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: Objective: Recent surveys identified trachomatous inflammation ? follicular (TF) at endemic levels in the Torres Strait Islands; however, local health staff do not report trachomatous trichiasis (TT) in adults. We undertook a cross?sectional survey involving eye examination and microbiological testing to better understand this disconnect. Methods: We examined 169 of 207 (82%) residents and collected ocular swabs for polymerase chain reaction (PCR) testing for Chlamydia trachomatis. Other viral PCR tests and bacterial culture were also performed. Results: TF prevalence in children aged 5?9 years was 23% (7/30). No ocular C. trachomatis was identified by PCR. For the 72 participants (43%) with follicles, bacterial culture was positive for 11 (15%) individuals. No individual had trachomatous trichiasis. Conclusions: Follicular conjunctivitis consistent with TF was prevalent but ocular C. trachomatis and cicatricial trachoma were absent. Non?chlamydial infections or environmental causes of follicular conjunctivitis may be causing TF in this community. Implications for public health: In similar settings, reliance on simplified clinical assessment alone may lead to an overestimation of the public health problem posed by trachoma. Consideration should be given to incorporating C. trachomatis PCR, and in certain settings, a detailed clinical exam could be performed by an experienced ophthalmologist during prevalence surveys., Trachoma, caused by ocular infection with specific serovars of the bacterium Chlamydia trachomatis, is the world's leading infectious cause of blindness.[sup.1] In communities where trachoma is endemic, children suffer repeated [...]

Objective: The type of health education messages that communities and individuals seek to have communicated about the human papillomavirus (HPV) vaccine is important if vaccine programmes are to succeed, especially in settings such as Papua New Guinea (PNG), which have a high burden of cervical cancer, low health literacy and negative experiences of earlier vaccination programmes. This study sought to identify the health education messages that are viewed as most appropriate in such a context. Methodology: A qualitative study using gender-specific focus group discussions (N = 21) and semi-structured interviews (N = 82) was undertaken in three sites in PNG. Sites included both rural and urban locations in Milne Bay, Eastern Highlands and Western Highlands Provinces. Results: Two divergent discourses emerged. One group of participants, largely young people, felt communication messages should stress that HPV is a preventable sexually transmitted infection, which can cause cervical cancer. The other group, mainly members of the older population, believed that messaging should focus on the vaccine as a prevention strategy for cervical cancer. A small minority wanted both aspects of the vaccine discussed. Conclusion: Sensitivity needs to be taken when engaging with communities which have negative experiences of earlier infant immunisation programmes. Ensuring that the health communication needs and priorities of different sections of the populations are taken into account is key to the successful introduction and roll-out of HPV vaccination in this setting.

Following a national population-based trachoma survey in Malawi one round of azithromycin mass drug administration (MDA) was carried out, with a post-MDA impact survey showing TF prevalence below 5% and considered eliminated as a public health problem. However, active trachoma was still present in over 200 children. We assessed whether water, sanitation, and hygiene (WASH) factors were associated with ongoing presence of TF in children aged 1–9 years following MDA. A secondary analysis was performed on a sub-set of the post-MDA impact survey data for children aged 1–9 years. We used a logistic regression analysis, adjusted for clustering at the household and village level. Among 16,142 children aged 1–9 years, 209 (1.3%) had TF after MDA. Factors associated with a significantly lower odds of TF after MDA were living in a household with a handwashing facility (aOR: 0.37) and living in a household where water for washing is located further away from the home (30 min away aOR: 0.39, p =.034, or more than 1 h away aOR: 0.31, p =.018) compared with water in the yard. The inverse association between a domestic handwashing facility and TF is consistent with previous findings, but the association of increasing distance to collect water for washing with a reduced risk of TF was unexpected and may reflect the impact of drought and unmeasured behavioural factors related to water usage. A more comprehensive collection of sociodemographic and WASH factor information in population-based trachoma surveys will provide insight into achieving and maintaining low levels of trachoma. [ABSTRACT FROM AUTHOR]

