901
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902
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Concato C, Piccioni L, Ranno S, Antonelli F, Buonomini A, Coltella L, Pizzichemi G, Chiavelli S, Riva E. Comparison of the Allplex TM Respiratory Panel Assays and the automated Fast Track Diagnostics Respiratory pathogens 21 assay for the diagnosis of pediatric respiratory viral infections. Arch Virol 2020; 165:1191-1196. [PMID: 32232675 PMCID: PMC7105963 DOI: 10.1007/s00705-020-04593-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/17/2020] [Indexed: 11/29/2022]
Abstract
Acute respiratory tract infections frequently occur in children and represent one of the leading causes of morbidity and mortality worldwide. Quick and accurate pathogen detection can lead to a more appropriate use of antimicrobial treatment as well as timely implementation of isolation precautions. In the last decade, several commercial assays have been developed for the simultaneous diagnosis of respiratory pathogens, which substantially vary in formulation and performance characteristics. The aim of this study was to compare the performance of the "AllplexTM Respiratory Panel Assays" (Seegene) with that of the automated "Fast Track Diagnostics Respiratory pathogens 21" assay (Siemens) for the diagnosis of pediatric respiratory viral infections. One hundred forty-five nasopharyngeal wash samples, collected at the Bambino Gesù Pediatric Hospital in Rome during the fall-winter 2017-2018 season, were processed and analyzed with both workflows. Our results suggest a high concordance between the two methods for positive and negative samples. Sensitivity and specificity were calculated with both tests as a reference method. For the AllplexTM Respiratory Panel Assays, they were 98% and 100%, respectively, and for the Fast Track Diagnostics Respiratory pathogens 21 assay, they were both 100%. This comparative study allowed us to highlight the characteristics of the two assays to evaluate the best solution, on the basis of diagnostic routine and laboratory workflows, keeping in mind local epidemiology.
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Affiliation(s)
- C Concato
- UOC Microbiology, Virology and Parassitology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Livia Piccioni
- UOC Microbiology, Virology and Parassitology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - S Ranno
- UOC Microbiology, Virology and Parassitology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - F Antonelli
- Lab of Virology, Campus Bio-Medico University, Rome, Italy
| | - A Buonomini
- Lab of Virology, Campus Bio-Medico University, Rome, Italy
| | - L Coltella
- UOC Microbiology, Virology and Parassitology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - G Pizzichemi
- UOC Microbiology, Virology and Parassitology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - S Chiavelli
- UOC Microbiology, Virology and Parassitology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - E Riva
- Lab of Virology, Campus Bio-Medico University, Rome, Italy
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903
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Chan WS, Au CH, Leung SM, Ho DN, Wong EYL, To MY, Ng MK, Chan TL, Ma ESK, Tang BSF. Potential utility of targeted Nanopore sequencing for improving etiologic diagnosis of bacterial and fungal respiratory infection. Diagn Pathol 2020; 15:41. [PMID: 32340617 PMCID: PMC7184685 DOI: 10.1186/s13000-020-00960-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/08/2020] [Indexed: 12/14/2022] Open
Abstract
Background Diversified etiology of lower respiratory tract infection renders diagnosis challenging. The mainstay microbial culture is time-consuming and constrained by variable growth requirements. In this study, we explored the use of Nanopore sequencing as a supplementary tool to alleviate this diagnostic bottleneck. Methods We developed a targeted Nanopore method based on amplification of bacterial 16S rRNA gene and fungal internal transcribed spacer region. The performance was compared with routine infectious disease workups on 43 respiratory specimens. Results Nanopore successfully identified majority of microbes (47/54, 87.04%) and 7 possible pathogens not detected by routine workups, which were attributable to the content of microbiological investigations (n = 5) and negative culture (n = 2). The average sequencing time for first target reads was 7 min (1–43 min) plus 5 h of pre-sequencing preparation. Conclusions The Nanopore method described here was rapid, economical and hypothesis-free, which might provide valuable hints to further microbiological follow-up for opportunistic pathogens missed or not detectable by conventional tests.
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Affiliation(s)
- Wai Sing Chan
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Chun Hang Au
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Sau Man Leung
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Dona N Ho
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | | | | | - Man Kin Ng
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Tsun Leung Chan
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | | | - Bone Siu Fai Tang
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong, China.
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904
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Naito T, Suzuki M, Kanazawa A, Takahashi H, Fujibayashi K, Yokokawa H, Kuwatsuru R, Watanabe A. Pneumococcal vaccination reduces in-hospital mortality, length of stay and medical expenditure in hospitalized elderly patients. J Infect Chemother 2020; 26:715-721. [PMID: 32334952 DOI: 10.1016/j.jiac.2020.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 03/04/2020] [Accepted: 03/25/2020] [Indexed: 11/25/2022]
Abstract
Pneumococcal vaccination has been shown to reduce occurrence of invasive pneumococcal diseases in elderly patients. In this study, we investigated the real-world efficacy of pneumococcal vaccination implemented in elderly individuals in Japan. We reviewed the in-patient database of Juntendo University Hospital and selected elderly patients (≥65 years-old) who had received in-patient care in the general medicine department during 2014-2018. A total of 1355 patients were retrospectively enrolled and comprised of 1045 unvaccinated and 315 vaccinated elderly individuals. Prior vaccination was found associated with all-cause shorter hospital stays (adjusted RR = 0.66, 95% CI = 0.57 to 0.76) and less medical expenditure (adjusted RR = 0.76, 95% CI = 0.66 to 0.87) compared with no vaccination, as well as protection for all-cause in-hospital mortality (adjusted OR = 0.42, 95% CI = 0.22 to 0.83). The association of shorter hospital stays and less medical expenditure with vaccination was also observed in the context of pneumonia, although no altered risk in mortality was observed. In conclusion, this study is one of the first reporting real-world data after the initiation of pneumococcal vaccination program in 2014 in Japan. The national PPV23 vaccination program contributed to the reduction of all-cause in-patient days, mortality, and medical expenses in the elderly aged ≥65 years. Further data is warranted to evaluate the contribution from influenza vaccination and protein-conjugate based pneumococcal vaccine.
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Affiliation(s)
- Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, 2 Chome-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan.
| | - Mai Suzuki
- Department of General Medicine, Juntendo University Faculty of Medicine, 2 Chome-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Akio Kanazawa
- Department of General Medicine, Juntendo University Faculty of Medicine, 2 Chome-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Hiromizu Takahashi
- Department of General Medicine, Juntendo University Faculty of Medicine, 2 Chome-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Kazutoshi Fujibayashi
- Department of General Medicine, Juntendo University Faculty of Medicine, 2 Chome-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Hirohide Yokokawa
- Department of General Medicine, Juntendo University Faculty of Medicine, 2 Chome-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Ryohei Kuwatsuru
- Department of Radiology, Juntendo University Faculty of Medicine, 2 Chome-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Akira Watanabe
- Research Division for Development of Anti-Infective Agents, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, 6 Chome-45-1 Kunimi, Aoba Ward, Sendai, Miyagi 981-8551, Japan
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905
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Isakova-Sivak I, Matyushenko V, Stepanova E, Matushkina A, Kotomina T, Mezhenskaya D, Prokopenko P, Kudryavtsev I, Kopeykin P, Sivak K, Rudenko L. Recombinant Live Attenuated Influenza Vaccine Viruses Carrying Conserved T-cell Epitopes of Human Adenoviruses Induce Functional Cytotoxic T-Cell Responses and Protect Mice against Both Infections. Vaccines (Basel) 2020; 8:E196. [PMID: 32344618 PMCID: PMC7349758 DOI: 10.3390/vaccines8020196] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 01/01/2023] Open
Abstract
Human adenoviruses (AdVs) are one of the most common causes of acute respiratory viral infections worldwide. Multiple AdV serotypes with low cross-reactivity circulate in the human population, making the development of an effective vaccine very challenging. In the current study, we designed a cross-reactive AdV vaccine based on the T-cell epitopes conserved among various AdV serotypes, which were inserted into the genome of a licensed cold-adapted live attenuated influenza vaccine (LAIV) backbone. We rescued two recombinant LAIV-AdV vaccines by inserting the selected AdV T-cell epitopes into the open reading frame of full-length NA and truncated the NS1 proteins of the H7N9 LAIV virus. We then tested the bivalent vaccines for their efficacy against influenza and human AdV5 in a mouse model. The vaccine viruses were attenuated in C57BL/6J mice and induced a strong influenza-specific antibody and cell-mediated immunity, fully protecting the mice against virulent influenza virus infection. The CD8 T-cell responses induced by both LAIV-AdV candidates were functional and efficiently killed the target cells loaded either with influenza NP366 or AdV DBP418 peptides. In addition, high levels of recall memory T cells targeted to an immunodominant H2b-restricted CD8 T-cell epitope were detected in the immunized mice after the AdV5 challenge, and the magnitude of these responses correlated with the level of protection against pulmonary pathology caused by the AdV5 infection. Our findings suggest that the developed recombinant vaccines can be used for combined protection against influenza and human adenoviruses and warrant further evaluation on humanized animal models and subsequent human trials.
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Affiliation(s)
- Irina Isakova-Sivak
- Institute of Experimental Medicine, 197376 Saint Petersburg, Russia; (V.M.); (E.S.); (A.M.); (T.K.); (D.M.); (P.P.); (I.K.); (P.K.); (L.R.)
| | - Victoria Matyushenko
- Institute of Experimental Medicine, 197376 Saint Petersburg, Russia; (V.M.); (E.S.); (A.M.); (T.K.); (D.M.); (P.P.); (I.K.); (P.K.); (L.R.)
| | - Ekaterina Stepanova
- Institute of Experimental Medicine, 197376 Saint Petersburg, Russia; (V.M.); (E.S.); (A.M.); (T.K.); (D.M.); (P.P.); (I.K.); (P.K.); (L.R.)
| | - Anastasia Matushkina
- Institute of Experimental Medicine, 197376 Saint Petersburg, Russia; (V.M.); (E.S.); (A.M.); (T.K.); (D.M.); (P.P.); (I.K.); (P.K.); (L.R.)
| | - Tatiana Kotomina
- Institute of Experimental Medicine, 197376 Saint Petersburg, Russia; (V.M.); (E.S.); (A.M.); (T.K.); (D.M.); (P.P.); (I.K.); (P.K.); (L.R.)
| | - Daria Mezhenskaya
- Institute of Experimental Medicine, 197376 Saint Petersburg, Russia; (V.M.); (E.S.); (A.M.); (T.K.); (D.M.); (P.P.); (I.K.); (P.K.); (L.R.)
| | - Polina Prokopenko
- Institute of Experimental Medicine, 197376 Saint Petersburg, Russia; (V.M.); (E.S.); (A.M.); (T.K.); (D.M.); (P.P.); (I.K.); (P.K.); (L.R.)
| | - Igor Kudryavtsev
- Institute of Experimental Medicine, 197376 Saint Petersburg, Russia; (V.M.); (E.S.); (A.M.); (T.K.); (D.M.); (P.P.); (I.K.); (P.K.); (L.R.)
| | - Pavel Kopeykin
- Institute of Experimental Medicine, 197376 Saint Petersburg, Russia; (V.M.); (E.S.); (A.M.); (T.K.); (D.M.); (P.P.); (I.K.); (P.K.); (L.R.)
| | - Konstantin Sivak
- Smorodintsev Research Institute of Influenza, 197376 Saint Petersburg, Russia;
| | - Larisa Rudenko
- Institute of Experimental Medicine, 197376 Saint Petersburg, Russia; (V.M.); (E.S.); (A.M.); (T.K.); (D.M.); (P.P.); (I.K.); (P.K.); (L.R.)
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906
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Calder PC, Carr AC, Gombart AF, Eggersdorfer M. Optimal Nutritional Status for a Well-Functioning Immune System Is an Important Factor to Protect against Viral Infections. Nutrients 2020; 12:E1181. [PMID: 32340216 PMCID: PMC7230749 DOI: 10.3390/nu12041181] [Citation(s) in RCA: 458] [Impact Index Per Article: 114.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/14/2020] [Accepted: 04/18/2020] [Indexed: 02/06/2023] Open
Abstract
Public health practices including handwashing and vaccinations help reduce the spread and impact of infections. Nevertheless, the global burden of infection is high, and additional measures are necessary. Acute respiratory tract infections, for example, were responsible for approximately 2.38 million deaths worldwide in 2016. The role nutrition plays in supporting the immune system is well-established. A wealth of mechanistic and clinical data show that vitamins, including vitamins A, B6, B12, C, D, E, and folate; trace elements, including zinc, iron, selenium, magnesium, and copper; and the omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid play important and complementary roles in supporting the immune system. Inadequate intake and status of these nutrients are widespread, leading to a decrease in resistance to infections and as a consequence an increase in disease burden. Against this background the following conclusions are made: (1) supplementation with the above micronutrients and omega-3 fatty acids is a safe, effective, and low-cost strategy to help support optimal immune function; (2) supplementation above the Recommended Dietary Allowance (RDA), but within recommended upper safety limits, for specific nutrients such as vitamins C and D is warranted; and (3) public health officials are encouraged to include nutritional strategies in their recommendations to improve public health.
