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Human Vaccines & Immunotherapeutics Jun 2021This review summarizes the published data on epidemiology and burden of pertussis in South Korea as these may be under-categorized. A systematic literature review of...
This review summarizes the published data on epidemiology and burden of pertussis in South Korea as these may be under-categorized. A systematic literature review of PubMed, SCOPUS, EMBASE and KMBASE was performed to identify published literature in South Korea since 2000. Pertussis detection rates among 19 eligible studies range from 0.7% to 100% across different age groups, detection methods and study settings. Highest rates are observed in infants, while adolescents and adults with pertussis infection may suffer from persistent coughing. Vaccination uptake of pertussis booster dose among adolescents and adults remains low while seropositivity (detection of anti-pertussis immunoglobulin G), is high among adults. This review reveals a high burden of vaccine-preventable pertussis in South Korea. Besides primary childhood vaccination, strategies like maternal immunization and decennial revaccination of adults should be considered. Active testing, reporting and better utilization of vaccine registries may provide insights for decision-makers nationwide.
Topics: Adolescent; Adult; Humans; Immunization, Secondary; Infant; Pertussis Vaccine; Registries; Republic of Korea; Vaccination; Whooping Cough
PubMed: 33412085
DOI: 10.1080/21645515.2020.1844505 -
BMC Medicine Aug 2020An effective vaccine against Bordetella pertussis was introduced into the Expanded Programme on Immunisation (EPI) by WHO in 1974, leading to a substantial global... (Meta-Analysis)
Meta-Analysis
The burden of laboratory-confirmed pertussis in low- and middle-income countries since the inception of the Expanded Programme on Immunisation (EPI) in 1974: a systematic review and meta-analysis.
BACKGROUND
An effective vaccine against Bordetella pertussis was introduced into the Expanded Programme on Immunisation (EPI) by WHO in 1974, leading to a substantial global reduction in pertussis morbidity and mortality. In low- and middle-income countries (LMICs), however, the epidemiology of pertussis remains largely unknown. This impacts negatively on pertussis control strategies in these countries. This study aimed to systematically and comprehensively review published literature on the burden of laboratory-confirmed pertussis in LMICs over the 45 years of EPI.
METHODS
Electronic databases were searched for relevant literature (1974 to December 2018) using common and MeSH terms for pertussis. Studies using PCR, culture or paired serology to confirm Bordetella pertussis and parapertussis in symptomatic individuals were included if they had clearly defined numerators and denominators to determine prevalence and mortality rates.
RESULTS
Eighty-two studies (49,167 participants) made the inclusion criteria. All six WHO regions were represented with most of the studies published after 2010 and involving mainly upper middle-income countries (n = 63; 77%). PCR was the main diagnostic test after the year 2000. The overall median point prevalence of PCR-confirmed Bordetella pertussis was 11% (interquartile range (IQR), 5-27%), while culture-confirmed was 3% (IQR 1-9%) and paired serology a median of 17% (IQR 3-23%) over the period. On average, culture underestimated prevalence by 85% (RR = 0.15, 95% CI, 0.10-0.22) compared to PCR in the same studies. Risk of pertussis increased with HIV exposure [RR, 1.4 (95% CI, 1.0-2.0)] and infection [RR, 2.4 (95% CI, 1.1-5.1)]. HIV infection and exposure were also related to higher pertussis incidences, higher rates of hospitalisation and pertussis-related deaths. Pertussis mortality and case fatality rates were 0.8% (95% CI, 0.4-1.4%) and 6.5% (95% CI, 4.0-9.5%), respectively. Most deaths occurred in infants less than 6 months of age.
CONCLUSIONS
Despite the widespread use of pertussis vaccines, the prevalence of pertussis remains high in LMIC over the last three decades. There is a need to increase access to PCR-based diagnostic confirmation in order to improve surveillance. Disease control measures in LMICs must take into account the persistent significant infant mortality and increased disease burden associated with HIV infection and exposure.
Topics: Bordetella pertussis; Developing Countries; Female; History, 20th Century; Humans; Immunization Programs; Male; Whooping Cough
PubMed: 32854714
DOI: 10.1186/s12916-020-01699-3 -
Deutsches Arzteblatt International May 2020Adequate immunity to so-called childhood diseases can lower the occupational risk of vaccine-preventable infectious diseases in persons who work in day-care centers for...
