High Coverage Levels Research Articles

Grain Size Characteristics of Sediments Found in Typical Landscapes in the Playa of Ebinur Lake, Arid Central Asia

A playa usually refers to a salt desert landscape mainly composed of loose and fine lacustrine sediments. Severe wind erosion on a playa causes the playa to become a source of dust and salt dust and poses a threat to vast areas downwind. Currently, little is known about the impact of wind erosion on the particle size distribution of sediments in different landscapes in the playa. In the present study, six dominant different landscapes in a natural state with the same sedimentary environment in the playa of Ebinur Lake were selected to provide insights into the different characteristics of particle size distribution under the effect of long-term wind erosion. The results reveal that the grain-size composition clearly differed among different landscapes. All samples had a common dominant size group consisting of very fine sand and sand. The very fine sand and sand content of Haloxylon ammodendron desert zone (LS5) was the lowest, while the clay and silt content was the highest at both depths among the six landscapes. The lowest clay and silt fraction and highest sand fraction appeared in the herbal desert zone (LS3) at both depths. Almost all of the sediment samples were of a bimodal distribution mode, with significant differences. The cumulative curve showed a similar S-shape, while the probability cumulative curve showed an inverted S-shape with three subpopulations of granularity characteristics. The smallest mean particle diameter appeared in LS5. The majority of the sediments were moderately to poorly sorted. The mean particle size of the sediments from the six landscapes was significantly different (p < 0.05), while no significant difference was observed among the other three parameters. Generally, it can be inferred that LS5 can reduce wind speed effectively, probably due to the smaller leaves and dense branches of Haloxylon ammodendron, which results in a high level of coverage. The results of the present study will have some implications for the grain size characteristics for changes in intensity in regional wind erosion environment and will also have some basis for wind erosion prevention and control in the playa of Ebinur Lake.

USING HISTORICAL AERIAL PHOTOGRAPHY FOR MONITORING OF ENVIRONMENT CHANGES: A CASE STUDY OF BOVAN LAKE, EASTERN SERBIA

Useful and important information for the spatial, ecological, and many other changes in the living environment may be obtained using the analysis of historical aerial photography, with comparison to contemporary imagery. This method provides the ability to determine the state of elements of the space over a long period, encompassing the time when it was not possible to acquire the data from satellite imagery or some other contemporary sources. Aerial images are suitable for mapping spatial phenomena with relatively limited spatial distribution because they possess a high level of details and low spatial coverage. With a comparative analysis of aerial imagery from the past, contemporary aerial imagery, and other sources of aerial imagery, we can obtain information about the nature and trends of the observed phenomena as well as directions of future actions, considering changes detected in the environment, whether they are preventive or corrective in nature. This paper gives the methodological framework for the appliance of the existing knowledge from various fields, intending to use historical aerial photography for monitoring of environmental changes of the Bovan Lake in Eastern Serbia.

The role of social cohesion in the implementation and coverage of a mass drug administration trial for malaria control in the Gambia: An in-depth comparison of two intervention villages

Mass drug administration (MDA), used increasingly in malaria eradication efforts, involves administering medication to an entire target population regardless of individual-level disease status. This strategy requires high levels of coverage and compliance. Previous studies have assessed individual and structural factors affecting MDA coverage, but there is a need to better understand the influence and expressions of community dynamics and social structures, such as social cohesion. We conducted a social science study concurrent to an MDA clinical trial for malaria control in The Gambia; ethnographic research was conducted prior to, throughout, and between MDA implementation July–November 2018, January–March 2019, and July–November 2019. We assessed how social cohesion, as expressed by the trial population, affects trial coverage through an in-depth ethnographic analysis of two trial villages, using observations, interviews, and focus group discussions with community members who took the trial medication and those who did not. We found that the villages had unique expressions of social cohesion. This was reflected through community participation in the trial implementation and may have affected coverage and compliance. The village with low coverage expressed a form of social cohesion where members followed advice to participate through a hierarchal system but did not actively participate in the MDA or its implementation. The village with high coverage expressed social cohesion as more participatory: individuals took the directive to participate but contextualized the trial implementation to their needs and wants. We analyze these different expressions of social cohesion and the important differences they make for the coverage and compliance levels reached in the two different villages.

