Abstract Purpose Given incomplete data reporting by race, we used data on COVID-19 cases and deaths in US counties to describe racial disparities in COVID-19 disease and death and associated determinants. Methods Using publicly available data (accessed April 13, 2020), predictors of COVID-19 cases and deaths were compared between disproportionately (≥13%) black and all other (<13% black) counties. Rate ratios were calculated and population attributable fractions (PAF) were estimated using COVID-19 cases and deaths via zero-inflated negative binomial regression model. National maps with county-level data and an interactive scatterplot of COVID-19 cases were generated. Results Nearly ninety-seven percent of disproportionately black counties (656/677) reported a case and 49% (330/677) reported a death versus 81% (1987/2,465) and 28% (684/ 2465), respectively, for all other counties. Counties with higher proportions of black people have higher prevalence of comorbidities and greater air pollution. Counties with higher proportions of black residents had more COVID-19 diagnoses (RR 1.24, 95% CI 1.17-1.33) and deaths (RR 1.18, 95% CI 1.00-1.40), after adjusting for county-level characteristics such as age, poverty, comorbidities, and epidemic duration. COVID-19 deaths were higher in disproportionally black rural and small metro counties. The PAF of COVID-19 diagnosis due to lack of health insurance was 3.3% for counties with <13% black residents and 4.2% for counties with ≥13% black residents. Conclusions Nearly twenty-two percent of US counties are disproportionately black and they accounted for 52% of COVID-19 diagnoses and 58% of COVID-19 deaths nationally. County-level comparisons can both inform COVID-19 responses and identify epidemic hot spots. Social conditions, structural racism, and other factors elevate risk for COVID-19 diagnoses and deaths in black communities.
Background: Alcohol cues on social media may influence young adults’ drinking patterns, these cues may be pro-social or pro-alcohol in nature. The influence of individual Facebook cues on young adults’ drinking intentions and behaviors remains unknown. Objectives: The purpose of this study was to assess how Facebook cues influence intention to drink, and how intention was associated with Theory of Reasoned Action constructs including alcohol-related attitudes and norms, and future behavior. Methods: Incoming university students completed a pre-college and a 2-year follow-up phone interview. A vignette presented individual Facebook cues representing “pro-social” or “pro-alcohol” sentiments. Participants indicated intention to drink alcohol and their rationale for this intention after each cue. Additional measures included TRA constructs of alcohol-related attitudes and norms, and problem alcohol use. Analyses included a qualitative approach to examine rationales for intention to drink in response to Facebook cues, and linear mixed effects models. Results: Of 338 participants, 56.1% were female, 74.8% were Caucasian. Alcohol-related attitudes and norms were positively associated with intention to drink in response to pro-social and pro-alcohol Facebook cues. Participants’ intention to drink in response to pro-alcohol cues was positively associated with problem alcohol use two years later. Conclusions/importance: Findings illuminate the influence of social media on alcohol-related behaviors and highlight potential future screening approaches.
Rotavirus infection remains an important cause of morbidity and mortality in children. The introduction of vaccination programs in more than 100 countries has contributed to a decrease in hospitalizations and mortality. This study investigates the epidemiological impact of the rotavirus vaccine ROTAVAC® in the Palestinian Territories, the first country to switch from ROTARIX® to this new vaccine.Clinical surveillance data was collected fromchildren younger than 5attendingoutpatient clinics throughout Gaza withdiarrhea between 2015 and 2020. The incidence of all-cause diarrhea was assessed using an interrupted time-series approach. Rotavirus prevalence was determined at the Caritas Baby Hospital in the West Bank usingELISA on stool specimen of children younger than 5with diarrhea. Genotyping was performed on 325 randomly selected rotavirus-positive samples from January 2015 through December 2020 using multiplex PCR analysis.Average monthly diarrhea casesdropped by 16.7% annually fromintroduction of rotavirus vaccination in May 2016 to the beginning of the SARS-CoV-2 epidemic in March 2020 for a total of 53%. Case count declines were maintained afterthe switchto ROTAVAC® in October 2018. Rotavirus positivity in stool samples declined by 67.1% over the same period without change followingthe switch to ROTAVAC®. The distribution of predominant genotypes in rotavirus-positive stool samples changed from a pre-vaccination G1P [8] to G9P[8] and G12P[8] during the ROTARIX® period and G2P[4] after the introduction of ROTAVAC®.ROTAVAC® has shown epidemiological impact on par with ROTARIX® after its introduction to the national immunization schedule in the Palestinian Territories. A molecular genotype shift from a pre-vaccination predominance of G1P[8] to a current predominance of G2P[4] requires more long-term surveillance.