BACKGROUND
Adequate immunity to so-called childhood diseases can lower the occupational risk of vaccine-preventable infectious diseases in persons who work in day-care centers for children.
METHODS
A systematic literature survey was carried out in PubMed and Embase for the period January 2000 to February 2019. Studies on immune status and vaccination status were included. In addition, data from the first wave of the German Health Interview and Examination Survey for Adults (Studie zur Gesundheit Erwachsener in Deutschland, DEGS1) and surveillance data on notifiable infections in Germany were evaluated.
RESULTS
Six studies and the DEGS1 analysis of vaccination or immune status for varicella zoster, rubella, hepatitis A (HAV), pertussis, measles, and mumps in persons caring for children in day-care centers, most of whom are women, were included in this review. According to DEGS1, childcare workers are more commonly vaccinated against HAV and pertussis than the general female population (prevalence ratios [PR]: 1.46 [1.12; 1.90] and 1.57 [1.05; 2.36]), yet 57% had not been vaccinated against HAV and 77% had not been vaccinated against pertussis. Childcare workers were found to be less commonly vaccinated against rubella than the general female population, although the difference was not statistically significant (PR: 0.87 [0.71; 1.07]). In a Canadian study, positive HAV serology was found to be correlated with the duration of activity as a childcare worker. In the DEGS1 study, large proportions of the younger childcare workers in particular were seronegative against measles (16%), mumps (19%), and HAV (37%). Notifiable disease statistics show that those working in community facilities had a markedly higher risk of mumps, pertussis, and varicella (relative risk [RR]: 1.8-2.6) and a somewhat higher risk of rubella and HAV (RR: 1.47 and 1.21, respectively).
CONCLUSION
Childcare workers have a higher occupational risk of infection but do not always receive the appropriate vaccinations. In particular, women of child-bearing age working in day-care centers should be made more aware of the need for vaccination.
Topics: Child; Child Care; Germany; Humans; Occupational Diseases; Vaccine-Preventable Diseases
PubMed: 32843135
DOI: 10.3238/arztebl.2020.0365 -
PloS One 2020The most important factor influencing maternal vaccination uptake is healthcare professional (HCP) recommendation. However, where data are available, one-third of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The most important factor influencing maternal vaccination uptake is healthcare professional (HCP) recommendation. However, where data are available, one-third of pregnant women remain unvaccinated despite receiving a recommendation. Therefore, it is essential to understand the significance of other factors and distinguish between vaccines administered routinely and during outbreaks. This is the first systematic review and meta-analysis (PROSPERO: CRD 42019118299) to examine the strength of the relationships between identified factors and maternal vaccination uptake.
METHODS
We searched MEDLINE, Embase Classic & Embase, PsycINFO, CINAHL Plus, Web of Science, IBSS, LILACS, AfricaWideInfo, IMEMR, and Global Health databases for studies reporting factors that influence maternal vaccination. We used random-effects models to calculate pooled odds ratios (OR) of being vaccinated by vaccine type.
FINDINGS
We screened 17,236 articles and identified 120 studies from 30 countries for inclusion. Of these, 49 studies were eligible for meta-analysis. The odds of receiving a pertussis or influenza vaccination were ten to twelve-times higher among pregnant women who received a recommendation from HCPs. During the 2009 influenza pandemic an HCP recommendation increased the odds of antenatal H1N1 vaccine uptake six times (OR 6.76, 95% CI 3.12-14.64, I2 = 92.00%). Believing there was potential for vaccine-induced harm had a negative influence on seasonal (OR 0.22, 95% CI 0.11-0.44 I2 = 84.00%) and pandemic influenza vaccine uptake (OR 0.16, 95% CI 0.09-0.29, I2 = 89.48%), reducing the odds of being vaccinated five-fold. Combined with our qualitative analysis the relationship between the belief in substantial disease risk and maternal seasonal and pandemic influenza vaccination uptake was limited.
CONCLUSIONS
The effect of an HCP recommendation during an outbreak, whilst still powerful, may be muted by other factors. This requires further research, particularly when vaccines are novel. Public health campaigns which centre on the protectiveness and safety of a maternal vaccine rather than disease threat alone may prove beneficial.
