Santa Clara de Nanay: The MAL-ED Cohort in Peru

Yori, Pablo Peñataro; Lee, Gwenyth; Olórtegui, Maribel Paredes; Chávez, César Banda; Flores, Julian Torres; Vasquez, Angel Orbe; Burga, Rosa; Pinedo, Silvia Rengifo; Asayag, César Ramal; Black, Robert E.; Caulfield, Laura E.; Kosek, Margaret

doi:10.1093/cid/ciu460

Cited by 62 publications

(65 citation statements)

References 28 publications

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“…The MAL-ED cohorts were selected to represent a broad range of low and middle income country settings including a mix of urban and rural locations where malnutrition and enteric disease burden were high [8], [9], [10], [11], [12], [13], [14], [15]. The median monthly household income across all sites was $113 (range $0–1648/month) ranging from $14 in TZH to $347 in BRF and the median maternal age was 26 years (range 14–49 years) while the median maternal education was 7 years (range 0–20 years) (Supplementary Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Children in the MAL-ED cohorts, located in Dhaka, Bangladesh (BGD), Fortaleza, Brazil (BRF), Vellore, India (INV), Bhaktapur, Nepal (NEB), Loreto, Peru (PEL), Naushero Feroze, Pakistan (PKN), Venda, South Africa (SAV), and Haydom, Tanzania (TZH), were followed for the first two years of life providing an opportunity to assess adherence to national EPI schedules in diverse settings [8], [9], [10], [11], [12], [13], [14], [15]. Here we describe vaccination coverage in the MAL-ED cohorts and examine adherence to country-specific EPI schedules.…”

Section: Introductionmentioning

confidence: 99%

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Vaccine coverage and adherence to EPI schedules in eight resource poor settings in the MAL-ED cohort study

Hoest

Seidman

Lee

et al. 2017

Vaccine

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BackgroundLaunched in 1974, the Expanded Program on Immunization (EPI) is estimated to prevent two-three million deaths annually from polio, diphtheria, tuberculosis, pertussis, measles, and tetanus. Additional lives could be saved through better understanding what influences adherence to the EPI schedule in specific settings.MethodsThe Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study followed cohorts in eight sites in South Asia, Africa, and South America and monitored vaccine receipt over the first two years of life for the children enrolled in the study. Vaccination histories were obtained monthly from vaccination cards, local clinic records and/or caregiver reports. Vaccination histories were compared against the prescribed EPI schedules for each country, and coverage rates were examined in relation to the timing of vaccination. The influence of socioeconomic factors on vaccine timing and coverage was also considered.ResultsCoverage rates for EPI vaccines varied between sites and by type of vaccine; overall, coverage was highest in the Nepal and Bangladesh sites and lowest in the Tanzania and Brazil sites. Bacillus Calmette-Guérin coverage was high across all sites, 87–100%, whereas measles vaccination rates ranged widely, 73–100%. Significant delays between the scheduled administration age and actual vaccination date were present in all sites, especially for measles vaccine where less than 40% were administered on schedule. A range of socioeconomic factors were significantly associated with vaccination status in study children but these results were largely site-specific.ConclusionsOur findings highlight the need to improve measles vaccination rates and reduce delayed vaccination to achieve EPI targets related to the establishment of herd immunity and reduction in disease transmission.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vaccine coverage and adherence to EPI schedules in eight resource poor settings in the MAL-ED cohort study

Hoest

Seidman

Lee

et al. 2017

Vaccine

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“…One of the MAL-ED study sites is located in Santa Clara de Nanay, a peri-urban community located 15 km from the city of Iquitos in the Loreto province of Peru, in a low-lying equatorial rainforest area situated at the confluence of several Amazon tributaries [29]. Since waterways are the main transport infrastructure in this region, the large majority of the population is located on or in close proximity to the banks of rivers, making them particularly vulnerable to flooding.…”

Section: Study Settingmentioning

confidence: 99%

Pathogen-Specific Impacts of the 2011–2012 La Niña-Associated Floods on Enteric Infections in the MAL-ED Peru Cohort: A Comparative Interrupted Time Series Analysis