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Affiliation(s)
- Philip C. Calder
- Faculty of Medicine, University of Southampton and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16-6YD, UK;
| | - Anitra C. Carr
- Nutrition in Medicine Research Group, Department of Pathology & Biomedical Science, University of Otago, Christchurch, P.O. Box 4345, Christchurch 8140, New Zealand;
| | - Adrian F. Gombart
- Linus Pauling Institute, Department of Biochemistry and Biophysics, Oregon State University, 307 Linus Pauling Science Center, Corvallis, OR 97331, USA;
| | - Manfred Eggersdorfer
- Department of Internal Medicine, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
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907
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Disruption of the cpsE and endA Genes Attenuates Streptococcus pneumoniae Virulence: Towards the Development of a Live Attenuated Vaccine Candidate. Vaccines (Basel) 2020; 8:vaccines8020187. [PMID: 32326482 PMCID: PMC7349068 DOI: 10.3390/vaccines8020187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/27/2020] [Accepted: 04/07/2020] [Indexed: 12/15/2022] Open
Abstract
The majority of deaths due to Streptococcus pneumoniae infections are in developing countries. Although polysaccharide-based pneumococcal vaccines are available, newer types of vaccines are needed to increase vaccine affordability, particularly in developing countries, and to provide broader protection across all pneumococcal serotypes. To attenuate pneumococcal virulence with the aim of engineering candidate live attenuated vaccines (LAVs), we constructed knockouts in S. pneumoniae D39 of one of the capsular biosynthetic genes, cpsE that encodes glycosyltransferase, and the endonuclease gene, endA, that had been implicated in the uptake of DNA from the environment as well as bacterial escape from neutrophil-mediated killing. The cpsE gene knockout significantly lowered peak bacterial density, BALB/c mice nasopharyngeal (NP) colonisation but increased biofilm formation when compared to the wild-type D39 strain as well as the endA gene knockout mutant. All constructed mutant strains were able to induce significantly high serum and mucosal antibody response in BALB/c mice. However, the cpsE-endA double mutant strain, designated SPEC, was able to protect mice from high dose mucosal challenge of the D39 wild-type. Furthermore, SPEC showed 23-fold attenuation of virulence compared to the wild-type. Thus, the cpsE-endA double-mutant strain could be a promising candidate for further development of a LAV for S. pneumoniae.
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908
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Zhang C, Huang S, Zheng F, Dai Y. Controversial treatments: An updated understanding of the coronavirus disease 2019. J Med Virol 2020; 92:1441-1448. [PMID: 32219882 PMCID: PMC7228369 DOI: 10.1002/jmv.25788] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/16/2020] [Accepted: 03/23/2020] [Indexed: 01/08/2023]
Abstract
An outbreak of severe acute respiratory syndrome-related coronavirus 2 infection has posed significant threats to international health and the economy. In the absence of specific treatment for this virus, there is an urgent need to learn from the experience and lessons in China. To reduce the case-fatality rate among coronavirus disease 2019 patients, we should not ignore the complications, such as RNAaemia, acute respiratory distress syndrome, and multiple organ dysfunction. To help understand the advantages and limitations of differential treatments, we provide a timely review and discuss the complications and corresponding major treatments, especially controversial ones such as antiviral therapy (remdesivir, ribavirin, and chloroquine), glucocorticoid therapy, extracorporeal support including an artificial liver system, and extracorporeal membrane oxygenation based on available evidence. As a result, we suggest that antiviral therapy and organ function support are vital to reduce mortality for mild patients and critical patients, respectively.
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Affiliation(s)
- Cantong Zhang
- Department of Clinical Medical Research Center, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital Southern University of Science and Technology, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Shaoying Huang
- Department of Clinical Medical Research Center, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital Southern University of Science and Technology, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Fengping Zheng
- Department of Clinical Medical Research Center, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital Southern University of Science and Technology, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Yong Dai
- Department of Clinical Medical Research Center, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital Southern University of Science and Technology, Shenzhen People's Hospital, Shenzhen, Guangdong, China.,Department of Nephrology, Guangxi Key Laboratory of Metabolic Disease Research, Guilin, China
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909
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Ahmed KY, Page A, Arora A, Ogbo FA. Associations between infant and young child feeding practices and acute respiratory infection and diarrhoea in Ethiopia: A propensity score matching approach. PLoS One 2020; 15:e0230978. [PMID: 32236145 PMCID: PMC7112197 DOI: 10.1371/journal.pone.0230978] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/12/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Acute respiratory infection (ARI) and diarrhoea are the leading causes of childhood morbidity and mortality in Ethiopia. Understanding the associations between infant and young child feeding (IYCF) and ARI and diarrhoea can inform IYCF policy interventions and advocacy in Ethiopia. This study aimed to investigate the relationship between IYCF practices and ARI and diarrhoea in Ethiopian children. METHODS This study used the Ethiopia Demographic and Health Survey (EDHS) data for the years 2000 (n = 3680), 2005 (n = 3528), 2011 (n = 4037), and 2016 (n = 3861). The association between IYCF practices and (i) ARI and (ii) diarrhoea were investigated using propensity score matching and multivariable logistic regression models. The IYCF practices include early initiation of breastfeeding, exclusive breastfeeding (EBF), predominant breastfeeding, introduction of complementary foods, continued breastfeeding at two years and bottle feeding. RESULTS Infants and young children who were breastfed within 1-hour of birth and those who were exclusively breastfed had a lower prevalence of ARI. Infants who were exclusively and predominantly breastfed had a lower prevalence of diarrhoea. Early initiation of breastfeeding (Odds ratio [OR]: 0.81; 95% confidence interval [CI]: 0.72, 0.92) and EBF (OR: 0.65; 95% CI: 0.51, 0.83) were associated with lower risk of ARI. Bottle-fed children had higher odds of ARI (OR: 1.36; 95% CI: 1.10, 1.68). Early initiation of breastfeeding and EBF were associated with lower odds of diarrhoea (OR: 0.88; 95% CI: 0.79, 0.94 for Early initiation of breastfeeding and OR: 0.51; 95% CI: 0.39, 0.65 for EBF). Infants who were predominantly breastfed were less likely to experience diarrhoea (OR: 0.69; 95% CI: 0.53, 0.89). CONCLUSION The recommended best practices for preventing ARI and diarrhoeal diseases in infants and young children namely: the early initiation of breastfeeding, EBF and avoidance of bottle feeding should be institutionalized and scale-up in Ethiopia as part of implementation science approach to cover the know-do-gaps.
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Affiliation(s)
- Kedir Y. Ahmed
- College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
| | - Amit Arora
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
- School of Science and Health, Western Sydney University, Campbelltown, NSW, Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Sydney, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Felix Akpojene Ogbo
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
- General Practice Unit, Prescot Specialist Medical Centre Makurdi, Makurdi, Benue State, Nigeria
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910
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Viruses of Respiratory Tract: an Observational Retrospective Study on Hospitalized Patients in Rome, Italy. Microorganisms 2020; 8:microorganisms8040501. [PMID: 32244685 PMCID: PMC7232519 DOI: 10.3390/microorganisms8040501] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 12/12/2022] Open
Abstract
Respiratory tract infections account for high morbidity and mortality around the world. Fragile patients are at high risk of developing complications such as pneumonia and may die from it. Limited information is available on the extent of the circulation of respiratory viruses in the hospital setting. Most knowledge relates to influenza viruses (FLU) but several other viruses produce flu-like illness. The study was conducted at the University Hospital Policlinico Tor Vergata, Rome, Italy. Clinical and laboratory data from hospitalized patients with respiratory tract infections during the period October 2016-March 2019 were analysed. The retrospective analysis included 17 viral agents detected by FilmArray test and clinical data from medical records and hospital discharge sheets. Models were adjusted for relevant confounders such as clinical severity and risk of death, socio-demographic characteristics and surgical procedures. From a total of 539 specimens analysed, 180 (33.39%) were positive for one or more respiratory viruses. Among them, 83 (46.1 %) were positive for influenza viruses (FLU), 36 (20%) rhino/enteroviruses (RHV/EV), 17 (9.44%) human coronaviruses (HCOV-229E, -HKU1, -NL63, and -OC43), 17 (9.44%) respiratory syncytial virus, 15 (8.33%) human metapneumovirus (HMPV), 8 (4.44%) parainfluenza viruses (PIV) and 4 (2.22%) adenoviruses (ADV). The distribution of viral agents varied across age groups and month of detection. The positive specimens were from 168 patients [102 M, 66 F; median age (range): 64 years (19-93)]. Overall, 40% of them had a high-grade clinical severity and a 27% risk of death; 27 patients died and 22 of them (81.5%) had received a clinical diagnosis of pneumonia. Respiratory viral infections may have a severe course and a poor prognosis in hospitalized patients, due to underlying comorbidities. Monitoring the circulation of respiratory viruses in hospital settings is important to improve diagnosis, prevention and treatment.
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911
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Sohn S, Hong K, Chun BC. Evaluation of the effectiveness of pneumococcal conjugate vaccine for children in Korea with high vaccine coverage using a propensity score matched national population cohort. Int J Infect Dis 2020; 93:146-150. [DOI: 10.1016/j.ijid.2020.01.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/08/2020] [Accepted: 01/19/2020] [Indexed: 01/06/2023] Open
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912
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Widhidewi NW, Wiyatno A, Dewantari AK, Paramasatiari L, Aryastuti SA, Artika IN, Setiawan WD, Soebandrio A, Aye Myint KS, safari D. Identification of viral etiology of acute respiratory tract infections in children and adults in Tabanan, Bali, Indonesia. Access Microbiol 2020; 2:acmi000120. [PMID: 32974585 PMCID: PMC7494194 DOI: 10.1099/acmi.0.000120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/31/2020] [Indexed: 12/04/2022] Open
Abstract
Acute respiratory tract infection (ARTI) is the most common infectious disease in humans worldwide. The morbidity and mortality rates are high, especially in developing countries from Southeast Asia and Africa. While ARTI is commonly associated with viruses, there is limited data on the spectrum of viruses causing ARTI in developing countries, including Indonesia. This study was based on utilizing molecular techniques targeting a panel of 11 endemic and emerging respiratory viral pathogens including zoonotic viruses in a cohort of children and adults presenting at Tabanan General Hospital, Bali, with acute respiratory illness, from January to November 2017. In total, 98 out of 200 samples (49.0 %) tested positive for viruses. Our study confirmed 64.3 % viral etiology in children and 12.2 % in adults. Viruses that were detected were Herpesviridae (15.0 %) followed by enteroviruses (12.0 %), influenza A virus (11.5 %), respiratory syncytial virus (8.0 %), Adenoviridae (6.5 %), human metapneumovirus (3.5 %), Paramyxoviridae (2.0 %), bocavirus (1.0 %) and Coronaviridae (0.5 %). The study sheds light on the viral spectrum of ARTI in children and adults in Tabanan, Bali, Indonesia.
