scholarly journals Effectiveness of live attenuated monovalent human rotavirus vaccination in rural Ecuador, 2008-2013

2018 ◽  
Author(s):  
Alicia N. M. Kraay ◽  
Edward L. Ionides ◽  
Gwenyth O. Lee ◽  
William F. Cevallos Trujillo ◽  
Joseph N.S. Eisenberg
Keyword(s):  
Indirect Effects ◽  
Cox Regression ◽  
Age Groups ◽  
Community Setting ◽  
Population Level ◽  
Population Based ◽  
Case Control ◽  
Rotavirus Infection ◽  
Human Rotavirus ◽  
Overall Effectiveness

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.

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
Keyword(s):  
Case Control Study ◽  
Cox Regression ◽  
Age Groups ◽  
Community Setting ◽  
Population Level ◽  
Population Based ◽  
Case Control ◽  
Rotavirus Infection ◽  
The Impact ◽  
Control Study

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.

scholarly journals Encounters for foot and ankle pain in UK primary care: a population-based cohort study of CPRD data

2019 ◽  
Vol 69 (683) ◽  
pp. e422-e429 ◽  
Author(s):  
Rachel Ferguson ◽  
David Culliford ◽  
Daniel Prieto-Alhambra ◽  
Rafael Pinedo-Villanueva ◽  
Antonella Delmestri ◽  
...  
Keyword(s):  
General Practice ◽  
Age Groups ◽  
Population Level ◽  
Population Based ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Foot Pain ◽  
Ankle Pain ◽  
Foot Health ◽  
Number Of Patients

BackgroundOlder patients who have foot pain report variation in access to services to manage their foot health. To plan services it is essential to understand the scale and burden of foot pain that exists for GPs.AimTo provide UK-wide population-level data of the frequency of foot and/or ankle pain encounters recorded in general practice.Design and settingPopulation-based cohort design study using data drawn from the UK Clinical Practice Research Datalink (CPRD) from January 2010 to December 2013.MethodAll CPRD data were collected prospectively by participating GPs. The primary outcome was prevalence of GP encounters for foot and/or ankle pain, stratified by age, sex, and different subgroups of causes.ResultsA foot and/or ankle pain encounter was recorded for 346 067 patients, and there was a total of 567 095 recorded encounters (mean per person 1.6, standard deviation [SD] 1.3). The prevalence of recorded encounters of foot and/or ankle pain was 2980 per 100 000 (3%). The number of patients with a recorded encounter of foot and/or ankle pain was 1820 per 100 000 (1.8%). Foot and/or ankle pain encounters were reported across all age groups (54.4% females), with those aged 71–80 years placing the greatest burden on GPs. The most common specified referrals were to orthopaedics (n = 36 881) and physiotherapy (n = 33 987), followed by podiatry (n = 25 980).ConclusionThe burden of foot and/or ankle pain encounters recorded by GPs is not insubstantial, and spans all ages, with a high proportion of referrals to orthopaedics. The authors recommend further exploration of ‘first-contact practitioners’ for foot and/or ankle pain in general practice to alleviate the burden on GPs.

Association Between Drug Exposure and Occurrence of Parkinsonism in Korea: A Population-Based Case-Control Study

2019 ◽  
Vol 53 (11) ◽  
pp. 1102-1110 ◽  
Author(s):  
Siin Kim ◽  
Sang-Myung Cheon ◽  
Hae Sun Suh
Keyword(s):  
Cumulative Dose ◽  
Drug Exposure ◽  
Case Control Study ◽  
Conditional Logistic Regression ◽  
Population Level ◽  
Population Based ◽  
Case Control ◽  
Drug Induced ◽  
Increased Risk ◽  
Control Study

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.

scholarly journals Characterization of enterotoxigenic Escherichia coli strains isolated from Nicaraguan children in hospital, primary care and community settings

2014 ◽  
Vol 63 (5) ◽  
pp. 729-734 ◽  
Author(s):  
Samuel Vilchez ◽  
Sylvia Becker-Dreps ◽  
Erick Amaya ◽  
Claudia Perez ◽  
Margarita Paniagua ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Primary Care ◽  
Age Groups ◽  
Community Setting ◽  
Population Based ◽  
Enterotoxigenic Escherichia Coli ◽  
Full Spectrum ◽  
Exact Test ◽  
Primary Care Clinics

