Department of Population Health Sciences

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Burden of lower respiratory infections in the Eastern Mediterranean Region between 1990 and 2015: findings from the Global Burden of Disease 2015 study
Mokdad, Ali H.; Moradi-Lakeh, Maziar; El Bcheraoui, Charbel; Charara, Raghid; Khalil, Ibrahim; Afshin, Ashkan; Kassebaum, Nicholas J.; Collison, Michael; Daoud, Farah; Chew, Adrienne; Krohn, Kristopher J.; Colombara, Danny; Ehrenkranz, Rebecca; Foreman, Kyle J.; Frostad, Joseph; Godwin, William W.; Kutz, Michael; Rao, Puja C.; Reiner, Robert; Troeger, Christopher; Wang, Haidong; Abajobir, Amanuel Alemu; Abbas, Kaja M.; Abera, Semaw Ferede; Abu-Raddad, Laith J.; Adane, Kelemework; Kiadaliri, Aliasghar Ahmad; Ahmadi, Alireza; Beshir, Muktar; Al-Eyadhy, Ayman; Alam, Khurshid; Alam, Noore; Alasfoor, Deena; Alizadeh-Navaei, Reza; Al-Maskari, Fatma; Al-Raddadi, Rajaa; Alsharif, Ubai; Altirkawi, Khalid A.; Anber, Nahla; Ansari, Hossein; Antonio, Carl Abelardo T.; Anwari, Palwasha; Asayesh, Hamid; Asgedom, Solomon Weldegebreal; Atey, Tesfay Mehari; Arthur, Euripide Frinel G.; Bacha, Umar; Barac, Aleksandra; Bazargan-Hejazi, Shahrzad; Drew, Charles R.; Geffen, David; Bedi, Neeraj; Bhutta, Zulfiqar A.; Michael, Brauer; Butt, Zahid A.; Castañeda-Orjuela, Carlos A.; Danawi, Hadi; Djalalinia, Shirin; Endries, Aman Yesuf; Eshrati, Babak; Farvid, Maryam S.; Fereshtehnejad, Seyed-Mohammad; Fischer, Florian; Garcia-Basteiro, Alberto L.; Gebrehiwot, Kiros Tedla; Gebrehiwot, Tsegaye Tewelde; Hailu, Gessessew Bugssa; Hamadeh, Randah Ribhi; Hambisa, Mitiku Teshome; Hamidi, Samer; Hassanvand, Mohammad Sadegh; Hedayati, Mohammad T.; Horita, Nobuyuki; Husseini, Abdullatif; Spencer, Lewis James; Javanbakht, Mehdi; Jonas, Jost B.; Kasaeian, Amir; Khader, Yousef Saleh; Khan, Ejaz Ahmad; Khan, Gulfaraz; Khoja, Abdullah Tawfih Abdullah; Khubchandani, Jagdish; Kim, Yun Jin; Kissoon, Niranjan; Larson, Heidi J.; Latif, Asma Abdul; Leshargie, Cheru Tesema; Lunevicius, Raimundas; Abd El Razek, Hassan Magdy; Abd El Razek, Mohammed Magdy; Majdzadeh, Reza; Majeed, Azeem; Malekzadeh, Reza; Farid, Habibolah Masoudi; Mehari, Alem; Memish, Ziad A.; Mengistu, Desalegn Tadese; Mensah, George A.; Mezgebe, Haftay Berhane; Nakamura, Sachiko; Oren, Eyal; Pourmalek, Farshad; Qorbani, Mostafa; Radfar, Amir; Rafay, Anwar; Rahimi-Movaghar, Vafa; Rai, Rajesh Kumar; Rawaf, David Laith; Rawaf, Salman; Refaat, Amany H.; Rezaei, Satar; Rezai, Mohammad Sadegh; Roba, Hirbo Shore; Roshandel, Gholamreza; Safdarian, Mahdi; Safiri, Saeid; Sahraian, Mohammad Ali; Salamati, Payman; Samy, Abdallah M.; Sartorius, Benn; Sepanlou, Sadaf G.; Shaikh, Masood Ali; Shamsizadeh, Morteza; Shigematsu, Mika; Singh, Jasvinder A.; Sufiyan, Muawiyyah Babale; Tehrani-Banihashemi, Arash; Temsah, Mohamad-Hani; Topor-Madry, Roman; Uthman, Olalekan A.; Vollset, Stein Emil; Wakayo, Tolassa; Werdecker, Andrea; Wijeratne, Tissa; Yaghoubi, Mohsen; Yimam, Hassen Hamid; Yonemoto, Naohiro; Younis, Mustafa Z.; Zaki, Maysaa El Sayed; Jumaan, Aisha O.; Vos, Theo; Naghavi, Mohsen; Hay, Simon I.; Murray, Christopher J. L. (2018-05)
We used data from the Global Burden of Disease 2015 study (GBD) to calculate the burden of lower respiratory infections (LRIs) in the 22 countries of the Eastern Mediterranean Region (EMR) from 1990 to 2015. We conducted a systematic analysis of mortality and morbidity data for LRI and its specific etiologic factors, including pneumococcus, Haemophilus influenzae type b, Respiratory syncytial virus, and influenza virus. We used modeling methods to estimate incidence, deaths, and disability-adjusted life-years (DALYs). We calculated burden attributable to known risk factors for LRI. In 2015, LRIs were the fourth-leading cause of DALYs, causing 11,098,243 (95% UI 9,857,095-12,396,566) DALYs and 191,114 (95% UI 170,934-210,705) deaths. The LRI DALY rates were higher than global estimates in 2015. The highest and lowest age-standardized rates of DALYs were observed in Somalia and Lebanon, respectively. Undernutrition in childhood and ambient particulate matter air pollution in the elderly were the main risk factors. Our findings call for public health strategies to reduce the level of risk factors in each age group, especially vulnerable child and elderly populations.
