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The Nicaraguan Birth Cohort Study

University of Michigan investigator(s) and unit: Aubree Gordon, PhD MPH. Department of Epidemiology, School of Public Health

International colleague(s) and unit: Guillermina Kuan, MD. Ministry of Health, Nicaragua and Lionel Gresh, PhD. Sustainable Sciences Institute, Managua, Nicaragua 

Purpose: To examine the burden of influenza and respiratory disease in infants including the effect of sociodemographic and nutritional factors on their health 

Rationale: This study is vital because it will provide much-needed information on the basic epidemiology and burden of influenza in children under 2 years of age. Empirical data on the burden of influenza in infants is needed to evaluate potential interventions, such as vaccination.  Additionally this study will provide important information on influenza epidemiology, including circulation of the virus in tropical developing countries, while expanding our scientific knowledge of the impact of risk factors unique to developing country settings, such as malnutrition.

Study design and methods:  The Nicaraguan Influenza Birth Cohort is a prospective study of 750 infants and toddlers who are enrolled in the study in the first four weeks of life and visited on a weekly basis until two years of age.  Children are provided with medical care through the study and a respiratory sample is collected each time the child has a fever. The study began in September of 2011.  This study is providing critical information on the burden of influenza in infants and very young children, including examining the contribution that influenza virus infection makes to the high rates of pneumonia seen in these children.  We are also assessing the effects of breast feeding practices, household exposures, and low birth weight to influenza virus infection and pneumonia.  Additionally, samples from this study will be used to examine the development of immunity to influenza virus.  Information gained through this study is crucial for the design of appropriate interventions and to support the need for influenza vaccination in these vulnerable populations.

Anticipated undergraduate/graduate student activities on project:

  • Evaluation of survey instruments and use of information and communication technologies for the collection of data
  • Collection of nutritional data and measurements
  • Data analyses

Techniques/methods students should become familiar with in advance: 

  • Knowledge of basic epidemiologic concepts
  • STATA/SAS programming ability desirable, but not required
  • Proficiency in Spanish

Suggested readings (minimum of 3-5 articles): 

  1. Gordon, A., Ortega, O., Kuan, G., Reingold, A., Saborio, S., Balmaseda, A., and Harris, E. Prevalence and seasonality of influenza-like illness in a pediatric cohort in Nicaragua. Infect. Dis. 2009 Mar. 15:408-414
  1. Kuan, G., Gordon, A., Aviles, W., Ortega, O., Elizondo, D., Nuñez, A., Coloma, J., Balmaseda, A., and Harris E. The Nicaraguan Pediatric Dengue Cohort Study: Study design, methods, use of information technology, and extension to other infectious diseases. J. Epidemiol. 2009 Jul. 170:120-9
  2. 3.   Gordon, A., Saborio, S., Videa, E., Lopez, R., Kuan, G., Balmaseda, A., Harris, E.  Clinical attack rate and presentation of pandemic H1N1 compared to seasonal influenza A and B in a pediatric cohort in Nicaragua. CID 2010Jun 1;50(11):1462-7.
  1. Nair, H. Brooks, W.A., Katz, M., Roca, A., Berkley J, Madhi, S., Simmerman, J.A., Gordon, A., Sato M., Howie, S.,  Krishnan, A, Ope M, Lindblade K.A., Carosone-Link, P., Lucero, M., Ochieng, W.,  Kamimoto, L., Dueger, E., Bhat N., Vong, S., Theodoratou, E., Chittaganpitch, M., Chimah, O., Balmaseda, A., Buchy, P., Harris, E., Evans, V., Katayose M.,  Gaur, B., O’Callaghan-Gordo C., Goswami, D., Arvelo, W., Venter, M., Briese, T., Tokarz, R., Widdowson, M.A., Mounts, A.W., Breiman R.F., Feikin, D.R., Klugman, K.P., Olsen S.J., Gessner B.D., Wright, P.F., Rudan I, Broor S., Simões, E.A.F, and Campbell, H. The global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis. Lancet 2011 Dec 3;378(9807):1917-30

