Principal #Controversies in #Vaccine #Safety in the #USA (Clin Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Clin Infect Dis. 2019 Feb 12. doi: 10.1093/cid/ciz135. [Epub ahead of print]

Principal Controversies in Vaccine Safety in the United States.

DeStefano F1, Bodenstab HM2, Offit PA3.

Author information: 1 Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA. 2 Department of Pharmacy Services, The Children’s Hospital of Philadelphia, Philadelphia, PA. 3 Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, PA.



Concerns about vaccine safety can lead to decreased acceptance of vaccines and resurgence of vaccine-preventable diseases. We summarize the key evidence on some of the main current vaccine safety controversies in the United States, including: 1) MMR vaccine and autism; 2) thimerosal, a mercury-based vaccine preservative, and the risk of neurodevelopmental disorders; 3) vaccine-induced Guillain-Barré Syndrome (GBS); 4) vaccine-induced autoimmune diseases; 5) safety of HPV vaccine; 6) aluminum adjuvant-induced autoimmune diseases and other disorders; and 7) too many vaccines given early in life predisposing children to health and developmental problems. A possible small increased risk of GBS following influenza vaccination has been identified, but the magnitude of the increase is less than the risk of GBS following influenza infection. Otherwise, the biological and epidemiologic evidence does not support any of the reviewed vaccine safety concerns.

PMID:  30753348  DOI: 10.1093/cid/ciz135

Keywords: Society; Vaccines; USA.



#Geography of #Microcephaly in the #Zika Era: A Study of #Newborn Distribution and Socio-environmental Indicators in #Recife, #Brazil, 2015-2016 (Public Health Rep., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Public Health Rep. 2018 Jul/Aug;133(4):461-471. doi: 10.1177/0033354918777256. Epub 2018 Jun 19.

Geography of Microcephaly in the Zika Era: A Study of Newborn Distribution and Socio-environmental Indicators in Recife, Brazil, 2015-2016.

Souza AI1, de Siqueira MT2, Ferreira ALCG1, de Freitas CU3, Bezerra ACV4, Ribeiro AG5, Nardocci AC5.

Author information: 1 Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil. 2 Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife, Brazil. 3 Independent Researcher, Recife, Brazil. 4 Instituto Federal de Pernambuco, Recife, Brazil. 5 Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil.




We assessed sociodemographic and health care factors of mothers and newborns during a 2015-2016 outbreak of microcephaly in Recife, Brazil, and we analyzed the spatial distribution and incidence risk of newborns with microcephaly in relation to socio-environmental indicators.


We collected data from August 2015 through May 2016 from Brazil’s Live Birth Information System and Bulletin of Microcephaly Notification, and we geocoded the data by maternal residence. We constructed thematic maps of districts, according to socio-environmental and vector indicators. We identified spatial aggregates of newborns with microcephaly by using the Bernoulli model. We performed logistic regression analyses to compare the incidence risk of microcephaly within socio-environmental indicator groups.


We geocoded 17 990 of 19 554 (92.0%) live births in Recife, of which 202 (1.1%) newborns were classified as having microcephaly, based on a head circumference of ≥2 standard deviations below the mean. Larger proportions of newborns with microcephaly (compared with newborns without microcephaly) were born to mothers who delivered in a public hospital, did not attend college, were aged ≤19, or were black or mixed race. A higher risk of microcephaly (incidence rate ratio [IRR] = 3.90; 95% confidence interval [CI], 1.88-8.06) occurred in districts with the lowest (vs highest) Municipal Human Development Index (ie, an index that assesses longevity, education, and income). The risk of microcephaly was significantly higher where rates of larvae density (IRR = 2.31; 95% CI, 1.19-4.50) and larvae detection (IRR = 2.04; 95% CI, 1.05-4.00) were higher and rates of sewage system (IRR = 2.20; 95% CI, 1.16-4.18) and garbage collection (IRR = 1.96; 95% CI, 0.99-3.88) were lower. Newborns with microcephaly lived predominantly in the poorest areas and in a high-risk cluster (relative risk = 1.89, P = .01) in the north.


The disproportionate incidence of microcephaly in newborns in poor areas of Recife reinforces the need for government and public health authorities to formulate policies that promote social equity and support for families and their children with microcephaly.

