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Experience conducting COVID-19 vaccine effectiveness studies in response to the COVID-19 pandemic in Japan and the Philippines: lessons for future epidemics and potential pandemics.
Get PDFPROBLEM: Once COVID-19 vaccines were rolled out, there was a need to monitor real-world vaccine effectiveness to accumulate evidence to inform policy and risk communication. This was especially true in Japan and the Philippines, given historical issues that affected vaccine confidence. CONTEXT: Neither country had public health surveillance that could be enhanced to evaluate vaccine effectiveness or readily available national vaccination databases. ACTION: Study groups were established in multiple health-care facilities in each country to assess vaccine effectiveness against both symptomatic infection and severe disease. OUTCOME: In Japan, multiple study reports were published in Japanese on the web site of the National Institute of Infectious Diseases and presented at the national government's advisory board. Nationwide media coverage facilitated transparency and increased the confidence of the government and the public in the vaccination programme. In the Philippines, the launch of the study was delayed so as to align the research plan with the interests of various stakeholders and to obtain institutional review board approval. Ultimately, the studies were successfully initiated and completed. DISCUSSION: There were four main challenges in conducting our studies: finding health-care facilities for data collection; obtaining exposure (vaccination) data; identifying epidemiological biases and confounders; and informing policy and risk communication in a timely manner. Preparedness during inter-emergency/epidemic/pandemic periods to rapidly evaluate relevant interventions such as vaccination is critical and should include the following considerations: (1) the establishment and maintenance of prospective data collection platforms, ideally under public health surveillance (if not, clinical research networks or linked databases); (2) uniform and practical protocols considering biases and confounders; and (3) communication with stakeholders including institutional review boards
Case-Control Study of Congenital Anomalies: Study Methods and Nonresponse Bias Assessment.
Get PDFBACKGROUND: To describe the methods of a congenital anomalies case-control study conducted in New Zealand, discuss the encountered methodological difficulties, and evaluate the potential for nonresponse bias. METHODS: The potential cases (n = 2710) were New Zealand live births in 2007-2009 randomly selected from the New Zealand Congenital Anomalies Registry. The potential controls (n = 2989) included live births identified from the Maternity and Newborn Information System, frequency matched to cases by the child's year of birth and sex. Mothers were invited to complete an interview covering demographic, lifestyle, and environmental factors. Response probabilities for case and control mothers were evaluated in relation to maternal age, deprivation, occupation, and ethnicity, available from the Electoral Roll, and inverse probability weights (IPWs) for participation were calculated. Odds ratios (ORs) for key demographic and selected risk factors were estimated through unconditional logistic regression, with and without IPW. RESULTS: A total of 652 (24%) of case mothers and 505 (17%) of control mothers completed the interview. Younger and more deprived mothers were underrepresented among the participants, particularly for controls, resulting in inflated ORs of associations with congenital anomalies for younger age, Māori ethnicity, deprivation, and risk factors under study, such as blue-collar occupations and smoking, indicative of nonresponse bias. Nonresponse bias was minimized through IPW, resulting in ORs and exposure prevalence estimates similar to those based on the prerecruitment sample. CONCLUSIONS: Attaining high participation rates was difficult in this study that was conducted in new mothers, particularly for the controls. The resulting nonresponse bias was minimized through IPW
Challenges to fracture service availability and readiness provided by allopathic and traditional health providers: national surveys across The Gambia and Zimbabwe.
Get PDFBackground:
Populations in Africa are ageing, hence the number of age-related fragility fractures, including hip fractures, is rising. Hip fractures are an indicator condition for older adult health provision, as they require a multifaceted pathway of care. To enable health service planning, detailed national-level understanding of current fracture service provision is needed.
Methods:
The WHO Service Availability & Readiness Assessment survey was modified to evaluate fracture service availability, and readiness. All health care facilities to which a patient with a hip fracture could present in The Gambia and Zimbabwe were invited to participate between October 2021 and January 2023. A further traditional bone-setter (TBS)-specific survey assessed TBS care in The Gambia. Availability of services per 100 000 adults ≥ 18 years, and general, fracture-specific, and hip fracture-specific care readiness were determined.