Child and Adolescent Health From 1990 to 2015: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study
Global Burden of Disease Child and Adolescent Health Collaboration; Kassebaum, N.; Kyu, H. H.; Zoeckler, L.; Olsen, H. E.; Thomas, K.; Pinho, C.; Bhutta, Z. A.; Dandona, L.; Ferrari, A.; Ghiwot, T. T.; Hay, Simon I.; Kinfu, Y.; Liang, X.; Lopez, A.; Malta, D. C.; Mokdad, Ali H.; Naghavi, Mohsen; Patton, G. C.; Salomon, J.; Sartorius, Benn; Topor-Madry, Roman; Vollset, S. E.; Werdecker, Andrea; Whiteford, H. A.; Abate, K. H.; Abbas, Kaja M.; Abreha Damtew, S.; Ahmed, M. B.; Akseer, N.; Al-Raddadi, Rajaa; Alemayohu, M. A.; Altirkawi, Khalid A.; Abajobir, A. A.; Amare, A. T.; Antonio, C. A.; Arnlov, J.; Artaman, A.; Asayesh, Hamid; Avokpaho, E. F.; Awasthi, A.; Ayala Quintanilla, B. P.; Bacha, Umar; Balem, D.; Barac, A.; Bärnighausen, T. W.; Baye, E.; Bedi, N.; Bensenor, I. M.; Berhane, Adugnaw; Bernabe, E.; Bernal, O. A.; Beyene, A. S.; Biadgilign, S.; Bikbov, B.; Boyce, C. A.; Brazinova, A.; Hailu, G. B.; Carter, Austin; Castañeda-Orjuela, Carlos A.; Catalá-López, F.; Charlson, F. J.; Chitheer, A. A.; Choi, J. J.; Ciobanu, L. G.; Crump, J.; Dandona, R.; Dellavalle, R. P.; Deribew, Amare; deVeber, G.; Dicker, D.; Betsu, B. B.; Ding, E. L.; Dubey, M.; Endries, A. Y.; Erskine, H. E.; Faraon, E. J.; Faro, A.; Farzadfar, F.; Fernandes, J. C.; Fijabi, D. O.; Fitzmaurice, C.; Fleming, T. D.; Flor, L. S.; Foreman, Kyle J.; Franklin, R. C.; Fraser, M. S.; Frostad, J. J.; Fullman, N.; Gebregergs, G. B.; Gebru, A. A.; Geleijnse, J. M.; Gibney, K. B.; Gidey Yihdego, M.; Ginawi, I. A.; Gishu, Melkamu Dedefo; Gizachew, T. A.; Glaser, E.; Gold, A. L.; Goldberg, E.; Gona, P.; Goto, A.; Gugnani, H. C.; Jiang, G.; Gupta, Rahul; Tesfay, F. H.; Hankey, G. J.; Havmoeller, R.; Hijar, M.; Horino, M.; Hosgood, H. D.; Hu, G.; Jacobsen, K. H.; Jakovljevic, M. B.; Jayaraman, S. P.; Jha, V.; Jibat, Tariku; Johnson, Catherine O.; Jonas, Jost; Kasaeian, Amir; Kawakami, Norito; Keiyoro, P. N.; Khalil, Ibrahim; Khang, Y. H.; Khubchandani, Jagdish; Ahmad Kiadaliri, A. A.; Kieling, C.; Kim, D.; Kissoon, Niranjan; Knibbs, L. D.; Koyanagi, Ai; Krohn, K. J.; Kuate Defo, B.; Kucuk Bicer, B.; Kulikoff, R.; Kumar, G. A.; Lal, D. K.; Lam, H. Y.; Larson, Heidi J.; Larsson, A.; Laryea, D. O.; Leung, J.; Lim, S. S.; Lo, L. T.; Lo, W. D.; Looker, K. J.; Lotufo, P. A.; Magdy Abd, H.; El Razek; Malekzadeh, Reza; Markos Shifti, D.; Mazidi, M.; Meaney, P. A.; Meles, K. G.; Memiah, Peter; Mendoza, Walter; Abera Mengistie, M.; Mengistu, G. W.; Mensah, G. A.; Miller, Ted R.; Mock, C.; Mohammadi, A.; Mohammed, S.; Monasta, L.; Mueller, U.; Nagata, C.; Naheed, A.; Nguyen, G.; Nguyen, Q. L.; Nsoesie, E.; Oh, I. H.; Okoro, A.; Olusanya, J. O.; Olusanya, B. O.; Ortiz, A.; Paudel, D.; Pereira, David M.; Perico, N.; Petzold, M.; Phillips, M. R.; Polanczyk, G. V.; Pourmalek, Farshad; Qorbani, Mostafa; Rafay, Anwar; Rahimi-Movaghar, Vafa; Rahman, M.; Rai, R. K.; Ram, U.; Rankin, Z.; Remuzzi, G.; Renzaho, Andre M. N.; Roba, H. S.; Rojas-Rueda, D.; Ronfani, L.; Sagar, R.; Sanabria, J. R.; Kedir