Drivers of HIV-1 drug resistance to non-nucleoside reverse-transcriptase inhibitors (NNRTIs) in nine southern African countries: a modelling study

IntroductionThe rise of HIV-1 drug resistance to non-nucleoside reverse-transcriptase inhibitors (NNRTI) threatens antiretroviral therapy's long-term success (ART). NNRTIs will remain an essential drug for the management of HIV-1 due to safety concerns associated with integrase inhibitors. We fitted a dynamic transmission model to historical data from 2000 to 2018 in nine countries of southern Africa to understand the mechanisms that have shaped the HIV-1 epidemic and the rise of pretreatment NNRTI resistance.MethodsWe included data on HIV-1 prevalence, ART coverage, HIV-related mortality, and survey data on pretreatment NNRTI resistance from nine southern Africa countries from a systematic review, UNAIDS and World Bank. Using a Bayesian hierarchical framework, we developed a dynamic transmission model linking data on the HIV-1 epidemic to survey data on NNRTI drug resistance in each country. We estimated the proportion of resistance attributable to unregulated, off-programme use of ART. We examined each national ART programme's vulnerability to NNRTI resistance by defining a fragility index: the ratio of the rate of NNRTI resistance emergence during first-line ART over the rate of switching to second-line ART. We explored associations between fragility and characteristics of the health system of each country.ResultsThe model reliably described the dynamics of the HIV-1 epidemic and NNRTI resistance in each country. Predicted levels of resistance in 2018 ranged between 3.3% (95% credible interval 1.9–7.1) in Mozambique and 25.3% (17.9–33.8) in Eswatini. The proportion of pretreatment NNRTI resistance attributable to unregulated antiretroviral use ranged from 6% (2–14) in Eswatini to 64% (26–85) in Mozambique. The fragility index was low in Botswana (0.01; 0.0–0.11) but high in Namibia (0.48; 0.16–10.17), Eswatini (0.64; 0.23–11.8) and South Africa (1.21; 0.83–9.84). The combination of high fragility of ART programmes and high ART coverage levels was associated with a sharp increase in pretreatment NNRTI resistance.ConclusionsThis comparison of nine countries shows that pretreatment NNRTI resistance can be controlled despite high ART coverage levels. This was the case in Botswana, Mozambique, and Zambia, most likely because of better HIV care delivery, including rapid switching to second-line ART of patients failing first-line ART.

Determination of the optimal coverage for heavy-duty-axle gears in shot peening

Pitting and wear often appear on heavy-duty-axle gears due to their harsh working conditions, such as high torques, high loads, and poor lubrication. Shot peening is a popular surface strengthening method for gears. In order to ensure complete coverage during shot peening, 100~200% coverage is usually prescribed for most gears. However, it is difficult to effectively improve the contact fatigue and wear resistance of heavy-duty-axle gears. Generally, increasing shot peening coverage can heighten the compressive residual stress for prolonging the service lifetime of gears, whereas high coverage levels may cause the deterioration of surface roughness, thus increasing the noise and vibration of gears. To address this issue, this paper deals with the determination of optimal coverage for heavy-duty-axle gears by experimental tests. The influence of shot peening coverage on the surface integrity of gears is analyzed in terms of residual stress, microhardness, surface morphology, and microstructure. The results show that the maximum compressive residual stress increases first and then keeps stable with the increase of coverage, and the maximum value is − 1172.10 MPa. The microhardness peak increases obviously in the beginning and then slowly rises with the increase of coverage, and the maximum value is 747.5 HV1.0. The surface roughness (Ra) decreases initially and then enhances with the increase of coverage, and the minimum value is 0.99 μm under the coverage of 1000%. The crystallite size can be refined from 36.88 to 28.79 nm by shot peening. The dislocation density increases with the increase of coverage, and the maximum value is 3.70 × 1016 m−2. Numerous damages (microscalings, spallings) occur on the treated gear tooth flank affecting the residual stress distribution and roughness under high coverage levels. Meanwhile, the wear behavior of gear steels is investigated, and the wear test results show that shot peening with the coverage of 1000% can lead to a better wear resistance. Taking into consideration of surface integrity and wear test results, the coverage of 1000% is the optimal coverage for heavy-duty-axle gears in shot peening.

