const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Pediatric Residency Conference";
pres.title = "Impact of Rotavirus Vaccine on Acute Gastroenteritis & Intussusception Safety";

// ─────────────────────────────────────────────
// COLOR PALETTE
// Primary dark navy: 0D1B2A
// Accent teal: 1AABAB
// Light slate bg: EEF3F7
// Warm yellow accent: F0A500
// Text dark: 1E2D3D
// Text light: FFFFFF
// Subtle gray: 9EAEBF
// ─────────────────────────────────────────────

const NAVY   = "0D1B2A";
const TEAL   = "1AABAB";
const LBKG   = "EEF3F7";
const YELLOW = "F0A500";
const DARK   = "1E2D3D";
const WHITE  = "FFFFFF";
const GRAY   = "9EAEBF";
const LTEAL  = "D8F0F0";

// helper: slide with dark bg
function darkSlide(title, opts) {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: NAVY } });
  if (title) {
    s.addText(title, {
      x: 0.5, y: 0.3, w: 9, h: 0.7,
      fontSize: 28, bold: true, color: TEAL, fontFace: "Calibri", margin: 0
    });
  }
  return s;
}

// helper: slide with light bg + teal header bar
function lightSlide(title) {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: LBKG } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.85, fill: { color: NAVY } });
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    fontSize: 22, bold: true, color: WHITE, fontFace: "Calibri", margin: 0
  });
  return s;
}

// helper: add a bullet block
function addBullets(slide, items, x, y, w, h, opts) {
  opts = opts || {};
  const fontSize = opts.fontSize || 16;
  const color = opts.color || DARK;
  const textArr = items.map((item, i) => ({
    text: item,
    options: {
      bullet: { type: "bullet", indent: opts.indent || 12 },
      breakLine: i < items.length - 1,
      fontSize,
      color,
      fontFace: "Calibri",
      paraSpaceAfter: 4
    }
  }));
  slide.addText(textArr, { x, y, w, h, valign: "top" });
}

// ─── SLIDE 1: TITLE ───────────────────────────────────────────────────────────
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: NAVY } });
  // teal decorative bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 3.5, w: 10, h: 0.08, fill: { color: TEAL } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 3.62, w: 4.5, h: 0.06, fill: { color: YELLOW } });

  s.addText("ROTAVIRUS VACCINE", {
    x: 0.6, y: 0.6, w: 8.8, h: 0.8,
    fontSize: 36, bold: true, color: TEAL, fontFace: "Calibri",
    charSpacing: 3, align: "center", margin: 0
  });
  s.addText("Impact on Acute Gastroenteritis &\nIntussusception Safety", {
    x: 0.6, y: 1.5, w: 8.8, h: 1.2,
    fontSize: 24, bold: false, color: WHITE, fontFace: "Calibri",
    align: "center"
  });
  s.addText("A Review for Pediatric Residents", {
    x: 0.6, y: 2.85, w: 8.8, h: 0.55,
    fontSize: 16, color: GRAY, fontFace: "Calibri", align: "center", italic: true
  });
  s.addText("Sources: Red Book 2021 | JAMA Pediatr 2021 | Vaccine 2022 | Rosen's EM | Sleisenger & Fordtran", {
    x: 0.6, y: 4.9, w: 8.8, h: 0.4,
    fontSize: 10, color: GRAY, fontFace: "Calibri", align: "center"
  });
}

// ─── SLIDE 2: OUTLINE ─────────────────────────────────────────────────────────
{
  const s = lightSlide("Presentation Outline");
  const items = [
    "1.  Rotavirus & Acute Gastroenteritis — the burden",
    "2.  Vaccines available: RV1 (Rotarix) & RV5 (RotaTeq)",
    "3.  Immunization schedule & mechanism",
    "4.  Impact on hospitalization & mortality — global data",
    "5.  Impact in low/middle-income vs high-income countries",
    "6.  Real-world effectiveness meta-analysis (JAMA Pediatr 2021)",
    "7.  Intussusception — background & baseline risk",
    "8.  Intussusception risk with RotaShield (withdrawn 1999)",
    "9.  Post-licensure surveillance — current vaccines",
    "10. Risk–benefit analysis",
    "11. Contraindications & precautions",
    "12. Take-home messages"
  ];
  addBullets(s, items, 0.5, 1.0, 9, 4.3, { fontSize: 14, color: DARK });
}

