Browsing by Author "Steenhoff, Andrew P."

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    Effect of Haemophilus influenzae Type b and 13-Valent Pneumococcal Conjugate Vaccines on Childhood Pneumonia Hospitalizations and Deaths in Botswana
    (Oxford University Press, 2021-07-15) Congdon, Morgan; Hong, Hwanhee; Young, Rebecca R.; Cunningham, Coleen K.; Enane, Leslie A.; Arscott-Mills, Tonya; Banda, Francis M.; Chise, Mamiki; Motlhatlhedi, Keneilwe; Feemster, Kristen; Patel, Sweta M.; Boiditswe, Sefelani; Leburu, Tiroyaone; Shah, Samir S.; Steenhoff, Andrew P.; Kelly, Matthew S.; Pediatrics, School of Medicine
    Background: Globally, pneumonia is the leading cause of death among children. Few data exist regarding the effect of Haemophilus influenzae type b (Hib) vaccine and 13-valent pneumococcal conjugate vaccine (PCV-13) on the burden of childhood pneumonia in African settings. Methods: We collected data on children aged 1 to 59 months at 3 hospitals in Botswana. Hib vaccine and PCV-13 were introduced in Botswana in November 2010 and July 2012, respectively. We compared pneumonia hospitalizations and deaths prevaccine (January 2009 to October 2010) with postvaccine (January 2013 to December 2017) using seasonally adjusted, interrupted time-series analyses. Results: We identified 6943 pneumonia hospitalizations and 201 pneumonia deaths. In the prevaccine period, pneumonia hospitalizations and deaths increased by 24% (rate, 1.24; 95% CI, .94-1.64) and 59% (rate, 1.59; 95% CI, .87-2.90) per year, respectively. Vaccine introduction was associated with a 48% (95% CI, 29-62%) decrease in the number of pneumonia hospitalizations and a 50% (95% CI, 1-75%) decrease in the number of pneumonia deaths between the end of the prevaccine period (October 2010) and the beginning of the postvaccine period (January 2013). During the postvaccine period, pneumonia hospitalizations and deaths declined by 6% (rate, .94; 95% CI, .89-.99) and 22% (rate, .78; 95% CI, .67-.92) per year, respectively. Conclusions: Pneumonia hospitalizations and deaths among children declined sharply following introduction of Hib vaccine and PCV-13 in Botswana. This effect was sustained for more than 5 years after vaccine introduction, supporting the long-term effectiveness of these vaccines in preventing childhood pneumonia in Botswana.
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    Investigating Outcomes of Adolescents and Young Adults (10–24 Years of Age) Lost to Follow-up from Tuberculosis Treatment in Gaborone, Botswana
    (Wolters Kluwer, 2019-10-01) Enane, Leslie A.; Lowenthal, Elizabeth D.; Arscott-Mills, Tonya; Eby, Jessica; Caiphus, Cynthia; Kgwaadira, Botshelo; Coffin, Susan E.; Steenhoff, Andrew P.; Pediatrics, School of Medicine
    This retrospective study investigated outcomes among lost to follow-up (LTFU) adolescents and young adults (AYA, ages 10–24) with tuberculosis (TB) registered from 2008–2014 in Gaborone, using surveillance data. Of 68 LTFU AYA, 16 repeated treatment; 8 completed and 6 were again LTFU. Of 4 confirmed deaths, 3 had TB/HIV co-infection. Approaches to improve AYA retention in TB care are needed.