Topics: Adult; Decision Making; Female; Health Personnel; Humans; Influenza A Virus, H1N1 Subtype; Influenza Vaccines; Influenza, Human; Odds Ratio; Patient Acceptance of Health Care; Pregnancy; Pregnant Women; Surveys and Questionnaires; Vaccination
PubMed: 32645112
DOI: 10.1371/journal.pone.0234827 -
Acta Bio-medica : Atenei Parmensis Apr 2020To investigate actual knowledge of official recommendations towards seasonal influenza (SID), and Tetanus-diphtheria acellular-pertussis (Tdap) vaccines in... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
To investigate actual knowledge of official recommendations towards seasonal influenza (SID), and Tetanus-diphtheria acellular-pertussis (Tdap) vaccines in obstetrics/gynecologists (OBGYN).
METHODS
PubMed and EMBASE databases were searched. A meta-analysis was performed to calculate odds ratio (OR) and 95% confidence interval (CI) among case controls, cross-sectional studies, either questionnaire or laboratory exams based. Results. A total of 6 studies met inclusion criteria, including 1323 OBGYN from 5 different countries. Overall, around 99% of sampled professionals were aware that official recommendations towards SID in pregnancy do exist, compared to 92% for Tdap, with significant heterogeneity (I2 > 95%, p < 0.001). Concerns about vaccine safety was reported by 10% of respondents for Tdap, and by 6.0% for SID, but again available studies were substantially heterogenous (I2 = 86.7% and 86.0%, p < 0.001). Eventually, 93% of respondents actively recommended SID in pregnancy, compared to 88% for Tdap (I2 98.8% and I2 95.9%, respectively p < 0.001). The evidence of significant publication bias was initially subjectively identified from the funnel plot, and then objectively confirmed through the regression test for all analyses.
CONCLUSIONS
These results suggest an appropriated understanding of official recommendation among sampled OBGYN, with high shares of professionals actively promoting vaccination practices among their patients. Despite the high heterogeneity and the significant publication bias we identified, our results also hint towards extensive knowledge gaps of OBGYN, and particularly regarding unmotivated concerns about vaccine safety. As a consequence, appropriate information and formation campaigns should be appropriately tailored.
Topics: Attitude of Health Personnel; Diphtheria-Tetanus-acellular Pertussis Vaccines; Female; Gynecology; Health Knowledge, Attitudes, Practice; Humans; Influenza Vaccines; Obstetrics; Pregnancy; Vaccination
PubMed: 32275268
DOI: 10.23750/abm.v91i3-S.9442 -
BMC Infectious Diseases Feb 2020Infants < 3 months of age are at highest risk for developing severe complications after pertussis. The majority of pregnant women has low concentrations of...
BACKGROUND
Infants < 3 months of age are at highest risk for developing severe complications after pertussis. The majority of pregnant women has low concentrations of pertussis-specific antibodies and thus newborns are insufficiently protected by maternally transferred antibodies. Acellular pertussis vaccination during pregnancy was recently implemented in various countries. Here, we assessed the evidence for safety and effectiveness of pertussis vaccination during pregnancy.
METHODS
We searched Medline, Embase, and ClinicalTrials.gov from January 1st 2010 to January 10th 2019. We assessed risk of bias (ROB) using the Cochrane ROB tool and ROBINS-I. We evaluated the quality of evidence using the GRADE approach.
RESULTS
We identified 1273 articles and included 22 studies (14 for safety; 8 for effectiveness), comprising 1.4 million pregnant women in safety studies and 855,546 mother-infant-pairs in effectiveness studies. No significant differences between vaccinated and unvaccinated women and their infants were observed for safety outcomes with the exception of fever and chorioamnionitis. Compared to no vaccination, three studies showed a significantly increased relative risk for the presence of the ICD-9 code for chorioamnionitis in electronic patient data after pertussis vaccination. However, no study reported an increased risk for clinical sequelae of chorioamnionitis after vaccination during pregnancy, such as preterm birth or neonatal intensive care unit admission. Vaccine effectiveness against pertussis in infants of immunized mothers ranged from 69 to 91% for pertussis prevention, from 91 to 94% for prevention of hospitalization and was 95% for prevention of death due to pertussis. Risk of bias was serious to critical for safety outcomes and moderate to serious for effectiveness outcomes. GRADE evidence quality was moderate to very low, depending on outcome.