// ─── SLIDE 3: DISEASE BURDEN ──────────────────────────────────────────────────
{
  const s = lightSlide("Rotavirus: Global Disease Burden");

  // left column — stats boxes
  const boxes = [
    { label: "Deaths/year pre-vaccine", val: "~528,000", sub: "children <5 worldwide" },
    { label: "Deaths/year by 2013", val: "~215,000", sub: "85% in Africa & Asia" },
    { label: "Hospital admissions", val: "30–70%", sub: "of all pediatric AGE" },
  ];
  boxes.forEach((b, i) => {
    const bx = 0.3;
    const by = 1.05 + i * 1.35;
    s.addShape(pres.ShapeType.roundRect, { x: bx, y: by, w: 4, h: 1.1, fill: { color: NAVY }, rectRadius: 0.12 });
    s.addText(b.val, { x: bx + 0.15, y: by + 0.05, w: 3.7, h: 0.55, fontSize: 26, bold: true, color: TEAL, fontFace: "Calibri", margin: 0 });
    s.addText(b.label, { x: bx + 0.15, y: by + 0.58, w: 3.7, h: 0.28, fontSize: 11, color: WHITE, fontFace: "Calibri", margin: 0 });
    s.addText(b.sub, { x: bx + 0.15, y: by + 0.8, w: 3.7, h: 0.22, fontSize: 10, color: GRAY, fontFace: "Calibri", italic: true, margin: 0 });
  });

  // right column — key facts
  s.addText("Key Epidemiology", { x: 4.8, y: 1.0, w: 4.8, h: 0.38, fontSize: 14, bold: true, color: NAVY, fontFace: "Calibri", margin: 0 });
  addBullets(s, [
    "Nearly ubiquitous in children <5 yrs globally",
    "Infection rates similar in developed & developing world",
    "Incubation: 1–3 days; inoculum as low as 1–10 virions",
    "Watery diarrhea, vomiting, fever in ~1/3",
    "Illness duration: 5–7 days on average",
    "Seizures (afebrile) in 2–3% of infected children",
    "Seasonality: peaks in cooler months (Jan–May in USA)",
    "Leading cause of diarrheal death in <5 globally"
  ], 4.8, 1.45, 4.8, 3.9, { fontSize: 13, color: DARK });

  s.addText("Sleisenger & Fordtran's GI & Liver Disease; Rosen's EM", {
    x: 0.3, y: 5.3, w: 9.4, h: 0.25, fontSize: 9, color: GRAY, italic: true, fontFace: "Calibri"
  });
}

// ─── SLIDE 4: THE VACCINES ────────────────────────────────────────────────────
{
  const s = lightSlide("Approved Rotavirus Vaccines");

  // RV1 box
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.0, w: 4.2, h: 4.3, fill: { color: NAVY }, rectRadius: 0.15 });
  s.addText("Rotarix (RV1)", { x: 0.4, y: 1.05, w: 4.0, h: 0.5, fontSize: 18, bold: true, color: TEAL, fontFace: "Calibri", align: "center", margin: 0 });
  s.addText("GlaxoSmithKline", { x: 0.4, y: 1.52, w: 4.0, h: 0.3, fontSize: 11, color: GRAY, fontFace: "Calibri", align: "center", italic: true, margin: 0 });
  s.addShape(pres.ShapeType.line, { x: 0.5, y: 1.85, w: 3.8, h: 0, line: { color: TEAL, width: 1 } });
  addBullets(s, [
    "Live-attenuated monovalent human G1P[8]",
    "2-dose oral series",
    "Doses at 2 & 4 months of age",
    "First dose: 6–14 wks 6 days",
    "Min interval: 4 weeks",
    "All doses by 8 months",
    "Licensed in USA: 2008"
  ], 0.4, 2.0, 4.0, 3.0, { fontSize: 13, color: WHITE });

