Spatiotemporal clustering analysis of Expanded Program on Immunization (EPI) vaccination coverage in Pakistan

Umer, Muhammad Farooq; Zofeen, Shumaila; Hu, Wenbiao; Xin, Qi; Zhuang, Guihua

doi:10.1038/s41598-020-67839-0

Cited by 15 publications

(14 citation statements)

References 37 publications

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“…Geographically, Balochistan is largest province in terms of area with scarcity of resources, impoverish and low socioeconomic status of population in contrast with sister provinces. Emerging bacterial antibiotic resistivity is a major challenge in Balochistan due to fragile healthcare system (Umer et al 2020; USAID Pakistan. 2012).…”

Section: Introductionmentioning

confidence: 99%

“…Thus in many regions of Pakistan, a drastic reduction (72%) in H. in uenza associated meningitis cases were observed due to vaccination coverage(Teleb et al 2013). The main reasons of high frequency of BM cases in Balochistan were due to low coverage of vaccination and higher urbanization among rural population(Umer et al 2020; Pakistan Bureau of Statistics. 2015).…”

mentioning

confidence: 99%

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WITHDRAWN: Antimicrobial Resistance Pattern of Bacterial Meningitis Among Patients in Quetta, Pakistan

Ali

Taj

Ali

2021

Preprint

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Bacterial meningitis (BM) is lethal infectious disease that persists as substantial cause of morbidity and mortality. The antimicrobial drug resistances in BM pathogens possess a major threat in the community, while escalating challenges for clinicians. We for the first time elucidate incidence rate of BM and its drug resistance among the population of Quetta, Balochistan. A cross-sectional study was conducted (form January 2018 to March 2021) among meningitis patients admitted at Government Hospitals in Quetta. The cerebrospinal fluid (CSF) specimen was collected and processed for microbiological and cytological analysis. Bacterial isolates were identified and confirmed using phylogenetic analysis of 16S rRNA gene. We found 35.9% (321/894) confirmed cases of BM among the population of Quetta, Balochistan. The identified bacterial isolates comprised of Streptococcus pneumonia 14.7% (130/894), Staphylococcus aureus 6.9% (61/894), Neisseria meningitidis 5.7% (51/894). Haemophilus influenza 2.5% (22/894), Escherichia coli 4.5% (40/894), and Klebsiella pneumoniae 1.9% (17/894). A surge in male patients 20.8% (186/894) was identified as compare to female patients 15.1% (135/894). Extreme age groups such as Infants (age range: 1month- 1year) and adults (age range: 61years- 99years) with low immunity were critically affected with BM. Clinical parameters such as abnormal CSF appearance, pH, high WBCs in BM patients with endocarditis as underlying disease were significantly at elevated risk of fatal outcome. 16S rRNA gene phylogenetic analysis confirmed evolutionary similarity of isolated strains with prevailing pathogenic strains in Asia. Furthermore, age was identified as significant risk factors for clinical outcomes. Majority of the identified BM patients belonged to rural areas with limited healthcare facilities and paramedics’ staff. High fatality rate demonstrates increased antibiotic resistance among BM isolates, thereby stimulating its devastation among underdeveloped region. Timely detection and intensive treatment of BM may improve critical outcomes in patients

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

WITHDRAWN: Antimicrobial Resistance Pattern of Bacterial Meningitis Among Patients in Quetta, Pakistan

Ali

Taj

Ali

2021

Preprint

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“…A high incidence rate of S. pneumoniae was observed among children who were unvaccinated or partially vaccinated due to low coverage of vaccination, higher urbanization among the rural population, which led to negligence and low vaccination rate among the population. 12 , 28 According to USAID report of Pakistan, 1 in every 5 children remains unvaccinated in cities while rural areas have high rate of unvaccinated children (ie 2 out of 3). 13 We also found significantly high percentage of children (less than one year of age) and elderly patients afflicted with E. coli and K. pneumoniae associated BM.…”

Section: Discussionmentioning

confidence: 99%

“…38 , 39 This rapid increase in fatality rates is a consequence of lack of basic healthcare facilities, absence of professional paramedics’ staff, and the shortage of medical equipments. 12 The bacterial culturing of the CSF is gold standard and routinely performed for diagnosis, yet it is a laborious and time-consuming method. The molecular detection method is suitable for BM patients with single-cell pathogens in CSF.…”

Section: Discussionmentioning

confidence: 99%

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Antimicrobial Resistance Pattern of Bacterial Meningitis Among Patients in Quetta, Pakistan

Ali¹,

Taj²,

Ali³

2021

IDR

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Introduction: Bacterial meningitis (BM) is a lethal infectious disease that persists as a substantial cause of morbidity and mortality. The antimicrobial drug resistance in BM pathogens poses a major threat to the community while raising challenges for clinicians. For the first time, we elucidate the incidence rate of BM and its drug resistance among the population of Quetta, Balochistan. Methods: A cross-sectional study was conducted (from January 2018 to March 2021) among meningitis patients admitted to government hospitals in Quetta. The cerebrospinal fluid (CSF) specimen was collected and processed for microbiological and cytological analysis. Bacterial isolates were identified and confirmed using phylogenetic analysis of the 16S rRNA gene. Results: We found 35.9% (321/894) confirmed cases of BM among the population of Quetta, Balochistan. The identified bacterial isolates comprised Streptococcus pneumoniae 14.7% (130/894), Staphylococcus aureus 6.9% (61/894), Neisseria meningitidis 5.7% (51/ 894), Haemophilus influenzae 2.5% (22/894), Escherichia coli 4.5% (40/894), and Klebsiella pneumoniae 1.9% (17/894). A high percentage in male patients of 20.8% (186/894) was identified as compared to female patients of 15.1% (135/894). Extreme age groups such as infants (age range: 1 month to 1 year) and adults (age range: 61 years to 99 years) with low immunity were critically affected by BM. Clinical parameters such as abnormal CSF appearance, pH, and high WBCs in BM patients with endocarditis as the underlying disease were significantly at elevated risk of fatal outcome. 16S rRNA gene phylogenetic analysis confirmed the evolutionary similarity of isolated strains with prevailing pathogenic strains in Asia. Furthermore, age was identified as a significant risk factor for clinical outcomes. Conclusion:The majority of the identified BM patients belonged to rural areas with limited health-care facilities and paramedic staff. The high case fatality rate 11% demonstrates increased antibiotic resistance among BM isolates, thereby stimulating its devastation in underdeveloped regions. Timely detection and intensive treatment of BM may improve critical outcomes in patients.

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From COVID-19 to measles: Prioritizing immunization in Pakistan's far-flung regions

Awan

Hussain²,

Qureshi³

et al. 2023

Journal of Infection

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Spatiotemporal clustering analysis of Expanded Program on Immunization (EPI) vaccination coverage in Pakistan

Cited by 15 publications

References 37 publications

WITHDRAWN: Antimicrobial Resistance Pattern of Bacterial Meningitis Among Patients in Quetta, Pakistan

WITHDRAWN: Antimicrobial Resistance Pattern of Bacterial Meningitis Among Patients in Quetta, Pakistan

Antimicrobial Resistance Pattern of Bacterial Meningitis Among Patients in Quetta, Pakistan

From COVID-19 to measles: Prioritizing immunization in Pakistan's far-flung regions

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