Integrated control programs for numerous neglected tropical diseases (NTDs) could potentially benefit from the application of a combined MDA approach.
The National Health and Medical Research Council of Australia and the Department of Foreign Affairs and Trade's Indo-Pacific Centre for Health Security contribute to health security initiatives.
The Supplementary Materials section includes the Tetum translation of the abstract.
Within the Supplementary Materials section, you'll find the Tetum translation of the abstract.
To combat a 2021 circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak in Liberia, the novel oral poliovirus vaccine type 2 (nOPV2) was given. Two national nOPV2 immunization drives were followed by a serological survey assessing polio antibody responses.
A seroprevalence survey, employing a clustered, cross-sectional, population-based design, was undertaken among children aged 0-59 months, more than four weeks after the second dose of nOPV2 vaccine. Our investigation in Liberia's four geographical regions utilized a clustered sampling method, which was then complemented by a simple random sample of households. From each eligible household, one child was randomly picked. Vaccination history was noted, and dried blood spots were sampled. Using standard microneutralization assays at the US Centers for Disease Control and Prevention in Atlanta, Georgia, USA, the antibody titres against all three poliovirus serotypes were determined.
436 of the 500 enrolled participants (87%) produced data that can be analyzed. YM155 Parental recollections showed that 371 children (85%) received two nOPV2 doses, 43 children (10%) received one dose, and 22 children (5%) received no doses. The seroprevalence of type 2 poliovirus antibodies was found to be 383% (95% confidence interval 337-430) among 167 participants out of a total of 436. The seroprevalence of type 2 in children aged six months or older, irrespective of receiving two doses of nOPV2 (421%, 95% CI 368-475; 144 of 342), one dose (280%, 121-494; seven of 25), or no doses (375%, 85-755; three of eight; p=0.39), did not show any notable divergence. The seroprevalence of type 1 was a remarkable 596% (a range of 549-643; 260 out of 436 participants), while the seroprevalence for type 3 stood at 530% (482-577; 231 out of 436).
A surprising result from the data was a low seroprevalence of type 2 after two doses of nOPV2. This observation may be influenced by the previously demonstrated lower immunogenicity of oral poliovirus vaccines in resource-limited settings, specifically the high prevalence of chronic intestinal infections in children, and other aspects analyzed in this research. nano biointerface This study provides the first detailed look at nOPV2's performance in outbreak situations throughout the African region.
WHO, along with Rotary International.
The organizations WHO and Rotary International.
The sample of choice for diagnosing active tuberculosis is sputum, but its production might be limited in individuals with HIV. Compared to other bodily fluids, urine is readily and easily available. We conjectured a link between sample availability and the success rate of various tuberculosis diagnostic tests.
This systematic review and meta-analysis of individual participant data scrutinized the diagnostic output of point-of-care urine lipoarabinomannan tests, evaluating its performance against sputum-based nucleic acid amplification tests (NAATs) and sputum smear microscopy (SSM). As the denominator, we employed microbiologically confirmed tuberculosis, detected by positive cultures or NAATs originating from any part of the body, and accounted for the provision of samples. A comprehensive search was conducted across PubMed, Web of Science, Embase, African Journals Online, and clinicaltrials.gov. A review of randomized controlled trials, cross-sectional studies, and cohort studies, spanning the period from the database's inception to February 24, 2022, examined urine lipoarabinomannan point-of-care tests and sputum NAATs for identifying active tuberculosis in participants. This analysis encompassed all participants regardless of symptoms, HIV status, CD4 cell count, or study site. Studies with non-consecutive, non-systematic, or non-random recruitment were excluded, requiring sputum or urine provision; diagnostic criteria required at least 30 tuberculosis cases; assays lacking clear cutoffs in early studies were not included; and studies of humans were excluded. From each study, we pulled the required data; and the researchers of qualifying studies were invited to furnish de-identified participant data. The most significant results revolved around the tuberculosis diagnostic performance of urine lipoarabinomannan tests, sputum NAATs, and SSM. Diagnostic yields were projected with the help of Bayesian random-effects and mixed-effects meta-analyses. The study is cataloged under PROSPERO, its unique identifier being CRD42021230337.
