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Immune Response to MVA-BN Vaccination for Mpox: Current Evidence and Future Directions.
Get PDFThe 2022 global mpox outbreak, caused by clade IIb of the monkeypox virus (MPXV), prompted emergency use authorisation of the Modified Vaccinia Ankara-Bavarian Nordic (MVA-BN) vaccine, previously approved for smallpox prevention. Understanding immune responses to the MVA-BN vaccine is critical to inform both current and future mpox vaccine policy, particularly amid reports of breakthrough infections in vaccinated persons, uncertainty about the durability of vaccine-induced protection, and the emergence of further outbreaks of mpox from different viral clades, including the clade I-driven public health emergency of international concern. MVA-BN elicits binding and neutralising antibody, memory B cells, and T cell responses. Immune responses vary by host factors, prior orthopoxvirus exposure, and dosing regimens. While seroconversion is generally robust, circulating antibody titres often wane rapidly, particularly in vaccinia-naïve and/or immunocompromised individuals, including people with HIV. Vaccine-induced neutralising antibody responses to MPXV are frequently lower than to vaccinia virus, and their role in protection remains ill-defined. In contrast, T cell responses appear more sustained and may support long-term immunity in the absence of persistent antibody titres. This narrative review synthesises current evidence on the immunogenicity and durability of MVA-BN vaccination, highlights challenges in assay interpretation, and outlines key research priorities, including the need to explore correlates of protection, booster strategies, and next-generation vaccine design
Mental Distress and Resource Insecurity in the Kingdom of Tonga After the 2022 Volcanic Eruption: Associations of Water and Food Insecurity With Mental Distress.
Get PDFBACKGROUND: Water and food insecurity can harm mental health; all 3 may, in turn, be exacerbated by humanitarian crises. The linkages between food insecurity, water insecurity, and mental health are gaining attention but have not been investigated after a natural disaster. OBJECTIVE: To investigate the associations between food insecurity, water insecurity, and mental distress, and how these relationships may differ between women and men, in the aftermath of the January 15, 2022, volcanic eruption in the Kingdom of Tonga. DESIGN: Secondary analysis of nationally representative cross-sectional data from the Equality Insights Rapid survey collected 4 to 5 months after the eruption, between May 17 and June 30, 2022 PARTICIPANTS/SETTING: This study analyzed individual data on food insecurity, water insecurity, mental distress, and sociodemographic covariates collected from women and men ≥18 years old (n = 6650). Participants were eligible if they had been a member of the same household since 2021 and were able to communicate independently on the phone in Tongan or English. MAIN OUTCOME MEASURES: Mental distress over the past 4 weeks, measured using the 6-item Kessler Screening Scale (K6) STATISTICAL ANALYSES PERFORMED: Multivariable negative binomial and logistic regression models were used to test how food and water insecurity relate to both continuous and dichotomized measures of mental distress, respectively. Food insecurity was measured using the 8-item Food Insecurity Experience Scale (FIES), and water insecurity was measured using the abbreviated Individual Water Insecurity Experiences (IWISE-4) Scale. Models were estimated separately for women and men and adjusted for age, marital status, number of minors and adults in the household, educational attainment, employment status, household wealth quintile, and urbanicity. RESULTS: Water insecurity was independently associated with higher odds of experiencing moderate-to-severe mental distress among women (odds ratio [OR], 1.66; 95% confidence interval [CI], 1.29-2.14) and men (OR = 1.40; 95% CI, 1.09-1.80) when adjusting for food insecurity. Those experiencing concurrent water and food insecurity were at the highest risk of experiencing mental distress compared with those experiencing only 1 insecurity or neither. The strength of associations was similar among women and men. CONCLUSIONS: The deleterious relationship between concurrent water and food insecurity and mental distress highlights the importance of addressing both insecurities and helping those experiencing both insecurities, particularly in the aftermath of humanitarian crises
A proposed framework for the evaluation of cholera surveillance systems in Africa
Get PDFBackground: Despite the global roadmap to end cholera by 2030, the disease remains a major public health challenge in Africa, compounded by weak surveillance systems, inadequate multisectoral coordination and delayed case detection. A significant impediment is the absence of a comprehensive surveillance evaluation framework for African nations to systematically identify and address these critical capacity deficits.
Aim: This study builds upon prior research that highlighted the wide variations in existing surveillance evaluation frameworks, aiming to propose a comprehensive conceptual framework for assessing cholera surveillance systems in Africa.
Setting: This study focused on empirical data and feedback gathered from eight cholera-affected countries: Democratic Republic of Congo, Nigeria, Zambia, Zimbabwe, Mozambique, Somalia, Kenya, and Ethiopia.