Background Scabies is a neglected tropical disease hyperendemic to many low- and middle-income countries. Scabies can be successfully controlled using mass drug administration (MDA) using 2 doses of ivermectin-based treatment. If effective, a strategy of 1-dose ivermectin-based MDA would have substantial advantages for implementing MDA for scabies at large scale. Methods and findings We did a cluster randomised, noninferiority, open-label, 3-group unblinded study comparing the effectiveness of control strategies on community prevalence of scabies at 12 months. All residents from 35 villages on 2 Fijian islands were eligible to participate. Villages were randomised 1:1:1 to 2-dose ivermectin-based MDA (IVM-2), 1-dose ivermectin-based MDA (IVM-1), or screen and treat with topical permethrin 5% for individuals with scabies and their household contacts (SAT). All groups also received diethylcarbamazine and albendazole for lymphatic filariasis control. For IVM-2 and IVM-1, oral ivermectin was dosed at 200 [mu]g/kg and when contraindicated substituted with permethrin. We designated a noninferiority margin of 5%. We enrolled 3,812 participants at baseline (July to November 2017) from the 35 villages with median village size of 108 (range 18 to 298). Age and sex of participants were representative of the population with 51.6% male and median age of 25 years (interquartile range 10 to 47). We enrolled 3,898 at 12 months (July to November 2018). At baseline, scabies prevalence was similar in all groups: IVM-2: 11.7% (95% confidence interval (CI) 8.5 to 16.0); IVM-1: 15.2% (95% CI 9.4 to 23.8); SAT: 13.6% (95% CI 7.9 to 22.4). At 12 months, scabies decreased substantially in all groups: IVM-2: 1.3% (95% CI 0.6 to 2.5); IVM-1: 2.7% (95% CI 1.1 to 6.5); SAT: 1.1% (95% CI 0.6 to 2.0). The risk difference in scabies prevalence at 12 months between the IVM-1 and IVM-2 groups was 1.2% (95% CI -0.2 to 2.7, p = 0.10). Limitations of the study included the method of scabies diagnosis by nonexperts, a lower baseline prevalence than anticipated, and the addition of diethylcarbamazine and albendazole to scabies treatment. Conclusions All 3 strategies substantially reduced prevalence. One-dose was noninferior to 2-dose ivermectin-based MDA, as was a screen and treat approach, for community control of scabies. Further trials comparing these approaches in varied settings are warranted to inform global scabies control strategies. Trial registration Clinitrials.gov NCT03177993 and ANZCTR N12617000738325., Author(s): Myra Hardy 1,2, Josaia Samuela 3, Mike Kama 3, Meciusela Tuicakau 3, Lucia Romani 4, Margot J. Whitfeld 5, Christopher L. King 6, Gary J. Weil 7, Tibor Schuster [...]

Objective To conduct a systematic review and meta-analysis of the long-term Impact of infant vaccination on the prevalence of hepatitis B virus (HBV) infection at the population level. Methods We searched online databases for articles reporting comparisons between population cohorts aged [greater than or equal to] 15 years who were exposed or unexposed to infant HBV immunization programmes. We categorized programmes as universal or targeted to infants whose mothers were positive for hepatitis B surface antigen (HBsAg). We included studies reporting prevalence of hepatitis B core antibody (HBcAb), HBsAg, or both. We evaluated the quality of the study methods and estimated the relative reduction in the prevalence of infection. Findings Of 26 studies that met the inclusion criteria, most were from China (20 studies). The prevalence of HBV infection in unvaccinated and universally vaccinated cohorts ranged from 0.6% (116 of 20 305 people) to 16.3% (60/367) and from 0.3% (1/300) to 8.5% (73/857), respectively. Comparing cohorts with universal vaccination to those without vaccination, relative prevalences were 0.24 (95% confidence interval, CI: 0.16-0.35) for HBsAg and 0.23 (95% CI: 0.17-0.32) for HBcAb. For populations with targeted vaccination, relative prevalences were 0.32 (95% CI: 0.24-0.43) and 0.33 (95% CI: 0.23-0.45), respectively. Conclusion The residual burden of infection in cohorts offered vaccination suggests that longer-term evaluations of vaccination coverage, timeliness and other aspects of programme quality are needed. As HBV-vaccinated infant cohorts reach adulthood, ongoing analysis of prevalence in adolescents and young