Mohammed, M. S.; Santos, I. S.; Satpathy, M.; Sawhney, M.; Schöttker, B.; Schwebel, D. C.; Scott, J. G.; Sepanlou, Sadaf G.; Shaheen, A.; Shaikh, M. A.; She, J.; Shiri, R.; Shiue, I.; Sigfusdottir, I. D.; Singh, J.; Slipakit, N.; Smith, A.; Sreeramareddy, C.; Stanaway, J. D.; Stein, D. J.; Steiner, C.; Sufiyan, M. B.; Swaminathan, S.; Tabarés-Seisdedos, R.; Tabb, K. M.; Tadese, F.; Tavakkoli, M.; Taye, B.; Teeple, S.; Tegegne, T. K.; Temam Shifa, G.; Terkawi, A. S.; Thomas, B.; Thomson, A. J.; Tobe-Gai, R.; Tonelli, Marcello; Tran, Bach Xuan; Troeger, Christopher; Ukwaja, Kingsley N.; Uthman, Olalekan; Vasankari, Tommi; Venketasubramanian, Narayanaswamy; Vlassov, Vasiliy Victorovich; Weiderpass, Elisabete; Weintraub, Robert; Gebrehiwot, Solomon Weldemariam; Westerman, Ronny; Williams, Hywel C.; Wolfe, Charles D. A.; Woodbrook, Rachel; Yano, Yuichiro; Yonemoto, Naohiro; Yoon, Seok-Jun; Younis, Mustafa Z.; Yu, Chuanhua; Zaki, Maysaa El Sayed; Zegeye, Elias Asfaw; Zuhlke, Liesl Joanna; Murray, Christopher J. L.; Vos, Theo (2017-04-03)
Importance: Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health. Objective: To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion. Evidence Review: Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss. Findings: Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries. Conclusions and Relevance: Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.
Clinical Response, Outbreak Investigation and Epidemiology of the Fungal Meningitis Epidemic in the United States: Systematic Review
Abbas, Kaja M.; Dorratoltaj, Nargesalsadat; O'Dell, Margaret L.; Bordwine, Paige; Kerkering, Thomas M.; Redican, Kerry J. (2016-10-01)
We conducted a systematic review of the 2012-2013 multistate fungal meningitis epidemic in the United States from the perspectives of clinical response, outbreak investigation, and epidemiology. Articles focused on clinical response, outbreak investigation, and epidemiology were included, whereas articles focused on compounding pharmacies, legislation and litigation, diagnostics, microbiology, and pathogenesis were excluded. We reviewed 19 articles by use of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework. The source of the fungal meningitis outbreak was traced to the New England Compounding Center in Massachusetts, where injectable methylprednisolone acetate products were contaminated with the predominant pathogen, Exserohilum rostratum. As of October 23, 2013, the final case count stood at 751 patients and 64 deaths, and no additional cases are anticipated. The multisectoral public health response to the fungal meningitis epidemic from the hospitals, clinics, pharmacies, and the public health system at the local, state, and federal levels led to an efficient epidemiological investigation to trace the outbreak source and rapid implementation of multiple response plans. This systematic review reaffirms the effective execution of a multisectoral public health response and efficient delivery of the core functions of public health assessment, policy development, and service assurances to improve population health.