Methods: This was a mixed-method study and leveraged insights from a previous systematic review lasted 7 months (July 2024 to January 2025). The approach involved a detailed assessment of existing frameworks and consultations with eight cholera-affected countries.
Results: The assessment of 10 existing frameworks revealed consistent gaps, notably the absence of essential components such as cross-border surveillance, digitisation, effective linkages between surveillance and laboratory systems, and sustainable financing mechanisms. Our conceptual framework is structured around three key pillars: resource allocation, system structures and core functions, all underpinned by strong governance and leadership.
Conclusion: This study recommends the adaptation and integration of our proposed comprehensive framework into broader surveillance strategies and guidelines to significantly improve cholera surveillance across Africa, thereby enhancing early detection and response capabilities.
Contribution: This study presents a novel comprehensive framework for cholera surveillance system evaluation and recommends its adaptation and integration into broader surveillance strategies and guidelines to significantly improve cholera surveillance in Africa
Association between size at birth, rapid weight gain in infancy, and overweight status among Palestinian refugees under 5 years old: a retrospective cohort study.
Get PDFBACKGROUND: Evidence on the association of birth size and rapid weight gain with overweight/obesity is inconsistent. Refugees face unique nutritional challenges that influence weight patterns, yet data remain limited. OBJECTIVES: We examined the association between size at birth, infant feeding, and rapid weight gain in the first year of life, and subsequent overweight/obesity in childhood among Palestinian refugees. METHODS: This retrospective cohort study used data from 388,347 live births from 1 January, 2010 to 31 December, 2020, linked to child growth monitoring data using United Nations Relief and Works Agency electronic-health records. The cohort included children aged 0 to 60 mo from 5 regions: Gaza, Jordan, Lebanon, Syria, and the West Bank. Size at birth was categorized into 9 phenotypes, and rapid weight gain was defined as an increase of 0.67 in weight-for-age z-score from birth until age 12 mo. Overweight/obesity occurrence was defined as a weight-for-height z-score >+2 at any time point after 24 to 60 mo of age. Multilevel mixed-effects models and structural equation modeling were used to analyze associations. RESULTS: Small for gestational age children had lower odds of exclusive human milk feeding [adjusted odds ratio (aOR): 0.83; 95% confidence interval (CI): 0.81, 0.85], higher odds of rapid weight gain (aOR: 2.39; 95% CI: 2.32, 2.45), and lower odds of overweight/obesity (aOR: 0.50; 95% CI: 0.46, 0.56) compared with appropriate for gestational age children. Large for gestational age children showed lower odds of rapid weight gain (aOR: 0.35; 95% CI: 0.33, 0.36) but higher odds of overweight/obesity (aOR: 2.76; 95% CI: 2.59, 2.95) compared with appropriate for gestational age. Between 22.2% and 34.4% of children experienced rapid weight gain. Rapid weight gain was strongly associated with overweight/obesity at 24 to 60 mo (aOR: 6.53; 95% CI: 6.15, 6.94). Exclusive human milk feeding was associated with lower odds of rapid weight gain (aOR: 0.66; 95% CI: 0.65, 0.67). CONCLUSIONS: Rapid weight gain in infancy, regardless of birth size, is a predictor of childhood overweight/obesity. Exclusive human milk feeding mitigates the risk of rapid weight gain and subsequent overweight/obesity
Wealth-based equity in essential newborn care practices in Ethiopia: A cross-sectional study.
Get PDFBACKGROUND: The World Health Organization has listed several newborn care practices as essential for health and survival. Reports from low-income countries, including Ethiopia, have shown inequities in these practices, but their link to place of birth remains insufficiently explored. We aimed to analyze the wealth-based equity of selected essential newborn care practices, i.e., skin-to-skin care, delayed bathing, proper cord care, and timely breastfeeding initiation, among neonates born in health facilities and homes in Ethiopia.
METHODS: The Performance Monitoring for Action Ethiopia 2019-2020 survey was conducted in five regions, representing 90% of the country's population, and included data on 2,493 newborns. Household wealth quintiles were derived using principal component analysis of asset ownership. We analyzed the wealth-based equity of selected essential newborn care practices for facility and home deliveries using equiplot, equity gaps, equity ratios, and concentration indices.
RESULTS: Overall, skin-to-skin care and delayed bathing showed minimal inequities among babies born in health facilities. When comparing the extreme wealth groups, minor socio-economic differences were observed in delayed bathing and timely breastfeeding initiation. When wealth was treated as a continuous variable across all respondents, delayed bathing and proper cord care were more common in better-off households. For home births, the equiplots showed that all selected essential newborn care practices were more frequent among the least poor groups. While comparing the extreme wealth groups, socio-economic inequities were evident in skin-to-skin care and delayed bathing practices. When wealth was considered a continuous variable, skin-to-skin care and delayed bathing were more common among better-off households.