Results:
All invited facilities in Zimbabwe (n = 186), 98% in The Gambia (n = 150), and 35 of 42 (83%) TBS participated in the survey. General availability of hospital facilities was low in both Zimbabwe and The Gambia and many facilities lacked regular electricity, reliable oxygen supplies, and sharp/infectious waste disposal. In The Gambia, 78.6% public hospitals and 53.8% other facility types (e.g. NGO/mission) had no doctors. Fracture care readiness: < 1 orthopaedic surgeon was available for 100 000 adults in both countries. Orthopaedic trained nurses, physiotherapists, and occupational therapists were few. Only 10 (6.7%) facilities in The Gambia and 56 (30.1%) in Zimbabwe had functioning X-ray facilities. Equipment for fracture immobilisation was widely unavailable. No public facility had a dual-energy X-ray absorptiometry scanner; antiresorptive treatment access was limited to < 5% facilities. Hip fracture readiness: only four facilities in The Gambia and 17 in Zimbabwe could offer surgery. Inpatient delays for surgery were long, especially in Zimbabwe. Non-operative management was common in Zimbabwe and in those visiting TBS in The Gambia. Over half TBS (51.4%) reported being able to set a hip fracture, management included traditional medicines (57.1%), splinting (20.0%), manipulation (14.3%) and traction (5.7%). Only 14.3% TBS referred hip fractures to hospital.
Conclusions:
Findings highlight multiple important modifiable gaps in care which warrant urgent focus, with recommendations made, given expected increases in fragility fractures and need for universal health coverage
Community perspectives on drug promotion on social media during the COVID-19 pandemic in KwaZulu-Natal, South Africa
Get PDFBackground During the COVID-19 pandemic, social media and web-based platforms were widely used to promote medicinal substances. To assess community perspectives on drug promotions on social media, we conducted qualitative research using three workshops. The workshops aimed to highlight the public understanding of drug advertising focusing on community perceptions of social media drug promotions, their risks and benefits. Discussions were conducted on the importance of adhering to national drug regulation policies and the World Health Organisation ethical criteria for promotion, advertisement, and publicity of medicines. Methods Participants for the workshops were purposively sampled from local community youth groups and healthcare facilities. Two workshops included ten young adults aged 18-35, while the third workshop involved three healthcare professionals and one traditional healer. Results The study participants’ highlighted the value of honesty and trust in the drug promotions. Gaps in the ethical conduct of advertising were observed and concerns were raised about the reliability of social media information and the omission of valuable details on the drug advertisements. Conclusion Individuals have a right to informed choices that ensure their health safety. This study has highlighted the need for transparency and accountability in pharmaceutical and complementary medicine marketing on social media. Collaboration is needed between regulatory bodies, pharmaceutical companies, healthcare providers and community members, to make sure that drug advertising upholds ethical standards and public health.</ns3:p
Conditional survival of children, adolescents and young adults (0-24 years) diagnosed with leukaemia during 2000-2014 world-wide: (CONCORD-3).