  // RV5 box
  s.addShape(pres.ShapeType.roundRect, { x: 5.1, y: 1.0, w: 4.5, h: 4.3, fill: { color: DARK }, rectRadius: 0.15 });
  s.addText("RotaTeq (RV5)", { x: 5.2, y: 1.05, w: 4.3, h: 0.5, fontSize: 18, bold: true, color: YELLOW, fontFace: "Calibri", align: "center", margin: 0 });
  s.addText("Merck & Co.", { x: 5.2, y: 1.52, w: 4.3, h: 0.3, fontSize: 11, color: GRAY, fontFace: "Calibri", align: "center", italic: true, margin: 0 });
  s.addShape(pres.ShapeType.line, { x: 5.3, y: 1.85, w: 4.1, h: 0, line: { color: YELLOW, width: 1 } });
  addBullets(s, [
    "Pentavalent human-bovine reassortant (G1–G4, P[8])",
    "3-dose oral series",
    "Doses at 2, 4 & 6 months of age",
    "First dose: 6–14 wks 6 days",
    "Min interval: 4 weeks",
    "All doses by 8 months",
    "Licensed in USA: 2006"
  ], 5.2, 2.0, 4.3, 3.0, { fontSize: 13, color: WHITE });

  s.addText("Note: AAP & CDC express no preference between RV1 and RV5  |  Red Book 2021", {
    x: 0.3, y: 5.35, w: 9.4, h: 0.22, fontSize: 9, color: GRAY, italic: true, fontFace: "Calibri"
  });
}

// ─── SLIDE 5: MECHANISM OF ACTION ────────────────────────────────────────────
{
  const s = lightSlide("Mechanism of Action & Immunogenicity");

  s.addText("How rotavirus vaccines work:", {
    x: 0.5, y: 1.0, w: 9, h: 0.4,
    fontSize: 16, bold: true, color: NAVY, fontFace: "Calibri", margin: 0
  });

  const steps = [
    { num: "1", text: "Live-attenuated vaccine virus replicates in the gut mucosa" },
    { num: "2", text: "Stimulates secretory IgA (sIgA) in intestinal lamina propria" },
    { num: "3", text: "Memory B & T cells generated; cross-serotype protection conferred" },
    { num: "4", text: "Serum IgA titers correlate strongly with vaccine protection\n(coefficient −1.599; R² = 99.7% — JAMA Pediatr 2021)" },
  ];
  steps.forEach((st, i) => {
    const bx = 0.4;
    const by = 1.5 + i * 0.92;
    s.addShape(pres.ShapeType.ellipse, { x: bx, y: by + 0.07, w: 0.45, h: 0.45, fill: { color: TEAL } });
    s.addText(st.num, { x: bx, y: by + 0.06, w: 0.45, h: 0.45, fontSize: 16, bold: true, color: WHITE, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
    s.addText(st.text, { x: bx + 0.6, y: by, w: 8.6, h: 0.6, fontSize: 15, color: DARK, fontFace: "Calibri", valign: "middle" });
    if (i < steps.length - 1) {
      s.addShape(pres.ShapeType.line, { x: bx + 0.22, y: by + 0.52, w: 0, h: 0.35, line: { color: TEAL, width: 1.5 } });
    }
  });

  s.addText("Rotavac, Rotasiil, Lanzhou Lamb (LLR) — additional WHO-prequalified vaccines used in Asia/Africa", {
    x: 0.5, y: 5.3, w: 9, h: 0.25, fontSize: 10, color: GRAY, italic: true, fontFace: "Calibri"
  });
}

// ─── SLIDE 6: IMPACT ON AGE (GLOBAL) ─────────────────────────────────────────
{
  const s = lightSlide("Impact on Acute Gastroenteritis — Global Evidence");

  // Headline stat
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.0, w: 9.4, h: 0.85, fill: { color: TEAL }, rectRadius: 0.1 });
  s.addText("Median 67% reduction in rotavirus AGE hospitalizations across 27 countries  |  38% reduction in all-cause AGE hospitalizations", {
    x: 0.4, y: 1.05, w: 9.2, h: 0.75, fontSize: 15, bold: true, color: WHITE, fontFace: "Calibri", align: "center", valign: "middle"
  });

