scholarly journals Effect of childhood rotavirus vaccination on community rotavirus prevalence in rural Ecuador, 2008-13

2020 ◽  
Vol 49 (5) ◽  
pp. 1691-1701
Author(s):  
Alicia N M Kraay ◽  
Edward L Ionides ◽  
Gwenyth O Lee ◽  
William F Cevallos Trujillo ◽  
Joseph N S Eisenberg

Abstract Background Although live attenuated monovalent human rotavirus vaccine (Rotarix) efficacy has been characterized through randomized studies, its effectiveness, especially in non-clinical settings, is less clear. In this study, we estimate the impact of childhood Rotarix® vaccination on community rotavirus prevalence. Methods We analyse 10 years of serial population-based diarrhoea case-control study, which also included testing for rotavirus infection (n = 3430), and 29 months of all-cause diarrhoea active surveillance from a child cohort (n = 376) from rural Ecuador during a period in which Rotarix vaccination was introduced. We use weighted logistic regression from the case-control data to assess changes in community rotavirus prevalence (both symptomatic and asymptomatic) and all-cause diarrhoea after the vaccine was introduced. We also assess changes in all-cause diarrhoea rates in the child cohort (born 2008–13) using Cox regression, comparing time to first all-cause diarrhoea case by vaccine status. Results Overall, vaccine introduction among age-eligible children was associated with a 82.9% reduction [95% confidence interval (CI): 49.4%, 94.2%] in prevalence of rotavirus in participants without diarrhoea symptoms and a 46.0% reduction (95% CI: 6.2%, 68.9%) in prevalence of rotavirus infection among participants experiencing diarrhoea. Whereas all age groups benefited, this reduction was strongest among the youngest age groups. For young children, prevalence of symptomatic diarrhoea also decreased in the post-vaccine period in both the case-control study (reduction in prevalence for children <1 year of age = 69.3%, 95% CI: 8.7%, 89.7%) and the cohort study (reduction in hazard for receipt of two Rotarix doses among children aged 0.5-2 years = 57.1%, 95% CI: 16.6, 77.9%). Conclusions Rotarix vaccination may suppress transmission, including asymptomatic transmission, in low- and middle-income settings. It was highly effective among children in a rural community setting and provides population-level benefits through indirect protection among adults.

2018 ◽  
Author(s):  
Alicia N. M. Kraay ◽  
Edward L. Ionides ◽  
Gwenyth O. Lee ◽  
William F. Cevallos Trujillo ◽  
Joseph N.S. Eisenberg

AbstractBackgroundWhile live attenuated monovalent human rotavirus vaccine (Rotarix) efficacy has been characterized through randomized studies, its effectiveness, especially in non-clinical settings, is unclear. In this study, we estimate direct, indirect, and overall effectiveness of Rotarix vaccination.MethodsWe analyze 29 months of all-cause diarrhea surveillance from a child cohort (n=376) and ten years of serial population-based case-control lab-confirmed rotavirus data (n=2489) from rural Ecuador during which Rotarix vaccination was introduced. We estimate: 1) the direct effect of vaccination from a cohort of children born from 2008-2013 using Cox regression to compare time to first all-cause diarrhea case by vaccine status; and 2) the overall effect on all-cause diarrheal and symptomatic and asymptomatic rotavirus infection for all age groups, including indirect effects on adults, from the case-control data using weighted logistic regression.ResultsRotarix vaccination provided direct protection against all-cause diarrhea among children 0.5 - 2 years (All-cause diarrhea reduction for receipt of 2 doses of Rotarix=57.1%, 95% CI: 16.6, 77.9%). Overall effectiveness against rotavirus infection was strong (Exposure to 100% coverage of Rotarix vaccination was associated with an 85.5% reduction, 95% CI: 61.1-94.6%) compared to 0% coverage. Indirect effects were observed among older, vaccine-ineligible children and adults (84.5% reduction, 95% CI: 48.2-95.4%). Vaccine effectiveness was high against both symptomatic (48.3% reduction,95% CI: 0.03-73.1%) and asymptomatic infection (90.1% reduction, 95% CI: 56.9-97.7%).ConclusionsRotarix vaccination suppresses overall transmission. It is highly effective among children in a rural community setting and provides population-level benefits through indirect protection among adults.