Mixed ownership reform and corporate tax avoidance: Evidence of Chinese listed firms

We find a significant negative relationship between a firm's mixed-ownership reform intensity ratio and the degree of corporate tax avoidance in China between 2003 and 2018. The path analyses demonstrate our finding is through the channel of a firm's financial constraints and analysts' earnings forecast dispersion. Furthermore, our main results are more pronounced for firms with a high level of media coverage and located in a region of weak tax enforcement or high willingness of government decentralisation. Finally, our results remain significant after alleviating a series of endogenous tests and robustness tests. We contribute to the literature to understand the causes of a firm's tax avoidance behaviour and the consequence of the mixed-ownership reform in China.

COVID-19 herd immunity v. learning to live with the virus.

Mutations of SARS-CoV-2 have been associated with increased transmissibility and occasionally reduced sensitivity to neutralising antibody activity induced by past ancestry virus infection or current COVID-19 vaccines. Nevertheless, COVID-19 vaccines have consistently demonstrated high efficacy and effectiveness against COVID-19 severe disease, hospitalisation and death, including disease caused by designated variants of concern. In contrast, COVID-19 vaccines are more heterogeneous in reducing the risk of infection and mild COVID19, and are modestly effective in interrupting virus transmission. Ongoing mutations of SARS-CoV-2 resulting in increased transmissibility and relative evasion of neutralising antibody activity induced by past virus infection or COVID-19 vaccines are likely. The duration of protection induced by COVID-19 vaccines is modelled to be relatively short in protecting against infection and mild COVID-19, but is likely to be 2 - 3 years against severe disease. Current experience from the UK and Israel demonstrates that even with high levels of COVID19 vaccine coverage (>85% of the adult population), resurgences with new variants of concern remain a strong probability. Nevertheless, such resurgences are not mirrored by high rates of hospitalisation and death compared with what was experienced in relatively COVID-19 vaccine-naive populations. Even though COVID-19 vaccines are unlikely to result in a herd immunity state, their ability to protect against severe COVID-19 and death could allow for a return to normalcy once a large enough proportion of the adult population in a country has been vaccinated.

Levels of pneumococcal conjugate vaccine coverage and indirect protection against invasive pneumococcal disease and pneumonia hospitalisations in Australia: An observational study.

There is limited empiric evidence on the coverage of pneumococcal conjugate vaccines (PCVs) required to generate substantial indirect protection. We investigate the association between population PCV coverage and indirect protection against invasive pneumococcal disease (IPD) and pneumonia hospitalisations among undervaccinated Australian children. Birth and vaccination records, IPD notifications, and hospitalisations were individually linked for children aged <5 years, born between 2001 and 2012 in 2 Australian states (New South Wales and Western Australia; 1.37 million children). Using Poisson regression models, we examined the association between PCV coverage, in small geographical units, and the incidence of (1) 7-valent PCV (PCV7)-type IPD; (2) all-cause pneumonia; and (3) pneumococcal and lobar pneumonia hospitalisation in undervaccinated children. Undervaccinated children received <2 doses of PCV at <12 months of age and no doses at ≥12 months of age. Potential confounding variables were selected for adjustment a priori with the assistance of a directed acyclic graph. There were strong inverse associations between PCV coverage and the incidence of PCV7-type IPD (adjusted incidence rate ratio [aIRR] 0.967, 95% confidence interval [CI] 0.958 to 0.975, p-value < 0.001), and pneumonia hospitalisations (all-cause pneumonia: aIRR 0.991 95% CI 0.990 to 0.994, p-value < 0.001) among undervaccinated children. Subgroup analyses for children <4 months old, urban, rural, and Indigenous populations showed similar trends, although effects were smaller for rural and Indigenous populations. Approximately 50% coverage of PCV7 among children <5 years of age was estimated to prevent up to 72.5% (95% CI 51.6 to 84.4) of PCV7-type IPD among undervaccinated children, while 90% coverage was estimated to prevent 95.2% (95% CI 89.4 to 97.8). The main limitations of this study include the potential for differential loss to follow-up, geographical misclassification of children (based on residential address at birth only), and unmeasured confounders. In this study, we observed substantial indirect protection at lower levels of PCV coverage than previously described-challenging assumptions that high levels of PCV coverage (i.e., greater than 90%) are required. Understanding the association between PCV coverage and indirect protection is a priority since the control of vaccine-type pneumococcal disease is a prerequisite for reducing the number of PCV doses (from 3 to 2). Reduced dose schedules have the potential to substantially reduce program costs while maintaining vaccine impact.