  // Three country-group columns
  const cols = [
    { label: "Low child mortality", hospit: "41%", rvage: "71%", color: "205A8C" },
    { label: "Medium child mortality", hospit: "30%", rvage: "59%", color: "127A7A" },
    { label: "High child mortality\n(Africa & Asia)", hospit: "46%", rvage: "60%", color: NAVY },
  ];
  cols.forEach((c, i) => {
    const cx = 0.3 + i * 3.2;
    s.addShape(pres.ShapeType.roundRect, { x: cx, y: 2.05, w: 3.1, h: 2.95, fill: { color: c.color }, rectRadius: 0.12 });
    s.addText(c.label, { x: cx + 0.1, y: 2.1, w: 2.9, h: 0.6, fontSize: 13, bold: true, color: TEAL, fontFace: "Calibri", align: "center" });
    s.addText("All-cause AGE\nhospitalization ↓", { x: cx + 0.1, y: 2.75, w: 2.9, h: 0.45, fontSize: 11, color: GRAY, fontFace: "Calibri", align: "center" });
    s.addText(c.hospit, { x: cx + 0.1, y: 3.2, w: 2.9, h: 0.6, fontSize: 28, bold: true, color: YELLOW, fontFace: "Calibri", align: "center", margin: 0 });
    s.addText("RV-specific AGE\nhospitalization ↓", { x: cx + 0.1, y: 3.85, w: 2.9, h: 0.4, fontSize: 11, color: GRAY, fontFace: "Calibri", align: "center" });
    s.addText(c.rvage, { x: cx + 0.1, y: 4.25, w: 2.9, h: 0.55, fontSize: 26, bold: true, color: WHITE, fontFace: "Calibri", align: "center", margin: 0 });
  });

  s.addText("Parashar et al., J Infect Dis 2017 (57 articles, 27 countries)", {
    x: 0.3, y: 5.3, w: 9.4, h: 0.25, fontSize: 9, color: GRAY, italic: true, fontFace: "Calibri"
  });
}

// ─── SLIDE 7: USA DATA ────────────────────────────────────────────────────────
{
  const s = lightSlide("Impact in the United States (Post-2006)");

  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.0, w: 9.4, h: 0.75, fill: { color: NAVY }, rectRadius: 0.1 });
  s.addText("RotaTeq licensed 2006 · Rotarix licensed 2008 → norovirus became leading AGE cause in US children", {
    x: 0.4, y: 1.05, w: 9.2, h: 0.65, fontSize: 13, color: WHITE, fontFace: "Calibri", align: "center", valign: "middle", italic: true
  });

  const usFacts = [
    { icon: "↓ 60–90%", label: "annual hospitalizations in children <5 yrs" },
    { icon: "177,000", label: "hospitalizations averted since vaccine introduction" },
    { icon: "242,000", label: "ED visits averted" },
    { icon: "1.1 million", label: "outpatient visits averted" },
    { icon: "Biennial", label: "seasonal pattern emerged (short, late winter/spring seasons)" },
  ];
  usFacts.forEach((f, i) => {
    const fx = 0.4;
    const fy = 1.95 + i * 0.67;
    s.addShape(pres.ShapeType.roundRect, { x: fx, y: fy, w: 9.2, h: 0.58, fill: { color: i % 2 === 0 ? LTEAL : "D9EBF5" }, rectRadius: 0.07 });
    s.addText(f.icon, { x: fx + 0.15, y: fy + 0.06, w: 1.7, h: 0.46, fontSize: 16, bold: true, color: NAVY, fontFace: "Calibri", valign: "middle", margin: 0 });
    s.addText(f.label, { x: fx + 1.9, y: fy + 0.06, w: 7.2, h: 0.46, fontSize: 13.5, color: DARK, fontFace: "Calibri", valign: "middle", margin: 0 });
  });

  s.addText("Rosen's Emergency Medicine (2022); CDC surveillance data", {
    x: 0.3, y: 5.33, w: 9.4, h: 0.22, fontSize: 9, color: GRAY, italic: true, fontFace: "Calibri"
  });
}