Enterotoxigenic Escherichia coli (ETEC) is one of the most common causes of diarrhoea among young children in developing countries. ETEC vaccines offer promise in reducing the burden of ETEC disease, but the development of these vaccines relies on the characterization of ETEC isolates from a variety of settings. To best reflect the full spectrum of ETEC disease in León, Nicaragua, the aim of this study was to characterize ETEC strains isolated from children with diarrhoea attending different settings (hospital, primary care clinics and in the community) and children from different age groups. We characterized ETEC isolates in terms of their colonization factors (CFs) and enterotoxins, and determined whether these factors varied with setting and age group. Diarrhoeal stool samples were obtained from children under the age of 60 months from: (1) the regional public hospital, (2) four public primary care clinics, and (3) a population-based cohort. In total, 58 ETEC-positive isolates were analysed by multiplex-PCR assays for the identification of CFs (CS1, CS2, CS3, CS4, CS5, CS6, CS7, CS8, CS12, CS13, CS14, CS15, CS17, CS18, CS19, CS20, CS21, CS22 and CFA/I), and enterotoxins [heat-labile toxin (LT) and heat-stable variants STh and STp]. The frequency of CFs and enterotoxins was compared among the three settings and for different age groups, using Fisher’s exact test or a χ2 test. At least one CF was detected among one-half of samples; CS19 was detected among all strains in which a CF was identified, either alone or in combination with another CF. Among all CFs detected, 91.7 % were identified as members of the class 5 fimbrial family. CFs were detected more commonly among samples from infants captured in the health facility setting compared with the community setting. Overall, LT was detected among 67.2 % of samples, STh was detected among 20.7 % and both enterotoxins were detected among 12.1 %. The enterotoxin STh was detected more commonly among cases in the community, whilst a combination of STh and LT was detected more commonly among cases treated in health facilities. Our results suggest that, to protect against diarrhoeal cases associated with this E. coli pathotype in León, Nicaragua, an ETEC vaccine that effectively targets the archeotype CFA/I of the class 5 fimbrial family would be the most effective in this setting.

scholarly journals Direct, indirect and total effects of 13-valent pneumococcal conjugate vaccination on invasive pneumococcal disease in children in Navarra, Spain, 2001 to 2014: cohort and case–control study

2016 ◽  
Vol 21 (14) ◽  
Author(s):  
Marcela Guevara ◽  
Aurelio Barricarte ◽  
Luis Torroba ◽  
Mercedes Herranz ◽  
Alberto Gil-Setas ◽  
...  
Keyword(s):  
Direct Effect ◽  
Invasive Pneumococcal Disease ◽  
Pneumococcal Disease ◽  
Case Control Study ◽  
Population Level ◽  
Baseline Period ◽  
Population Based ◽  
Case Control ◽  
Conjugate Vaccination ◽  
Control Study

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.

Association of Body Mass Index in Adolescence and Young Adulthood and Long-term Risk of Multiple Sclerosis: A Population-Based Study

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012957
Author(s):  
Rune A. Aa. Høglund ◽  
Haakon E. Meyer ◽  
Hein Stigum ◽  
Øivind Torkildsen ◽  
Nina Grytten ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Body Mass Index ◽  
Body Mass ◽  
Screening Program ◽  
Age Groups ◽  
Population Level ◽  
Population Based ◽  
Tuberculosis Screening ◽  
Objectively Measured

Objective:To prospectively investigate the long-term relationship between body mass index (BMI) in adolescents and young adults, and risk for multiple sclerosis (MS) at population level.Methods:We utilized data from the population-based compulsory Norwegian tuberculosis screening program during 1963-1975, including objectively measured height and weight from approximately 85% of all eligible citizens. This was combined with data from the Norwegian MS registry and biobank up to November 2020. BMI was standardized according to age and sex, and risk for MS was calculated using Cox proportional hazard models.Results:During 30,829,506 years of follow-up we found 1,409 cases of MS among 648,734 participants in eligible age groups (14-34 years). Overall, obesity was associated with increased MS risk (HR 1.53 [95% CI 1.25-1.88]), and the risk was similar in men (HR 1.4 [95% CI 0.95-2.06] and women (HR 1.59 [95% CI 1.25-2.02]). Risk was highest for the youngest age groups (age 14-16: HR 1.73 [95% CI 1.19-2.53], 17-19: HR 1.61 [95% CI 1.08-2.39] and 20-24: HR 1.56 [95% CI 1.04-2.36]) and was no longer present for those older than 30 years.Conclusion:High BMI in individuals aged 14 to 24 years was associated with increased MS-risk later in life, in both males and females.