Colston

Olórtegui

Zaitchik

et al. 2020

IJERPH

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Extreme floods pose multiple direct and indirect health risks. These risks include contamination of water, food, and the environment, often causing outbreaks of diarrheal disease. Evidence regarding the effects of flooding on individual diarrhea-causing pathogens is limited, but is urgently needed in order to plan and implement interventions and prioritize resources before climate-related disasters strike. This study applied a causal inference approach to data from a multisite study that deployed broadly inclusive diagnostics for numerous high-burden common enteropathogens. Relative risks (RRs) of infection with each pathogen during a flooding disaster that occurred at one of the sites—Loreto, Peru—were calculated from generalized linear models using a comparative interrupted time series framework with the other sites as a comparison group and adjusting for background seasonality. During the early period of the flood, increased risk of heat-stable enterotoxigenic E. coli (ST-ETEC) was identified (RR = 1.73 [1.10, 2.71]) along with a decreased risk of enteric adenovirus (RR = 0.36 [0.23, 0.58]). During the later period of the flood, sharp increases in the risk of rotavirus (RR = 5.30 [2.70, 10.40]) and sapovirus (RR = 2.47 [1.79, 3.41]) were observed, in addition to increases in transmission of Shigella spp. (RR = 2.86 [1.81, 4.52]) and Campylobacter spp. (RR = 1.41 (1.01, 1.07). Genotype-specific exploratory analysis reveals that the rise in rotavirus transmission during the flood was likely due to the introduction of a locally atypical, non-vaccine (G2P[4]) strain of the virus. Policy-makers should target interventions towards these pathogens—including vaccines as they become available—in settings where vulnerability to flooding is high as part of disaster preparedness strategies, while investments in radical, transformative, community-wide, and locally-tailored water and sanitation interventions are also needed.

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“…For children 0-5, 6–11, and 12–24 months of age, the incidence was 2.4, 6.6 and 7.0 cases per 100 child-months, respectively. We also performed the analysis using recent data collected from an ongoing rural jungle diarrhea surveillance site in the Amazon Basin [15–17]. With these estimates, children aged 0–5 months, 6–11 months, 12–17 months, 18–24 months, 25–35 months, 36–47 months, and 48–59 months, experienced an incidence of 3.6, 15.8, 15.1, 8.6, 7.9, 6.8, and 5.5 cases per 100 child-months, respectively.…”

Section: Methods and Datamentioning

confidence: 99%

“…One-way sensitivity of Cost per Disability Adjusted Life Year (DALY) Averted versus Vaccine Cost (2A, top) and Vaccine Effectiveness (2B, bottom) using Peri-urban [6] and Jungle [15] Norovirus Incidence Rates.…”

Section: Figurementioning

confidence: 99%

Cost-effectiveness of norovirus vaccination in children in Peru

Mirelman

Ballard

Saito

et al. 2015

Vaccine

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Background With candidate norovirus (NV) vaccines in a rapid phase of development, assessment of the potential economic value of vaccine implementation will be necessary to aid health officials in vaccine implementation decisions. To date, no evaluations have been performed to evaluate the benefit of adopting NV vaccines for use in the childhood immunization programs of low- and middle-income countries. Methods We used a Markov decision model to evaluate the cost-effectiveness of adding a two-dose NV vaccine to Peru’s routine childhood immunization schedule using two recent estimates of NV incidence, one for a peri-urban region and one for a jungle region of the country. Results Using the peri-urban NV incidence estimate, the annual cost of vaccination would be $13.0 million, offset by $2.6 million in treatment savings. Overall, this would result in 473 total DALYs averted; 526,245 diarrhea cases averted;153,735 outpatient visits averted; and 414 hospitalizations averted between birth and the fifth year of life. The incremental cost-effectiveness ratio would be $21,415 per DALY averted; $19.86 per diarrhea case; $68.23 per outpatient visit; and $26,298 per hospitalization. Using the higher jungle NV incidence rates provided a lower cost per DALY of $10,135. The incremental cost per DALY with per-urban NV incidence is greater than three times the 2012 GDP per capita of Peru but the estimate drops below this threshold using the incidence from the jungle setting. In addition to the impact of incidence, sensitivity analysis showed that vaccine price and efficacy play a strong role in determining the level of cost-effectiveness. Conclusions The introduction of a NV vaccine would prevent many healthcare outcomes in the Peru and potentially be cost-effective in scenarios with high NV incidence. The vaccine cost-effectiveness model could also be applied to the evaluation of NV vaccine cost-effectiveness in other countries. In resource-poor settings, where NV incidence rates are expected to be higher.

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Santa Clara de Nanay: The MAL-ED Cohort in Peru

Cited by 62 publications

References 28 publications

Vaccine coverage and adherence to EPI schedules in eight resource poor settings in the MAL-ED cohort study

Vaccine coverage and adherence to EPI schedules in eight resource poor settings in the MAL-ED cohort study

Pathogen-Specific Impacts of the 2011–2012 La Niña-Associated Floods on Enteric Infections in the MAL-ED Peru Cohort: A Comparative Interrupted Time Series Analysis

Cost-effectiveness of norovirus vaccination in children in Peru

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