2021 ◽  
Vol 20 (1) ◽  
Author(s):  
C. Airoldi ◽  
C. Magnani ◽  
F. Lazzarato ◽  
D. Mirabelli ◽  
S. Tunesi ◽  
...  

Abstract Background Neighborhood exposure to asbestos increases the risk of developing malignant mesothelioma (MM) in residents who live near asbestos mines and asbestos product plants. The area of Casale Monferrato (Northwest Italy) was impacted by several sources of asbestos environmental pollution, due to the presence of the largest Italian asbestos cement (AC) plant. In the present study, we examined the spatial variation of MM risk in an area with high levels of asbestos pollution and secondly, and we explored the pattern of clustering. Methods A population-based case–control study conducted between 2001 and 2006 included 200 cases and 348 controls. Demographic and occupational data along with residential information were recorded. Bivariate Kernel density estimation was used to map spatial variation in disease risk while an adjusted logistic model was applied to estimate the impact of residential distance from the AC plant. Kulldorf test and Cuzick Edward test were then performed. Results One hundred ninety-six cases and 322 controls were included in the analyses. The contour plot of the cases to controls ratio showed a well-defined peak of MM incidence near the AC factory, and the risk decreased monotonically in all directions when large bandwidths were used. However, considering narrower smoothing parameters, several peaks of increased risk were reported. A constant trend of decreasing OR with increasing distance was observed, with estimates of 10.9 (95% CI 5.32–22.38) and 10.48 (95%CI 4.54–24.2) for 0–5 km and 5–10 km, respectively (reference > 15 km). Finally, a significant (p < 0.0001) excess of cases near the pollution source was identified and cases are spatially clustered relative to the controls until 13 nearest neighbors. Conclusions In this study, we found an increasing pattern of mesothelioma risk in the area around a big AC factory and we detected secondary clusters of cases due to local exposure points, possibly associated to the use of asbestos materials.


2005 ◽  
Vol 36 (2) ◽  
pp. 106-107 ◽  
Author(s):  
Jennie Borg ◽  
Deborah Christie ◽  
Pietro Coen ◽  
Robert Booy ◽  
Russell Viner

Author(s):  
Mark Elwood

This chapter shows a large population-based case-control study, to address the quantitative relationship between alcohol consumption and breast cancer. It shows the logistic and design issues, and the assessment of dose-response, consistency and specificity. The critical assessment follows the scheme set out in chapter 10: describing the study, assessing the non-causal explanations of observation bias, confounding, and chance variation; assessing time relationships, strength, dose-response, consistency and specificity, and applying the results to the eligible, source, and target populations; and then comparing the results with evidence from other studies, considering consistency and specificity, biological mechanisms, and coherence with the distribution of exposures and outcomes. The chapter gives a summary and table of the critical assessment and its conclusions; and comments on the impact of the study and research carried out since.


2019 ◽  
Vol 53 (11) ◽  
pp. 1102-1110 ◽  
Author(s):  
Siin Kim ◽  
Sang-Myung Cheon ◽  
Hae Sun Suh

Background: Although drug-induced parkinsonism is reversible in most cases, some patients can suffer from persistent/recurrent symptoms. Therefore, prevention is the most efficient way to manage drug-induced parkinsonism. However, there is a paucity of studies exploring the relationship between parkinsonism and drug exposure. Objective: To examine the association between drug exposure and the risk of parkinsonism using Korean population-based data. Methods: We conducted a matched case-control study using the National Health Insurance Service—National Sample Cohort database. Cases and controls were defined as individuals with and without parkinsonism, respectively, between 2007 and 2013. Cases and controls were matched for sex, age group, income, type of insurance, and Charlson comorbidity index. Drug exposures, including propulsives, antipsychotics, and flunarizine, were identified at 1 year before the first date of parkinsonism and stratified by recency and cumulative dose. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% CIs. Results: We identified 5496 cases and 5496 controls. ORs for current use group of propulsives, antipsychotics, and flunarizine compared with those of the never use group were 2.812 (95% CI = 2.466-3.206), 3.009 (95% CI = 1.667-5.431), and 4.950 (95% CI = 2.711-9.037), respectively. ORs were greater in those more recently exposed and those exposed to higher cumulative doses. Conclusion and Relevance: At the population level, use of propulsives, antipsychotics, and flunarizine had a significant association with the increased risk of parkinsonism, depending on recency and cumulative dose. Drugs associated with parkinsonism should be used with careful monitoring to prevent drug-induced parkinsonism.


