Distance to health services affects local-level vaccine efficacy for pneumococcal conjugate vaccine (PCV) among rural Filipino children

Pneumococcal conjugate vaccines (PCVs) have demonstrated efficacy against childhood pneumococcal disease in several regions globally. We demonstrate how spatial epidemiological analysis of a PCV trial can assist in developing vaccination strategies that target specific geographic subpopulations at g...

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Vydáno v:Proceedings of the National Academy of Sciences - PNAS Ročník 111; číslo 9; s. 3520
Hlavní autoři: Root, Elisabeth Dowling, Lucero, Marilla, Nohynek, Hanna, Anthamatten, Peter, Thomas, Deborah S K, Tallo, Veronica, Tanskanen, Antti, Quiambao, Beatriz P, Puumalainen, Taneli, Lupisan, Socorro P, Ruutu, Petri, Ladesma, Erma, Williams, Gail M, Riley, Ian, Simões, Eric A F
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States 04.03.2014
Témata:
Geographic Information Systems
Geography
Health Services Accessibility - statistics & numerical data
Humans
Infant
Mass Vaccination - methods
Philippines - epidemiology
Pneumococcal Vaccines - administration & dosage
Pneumonia, Pneumococcal - epidemiology
Pneumonia, Pneumococcal - prevention & control
Regression Analysis
Rural Population - statistics & numerical data
Spatial Analysis
Philippines
GIS
spatial epidemiology
spatial analysis
targeted intervention
randomized controlled trial
ISSN:1091-6490, 1091-6490
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Shrnutí:Pneumococcal conjugate vaccines (PCVs) have demonstrated efficacy against childhood pneumococcal disease in several regions globally. We demonstrate how spatial epidemiological analysis of a PCV trial can assist in developing vaccination strategies that target specific geographic subpopulations at greater risk for pneumococcal pneumonia. We conducted a secondary analysis of a randomized, placebo-controlled, double-blind vaccine trial that examined the efficacy of an 11-valent PCV among children less than 2 y of age in Bohol, Philippines. Trial data were linked to the residential location of each participant using a geographic information system. We use spatial interpolation methods to create smoothed surface maps of vaccination rates and local-level vaccine efficacy across the study area. We then measure the relationship between distance to the main study hospital and local-level vaccine efficacy, controlling for ecological factors, using spatial autoregressive models with spatial autoregressive disturbances. We find a significant amount of spatial variation in vaccination rates across the study area. For the primary study endpoint vaccine efficacy increased with distance from the main study hospital from -14% for children living less than 1.5 km from Bohol Regional Hospital (BRH) to 55% for children living greater than 8.5 km from BRH. Spatial regression models indicated that after adjustment for ecological factors, distance to the main study hospital was positively related to vaccine efficacy, increasing at a rate of 4.5% per kilometer distance. Because areas with poor access to care have significantly higher VE, targeted vaccination of children in these areas might allow for a more effective implementation of global programs.
Bibliografie:ObjectType-Article-1
SourceType-Scholarly Journals-1
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content type line 23
ISSN:1091-6490
1091-6490
DOI:10.1073/pnas.1313748111