Production of affordable coronavirus disease 2019 (COVID-19) vaccines in low- and lower-middle-income countries is needed. NDV-HXP-S is an inactivated egg-based recombinant Newcastle disease virus vaccine expressing the spike protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A public sector manufacturer in Vietnam assessed the immunogenicity of NDV-HXP-S (COVIVAC) relative to an authorized vaccine. Healthy males and non-pregnant females, 18 years of age and older, were eligible. Participants were randomised by age (18-59, ≥60 years) to receive one of three treatments by intramuscular injection twice, 28 days apart: COVIVAC at 3 µg or 6 µg, or AstraZeneca COVID-19 vaccine VAXZEVRIA. ClinicalTrials.gov NCT05940194.During August 10-23, 2021, 737 individuals were screened, and 374 were randomised (124-125 per group); all received dose one, and three missed dose two. On day 43, the geometric mean fold rise of 50% neutralising antibody titers for subjects age 18-59 years was 31·20 (COVIVAC 3 μg N=82, 95% CI 25·14-38·74), 35·80 (COVIVAC 6 μg; N=83, 95% CI 29·03-44·15), 18·85 (VAXZEVRIA; N=82, 95% CI 15·10-23·54), and for subjects age ≥60 years was 37·27 (COVIVAC 3 μg; N=42, 95% CI 27·43-50·63), 50·10 (COVIVAC 6 μg; N=40, 95% CI 35·46-70·76), 16·11 (VAXZEVRIA; N=40, 95% CI 11·73-22·13). Among subjects seronegative for anti-S IgG at baseline, the day 43 geometric mean titer ratio of neutralising antibody (COVIVC 6 μg/VAXZEVRIA) was 1·77 (95% CI 1·30-2·40) for subjects age 18-59 years and 3·24 (95% CI 1·98-5·32) for subjects age ≥60 years. On day 197, the age-specific ratios were 1·11 (95% CI 0·51-2·43) and 2·32 (0·69-7·85). Vaccines were well tolerated; reactogenicity was predominantly mild and transient. Considering that induction of neutralising antibodies against SARS-CoV-2 has been correlated with the efficacy of COVID-19 vaccines, including VAXZEVRIA, our results suggest that vaccination with COVIVAC may afford clinical benefit matching or exceeding that of the VAXZEVRIA vaccine.
Background: First discovered in 1999 in Malaysia, Nipah virus (NiV) causes yearly outbreaks throughout south and southeast Asia with associated mortality rates of 40 to 75 %. Due to similarities between NiV and Hendra virus (HeV) glycoproteins, this study evaluated a recombinant subunit vaccine consisting of a soluble version of the HeV attachment G glycoprotein (HeV-sG-V) for safety, tolerability, and immunogenicity.Methods: We conducted a Phase 1, adult only, single-centre, randomised, placebo-controlled, double-blind study. Participants were randomised to receive either one or two administrations of the vaccine candidate (at varying dosages) or placebo. We collected solicited and unsolicited adverse events (AEs), medically attended adverse events, and serious adverse events (SAEs). Immunogenicity was determined by measuring serum immunoglobulin G binding and neutralising antibody responses against prototypical NiV Bangladesh and NiV Malaysia strains.Findings: The study enrolled 192 participants, 173 of whom met per-protocol criteria. Mild-to-moderate injection site pain was the most commonly reported AE. No SAEs were reported. The immune response was dose and dosage dependent; a single administration was not sufficiently immunogenic whereas two administrations were immunogenic with the highest response rates seen among vaccinees that received two administrations of the 100 mcg vaccine candidate 28 days apart.Interpretation: All three doses and regimens of the vaccine candidate were safe and immunogenic. The induction of antibodies within one month of vaccination, along with the persistence afforded by two dosages, suggests the vaccine candidate has potential for reactive outbreak control and preventative use.Ethical Approval: The study is registered at ClinicalTrials.gov as NCT04199169.Funding: This study was funded by Coalition for Epidemic Preparedness Innovations (CEPI).Declaration of Interest: No conflicts of interest were disclosed by the Authors. Ethical Approval: This study was reviewed and approved by the Cincinnati Children's Hospital Medical Center (CCHMC) Institutional Review Board and conducted in accordance with 45 US Code of Federal Regulations (CFR) Part 46 and 21 CFR 50.
Abstract Nigeria is one of three countries projected to have the largest absolute increase in the size of its urban population and this could intensify malaria transmission in cities. Accelerated urban population growth is out-pacing the availability of affordable housing and basic services and resulting in living conditions that foster vector breeding and heterogeneous malaria transmission. Understanding community determinants of malaria transmission in urban areas informs the targeting of interventions to populations at greatest risk. In this study, we analyzed cluster-level data from the Demographic and Health Surveys (DHS) and the Malaria Indicator Survey (MIS) as well as geospatial covariates to describe malaria burden and its determinants in areas administratively defined as urban in Nigeria. Overall, we found low malaria test positivity across urban areas,. We observed declines in test positivity rate over time and identified the percentage of individuals with post-primary education, the percentage of individuals in the rich wealth quintiles, the percentage of individuals living in improved housing in 2015, all age population density, median age, the percentage of children under the age of five that sought medical treatment for fever, total precipitation and enhanced vegetation index as key community predictors of malaria transmission intensity. The unrepresentativeness of the DHS and MIS in urban settings at the state and geopolitical zonal level, regional differences in malaria seasonality across Nigeria, and information detection bias were among likely factors that limited our ability to compare malaria burden across geographic space and ultimately drove model uncertainty. Nevertheless, study findings provide a starting point for informing decisions on intervention prioritization within urban spaces and underscore the need for improved regionally-focused surveillance systems in Nigeria.