Demographics, perceptions, and socioeconomic factors affecting influenza vaccination among adults in the United States
Abbas, Kaja M.; Kang, Gloria J.; Chen, Daniel; Werre, Stephen R.; Marathe, Achla (PeerJ, 2018-07-13)
Objective. The study objective is to analyze influenza vaccination status by demographic factors, perceived vaccine efficacy, social influence, herd immunity, vaccine cost, health insurance status, and barriers to influenza vaccination among adults 18 years and older in the United States. Background. Influenza vaccination coverage among adults 18 years and older was 41% during 2010 2011 and has increased and plateaued at 43% during 2016 2017. This is below the target of 70% influenza vaccination coverage among adults, which is an objective of the Healthy People 2020 initiative. Methods. We conducted a survey of a nationally representative sample of adults 18 years and older in the United States on factors affecting influenza vaccination. We conducted bivariate analysis using Rao-Scott chi-square test and multivariate analysis using weighted multinomial logistic regression of this survey data to determine the effect of demographics, perceived vaccine efficacy, social influence, herd immunity, vaccine cost, health insurance, and barriers associated with influenza vaccination uptake among adults in the United States. Results. Influenza vaccination rates are relatively high among adults in older age groups (73.3% among 75Cyear old), adults with education levels of bachelor's degree or higher (45.1%), non-Hispanic Whites (41.8%), adults with higher incomes (52.8% among adults with income of over $150,000), partnered adults (43.2%), non-working adults (46.2%), and adults with internet access (39.9%). Influenza vaccine is taken every year by 76% of adults who perceive that the vaccine is very effective, 64.2% of adults who are socially influenced by others, and 41.8% of adults with health insurance, while 72.3% of adults without health insurance never get vaccinated. Facilitators for adults getting vaccinated every year in comparison to only some years include older age, perception of high vaccine effectiveness, higher income and no out-of-pocket payments. Barriers for adults never getting vaccinated in comparison to only some years include lack of health insurance, disliking of shots, perception of low vaccine effectiveness, low perception of risk for influenza infection, and perception of risky side effects. Conclusion. Influenza vaccination rates among adults in the United States can be improved towards the Healthy People 2020 target of 70% by increasing awareness of the safety, efficacy and need for influenza vaccination, leveraging the practices and principles of commercial and social marketing to improve vaccine trust, confidence and acceptance, and lowering out-of-pocket expenses and covering influenza vaccination costs through health insurance.
Editorial Comment: Cost-Effectiveness Analysis for Prioritization of Limited Public Health Resources - Tuberculosis Interventions in Texas
Abbas, Kaja M. (2014)
Public health departments have limited evidence to understand and analyze the costs and benefits of different health programs, including tuberculosis control and prevention programs. The study by Miller et. al addresses this challenge to estimate costs and benefits of tuberculosis prevention programs in Texas and identify cost-effective diagnostic and treatment combinations, thereby improving the evidence-based decision making power of the public health departments.
Epidemiological and economic impact of pandemic influenza in Chicago: Priorities for vaccine interventions
Dorratoltaj, Nargesalsadat; Marathe, Achla; Lewis, Bryan L.; Swarup, Samarth; Eubank, Stephen G.; Abbas, Kaja M. (PLOS, 2017-06-01)
The study objective is to estimate the epidemiological and economic impact of vaccine interventions during influenza pandemics in Chicago, and assist in vaccine intervention priorities. Scenarios of delay in vaccine introduction with limited vaccine efficacy and limited supplies are not unlikely in future influenza pandemics, as in the 2009 H1N1 influenza pandemic. We simulated influenza pandemics in Chicago using agent-based transmission dynamic modeling. Population was distributed among high-risk and non-high risk among 0±19, 20±64 and 65+ years subpopulations. Different attack rate scenarios for catastrophic (30.15%), strong (21.96%), and moderate (11.73%) influenza pandemics were compared against vaccine intervention scenarios, at 40% coverage, 40% efficacy, and unit cost of $28.62. Sensitivity analysis for vaccine compliance, vaccine efficacy and vaccine start date was also conducted. Vaccine prioritization criteria include risk of death, total deaths, net benefits, and return on investment. The risk of death is the highest among the high-risk 65+ years subpopulation in the catastrophic influenza pandemic, and highest among the high-risk 0±19 years subpopulation in the strong and moderate influenza pandemics. The proportion of total deaths and net benefits are the highest among the high-risk 20±64 years subpopulation in the catastrophic, strong and moderate influenza pandemics. The return on investment is the highest in the high-risk 0±19 years subpopulation in the catastrophic, strong and moderate influenza pandemics. Based on risk of death and return on investment, high-risk groups of the three age group subpopulations can be prioritized for vaccination, and the vaccine interventions are cost saving for all age and risk groups. The attack rates among the children are higher than among the adults and seniors in the catastrophic, strong, and moderate influenza pandemic scenarios, due to their larger social contact network and homophilous interactions in school. Based on return on investment and higher attack rates among children, we recommend prioritizing children (0±19 years) and seniors (65+ years) after high-risk groups for influenza vaccination during times of limited vaccine supplies. Based on risk of death, we recommend prioritizing seniors (65+ years) after high-risk groups for influenza vaccination during times of limited vaccine supplies.
