interquartile range 33-61) years, 2,079 (61%) patients were male, 1,273 (57%) patients were hospitalized, and 76 (7%) patients died. Incidence rates varied markedly between and within states. The high hospitalization rate suggests that histoplasmosis surveillance underestimates the true number of cases. Improved surveillance standardization and surveillance by additional states would provide more comprehensive knowledge of histoplasmosis in the United States. |
The accuracy of HIV rapid testing in integrated bio-behavioral surveys of men who have sex with men across 5 provinces in South Africa
Kufa T , Lane T , Manyuchi A , Singh B , Isdahl Z , Osmand T , Grasso M , Struthers H , McIntyre J , Chipeta Z , Puren A . Medicine (Baltimore) 2017 96 (28) e7391 We describe the accuracy of serial rapid HIV testing among men who have sex with men (MSM) in South Africa and discuss the implications for HIV testing and prevention.This was a cross-sectional survey conducted at five stand-alone facilities from five provinces.Demographic, behavioral, and clinical data were collected. Dried blood spots were obtained for HIV-related testing. Participants were offered rapid HIV testing using 2 rapid diagnostic tests (RDTs) in series. In the laboratory, reference HIV testing was conducted using a third-generation enzyme immunoassay (EIA) and a fourth-generation EIA as confirmatory. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value, false-positive, and false-negative rates were determined.Between August 2015 and July 2016, 2503 participants were enrolled. Of these, 2343 were tested by RDT on site with a further 2137 (91.2%) having definitive results on both RDT and EIA. Sensitivity, specificity, positive predictive value, negative predictive value, false-positive rates, and false-negative rates were 92.6% [95% confidence interval (95% CI) 89.6-94.8], 99.4% (95% CI 98.9-99.7), 97.4% (95% CI 95.2-98.6), 98.3% (95% CI 97.6-98.8), 0.6% (95% CI 0.3-1.1), and 7.4% (95% CI 5.2-10.4), respectively. False negatives were similar to true positives with respect to virological profiles.Overall accuracy of the RDT algorithm was high, but sensitivity was lower than expected. Post-HIV test counseling should include discussions of possible false-negative results and the need for retesting among HIV negatives. |
Comparison of measured multi-decadal rainfall variability with farmers’ perceptions of and responses to seasonal changes in western Uganda
Diem JE , Hartter J , Salerno J , McIntyre E , Stuart Grandy A . Reg Environ Change 2016 17 (4) 1127–1140 Smallholder farmers in Sub-Saharan Africa (SSA) are not only dealing with decreased production from land degradation, but are also impacted heavily by climate variability. Farmers perceive decreased rainfall or shortened rainy seasons throughout SSA; however, the link between perceptions and climate variability is complex, especially in areas with increasing land degradation. Moreover, little is known about climate variability and farmers’ perceptions in central equatorial Africa. The purpose of this study is to quantify interannual rainfall variability from 1983 to 2014 in western Uganda and to relate the rainfall variability and associated changes in soil moisture to perceptions and coping strategies of local farmers. Surveys of 308 farming households and 14 group interviews were conducted near Kibale National Park, and daily satellite-based rainfall data for the region were extracted from the African Rainfall Climatology version 2 database. Results indicate a decrease in the long rains by approximately 3 weeks throughout much of the region; thus, soil-water deficits have intensified. Farmers perceived later onsets of both the short rains and long rains, while also reporting decreasing soil fertility and crop yields. Therefore, farmers’ perceptions of rainfall variability in the Kibale region may reflect more the decrease in soil fertility than the shortened rainy seasons and decreased soil moisture. Expanding croplands has been the farmers’ most prevalent coping strategy to decreased yields; however, nearly all the unfarmed land in western Uganda is now in protected areas. Consequently, western Uganda is facing a crisis at the nexus of population growth, land use change, and climate change. |
Place of influenza vaccination among children-United States, 2010-11 through 2013-14 influenza seasons