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Affiliation(s)
- Ni Wayan Widhidewi
- Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya, No. 6 Jakarta, Indonesia
- Faculty of Medicine, Universitas Warmadewa, Jl. Terompong No.24 Denpasar, Bali, Indonesia
| | - Ageng Wiyatno
- Eijkman Institute of Molecular Biology, Jl. Diponegoro No. 69, Jakarta, Indonesia
| | | | - Lila Paramasatiari
- Faculty of Medicine, Universitas Warmadewa, Jl. Terompong No.24 Denpasar, Bali, Indonesia
| | - Sri Agung Aryastuti
- Faculty of Medicine, Universitas Warmadewa, Jl. Terompong No.24 Denpasar, Bali, Indonesia
| | - I Nengah Artika
- Tabanan General Hospital, Jl. Pahlawan, Tabanan, Bali, Indonesia
| | | | - Amin Soebandrio
- Faculty of Medicine, Universitas Indonesia, Jl. Salemba Raya, No. 6 Jakarta, Indonesia
- Eijkman Institute of Molecular Biology, Jl. Diponegoro No. 69, Jakarta, Indonesia
| | - Khin Saw Aye Myint
- Eijkman Institute of Molecular Biology, Jl. Diponegoro No. 69, Jakarta, Indonesia
| | - Dodi safari
- Eijkman Institute of Molecular Biology, Jl. Diponegoro No. 69, Jakarta, Indonesia
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913
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Wu W, Choi EJ, Lee I, Lee YS, Bao X. Non-Coding RNAs and Their Role in Respiratory Syncytial Virus (RSV) and Human Metapneumovirus (hMPV) Infections. Viruses 2020; 12:v12030345. [PMID: 32245206 PMCID: PMC7150941 DOI: 10.3390/v12030345] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/14/2020] [Accepted: 03/18/2020] [Indexed: 12/17/2022] Open
Abstract
Recent high-throughput sequencing revealed that only 2% of the transcribed human genome codes for proteins, while the majority of transcriptional products are non-coding RNAs (ncRNAs). Herein, we review the current knowledge regarding ncRNAs, both host- and virus-derived, and their role in respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) infections. RSV is known as the most common cause of lower respiratory tract infection (LRTI) in children, while hMPV is also a significant contributor to LRTI in the pediatrics population. Although RSV and hMPV are close members, belonging to the Pneumoviridae family, they induce distinct changes in the ncRNA profile. Several types of host ncRNAs, including long ncRNA (lncRNA), microRNAs (miRNAs), and transfer RNA (tRNA)-derived RNA fragments (tRFs), are involved as playing roles in RSV and/or hMPV infection. Given the importance of ncRNAs in regulating the expression and functions of genes and proteins, comprehensively understanding the roles of ncRNAs in RSV/hMPV infection could shed light upon the disease mechanisms of RSV and hMPV, potentially providing insights into the development of prevention strategies and antiviral therapy. The presence of viral-derived RNAs and the potential of using ncRNAs as diagnostic biomarkers are also discussed in this review.
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Affiliation(s)
- Wenzhe Wu
- Department of Pediatrics, The University of Texas Medical Branch, Galveston, TX 77555, USA; (W.W.); (E.-J.C.)
| | - Eun-Jin Choi
- Department of Pediatrics, The University of Texas Medical Branch, Galveston, TX 77555, USA; (W.W.); (E.-J.C.)
| | | | - Yong Sun Lee
- Department of Cancer System Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si Gyeonggi-do 10408, Korea;
| | - Xiaoyong Bao
- Department of Pediatrics, The University of Texas Medical Branch, Galveston, TX 77555, USA; (W.W.); (E.-J.C.)
- Sealy Center for Molecular Medicine, The University of Texas Medical Branch, Galveston, TX 77555, USA
- The Institute of Translational Sciences, The University of Texas Medical Branch, Galveston, TX 77555, USA
- The Institute for Human Infections and Immunity, The University of Texas Medical Branch, Galveston, TX 77555, USA
- Correspondence: ; Tel.: +409-772-1777
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914
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Lecrenier N, Marijam A, Olbrecht J, Soumahoro L, Nieto Guevara J, Mungall B. Ten years of experience with the pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (Synflorix) in children. Expert Rev Vaccines 2020; 19:247-265. [DOI: 10.1080/14760584.2020.1738226] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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915
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Hong M, Xiong T, Huang J, Wu Y, Lin L, Zhang Z, Huang L, Gao D, Wang H, Kang C, Gao Q, Yang X, Yang N, Hao L. Association of vitamin D supplementation with respiratory tract infection in infants. MATERNAL AND CHILD NUTRITION 2020; 16:e12987. [PMID: 32141233 PMCID: PMC7296792 DOI: 10.1111/mcn.12987] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 02/03/2020] [Accepted: 02/18/2020] [Indexed: 02/06/2023]
Abstract
Vitamin D deficiency has been reported to be associated with respiratory tract infection (RTI). However, evidence regarding the effects of vitamin D supplementation on susceptibility of infants to RTI is limited. In this prospective birth cohort study, we examined whether vitamin D supplementation reduced RTI risk in 2,244 infants completing the follow‐up from birth to 6 months of age. The outcome endpoint was the first episode of paediatrician‐diagnosed RTI or 6 months of age when no RTI event occurred. Infants receiving vitamin D supplements at a daily dose of 400–600 IU from birth to the outcome endpoint were defined as vitamin D supplementation and divided into four groups according to the average frequency of supplementation: 0, 1–2, 3–4, and 5–7 days/week. We evaluated the relationship between vitamin D supplementation and time to the first episode of RTI with Kaplan–Meier plots. The associations of vitamin D supplementation with infant RTI, lower RTI (LRTI), and RTI‐related hospitalization were assessed using modified Poisson regression. The median time to first RTI episode was 60 days after birth (95% CI [60, 90]) for infants without supplementation and longer than 6 months of age for infants with supplementation (p < .001). We observed inverse trends between supplementation frequency and risk of RTI, LRTI, and RTI‐related hospitalization (p for trend < .001), with the risk ratios in the 5–7 days/week supplementation group of 0.46 (95% CI [0.41, 0.50]), 0.17 (95% CI [0.13, 0.24]), and 0.18 (95% CI [0.12, 0.27]), respectively. These associations were significant and consistent in a subgroup analysis stratified by infant feeding.
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Affiliation(s)
- Miao Hong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Xiong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junmei Huang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Clinical Nutrition, People's Hospital of Sanya City, Sanya, China
| | - Yuanjue Wu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lixia Lin
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Zhang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Huang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Duan Gao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huanzhuo Wang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chun Kang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qin Gao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuefeng Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nianhong Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liping Hao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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916
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Vargas Buonfiglio LG, Comellas AP. Mechanism of ambient particulate matter and respiratory infections. J Thorac Dis 2020; 12:134-136. [PMID: 32274073 PMCID: PMC7139067 DOI: 10.21037/jtd.2019.12.33] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Luis G Vargas Buonfiglio
- Department of Internal Medicine, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | - Alejandro P Comellas
- Department of Internal Medicine, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
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917
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Sempere J, de Miguel S, González-Camacho F, Yuste J, Domenech M. Clinical Relevance and Molecular Pathogenesis of the Emerging Serotypes 22F and 33F of Streptococcus pneumoniae in Spain. Front Microbiol 2020; 11:309. [PMID: 32174903 PMCID: PMC7056674 DOI: 10.3389/fmicb.2020.00309] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/12/2020] [Indexed: 12/21/2022] Open
Abstract
Streptococcus pneumoniae is the main bacterial cause of respiratory infections in children and the elderly worldwide. Serotype replacement is a frequent phenomenon after the introduction of conjugated vaccines, with emerging serotypes 22F and 33F as frequent non-PCV13 serotypes in children and adults in North America and other countries. Characterization of mechanisms involved in evasion of the host immune response by these serotypes is of great importance in public health because they are included in the future conjugated vaccines PCV15 and PCV20. One of the main strategies of S. pneumoniae to persistently colonize and causes infection is biofilm formation. In this study, we have evaluated the influence of capsule polysaccharide in biofilm formation and immune evasion by using clinical isolates from different sources and isogenic strains with capsules from prevalent serotypes. Since the introduction of PCV13 in Spain in the year 2010, isolates of serotypes 22F and 33F are rising among risk populations. The predominant circulating genotypes are ST43322F and ST71733F, being CC433 in 22F and CC717 in 33F the main clonal complexes in Spain. The use of clinical isolates of different origin, demonstrated that pediatric isolates of serotypes 22F and 33F formed better biofilms than adult isolates and this was statistically significant. This phenotype was greater in clinical isolates from blood origin compared to those from cerebrospinal fluid, pleural fluid and otitis. Opsonophagocytosis assays showed that serotype 22F and 33F were recognized by the PSGL-1 receptor on leukocytes, although serotype 22F, was more resistant than serotype 33F to phagocytosis killing and more lethal in a mouse sepsis model. Overall, the emergence of additional PCV15 serotypes, especially 22F, could be associated to an enhanced ability to divert the host immune response that markedly increased in a biofilm state. Our findings demonstrate that pediatric isolates of 22F and 33F, that form better biofilm than isolates from adults, could have an advantage to colonize the nasopharynx of children and therefore, be important in carriage and subsequent dissemination to the elderly. The increased ability of serotype 22F to avoid the host immune response, might explain the emergence of this serotype in the last years.
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Affiliation(s)
- Julio Sempere
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Sara de Miguel
- Servicio de Epidemiología de la Comunidad de Madrid, Dirección General de Salud Pública, Madrid, Spain
| | | | - José Yuste
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Mirian Domenech
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
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918
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Ang LW, Mak TM, Cui L, Leo YS, Lee VJM, Lin RTP. Characterisation of respiratory syncytial virus activity in children and adults presenting with acute respiratory illness at primary care clinics in Singapore, 2014-2018. Influenza Other Respir Viruses 2020; 14:412-419. [PMID: 32090482 PMCID: PMC7298310 DOI: 10.1111/irv.12730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/03/2020] [Accepted: 02/08/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is an important respiratory pathogen that affects people of all ages. OBJECTIVES We examined the patterns of RSV circulation in 2014-2018, and investigated their age-specific differences in tropical Singapore. METHODS Nasopharyngeal and/or throat swabs were taken from outpatient attendees for the national influenza virological surveillance among those who presented with acute respiratory illness in the community. Specimens tested negative for influenza were then tested for RSV and other respiratory pathogens. RESULTS Among 8436 influenza-negative specimens tested during the five-year period, 5.8% (95% confidence interval 5.3%-6.3%) were positive for RSV. The peak of RSV activity occurred around middle of the year. The age-specific proportion of RSV detections showed a reverse J-shaped pattern; RSV positivity was the highest in young children ≤2 years of age (10.9%), followed by those aged 3-5 years (6.4%) and persons aged ≥65 years (5.3%), while the nadir was observed in the age group of 15-24 years (1.2%). RSV type A was predominantly circulating in children ≤5 years of age from 2014 to 2015 and 2017, whereas in 2016, they were more affected by type B. CONCLUSION Respiratory syncytial virus was more frequently detected among the two age groups that have been recommended for influenza vaccination; persons ≥65 years of age and children 6 months to <5 years of age. Characterisation of RSV activity in the community helps to better inform public health policies for effective prevention and control interventions.
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Affiliation(s)
- Li Wei Ang
- National Centre for Infectious Diseases, Singapore City, Singapore.,Public Health Group, Ministry of Health, Singapore City, Singapore
| | - Tze Minn Mak
- National Centre for Infectious Diseases, Singapore City, Singapore
| | - Lin Cui
- National Centre for Infectious Diseases, Singapore City, Singapore
| | - Yee Sin Leo
- National Centre for Infectious Diseases, Singapore City, Singapore
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919
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Abstract
Chest infection is a health care problem in many regions of the world, and pleural empyema is the most common type of surgical chest infection. In the past decennium, the introduction of nonintubated surgery and uniportal video-assisted thoracic surgery changed considerably surgical treatment of pleural empyema. Although the advantages seem evident, the need for randomized controlled trials is necessary to confirm the usefulness. Moreover, in the future, an education and training program for thoracic surgeons and anesthesiologists would allow increasing the number of awake surgical options in caring for patients with stages II to III empyema.
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Affiliation(s)
- Marcello Migliore
- Section of Thoracic Surgery, Department of Surgery and Medical Specialities, University of Catania, Policlinic University Hospital, Catania, Italy.
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920
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Critical Parameters for the Development of Novel Therapies for Severe and Resistant Infections-A Case Study on CAL02, a Non-Traditional Broad-Spectrum Anti-Virulence Drug. Antibiotics (Basel) 2020; 9:antibiotics9020094. [PMID: 32098274 PMCID: PMC7168140 DOI: 10.3390/antibiotics9020094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/16/2020] [Accepted: 02/16/2020] [Indexed: 12/29/2022] Open
Abstract
Background: Poor outcomes in severe and resistant infections, together with the economic struggles of companies active in the field of anti-infective development, call for new solutions and front runners with novel approaches. Among “non-traditional” approaches, blocking virulence could be a game changer. Objectives: This review offers a perspective on parameters that have determined the development path of CAL02, a novel anti-virulence agent, with a view to steering clear of the obstacles and limitations that impede market sustainability for new anti-infective drugs. Conclusions and implications of key findings: This case study highlights four pillars that may support the development of other non-traditional drugs and, concurrently, provide a new model that could reshape the field. Therapeutic triggers, study designs, and economic parameters are discussed.