Get PDFBACKGROUND: Population-based survival estimates provide valuable insights into cancer care patterns world-wide. Access to optimal treatment leads to better outcomes, however, treatment pathways vary globally. Conditional survival is the probability that patients who have already survived for a given number of years since diagnosis will live for an additional number of years. It is a useful proxy to assess the success of initial treatment or remission of leukaemia. METHODS: We analysed data for 164,563 patients aged 0-24 years diagnosed during 2000-2014, from 258 population-based cancer registries in 61 countries. Using the Pohar-Perme estimator, we estimated net survival at five years, conditional on surviving at least one year, and at 10 years conditional on surviving five years. To control for background mortality, we used life tables of all-cause mortality by single year of age, sex, country and calendar year. All-ages survival estimates were standardised to the marginal age distribution. FINDINGS: During 2010-2014, age-standardised five-year conditional net survival ranged from 61.8 % in Mexico to 90 % or more in 20 countries. By 2010-2014, five-year conditional survival in most high-income countries exceeded 90 % for children, but not for older patients, and for acute myeloid leukaemia it was typically 5-10 % lower than for lymphoid leukaemia. Ten-year conditional survival was 90 % or higher in most countries, with less variation world-wide. INTERPRETATION: World-wide variation in survival was less marked for patients who survived the first year(s) after diagnosis. Notable gains occurred in countries with initially lower five-year survival (e.g., China or Mexico), where legislative changes contributed to improved access to treatment for young patients with cancer. Nonetheless, inequalities persisted between high-income and low- and middle-income countries. Population-based cancer registry data remain essential to monitor further improvements. FUNDING: Children with Cancer UK; the Institut National du Cancer, La Ligue Contre le Cancer, Centers for Disease Control and Prevention, Swiss Re, Swiss Cancer Research foundation, Swiss Cancer League, Rossy Family Foundation, US National Cancer Institute and the American Cancer Society
An individual-based modelling study estimating the impact of maternity service delivery on health in Malawi.
Get PDFMaternal and perinatal morbidity and mortality remain high in Malawi, partially due to gaps in the coverage and quality of health services. We developed an individual-based model of maternal and perinatal health and healthcare in Malawi, situated in a 'whole-health system, all-disease' framework (Thanzi La Onse). We modelled sixteen scenarios estimating the impact of current and improved coverage and quality of antenatal, intrapartum, and postnatal services from 2023 to 2030. Whilst current service delivery is inferred to avert morbidity and mortality, the largest reductions in the stillbirth, maternal and neonatal mortality rates were observed when the use and quality of all services was maximised concurrently (a 10%, 52% and 57% reduction respectively). When services were considered in isolation, generally, increased coverage without quality improvement did not impact mortality or DALYs. In only three scenarios was a sufficient reduction in neonatal mortality observed to achieve target 3.2 of the United Nation's Sustainable Development Goals (SDG), and in no scenarios was a reduction in maternal mortality sufficient to achieve SDG target 3.1 observed, reaffirming that system wide investments are essential to achieve these goals
Estimating the prevalence, socioeconomic determinants, and health seeking behavior of individuals with depression in Ghana.
Get PDFDepression is a growing public health concern in Ghana, exacerbated by limited mental health services, stigma, and socio-economic disparities. While awareness is rising, research on its prevalence, health-seeking behavior, and socio-economic determinants remains limited. This study estimates depression prevalence, assesses health-seeking behavior, and identifies socio-economic drivers influencing these outcomes. Using three waves of the Ghana Socioeconomic Panel Survey (2009/2010, 2013/2014, 2018/2019), depression was measured via the Kessler Psychological Distress Scale (K10). Logistic regression and random-effects models analyzed the socio-economic factors affecting depression and mental health-seeking behavior. Depression prevalence declined from 31.04% in 2009/2010 to 27.21% in 2013/2014 but rose again to 29.54% in 2018/2019. Health-seeking behavior improved from 6.38 to 14.88%, though rural and disadvantaged groups remained underserved. Older adults (65+) and Northern Region residents had significantly higher odds of depression, while post-secondary education reduced risk. Unemployment correlated with lower depression odds, likely reflecting the protective role of communal networks in Ghana. Depression remains a significant issue, with persistent disparities in access to care. Expanding rural mental health services, improving mental health literacy, and addressing regional inequalities are crucial to reducing Ghana's mental health burden
Induction of hemagglutinin stalk reactive antibodies by the administration of a live-attenuated influenza virus vaccine in children.