Screening Rates for Primary Aldosteronism Among Individuals With Hypertension Plus Hypokalemia: A Population-Based Retrospective Cohort Study

Hypertension ◽  
2021 ◽  
Author(s):  
Gregory L. Hundemer ◽  
Haris Imsirovic ◽  
Anand Vaidya ◽  
Nicholas Yozamp ◽  
Rémi Goupil ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Primary Aldosteronism ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Time Window ◽  
Population Level ◽  
Population Based ◽  
Clinical Predictors ◽  
Antihypertensive Medications

Primary aldosteronism is a common, yet highly underdiagnosed, cause of hypertension that leads to disproportionately high rates of cardiovascular disease. Hypertension plus hypokalemia is a guideline-recommended indication to screen for primary aldosteronism, yet the uptake of this recommendation at the population level remains unknown. We performed a population-based retrospective cohort study of adults ≥18 years old in Ontario, Canada, with hypertension plus hypokalemia (potassium <3.5 mEq/L) from 2009 to 2015 with follow-up through 2017. We measured the proportion of individuals who underwent primary aldosteronism screening via the aldosterone-to-renin ratio based upon hypokalemia frequency and severity along with concurrent antihypertensive medication use. We assessed clinical predictors associated with screening via Cox regression. The cohort included 26 533 adults of which only 422 (1.6%) underwent primary aldosteronism screening. When assessed by number of instances of hypokalemia over a 2-year time window, the proportion of eligible patients who were screened increased only modestly from 1.0% (158/15 983) with one instance to 4.8% (71/1494) with ≥5 instances. Among individuals with severe hypokalemia (potassium <3.0 mEq/L), only 3.9% (58/1422) were screened. Among older adults prescribed ≥4 antihypertensive medications, only 1.0% were screened. Subspecialty care with endocrinology (hazard ratio [HR], 1.52 [95% CI, 1.10–2.09]), nephrology (HR, 1.43 [95% CI, 1.07–1.91]), and cardiology (HR, 1.39 [95% CI, 1.14–1.70]) were associated with an increased likelihood of screening, whereas age (HR, 0.95 [95% CI, 0.94–0.96]) and diabetes (HR, 0.66 [95% CI, 0.50–0.89]) were inversely associated with screening. In conclusion, population-level uptake of guideline recommendations for primary aldosteronism screening is exceedingly low. Increased education and awareness are critical to bridge this gap.

scholarly journals Use of serotonin reuptake inhibitors and risk of subsequent bone loss in a nationwide population-based cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sunyoung Kang ◽  
Minkyung Han ◽  
Chun Il Park ◽  
Inkyung Jung ◽  
Eun Hwa Kim ◽  
...  
Keyword(s):  
Bone Loss ◽  
Conditional Logistic Regression ◽  
Laboratory Data ◽  
Population Level ◽  
Population Based ◽  
Case Control ◽  
Newly Diagnosed ◽  
Confidential Interval ◽  
Increased Risk ◽  
Nested Case Control

AbstractThis study examined whether the use of SRIs is associated with an increased risk of bone loss using a nested case–control design with a nationwide population–based cohort in Korea. Using the Korean National Health Screening Cohort, subjects newly diagnosed with osteoporosis or osteopenia (n = 55,799) were matched with controls (n = 278,995) at a ratio of 1:5. We stratified the participants by their time-dependent use of SRIs and sex and controlled for various confounders, including lifestyle habits, laboratory data, and comorbidities. Conditional logistic regression showed that both recent and former users of SRIs had an increased risk of subsequent bone loss compared with non-users: men [recent users: odds ratio (OR) 1.35, 95% confidential interval (CI) 1.20, 1.53; former-users: OR 1.10, 95% CI 1.01, 1.20]; women (recent users: OR 1.38, 95% CI 1.28–1.48; former-users: OR 1.07, 95% CI 1.02, 1.21). The use of SRIs was associated with an increased risk of bone loss in both men and women. In particular, the association was stronger in recent users. These findings provide population-level evidence for the risk of bone loss associated with SRI exposure and highlight the importance of monitoring the bone health of SRI users.