Santibanez TA , Vogt T , Zhai Y , McIntyre A . Vaccine 2016 34 (10) 1296-303 BACKGROUND: Studies are published on settings adults receive influenza vaccination but few have reported on settings children are vaccinated and how this might be changing over time or vary by socio-demographics. METHODS: Data from the National Immunization Survey-Flu were analyzed to assess place of influenza vaccination among vaccinated children 6 months-17 years during the 2010-11, 2011-12, 2012-13, and 2013-14 influenza seasons. The percentage of children vaccinated at each place was calculated overall and by age, race/ethnicity, income, and Metropolitan Statistical Area (MSA). RESULTS: The places children received influenza vaccination varied little over four recent influenza seasons. From the 2010-11 through 2013-14 influenza seasons the percentage of vaccinated children receiving influenza vaccination at a doctor's office was 64.1%, 65.1%, 65.3%, and 65.3%, respectively with no differences from one season to the next. Likewise, for vaccination at clinics or health centers (17.8%, 17.5%, 17.0%. 18.0%), health departments (3.2%, 3.6%, 3.0%, 2.8%), and other non-medical places (1.6%, 1.4%, 1.2%, 1.1%), there were no differences from one season to the next. There were some differences for vaccinations at hospitals, pharmacies, and schools. There was considerable variability in the place of influenza vaccination by age, race/ethnicity, income, and MSA. Fewer Hispanic children were vaccinated at a doctor's office than black, white, and other or multiple race children and fewer black children and children of other or multiple races were vaccinated at a doctor's office than white children. More children at or below the poverty level were vaccinated at a clinic or health center than all of the other income groups. CONCLUSION: Most vaccinated children receive their influenza vaccination at a doctor's office. Place of vaccination changed little over four recent influenza seasons. Large variability in place of vaccination exists by age, race/ethnicity, income, and MSA. Monitoring place of vaccination can help shape future immunization programs. |
An international survey of cerebral palsy registers and surveillance systems
Goldsmith S , McIntyre S , Smithers-Sheedy H , Blair E , Cans C , Watson L , Yeargin-Allsopp M . Dev Med Child Neurol 2016 58 Suppl 2 11-7 AIM: To describe cerebral palsy (CP) surveillance programmes and identify similarities and differences in governance and funding, aims and scope, definition, inclusion/exclusion criteria, ascertainment and data collection, to enhance the potential for research collaboration. METHOD: Representatives from 38 CP surveillance programmes were invited to participate in an online survey and submit their data collection forms. Descriptive statistics were used to summarize information submitted. RESULTS: Twenty-seven surveillance programmes participated (25 functioning registers, two closed owing to lack of funding). Their aims spanned five domains: resource for CP research, surveillance, aetiology/prevention, service planning, and information provision (in descending order of frequency). Published definitions guided decision making for the definition of CP and case eligibility for most programmes. Consent, case identification, and data collection methods varied widely. Ten key data items were collected by all programmes and a further seven by at least 80% of programmes. All programmes reported an interest in research collaboration. INTERPRETATION: Despite variability in methodologies, similarities exist across programmes in terms of their aims, definitions, and data collected. These findings will facilitate harmonization of data and collaborative research efforts, which are so necessary on account of the heterogeneity and relatively low prevalence of CP. |
Decline of FoxP3+ regulatory CD4 T cells in peripheral blood of children heavily exposed to malaria
Boyle MJ , Jagannathan P , Farrington LA , Eccles-James I , Wamala S , McIntyre TI , Vance HM , Bowen K , Nankya F , Auma A , Nalubega M , Sikyomu E , Naluwu K , Rek J , Katureebe A , Bigira V , Kapisi J , Tappero J , Muhindo MK , Greenhouse B , Arinaitwe E , Dorsey G , Kamya MR , Feeney ME . PLoS Pathog 2015 11 (7) e1005041 FoxP3+ regulatory CD4 T cells (Tregs) help to maintain the delicate balance between pathogen-specific immunity and immune-mediated pathology. Prior studies suggest that Tregs are induced by P. falciparum both in vivo and in vitro; however, the factors influencing Treg homeostasis during acute and chronic infections, and their role in malaria immunopathogenesis, remain unclear. We assessed the frequency and phenotype of Tregs in well-characterized cohorts of children residing in a region of high malaria endemicity in Uganda. We found that both the frequency and absolute numbers of FoxP3+ Tregs in peripheral blood declined markedly with increasing prior malaria incidence. Longitudinal measurements confirmed that this decline occurred only among highly malaria-exposed children. The decline of Tregs from peripheral blood was accompanied by reduced in vitro induction of Tregs by parasite antigen and decreased expression of TNFR2 on Tregs among children who had intense prior exposure to malaria. While Treg frequencies were not associated with protection from malaria, there was a trend toward reduced risk of symptomatic malaria once infected with P. falciparum among children with lower Treg frequencies. These data demonstrate that chronic malaria exposure results in altered Treg homeostasis, which may impact the development of antimalarial immunity in naturally exposed populations. |
Pertussis vaccine in pregnancy - first dose for every infant?