Genetic Screening of Cervical Cancer

Medical genetics plays an important role in the screening and prevention of numerous diseases. Thus, it is important to develop effective screening and prevention programs and improve the assessment of the susceptibility of diseases. The development of screening and prevention programs depends on the identification of early biomarkers (including functional and behavioral) for the risk and onset of the disease, and such programs need to be designed according to internationally accepted criteria. Cervical cancer represents a very relevant disease from the health and social perspective; around 528,000 new cases are diagnosed every year globally, of which, 85% are from developing countries, representing almost 12% of all cancers in females. Substantial reductions in the incidence of and mortality from cervical cancer have been observed after the introduction of prevention campaigns with the implementation of cervical screening programs through Papanicolaou (Pap) tests and, in particular, following the introduction of organized programs which guarantee a high level of screening coverage, as well as, the quality and continuity of diagnostic-therapeutic procedures. It is estimated that Pap smear screening every 3-5 years provides 80% protection against the onset of cancer. Advances in diagnostic techniques, particularly the development of easy-to-use molecular genetic tests, are replacing the use of the established Pap smear as a screening tool. This is possible owing to the discovery in 1975 that some cellular morphological changes (koilocytosis) were related to the presence of a Human Papillomavirus (HPV) infection. The HPV test is performed on a small sample of cells taken from the cervix, similar to the Pap test; however, it is not a morphological exam but a molecular biology exam that detects the presence of HPV by identifying its deoxyribonucleic acid (DNA) or messenger ribonucleic acid (mRNA). The results of numerous experimental studies have demonstrated a greater sensitivity of this test compared to the sensitivity of the traditional Pap test. However, the HPV test has a lower specificity due to two main factors: 1) The HPV test is based on the search for the types of viruses that have a greater oncogenic potential, and 2) It does not discriminate between transient infections and persistent and productive infections. The most widely used molecular tests are based on the search for HPV sequences and genotyping using molecular biology techniques, such as direct hybridization, qualitative polymerase chain reaction (PCR), and viral nucleotide sequencing.

How Public Health Professionals View Mandatory Vaccination in Italy-A Cross-Sectional Survey.

In response to the decline in child vaccination coverage and the subsequent occurrence of large vaccine-preventable disease outbreaks, in 2017 Italy introduced a new law that made ten vaccines mandatory for children aged 0–16 years. The policy change initiated an ongoing debate among the general public, as well as in the political arena and the scientific community, over this major public health concern. Hence, we conducted a survey aimed at assessing Italian public health professionals’ attitudes towards and opinions on mandatory vaccination. A validated online questionnaire was administered to 1350 members of the Italian Society of Hygiene, Preventive Medicine and Public Health. Among the 1044 responders (response rate 77%), a large majority were in favour of the Italian mandatory vaccination law (91%) and against its repeal (74%). Nevertheless, according to our sample, maintaining a high level of vaccination coverage without the need to mandate would be preferable, and thus efforts to promote vaccine confidence and proactive vaccine uptake are still needed.

Cost-Effectiveness of Improved Hypertension Management in India through Increased Treatment Coverage and Adherence: A Mathematical Modeling Study.