The Nicaraguan Pediatric Influenza Cohort Study

University of Michigan investigator(s) and unit: Aubree Gordon, PhD MPH. Department of Epidemiology, School of Public Health

International colleague(s) and unit: Guillermina Kuan, MD. Ministry of Health, Nicaragua and Raquel Burger-Calderon PhD. Sustainable Sciences Institute, Managua, Nicaragua 

Purpose: To examine the burden of influenza and respiratory disease in young children including the effect of sociodemographic and nutritional factors on their health 

Rationale: This study is vital because it will provide much-needed information on the basic epidemiology and burden of influenza in children. Empirical data on the burden of influenza in children is needed to evaluate potential interventions, such as vaccination.  Additionally this study will provide important information on influenza epidemiology, including circulation of the virus in tropical developing countries, while expanding our scientific knowledge of the impact of risk factors unique to developing country settings, such as malnutrition.

Study design and methods:  The Nicaraguan Pediatric Influenza Cohort Study is a prospective study of ~1600 children who are enrolled in the study in the first four weeks of life and followed through up to 14 years of age.  Children are provided with medical care through the study and a respiratory sample is collected each time the child has a fever. The study began in January of 2010.  This study is providing critical information on the burden of influenza in infants and very young children, including examining the contribution that influenza virus infection makes to the high rates of pneumonia seen in these children.  We are also assessing the effects of breast feeding practices, household exposures, and low birth weight to influenza virus infection and pneumonia.  Additionally, samples from this study will be used to examine the development of immunity to influenza virus.  Information gained through this study is crucial for the design of appropriate interventions and to support the need for influenza vaccination in these vulnerable populations.

Anticipated undergraduate/graduate student activities on project:

  • Evaluation of survey instruments and use of information and communication technologies for the collection of data
  • Collection of nutritional data and measurements
  • Data analyses

Techniques/methods students should become familiar with in advance: 

  • Knowledge of basic epidemiologic concepts
  • STATA/SAS programming ability desirable, but not required
  • Proficiency in Spanish

Suggested readings (minimum of 3-5 articles): 

  1. Gordon, A., Ortega, O., Kuan, G., Reingold, A., Saborio, S., Balmaseda, A., and Harris, E. Prevalence and seasonality of influenza-like illness in a pediatric cohort in Nicaragua. Dis. 2009 Mar. 15:408-414
  2. Kuan, G., Gordon, A., Aviles, W., Ortega, O., Elizondo, D., Nuñez, A., Coloma, J., Balmaseda, A., and Harris E. The Nicaraguan Pediatric Dengue Cohort Study: Study design, methods, use of information technology, and extension to other infectious diseases.  Epidemiol.2009 Jul. 170:120-9
  3. Gordon, A., Saborio, S., Videa, E., Lopez, R., Kuan, G., Balmaseda, A., Harris, E.  Clinical attack rate and presentation of pandemic H1N1 compared to seasonal influenza A and B in a pediatric cohort in Nicaragua. CID 2010Jun 1;50(11):1462-7.
  4. Nair, H. Brooks, W.A., Katz, M., Roca, A., Berkley J, Madhi, S., Simmerman, J.A., Gordon, A., Sato M., Howie, S.,  Krishnan, A, Ope M, Lindblade K.A., Carosone-Link, P., Lucero, M., Ochieng, W.,  Kamimoto, L., Dueger, E., Bhat N., Vong, S., Theodoratou, E., Chittaganpitch, M., Chimah, O., Balmaseda, A., Buchy, P., Harris, E., Evans, V., Katayose M.,  Gaur, B., O’Callaghan-Gordo C., Goswami, D., Arvelo, W., Venter, M., Briese, T., Tokarz, R., Widdowson, M.A., Mounts, A.W., Breiman R.F., Feikin, D.R., Klugman, K.P., Olsen S.J., Gessner B.D., Wright, P.F., Rudan I, Broor S., Simões, E.A.F, and Campbell, H. The global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis. Lancet2011 Dec 3;378(9807):1917-30