// ─── SLIDE 8: JAMA META-ANALYSIS ──────────────────────────────────────────────
{
  const s = lightSlide("Vaccine Efficacy Meta-Analysis  |  JAMA Pediatrics 2021");

  s.addText("Sun et al., JAMA Pediatr 2021 — 20 RCTs + 38 case-control studies (PMID: 33970192)", {
    x: 0.4, y: 0.95, w: 9.2, h: 0.38, fontSize: 12, color: TEAL, italic: true, fontFace: "Calibri", margin: 0
  });

  const headers = ["Vaccine", "Outcome", "Risk Ratio / OR", "95% CI"];
  const rows = [
    ["Rotarix (RV1)", "RVGE reduction", "RR 0.316", "0.224–0.345"],
    ["Rotarix (RV1)", "RVGE hospitalization", "OR 0.347", "0.279–0.432"],
    ["RotaTeq (RV5)", "RVGE reduction", "RR 0.350", "0.275–0.445"],
    ["RotaTeq (RV5)", "RVGE hospitalization", "OR 0.272", "0.197–0.376"],
    ["Rotavac", "RVGE reduction", "RR 0.664", "0.548–0.804"],
    ["Rotasiil", "RVGE reduction", "RR 0.705", "0.605–0.821"],
  ];

  const colW = [2.0, 2.4, 2.0, 1.9];
  const colX = [0.35, 2.4, 4.85, 6.9];
  const rowH = 0.48;

  // Header row
  headers.forEach((h, ci) => {
    s.addShape(pres.ShapeType.rect, { x: colX[ci], y: 1.42, w: colW[ci], h: 0.42, fill: { color: NAVY } });
    s.addText(h, { x: colX[ci] + 0.05, y: 1.42, w: colW[ci] - 0.1, h: 0.42, fontSize: 12, bold: true, color: WHITE, fontFace: "Calibri", valign: "middle", align: ci > 1 ? "center" : "left", margin: 0 });
  });

  rows.forEach((row, ri) => {
    const ry = 1.88 + ri * rowH;
    const fill = ri % 2 === 0 ? WHITE : "E8F4F4";
    row.forEach((cell, ci) => {
      s.addShape(pres.ShapeType.rect, { x: colX[ci], y: ry, w: colW[ci], h: rowH - 0.02, fill: { color: fill } });
      const isStat = ci > 1;
      s.addText(cell, {
        x: colX[ci] + 0.07, y: ry + 0.02, w: colW[ci] - 0.1, h: rowH - 0.06,
        fontSize: 12.5, color: isStat ? (ci === 2 ? "1A5276" : DARK) : DARK,
        bold: ci === 2, fontFace: "Calibri", valign: "middle", align: isStat ? "center" : "left", margin: 0
      });
    });
  });

  s.addText("All vaccines: no significant increase in serious adverse events  |  RV1 & RV5 showed comparable protection (adjusted indirect comparison)", {
    x: 0.35, y: 5.2, w: 9.2, h: 0.3, fontSize: 10.5, color: NAVY, bold: true, fontFace: "Calibri"
  });
}

// ─── SLIDE 9: INTUSSUSCEPTION BACKGROUND ─────────────────────────────────────
{
  const s = lightSlide("Intussusception — Background");

  // left: definition box
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 1.0, w: 4.5, h: 4.35, fill: { color: NAVY }, rectRadius: 0.12 });
  s.addText("What is intussusception?", { x: 0.4, y: 1.05, w: 4.3, h: 0.45, fontSize: 15, bold: true, color: TEAL, fontFace: "Calibri", margin: 0 });
  addBullets(s, [
    "Telescoping of one bowel segment into adjacent segment",
    "Most common cause of intestinal obstruction in infants",
    "Peak age: 5–12 months",
    "Classic triad: colicky pain, vomiting, currant-jelly stools",
    "Diagnosis: ultrasound (target/doughnut sign)",
    "Treatment: pneumatic/hydrostatic enema or surgery",
    "Background rate: ~1–3/1,000 live births (varies by country)"
  ], 0.4, 1.55, 4.3, 3.6, { fontSize: 13, color: WHITE });