KEYWORDS: Zika; ecological studies; environmental indicators; health inequalities; microcephaly; social indicators

PMID: 29920225 PMCID: PMC6055288 [Available on 2019-07-01] DOI:
10.1177/0033354918777256 [Indexed for MEDLINE]

Keywords: Zika Virus; Zika Congenital Syndrome; Microcephaly; Society; Brazil.


#Economic factors influencing #zoonotic disease #dynamics: demand for #poultry meat and seasonal #transmission of #avian #influenza in #Vietnam (Sci Rep., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Sci Rep. 2017 Jul 19;7(1):5905. doi: 10.1038/s41598-017-06244-6.

Economic factors influencing zoonotic disease dynamics: demand for poultry meat and seasonal transmission of avian influenza in Vietnam.

Delabouglise A1,2, Choisy M3,4, Phan TD5, Antoine-Moussiaux N6, Peyre M7, Vu TD5, Pfeiffer DU8,9, Fournié G8.

Author information: 1 Veterinary Epidemiology, Economics and Public Health Group, Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hawkshead Lane, Hatfield, Hertfordshire, AL97TA, United Kingdom. 2 AGIRs-Animal and Integrated Risk Management Research Unit, CIRAD-Agricultural Research Center for International Development, Campus International de Baillarguet, Montpellier Cedex 5, 34398, Montpellier, France. 3 Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, 78 Giai Phong, Dong Da, Hanoi, Vietnam. 4 MIVEGEC, University of Montpellier, CNRS 5290, IRD 224, 911 Avenue Agropolis, 64501, Montpellier cedex 5, 34394, France. 5 Center for Interdisciplinary Research on Rural Development, Vietnam National University of Agriculture, Ngo Xuan Quang Street, Trau Quy, Gia Lam, Hanoi, Vietnam. 6 FARAH-Fundamental and Applied Research for Animals & Health, University of Liège, Avenue de Cureghem 7A-7D, Liège, 4000, Belgium. 7 AGIRs-Animal and Integrated Risk Management Research Unit, CIRAD-Agricultural Research Center for International Development, Campus International de Baillarguet, Montpellier Cedex 5, 34398, Montpellier, France. 8 Veterinary Epidemiology, Economics and Public Health Group, Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hawkshead Lane, Hatfield, Hertfordshire, AL97TA, United Kingdom. 9 School of Veterinary Medicine, City University of Hong Kong, 31 To Yuen Street, Kowloon, Hong Kong.



While climate is often presented as a key factor influencing the seasonality of diseases, the importance of anthropogenic factors is less commonly evaluated. Using a combination of methods – wavelet analysis, economic analysis, statistical and disease transmission modelling – we aimed to explore the influence of climatic and economic factors on the seasonality of H5N1 Highly Pathogenic Avian Influenza in the domestic poultry population of Vietnam. We found that while climatic variables are associated with seasonal variation in the incidence of avian influenza outbreaks in the North of the country, this is not the case in the Centre and the South. In contrast, temporal patterns of H5N1 incidence are similar across these 3 regions: periods of high H5N1 incidence coincide with Lunar New Year festival, occurring in January-February, in the 3 climatic regions for 5 out of the 8 study years. Yet, daily poultry meat consumption drastically increases during Lunar New Year festival throughout the country. To meet this rise in demand, poultry production and trade are expected to peak around the festival period, promoting viral spread, which we demonstrated using a stochastic disease transmission model. This study illustrates the way in which economic factors may influence the dynamics of livestock pathogens.

PMID: 28724978 PMCID: PMC5517570 DOI: 10.1038/s41598-017-06244-6 [Indexed for MEDLINE] Free PMC Article

Keywords: Avian Influenza; H5N1; Poultry; Society; Vietnam.


Stalls in #Africa’s #fertility #decline partly result from #disruptions in female #education (Proc Natl Acad Sci USA, abstract)

[Source: Proceedings of the National Academy of Sciences of the United States of America, full page: (LINK). Abstract, edited.]