CONCLUSION
Although an increased risk for a diagnosis of fever and chorioamnionitis was detected in pregnant women after pertussis vaccination, there was no association with a higher frequency of clinically relevant sequelae. Vaccine effectiveness for prevention of infant pertussis, hospitalization and death is high. Pertussis vaccination during pregnancy has an overall positive benefit-risk ratio. In view of the overall quality of available evidence ongoing surveillance of chorioamnionitis and its potential sequelae is recommended when pertussis vaccination in pregnancy is implemented.
TRIAL REGISTRATION
PROSPERO CRD42018087814, CRD42018090357.
Topics: Adolescent; Adult; Bordetella pertussis; Child; Chorioamnionitis; Diphtheria-Tetanus-acellular Pertussis Vaccines; Female; Fever; Humans; Infant; Infant, Newborn; Middle Aged; Pregnancy; Pregnant Women; Premature Birth; Risk; Treatment Outcome; Vaccination; Whooping Cough; Young Adult
PubMed: 32054444
DOI: 10.1186/s12879-020-4824-3 -
The Cochrane Database of Systematic... Jan 2020Adolescent vaccination has received increased attention since the Global Vaccine Action Plan's call to extend the benefits of immunisation more equitably beyond... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Adolescent vaccination has received increased attention since the Global Vaccine Action Plan's call to extend the benefits of immunisation more equitably beyond childhood. In recent years, many programmes have been launched to increase the uptake of different vaccines in adolescent populations; however, vaccination coverage among adolescents remains suboptimal. Therefore, understanding and evaluating the various interventions that can be used to improve adolescent vaccination is crucial.
OBJECTIVES
To evaluate the effects of interventions to improve vaccine uptake among adolescents.
SEARCH METHODS
In October 2018, we searched the following databases: CENTRAL, MEDLINE Ovid, Embase Ovid, and eight other databases. In addition, we searched two clinical trials platforms, electronic databases of grey literature, and reference lists of relevant articles. For related systematic reviews, we searched four databases. Furthermore, in May 2019, we performed a citation search of five other websites.
SELECTION CRITERIA
Randomised trials, non-randomised trials, controlled before-after studies, and interrupted time series studies of adolescents (girls or boys aged 10 to 19 years) eligible for World Health Organization-recommended vaccines and their parents or healthcare providers.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened records, reviewed full-text articles to identify potentially eligible studies, extracted data, and assessed risk of bias, resolving discrepancies by consensus. For each included study, we calculated risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) where appropriate. We pooled study results using random-effects meta-analyses and assessed the certainty of the evidence using GRADE.
MAIN RESULTS
We included 16 studies (eight individually randomised trials, four cluster randomised trials, three non-randomised trials, and one controlled before-after study). Twelve studies were conducted in the USA, while there was one study each from: Australia, Sweden, Tanzania, and the UK. Ten studies had unclear or high risk of bias. We categorised interventions as recipient-oriented, provider-oriented, or health systems-oriented. The interventions targeted adolescent boys or girls or both (seven studies), parents (four studies), and providers (two studies). Five studies had mixed participants that included adolescents and parents, adolescents and healthcare providers, and parents and healthcare providers. The outcomes included uptake of human papillomavirus (HPV) (11 studies); hepatitis B (three studies); and tetanus-diphtheria-acellular-pertussis (Tdap), meningococcal, HPV, and influenza (three studies) vaccines among adolescents. Health education improves HPV vaccine uptake compared to usual practice (RR 1.43, 95% CI 1.16 to 1.76; I² = 0%; 3 studies, 1054 participants; high-certainty evidence). In addition, one large study provided evidence that a complex multi-component health education intervention probably results in little to no difference in hepatitis B vaccine uptake compared to simplified information leaflets on the vaccine (RR 0.98, 95% CI 0.97 to 0.99; 17,411 participants; moderate-certainty evidence). Financial incentives may improve HPV vaccine uptake compared to usual practice (RR 1.45, 95% CI 1.05 to 1.99; 1 study, 500 participants; low-certainty evidence). However, we are uncertain whether combining health education and financial incentives has an effect on hepatitis B vaccine uptake, compared to usual practice (RR 1.38, 95% CI 0.96 to 2.00; 1 study, 104 participants; very low certainty evidence). Mandatory vaccination probably leads to a large increase in hepatitis B vaccine uptake compared to usual practice (RR 3.92, 95% CI 3.65 to 4.20; 1 study, 6462 participants; moderate-certainty