2008 ◽  
Vol 15 (6) ◽  
pp. 372-382 ◽  
Author(s):  
Sarah Polack ◽  
Hannah Kuper ◽  
Cristina Eusebio ◽  
Wanjiku Mathenge ◽  
Zakia Wadud ◽  
...  

Author(s):  
Wayne R. Lawrence ◽  
Aida Soim ◽  
Wangjian Zhang ◽  
Ziqiang Lin ◽  
Yi Lu ◽  
...  

Abstract Although prenatal exposure to high ambient temperatures were reported to be associated with preterm birth, limited research assessed the impact of weather-related extreme heat events (EHE) on birthweight, particularly by trimester. We, therefore, investigated the impact of prenatal EHE on birthweight among term babies (tLBW) by trimester and birthweight percentile. We conducted a population-based case–control study on singleton live births at 38–42 gestational weeks in New York State (NYS) by linking weather data with NYS birth certificates. A total of 22,615 cases were identified as birthweight <2500 gram, and a random sample of 139,168 normal birthweight controls was included. EHE was defined as three consecutive days with the maximum temperatures of ≥32.2 °C/90 °F (EHE90) and two consecutive days of temperatures ≥97th percentile (EHE97) based on the distribution of the maximum temperature for the season and region. We estimated odds ratios (ORs) and 95% confidence intervals (95% CI) with multivariable unconditional logistic regression, controlling for confounders. Overall exposure to EHE97 for 2 d was associated with tLBW (OR 1.05; 95% CI 1.02, 1.09); however, the strongest associations were only observed in the first trimester for both heat indicators, especially when exposure was ≥3 d (ORs ranged: 1.06–1.13). EHE in the first trimester was associated with significant reduction in mean birthweight from 26.78 gram (EHE90) to 36.25 gram (EHE97), which mainly affected the 40th and 60th birthweight percentiles. Findings revealed associations between multiple heat indicators and tLBW, where the impact was consistently strongest in the first trimester.


2016 ◽  
Vol 21 (14) ◽  
Author(s):  
Marcela Guevara ◽  
Aurelio Barricarte ◽  
Luis Torroba ◽  
Mercedes Herranz ◽  
Alberto Gil-Setas ◽  
...  

We estimated the direct, indirect and total effects of the 13-valent pneumococcal conjugate vaccine (PCV13) on invasive pneumococcal disease (IPD) in children. A population-based cohort study followed children aged between 2.5 and 59 months between 2001 and 2014 in Navarra, Spain. IPD incidence was compared by PCV status and period. All cases diagnosed from July 2010 to December 2014 and eight matched controls per case were analysed to estimate the adjusted direct effect of PCV13. A total of 120,980 children were followed and 206 IPD cases were detected. Compared with unvaccinated children in the baseline period (2001–2004), overall IPD incidence in 2011–2014 (76% average PCV coverage) declined equally in vaccinated (total effect: 76%; hazard ratio (HR): 0.24; 95% confidence interval (CI): 0.14–0.40) and unvaccinated children (indirect effect: 78%; HR: 0.22; 95% CI: 0.09–0.55). IPD incidence from non-PCV13 serotypes increased among vaccinated children (HR: 2.84; 95% CI: 1.02–7.88). The direct effect of one or more doses of PCV13 against vaccine serotypes was 95% (odds ratio: 0.05; 95% CI: 0.01–0.55). PCV13 was highly effective in preventing vaccine-serotype IPD. The results suggest substantial and similar population-level vaccine benefits in vaccinated and unvaccinated children through strong total and indirect effects.


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