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921
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Methods of Granulocyte Isolation from Human Blood and Labeling with Multimodal Superparamagnetic Iron Oxide Nanoparticles. Molecules 2020; 25:molecules25040765. [PMID: 32053865 PMCID: PMC7070653 DOI: 10.3390/molecules25040765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/17/2020] [Accepted: 02/02/2020] [Indexed: 02/08/2023] Open
Abstract
This in vitro study aimed to find the best method of granulocyte isolation for subsequent labeling with multimodal nanoparticles (magnetic and fluorescent properties) to enable detection by optical and magnetic resonance imaging (MRI) techniques. The granulocytes were obtained from venous blood samples from 12 healthy volunteers. To achieve high purity and yield, four different methods of granulocyte isolation were evaluated. The isolated granulocytes were labeled with multimodal superparamagnetic iron oxide nanoparticles (M-SPIONs) coated with dextran, and the iron load was evaluated qualitatively and quantitatively by MRI, near-infrared fluorescence (NIRF) and inductively coupled plasma mass spectrometry (ICP-MS). The best method of granulocyte isolation was Percoll with Ficoll, which showed 95.92% purity and 94% viability. After labeling with M-SPIONs, the granulocytes showed 98.0% purity with a yield of 3.5 × 106 cells/mL and more than 98.6% viability. The iron-loading value in the labeled granulocytes, as obtained by MRI, was 6.40 ± 0.18 pg/cell. Similar values were found with the ICP-MS and NIRF imaging techniques. Therefore, our study shows that it is possible to isolate granulocytes with high purity and yield and labeling with M-SPIONs provides a high internalized iron load and low toxicity to cells. Therefore, these M-SPION-labeled granulocytes could be a promising candidate for future use in inflammation/infection detection by optical and MRI techniques.
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922
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A Nonfunctional Opsonic Antibody Response Frequently Occurs after Pneumococcal Pneumonia and Is Associated with Invasive Disease. mSphere 2020; 5:5/1/e00925-19. [PMID: 32024704 PMCID: PMC7002313 DOI: 10.1128/msphere.00925-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Numerous reports on the dynamics of antipneumococcal immunity in relation to immunization with pneumococcal vaccines and on the prevalence of naturally acquired immunity in various populations have been published. In contrast, studies on the dynamics of the humoral immune response triggered by pneumococcal infection are scarce. This study provides valuable information that will contribute to fill this knowledge gap. Our main results indicate that a functional immune response frequently fails to occur after CAP, predominantly among patients with simultaneous bacteremia. Naturally acquired opsonic antipneumococcal antibodies are commonly found in nonvaccinated adults and confer protection against infection and colonization. Despite this, only limited data exist regarding the adaptive immune response after pneumococcal exposure. To investigate the dynamics of naturally acquired antipneumococcal immunity in relation to an episode of infection, opsonic antibody activity was studied with paired acute-phase and convalescent-phase sera obtained from 54 patients with pneumococcal community-acquired pneumonia (CAP) using an opsonophagocytic assay (OPA). Results were compared with clinical characteristics and anticapsular immunoglobulin (Ig) concentrations. Interestingly, a nonfunctional opsonic antibody response (characterized by a decreased convalescent-phase serum OPA titer compared to that of the acute-phase serum or undetectable titers in both sera) was observed in 19 (35%) patients. A nonfunctional convalescent-phase response was significantly more common among patients with invasive pneumococcal disease (i.e., bacteremia) than in patients without invasive disease (53%; P = 0.019). Remaining individuals exhibited either an increased convalescent-phase OPA titer (n = 24 [44%]) or a detectable, but unchanged, titer at both time points (n = 11 [20%]). No correlation was found between anticapsular Ig concentrations and OPA titers. Our findings indicate that an episode of pneumococcal infection may act as an immunizing event, leading to an improved antipneumococcal adaptive immune status. However, in some cases, when patients with CAP also suffer from bacteremia, a nonfunctional opsonic antibody response may occur. Furthermore, the results suggest that factors other than anticapsular Ig concentrations are important for opsonic antibody activity in serum. IMPORTANCE Numerous reports on the dynamics of antipneumococcal immunity in relation to immunization with pneumococcal vaccines and on the prevalence of naturally acquired immunity in various populations have been published. In contrast, studies on the dynamics of the humoral immune response triggered by pneumococcal infection are scarce. This study provides valuable information that will contribute to fill this knowledge gap. Our main results indicate that a functional immune response frequently fails to occur after CAP, predominantly among patients with simultaneous bacteremia.
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923
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Berrueta M, Bardach A, Ciaponni A, Xiong X, Stergachis A, Zaraa S, Buekens P. Maternal and neonatal data collection systems in low- and middle-income countries: scoping review protocol. Gates Open Res 2020; 4:18. [PMID: 32420540 PMCID: PMC7199220 DOI: 10.12688/gatesopenres.13106.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 01/25/2023] Open
Abstract
Background: Pregnant women and neonates represent one of the most vulnerable groups, especially in low- and middle-income countries (LMICs). A recent analysis reported that most vaccine pharmacovigilance systems in LMICs consist of spontaneous (passive) adverse event reporting. Thus, LMICs need effective active surveillance approaches, such as pregnancy registries. We intend to identify currently active maternal and neonatal data collection systems in LMICs, with the potential to inform active safety electronic surveillance for novel vaccines using standardized definitions. Methods: A scoping review will be conducted based on established methodology. Multiple databases of indexed and grey literature will be searched with a specific focus on existing electronic and paper-electronic systems in LMICs that collect continuous, prospective, and individual-level data from antenatal care, delivery, neonatal care (up to 28 days), and postpartum (up to 42 days) at the facility and community level, at the national and district level, and at large hospitals. Also, experts will be contacted to identify unpublished information on relevant data collection systems. General and specific descriptions of Health Information Systems (HIS) extracted from the different sources will be combined and duplicated HIS will be removed, producing a list of unique statements. We will present a final list of Maternal, Newborn, and Child Health systems considered flexible enough to be updated with necessary improvements to detect, assess and respond to safety concerns during the introduction of vaccines and other maternal health interventions. Selected experts will participate in an in-person consultation meeting to select up to three systems to be further explored in situ. Results and knowledge gaps will be synthesized after expert consultation.
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Affiliation(s)
- Mabel Berrueta
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, C1414CPV, Argentina
| | - Ariel Bardach
- Argentine Cochrane Center, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, C1414CPV, Argentina
| | - Agustin Ciaponni
- Argentine Cochrane Center, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, C1414CPV, Argentina
| | - Xu Xiong
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, LA 70112, USA
| | | | - Sabra Zaraa
- University of Washington, Seattle, WA 98195-7631, USA
| | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, LA 70112, USA
| | - Scoping Review Collaboration Group
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, C1414CPV, Argentina
- Argentine Cochrane Center, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, C1414CPV, Argentina
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, LA 70112, USA
- University of Washington, Seattle, WA 98195-7631, USA
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924
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De Ste Croix M, Mitsi E, Morozov A, Glenn S, Andrew PW, Ferreira DM, Oggioni MR. Phase variation in pneumococcal populations during carriage in the human nasopharynx. Sci Rep 2020; 10:1803. [PMID: 32019989 PMCID: PMC7000782 DOI: 10.1038/s41598-020-58684-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/28/2019] [Indexed: 11/10/2022] Open
Abstract
Streptococcus pneumoniae is one of the world's leading bacterial pathogens, responsible for pneumonia, septicaemia and meningitis. Asymptomatic colonisation of the nasopharynx is considered to be a prerequisite for these severe infections, however little is understood about the biological changes that permit the pneumococcus to switch from asymptomatic coloniser to invasive pathogen. A phase variable type I restriction-modification (R-M) system (SpnIII) has been linked to a change in capsule expression and to the ability to successfully colonise the murine nasopharynx. Using our laboratory data, we have developed a Markov change model that allows prediction of the expected level of phase variation within a population, and as a result measures when populations deviate from those expected at random. Using this model, we have analysed samples from the Experimental Human Pneumococcal Carriage (EHPC) project. Here we show, through mathematical modelling, that the patterns of dominant SpnIII alleles expressed in the human nasopharynx are significantly different than those predicted by stochastic switching alone. Our inter-disciplinary work demonstrates that the expression of alternative methylation patterns should be an important consideration in studies of pneumococcal colonisation.
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Affiliation(s)
- M De Ste Croix
- Department of Genetics and Genome Biology, University of Leicester, University Rd, Leicester, LE1 7RH, United Kingdom
| | - E Mitsi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, L3 5QA, United Kingdom
| | - A Morozov
- Department of Mathematics, University of Leicester, University Rd, Leicester, LE1 7RH, United Kingdom
- Institute of Ecology and Evolution, Russian Academy of Sciences, 33 Leninskii pr., Moscow, 119071, Russia
| | - S Glenn
- Department of Respiratory Sciences, University of Leicester, University Rd, Leicester, LE1 7RH, United Kingdom
| | - P W Andrew
- Department of Respiratory Sciences, University of Leicester, University Rd, Leicester, LE1 7RH, United Kingdom
| | - D M Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool, L3 5QA, United Kingdom
| | - M R Oggioni
- Department of Genetics and Genome Biology, University of Leicester, University Rd, Leicester, LE1 7RH, United Kingdom.
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925
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Sevilla JP, Stawasz A, Burnes D, Agarwal A, Hacibedel B, Helvacioglu K, Sato R, Bloom DE. Indirect costs of adult pneumococcal disease and the productivity-based rate of return to the 13-valent pneumococcal conjugate vaccine for adults in Turkey. Hum Vaccin Immunother 2020; 16:1923-1936. [PMID: 31995443 PMCID: PMC7482724 DOI: 10.1080/21645515.2019.1708668] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Productivity benefits of health technologies are ignored in typical economic evaluations from a health payer’s perspective, risking undervaluation. We conduct a productivity-based cost-benefit analysis from a societal perspective and estimate indirect costs of adult pneumococcal disease, vaccination benefits from the adult 13-valent pneumococcal conjugate vaccine (PCV13 Adult), and rates of return to PCV13 Adult for a range of hypothetical vaccination costs. Our context is Turkey’s funding PCV13 for the elderly and for non-elderly adults with select comorbidities within the Ministry of Health’s National Immunization Program. We use a Markov model with one-year cycles. Indirect costs from death or disability equal the expected present discounted value of lifetime losses in the infected individual’s paid and unpaid work and in caregivers’ paid work. Vaccination benefits comprise averted indirect costs. Rates of return equal vaccination benefits divided by vaccination costs, minus one. Input parameters are from public data sources. We model comorbidities’ effects by scalar multiplication of the parameters of the general population. Indirect costs per treatment episode of inpatient community-acquired pneumonia (CAP), bacteremia, and meningitis – but not for outpatient CAP – approach or exceed Turkish per capita gross domestic product. Vaccination benefits equal $207.02 per vaccination in 2017 US dollars. The rate of return is positive for all hypothetical costs below this. Results are sensitive to herd effects from pediatric vaccination and vaccine efficacy rates. For a wide range of hypothetical vaccination costs, the rate of return compares favorably with those of other global development interventions with well-established strong investment cases.
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Affiliation(s)
- J P Sevilla
- Life Sciences Group, Data for Decisions, LLC , Waltham, MA, USA
| | - Andrew Stawasz
- Life Sciences Group, Data for Decisions, LLC , Waltham, MA, USA
| | - Daria Burnes
- Life Sciences Group, Data for Decisions, LLC , Waltham, MA, USA
| | - Anubhav Agarwal
- Life Sciences Group, Data for Decisions, LLC , Waltham, MA, USA
| | - Basak Hacibedel
- Health Economics and Outcomes Research, Pfizer Turkey , Istanbul, Turkey
| | - Kerem Helvacioglu
- Health Economics and Outcomes Research, Pfizer Turkey , Istanbul, Turkey
| | - Reiko Sato
- Health Economics and Outcomes Research, Pfizer Inc , Collegeville, PA, USA
| | - David E Bloom
- Life Sciences Group, Data for Decisions, LLC , Waltham, MA, USA
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926
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Defining Community-Acquired Pneumonia as a Public Health Threat: Arguments in Favor from Spanish Investigators. Med Sci (Basel) 2020; 8:medsci8010006. [PMID: 31991843 PMCID: PMC7151587 DOI: 10.3390/medsci8010006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 01/18/2023] Open
Abstract
Despite advances in its prevention, pneumonia remains associated with high morbidity, mortality, and health costs worldwide. Studies carried out in the last decade have indicated that more patients with community-acquired pneumonia (CAP) now require hospitalization. In addition, pneumonia management poses many challenges, especially due to the increase in the number of elderly patients with multiple comorbidities, antibiotic-resistant pathogens, and the difficulty of rapid diagnosis. In this new call to action, we present a wide-ranging review of the information currently available on CAP and offer some reflections on ways to raise awareness of this disease among the general public. We discuss the burden of CAP and the importance of attaining better, faster microbiological diagnosis and initiating appropriate treatment. We also suggest that closer cooperation between health professionals and the population at large could improve the management of this largely preventable infectious disease that takes many lives each year.
