Vaccine Efficacy after a Sanitation Campaign: A Natural Experiment

卫生运动后的疫苗功效：自然实验

• 批准号: 9433315
• 负责人: Tim Allen Bruckner
• 金额: $ 7.1万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-02-21 至 2021-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9433315
• 关键词: 5 year old; Adolescence; Adult; Atrophic; Attenuated Vaccines; Child; Child Health; Child Malnutrition; Childhood; Chronic; Collaborations; Communicable Diseases; Communities; Country; Cross-Sectional Studies; Data; Data Quality; Defecation; Demographic and Health Surveys; Development; Diagnosis; Diarrhea; Diphtheria; Disease; Disease Surveillance; Enteral; Environment; Epidemiology; Exhibits; Exposure to; Failure; Family health status; Federal Government; Funding; Future; Gastrointestinal tract structure; Goals; Government; Growth; Health; Health Promotion; Health Status; Health Surveys; Health behavior; Household; Human; Hygiene; Hyperplasia; Immune response; Impaired cognition; Impairment; India; Infection; Inflammation; Institutes; Link; Malabsorption Syndromes; Malnutrition; Measles; Mission; Morphology; Natural experiment; Nature; Outcome; Pertussis; Physiology; Policies; Politics; Prevalence; Public Health; Reporting; Research; Research Design; Research Personnel; Research Project Grants; Risk; Rural; Sanitation; Shock; Small Intestines; Soil; Source; Study Section; Surveys; Testing; Tetanus; Time; Tumor-infiltrating immune cells; Underweight; United States National Institutes of Health; Urination; Vaccines; Water; Work; aged; community intervention; diarrheal disease; helminth infection; immune function; improved; intestinal villi; jejunum; longitudinal analysis; national surveillance; nutrient absorption; oral vaccine; pathogen; pathogenic bacteria; population based; programs; response; surveillance data; vaccine efficacy; wasting; willingness

ABSTRACT Open defecation contaminates ambient environment and water sources with pathogenic bacteria and may, over time, decrease vaccine efficacy and increase childhood malnutrition. Prolonged exposure to fecal pathogens causes a condition called environmental enteropathy, which is characterized by malabsorption, atrophy of intestinal villi, crypt hyperplasia, T-cell infiltration and inflammation of the jejunum. These changes can diminish a vaccine-specific response, or destroy an attenuated vaccine by an aggressive local immune response in the digestive tract. Furthermore, hyperplasia or thickening of small intestine walls may obstruct proper absorption of nutrients, leading to malnutrition. However, alarmingly few community interventions with strong study designs quantify the relation between open defecation, vaccine efficacy, diarrhea and child malnutrition. We propose a state and district-level analysis of India's national disease surveillance and regional survey data from two-time periods, 2013 and 2016, to estimate this relation by using as a natural experiment India's national sanitation campaign, Swachh Bharat Mission (SBM). SBM is a restructured version of India's Total Sanitation Campaign (TSC), which was originally initiated in 1999, but revamped in 2014 with the goal of complete eradication of open defecation, and installation of toilets in every household across the country by 2019. The election of a new federal government in 2014 brought in a strong, national mandate on sanitation and hygiene. According to national estimates, > 10 million toilets have been constructed thus far, with an annual funding of over $ 1 billion allotted exclusively towards SBM. We hypothesize that increased toilet construction owing to implementation of SBM by India's newly elected central government (in 2014) precedes a reduction in vaccine preventable illnesses (diphtheria, pertussis, tetanus and measles), diarrhea and malnutrition (stunting, wasting and underweight) in children less than 5 years of age. We further aim to test the association between political impetus towards SBM implementation and child health outcomes using data on state and district level utilization of government funding allocated for SBM. We will use high-quality data from India's Demographic and Health Survey (comprising District Level Household & Facility Survey, Annual Health Survey, and National Family Health Survey) and national administrative Health Surveillance Reports to achieve our study Aims. The results of this study may hold strong implications for control of diarrheal diseases and vaccine efficacy. Our collaboration with the Indian Institute of Management Bangalore (IIMB), moreover, on this topic aligns well with NIH's Indo-US Vaccine Action Program (VAP) Small Research Grant's stated goal of supporting collaborative vaccine-related research that may ultimately reduce the burden of infectious diseases in India.

摘要 露天排便会用病原菌污染周围环境和水源， 随着时间的推移，可能会降低疫苗的效力，增加儿童营养不良。长时间暴露于 粪便病原体引起一种称为环境性肠病的疾病，其特征是 吸收不良、肠绒毛萎缩、隐窝增生、T细胞浸润和 空肠这些变化可以减少疫苗特异性反应，或通过以下方式破坏减毒疫苗： 消化道中的局部免疫反应。此外，增生或增厚的 小肠壁可能会阻碍营养的正常吸收，导致营养不良。然而，在这方面， 令人震惊的是，很少有强有力的研究设计的社区干预措施量化了开放性和非开放性之间的关系。 排便、疫苗效力、腹泻和儿童营养不良。我们建议在州和地区一级 2013年两个时期印度国家疾病监测和区域调查数据分析 和2016年，通过使用印度的国家卫生设施作为自然实验来估计这种关系， Swachh Bharat使命（SBM）。SBM是印度全面卫生的重组版本 运动（TSC），最初于1999年启动，但在2014年进行了修改，目标是完成 消除露天排便，在全国每户家庭安装厕所， 2019. 2014年新一届联邦政府的选举带来了强有力的全国性授权， 环境卫生和个人卫生。据国家估计，已经建造了超过1000万个厕所， 到目前为止，每年有超过10亿美元的资金专门用于SBM。我们假设 由于印度新当选的中央政府实施了SBM， 政府（2014年）在疫苗可预防疾病（白喉，百日咳， 破伤风和麻疹）、腹泻和营养不良（发育迟缓、消瘦和体重不足） 5岁以上。我们进一步的目标是测试对SBM的政治动力之间的关联 利用州和地区一级利用数据， 政府为SBM拨款。我们将使用来自印度人口统计和 健康调查（包括地区一级住户和设施调查、年度健康调查和 国家家庭健康调查）和国家行政健康监测报告，以实现我们的 研究目的。这项研究的结果可能对控制疟疾疾病具有重要意义， 疫苗功效。我们与班加罗尔印度管理学院（IIMB）的合作， 此外，在这一主题上，与美国国立卫生研究院的印美疫苗行动计划（VAP）小规模研究也保持一致 格兰特的既定目标是支持与疫苗相关的合作研究，最终可能减少 印度的传染病负担。