Background:Despite the availability of effective and affordable treatments, only 14% of hypertensive Indians have controlled blood pressure. Increased hypertension treatment coverage (the proportion of individuals initiated on treatment) and adherence (proportion of patients taking medicines as recommended) promise population health gains. However, governments and other payers will not invest in a large-scale hypertension control program unless it is both affordable and effective.Objective:To investigate if a national hypertension control intervention implemented across the private and public sector facilities in India could save overall costs of CVD prevention and treatment.Methods:We developed a discrete-time microsimulation model to assess the cost-effectiveness of population-level hypertension control intervention in India for combinations of treatment coverage and adherence targets. Input clinical parameters specific to India were obtained from large-scale surveys such as the Global Burden of Disease as well as local clinical trials. Input hypertensive medication cost parameters were based on government contracts. The model projected antihypertensive treatment costs, avoided CVD care costs, changes in disability-adjusted life year (DALYs) and incremental cost per DALY averted (represented as incremental cost-effectiveness ratio or ICER) over 20 years.Results:Over 20 years, at 70% coverage and adherence, the hypertension control intervention would avert 1.68% DALYs and be cost-saving overall. Increasing adherence (while keeping coverage constant) resulted in greater improvement in cost savings compared to increasing coverage (while keeping adherence constant). Results were most sensitive to the cost of antihypertensive medication, but the intervention remained highly cost-effective under all one-way sensitivity analyses.Conclusion:A national hypertension control intervention in India would most likely be budget neutral or cost-saving if the intervention can achieve and maintain high levels of both treatment coverage and adherence.

Attitudes on voluntary and mandatory vaccination against COVID-19: Evidence from Germany.

Several vaccines against COVID-19 have now been developed and are already being rolled out around the world. The decision whether or not to get vaccinated has so far been left to the individual citizens. However, there are good reasons, both in theory as well as in practice, to believe that the willingness to get vaccinated might not be sufficiently high to achieve herd immunity. A policy of mandatory vaccination could ensure high levels of vaccination coverage, but its legitimacy is doubtful. We investigate the willingness to get vaccinated and the reasons for an acceptance (or rejection) of a policy of mandatory vaccination against COVID-19 in June and July 2020 in Germany based on a representative real time survey, a random sub-sample (SOEP-CoV) of the German Socio-Economic Panel (SOEP). Our results show that about 70 percent of adults in Germany would voluntarily get vaccinated against the coronavirus if a vaccine without side effects was available. About half of residents of Germany are in favor, and half against, a policy of mandatory vaccination. The approval rate for mandatory vaccination is significantly higher among those who would get vaccinated voluntarily (around 60 percent) than among those who would not get vaccinated voluntarily (27 percent). The individual willingness to get vaccinated and acceptance of a policy of mandatory vaccination correlates systematically with socio-demographic and psychological characteristics of the respondents. We conclude that as far as people’s declared intentions are concerned, herd immunity could be reached without a policy of mandatory vaccination, but that such a policy might be found acceptable too, were it to become necessary.

Lives and Costs Saved by Expanding and Expediting Coronavirus Disease 2019 Vaccination.

BackgroundWith multiple coronavirus disease 2019 (COVID-19) vaccines available, understanding the epidemiologic, clinical, and economic value of increasing coverage levels and expediting vaccination is important.MethodsWe developed a computational model (transmission and age-stratified clinical and economics outcome model) representing the United States population, COVID-19 coronavirus spread (February 2020–December 2022), and vaccination to determine the impact of increasing coverage and expediting time to achieve coverage.ResultsWhen achieving a given vaccination coverage in 270 days (70% vaccine efficacy), every 1% increase in coverage can avert an average of 876 800 (217 000–2 398 000) cases, varying with the number of people already vaccinated. For example, each 1% increase between 40% and 50% coverage can prevent 1.5 million cases, 56 240 hospitalizations, and 6660 deaths; gain 77 590 quality-adjusted life-years (QALYs); and save $602.8 million in direct medical costs and $1.3 billion in productivity losses. Expediting to 180 days could save an additional 5.8 million cases, 215 790 hospitalizations, 26 370 deaths, 206 520 QALYs, $3.5 billion in direct medical costs, and $4.3 billion in productivity losses.ConclusionsOur study quantifies the potential value of decreasing vaccine hesitancy and increasing vaccination coverage and how this value may decrease with the time it takes to achieve coverage, emphasizing the need to reach high coverage levels as soon as possible, especially before the fall/winter.

