All Publications

  • Pulse oximetry training landscape for healthcare workers in low- and middle-income countries: A scoping review. Journal of global health Peterson, M. E., Docter, S., Ruiz-Betancourt, D. R., Alawa, J., Arimino, S., Weiser, T. G. 2023; 13: 04074


    Background: Pulse oximetry has been used in medical care for decades. Its use quickly became standard of care in high resource settings, with delayed widespread availability and use in lower resource settings. Pulse oximetry training initiatives have been ongoing for years, but a map of the literature describing such initiatives among health care workers in low- and middle-income countries (LMICs) has not previously been conducted. Additionally, the coronavirus disease 2019 (COVID-19) pandemic further highlighted the inequitable distribution of pulse oximetry use and training. We aimed to characterise the landscape of pulse oximetry training for health care workers in LMICs prior to the COVID-19 pandemic as described in the literature.Methods: We systematically searched six databases to identify studies reporting pulse oximetry training among health care workers, broadly defined, in LMICs prior to the COVID-19 pandemic. Two reviewers independently assessed titles and abstracts and relevant full texts for eligibility. Data were charted by one author and reviewed for accuracy by a second. We synthesised the results using a narrative synthesis.Results: A total of 7423 studies were identified and 182 screened in full. A total of 55 training initiatives in 42 countries met inclusion criteria, as described in 66 studies since some included studies reported on different aspects of the same training initiative. Five overarching reasons for conducting pulse oximetry training were identified: 1) anaesthesia and perioperative care, 2) respiratory support programme expansion, 3) perinatal assessment and monitoring, 4) assessment and monitoring of children and 5) assessment and monitoring of adults. Educational programmes varied in their purpose with respect to the types of patients being targeted, the health care workers being instructed, and the depth of pulse oximetry specific training.Conclusions: Pulse oximetry training initiatives have been ongoing for decades for a variety of purposes, utilising a multitude of approaches to equip health care workers with tools to improve patient care. It is important that these initiatives continue as pulse oximetry availability and knowledge gaps remain. Neither pulse oximetry provision nor training alone is enough to bolster patient care, but sustainable solutions for both must be considered to meet the needs of both health care workers and patients.

    View details for DOI 10.7189/jogh.13.04074

    View details for PubMedID 37736848

  • Pulse oximeter provision and training of non-physician anesthetists in Zambia: a qualitative study exploring perioperative care after training. BMC health services research Peterson, M. E., Mattingly, A. S., Merrell, S. B., Asnake, B. M., Ahmed, I., Weiser, T. G. 2022; 22 (1): 1395


    BACKGROUND: Pulse oximetry monitoring is included in the WHO Safe Surgery Checklist and recognized as an essential perioperative safety monitoring device. However, many low resource countries do not have adequate numbers of pulse oximeters available or healthcare workers trained in their use. Lifebox, a nonprofit organization focused on improving anesthetic and surgical safety, has procured and distributed pulse oximeters and relevant educational training in over 100 countries. We aimed to understand qualitatively how pulse oximetry provision and training affected a group of Zambian non-physician anesthetists' perioperative care and what, if any, capacity gaps remain.METHODS: We identified and approached non-physician anesthetists (NPAPs) in Zambia who attended a 2019 Lifebox pulse oximetry training course to participate in a semi-structured interview. Interviews were audio recorded and transcribed. Codes were iteratively derived; the codebook was tested for inter-rater reliability (pooled kappa>0.70). Team-based thematic analysis identified emergent themes on pulse oximetry training and perioperative patient care.RESULTS: Ten of the 35 attendees were interviewed. Two themes emerged concerning pulse oximetry provision and training in discussion with non-physician anesthetists about their experience after training: (1) Impact on Non-Physician Anesthetists and the Healthcare Team and (2) Impact on Perioperative Patient Monitoring. These broad themes were further explored through subthemes. Increased knowledge brought confidence in monitoring and facilitated quick interventions. NPAPs reported improved preoperative assessments and reaffirmed the necessity of having pulse oximetry intraoperatively. However, lack of device availability led to case delays or cancellations. A portable device travelling with the patient to the recovery ward was noted as a major improvement in postoperative care. Pulse oximeters also improved communication between nurses and NPAPs, giving NPAPs confidence in the recovery process. However, this was not always possible, as lack of pulse oximeters and ward staff unfamiliarity with oximetry was commonly reported. NPAPs expressed that wider pulse oximetry availability and training would be beneficial.CONCLUSION: Among a cohort of non-physician anesthetists in Zambia, the provision of pulse oximeters and training was perceived to improve patient care throughout the perioperative timeline. However, capacity and resource gaps remain in their practice settings, especially during transfers of care. NPAPs identified a number of areas where patient care and safety could be improved, including expanding access to pulse oximetry training and provision to ward and nursing staff to ensure the entire healthcare team is aware of the benefits and importance of its use.