  // right: why it matters
  s.addText("Why it matters for vaccine safety:", {
    x: 5.1, y: 1.0, w: 4.5, h: 0.4,
    fontSize: 15, bold: true, color: NAVY, fontFace: "Calibri", margin: 0
  });
  addBullets(s, [
    "1998 RotaShield (RRV-TV) was withdrawn after detected ~1/10,000 intussusception risk",
    "Temporal clustering: within 1–2 weeks post-dose",
    "Raised the standard for all subsequent rotavirus vaccines",
    "Pre-licensure trials of RV1 & RV5 each enrolled >60,000 infants specifically to detect this signal",
    "Post-marketing surveillance is ongoing globally via VAERS, VSD, and international registries"
  ], 5.1, 1.5, 4.5, 3.9, { fontSize: 13, color: DARK });

  s.addText("Rosen's Emergency Medicine; Sleisenger & Fordtran", {
    x: 0.3, y: 5.33, w: 9.4, h: 0.22, fontSize: 9, color: GRAY, italic: true, fontFace: "Calibri"
  });
}

// ─── SLIDE 10: ROTASHIELD LESSON ──────────────────────────────────────────────
{
  const s = darkSlide("Historical Context: RotaShield (RRV-TV) — 1999");

  s.addShape(pres.ShapeType.roundRect, { x: 0.4, y: 1.0, w: 9.2, h: 0.7, fill: { color: "8B0000" }, rectRadius: 0.08 });
  s.addText("RotaShield WITHDRAWN from US market in October 1999", {
    x: 0.5, y: 1.05, w: 9.0, h: 0.6, fontSize: 17, bold: true, color: WHITE, fontFace: "Calibri", align: "center", valign: "middle"
  });

  addBullets(s, [
    "First licensed US rotavirus vaccine (Wyeth-Lederle) — 1998",
    "Rhesus-human reassortant tetravalent oral vaccine",
    "Post-licensure: VSD detected ~1 excess intussusception per 10,000 vaccinated infants",
    "Risk concentrated in the 2 weeks following dose 1 & dose 2",
    "Estimated: 1 excess intussusception per 5,000–10,000 vaccines administered",
    "ACIP vote July 1999 → CDC withdrawal recommendation",
    "KEY LESSON: Drove requirement for massive pre-licensure safety trials for RV1 & RV5",
    "No similar excess risk found in RotaTeq (60,000 infant trial) or Rotarix (63,000 infant trial)"
  ], 0.5, 1.85, 9.0, 3.5, { fontSize: 14, color: WHITE });

  s.addText("This withdrawal fundamentally changed the vaccine safety evaluation paradigm for enteric vaccines", {
    x: 0.4, y: 5.1, w: 9.2, h: 0.4, fontSize: 12, color: TEAL, bold: true, fontFace: "Calibri", align: "center"
  });
}

// ─── SLIDE 11: POST-LICENSURE INTUSSUSCEPTION RISK ────────────────────────────
{
  const s = lightSlide("Post-Licensure Intussusception Risk — Current Vaccines");

  s.addText("Pre-licensure RCTs (n > 60,000 each): NO excess intussusception signal", {
    x: 0.4, y: 1.0, w: 9.2, h: 0.38, fontSize: 14, bold: true, color: "205A8C", fontFace: "Calibri", margin: 0
  });

  s.addText("Post-marketing surveillance findings:", {
    x: 0.4, y: 1.5, w: 9.2, h: 0.36, fontSize: 14, bold: true, color: NAVY, fontFace: "Calibri", margin: 0
  });

  // Two columns
  const leftData = [
    "Studies showing NO increased risk:",
    "  • United States (multiple studies)",
    "  • Canada",
    "  • Korea",
    "  • Africa (multiple countries)",
    "  • Brazil",
    "  • Taiwan",
    "",
    "Vaccine 2022 (Henschke et al.):",
    "  • 4 WHO-prequalified vaccines",
    "  • NO intussusception increase in high-mortality African & Asian settings"
  ];
  const rightData = [
    "Studies finding SMALL increased risk:",
    "  • USA (VAERS, VSD): ~1–5 excess cases per 100,000 vaccinated",
    "  • Australia (up to 21 days post dose 1)",
    "  • Mexico, Brazil",
    "",
    "Risk characteristics when found:",
    "  • Primarily within first 7 days post-dose",
    "  • Mainly after dose 1 or 2",
    "  • Highest excess: ~6 per 100,000 (Aus. data)",
    "  • Red Book 2021: 1–5 excess cases/100,000 vaccinated (US estimate)"
  ];

