Disease burden and seasonal impact of improving rotavirus vaccine coverage in the United States: A modeling study.

BACKGROUND: Prior to vaccine introduction in 2006, rotavirus was the leading cause of severe diarrhea in children under five years of age in the U.S. Vaccination of infants has led to major reductions in disease burden, a shift in the seasonal peak and the emergence of a biennial pattern of disease. However, rotavirus vaccine coverage has remained relatively low (70-75%) compared to other infant immunizations in the U.S. Part of the reason for this lower coverage is that children whose care is provided by family practitioners (FP) have considerably lower probability of being vaccinated compared to those seen be pediatricians (PE). We used a dynamic transmission model to assess the impact of improving rotavirus vaccine coverage by FP and/or PE on rotavirus gastroenteritis (RVGE) incidence and seasonal patterns. METHODS: A deterministic age-structured dynamic model with susceptible, infectious, and recovered compartments (SIRS model) was used to simulate rotavirus transmission and vaccination. We estimated the reduction of RVGE cases by 2 doses of rotavirus vaccine with three vaccination scenarios: (Status Quo: 85% coverage by pediatricians and 45% coverage by family practitioners; Improved FP: 85% coverage by pediatricians and family practitioners; Improved FP+PE: 95% coverage by pediatricians and family practitioners). In addition, we tested the sensitivity of the model to the assumption of random mixing patterns between children visiting pediatricians and children visiting family practitioners. RESULTS: In this model, higher vaccine coverage provided by family practitioners and pediatricians leads to lower incidence of severe RVGE cases (23% averted in Improved FP and 57% averted in Improved FP+PE compared to Status Quo) including indirect effects. One critical impact of higher total vaccine coverage is the effect on rotavirus epidemic patterns in the U.S.; the biennial rotavirus epidemic patterns shifted to reduced annual epidemic patterns. Additionally, assortative mixing patterns in children visiting pediatricians and family practitioners amplify the impact of increasing vaccine coverage. CONCLUSION: Other high-income countries that introduced vaccine have not experienced biennial patterns, like the U.S. Our results suggest that increasing overall vaccine coverage to 85% among infants would lead to an overall reduction in incidence with annual epidemic patterns.

Blood and seminal plasma mercury levels and predatory fish intake in relation to low semen quality.

Declining human sperm quality has been demonstrated in several recent studies. Age, environmental factors, and nutritional factors can affect semen quality. Mercury (Hg) is considered a male reproductive toxicant. Animal studies indicated that exposure to Hg can cause DNA damage, sperm dysfunction, and decreased sperm motility. Some previous studies also revealed that blood Hg levels in infertile or subfertile males were higher than those in normal males. In this study, we recruited 84 male participants from a reproductive medical center and investigated the Hg, lead, and selenium levels in blood and seminal plasma. Participants were divided into two groups, low- and high-quality semen groups, according to the World Health Organization reference values for human semen characteristics. The distribution of blood reproductive hormones and information on participants' lifestyle and medical history were collected from structured questionnaires. Average Hg levels in blood were 9.3±5.9 versus 8.9±5.9 and in seminal plasma were 1.26±0.61 versus 1.05±0.52 µg/L in the low- and high-quality semen groups, respectively. There was a dose-dependent relationship between blood Hg levels and normal sperm morphology (p=0.02). Participants with predatory fish intake and high blood Hg level had lower sperm with a normal morphology. Therefore, predatory fish intake may be a critical risk factor for elevated Hg levels in males and cause low semen quality.