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927
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Jullien S, Pradhan D, Bassat Q. Pneumonia in Bhutanese children: what we know, and what we need to know. Pneumonia (Nathan) 2020; 12:1. [PMID: 31998604 PMCID: PMC6982390 DOI: 10.1186/s41479-019-0065-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 12/10/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Pneumonia is the single largest cause of death in under-five children worldwide. We conducted a systematic review to identify the knowledge gaps around childhood pneumonia in Bhutan. METHODS We searched PubMed, ScienceDirect and Google scholar from conception to 3rd December 2018, World Health Organization, UNICEF, Bhutan's Ministry of Health and other local databases for relevant reports. We included any report describing pneumonia in Bhutanese children with regards to the burden of the disease, aetiology, related risk factors, clinical and prognostic characteristics, surveillance systems and national preventive strategies. Two review authors identified the records. We summarized the findings narratively. RESULTS We included 44 records. Although with notable decreasing trends, pneumonia is still accountable for a high burden and mortality rate in Bhutanese children. The national surveillance system focuses mainly on influenza identification but has recently introduced other viral aetiology to monitor. We found very scarce or no data with regard to the bacterial aetiology, related risk factors and clinico-radiological and prognostic characteristics. CONCLUSION There is a dearth of data regarding the epidemiological, microbiological, clinical and radiological characteristics of pneumonia in children in Bhutan, leading to challenges while implementing evidence-based management and effective national preventive strategies.
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Affiliation(s)
- Sophie Jullien
- 1ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Dinesh Pradhan
- Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB), Thimphu, Bhutan
| | - Quique Bassat
- 1ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- 4ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain
- 5Paediatric Infectious Diseases Unit, Paediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- 6Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- 7CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain
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928
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Dai S, Chan KC. Associations of household environmental tobacco smoke exposure with respiratory symptoms and utilisation of medical services in healthy young children in Hong Kong. Tob Induc Dis 2020; 18:02. [PMID: 31966027 PMCID: PMC6964497 DOI: 10.18332/tid/114461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Young children are especially vulnerable to environmental tobacco smoke (ETS) exposure. This study was carried out to determine whether household ETS exposure was associated with respiratory symptoms and medical service utilisation among Hong Kong healthy children in their first eighteen months of age. METHODS A secondary analysis was done on the data obtained from our previous cross-sectional territory-wide pneumococcal carriage surveillance study in Hong Kong in 2013–2014. All measures were reported by caregivers. Univariable and multivariable analyses were performed to examine the associations between ETS exposure and outcome measures. Covariates included children’s sex, age, body mass index z score, history of breastfeeding, gestational age at birth, birthweight, maternal age, living region, overcrowding of living area, household income, child care attendance, and presence of siblings. Additional adjustment for season and households’ respiratory symptoms were made to ascertain the association between ETS and children’s respiratory symptoms. RESULTS The analysis included 1541 children (mean age: 11.2 ± 6.4 months; males: 50.7%). Current household ETS exposure (AOR=1.30; 95% CI: 1.00– 1.66; p=0.050) and postnatal maternal smoking (AOR=2.21; 95% CI: 1.06–4.64; p=0.035) were independently and significantly associated with all-cause doctor consultation in the past 3 months. Children living with more than one household smoker were more likely to have all-cause doctor consultation compared with the non-exposed children (AOR=1.70; 95% CI: 1.04–2.77, p=0.028). Postnatal maternal smoking was associated with all-cause hospitalisation in the past 3 months (AOR=2.48; 95% CI: 1.05–5.86; p=0.039). Children living in a household, where the daily consumption by household smokers was more than 20 cigarettes, were more likely to have respiratory symptoms compared with non-exposed children (AOR=1.99; 95% CI: 1.12–3.52; p=0.016). CONCLUSIONS Household ETS exposure in young children was associated with respiratory symptoms and all-cause outpatient or inpatient medical service utilisation. The associations were potentially dose-dependent.
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Affiliation(s)
- Siyu Dai
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Kate C Chan
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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929
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Castro JT, Oliveira GS, Nishigasako MA, Debrie AS, Miyaji EN, Soares-Schanoski A, Akamatsu MA, Locht C, Ho PL, Mielcarek N, Oliveira MLS. Evaluation of inactivated Bordetella pertussis as a delivery system for the immunization of mice with Pneumococcal Surface Antigen A. PLoS One 2020; 15:e0228055. [PMID: 31945121 PMCID: PMC6964896 DOI: 10.1371/journal.pone.0228055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 01/06/2020] [Indexed: 11/19/2022] Open
Abstract
Pneumococcal Surface Protein A (PspA) has been successfully tested as vaccine candidate against Streptococcus pneumoniae infections. Vaccines able to induce PspA-specific antibodies and Th1 cytokines usually provide protection in mice. We have shown that the whole cell pertussis vaccine (wP) or components from acellular pertussis vaccines, such as Pertussis Toxin or Filamentous Hemagglutinin (FHA), are good adjuvants to PspA, suggesting that combined pertussis-PspA vaccines would be interesting strategies against the two infections. Here, we evaluated the potential of wP as a delivery vector to PspA. Bordetella pertussis strains producing a PspA from clade 4 (PspA4Pro) fused to the N-terminal region of FHA (Fha44) were constructed and inactivated with formaldehyde for the production of wPPspA4Pro. Subcutaneous immunization of mice with wPPspA4Pro induced low levels of anti-PspA4 IgG, even after 3 doses, and did not protect against a lethal pneumococcal challenge. Prime-boost strategies using wPPspA4Pro and PspA4Pro showed that there was no advantage in using the wPPspA4Pro vaccine. Immunization of mice with purified PspA4Pro induced higher levels of antibodies and protection against pneumococcal infection than the prime-boost strategies. Finally, purified Fha44:PspA4Pro induced high levels of anti-PspA4Pro IgG, but no protection, suggesting that the antibodies induced by the fusion protein were not directed to protective epitopes.
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Affiliation(s)
- Julia T. Castro
- Laboratório de Bacteriologia, Instituto Butantan, São Paulo, SP, Brazil
| | | | | | - Anne-Sophie Debrie
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 –UMR 8204 –CIIL—Center for Infection and Immunity of Lille, Lille, France
| | - Eliane N. Miyaji
- Laboratório de Bacteriologia, Instituto Butantan, São Paulo, SP, Brazil
| | | | - Milena A. Akamatsu
- Seção de Vacinas Aeróbicas, Divisão Bioindustrial, Instituto Butantan, São Paulo, SP, Brazil
| | - Camille Locht
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 –UMR 8204 –CIIL—Center for Infection and Immunity of Lille, Lille, France
| | - Paulo L. Ho
- Seção de Vacinas Aeróbicas, Divisão Bioindustrial, Instituto Butantan, São Paulo, SP, Brazil
| | - Nathalie Mielcarek
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 –UMR 8204 –CIIL—Center for Infection and Immunity of Lille, Lille, France
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930
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Increased Detection of Viruses in Children with Respiratory Tract Infection Using PCR. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020564. [PMID: 31952364 PMCID: PMC7013517 DOI: 10.3390/ijerph17020564] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/06/2020] [Accepted: 01/12/2020] [Indexed: 01/06/2023]
Abstract
Respiratory viruses are a common cause of respiratory tract infection (RTI), particularly in neonates and children. Rapid and accurate diagnosis of viral infections could improve clinical outcomes and reduce the use of antibiotics and treatment sessions. Advances in diagnostic technology contribute to the accurate detection of viruses. We performed a multiplex real-time polymerase chain reaction (PCR) to investigate the viral etiology in pediatric patients and compared the detection rates with those determined using traditional antigen tests and virus cultures. Fifteen respiratory viruses were included in our investigation: respiratory syncytial virus A/B (RSV), influenza virus A (FluA) and influenza virus B (FluB), human metapneumovirus (MPV), enterovirus (EV), human parainfluenza virus (PIV) types 1-4, human rhinovirus (RV), human coronavirus OC43, NL63, and 229E, human adenovirus (ADV), and human bocavirus (Boca). In total, 474 specimens were collected and tested. Respiratory viruses were detected more frequently by PCR (357, 75.3%) than they were by traditional tests (229, 49.3%). The leading pathogens were RSV (113, 23.8%), RV (72, 15.2%), PIV3 (53, 11.2%), FluA (51, 10.8%), and ADV (48, 10.1%). For children younger than 5 years, RSV and RV were most prevalent; for children older than 5 years, FluA and ADV were the most frequently detected. Of the specimens, 25.8% (92/357) were coinfected with two or more viruses. RV, Boca, PIV2, FluB, and PIV4 had higher rates of coinfection; MPV and PIV1 had the lowest rates of coinfection (9.1% and 5.3%). To conclude, the detection power of PCR was better than that of traditional antigen tests and virus cultures when considering the detection of respiratory viruses. RSV and RV were the leading viral pathogens identified in the respiratory specimens. One-quarter of the positive specimens were coinfected with two or more viruses. In the future, further application of PCR may contribute to the rapid and accurate diagnosis of respiratory viruses and could improve patient outcomes.
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931
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Dai S, Chan KCC. Household environmental tobacco smoke exposure in healthy young children in Hong Kong: Prevalence and risk factors. PLoS One 2020; 15:e0227733. [PMID: 31935251 PMCID: PMC6959553 DOI: 10.1371/journal.pone.0227733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 12/29/2019] [Indexed: 11/18/2022] Open
Abstract
Background Environmental tobacco smoke (ETS) exposure attributable respiratory illness burden is huge in paediatric population. Understanding the epidemiology of ETS exposure is important to guide health promotion planning. Therefore, we designed this study to determine the prevalence of household ETS exposure in healthy young children under 2 years of age in Hong Kong, and to explore risk factors associated with the exposure. Our secondary goal was to characterise children’s exposure profile to maternal smoking. Methods A secondary analysis was performed based on the data collected from our 2013–2014 territory-wide cross-sectional pneumococcal carriage surveillance study, with a sample size of 1541. We conducted descriptive analysis for exposure prevalence, univariate and multivariate analysis for identification of risk factors. Results 1541 children (mean age: 11.2 ± 6.4 months, male: 50.7%) were included in the analysis. The overall prevalence of current household ETS exposure was 31.5%, prevalence of prenatal and postnatal maternal smoking was 3.5% and 1.6% respectively. Independent factors associated with children’s ETS exposure were: never breastfed (AOR: 1.48, 95% CI: 1.13–1.93, p = 0.004); prenatal maternal smoking (AOR: 7.46, 95% CI: 2.73–20.39, p< 0.001); overcrowding of household living place (AOR: 3.17, 95% CI: 2.02–4.96, P< 0.001); lower household income (AOR: 1.34, 95% CI: 1.04–1.72, p = 0.02). Interestingly, children residing in Kowloon (AOR: 1.66, 95% CI: 1.19–2.33, p = 0.003) and New Territories West (AOR: 1.54, 95% CI: 1.11–2.15, p = 0.01) were associated with exposure compared with children residing in Hong Kong Island. Conclusion Exposure to household ETS is prevalent among Hong Kong young children, particularly in children with maternal unfavourable behaviour and lower socioeconomic status. The identified risk factors should be considered while tobacco control interventions and legislations are planned.