The goal of the study was to evaluate the efficacy of physical therapy in restoring function and mobility after a pediatric supracondylar humeral fracture.The study included sixty-one patients from five to twelve years of age with a supracondylar humeral fracture that was treated with casting or with closed reduction and pinning followed by casting. Patients were randomized to receive either no further treatment (no-PT group) or six sessions of a standardized hospital-based physical therapy program (PT group). The ASK-p (Activities Scale for Kids-performance version) and self-assessments of activity were used to assess function at one, nine, fifteen, and twenty-seven weeks after injury. Motion was measured at nine and fifteen weeks after injury by a blinded therapist. Anxiety was measured at one and nine weeks after injury with a self-assessment. Differences in ASK-p scores and anxiety level were analyzed with use of multivariate generalized estimating equations.ASK-p scores were significantly better in the no-PT group at nine and fifteen weeks after injury (p = 0.02 and 0.01, respectively) but the difference at twenty-seven weeks was not significant. There were no differences between groups with respect to performance of activities of daily living or time to return to sports. Anxiety at nine weeks was associated with worse ASK-p scores at nine and fifteen weeks in the PT group and with better ASK-p scores in the no-PT group at these time points (p = 0.01 and 0.02, respectively). There were no differences between the groups with respect to elbow motion in the injured arm at any time. Severity of injury had no impact on function or elbow motion in either the PT or the no-PT group.Children undergoing closed treatment of a supracondylar humeral fracture that was limited to approximately three weeks of cast immobilization received no benefit involving either return of function or elbow motion from a short course of physical therapy.Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Ambitious global goals have been established to provide universal access to affordable modern contraceptive methods. The UN's sustainable development goal 3.7.1 proposes satisfying the demand for family planning (FP) services by increasing the proportion of women of reproductive age using modern methods. To measure progress toward such goals in populous countries like Nigeria, it's essential to characterize the current levels and trends of FP indicators such as unmet need and modern contraceptive prevalence rates (mCPR). Moreover, the substantial heterogeneity across Nigeria and scale of programmatic implementation requires a sub-national resolution of these FP indicators. However, significant challenges face estimating FP indicators sub-nationally in Nigeria. In this article, we develop a robust, data-driven model to utilize all available surveys to estimate the levels and trends of FP indicators in Nigerian states for all women and by age-parity demographic subgroups. We estimate that overall rates and trends of mCPR and unmet need have remained low in Nigeria: the average annual rate of change for mCPR by state is 0.5% (0.4%,0.6%) from 2012-2017. Unmet need by age-parity demographic groups varied significantly across Nigeria; parous women express much higher rates of unmet need than nulliparous women. Our hierarchical Bayesian model incorporates data from a diverse set of survey instruments, accounts for survey uncertainty, leverages spatio-temporal smoothing, and produces probabilistic estimates with uncertainty intervals. Our flexible modeling framework directly informs programmatic decision-making by identifying age-parity-state subgroups with large rates of unmet need, highlights conflicting trends across survey instruments, and holistically interprets direct survey estimates.
Abstract Background Previous studies show a positive association between household wealth and overweight in sub-Saharan African (SSA) countries; however, the manner in which this relationship differs in the presence of educational attainment has not been well-established. This study examined the multiplicative effect modification of educational attainment on the association between middle-income and rich household wealth and overweight status among adult females in 22 SSA countries. We hypothesized that household wealth was associated with a greater likelihood of being overweight among middle income and rich women with lower levels of educational attainment compared to those with higher levels of educational attainment. Methods Demographic and Health Survey (DHS) data from 2006 to 2016 for women aged 18–49 years in SSA countries were used for the study. Overweight was defined as a body mass index (BMI) ≥ 25 kg/m 2 . Household wealth index tertile was the exposure and educational attainment, the effect modifier. Potential confounders included age, ethnicity, place of residence, and parity. Descriptive analysis was conducted, and separate logistic regression models were fitted for each of the 22 SSA countries to compute measures of effect modification and 95% confidence intervals. Analysis of credibility (AnCred) methods were applied to assess the intrinsic credibility of the study findings and guide statistical inference. Results The prevalence of overweight ranged from 12.6% in Chad to 56.6% in Swaziland. Eighteen of the 22 SSA countries had measures of effect modification below one in at least one wealth tertile. This included eight of the 12 low-income countries and all 10 middle income countries. This implied that the odds of overweight were greater among middle-income and rich women with lower levels of educational attainment than those with higher educational attainment. On the basis of the AnCred analysis, it was found that the majority of the study findings across the region provided some support for the study hypothesis. Conclusions Women in higher wealth strata and with lower levels of educational attainment appear to be more vulnerable to overweight compared to those in the same wealth strata but with higher levels of educational attainment in most low- and middle- income SSA countries.
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