An Adaptive Search Budget Allocation Approach for Search-Based Test Case Generation

Search-based techniques have been successfully used to automate test case generation. Such approaches allocate a fixed search budget to generate test cases aiming at maximizing code coverage. The search budget plays a crucial role; due to the hugeness of the search space, the higher the assigned budget, the higher the expected coverage. Code components have different structural properties that may affect the ability of search-based techniques to achieve a high coverage level. Thus, allocating a fixed search budget for all the components is not recommended and a component-specific search budget should be preferred. However, deciding the budget to assign to a given component is not a trivial task. In this article, we introduce Budget Optimization for Testing (BOT), an approach to adaptively allocate the search budget to the classes under test. BOT requires information about the branch coverage that will be achieved on each class with a given search budget. Therefore, we also introduce BRANCHOS, an approach that predicts coverage in a budget-aware way. The results of our experiments show that (i) BRANCHOS can approximate the branch coverage in time with a low error, and (ii) BOT can significantly increase the coverage achieved by a test generation tool and the effectiveness of generated tests.

Progress in Immunization Safety Monitoring - Worldwide, 2010-2019.

High levels of coverage with safe and effective immunizations are critical to the successful control and prevention of vaccine-preventable diseases worldwide. In addition to stringent standards to regulate the safety of vaccines, robust postlicensure monitoring systems help ensure that the benefits of vaccines continue to outweigh the risks for the populations who receive them. National Expanded Programmes on Immunization (EPI) are typically responsible for identifying and investigating adverse events following immunization (AEFI), including assessment of causality. National regulatory authorities (NRAs) are mandated to perform postlicensure surveillance of adverse drug reactions, including those associated with receipt of vaccines. This report describes global progress toward meeting World Health Organization (WHO) indicators on minimal country capacity for vaccine safety surveillance and coordination of AEFI reporting between countries' EPI and NRAs. In 2019, among 194 countries, 129 (66.5%) reported having an operational national AEFI causality review committee, compared with 94 (48.5%) in 2010. During 2010-2019, the proportion of countries reporting ≥10 AEFI per 100,000 surviving infants per year (an indicator of country capacity to monitor immunization safety) increased, from 41.2% to 56.2%. In 2019, however, only 46 (23.7%) countries reported AEFI data from both EPI and NRAs. Although global progress has been made toward strengthening systems for vaccine safety monitoring over the past decade, new indicators for monitoring global immunization safety performance are needed to better reflect program functionality. Continued global efforts will be vital to address barriers to routine reporting of AEFI, build national capacity for AEFI investigation and data management, and improve sharing of AEFI data at national, regional, and global levels.

COVID-19 vaccine hesitancy and resistance: Correlates in a nationally representative longitudinal survey of the Australian population.

High levels of vaccination coverage in populations will be required even with vaccines that have high levels of effectiveness to prevent and stop outbreaks of coronavirus. The World Health Organisation has suggested that governments take a proactive response to vaccine hesitancy 'hotspots' based on social and behavioural insights. Representative longitudinal online survey of over 3000 adults from Australia that examines the demographic, attitudinal, political and social attitudes and COVID-19 health behavior correlates of vaccine hesitance and resistance to a COVID-19 vaccine. Overall, 59% would definitely get the vaccine, 29% had low levels of hesitancy, 7% had high levels of hesitancy and 6% were resistant. Females, those living in disadvantaged areas, those who reported that risks of COVID-19 was overstated, those who had more populist views and higher levels of religiosity were more likely to be hesitant or resistant while those who had higher levels of household income, those who had higher levels of social distancing, who downloaded the COVID-Safe App, who had more confidence in their state or territory government or confidence in their hospitals, or were more supportive of migration were more likely to intend to get vaccinated. Our findings suggest that vaccine hesitancy, which accounts for a significant proportion of the population can be addressed by public health messaging but for a significant minority of the population with strongly held beliefs, alternative policy measures may well be needed to achieve sufficient vaccination coverage to end the pandemic.