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Affiliation(s)
- Siyu Dai
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kate Ching Ching Chan
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- * E-mail:
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932
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Goes A, Lapuhs P, Kuhn T, Schulz E, Richter R, Panter F, Dahlem C, Koch M, Garcia R, Kiemer AK, Müller R, Fuhrmann G. Myxobacteria-Derived Outer Membrane Vesicles: Potential Applicability Against Intracellular Infections. Cells 2020; 9:cells9010194. [PMID: 31940898 PMCID: PMC7017139 DOI: 10.3390/cells9010194] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/22/2022] Open
Abstract
In 2019, it was estimated that 2.5 million people die from lower tract respiratory infections annually. One of the main causes of these infections is Staphylococcus aureus, a bacterium that can invade and survive within mammalian cells. S. aureus intracellular infections are difficult to treat because several classes of antibiotics are unable to permeate through the cell wall and reach the pathogen. This condition increases the need for new therapeutic avenues, able to deliver antibiotics efficiently. In this work, we obtained outer membrane vesicles (OMVs) derived from the myxobacteria Cystobacter velatus strain Cbv34 and Cystobacter ferrugineus strain Cbfe23, that are naturally antimicrobial, to target intracellular infections, and investigated how they can affect the viability of epithelial and macrophage cell lines. We evaluated by cytometric bead array whether they induce the expression of proinflammatory cytokines in blood immune cells. Using confocal laser scanning microscopy and flow cytometry, we also investigated their interaction and uptake into mammalian cells. Finally, we studied the effect of OMVs on planktonic and intracellular S. aureus. We found that while Cbv34 OMVs were not cytotoxic to cells at any concentration tested, Cbfe23 OMVs affected the viability of macrophages, leading to a 50% decrease at a concentration of 125,000 OMVs/cell. We observed only little to moderate stimulation of release of TNF-alpha, IL-8, IL-6 and IL-1beta by both OMVs. Cbfe23 OMVs have better interaction with the cells than Cbv34 OMVs, being taken up faster by them, but both seem to remain mostly on the cell surface after 24 h of incubation. This, however, did not impair their bacteriostatic activity against intracellular S. aureus. In this study, we provide an important basis for implementing OMVs in the treatment of intracellular infections.
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Affiliation(s)
- Adriely Goes
- Helmholtz Centre for Infection Research (HZI), Biogenic Nanotherapeutics Group (BION), Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Campus E8.1, 66123 Saarbrücken, Germany; (A.G.); (P.L.); (T.K.); (E.S.)
- Department of Pharmacy, Saarland University, Campus Building E8.1, 66123 Saarbrücken, Germany; (R.R.); (R.M.)
| | - Philipp Lapuhs
- Helmholtz Centre for Infection Research (HZI), Biogenic Nanotherapeutics Group (BION), Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Campus E8.1, 66123 Saarbrücken, Germany; (A.G.); (P.L.); (T.K.); (E.S.)
- Department of Pharmacy, Saarland University, Campus Building E8.1, 66123 Saarbrücken, Germany; (R.R.); (R.M.)
| | - Thomas Kuhn
- Helmholtz Centre for Infection Research (HZI), Biogenic Nanotherapeutics Group (BION), Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Campus E8.1, 66123 Saarbrücken, Germany; (A.G.); (P.L.); (T.K.); (E.S.)
- Department of Pharmacy, Saarland University, Campus Building E8.1, 66123 Saarbrücken, Germany; (R.R.); (R.M.)
| | - Eilien Schulz
- Helmholtz Centre for Infection Research (HZI), Biogenic Nanotherapeutics Group (BION), Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Campus E8.1, 66123 Saarbrücken, Germany; (A.G.); (P.L.); (T.K.); (E.S.)
- Department of Pharmacy, Saarland University, Campus Building E8.1, 66123 Saarbrücken, Germany; (R.R.); (R.M.)
| | - Robert Richter
- Department of Pharmacy, Saarland University, Campus Building E8.1, 66123 Saarbrücken, Germany; (R.R.); (R.M.)
- Helmholtz Centre for Infection Research (HZI), Department of Drug Delivery (DDEL), Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Campus E8.1, 66123 Saarbrücken, Germany
| | - Fabian Panter
- Helmholtz Centre for Infection Research (HZI), Department of Microbial Natural Products (MINS), Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Campus E8.1, 66123 Saarbrücken, Germany; (F.P.); (R.G.)
| | - Charlotte Dahlem
- Department of Pharmacy, Pharmaceutical Biology, Saarland University, 66123 Saarbrücken, Germany; (C.D.); (A.K.K.)
| | - Marcus Koch
- INM-Leibniz Institute for New Materials, Campus D2 2, 66123 Saarbrücken, Germany;
| | - Ronald Garcia
- Helmholtz Centre for Infection Research (HZI), Department of Microbial Natural Products (MINS), Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Campus E8.1, 66123 Saarbrücken, Germany; (F.P.); (R.G.)
| | - Alexandra K. Kiemer
- Department of Pharmacy, Pharmaceutical Biology, Saarland University, 66123 Saarbrücken, Germany; (C.D.); (A.K.K.)
| | - Rolf Müller
- Department of Pharmacy, Saarland University, Campus Building E8.1, 66123 Saarbrücken, Germany; (R.R.); (R.M.)
- Helmholtz Centre for Infection Research (HZI), Department of Microbial Natural Products (MINS), Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Campus E8.1, 66123 Saarbrücken, Germany; (F.P.); (R.G.)
- German Center for Infection Research (DZIF), 38124 Braunschweig, Germany
| | - Gregor Fuhrmann
- Helmholtz Centre for Infection Research (HZI), Biogenic Nanotherapeutics Group (BION), Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Campus E8.1, 66123 Saarbrücken, Germany; (A.G.); (P.L.); (T.K.); (E.S.)
- Department of Pharmacy, Saarland University, Campus Building E8.1, 66123 Saarbrücken, Germany; (R.R.); (R.M.)
- Correspondence: ; Tel.: +49-68-198-806 (ext. 1500)
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933
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Benítez-Guerra D, Piña-Flores C, Zamora-López M, Escalante-Padrón F, Lima-Rogel V, González-Ortiz AM, Guevara-Tovar M, Bernal-Silva S, Benito-Cruz B, Castillo-Martínez F, Martínez-Rodríguez LE, Ramírez-Ojeda V, Tello-Martínez N, Lomelí-Valdez R, Salto-Quintana J, Cadena-Mota S, Noyola DE. Respiratory syncytial virus acute respiratory infection-associated hospitalizations in preterm Mexican infants: A cohort study. Influenza Other Respir Viruses 2020; 14:182-188. [PMID: 31917902 PMCID: PMC7040972 DOI: 10.1111/irv.12708] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/18/2019] [Accepted: 11/21/2019] [Indexed: 01/29/2023] Open
Abstract
Background Respiratory syncytial virus (RSV) is the leading cause of severe acute respiratory infections (ARI) in preterm infants. The incidence of RSV‐associated hospitalizations has not been defined in Mexico. Objectives To determine the incidence of ARI‐ and RSV‐associated hospitalizations in preterm infants during the first year of life. Methods Prospective cohort study of 294 preterm infants followed up through monthly telephone calls and routine outpatient visits. Hospitalized children were identified through daily visits to pediatric wards of participating hospitals and through telephone calls. Respiratory samples were tested for RSV by RT‐PCR. Results Mean gestational age of participating infants was 33 weeks. Ninety‐six infants were diagnosed with bronchopulmonary dysplasia (BPD) and 17 with congenital heart disease (CHD); 11 had both conditions. There were 71 hospitalization episodes in 53 infants. Respiratory samples for RSV detection were available in 44 hospitalization episodes, and the result was positive in 16 (36.3%). At least one hospitalization for ARI was recorded in 33 of 96 participants with BPD, in seven of 17 with CHD, and 18 of 192 infants without these diagnoses. Five (71.4%) of CHD infants who required admission also had BPD. RSV‐confirmed hospitalization rates were 9.4%, 5.9%, and 2.6% for infants with BPD, CHD, and otherwise healthy preterm infants, respectively. Attributable RSV admission frequencies were estimated to be 13.6%, 16.5%, and 4.1%, respectively. Conclusions Mexican preterm infants, particularly those with BPD, have high rates of ARI‐ and RSVassociated hospitalizations. Specific interventions to reduce the incidence of severe infections in this highrisk group are required.
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Affiliation(s)
- Daniela Benítez-Guerra
- Neonatology Department, Hospital Central "Dr. Ignacio Morones Prieto", San Luis Potosí, México
| | - Cecilia Piña-Flores
- Neonatology Department, Hospital Central "Dr. Ignacio Morones Prieto", San Luis Potosí, México
| | - Miguel Zamora-López
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | | | - Victoria Lima-Rogel
- Neonatology Department, Hospital Central "Dr. Ignacio Morones Prieto", San Luis Potosí, México
| | - Ana María González-Ortiz
- Pediatrics Department, Hospital del Niño y la Mujer "Dr. Alberto López Hermosa", San Luis Potosí, México
| | - Marcela Guevara-Tovar
- Pediatrics Department, Hospital del Niño y la Mujer "Dr. Alberto López Hermosa", San Luis Potosí, México
| | - Sofía Bernal-Silva
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Beatriz Benito-Cruz
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Fernanda Castillo-Martínez
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Luz E Martínez-Rodríguez
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Vianney Ramírez-Ojeda
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Nallely Tello-Martínez
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Rodrigo Lomelí-Valdez
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Jack Salto-Quintana
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Sandra Cadena-Mota
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Daniel E Noyola
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
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934
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Mettu R, Chen CY, Wu CY. Synthetic carbohydrate-based vaccines: challenges and opportunities. J Biomed Sci 2020; 27:9. [PMID: 31900143 PMCID: PMC6941340 DOI: 10.1186/s12929-019-0591-0] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/18/2019] [Indexed: 01/05/2023] Open
Abstract
Glycoconjugate vaccines based on bacterial capsular polysaccharides (CPS) have been extremely successful in preventing bacterial infections. The glycan antigens for the preparation of CPS based glycoconjugate vaccines are mainly obtained from bacterial fermentation, the quality and length of glycans are always inconsistent. Such kind of situation make the CMC of glycoconjugate vaccines are difficult to well control. Thanks to the advantage of synthetic methods for carbohydrates syntheses. The well controlled glycan antigens are more easily to obtain, and them are conjugated to carrier protein to from the so-call homogeneous fully synthetic glycoconjugate vaccines. Several fully glycoconjugate vaccines are in different phases of clinical trial for bacteria or cancers. The review will introduce the recent development of fully synthetic glycoconjugate vaccine.
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Affiliation(s)
- Ravinder Mettu
- Genomics Research Center, Academia Sinica, No. 128 Academia Road, Section 2, Nangang District, Taipei, 11529, Taiwan
| | - Chiang-Yun Chen
- Genomics Research Center, Academia Sinica, No. 128 Academia Road, Section 2, Nangang District, Taipei, 11529, Taiwan.,Chemical Biology and Molecular Biophysics, Taiwan International Graduate Program, Academia Sinica, No. 128 Academia Road, Section 2, Nangang District, Taipei, 11529, Taiwan
| | - Chung-Yi Wu
- Genomics Research Center, Academia Sinica, No. 128 Academia Road, Section 2, Nangang District, Taipei, 11529, Taiwan.
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935
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Kugler-Umana O, Devarajan P, Swain SL. Understanding the Heterogeneous Population of Age-Associated B Cells and Their Contributions to Autoimmunity and Immune Response to Pathogens. Crit Rev Immunol 2020; 40:297-309. [PMID: 33426819 PMCID: PMC8118092 DOI: 10.1615/critrevimmunol.2020034934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In humans and mice, susceptibility to infections and autoimmunity increases with age due to age-associated changes in innate and adaptive immune responses. Aged innate cells are also less active, leading to decreased naive T- and B-cell responses. Aging innate cells contribute to an overall heightened inflammatory environment. Naive T and B cells undergo cell-intrinsic age-related changes that result in reduced effector and memory responses. However, previously established B- and T-cell memory responses persist with age. One dramatic change is the appearance of a newly recognized population of age-associated B cells (ABCs) that has a unique cluster of differentiation (CD)21-CD23- phenotype. Here, we discuss the discovery and origins of the naive phenotype immunoglobulin (Ig)D+ versus activated CD11c+T-bet+ ABCs, with a focus on protective and pathogenic properties. In humans and mice, antigen-experienced CD11c+T-bet+ ABCs increase with autoimmunity and appear in response to bacterial and viral infections. However, our analyses indicate that CD21-CD23- ABCs include a resting, naive, progenitor ABC population that expresses IgD. Similar to generation of CD11c+T-bet+ ABCs, naive ABC response to pathogens depends on toll-like receptor stimulation, making this a key feature of ABC activation. Here, we put forward a potential developmental map of distinct subsets from putative naive ABCs. We suggest that defining signals that can harness the naive ABC response may contribute to protection against pathogens in the elderly. CD11c+T-bet+ ABCs may be useful targets for therapeutic strategies to counter autoimmunity.