    View details for DOI 10.1186/s12913-022-08698-5

    View details for PubMedID 36419106

  • The environmental impact of surgery: A systematic review. Surgery Shoham, M. A., Baker, N. M., Peterson, M. E., Fox, P. 2022


    BACKGROUND: Climate change is a significant public health threat. Health care comprises 10% of greenhouse gas emissions in the United States, where surgery is especially resource intensive. We did a systematic review to assess and summarize the published evidence of the environmental impact of surgery.METHODS: We searched Medline, Embase, Web of Science, and GreenFILE databases for publications that report any environmental impact measure by all surgical subspecialties, including anesthesia. Inclusion criteria were published in English, original research, and passed peer review. Because data were heterogeneous and the aim was broad, we conducted a qualitative summary of data. Where possible, we compare impact measures.RESULTS: In the study, 167 articles were identified by our search strategy and reviewed, of which 55 studies met criteria. Eight were about anesthesia, 27 about operating room waste, and 6 were life cycle assessments. Other topics include carbon footprint and greenhouse gas emissions. Nine papers fell into 2 or more categories. Overall, the operating room is a significant source of emissions and waste. Using anesthetic gases with low global warming potential reduces operating room emissions without compromising patient safety. Operating room waste is often disposed of improperly, often due to convenience or knowledge gaps. There are environmental benefits to replacing disposable materials with reusable equivalents, and to proper recycling. Surgeons can help implement these changes at their institution.CONCLUSION: Although there is a clear need to lower the carbon footprint of surgery, the quality of research with which to inform protocol changes is deficient overall. Our attempt to quantify surgery's carbon footprint yielded heterogeneous data and few standardized, actionable recommendations. However, this data serves as a starting point for important future initiatives to decrease the environmental impact of surgery.

    View details for DOI 10.1016/j.surg.2022.04.010

    View details for PubMedID 35788282

  • The Environmental Impact of Surgery Shoham, M., Baker, N., Peterson, M., Fox, P. ELSEVIER SCIENCE INC. 2021: S133
  • Changes in Invasive Pneumococcal Disease Caused by Streptococcus pneumoniae Serotype 1 Following Introduction of PCV10 and PCV13: Findings from the PSERENADE Project. Microorganisms Bennett, J. C., Hetrich, M. K., Quesada, M. G., Sinkevitch, J. N., Knoll, M. D., Feikin, D. R., Zeger, S. L., Kagucia, E. W., Cohen, A. L., Ampofo, K., Brandileone, M. C., Bruden, D., Camilli, R., Castilla, J., Chan, G., Cook, H., Cornick, J. E., Dagan, R., Dalby, T., Danis, K., Miguel, S. d., Wals, P. D., Desmet, S., Georgakopoulou, T., Gilkison, C., Grgic-Vitek, M., Hammitt, L. L., Hilty, M., Ho, P. L., Jayasinghe, S., Kellner, J. D., Kleynhans, J., Knol, M. J., Kozakova, J., Kristinsson, K. G., Ladhani, S. N., MacDonald, L., Mackenzie, G. A., Mad'arová, L., McGeer, A., Mereckiene, J., Morfeldt, E., Mungun, T., Muñoz-Almagro, C., Nuorti, J. P., Paragi, M., Pilishvili, T., Puentes, R., Saha, S. K., Khan, A. S., Savrasova, L., Scott, J. A., Skoczyńska, A., Suga, S., Linden, M. v., Verani, J. R., Gottberg, A. v., Winje, B. A., Yildirim, I., Zerouali, K., Hayford, K. 2021; 9 (4)