scholarly journals COVID-19 critical illness in Sweden: characteristics and outcomes at a national population level

2020 ◽  
Vol 22 (4) ◽  
pp. 312-320
Author(s):  
Johan Mårtensson ◽  
◽  
Lars Engerström ◽  
Sten Walther ◽  
Jonathan Grip ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cox Regression ◽  
Invasive Mechanical Ventilation ◽  
Population Level ◽  
Population Based ◽  
Simplified Acute Physiology Score ◽  
Illness Severity ◽  
Acute Illness ◽  
Chronic Obstructive ◽  
Saps 3

OBJECTIVE: During the coronavirus disease 2019 (COVID-19) pandemic, baseline demographics and comorbidities of patients with COVID-19 have been presented, but there are limited data on outcomes of severely ill patients. We aimed to examine the association between patient characteristics and 30-day mortality among patients with COVID-19 treated in the intensive care unit (ICU). DESIGN: Population-based cohort study. SETTING: ICUs in Sweden. Participants: All consecutive patients with COVID-19 admitted to Swedish ICUs from 6 March to 5 April 2020. Main outcome measures: The primary outcome was 30day mortality after ICU admission. Patient demographics, comorbidities and clinical characteristics were also retrieved. RESULTS: A total of 604 patients were included. The median age was 61 years (interquartile range [IQR], 52–70 years) and 458 patients (76%) were males. The most common comorbidities were hypertension (35.9%) and diabetes (25.7%), whereas 36.4% of patients had no comorbidities. Median Simplified Acute Physiology Score (SAPS) 3 was 53 (IQR, 46–60). Of 573 patients with available respiratory support data, 487 (85.0%) received invasive mechanical ventilation. Among 518 patients with available data, 117 (22.6%) received renal replacement therapy. Median length of stay was 13 days (IQR, 6–20 days). Mortality at 30 days was 32.6%. In the multivariable Cox regression model, age (hazard ratio [HR] 1.06; 95% CI, 1.04–1.07 per year), the presence of one or more comorbidities (HR, 1.80; 95% CI, 1.20–2.68), chronic obstructive pulmonary disease or asthma (HR, 1.68; 95% CI, 1.12–2.50), hypertension (HR, 1.41; 95% CI, 1.01–1.99), and acute illness severity (SAPS 3 excluding age and comorbidity) (HR, 1.06; 95% CI, 1.04– 1.09) were associated with 30-day mortality. CONCLUSIONS: This population-based cohort study presents 30-day mortality of 604 ICU patients with COVID-19. The higher mortality was explained by older age, the presence chronic illness, and acute illness severity.

scholarly journals Incidence of pneumonia in nursing home residents in Germany: results of a claims data analysis

2018 ◽  
Vol 146 (9) ◽  
pp. 1123-1129 ◽  
Author(s):  
A. M. Fassmer ◽  
O. Spreckelsen ◽  
F. Hoffmann
Keyword(s):  
Cox Regression ◽  
Age Groups ◽  
Nursing Home Residents ◽  
The Elderly ◽  
Population Based ◽  
Insurance Fund ◽  
Cox Regression Analysis ◽  
Using Data ◽  
Claims Data Analysis ◽  
Incident Cases

AbstractPneumonia is one of the most common infectious diseases with a high mortality, especially in the elderly population. To date, there have been only a few population-based studies dealing with the incidence of pneumonia in nursing homes (NHs). We conducted a cohort study using data from a large German statutory health insurance fund. Between 2010 and 2014, 127 227 NH residents 65 years and older were analysed. For the calculation of incidences per 100 person-years (PY) and 95% confidence intervals (CIs), we assessed the first diagnosis of pneumonia during the time in NH. We compared the rates between sexes, age groups, care levels, and comorbidities and we performed a multivariate Cox regression analysis. The mean age in the cohort was 84.0 years (74.6% female). A total of 19 183 incident cases led to an overall 5-year-incidence of 11.8 per 100 PY (95% CI 11.7–12.0). The incidence in men was substantially higher than in women. Rates were highest in the first month after NH placement. Our study revealed that the incidence of pneumonia is high in German NH residents and especially in males. Due to demographic changes, pneumonia will likely be increasingly relevant in the health care of the elderly and institutionalised population.

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