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Affiliation(s)
- Olivia Kugler-Umana
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | | | - Susan L. Swain
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA 01605, USA
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936
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Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years: an analysis for the Global Burden of Disease Study 2017. THE LANCET. INFECTIOUS DISEASES 2020; 20:60-79. [PMID: 31678026 PMCID: PMC7185492 DOI: 10.1016/s1473-3099(19)30410-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/13/2019] [Accepted: 07/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite large reductions in under-5 lower respiratory infection (LRI) mortality in many locations, the pace of progress for LRIs has generally lagged behind that of other childhood infectious diseases. To better inform programmes and policies focused on preventing and treating LRIs, we assessed the contributions and patterns of risk factor attribution, intervention coverage, and sociodemographic development in 195 countries and territories by drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) LRI estimates. METHODS We used four strategies to model LRI burden: the mortality due to LRIs was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive ensemble modelling tool; the incidence of LRIs was modelled using population representative surveys, health-care utilisation data, and scientific literature in a compartmental meta-regression tool; the attribution of risk factors for LRI mortality was modelled in a counterfactual framework; and trends in LRI mortality were analysed applying changes in exposure to risk factors over time. In GBD, infectious disease mortality, including that due to LRI, is among HIV-negative individuals. We categorised locations based on their burden in 1990 to make comparisons in the changing burden between 1990 and 2017 and evaluate the relative percent change in mortality rate, incidence, and risk factor exposure to explain differences in the health loss associated with LRIs among children younger than 5 years. FINDINGS In 2017, LRIs caused 808 920 deaths (95% uncertainty interval 747 286-873 591) in children younger than 5 years. Since 1990, there has been a substantial decrease in the number of deaths (from 2 337 538 to 808 920 deaths; 65·4% decrease, 61·5-68·5) and in mortality rate (from 362·7 deaths [330·1-392·0] per 100 000 children to 118·9 deaths [109·8-128·3] per 100 000 children; 67·2% decrease, 63·5-70·1). LRI incidence declined globally (32·4% decrease, 27·2-37·5). The percent change in under-5 mortality rate and incidence has varied across locations. Among the risk factors assessed in this study, those responsible for the greatest decrease in under-5 LRI mortality between 1990 and 2017 were increased coverage of vaccination against Haemophilus influenza type b (11·4% decrease, 0·0-24·5), increased pneumococcal vaccine coverage (6·3% decrease, 6·1-6·3), and reductions in household air pollution (8·4%, 6·8-9·2). INTERPRETATION Our findings show that there have been substantial but uneven declines in LRI mortality among countries between 1990 and 2017. Although improvements in indicators of sociodemographic development could explain some of these trends, changes in exposure to modifiable risk factors are related to the rates of decline in LRI mortality. No single intervention would universally accelerate reductions in health loss associated with LRIs in all settings, but emphasising the most dominant risk factors, particularly in countries with high case fatality, can contribute to the reduction of preventable deaths. FUNDING Bill & Melinda Gates Foundation.
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937
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Quadrivalent Influenza Vaccine Prevents Illness and Reduces Healthcare Utilization Across Diverse Geographic Regions During Five Influenza Seasons: A Randomized Clinical Trial. Pediatr Infect Dis J 2020; 39:e1-e10. [PMID: 31725115 PMCID: PMC7004464 DOI: 10.1097/inf.0000000000002504] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We evaluated an inactivated quadrivalent influenza vaccine (IIV4) in children 6-35 months of age in a phase III, observer-blind trial. METHODS The aim of this analysis was to estimate vaccine efficacy (VE) in preventing laboratory-confirmed influenza in each of 5 independent seasonal cohorts (2011-2014), as well as vaccine impact on healthcare utilization in 3 study regions (Europe/Mediterranean, Asia-Pacific and Central America). Healthy children were randomized 1:1 to IIV4 or control vaccines. VE was estimated against influenza confirmed by reverse transcription polymerase chain reaction on nasal swabs. Cultured isolates were characterized as antigenically matched/mismatched to vaccine strains. RESULTS The total vaccinated cohort included 12,018 children (N = 1777, 2526, 1564, 1501 and 4650 in cohorts 1-5, respectively). For reverse transcription polymerase chain reaction confirmed influenza of any severity (all strains combined), VE in cohorts 1-5 was 57.8%, 52.9%, 73.4%, 30.3% and 41.4%, respectively, with the lower limit of the 95% confidence interval >0 for all estimates. The proportion of vaccine match for all strains combined in each cohort was 0.9%, 79.3%, 72.5%, 24.1% and 28.6%, respectively. Antibiotic use associated with influenza illness was reduced with IIV4 by 71% in Europe, 36% in Asia Pacific and 59% in Central America. CONCLUSIONS IIV4 prevented influenza in children 6-35 months of age in each of 5 separate influenza seasons in diverse geographical regions. A possible interaction between VE, degree of vaccine match and socioeconomic status was observed. The IIV4 attenuated the severity of breakthrough influenza illness and reduced healthcare utilization, particularly antibiotic use.
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938
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Marques A, Pinho C, De Francesco S, Martins P, Neves J, Oliveira A. A randomized controlled trial of respiratory physiotherapy in lower respiratory tract infections. Respir Med 2020; 162:105861. [PMID: 31916533 DOI: 10.1016/j.rmed.2019.105861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/18/2019] [Accepted: 12/28/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Physiotherapy may play a role in the recovery of signs, symptoms and function of patients with lower respiratory tract infections (LRTI) but its effectiveness is still controversial. OBJECTIVES To assess the effects of respiratory physiotherapy compared with standard pharmacological care on symptoms and function in outpatients with LRTI. DESIGN Single-blind, randomised controlled trial. SETTING Outpatients were recruited from the casualties of a central hospital. PARTICIPANTS Outpatients with LRTI were recruited and randomly allocated to the control (pharmacological) or experimental (pharmacological and respiratory physiotherapy) group. INTERVENTION The intervention consisted of conventional pharmacological treatment and conventional pharmacological treatment plus respiratory physiotherapy. Respiratory physiotherapy included breathing and airway clearance techniques, exercise training and education during 3-weeks, 3 times per week. MAIN OUTCOME MEASURE Primary outcome measures - occupation rate of wheezes Wh%; Secondary outcome measures - number of crackles, peripheral oxygen saturation (SpO2) modified Borg scale (mBorg), modified Medical Research Council scale (mMRC), 6-min walk test (6MWT), forced expiratory volume in 1 s and forced vital capacity, and volume and density of the lung and bronchial tree volume. RESULTS Ninety-seven patients (53 controls and 44 experimental) completed the intervention. After the intervention, both groups improved significantly in all variables (0.0001 < p < 0.04; 0.001<ƞ2<0.092), with the exception of the mBorg. The magnitude of improvement of the experimental group exceeded the control group in the number of crackles, SpO2 levels, mMRC and 6MWT (0.002 < p < 0.032; 0.002<ƞ2<0.092). CONCLUSION Adding respiratory physiotherapy to the pharmacological treatment of outpatients with LRTI results in greater recovery of symptoms and function parameters. TRIAL REGISTRATION NCT02053870.
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Affiliation(s)
- Alda Marques
- School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.
| | - Cátia Pinho
- Instituto de Telecomunicações (IT) and Department of Electronics, Telecommunications and Informatics (DETI), University of Aveiro, 3810-193, Aveiro, Portugal.
| | - Silvia De Francesco
- School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; Institute of Electronics and Informatics Engineering of Aveiro (IEETA), University of Aveiro, Aveiro, Portugal.
| | - Paula Martins
- School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal; Institute of Electronics and Informatics Engineering of Aveiro (IEETA), University of Aveiro, Aveiro, Portugal.
| | - Joana Neves
- Centro Hospital Do Baixo Vouga, Internal Medicine Department, Aveiro, Portugal.
| | - Ana Oliveira
- School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; Lab 3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.
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939
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Koul PA. Clinical practice guidelines for influenza and pneumococcal vaccination: The Indian perspective. Lung India 2020; 37:S1-S3. [PMID: 32830788 PMCID: PMC7703814 DOI: 10.4103/lungindia.lungindia_628_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Parvaiz A Koul
- Department of Internal and Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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940
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van de Maat JS, Peeters D, Nieboer D, van Wermeskerken AM, Smit FJ, Noordzij JG, Tramper-Stranders G, Driessen GJA, Obihara CC, Punt J, van der Lei J, Polinder S, Moll HA, Oostenbrink R. Evaluation of a clinical decision rule to guide antibiotic prescription in children with suspected lower respiratory tract infection in The Netherlands: A stepped-wedge cluster randomised trial. PLoS Med 2020; 17:e1003034. [PMID: 32004317 PMCID: PMC6993966 DOI: 10.1371/journal.pmed.1003034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/06/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Optimising the use of antibiotics is a key component of antibiotic stewardship. Respiratory tract infections (RTIs) are the most common reason for antibiotic prescription in children, even though most of these infections in children under 5 years are viral. This study aims to safely reduce antibiotic prescriptions in children under 5 years with suspected lower RTI at the emergency department (ED), by implementing a clinical decision rule. METHODS AND FINDINGS In a stepped-wedge cluster randomised trial, we included children aged 1-60 months presenting with fever and cough or dyspnoea to 8 EDs in The Netherlands. The EDs were of varying sizes, from diverse geographic and demographic regions, and of different hospital types (tertiary versus general). In the pre-intervention phase, children received usual care, according to the Dutch and NICE guidelines for febrile children. During the intervention phase, a validated clinical prediction model (Feverkidstool) including clinical characteristics and C-reactive protein (CRP) was implemented as a decision rule guiding antibiotic prescription. The intervention was that antibiotics were withheld in children with a low or intermediate predicted risk of bacterial pneumonia (≤10%, based on Feverkidstool). Co-primary outcomes were antibiotic prescription rate and strategy failure. Strategy failure was defined as secondary antibiotic prescriptions or hospitalisations, persistence of fever or oxygen dependency up to day 7, or complications. Hospitals were randomly allocated to 1 sequence of treatment each, using computer randomisation. The trial could not be blinded. We used multilevel logistic regression to estimate the effect of the intervention, clustered by hospital and adjusted for time period, age, sex, season, ill appearance, and fever duration; predicted risk was included in exploratory analysis. We included 999 children (61% male, median age 17 months [IQR 9 to 30]) between 1 January 2016 and 30 September 2018: 597 during the pre-intervention phase and 402 during the intervention phase. Most children (77%) were referred by a general practitioner, and half of children were hospitalised. Intention-to-treat analyses showed that overall antibiotic prescription was not reduced (30% to 25%, adjusted odds ratio [aOR] 1.07 [95% CI 0.57 to 2.01, p = 0.75]); strategy failure reduced from 23% to 16% (aOR 0.53 [95% CI 0.32 to 0.88, p = 0.01]). Exploratory analyses showed that the intervention influenced risk groups differently (p < 0.01), resulting in a reduction in antibiotic prescriptions in low/intermediate-risk children (17% to 6%; aOR 0.31 [95% CI 0.12 to 0.81, p = 0.02]) and a non-significant increase in the high-risk group (47% to 59%; aOR 2.28 [95% CI 0.84 to 6.17, p = 0.09]). Two complications occurred during the trial: 1 admission to the intensive care unit during follow-up and 1 pleural empyema at day 10 (both unrelated to the study intervention). Main limitations of the study were missing CRP values in the pre-intervention phase and a prolonged baseline period due to logistical issues, potentially affecting the power of our study. CONCLUSIONS In this multicentre ED study, we observed that a clinical decision rule for childhood pneumonia did not reduce overall antibiotic prescription, but that it was non-inferior to usual care. Exploratory analyses showed fewer strategy failures and that fewer antibiotics were prescribed in low/intermediate-risk children, suggesting improved targeting of antibiotics by the decision rule. TRIAL REGISTRATION Netherlands Trial Register NTR5326.
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Affiliation(s)
- Josephine S. van de Maat
- Department of General Paediatrics, Erasmus MC–Sophia Children’s Hospital, Rotterdam, The Netherlands
- * E-mail:
| | - Daphne Peeters
- Department of Paediatrics, HAGA–Juliana Children’s Hospital, Den Haag, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | | | - Frank J. Smit
- Department of Paediatrics, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Jeroen G. Noordzij
- Department of Paediatrics, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | | | | | - Charlie C. Obihara
- Department of Paediatrics, Elisabeth–TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Jeanine Punt
- Department of Paediatrics, LangeLand Ziekenhuis, Zoetermeer, The Netherlands
| | - Johan van der Lei
- Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Henriette A. Moll
- Department of General Paediatrics, Erasmus MC–Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Rianne Oostenbrink
- Department of General Paediatrics, Erasmus MC–Sophia Children’s Hospital, Rotterdam, The Netherlands
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941
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Kozhikhova KV, Shilovskiy IP, Shatilov AA, Timofeeva AV, Turetskiy EA, Vishniakova LI, Nikolskii AA, Barvinskaya ED, Karthikeyan S, Smirnov VV, Kudlay DA, Andreev SM, Khaitov MR. Linear and dendrimeric antiviral peptides: design, chemical synthesis and activity against human respiratory syncytial virus. J Mater Chem B 2020; 8:2607-2617. [DOI: 10.1039/c9tb02485a] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Novel artificial peptides possess anti-RSV activity through a combination of two mechanisms: direct nonspecific destabilization of the viral envelope and competitive interaction with the RSV cellular receptor.