Epidemiological Modeling of Bovine Brucellosis in India
Kang, Gloria J.; Gunaseelan, L.; Abbas, Kaja M. (IEEE, 2014-01-01)
Facilitators and barriers of parental attitudes and beliefs toward school-located influenza vaccination in the United States: Systematic review
Kang, Gloria J.; Culp, Rachel K.; Abbas, Kaja M. (2017-04-11)
The study objective was to identify facilitators and barriers of parental attitudes and beliefs toward school-located influenza vaccination in the United States. In 2009, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention expanded their recommendations for influenza vaccination to include school-aged children. We conducted a systematic review of studies focused on facilitators and barriers of parental attitudes toward school-located influenza vaccination in the United States from 1990 to 2016. We reviewed 11 articles by use of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework. Facilitators were free/low cost vaccination; having belief in vaccine efficacy, influenza severity, and susceptibility; belief that vaccination is beneficial, important, and a social norm; perception of school setting advantages; trust; and parental presence. Barriers were cost; concerns regarding vaccine safety, efficacy, equipment sterility, and adverse effects; perception of school setting barriers; negative physician advice of contraindications; distrust in vaccines and school-located vaccination programs; and health information privacy concerns. We identified the facilitators and barriers of parental attitudes and beliefs toward school-located influenza vaccination to assist in the evidence-based design and implementation of influenza vaccination programs targeted for children in the United States and to improve influenza vaccination coverage for population-wide health benefits.
Impact of demographic disparities in social distancing and vaccination on influenza epidemics in urban and rural regions of the United States
Singh, Meghendra; Sarkhel, Prasenjit; Kang, Gloria J.; Marathe, Achla; Boyle, Kevin J.; Murray-Tuite, Pamela; Abbas, Kaja M.; Swarup, Samarth (2019-03-04)
Background Self-protective behaviors of social distancing and vaccination uptake vary by demographics and affect the transmission dynamics of influenza in the United States. By incorporating the socio-behavioral differences in social distancing and vaccination uptake into mathematical models of influenza transmission dynamics, we can improve our estimates of epidemic outcomes. In this study we analyze the impact of demographic disparities in social distancing and vaccination on influenza epidemics in urban and rural regions of the United States. Methods We conducted a survey of a nationally representative sample of US adults to collect data on their self-protective behaviors, including social distancing and vaccination to protect themselves from influenza infection. We incorporated this data in an agent-based model to simulate the transmission dynamics of influenza in the urban region of Miami Dade county in Florida and the rural region of Montgomery county in Virginia. Results We compare epidemic scenarios wherein the social distancing and vaccination behaviors are uniform versus non-uniform across different demographic subpopulations. We infer that a uniform compliance of social distancing and vaccination uptake among different demographic subpopulations underestimates the severity of the epidemic in comparison to differentiated compliance among different demographic subpopulations. This result holds for both urban and rural regions. Conclusions By taking into account the behavioral differences in social distancing and vaccination uptake among different demographic subpopulations in analysis of influenza epidemics, we provide improved estimates of epidemic outcomes that can assist in improved public health interventions for prevention and control of influenza.