    Streptococcus pneumoniae serotype 1 (ST1) was an important cause of invasive pneumococcal disease (IPD) globally before the introduction of pneumococcal conjugate vaccines (PCVs) containing ST1 antigen. The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project gathered ST1 IPD surveillance data from sites globally and aimed to estimate PCV10/13 impact on ST1 IPD incidence. We estimated ST1 IPD incidence rate ratios (IRRs) comparing the pre-PCV10/13 period to each post-PCV10/13 year by site using a Bayesian multi-level, mixed-effects Poisson regression and all-site IRRs using a linear mixed-effects regression (N = 45 sites). Following PCV10/13 introduction, the incidence rate (IR) of ST1 IPD declined among all ages. After six years of PCV10/13 use, the all-site IRR was 0.05 (95% credibility interval 0.04-0.06) for all ages, 0.05 (0.04-0.05) for <5 years of age, 0.08 (0.06-0.09) for 5-17 years, 0.06 (0.05-0.08) for 18-49 years, 0.06 (0.05-0.07) for 50-64 years, and 0.05 (0.04-0.06) for ≥65 years. PCV10/13 use in infant immunization programs was followed by a 95% reduction in ST1 IPD in all ages after approximately 6 years. Limited data availability from the highest ST1 disease burden countries using a 3+0 schedule constrains generalizability and data from these settings are needed.

    View details for DOI 10.3390/microorganisms9040696

    View details for PubMedID 33801760

    View details for PubMedCentralID PMC8066231

  • Global Landscape Review of Serotype-Specific Invasive Pneumococcal Disease Surveillance among Countries Using PCV10/13: The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) Project. Microorganisms Deloria Knoll, M. n., Bennett, J. C., Garcia Quesada, M. n., Kagucia, E. W., Peterson, M. E., Feikin, D. R., Cohen, A. L., Hetrich, M. K., Yang, Y. n., Sinkevitch, J. N., Ampofo, K. n., Aukes, L. n., Bacci, S. n., Bigogo, G. n., Brandileone, M. C., Bruce, M. G., Camilli, R. n., Castilla, J. n., Chan, G. n., Chanto Chacón, G. n., Ciruela, P. n., Cook, H. n., Corcoran, M. n., Dagan, R. n., Danis, K. n., de Miguel, S. n., De Wals, P. n., Desmet, S. n., Galloway, Y. n., Georgakopoulou, T. n., Hammitt, L. L., Hilty, M. n., Ho, P. L., Jayasinghe, S. n., Kellner, J. D., Kleynhans, J. n., Knol, M. J., Kozakova, J. n., Kristinsson, K. G., Ladhani, S. N., Lara, C. S., León, M. E., Lepp, T. n., Mackenzie, G. A., Mad'arová, L. n., McGeer, A. n., Mungun, T. n., Mwenda, J. M., Nuorti, J. P., Nzoyikorera, N. n., Oishi, K. n., De Oliveira, L. H., Paragi, M. n., Pilishvili, T. n., Puentes, R. n., Rafai, E. n., Saha, S. K., Savrasova, L. n., Savulescu, C. n., Scott, J. A., Scott, K. J., Serhan, F. n., Setchanova, L. P., Sinkovec Zorko, N. n., Skoczyńska, A. n., Swarthout, T. D., Valentiner-Branth, P. n., van der Linden, M. n., Vestrheim, D. F., von Gottberg, A. n., Yildirim, I. n., Hayford, K. n., The Pserenade Team, n. n. 2021; 9 (4)