CONCLUSION: The coverage of selected essential newborn care practices was higher in facility deliveries. There were minimal socio-economic differences in newborn care for facility births, while inequities in skin-to-skin care and delayed bathing were prominent in home births. Initiatives should aim to enhance equity in newborn care within health facilities while promoting facility deliveries and improving newborn care practices at home to achieve equitable newborn care in Ethiopia
Highly conserved Plasmodium vivax genomes in Duffy-negative individuals from Sudan.
Get PDFDuffy-negatives were previously thought to be immune to Plasmodium vivax infections due to Duffy binding protein's (PvDBP1) inability to invade erythrocytes lacking Duffy antigen receptor for chemokines (DARC) expression. Nevertheless, reports of P. vivax cases are growing throughout Africa and among Duffy-negative people. Although there are alternative invasion mechanisms by P. vivax, the exact mechanisms in Duffy-negative individuals are unclear. Sudan, with a mixed Duffy-negative and Duffy-positive population, is ideal to study differences between these infections on epidemiological and genetic scales. The goal of this study was to compare Duffy-positive and Duffy-negative infections in Sudanese individuals on epidemiological and genomic scales. We collected epidemiological data and sequenced parasite genomes and found that Duffy-positive individuals had significantly higher parasitemia than Duffy-negatives. Furthermore, Duffy-positive infected P. vivax genomes were much more diverse than Duffy-negatives, across all 14 chromosomes and 44 specific erythrocyte binding gene candidates. Genes of the merozoite surface protein family account for much of the genetic diversity found. Many erythrocyte binding gene candidates are under selection pressure, both positive and negative. Finally, in DBP and RBP genes, as well as TRAg38, changes in amino acids in the binding regions to a structurally different residue could affect erythrocyte binding affinity and antigenic conformation
Feasibility and acceptability of peer-led assessment of HIV risk among female sex workers in Zimbabwe.
Get PDFINTRODUCTION: Female sex workers (FSWs) in sub-Saharan Africa are at higher risk of HIV acquisition and transmission. However, FSWs' life experiences are heterogeneous and are important to characterise in order to tailor responses to individual needs. Peer microplanners are FSWs trained to engage other FSWs and offer each individual a tailored package of support. We sought to assess the feasibility, acceptability and fidelity of implementing peer-led assessments of risk.
METHODS: Between December 2020 and August 2021, we conducted a qualitative process evaluation study of the Adapted Microplanning: Eliminating Transmissible HIV In Sex Transactions (AMETHIST) trial's peer-led assessment of FSWs' risk of HIV acquisition and transmission. We enrolled 60 participants (30 FSW and 30 peer microplanners) for semistructured in-depth interviews at 3 of 11 intervention sites. Interview guides and analysis were underpinned by three elements adapted from the UK Medical Research Council's process evaluation framework: (1) feasibility, (2) acceptability and (3) fidelity. Using a framework analytic approach, data were familiarised, coded with NVivo V.12 software, charted, interpreted and then deductively mapped to these three elements.
RESULTS: Peer microplanners used the risk scores to tailor their support to FSW with good fidelity. Some experienced difficulties completing assessments during the initial period of implementation. However, it was feasible for peer microplanners to establish strong relationships, and they used observational and conversational skills to elicit sensitive information from FSW to support their assessment. The assessments and tailored support offered by peer microplanners were acceptable to FSWs, although some did not appear to know they were being assessed.
CONCLUSIONS: Our findings show that peer microplanners feasibly and acceptably assessed FSW for certain risk factors through a scoring tool and focused their support accordingly. This approach could be integrated into other peer-led interventions to improve prioritisation of HIV programmes
Early lymph node T follicular helper cell signalling hub drives influenza vaccine response in an ancestrally diverse cohort.
Get PDFBACKGROUND: Early in vivo dynamics of human immune-cell activation across regionally activated lymphoid tissue sites upon immunisation are poorly characterised in ancestrally-diverse individuals with consequences for pandemic preparedness.
METHODS: In this experimental medicine study, draining and non-draining lymph nodes (dLNs and ndLNs) were studied by ultrasound (US)-guided fine-needle aspiration (FNA) in 13 adults aged 18-55 years with African and Asian ancestry, before and after receiving adjuvanted seasonal influenza vaccine (aQIV). A multi-modal investigation of ultrasound data, genotyping, systems serology, and single-cell multi-omics was undertaken.