Multi-scale immunoepidemiological modeling of within-host and between-host HIV dynamics: systematic review of mathematical models
Dorratoltaj, Nargesalsadat; Nikin-Beers, Ryan; Ciupe, Stanca M.; Eubank, Stephen G.; Abbas, Kaja M. (PeerJ, 2017-09-28)
Objective The objective of this study is to conduct a systematic review of multi-scale HIV immunoepidemiological models to improve our understanding of the synergistic impact between the HIV viral-immune dynamics at the individual level and HIV transmission dynamics at the population level. Background While within-host and between-host models of HIV dynamics have been well studied at a single scale, connecting the immunological and epidemiological scales through multi-scale models is an emerging method to infer the synergistic dynamics of HIV at the individual and population levels. Methods We reviewed nine articles using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework that focused on the synergistic dynamics of HIV immunoepidemiological models at the individual and population levels. Results HIV immunoepidemiological models simulate viral immune dynamics at the within-host scale and the epidemiological transmission dynamics at the between-host scale. They account for longitudinal changes in the immune viral dynamics of HIV+ individuals, and their corresponding impact on the transmission dynamics in the population. They are useful to analyze the dynamics of HIV super-infection, co-infection, drug resistance, evolution, and treatment in HIV+ individuals, and their impact on the epidemic pathways in the population. We illustrate the coupling mechanisms of the within-host and between-host scales, their mathematical implementation, and the clinical and public health problems that are appropriate for analysis using HIV immunoepidemiological models. Conclusion HIV immunoepidemiological models connect the within-host immune dynamics at the individual level and the epidemiological transmission dynamics at the population level. While multi-scale models add complexity over a single-scale model, they account for the time varying immune viral response of HIV+ individuals, and the corresponding impact on the time-varying risk of transmission of HIV+ individuals to other susceptibles in the population.
Rethinking health systems strengthening: key systems thinking tools and strategies for transformational change
Swanson, R. Chad; Cattaneo, Aadriano; Bradley, Elizabeth; Chunharas, Somsak; Atun, Rifat; Abbas, Kaja M.; Katsaliaki, Korina; Mustafee, Navonil; Mason Meier, Benjamin; Best, Allan (Oxford University Press, 2012-10-01)
While reaching consensus on future plans to address current global health challenges is far from easy, there is broad agreement that reductionist approaches that suggest a limited set of targeted interventions to improve health around the world are inadequate. We argue that a comprehensive systems perspective should guide health practice, education, research and policy. We propose key ‘systems thinking’ tools and strategies that have the potential for transformational change in health systems. Three overarching themes span these tools and strategies: collaboration across disciplines, sectors and organizations; ongoing, iterative learning; and transformational leadership. The proposed tools and strategies in this paper can be applied, in varying degrees, to every organization within health systems, from families and communities to national ministries of health. While our categorization is necessarily incomplete, this initial effort will provide a valuable contribution to the health systems strengthening debate, as the need for a more systemic, rigorous perspective in health has never been greater.
Role of bacille Calmette-Guérin in preventing tuberculous infection
Adinarayanan, S.; Culp, Rachel K.; Subramani, R.; Abbas, Kaja M.; Radhakrishna, S.; Swaminathan, S. (2017-04-01)
SETTING: Rural community in South India. OBJECTIVE: To determine the role of bacille Calmette-Guérin (BCG) in preventing tuberculous infection in children. DESIGN: A prevalence survey was undertaken in 1999-2001 in a representative rural population in Tiruvallur District in South India using cluster sampling. Tuberculin testing was performed among all children aged <15 years, and all adults aged 15 years were questioned about chest symptoms and underwent radiography, followed by sputum examinations, if indicated. RESULTS: In children living in households with a tuberculosis case, the proportion with evidence of tuberculous infection was 35.5% of 200 in the absence of a BCG scar and 27.0% of 100 in its presence, a reduction of 24% (P = 0.14). In very young children (age <5 years), the corresponding proportions were 29.1% of 55 and 11.9% of 42, a reduction of 59%; the difference was statistically significant (P = 0.048). CONCLUSION: There is a possible role for BCG in preventing tuberculous infection in very young children.
Spatial Big Data Analytics of Influenza Epidemic in Vellore, India
Lopez, Daphne; Gunasekaran, M.; Murugan, B. Senthil; Kaur, Harpreet; Abbas, Kaja M. (IEEE, 2014-01-01)
The study objective is to develop a big spatial data model to predict the epidemiological impact of influenza in Vellore, India. Large repositories of geospatial and health data provide vital statistics on surveillance and epidemiological metrics, and valuable insight into the spatiotemporal determinants of disease and health. The integration of these big data sources and analytics to assess risk factors and geospatial vulnerability can assist to develop effective prevention and control strategies for influenza epidemics and optimize allocation of limited public health resources. We used the spatial epidemiology data of the HIN1 epidemic collected at the National Informatics Center during 2009-2010 in Vellore. We developed an ecological niche model based on geographically weighted regression for predicting influenza epidemics in Vellore, India during 2013-2014. Data on rainfall, temperature, wind speed, humidity and population are included in the geographically weighted regression analysis. We inferred positive correlations for H1N1 influenza prevalence with rainfall and wind speed, and negative correlations for H1N1 influenza prevalence with temperature and humidity. We evaluated the results of the geographically weighted regression model in predicting the spatial distribution of the influenza epidemic during 2013-2014.
