Daniella Trowbridge

Background: A maternal vaccine and long-acting monoclonal antibodies for prevention of respiratory syncytial virus (RSV) in infants were market authorized and introduced globally; however, data on acceptability remain limited.Methods: We conducted a cross-sectional knowledge, attitudes, and practices (KAP) survey in September 2024 among 2645 healthcare personnel (HCP) from five hospitals in Lima, participating in an ongoing cohort study. The survey assessed knowledge of RSV disease and prevention products (11-item knowledge score), attitudes about risk and prevention, and likelihood to recommend RSV prevention products. Demographic data and immunization history were collected at cohort enrollment. Chi-square tests were used to examine associations with respondents’ likelihood to recommend either product; bivariable and multivariable analysis compared those likely to recommend versus unsure.Findings: Among HCP in the cohort, 2583 (97·6%) completed the survey. Most were nurses (n=1918, 76·2%), female (n=2113, 81·8%) with median age of 45 years. Knowledge of RSV was low (median score 3 [IQR 0·0–5·5]). Among HCPs, 74.0% (n=1912) were likely to recommend vaccine and 70·7% (n=1826) were likely to recommend antibodies with 20·8% and 23·2% unsure, respectively. In multivariable analysis, younger age and higher knowledge scores had the greatest effect on increased likelihood to recommend RSV products (p <0·05).Interpretation: Limited RSV knowledge exists among HCP and was associated with likelihood to recommend RSV products. Targeted HCP education may result in greater likelihood of HCPs recommending vaccination to their patients.

Background: Cholera is a major cause of mortality and morbidity in low-resource and humanitarian settings. It is transmitted by fecal-oral route, and the infection risk is higher to those living in and near cholera cases. Rapid identification of cholera cases and implementation of measures to prevent subsequent transmission around cases may be an efficient strategy to reduce the size and scale of cholera outbreaks. Methodology/Principle findings: We investigated implementation of cholera case-area targeted interventions (CATIs) using systematic reviews and case studies. We identified 11 peer-reviewed and eight grey literature articles documenting CATIs and completed 30 key informant interviews in case studies in Democratic Republic of Congo, Haiti, Yemen, and Zimbabwe. We documented 15 outbreaks in 12 countries where CATIs were used. The team composition and the interventions varied, with water, sanitation, and hygiene interventions implemented more commonly than those of health. Alert systems triggering interventions were diverse ranging from suspected cholera cases to culture confirmed cases. Selection of high-risk households around the case household was inconsistent and ranged from only one case to approximately 100 surrounding households with different methods of selecting them. Coordination among actors and integration between sectors were consistently reported as challenging. Delays in sharing case information impeded rapid implementation of this approach, while evaluation of the effectiveness of interventions varied. Conclusions/Significance: CATIs appear effective in reducing cholera outbreaks, but there is limited and context specific evidence of their effectiveness in reducing the incidence of cholera cases and lack of guidance for their consistent implementation. We propose to 1) use uniform cholera case definitions considering a local capacity to trigger alert; 2) evaluate the effectiveness of individual or sets of interventions to interrupt cholera, and establish a set of evidence-based interventions; 3) establish criteria to select high-risk households; and 4) improve coordination and data sharing amongst actors and facilitate integration among sectors to strengthen CATI approaches in cholera outbreaks.