Immunization of Mothers of Children with Cerebral Palsy in Rural Bangladesh.

BACKGROUND: Vaccination is one of the most effective public health tools for the prevention of infectious diseases, morbidity and disability. Little is known about the rate of maternal immunization among mothers of children with Cerebral Palsy (CP), as well as any possible role of maternal immunization in development of CP in the newborns. OBJECTIVE: To determine the socio-demographic characteristics and self-reported vaccination status of mothers of children with CP and compare vaccination coverage in this cohort with national data on immunization. The study also aims to assess the vaccination status of children with CP. METHODS: A subset of the Bangladesh CP Register (BCPR) cohort of women who had children with CP were recruited during April 2017 from a community based early intervention and rehabilitation program going on in Shahjadpur. Socio-demographic characteristics and maternal immunization status were assessed using a semi-structured questionnaire. The vaccination status of the children was also assessed by interviewing mother and observing the BCG marks. All data were compared with the corresponding information among general population using national vaccination coverage survey reports of the Ministry of Health and Family Welfare, Bangladesh. RESULT: Sixty-eight mothers were interviewed of which 17.6% of mothers reported not receiving any vaccine during pregnancy. Tetanus vaccine was most commonly (82.0%) received during pregnancy. Overall coverage for at least two doses of tetanus toxoid (TT) among mothers of children with CP was significantly lower than the national tetanus coverage (79.4% versus 96.4%, p<0.01). Forty-two (61.7%) mothers with a child with CP reported having not received tetanus vaccine during their pregnancy compared to only twenty (29.4%) mothers with healthy children reported missing tetanus vaccination during their pregnancy. This difference was statistically significant (p<0.01). Hepatitis B and influenza vaccine were received by mothers of children with CP during the antenatal period (2 and 6 respectively). CONCLUSION: Immunization among mothers of children with CP is significantly poorer than the national coverage. Also, the immunization of the children with CP is poorer than the national EPI coverage. Our findings reflect the necessity for specific strategies to improve the vaccination coverage among mothers of children with disabilities especially CP and the children with CP.

Assessing the Impact of a Vi-polysaccharide Conjugate Vaccine in Preventing Typhoid Infection Among Bangladeshi Children: A Protocol for a Phase IIIb Trial.

BACKGROUND: Typhoid fever illnesses are responsible for more than 100 000 deaths worldwide each year. In Bangladesh, typhoid fever is endemic, with incidence rates between 292-395 per 100 000 people annually. While considerable effort has been made to improve access to clean water and sanitation services in the country, there is still a significant annual typhoid burden, which particularly affects children. A typhoid conjugate vaccine (Vi-TCV) was recently prequalified by the World Health Organization and recommended for use, and offers the potential to greatly reduce the typhoid burden in Bangladesh. METHODS: This study is a double-blind, cluster-randomized, controlled trial of Vi-TCV in a geographically defined area in Dhaka, Bangladesh. At least 32 500 children from 9 months to <16 years of age will be vaccinated and followed for 2 years to assess the effectiveness and safety of Vi-TCV in a real-world setting. All cluster residents will also be followed to measure the indirect effect of Vi-TCV in this community. ETHICS AND DISSEMINATION: This protocol has been approved by the International Centre for Diarrhoeal Disease Research, Bangladesh; a University of Oxford research review; and both ethical review committees. Informed written consent and assent will be obtained before enrollment. Vi-TCV has been shown to be safe and effective in previous, smaller-scale studies. The results of this study will be shared through a series of peer-reviewed journal articles. The findings will also be disseminated to the local government, stakeholders within the community, and the population within which the study was conducted. CONCLUSIONS: This trial is the largest and only cluster-randomized control trial of Vi-TCV ever conducted, and will describe the effectiveness of Vi-TCV in an endemic population. The results of this trial may provide important evidence to support the introduction of TCVs in countries with a high burden of typhoid. CLINICAL TRIALS REGISTRATION: ISRCTN11643110.

Baseline Widal Titer Among Healthy Adult Males from the Greater Mymensingh Division of Bangladesh.

BACKGROUND: Widal test is the most widely used laboratory investigation for diagnosis of typhoid. However, the test interpretation remains controversial in the context of endemic regions such as Bangladesh, as agglutination occurs at varied titrations among a large percentage of healthy population. Paired Widal tests are often not feasible; hence single unpaired test has to be used for screening, diagnosis and treatment. OBJECTIVE: We aimed to assess the normal range of baseline titre for Anti TO, TH, AO, AH, BO agglutinins among healthy population in an endemic country with a view to guide the researchers and the clinicians, facilitating further investigation on updating cut off points of single Widal test for screening and diagnosis of typhoid fever in the context of Bangladesh. METHODS: A cross-sectional study was carried out in Mymensingh Medical College, Bangladesh on 2925 male immigration applicants. A single blood sample was collected for Widal test and interpreted using standard guidelines. RESULTS: The highest baseline titer for Anti TO, TH, AO, AH, BO agglutinins among 95% of the healthy participants was found to be 1:80 for each respectively. A titre of 1: 40 was observed for BH antigen. CONCLUSION: In case of singular Widal test, baseline values for the normal range was found to be 1:20 - 1:80 for all the antigens (TO, TH, AO, AH, BO, BH), except BH, for which it was 1:20-1:40. Further studies, inclusive of other sociodemographic groups and positive controls are required to determine the updated cut off values.