Studies in Big Data Series: Internet of Things and Big Data Technologies for Next Generation Healthcare
Abbas, Kaja M.; Manogaran, Gunasekaran; Thota, Chandu; Lopez, Daphne; Vijayakumar, V.; Sundarsekar, Revathi (2017)
The health care systems are rapidly adopting large amounts of data, driven by record keeping, compliance and regulatory requirements, and patient care. The advances in healthcare system will rapidly enlarge the size of the health records that are accessible electronically. Concurrently, fast progress has been made in clinical analytics. For example, new techniques for analyzing large size of data and gleaning new business insights from that analysis is part of what is known as big data. Big data also hold the promise of supporting a wide range of medical and healthcare functions, including among others disease surveillance, clinical decision support and population health management. Hence, effective big data based knowledge management system is needed for monitoring of patients and identify the clinical decisions to the doctor. The chapter proposes a big data based knowledge management system to develop the clinical decisions. The proposed knowledge system is developed based on variety of databases such as Electronic Health Record (EHR), Medical Imaging Data, Unstructured Clinical Notes and Genetic Data. The proposed methodology asynchronously communicates with different data sources and produces many alternative decisions to the doctor.
Trends in HIV/AIDS morbidity and mortality in Eastern Mediterranean countries, 1990-2015: findings from the Global Burden of Disease 2015 study
Mokdad, Ali H.; El Bcheraoui, Charbel; Wang, Haidong; Charara, Raghid; Khalil, Ibrahim; Moradi-Lakeh, Maziar; Afshin, Ashkan; Collison, Michael; Daoud, Farah; Chew, Adrienne; Krohn, Kristopher J.; Carter, Austin; Foreman, Kyle J.; He, Fei; Kassebaum, Nicholas J.; Kutz, Michael; Mirarefin, Mojde; Nguyen, Grant; Silpakit, Naris; Sligar, Amber; Abajobir, Amanuel Alemu; Abate, Kalkidan Hassen; Abbas, Kaja M.; Abd-Allah, Foad; Abera, Semaw Ferede; Adane, Kelemework; Agarwal, Arnav; Kiadaliri, Aliasghar Ahmad; Ahmadi, Alireza; Ahmed, Muktar Beshir; Al Lami, Faris Hasan; Alam, Khurshid; Alasfoor, Deena; Alizadeh-Navaei, Reza; Al-Maskari, Fatma; Al-Raddadi, Rajaa; Altirkawi, Khalid A.; Alvis-Guzman, Nelson; Ammar, Walid; Anber, Nahla; Antonio, Carl Abelardo T.; Anwari, Palwasha; Asayesh, Hamid; Asghar, Rana Jawad; Atey, Tesfay Mehari; Avokpaho, Euripide Frinel G. Arthur; Ayele, Tadesse Awoke; Azzopardi, Peter; Bacha, Umar; Barac, Aleksandra; Baernighausen, Till; Bazargan-Hejazi, Shahrzad; Geffen, David; Bedi, Neeraj; Bensenor, Isabela M.; Berhane, Adugnaw; Bessong, Pascal Obong; Beyene, Addisu Shunu; Bhutta, Zulfiqar A.; Birungi, Charles; Butt, Zahid A.; Cahuana-Hurtado, Lucero; Danawi, Hadi; das Neves, Jose; Deribe, Kebede; Deribew, Amare; Jarlais, Don C. Des; Dharmaratne, Samath D.; Djalalinia, Shirin; Doyle, Kerrie E.; Endries, Aman Yesuf; Eshrati, Babak; Faraon, Emerito Jose Aquino; Farvid, Maryam S.; Fereshtehnejad, Seyed-Mohammad; Feyissa, Tesfaye Regassa; Fischer, Florian; Garcia-Basteiro, Alberto L.; Gebrehiwot, Tsegaye Tewelde; Gesesew, Hailay Abrha; Gishu, Melkamu Dedefo; Glaser, Elizabeth; Gona, Philimon N.; Gugnani, Harish Chander; Gupta, Rahul; Bidgoli, Hassan