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.

抽象的 开放式排便污染了环境环境和致病细菌的水源和水源 随着时间的流逝，可能会降低疫苗功效并增加儿童营养不良。长时间接触 粪便病原体会导致一种称为环境肠病的疾病，其特征是 吸收不良，肠绒毛萎缩，隐窝增生，T细胞浸润和炎症 空肠。这些变化可以减少特定疫苗的反应，或者通过 消化道中有侵略性的局部免疫反应。此外，增生或增厚 小肠壁可能会妨碍适当的养分吸收，从而导致营养不良。然而， 令人震惊的是，很少有针对强大研究设计的社区干预量化开放之间的关系 排便，疫苗功效，腹泻和儿童营养不良。我们建议一个州和地区级别 对印度国家疾病监测和区域调查数据的分析，2013年两次 和2016年，通过用作自然实验印度的民族卫生，估算这种关系 竞选，Swachh Bharat Mission（SBM）。 SBM是印度总卫生的重组版本 竞选活动（TSC）最初于1999年启动，但在2014年进行了改进，目的是完成 消除公开排便，并在全国各地的每个家庭中安装厕所 2019年。2014年新联邦政府的选举带来了强大的国家任务 卫生和卫生。根据国家估计，已经建造了一千万厕所 迄今为止，年度资金超过10亿美元，专门为SBM分配。我们假设这一点 由于印度新当选的中央 政府（2014年）先于疫苗可预防疾病的减少（白喉，百日咳， 儿童的破伤风和麻疹），腹泻和营养不良（发育迟缓，浪费和体重不足） 超过5岁。我们进一步旨在测试政治动力与SBM之间的关联 使用有关州和地区一级利用的数据实施和儿童健康结果 为SBM分配的政府资金。我们将使用印度人口统计和的高质量数据 健康调查（包括地区一级家庭与设施调查，年度健康调查以及 国家家庭健康调查）和国家行政健康监视报告，以实现我们的 研究目的。这项研究的结果可能对控制腹泻疾病和 疫苗功效。我们与印度管理学院班加罗尔（IIMB）的合作， 此外，关于这个主题，与NIH的Indo-US疫苗动作计划（VAP）小型研究非常相吻合 格兰特（Grant 印度传染病负担。