    Serotype-specific surveillance for invasive pneumococcal disease (IPD) is essential for assessing the impact of 10- and 13-valent pneumococcal conjugate vaccines (PCV10/13). The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project aimed to evaluate the global evidence to estimate the impact of PCV10/13 by age, product, schedule, and syndrome. Here we systematically characterize and summarize the global landscape of routine serotype-specific IPD surveillance in PCV10/13-using countries and describe the subset that are included in PSERENADE. Of 138 countries using PCV10/13 as of 2018, we identified 109 with IPD surveillance systems, 76 of which met PSERENADE data collection eligibility criteria. PSERENADE received data from most (n = 63, 82.9%), yielding 240,639 post-PCV10/13 introduction IPD cases. Pediatric and adult surveillance was represented from all geographic regions but was limited from lower income and high-burden countries. In PSERENADE, 18 sites evaluated PCV10, 42 PCV13, and 17 both; 17 sites used a 3 + 0 schedule, 38 used 2 + 1, 13 used 3 + 1, and 9 used mixed schedules. With such a sizeable and generally representative dataset, PSERENADE will be able to conduct robust analyses to estimate PCV impact and inform policy at national and global levels regarding adult immunization, schedule, and product choice, including for higher valency PCVs on the horizon.

    View details for DOI 10.3390/microorganisms9040742

    View details for PubMedID 33918127

  • Serotype Distribution of Remaining Pneumococcal Meningitis in the Mature PCV10/13 Period: Findings from the PSERENADE Project. Microorganisms Garcia Quesada, M. n., Yang, Y. n., Bennett, J. C., Hayford, K. n., Zeger, S. L., Feikin, D. R., Peterson, M. E., Cohen, A. L., Almeida, S. C., Ampofo, K. n., Ang, M. n., Bar-Zeev, N. n., Bruce, M. G., Camilli, R. n., Chanto Chacón, G. n., Ciruela, P. n., Cohen, C. n., Corcoran, M. n., Dagan, R. n., De Wals, P. n., Desmet, S. n., Diawara, I. n., Gierke, R. n., Guevara, M. n., Hammitt, L. L., Hilty, M. n., Ho, P. L., Jayasinghe, S. n., Kleynhans, J. n., Kristinsson, K. G., Ladhani, S. N., McGeer, A. n., Mwenda, J. M., Nuorti, J. P., Oishi, K. n., Ricketson, L. J., Sanz, J. C., Savrasova, L. n., Setchanova, L. P., Smith, A. n., Valentiner-Branth, P. n., Valenzuela, M. T., van der Linden, M. n., van Sorge, N. M., Varon, E. n., Winje, B. A., Yildirim, I. n., Zintgraff, J. n., Knoll, M. D., The Pserenade Team, n. n. 2021; 9 (4)


    Pneumococcal conjugate vaccine (PCV) introduction has reduced pneumococcal meningitis incidence. The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project described the serotype distribution of remaining pneumococcal meningitis in countries using PCV10/13 for least 5-7 years with primary series uptake above 70%. The distribution was estimated using a multinomial Dirichlet regression model, stratified by PCV product and age. In PCV10-using sites (N = 8; cases = 1141), PCV10 types caused 5% of cases <5 years of age and 15% among ≥5 years; the top serotypes were 19A, 6C, and 3, together causing 42% of cases <5 years and 37% ≥5 years. In PCV13-using sites (N = 32; cases = 4503), PCV13 types caused 14% in <5 and 26% in ≥5 years; 4% and 13%, respectively, were serotype 3. Among the top serotypes are five (15BC, 8, 12F, 10A, and 22F) included in higher-valency PCVs under evaluation. Other top serotypes (24F, 23B, and 23A) are not in any known investigational product. In countries with mature vaccination programs, the proportion of pneumococcal meningitis caused by vaccine-in-use serotypes is lower (≤26% across all ages) than pre-PCV (≥70% in children). Higher-valency PCVs under evaluation target over half of remaining pneumococcal meningitis cases, but questions remain regarding generalizability to the African meningitis belt where additional data are needed.