adults will ensure that elimination efforts are on track. Objectif Realiser une revue systematique et une meta-analyse de l'impact a long terme de la vaccination des nourrissons sur la prevalence de l'infection par le virus de l'hepatite B au niveau de la population. Methodes Nous avons consulte des bases de donnees en ligne a la recherche d'articles etablissant des comparaisons entre des cohortes de populations agees de 15 ans ou plus ayant beneficie ou non de programmes de vaccination contre le virus de l'hepatite B pour les nourrissons. Nous avons divise ces programmes en deux categories: les programmes universels et les programmes cibles sur des nourrissons dont les meres etaient positives pour l'antigene de surface de l'hepatite B (HBsAg). Nous avons inclus des etudes Indiquant la prevalence de l'etat de l'anticorps nucleocapsidique de l'hepatite B (HBcAb), du HBsAg ou des deux. Nous avons evalue la qualite des methodes d'etude et estime la diminution relative de la prevalence de l'infection. Resultats Sur les 26 etudes reunissant les criteres d'inclusion, 20 provenaient de Chine. La prevalence de l'infection par le virus de l'hepatite B variait de 0,6% (116 individus sur 20 305) a 16,3% (60/367) chez les cohortes non vaccinees, et de 0,3% (1/300) a 8,5% (73/857) chez les cohortes ayant beneficie d'une vaccination universelle. La comparaison des cohortes ayant beneficie d'une vaccination universelle avec les cohortes n'ayant recu aucune vaccination a revele une prevalence relative de 0,24 (intervalle de confiance, IC, a 95%: 0,16-0,35) pour le HBsAg et de 0,23 (IC a 95%: 0,17-0,32) pour le HBcAb. Dans le cas des populations ayant recu une vaccination ciblee, la prevalence relative etait de 0,32 (IC a 95%: 0,24-0,43) pour le HBsAg et de 0,33 (IC a 95%: 0,23-0,45) pour le HBcAb. Conclusion La charge residuelle liee a l'infection dans le cas de plusieurs cohortes ayant beneficie d'une vaccination laisse entendre que des evaluations a long terme de la couverture vaccinale, du caractere opportun et d'autres aspects de la qualite des programmes sont necessaires. A mesure que les cohortes de nourrissons vaccines contre le virus de l'hepatite B atteignent l'age adulte, une analyse continue de la prevalence chez les adolescents et les jeunes adultes permettra de garantir que les efforts d'elimination sont sur la bonne voie. Objetivo Realizar una revision sistematica y un meta-analisis del impacto a largo plazo de la vacunacion infantil sobre la prevalencia de la infeccion por el virus de la hepatitis B (VHB) a nivel de la poblacion. Metodos Investigamos en bases de datos en Internet en busca de articulos que informaran sobre comparaciones entre cohortes de poblacion con edades de [greater than or equal to] 15 anos, que se vieron expuestas o no a programas de inmunizacion infantil del VHB. Clasificamos los programas como universales o dirigidos a menores de edad, cuyas madres dieron positivo en el antigeno de superficie de la hepatitis B (HBsAg). Incluimos estudios que informan de la prevalencia del anticuerpo core de la hepatitis B (HBcAb) o del estado de HBsAg o de ambos. Evaluamos la calidad de los metodos de estudio y estimamos la reduccion relativa en la prevalencia de la infeccion. Resultados De los 26 estudios que cumplian con los criterios de inclusion, la mayoria procedian de China (20 estudios). La prevalencia de la infeccion por VHB en cohortes sin vacunar y vacunadas de forma universal variaba desde el 0,6% (116 de 20 305 personas) hasta el 16,3% (60/367) y desde el 0,3% (1/300) hasta el 8,5% (73/857), respectivamente. Al comparar las cohortes con vacunacion universal y aquellas sin vacunacion, la prevalencia relativa fue del 0,24 (intervalo de confianza del 95%, IC: 0,16-0,35) para HBsAg y 0,23 (95% IC: 0,17-0,32) para HBcAb. En aquellas poblaciones con vacunacion dirigida, la prevalencia relativa fue del 0,32 (95% IC: 0,24-0,43) y del 0,33 (95% IC: 0,23-0,45), respectivamente. Conclusion La carga residual de la infeccion que ofrece la vacunacion en diversas cohortes, sugiere que son necesarias las evaluaciones a largo plazo de la cobertura de vacunacion, del caracter oportuno y de otros aspectos sobre la calidad del programa. A medida que las cohortes de ninos vacunados contra el VHB alcanzan la edad adulta, un analisis continuo de la prevalencia en adolescentes y en jovenes asegurara que los esfuerzos para su eliminacion van por buen camino., [phrase omitted] Introduction Infection with the hepatitis B virus (HBV) is a major global cause of ill health that particularly affects low- and middle-income countries. An estimated 257 million people [...]