evidence). Provider prompts probably make little or no difference compared to usual practice, on completion of Tdap (OR 1.28, 95% CI 0.59 to 2.80; 2 studies, 3296 participants), meningococcal (OR 1.09, 95% CI 0.67 to 1.79; 2 studies, 3219 participants), HPV (OR 0.99, 95% CI 0.55 to 1.81; 2 studies, 859 participants), and influenza (OR 0.91, 95% CI 0.61 to 1.34; 2 studies, 1439 participants) vaccination schedules (moderate-certainty evidence). Provider education with performance feedback may increase the proportion of adolescents who are offered and accept HPV vaccination by clinicians, compared to usual practice. Compared to adolescents visiting non-participating clinicians (in the usual practice group), the adolescents visiting clinicians in the intervention group were more likely to receive the first dose of HPV during preventive visits (5.7 percentage points increase) and during acute visits (0.7 percentage points for the first and 5.6 percentage points for the second doses of HPV) (227 clinicians and more than 200,000 children; low-certainty evidence). A class-based school vaccination strategy probably leads to slightly higher HPV vaccine uptake than an age-based school vaccination strategy (RR 1.09, 95% CI 1.06 to 1.13; 1 study, 5537 participants; moderate-certainty evidence). A multi-component provider intervention (including an education session, repeated contacts, individualised feedback, and incentives) probably improves uptake of HPV vaccine compared to usual practice (moderate-certainty evidence). A multi-component intervention targeting providers and parents involving social marketing and health education may improve HPV vaccine uptake compared to usual practice (RR 1.41, 95% CI 1.25 to 1.59; 1 study, 25,869 participants; low-certainty evidence).
AUTHORS' CONCLUSIONS
Various strategies have been evaluated to improve adolescent vaccination including health education, financial incentives, mandatory vaccination, and class-based school vaccine delivery. However, most of the evidence is of low to moderate certainty. This implies that while this research provides some indication of the likely effect of these interventions, the likelihood that the effects will be substantially different is high. Therefore, additional research is needed to further enhance adolescent immunisation strategies, especially in low- and middle-income countries where there are limited adolescent vaccination programmes. In addition, it is critical to understand the factors that influence hesitancy, acceptance, and demand for adolescent vaccination in different settings. This is the topic of an ongoing Cochrane qualitative evidence synthesis, which may help to explain why and how some interventions were more effective than others in increasing adolescent HPV vaccination coverage.
Topics: Adolescent; Child; Controlled Before-After Studies; Health Education; Health Personnel; Humans; Parents; Randomized Controlled Trials as Topic; Vaccination
PubMed: 31978259
DOI: 10.1002/14651858.CD011895.pub2 -
Vaccines Dec 2019The growing number of available vaccines that can be potentially co-administered makes the assessment of the safety of vaccine co-administration increasingly relevant... (Review)
Review
The growing number of available vaccines that can be potentially co-administered makes the assessment of the safety of vaccine co-administration increasingly relevant but complex. We aimed to synthesize the available scientific evidence on the safety of vaccine co-administrations in children by performing a systematic literature review of studies assessing the safety of vaccine co-administrations in children between 1999 and 2019, in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fifty studies compared co-administered vaccines versus the same vaccines administered separately. The most frequently studied vaccines included quadrivalent meningococcal conjugate (MenACWY) vaccine, diphtheria and tetanus toxoids and acellular pertussis (DTaP) or tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccines, diphtheria and tetanus toxoids and acellular pertussis adsorbed, hepatitis B, inactivated poliovirus and type b conjugate (DTaP-HepB-IPV/Hib) vaccine, measles, mumps, and rubella (MMR) vaccine, and pneumococcal conjugate 7-valent (PCV7) or 13-valent (PCV13) vaccines. Of this, 16% (n = 8) of the studies reported significantly more adverse events following immunization (AEFI) while in 10% (n = 5) significantly fewer adverse events were found in the co-administration groups. Statistically significant differences between co-administration and separate administration were found for 16 adverse events, for 11 different vaccine co-administrations. In general, studies briefly described safety and one-third of studies lacked any statistical assessment of AEFI. Overall, the evidence on the safety of vaccine co-administrations compared to separate vaccine administrations is inconclusive and there is a paucity of large post-licensure studies addressing this issue.