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    Near-term pregnant women in the Dominican Republic experience high rates of Group B Streptococcus rectovaginal colonization with virulent strains
    (Public Library of Science, 2023-09-21) Laycock, Katherine M.; Acosta, Francia; Valera, Sandra; Villegas, Ana; Mejia, Elia; Mateo, Christian; Felipe, Rosa; Fernández, Anabel; Job, Megan; Dongas, Sophia; Steenhoff, Andrew P.; Ratner, Adam J.; Geoghegan, Sarah; Pediatrics, School of Medicine
    Maternal colonization with Group B Streptococcus (GBS) is an important cause of stillbirth, prematurity, and serious infection and death in infants worldwide. Resource constraints limit prevention strategies in many regions. Maternal GBS vaccines in development could be a more accessible prevention strategy, but data on geographic variations in GBS clones are needed to guide development of a broadly effective vaccine. In the Dominican Republic (DR), limited data suggest that pregnant women experience GBS colonization at rates among the highest globally. We aimed to determine the prevalence of maternal rectovaginal GBS colonization and describe clonal characteristics of colonizing strains in the DR. A cross-sectional study assessed rectovaginal GBS colonization in 350 near-term pregnant women presenting for routine prenatal care at an urban tertiary center in the DR. Rectovaginal samples were tested with chromogenic Strep B Carrot Broth and cultured for confirmatory whole-genome sequencing. In a secondary analysis, participants' demographics and histories were assessed for association with GBS colonization. Rectovaginal GBS colonization occurred in 26.6% of women. Serotypes Ia, Ib, II, III, IV, and V were detected, with no one serotype predominating; serotype III was identified most frequently (21.5%). Virulent and emerging strains were common, including CC17 (15.1%) and ST1010 (17.2%). In this first characterization of maternal GBS serotypes in the DR, we found high rates of rectovaginal colonization including with virulent and emerging GBS strains. The serotypes observed here are all targeted by candidate hexavalent GBS vaccines, suggesting effective protection in the DR.
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    Tuberculosis in Adolescents and Young Adults: Emerging Data on TB Transmission and Prevention among Vulnerable Young People
    (MDPI, 2021-08-05) Laycock, Katherine M.; Enane, Leslie A.; Steenhoff, Andrew P.; Pediatrics, School of Medicine
    Adolescents and young adults (AYA, ages 10–24 years) comprise a uniquely important but understudied population in global efforts to end tuberculosis (TB), the leading infectious cause of death by a single agent worldwide prior to the COVID-19 pandemic. While TB prevention and care strategies often overlook AYA by grouping them with either children or adults, AYA have particular physiologic, developmental, and social characteristics that require dedicated approaches. This review describes current evidence on the prevention and control of TB among AYA, including approaches to TB screening, dynamics of TB transmission among AYA, and management challenges within the context of unique developmental needs. Challenges are considered for vulnerable groups of AYA such as migrants and refugees; AYA experiencing homelessness, incarceration, or substance use; and AYA living with HIV. We outline areas for needed research and implementation strategies to address TB among AYA globally.
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    "We did not know what was wrong"-Barriers along the care cascade among hospitalized adolescents with HIV in Gaborone, Botswana
    (Public Library of Science, 2018-04-09) Enane, Leslie A.; Mokete, Keboletse; Dipesalema, Joel; Daimari, Rahul; Tshume, Ontibile; Anabwani, Gabriel; Mazhani, Loeto; Steenhoff, Andrew P.; Lowenthal, Elizabeth D.; Pediatrics, School of Medicine
    High mortality among adolescents with HIV reflects delays and failures in the care cascade. We sought to elucidate critical missed opportunities and barriers to care among adolescents hospitalized with HIV at Botswana's tertiary referral hospital. We enrolled all HIV-infected adolescents (aged 10-19 years) hospitalized with any diagnosis other than pregnancy from July 2015 to January 2016. Medical records were reviewed for clinical variables and past engagement in care. Semi-structured interviews of the adolescents (when feasible) and their caregivers explored delays and barriers to care. Twenty-one eligible adolescents were identified and 15 were enrolled. All but one were WHO Clinical Stage 3 or 4. Barriers to diagnosis included lack of awareness about perinatal HIV infection, illness or death of the mother, and fear of discrimination. Barriers to adherence to antiretroviral therapy included nondisclosure, isolation, and mental health concerns. The number of hospitalized HIV-infected adolescents was lower than expected. However, among those hospitalized, the lack of timely diagnosis and subsequent gaps in the care cascade elucidated opportunities to improve outcomes and quality of life for this vulnerable group.