Pertussis immunity in pregnant women and factors associated with seronegative status

Despite high level of vaccination coverage, pertussis remains a serious problem of modern medicine. Pertussis cases are registered among infants, adolescents, and adults. Infants younger than three months of age have the highest rate of serious clinical pertussis course. Transplacental transfer of pertussis-specific antibodies induce protection against infection. The available data regarding anti-pertussis antibody level in pregnant women in Russia remain sparce. To evaluate the humoral immunity to Bordetella pertussis in pregnant women and factors associated with seronegative status, we performed a cross-sectional study with 388 participants. SeroPertussis IgG (Israel) ELISA kit was used to quantitate antibodies against pertussis toxin/hemagglutinin. Binary logistic regression analysis was performed to assess factors associated with seronegative status. The median age of the subjects was 30 years old, more than half of which (51.3%) provided no verified pertussis vaccination data so that their children will not receive transplacental anti-infectious immunity. Gestational age was significantly associated with seronegative status. Compared to women tested during the first trimester, participants in the third trimester of pregnancy were more likely to be seronegative against pertussis. The odds of being susceptible rose with increased gestational period (p 0.01 for linear trend). Age, number of pregnancies and vaccination status revealed no impact on significant differences between seropositive and seronegative subjects. Pertussis booster vaccinations for preschool children, adolescents and healthcare workers dealing with pregnant women and neonates as well as cocoon vaccination strategy and vaccination during pregnancy were necessary to be implemented to protect infants against pertussis.

The Challenges of Managing Depredation and Bycatch of Toothed Whales in Pelagic Longline Fisheries: Two U.S. Case Studies

Direct interactions with fisheries are broadly recognized as the leading conservation threat to small cetaceans. In open-ocean environments, one of the primary gear types implicated in these interactions is the pelagic longline. Unlike accidental entanglement in driftnets or deliberate entrapment by purse-seines, interactions between cetaceans and longlines are often driven by attraction of the animals to feed on bait or fish secured on the gear, a behavior known as depredation. Many small and medium-sized delphinid species have learned to exploit such opportunities, leading to economic costs to fisheries and a risk of mortality to the animals from either retaliation by fishermen or hooking or entanglement in fishing gear. Two pelagic longline fisheries in the United States experience depredation and bycatch by odontocete depredators: the Hawai‘i deep-set longline fishery, which is depredated primarily by false killer whales (Pseudorca crassidens), and the Atlantic pelagic longline fishery depredated primarily by short-finned pilot whales (Globicephala macrorhynchus). These fisheries are among the most intensively documented and managed pelagic longline fisheries in the world, with high levels of observer coverage, and bycatch mitigation measures required to reduce the mortality of seabirds, sea turtles and cetaceans. Both fisheries have active, multi-stakeholder “Take Reduction Teams,” enacted under the U.S. Marine Mammal Protection Act (MMPA), that are tasked to develop measures to reduce the bycatch of cetaceans below statutory reference points. Consequently, these two Teams represent model processes within which to address depredation and bycatch, having access to detailed, high-quality data on the nature and frequency of interactions with cetaceans, meaningful stakeholder involvement, resources to test potential solutions, and the institutional will to improve outcomes. We review how mitigation strategies have been considered, developed, and implemented by both Teams and provide a critical analysis of their effectiveness in addressing these problems. Notably, in the absence of straightforward avoidance or deterrence strategies, both Teams have developed gear and handling strategies that depend critically on comprehensive observer coverage. Lessons offered from these Teams, which have implemented consensus-driven management measures under a statutory framework, provide important insights to managers and scientists addressing other depredation problems.