Stalls in Africa’s fertility decline partly result from disruptions in female education

Endale Kebede, Anne Goujon, and Wolfgang Lutz

PNAS published ahead of print February 4, 2019 / DOI:

Contributed by Wolfgang Lutz, October 18, 2018 (sent for review October 3, 2017; reviewed by John Casterline and Alex C. Ezeh)



The future pace of fertility decline in sub-Saharan Africa is the main determinant of future world population growth and will have massive implications for Africa and the rest of the world, not least through international migration pressure and difficulties in meeting the sustainable development goals. In this context, there have been concerns about recent stalls in the fertility decline in some African countries. Our findings suggest that these stalls are in part explained by earlier stalls in female education and that less-educated women are more vulnerable to adverse period conditions. This has important implications for setting policy priorities.



Population projections for sub-Saharan Africa have, over the past decade, been corrected upwards because in a number of countries, the earlier declining trends in fertility stalled around 2000. While most studies so far have focused on economic, political, or other factors around 2000, here we suggest that in addition to those period effects, the phenomenon also matched up with disruptions in the cohort trends of educational attainment of women after the postindependence economic and political turmoil. Disruptions likely resulted in a higher proportion of poorly educated women of childbearing age in the late 1990s and early 2000s than there would have been otherwise. In addition to the direct effects of education on lowering fertility, these less-educated female cohorts were also more vulnerable to adverse period effects around 2000. To explore this hypothesis, we combine individual-level data from Demographic and Health Surveys for 18 African countries with and without fertility stalls, thus creating a pooled dataset of more than two million births to some 670,000 women born from 1950 to 1995 by level of education. Statistical analyses indicate clear discontinuities in the improvement of educational attainment of subsequent cohorts of women and stronger sensitivity of less-educated women to period effects. We assess the magnitude of the effect of educational discontinuity through a comparison of the actual trends with counterfactual trends based on the assumption of no education stalls, resulting in up to half a child per woman less in 2010 and 13 million fewer live births over the 1995–2010 period.

fertility – sub-Saharan Africa – educational discontinuity – macro-economic crisis – population projections

Keywords: Africa Region; Society; Demographics.


Exploring the #contribution of #exposure heterogeneity to the #cessation of the 2014 #Ebola #epidemic (PLoS One, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

PLoS One. 2019 Feb 1;14(2):e0210638. doi: 10.1371/journal.pone.0210638. eCollection 2019.

Exploring the contribution of exposure heterogeneity to the cessation of the 2014 Ebola epidemic.

Uekermann F1, Simonsen L2, Sneppen K1.

Author information: 1 Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark. 2 Department of Science and Enviroment, Roskilde University, Roskilde, Denmark.



The unexpected early cessation of the recent West Africa Ebola outbreak demonstrated shortcomings of popular forecasting approaches and has not been fully understood yet. A popular hypothesis is that public health interventions mitigated the spread, such as ETUs and safe burials. We investigate whether risk heterogeneity within the population could serve as an alternative explanation. We introduce a model for spread in heterogeneous host population that is particularly well suited for early predictions due to its simplicity and ease of application. Furthermore, we explore the conditions under which the observed epidemic trajectory can be explained without taking into account the effect of public health interventions. While the obtained fits closely match the total case count time series, closer inspection of sub-population results made us conclude that risk heterogeneity is unlikely to fully explain the early cessation of Ebola; other factors such as behavioral changes and other interventions likely played a major role. More accurate predictions in a future scenario require models that allow for early sub-exponential growth, as well as access to additional data on patient occupation (risk level) and location, to allow identify local phenomena that influence spreading behavior.

PMID: 30707729 DOI: 10.1371/journal.pone.0210638 Free full text

Keywords: Ebola; West Africa; Society.


Lowland #grazing and #Marburg virus disease (MVD) #outbreak in Kween district, Eastern #Uganda (BMC Public Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

BMC Public Health. 2019 Jan 31;19(1):136. doi: 10.1186/s12889-019-6477-y.

Lowland grazing and Marburg virus disease (MVD) outbreak in Kween district, Eastern Uganda.

Siya A1,2, Bazeyo W3,4, Tuhebwe D3,4, Tumwine G5,4, Ezama A6, Manirakiza L7, Kugonza DR8, Rwego IB5,9.

Author information: 1 College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. Box 7062, Kampala, Uganda. 2 One Health Central and Eastern Africa, Kampala, Uganda. 3 College of Health Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda. 4 One Health Central and Eastern Africa, Kampala, Uganda. 5 College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. Box 7062, Kampala, Uganda. 6 Uganda Red Cross Society, P.O. Box 494, Kampala, Uganda. 7 The National Pharmacovigilance Center, National Drug Authority, P.O. Box 23096, Kampala, Uganda. 8 College of Agricultural and Environmental Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda. 9 Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA.