Haghparast; Hailu, Gessessew Bugssa; Hamadeh, Randah Ribhi; Hambisa, Mitiku Teshome; Hamidi, Samer; Harb, Hilda L.; Hareri, Habtamu Abera; Horita, Nobuyuki; Husseini, Abdullatif; Ibrahim, Ahmed; James, Spencer Lewis; Jonas, Jost B.; Kasaeian, Amir; Kassaw, Nigussie Assefa; Khader, Yousef Saleh; Khan, Ejaz Ahmad; Khan, Gulfaraz; Khoja, Abdullah Tawfih Abdullah; Khubchandani, Jagdish; Kim, Yun Jin; Koyanagi, Ai; Defo, Barthelemy Kuate; Larson, Heidi J.; Latif, Asma Abdul; Leshargie, Cheru Tesema; Lunevicius, Raimundas; Abd El Razek, Mohammed Magdy; Majdzadeh, Reza; Majeed, Azeem; Malekzadeh, Reza; Manyazewal, Tsegahun; Markos, Desalegn; Farid, Habibolah Masoudi; Mehari, Alem; Mekonnen, Alemayehu B.; Memiah, Peter; Memish, Ziad A.; Mendoza, Walter; Mengesha, Melkamu Merid; Mengistu, Desalegn Tadese; Mezgebe, Haftay Berhane; Mhimbira, Francis Apolinary; Miller, Ted R.; Moore, Ami R.; Mumtaz, Ghina R.; Natarajan, Gopalakrishnan; Negin, Joel; Obermeyer, Carla Makhlouf; Ogbo, Felix Akpojene; Oh, In-Hwan; Ota, Erika; Pereira, David M.; Pourmalek, Farshad; Qorbani, Mostafa; Radfar, Amir; Rafay, Anwar; Rahimi-Movaghar, Vafa; Rai, Rajesh Kumar; Ram, Usha; Rawaf, David Laith; Rawaf, Salman; Renzaho, Andre M. N.; Rezaei, Satar; Rezai, Mohammad Sadegh; Roba, Hirbo Shore; Roshandel, Gholamreza; Safdarian, Mahdi; Safiri, Saeid; Sahraian, Mohammad Ali; Salamati, Payman; Samy, Abdallah M.; Sartorius, Benn; Sepanlou, Sadaf G.; Shaikh, Masood Ali; Shamsizadeh, Morteza; Sibamo, Ephrem Lejore Sibamo; Singh, Jasvinder A.; Sobaih, Badr H. A.; Soshnikov, Sergey; Sufiyan, Muawiyyah Babale; Sykes, Bryan L.; Taveira, Nuno; Tegegne, Teketo Kassaw; Tehrani-Banihashemi, Arash; Tekelab, Tesfalidet; Shifa, Girma Temam; Temsah, Mohamad-Hani; Tesssema, Belay; Topor-Madry, Roman; Ukwaja, Kingsley Nnanna; Uthman, Olalekan A.; Vollset, Stein Emil; Wadilo, Fiseha; Wakayo, Tolassa; Alebachew, Minyahil; Workicho, Abdulhalik; Workie, Shimelash Bitew; Yaghoubi, Mohsen; Yalew, Ayalnesh Zemene; Yimam, Hassen Hamid; Yonemoto, Naohiro; Yoon, Seok-Jun; Yotebieng, Marcel; Younis, Mustafa Z.; Zaki, Maysaa El Sayed; Jumaan, Aisha O.; Vos, Theo; Hay, Simon I.; Naghavi, Mohsen; Murray, Christopher J. L. (2018-05)
We used the results of the Global Burden of Disease 2015 study to estimate trends of HIV/AIDS burden in Eastern Mediterranean Region (EMR) countries between 1990 and 2015. Tailored estimation methods were used to produce final estimates of mortality. Years of life lost (YLLs) were calculated by multiplying the mortality rate by population by age-specific life expectancy. Years lived with disability (YLDs) were computed as the prevalence of a sequela multiplied by its disability weight. In 2015, the rate of HIV/AIDS deaths in the EMR was 1.8 (1.4-2.5) per 100,000 population, a 43% increase from 1990 (0.3; 0.2-0.8). Consequently, the rate of YLLs due to HIV/AIDS increased from 15.3 (7.6-36.2) per 100,000 in 1990 to 81.9 (65.3-114.4) in 2015. The rate of YLDs increased from 1.3 (0.6-3.1) in 1990 to 4.4 (2.7-6.6) in 2015. HIV/AIDS morbidity and mortality increased in the EMR since 1990. To reverse this trend and achieve epidemic control, EMR countries should strengthen HIV surveillance, and scale up HIV antiretroviral therapy and comprehensive prevention services.

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