McIntyre PB , Clark TA . Lancet 2014 384 (9953) 1484-6 The potential for whole-cell pertussis vaccination in pregnancy to reduce high-mortality early infant disease was first shown almost 75 years ago.1 Although interest was rekindled by the advent of acellular pertussis vaccines in the 1980s,2 the first recommendation for routine pertussis vaccination in pregnancy was not given until 2011.3 Uptake of this recommendation in the USA has been slow, and empirical evidence that pertussis vaccination in pregnancy prevents early infant disease is lacking.4 | In The Lancet, Gayatri Amirthalingam and colleagues5 document outcomes in infants after pertussis vaccination was recommended in the UK in September, 2012, for all women in late pregnancy. As an emergency programme, vaccine coverage rapidly reached 70%. Its effects were shown both through disproportionate decreases in hospital admissions for infants younger than 3 months, relative to preceding epidemic (2012) and pre-epidemic (2011) years, and by measurement of vaccine effectiveness by use of a modified screening method approach.6 Estimated vaccine effectiveness among infants was 91% (95% CI 84 to 95) for vaccination at least 7 days before birth, but fell to 38% (−95 to 80) for vaccination between 6 days before and up to 13 days after birth. Evidence of the effectiveness of pertussis vaccine in pregnancy from this study is convincing, because of its magnitude, specificity, and the robustness of vaccine effectiveness estimates in sensitivity analysis, against a background of high biological plausibility.1, 3 |
Outbreak of Serratia marcescens bloodstream infections in patients receiving parenteral nutrition prepared by a compounding pharmacy
Gupta N , Hocevar SN , Moulton-Meissner H , Stevens KM , McIntyre MG , Jensen B , Kuhar DT , Noble-Wang J , Schnatz RG , Becker SC , Kastango ES , Shehab N , Kallen AJ . Clin Infect Dis 2014 59 (1) 1-8 BACKGROUND: Compounding pharmacies often prepare parenteral nutrition (PN) and must adhere to rigorous standards to avoid contamination of the sterile preparation. In March 2011, Serratia marcescens bloodstream infections (BSIs) were identified in five patients receiving PN from a single compounding pharmacy. An investigation was conducted to identify potential sources of contamination and prevent further infections. METHODS: Cases were defined as S. marcescens BSIs in patients receiving PN from the pharmacy between January and March 2011. We reviewed case-patient clinical records, evaluated pharmacy compounding practices, and obtained epidemiologically-directed environmental cultures. Molecular relatedness of available Serratia isolates was determined by pulsed-field gel electrophoresis (PFGE). RESULTS: Nineteen case-patients were identified; nine died. The attack rate for patients receiving PN in March was 35%. No case-patients were younger than 18 years. In October 2010, the pharmacy began compounding and filter-sterilizing amino acid solution for adult PN using non-sterile amino acids due to a national manufacturer shortage. Review of this process identified breaches in mixing, filtration, and sterility testing practices. Serratia marcescens was identified from a pharmacy water faucet, mixing container, and opened amino acid powder. These isolates were indistinguishable from the outbreak strain by PFGE. CONCLUSIONS: Compounding of non-sterile amino acid components of PN was initiated due to a manufacturer shortage. Failure to follow recommended compounding standards contributed to an outbreak of S. marcescens BSIs. Improved adherence to sterile compounding standards, critical examination of standards for sterile compounding from non-sterile ingredients, and more rigorous oversight of compounding pharmacies is needed to prevent future outbreaks. |
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