Uganda is one of the few countries in Africa that has been experiencing outbreaks of viral hemorrhagic fevers such as Ebola, Marburg and Crimean-Congo Hemorrhagic fevers. In 2017 Uganda experienced a Marburg Virus Disease (MVD) outbreak with case fatality rate of 100% in Kween district. Although hunting for wild meat was linked to the MVD outbreak in Kween district, less was reported on the land use changes, especially the changing animal grazing practices in Kween district.


Through Makerere University One Health graduate fellowship program with attachment to Uganda Red Cross Society, a study was conducted among the agricultural communities to elucidate the risk behaviors in Kween district that can be linked to the 2017 Marburg disease outbreak.


Results show that although a few elderly participants ascribed fatal causes (disobedience to gods, ancestors, and evil spirits) to the MVD outbreak during FGDs, majority of participants linked MVD to settling in caves (inhabited by Fruit Bats) during wet season as upper belts are extensively used for crop production leaving little space for animal grazing. Members also noted side activities like hunting for wild meat during this grazing period that could have predisposed them to Marburg Virus.


There is need to integrate One Health concepts within agricultural extension service provision in Uganda so as to enhance the management of such infectious diseases.

KEYWORDS: Agriculture; Livelihoods; One health; Zoonotic diseases

PMID: 30704427 DOI: 10.1186/s12889-019-6477-y Free full text

Keywords: Marburg virus; Uganda; Society.


Predicting #risk of #avian #influenza a(#H5N1) in #Egypt: the creation of a community level metric (BMC Public Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

BMC Public Health. 2018 Mar 21;18(1):388. doi: 10.1186/s12889-018-5288-x.

Predicting risk of avian influenza a(H5N1) in Egypt: the creation of a community level metric.

Geerlings ECL1,2, Heffernan C3,4.

Author information: 1 Department of Agriculture, University of Reading, Reading, UK. 2 Research & International Development Consultancy Services (EGRID), Deventer, The Netherlands. 3 School of Veterinary Sciences, University of Bristol, Bristol, UK. 4 London International Development Centre (LIDC), London, UK.




Efficient A(H5N1) control is unlikely to be based on epidemiological data alone. Such control depends on a thorough understanding and appreciation of the interconnectedness of epidemiological, social, and economic factors that contribute to A(H5N1) vulnerability. To date, the control of A(H5N1) in Egypt has been challenging. The disease has been endemic for more than 10 years with a dramatic increase in human cases between December 2014 and March 2015. Part of the problem has been a lack of understanding of the inter-play of drivers, conditions and motives that influence preventive behaviours at the household level.


To address this issue, the authors developed a Composite Risk Index (CRI) to inform decision-makers of critical epidemiological, livelihood, food security and risk perception factors that were found to contribute to A(H5N1) vulnerability at the community level. The CRI consists of seven constructs that were individually scored for each community. The seven constructs included poultry sales, previous flock exposure to A(H5N1), human risk probability, sense of control over the disease, preventative actions taken, level of household food insecurity and community norms toward certain handling and disposal practices. One hundred forty female poultry keepers across four governorates were interviewed in 2010 using a mix of random and purposive sampling techniques. A mixed method approach underpinned the analysis. The study used wealth ranking in order to help decision-makers in understanding the specific constraints of different wealth groups and aid better targeting of A(H5N1) control and prevention strategies.


Poverty, widowhood and lack of education were among the factors associated with high risk scores. CRI scores in those villages where awareness raising had taken place were not significantly different compared to those villages where awareness raising had not taken place.


The aim of the tool is to enable targeting those communities that are likely to be highly vulnerable to A(H5N1) outbreaks and where control and awareness-raising efforts are expected to be most effective. In this manner, policy makers and practitioners will be able to better allocate limited resources to those communities most vulnerable to the negative impact of A(H5N1).

KEYWORDS: Decision support techniques; Egypt; H5N1 subtype; Influenza a virus; Public health; Risk factors

PMID: 29562878 PMCID: PMC5863456 DOI: 10.1186/s12889-018-5288-x [Indexed for MEDLINE] Free PMC Article

Keywords: Avian Influenza; H5N1; Society; Egypt.