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  });
}

// ─── SLIDE 12: RISK-BENEFIT ───────────────────────────────────────────────────
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  s.addText("CDC, WHO, AAP, IAP all recommend rotavirus vaccination — benefits far outweigh risks", {
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  });

  // vs table
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  const hdrs = ["RISK (Intussusception)", "BENEFIT (AGE prevention)"];
  const hdColors = ["8B2020", "0A5C36"];
  const items2 = [
    ["1–5 excess cases per 100,000 vaccinated (US)", "67% reduction in RV AGE hospitalizations"],
    ["Risk window: mainly 7 days post dose 1 or 2", "177,000 hospitalizations averted/year in USA"],
    ["Self-limited with prompt treatment in most", "60–90% reduction in US pediatric RV hospitalizations"],
    ["No excess mortality from intussusception in trials", "528,000 → 215,000 global deaths avoided/year"],
    ["Background intussusception rate: ~1–3/1,000", "46% reduction in high-mortality countries"],
    ["Baseline cases occur without vaccine", "Prevents severe dehydration, ICU admissions, death"],
  ];

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}

// ─── SLIDE 13: CONTRAINDICATIONS ──────────────────────────────────────────────
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    "History of intussusception",
    "Severe combined immunodeficiency (SCID)",
    "Severe allergic reaction to prior dose",
    "Do NOT initiate first dose ≥15 weeks 0 days of age",
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  s.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.0, w: 4.6, h: 0.45, fill: { color: "E67E22" } });
  s.addText("PRECAUTIONS", { x: 5.15, y: 1.0, w: 4.5, h: 0.45, fontSize: 13, bold: true, color: WHITE, fontFace: "Calibri", valign: "middle", margin: 0 });
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    "Premature infants: vaccinate at chronological age (not corrected) per schedule",
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    "HIV: WHO does not contraindicate; weigh benefits vs. risks individually"
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}

// ─── SLIDE 14: GLOBAL DEPLOYMENT & WHO ───────────────────────────────────────
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    ["Coverage 2024", ">120 countries have introduced rotavirus vaccine (WHO)"],
    ["4 WHO-prequalified\nvaccines", "RV1 (Rotarix), RV5 (RotaTeq), Rotavac (India), Rotasiil (India)"],
    ["Efficacy in\nhigh-mortality settings", "48–57% against severe RVGE in year 1; 29–54% in year 2 (Henschke 2022)"],
    ["China Expert\nConsensus 2024", "All WHO-prequalified vaccines show favorable safety profiles; highlight intussusception risk in programs"],
    ["Complementary measures", "Exclusive breastfeeding, hand hygiene, ORS + zinc supplementation for management"],
  ];

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// ─── SLIDE 15: TAKE-HOME / CONCLUSIONS ───────────────────────────────────────
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    { num: "02", text: "RV1 (Rotarix) & RV5 (RotaTeq): ~65–70% reduction in RVGE and RVGE hospitalizations in fully vaccinated children." },
    { num: "03", text: "In the USA: 60–90% fewer hospitalizations, 177,000 hospitalizations + 242,000 ED visits averted annually." },
    { num: "04", text: "RotaShield was withdrawn (1999) due to ~1/10,000 intussusception risk. Current vaccines have a far smaller signal." },
    { num: "05", text: "Current estimates: 1–5 excess intussusception cases per 100,000 vaccinated infants; risk within 7 days of doses 1–2." },
    { num: "06", text: "Benefits overwhelmingly outweigh risks — CDC, WHO, AAP, IAP all recommend universal infant vaccination." },
    { num: "07", text: "Counsel parents: recognize intussusception (colicky crying, bilious vomiting, currant-jelly stool) → seek immediate care." },
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// ─── WRITE FILE ───────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/rotavirus-pptx/Rotavirus_Vaccine_Impact_Peds.pptx" })
  .then(() => console.log("SUCCESS: PPTX written"))
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