FINDINGS: HLA subtypes reflected self-declared ethnicity and included understudied alleles. Draining but not ndLNs rapidly increased in size post-vaccination, by day 3, with distinct cellular dynamics culminating in a cross-protective serological response. Dissecting LN cellular diversity into 42 lymphoid and non-lymphoid cell states, early post-vaccination cell abundance changes were observed across all LNs, but dLNs were characterised by CD4+ T follicular helper (CD4+ Tfh) cell expansion. Gene expression analysis revealed a dLN post-vaccination hub defined by CD4+ Tfh signalling, cross-compartmental activation, translation, and enhanced antigen-presentation capacity.
INTERPRETATION: Early CD4+ Tfh coordination in draining lymphoid tissue underpins robust responses to adjuvanted influenza vaccine that transcend ancestral inter-individual variation in young adults, with implications for vaccine design in ancestrally-diverse populations.
FUNDING: The study was funded by the Silicon Valley Community Foundation with a Chan Zuckerberg Initiative donation. The funder had no role in the study design, data analysis or decision to publish. The funder provided infrastructure support for the posting of the dataset with CELLxGENE
Patterns of antidepressant prescribing around pregnancy: a descriptive analysis using Clinical Practice Research Datalink GOLD.
Get PDFBACKGROUND: Antidepressant use is increasing during pregnancy but estimates of prevalence and patterns of prescribing are outdated. AIM: To describe the prevalence and patterns of antidepressant prescribing in and around pregnancy. DESIGN AND SETTING: This was a drug utilisation study using the UK's Clinical Practice Research Datalink (CPRD) GOLD Pregnancy Register. METHOD: Using primary care prescription records, individuals were identified who had been prescribed antidepressants in and around pregnancy between 1996 and 2018 and the prevalence of prescribing during pregnancy over time was described. Those with 'prevalent' or 'incident' antidepressant use were defined, where the 'prevalent' group contained individuals who were prescribed antidepressants both before and during pregnancy, whereas individuals in the 'incident' group were newly prescribed antidepressants during pregnancy. Patterns of prescribing were then qualitatively compared between these two groups. The study also investigated post-pregnancy prescribing, as well as characteristics associated with antidepressant discontinuation anytime during pregnancy. RESULTS: A total of 1 033 783 pregnancies were eligible: 79 144/1 033 783 (7.7%) individuals were prescribed antidepressants during pregnancy and 15 733/79 144 (19.9%) were in the 'incident' group. Antidepressant prescribing during pregnancy increased from 3.2% (556/17 653) in 1996 to 13.4% (3889/29 079) in 2018. Most women, both those whose antidepressants were 'prevalent' and 'incident' prescribed, discontinued their medication anytime during pregnancy (54.9% [34 801/63 411] and 59.9% [9427/15 733], respectively). Over half of those who discontinued during pregnancy were prescribed antidepressants in the 12 months after pregnancy (53.0%, 23 457/44 228). Younger age, previous stillbirth, and higher deprivation were associated with more frequent discontinuation anytime during pregnancy. CONCLUSION: Antidepressant prescribing during pregnancy has been increasing in the UK. Over half of the sample discontinued antidepressants at some point before the end of pregnancy, but post-pregnancy resumption of antidepressants was common. The results presented here highlight the benefit of counselling women when initiating antidepressants to support informed decision making
Woman-centeredness of family planning care and associated factors in a semi-urban health district in West Cameroon.
Get PDFOBJECTIVE: To measure the woman-centeredness of family planning (FP) care and determine its correlates in West Cameroon.
METHODS: We conducted a cross-sectional analytical study from August to November 2024 in the Mifi Health District (MHD). We included women receiving FP care in all the public health facilities. We collected data were using the person-centered FP care scale (PCFPS). Descriptive and inferential statistics were computed with R software. Respondents' characteristics were summarized, and woman-centeredness scores computed using the PCFPS guide. We used the cutoff threshold technique to distinguish high and low scores. Bivariate and multivariate linear regressions were conducted to determine the correlates of woman-centeredness of FP care. Regression coefficients with their 95% confidence intervals (CIs) were computed with a significance threshold of 5%.
RESULTS: The median (range) woman-centeredness score for the 179 respondents was 73.33% (12.22-88.88). Specifically, the median (range) score (76.38% [8.33-91.66]) for woman's respect and autonomy was higher than that (61.11% [5.55-100]) for health facility environment. The FP care woman-centeredness score at the district hospital was seven-point higher than in first-level primary healthcare facilities (a.Coefficient: 7.33; 95% CI: 1.11-13.56; P = 0.02). Likewise the woman-centeredness score of FP care for women with a monthly income ≤100 USD was significantly lower than for women earning >300 USD monthly (a.Coefficient: -6.98; 95% CI: -12.96 to -1.01; P = 0.02).
CONCLUSION: FP care in the MHD was highly women centered. However, FP care was less likely to be woman-centered for low-income women and for those attending first-level primary health care facilities