PubMed: 31906218
DOI: 10.3390/vaccines8010012 -
Human Vaccines & Immunotherapeutics Mar 2020Children who had received MMR as the most recent vaccine had a pooled 35% (95%CI: 12-53%) lower risk for hospitalization due to any infectious disease, compared to... (Meta-Analysis)
Meta-Analysis
Non-specific effects of MMR vaccines on infectious disease related hospitalizations during the second year of life in high-income countries: a systematic review and meta-analysis.
Children who had received MMR as the most recent vaccine had a pooled 35% (95%CI: 12-53%) lower risk for hospitalization due to any infectious disease, compared to children who had received DTaP as the most recent vaccine (three studies, 1,919,192 children). The effect was stronger for respiratory tract infections than for gastrointestinal infections. Two studies investigated MMR alone, compared to concurrent administration of MMR and DTaP vaccines. Here, the pooled estimate for reduction in risk of hospitalization for any infectious disease was smaller and not significant (15%; 95%CI: -9% to 34%). Risk of bias was serious to critical in all studies. Moreover, two of the five studies demonstrated a significantly reduced risk for a control outcome (hospitalization for injuries), strongly indicating healthy vaccinee bias or residual confounding. The available evidence is insufficient to support a change in current vaccination schedules.
Topics: Child; Communicable Diseases; Developed Countries; Diphtheria-Tetanus-Pertussis Vaccine; Hospitalization; Humans; Infant; Measles-Mumps-Rubella Vaccine
PubMed: 31625797
DOI: 10.1080/21645515.2019.1663119 -
BMJ Global Health 2019We have previously reported, in a systematic review of 181 studies, that restriction of antibiotic use in food-producing animals is associated with a reduction in...
BACKGROUND
We have previously reported, in a systematic review of 181 studies, that restriction of antibiotic use in food-producing animals is associated with a reduction in antibiotic-resistant bacterial isolates. While informative, that report did not concretely specify whether different types of restriction are associated with differential effectiveness in reducing resistance. We undertook a sub-analysis of the systematic review to address this question.
METHODS
We created a classification scheme of different approaches to antibiotic restriction: (1) complete restriction; (2) single antibiotic-class restriction; (3) single antibiotic restriction; (4) all non-therapeutic use restriction; (5) growth promoter and prophylaxis restriction; (6) growth promoter restriction and (7) other/undetermined. All studies in the original systematic review that were amenable to meta-analysis were included into this substudy and coded by intervention type. Meta-analyses were conducted using random effects models, stratified by intervention type.
RESULTS
A total of 127 studies were included. The most frequently studied intervention type was complete restriction (n=51), followed by restriction of non-therapeutic (n=33) and growth promoter (n=19) indications. None examined growth promoter and prophylaxis restrictions together. Three and seven studies examined single antibiotic-class and single antibiotic restrictions, respectively; these two intervention types were not significantly associated with reductions in antibiotic resistance. Though complete restrictions were associated with a 15% reduction in antibiotic resistance, less prohibitive approaches also demonstrated reduction in antibiotic resistance of 9%-30%.
CONCLUSION
Broad interventions that restrict global antibiotic use appear to be more effective in reducing antibiotic resistance compared with restrictions that narrowly target one specific antibiotic or antibiotic class. Importantly, interventions that allow for therapeutic antibiotic use appear similarly effective compared with those that restrict all uses of antibiotics, suggesting that complete bans are not necessary. These findings directly inform the creation of specific policies to restrict antibiotic use in food-producing animals.
PubMed: 31543995
DOI: 10.1136/bmjgh-2019-001710