Get PDFEarly life exposures to influenza viruses may imprint a hemagglutinin group-specific signature on immunity that impacts future responses to infection or vaccination. We assessed the administration of a live attenuated influenza virus (LAIV) vaccine in children. Two LAIV formulations (2016-17 and 2017-18) containing distinct H1N1 components were used. Modest boosting of pre-existing serum stalk reactive titers and enhancement of functional antibody-dependent cellular cytotoxicity activity (ADCC) was observed. The magnitude of stalk antibody induction in children naive to influenza A viruses was low; however, LAIV induced de novo stalk antibodies, increasing the number of children seropositive to both group 1 (G1) and group 2 (G2) influenza viruses. The 2018 LAIV formulation, containing an updated H1N1 component, induced higher stalk reactive antibodies with strong ADCC effector functions to the G1 stalk. No significant changes were detected in NA-reactive antibodies in serum or in stalk- or NA-secretory IgA (sIgA) in oral fluid
Recent Advances in Bioconjugate Vaccine Development.
Get PDFGlycoconjugate vaccines, consisting of a protein component covalently linked to a glycan antigen, have led to a significant reduction in the global occurrence of bacterial meningitis and pneumonia. They provide robust, lasting immunity in all age groups. However, their production by traditional chemical conjugation approaches has drawbacks in terms of complexity, cost, and lack of flexibility in design, which explains their limited application to a few pathogenic bacteria in the past four decades. Protein glycan coupling technology (PGCT) or bioconjugation, where glycoconjugates are produced in purpose-engineered bacterial cells, is a useful alternative to chemical conjugation and promises an array of low-cost custom-made glycoconjugate vaccines with vast protein glycan combinations. The technology has undergone significant development since its inception, and new advances and refinements continually drive the field forward. Several bioconjugate vaccines are currently in clinical trials, demonstrating the potential of the technology. We will review the wide applicability of bioconjugation and recent developments in each of the components of the technology, namely, glycan expression, protein selection, and the coupling of selected glycan with proteins, all within custom-designed E. coli cells. These advances promise to deliver effective glycoconjugate vaccines for multiple unmet medical needs
Knowledge of HIV status among men aged 20-35 years in Lusaka, Zambia: Findings from a pilot time location sampling survey in the "Yaba Guy Che" (for the guys) study.
Get PDFOBJECTIVES: We conducted a pilot time location sampling survey with young men aged 20-35 years in Lusaka, Zambia and aimed to describe knowledge of HIV status and determine factors associated with knowledge of HIV status. METHODS: Hotspots where men congregate were identified in a densely populated community in Lusaka. Hotspots were grouped into five strata (betting shops; car parks/washes; bus stations/taxi ranks; churches; and markets/shopping streets) and day/times when hotspots were frequented by men were listed. Within each stratum, three hotspots were randomly selected. Subsequently, 1 day/time was randomly selected for each hotspot. Men aged 20-35 were approached for participation and data was collected between July and October 2022. We describe participation in the survey, socio-demographics, and sexual behaviours. Using logistic regression, we explored factors associated with knowledge of HIV status. RESULTS: 339 men were approached, among whom 304 (90%) were eligible and 297 (98%) consenting to participate. Overall, 61% knew their HIV status. Adjusting for recruitment strata, knowledge of HIV status was similar by age (20-24: 56%; 25-29: 68%; and 30-35: 55%; p = 0.19). Among men reporting sex in the last month, men reporting no condomless sex were more likely to know their HIV status (78.2%) compared to men reporting one condomless sex partner in the past 1 month (55.5%; age-adjusted OR = 3.02; 95%CI 1.07, 8.55; p = 0.07). Knowledge of HIV status was lower among men who thought their friends were testing every 2-5 years (48%; n = 12/29) compared to those assuming that their friends tested more frequently (70.0%; adjOR = 0.28; 95%CI 0.08, 0.98; p < 0.001). CONCLUSION: The time location sampling survey was acceptable among men, as evidenced by high participation. Overall, 40% of young men did not know their HIV status. A hotspot-driven approach to delivering HIV testing services may prove effective at reaching men. Furthermore, time location sampling surveys should be explored as a tool to evaluate interventions targeting men