    View details for DOI 10.3390/microorganisms9040738

    View details for PubMedID 33916227

  • Meningococcal serogroups and surveillance: a systematic review and survey JOURNAL OF GLOBAL HEALTH Peterson, M. E., Li, Y., Bita, A., Moureau, A., Nair, H., Kyaw, M. H., Abad, R., Bailey, F., Garcia, I., Decheva, A., Krizova, P., Melillo, T., Skoczynska, A., Vladimirova, N., Meningococcal Surveillance Grp 2019; 9 (1): 010409


    Meningococcal disease continues to be a global public health concern due to its epidemic potential, severity, and sequelae. The global epidemiological data on circulating meningococcal serogroups have never been reviewed concurrently with the laboratory capacity for meningococcal surveillance at the national level. We, therefore, aimed to conduct a country-level review of meningococcal surveillance, serogroup distribution, and vaccine use.We conducted a systematic literature review across six databases to identify studies (published January 1, 2010 to October 16, 2017) and grey literature reporting meningococcal serogroup data for the years 2010-2016. We performed independent random effects meta-analyses for serogroups A, B, C, W, X, Y, and other. We developed and circulated a questionnaire-based survey to surveillance focal points in countries (N = 95) with known regional bacterial meningitis surveillance programs to assess their surveillance capacity and summarized using descriptive methods.We included 173 studies from 59 countries in the final analysis. The distribution of meningococcal serogroups differed markedly between countries and regions. Meningococcal serogroups C and W accounted for substantial proportions of meningococcal disease in most of Africa and Latin America. Serogroup B was the predominant cause of meningococcal disease in many locations in Europe, the Americas, and the Western Pacific. Serogroup Y also caused many cases of meningococcal disease in these regions, particularly in Nordic countries. Survey responses were received from 51 countries. All countries reported the ability to confirm the pathogen in-country, while approximately 30% either relied on reference laboratories for serogrouping (N = 10) or did not serogroup specimens (N = 5). Approximately half of countries did not utilize active laboratory-based surveillance system (N = 22). Nationwide use of a meningococcal vaccine varied, but most countries (N = 36) utilized a meningococcal vaccine at least for certain high-risk population groups, in private care, or during outbreaks.Due to the large geographical variations in circulating meningococcal serogroups, each country should continue to be monitored for changes in major disease-causing serogroups in order to inform vaccine and control policies. Similarly, laboratory capacity should be appropriately scaled up to more accurately understand local epidemiology and disease burden, as well as the impact of vaccination programs.

    View details for DOI 10.7189/jogh.09.010409

    View details for Web of Science ID 000476640500034

    View details for PubMedID 30603079

    View details for PubMedCentralID PMC6304171

  • Serogroup-specific meningococcal carriage by age group: a systematic review and meta-analysis BMJ OPEN Peterson, M. E., Li, Y., Shanks, H., Mile, R., Nair, H., Kyaw, M. H., Amicizia, D., Bayliss, C. D., Campos, L., Cleary, P., Delbos, V., Esposito, S., Kristiansen, P. A., Mbaeyi, S. A., Oldfield, N. J., Panatto, D., Rodrigues, F., Soeters, H. M., Turner, D. J., Xu, A., Meningococcal Carriage Grp 2019; 9 (4): e024343