Drivers of HIV-1 Drug Resistance to Non-Nucleoside Reverse-Transcriptase Inhibitors (NNRTIs) in Nine African Countries: A Modelling Study

Background: The rise of HIV-1 drug resistance to non-nucleoside reverse-transcriptase inhibitors (NNRTI) threatens antiretroviral therapy (ART) programmes' long-term success. NNRTIs will likely remain an essential drug for the management of HIV-1 due to the adverse effects and safety concerns associated with integrase inhibitors. Mathematical models can contribute to a better understanding of the mechanisms that shape the HIV-1 epidemic and the rise of NNRTI pretreatment resistance in a country. We fitted a dynamic transmission model to data 2000-2018 from nine countries of southern Africa. Methods: We included data on HIV-1 prevalence, ART coverage, HIV-related mortality, and survey data on NNRTI pretreatment drug resistance from Botswana, Eswatini, Lesotho, Malawi, Mozambique, Namibia, South Africa, Zambia, and Zimbabwe, from a systematic review, UNAIDS and the World Bank. Using a Bayesian hierarchical framework, we developed a dynamic transmission model linking the country-specific data on the HIV-1 epidemic to survey data on NNRTI drug resistance in each country. We estimated the proportion of resistance attributable to unregulated, off-programme use of ART. We examined the vulnerability of national ART programmes to NNRTI resistance by defining a fragility index: the ratio of the rate of NNRTI resistance emergence during first-line ART over the rate of switching to second-line ART. We explored associations between national ART programme's fragility and the characteristics of health systems and countries. Findings: The model reliably described the dynamics of the HIV-1 epidemic and NNRTI resistance in each country. Predicted levels of resistance in 2018 ranged between 3.3% (95% credible interval [CrI] 1.9 to 7.1%) in Mozambique and 25.3% (17.9 to 33.8%) in Eswatini. The proportion of NNRTI pretreatment drug resistance attributable to unregulated antiretroviral use ranged from 6% (95%CrI 2-14) in Eswatini to 64% (95%CrI 26-85) in Mozambique. The fragility index was low in Botswana (0.01; 95%CrI 0.0-0.11) but high in Namibia (0.48; 95% CrI 0.16-10.17), Eswatini (0.64; 95%CrI 0.23-11.8) and South Africa to 1.21 (95%CrI 0.83-9.84). The combination of high fragility of ART programmes and high levels of ART coverage was associated with a sharp increase in NNRTI pretreatment drug resistance. Interpretation: This comparison of nine countries shows that NNRTI pretreatment drug resistance can be controlled despite high ART coverage levels, as in Botswana, Mozambique, or Zambia, most likely because of better HIV care delivery, including rapid switching to second-line ART of patients failing first-line ART. Funding Statement: National Institute of Allergy and Infectious Diseases (grant 5U01-AI069924-05) and Swiss National Science Foundation (grant 174281). Declaration of Interests: We declare no conflict of interest.

The effect of screening for vaccine hesitancy on the subsequent development of hesitancy: a randomized controlled trial, Houston, TX

ABSTRACT Vaccine hesitancy remains a global health threat. Addressing parental vaccine hesitancy is essential to maintaining high vaccine coverage levels and preventing disease outbreaks; however, it is unknown if administering a vaccine hesitancy screening tool negatively impacts parental vaccine beliefs. We conducted a stratified randomized controlled trial in pediatric primary care practices. English-speaking parents ≥18 years of age seeking routine care for infants <3 months of age were eligible. Participants were randomized to receive 1 of 2 surveys – the Parent Attitudes about Childhood Vaccines (PACV) survey or a placebo survey. Six months after initial enrollment, all participants were asked to complete the PACV, regardless of initial randomization group. Our primary outcome was the proportion of hesitant to non-hesitant parents at 6-months between randomization groups. We examined associations between vaccine hesitancy and participant characteristics. We also evaluated the change in the proportion of vaccine-hesitant parents in the PACV group between baseline and 6-month follow up. We enrolled 1705 parents at baseline. At 6-month follow up, 819 parents completed the PACV (50.2% from PACV group vs. 54.1% from placebo group). The proportion of hesitant parents at 6 months did not differ between PACV and placebo groups (6.6% vs. 6.1%; p = .78) and the odds of hesitancy among PACV group participants was not higher than those in the placebo group (OR = 1.10; 95% CI: 0.63–1.93; p = .743). Race was the only characteristic significantly associated with vaccine hesitancy at 6-month follow up (p = .003). Overall, administration of the PACV did not trigger vaccine hesitancy in this study population.