The meta-analysis included 20 datasets and 10202 participants (4561 male, representing 45%, and 5641 female participants, accounting for 55%) from the 844 records identified. Each study included participants living with HIV, 15 years or older, and assessed sputum Xpert (MTB/RIF or Ultra, manufactured by Cepheid, Sunnyvale, CA, USA) and urine Alere Determine TB LAM (AlereLAM, Abbott, Chicago, IL, USA). Of the 10202 participants, urine samples were collected from nearly all (9957, representing 98%) and 82% (8360) of them also submitted sputum samples within a span of 2 days. Across unselected inpatient cohorts, irrespective of tuberculosis manifestations, sputum was collected from 54% (1084 of 1993) of individuals, contrasting with 99% (1966 of 1993) who furnished urine samples. AlereLAM demonstrated a diagnostic yield of 41% (95% credible interval [CrI] 15-66), while Xpert achieved 61% (95% credible region 25-88), and SSM yielded 32% (95% credible region 10-55). Studies demonstrated varying diagnostic capabilities, contingent upon CD4 cell counts, tuberculosis symptoms, and the specific clinical context. In predefined subgroups of participants, all tests exhibited enhanced yields in symptomatic individuals; specifically, the AlereLAM test demonstrated superior yields in patients with low CD4 counts and those admitted to hospitals. Studies encompassing unselected inpatients not assessed for tuberculosis symptoms indicated a comparable performance for AlereLAM and Xpert, achieving results of 51% and 47%, respectively. AlereLAM and Xpert testing, performed on unselected inpatient populations, achieved a yield of 71%, supporting the strategy of integrating these tests for diagnosis.
For HIV-positive inpatients undergoing tuberculosis treatment, AlereLAM, characterized by its rapid turnaround time and simplicity, deserves preferential consideration, regardless of any symptoms or CD4 cell count. The efficiency of sputum-based tuberculosis testing is compromised by the inability to produce sputum in individuals living with HIV, a stark contrast to the near-universal capacity for participants to provide urine samples. Despite its strengths in employing a substantial sample size, a carefully harmonized denominator, and Bayesian random-effects and mixed-effects models for yield prediction, this meta-analysis suffers from geographic restrictions in its data, the exclusion of clinically diagnosed tuberculosis from the denominator, and a dearth of information on sputum sample acquisition strategies.
FIND, the global alliance for diagnostics, is a valuable resource.
Identify FIND, the Global Alliance for Diagnostics.
Linear growth in children is a significant factor in determining future economic output. Linear growth retardation is a recognized consequence of enteric infections, notably those caused by Shigella. Still, the prospective reduction in LGF is rarely accounted for within the economic analysis of enteric infection cases. The study's aim was to determine the economic benefits derived from vaccination, targeting the decrease in Shigella-associated illnesses and associated long-term gastrointestinal (LGF) problems, versus the overall financial burden of the vaccine program itself.
In this benefit-cost assessment, we modeled the impact of productivity benefits in 102 low- and middle-income countries that held recent stunting data, had at least one Shigella-related death annually, and possessed available economic data, particularly concerning gross national income and growth rate projections. Linear growth improvements were the sole basis for our benefit analysis, with no consideration given to benefits resulting from a decrease in diarrheal disease burden. sequential immunohistochemistry Shifts in height-for-age Z-score (HAZ) were employed to estimate the effect size in each country for preventing Shigella-related less-severe and moderate-to-severe diarrhea separately in children under five, reflecting population average changes. Benefit assessment at a national level, integrated with predicted vaccine program net costs, generated benefit-cost ratios (BCRs). Ratios surpassing a one-to-one benefit-to-cost ratio (with a 10% margin signifying borderline at 1.1) were considered financially advantageous. Countries were clustered for analysis based on their affiliation with WHO regions, their income classification by the World Bank, and their eligibility for assistance from Gavi, the Vaccine Alliance.
In the case of baseline conditions, each region showed a positive cost-benefit ratio, the South-East Asia region and Gavi-eligible countries leading with the highest (2167 and 1445, respectively), while the Eastern Mediterranean region produced the lowest (290). Beneficial results from vaccination were consistently observed in each region, with the caveat that this was not the case in more conservative models – especially those projecting early retirement and elevated discount rates. Our data showed a sensitivity to anticipated returns for increased height, the efficacy of vaccines against declines in linear growth, the predicted change in HAZ, and the discount rate's influence. Existing cost-effectiveness projections, augmented by the productivity benefits of diminished LGF levels, showcased longer-term cost reductions across most regional contexts.