    Neisseria meningitidis carriage prevalence has known variation across the lifespan, but it is unclear whether carriage varies among meningococcal capsular groups. Therefore, we aimed to characterise group-specific meningococcal carriage by age group and world region from 2007 to 2016.Systematic review and meta-analysis.MEDLINE, Embase, Global Health Database, WHO Global Health Library, Web of Science, Current Contents Connects, China National Knowledge Infrastructure and Wanfang were systematically searched. Database searches were conducted through July 2018 and Google Scholar forward searches of included studies were conducted through August 2018. References of included studies and relevant conference abstracts were also searched to identify additional articles for inclusion.Studies were eligible for inclusion if they reported capsular group-specific meningococcal carriage in a healthy population of a specified age group and geographical region. For this review, only studies conducted between 2007 and 2016 were included.Data were independently extracted by two authors into Microsoft Access. Studies were assessed for risk of bias using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Studies eligible for inclusion in quantitative analyses by pre-specified age groups were pooled using random effects meta-analyses. Results are reported by capsular group, age group and WHO region. Where meta-analyses were not appropriate, study results were discussed narratively.7511 articles were identified and 65 were eligible for inclusion. Adolescents and young adults were the focus of many studies (n=24), especially in the Americas and Europe. Studies from China and Africa, typically, included data from a wider age range. The overall carriage prevalence varied markedly by age group and region. Based on the available data, 21 studies were included in meta-analyses reporting serogroup carriage for: all ages in Africa, 18-24-year olds in the Americas, and 11-17 and 18-24-year olds in Europe. Capsular groups W, X, Y and 'other' (non-ABCWXY, including non-groupable) were the most prevalent in Africa, and 5-17-year olds had higher carriage prevalence than other age groups. 'Other' serogroups (11.5%, 95% CI 1.6% to 16.1%) were the most common among 18-24-year olds from the Americas. In Europe, 18-24-year old were carriers more frequently than 11-17-year olds, and groups B (5.0%, 95% CI 3.0% to 7.5%), Y (3.9%, 95% CI 1.3% to 7.8%) and 'other' (6.4%, 95% CI 3.1% to 10.8%) were the most commonly carried in the older age group.Of the age groups included in the analysis, carriage patterns by age were similar across capsular groups within a region but differed between regions. Data gaps remain for age- and capsular group-specific carriage in many regions, especially in the Eastern Mediterranean and South-East Asia. As such, clear and robust conclusions about the variation of capsular group-specific carriage by age group and WHO region were unable to be determined.CRD42017074671.

    View details for DOI 10.1136/bmjopen-2018-024343

    View details for Web of Science ID 000471157200052

    View details for PubMedID 31005910

    View details for PubMedCentralID PMC6500331

  • At-risk children with asthma (ARC): a systematic review THORAX Buelo, A., McLean, S., Julious, S., Flores-Kim, J., Bush, A., Henderson, J., Paton, J. Y., Sheikh, A., Shields, M., Pinnock, H., ARC Grp 2018; 73 (9): 813–24


    Asthma attacks are responsible for considerable morbidity and may be fatal. We aimed to identify and weight risk factors for asthma attacks in children (5-12 years) in order to inform and prioritise care.We systematically searched six databases (May 2016; updated with forward citations January 2017) with no language/date restrictions. Two reviewers independently selected studies for inclusion, assessed study quality and extracted data. Heterogeneity precluded meta-analysis. Weighting was undertaken by an Expert Panel who independently assessed each variable for degree of risk and confidence in the assessment (based on study quality and size, effect sizes, biological plausibility and consistency of results) and then achieved consensus by discussion. Assessments were finally presented, discussed and agreed at a multidisciplinary workshop.From 16 109 records, we included 68 papers (28 cohort; 4 case-control; 36 cross-sectional studies). Previous asthma attacks were associated with greatly increased risk of attack (ORs between 2.0 and 4.1). Persistent symptoms (ORs between 1.4 and 7.8) and poor access to care (ORs between 1.2 and 2.3) were associated with moderately/greatly increased risk. A moderately increased risk was associated with suboptimal drug regimen, comorbid atopic/allergic disease, African-American ethnicity (USA), poverty and vitamin D deficiency. Environmental tobacco smoke exposure, younger age, obesity and low parental education were associated with slightly increased risk.Assessment of the clinical and demographic features identified in this review may help clinicians to focus risk reduction management on the high-risk child. Population level factors may be used by health service planners and policymakers to target healthcare initiatives.CRD42016037464.

    View details for DOI 10.1136/thoraxjnl-2017-210939

    View details for Web of Science ID 000445107400006

    View details for PubMedID 29871982

    View details for PubMedCentralID PMC6109248

  • Meningococcal carriage in high-risk settings: A systematic review INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES Peterson, M. E., Mile, R., Li, Y., Nair, H., Kyaw, M. H. 2018; 73: 109–17


    Historically, semi-closed populations have had high rates of meningococcal carriage and have experienced recurrent outbreaks. As such, these high-risk groups are recommended for targeted vaccination in many countries.A systematic review of eight databases and Google Scholar forward citations was conducted to characterize serogroup-specific meningococcal carriage in university students, military personnel, and Hajj pilgrims from 2007 to 2016.A total of 7014 records were identified and 22 studies were included. Overall carriage ranged from 0.0% to 27.4% in Hajj pilgrims, from 1.5% to 71.1% in university students, and from 4.2% to 15.2% in military personnel. Among serogroups A, B, C, W, X, and Y, serogroup B was most prevalent in Hajj pilgrims, B and Y in university students, and B, C, and Y in military personnel. 'Other' serogroups were more prevalent in university students than Hajj pilgrims or military personnel. Risk factors for carriage varied by setting. Among Hajj pilgrims, a high endemicity in the country of origin increased the risk of carriage, while smoking, male sex, and frequently attending parties increased the carriage risk for university students. Similarly, smoking increased the carriage risk for professional soldiers. Data gaps remain for many regions.Preventative vaccination policies for high-risk groups should be based on current disease data in individual countries, supplemented by carriage data. Meningococcal carriage studies and disease surveillance are critical for determining the local epidemiology, populations responsible for disease transmission, and the need for targeted vaccination.

    View details for DOI 10.1016/j.ijid.2018.05.022

    View details for Web of Science ID 000440348300020

    View details for PubMedID 29997031

  • Association of seasonal viral acute respiratory infection with pneumococcal disease: a systematic review of population-based studies BMJ OPEN Li, Y., Peterson, M. E., Campbell, H., Nair, H. 2018; 8 (4): e019743


    Animal and in vitro studies suggest that viral acute respiratory infection (VARI) can predispose to pneumococcal infection. These findings suggest that the prevention of VARI can yield additional benefits for the control of pneumococcal disease (PD). In population-based studies, however, the evidence is not in accordance, possibly due to a variety of methodological challenges and problems in these studies. We aimed to summarise and critically review the methods and results from these studies in order to inform future studies.We conducted a systematic review of population-based studies that analysed the association between preceding seasonal VARI and subsequent PD. We searched MEDLINE, Embase and Global Health databases using tailored search strategies.A total of 28 studies were included. After critically reviewing the methodologies and findings, 11 studies did not control for seasonal factors shared by VARI and PD. This, in turn, could lead to an overestimation of the association between the two illnesses. One case-control study was limited by its small sample size (n case=13). The remaining 16 studies that controlled for seasonal factors suggested that influenza and/or respiratory syncytial virus (RSV) infections were likely to be associated with the subsequent occurrence of PD (influenza: 12/14 studies; RSV: 4/5 studies). However, these 16 studies were unable to conduct individual patient data-based analyses. Nevertheless, these studies suggested the association between VARI and subsequent PD was related to additional factors such as virus type and subtype, age group, comorbidity status, presentation of PD and pneumococcal serotype.Population-based studies do not give consistent support for an association between preceding seasonal VARI and subsequent PD incidence. The main methodological challenges of existing studies include the failure to use individual patient data, control for seasonal factors of VARI and PD, or include other factors related to the association (eg, virus, age, comorbidity and pneumococcal serotype).

    View details for DOI 10.1136/bmjopen-2017-019743

    View details for Web of Science ID 000435176700088

    View details for PubMedID 29680810

    View details for PubMedCentralID PMC5914779