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Affiliation(s)
| | | | - Artem A. Shatilov
- NRC Institute Immunology FMBA
- Moscow
- Russian Federation
- Sechenov First Moscow State Medical University
- Moscow
| | - Anastasiia V. Timofeeva
- NRC Institute Immunology FMBA
- Moscow
- Russian Federation
- Sechenov First Moscow State Medical University
- Moscow
| | - Evgeny A. Turetskiy
- NRC Institute Immunology FMBA
- Moscow
- Russian Federation
- Sechenov First Moscow State Medical University
- Moscow
| | | | | | | | | | - Valeriy V. Smirnov
- NRC Institute Immunology FMBA
- Moscow
- Russian Federation
- Sechenov First Moscow State Medical University
- Moscow
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942
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Nakano S, Fujisawa T, Ito Y, Chang B, Matsumura Y, Yamamoto M, Suga S, Ohnishi M, Nagao M. Nationwide surveillance of paediatric invasive and non-invasive pneumococcal disease in Japan after the introduction of the 13-valent conjugated vaccine, 2015-2017. Vaccine 2019; 38:1818-1824. [PMID: 31882246 DOI: 10.1016/j.vaccine.2019.12.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 01/28/2023]
Abstract
Streptococcus pneumoniae is still one of the major causes of morbidity and mortality worldwide. In Japan, pneumococcal conjugate vaccine (PCV)7 and PCV13 were licensed in 2010 and 2013, respectively. We conducted a nationwide paediatric invasive pneumococcal disease (IPD) and non-IPD surveillance study in Japan between 2015 and 2017. We collected 498 IPD isolates and 231 non-IPD isolates from a total of 187 medical institutions in Japan. We performed serotyping, antimicrobial susceptibility testing and multi-locus sequencing typing (MLST) for the collected isolates. Among the 498 IPD isolates, the most prevalent serotype was 24F, followed by 12F, 15A and 15B/C. However, 12F increased and 24F significantly decreased during the study period (p < 0.001), resulting in 12F becoming the most prevalent serotype in 2017. Among the IPD isolates, the PCV7 and PCV13 coverage rates were 0.8% and 9.2%, respectively. The most prevalent serotype among the non-IPD isolates was 15A, followed by 35B, 15B/C and 19A. The overall resistance rates to penicillin (PG), cefotaxime (CTX), meropenem (MEM), erythromycin (EM) and levofloxacin (LFX) were 40.5%, 12.2%, 19.4%, 91.8% and 0.5%, respectively. PG, CTX and MEM resistance rates were significantly higher in non-IPD isolates than in IPD isolates (p < 0.001). Serotype 15A-CC63 and serotype 35B-CC558 tended to be multi-drug resistant. In conclusion, the PCV13 coverage rate was significantly lower than that in a previous surveillance study in Japan between 2012 and 2014, and IPD cases attributable to serotype 19A also decreased. We should note the rapid increase in the prevalence of serotype 12F in IPD cases and the spread of the multi-drug resistant serotype 15A-CC63 and 35B-CC558 lineages.
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Affiliation(s)
- Satoshi Nakano
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Takao Fujisawa
- Department of Clinical Research, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Yutaka Ito
- Department of Respiratory Medicine, Allergy and Rheumatology, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Bin Chang
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yasufumi Matsumura
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaki Yamamoto
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shigeru Suga
- Department of Clinical Research, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Makoto Ohnishi
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Miki Nagao
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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943
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Sheshadri A, Godoy M, Erasmus JJ, Gruschkus S, Hasan A, Evans SE, Barreda-Garcia J, Chemaly RF, Dickey B, Ost D. Progression of the Radiologic Severity Index is associated with increased mortality and healthcare resource utilisation in acute leukaemia patients with pneumonia. BMJ Open Respir Res 2019; 6:e000471. [PMID: 31921429 PMCID: PMC6937103 DOI: 10.1136/bmjresp-2019-000471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 12/25/2022] Open
Abstract
Background Pneumonia is a major cause of mortality and morbidity, but the development of new antimicrobials is lacking. Radiological assessment of pneumonia severity may serve as an effective intermediate endpoint to reduce barriers to successful completion of antimicrobial trials. We sought to determine whether the Radiologic Severity Index (RSI) correlated with mortality and healthcare resource utilisation in patients with acute leukaemia undergoing induction chemotherapy. Methods We measured RSI (range 0–72) on all chest radiographs performed within 33 days of induction chemotherapy in 165 haematological malignancy patients with pneumonia. Peak RSI was defined as the highest RSI score within 33 days of induction. We used extended Cox proportional hazards models to measure the association of time-varying RSI with all-cause mortality within the first 33 days after induction chemotherapy, and logistic regression or generalised models to measure the association of RSI with total daily cost and healthcare resource utilisation. Results After adjustment for clinical variables, each one-point increase in RSI was associated with a 7% increase in all-cause 33-day mortality (HR 1.07, 95% CI 1.05 to 1.09, p<0.0001). Peak RSI values of 37.5 or higher were associated with 86% higher daily direct costs (p<0.0001), more days in intensive care unit (9.9 vs 4.8 days, p=0.001) and higher odds for mechanical ventilation (OR 12.1, p<0.0001). Conclusions Greater radiological severity as measured by RSI was associated with increased mortality and morbidity in acute leukaemia patients with pneumonia. RSI is a promising intermediate marker of pneumonia severity and is well suited for use in antimicrobial trials.
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Affiliation(s)
- Ajay Sheshadri
- Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Myrna Godoy
- Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeremy J Erasmus
- Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen Gruschkus
- Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Arain Hasan
- Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Scott E Evans
- Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Javier Barreda-Garcia
- Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roy F Chemaly
- Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Burton Dickey
- Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Ost
- Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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944
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Young S, Phillips J, Griego-Fullbright C, Wagner A, Jim P, Chaudhuri S, Tang S, Sickler J. Molecular point-of-care testing for influenza A/B and respiratory syncytial virus: comparison of workflow parameters for the ID Now and cobas Liat systems. J Clin Pathol 2019; 73:328-334. [PMID: 31826935 PMCID: PMC7279563 DOI: 10.1136/jclinpath-2019-206242] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 11/21/2022]
Abstract
Aims Point-of-care (POC) tests for influenza and respiratory syncytial virus (RSV) offer the potential to improve patient management and antimicrobial stewardship. Studies have focused on performance; however, no workflow assessments have been published comparing POC molecular tests. This study compared the Liat and ID Now systems workflow, to assist end-users in selecting an influenza and/or RSV POC test. Methods Staffing, walk-away and turnaround time (TAT) of the Liat and ID Now systems were determined using 40 nasopharyngeal samples, positive for influenza or RSV. The ID Now system requires separate tests for influenza and RSV, so parallel (two instruments) and sequential (one instrument) workflows were evaluated. Results The ID Now ranged 4.1–6.2 min for staffing, 1.9–10.9 min for walk-away and 6.4–15.8 min for TAT per result. The Liat ranged 1.1–1.8 min for staffing, 20.0–20.5 min for walk-away and 21.3–22.0 min for TAT. Mean walk-away time comprised 38.0% (influenza positive) and 68.1% (influenza negative) of TAT for ID Now and 93.7% (influenza/RSV) for Liat. The ID Now parallel workflow resulted in medians of 5.9 min for staffing, 9.7 min for walk-away and 15.6 min for TAT. Assuming prevalence of 20% influenza and 20% RSV, the ID Now sequential workflow resulted in medians of 9.4 min for staffing, 17.4 min for walk-away, and 27.1 min for TAT. Conclusions The ID Now and Liat systems offer different workflow characteristics. Key considerations for implementation include value of both influenza and RSV results, clinical setting, staffing capacity, and instrument(s) placement.
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Affiliation(s)
- Stephen Young
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA .,TriCore Reference Laboratories, Albuquerque, New Mexico, USA
| | | | | | - Aaron Wagner
- TriCore Reference Laboratories, Albuquerque, New Mexico, USA
| | - Patricia Jim
- TriCore Reference Laboratories, Albuquerque, New Mexico, USA
| | | | - Shaowu Tang
- Roche Molecular Systems Inc, Pleasanton, California, USA
| | - Joanna Sickler
- Roche Molecular Systems Inc, Pleasanton, California, USA
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Reiner RC, Welgan CA, Casey DC, Troeger CE, Baumann MM, Nguyen QP, Swartz SJ, Blacker BF, Deshpande A, Mosser JF, Osgood-Zimmerman AE, Earl L, Marczak LB, Munro SB, Miller-Petrie MK, Rodgers Kemp G, Frostad J, Wiens KE, Lindstedt PA, Pigott DM, Dwyer-Lindgren L, Ross JM, Burstein R, Graetz N, Rao PC, Khalil IA, Davis Weaver N, Ray SE, Davis I, Farag T, Brady OJ, Kraemer MUG, Smith DL, Bhatt S, Weiss DJ, Gething PW, Kassebaum NJ, Mokdad AH, Murray CJL, Hay SI. Identifying residual hotspots and mapping lower respiratory infection morbidity and mortality in African children from 2000 to 2017. Nat Microbiol 2019; 4:2310-2318. [PMID: 31570869 PMCID: PMC6877470 DOI: 10.1038/s41564-019-0562-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/15/2019] [Indexed: 12/13/2022]
Abstract
Lower respiratory infections (LRIs) are the leading cause of death in children under the age of 5, despite the existence of vaccines against many of their aetiologies. Furthermore, more than half of these deaths occur in Africa. Geospatial models can provide highly detailed estimates of trends subnationally, at the level where implementation of health policies has the greatest impact. We used Bayesian geostatistical modelling to estimate LRI incidence, prevalence and mortality in children under 5 subnationally in Africa for 2000-2017, using surveys covering 1.46 million children and 9,215,000 cases of LRI. Our model reveals large within-country variation in both health burden and its change over time. While reductions in childhood morbidity and mortality due to LRI were estimated for almost every country, we expose a cluster of residual high risk across seven countries, which averages 5.5 LRI deaths per 1,000 children per year. The preventable nature of the vast majority of LRI deaths mandates focused health system efforts in specific locations with the highest burden.
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Affiliation(s)
- Robert C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
| | - Catherine A Welgan
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Daniel C Casey
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Christopher E Troeger
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mathew M Baumann
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - QuynhAnh P Nguyen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Scott J Swartz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Brigette F Blacker
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Aniruddha Deshpande
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jonathan F Mosser
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Lucas Earl
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Laurie B Marczak
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Sandra B Munro
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Molly K Miller-Petrie
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Grant Rodgers Kemp
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Michigan State University, East Lansing, MI, USA
| | - Joseph Frostad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kirsten E Wiens
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Paulina A Lindstedt
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - David M Pigott
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Laura Dwyer-Lindgren
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Jennifer M Ross
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Roy Burstein
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nicholas Graetz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Puja C Rao
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ibrahim A Khalil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Nicole Davis Weaver
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Sarah E Ray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ian Davis
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Tamer Farag
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Oliver J Brady
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Moritz U G Kraemer
- Department of Zoology, University of Oxford, Oxford, UK
- Harvard Medical School, University of Harvard, Boston, MA, USA
| | - David L Smith
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | | | | | | | - Nicholas J Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
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946
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Naucler P, Henriques-Normark B, Hedlund J, Galanis I, Granath F, Örtqvist Å. The changing epidemiology of community-acquired pneumonia: nationwide register-based study in Sweden. J Intern Med 2019; 286:689-701. [PMID: 31278792 DOI: 10.1111/joim.12956] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND There is limited evidence on the impact of pneumococcal conjugate vaccine childhood immunization programmes (PCV-CIP) on community-acquired pneumonia (CAP) in individuals with underlying diseases. METHODS A nationwide cohort study using Swedish health registers to assess the incidence of hospitalization with all-cause (AC-CAP) and pneumococcal or lobar (PL-CAP) CAP between 2005 and 2015, in relation to PCV-CIP introduction in 2007-09. RESULTS In total, 303 691 episodes of AC-CAP occurred, of which 14 225 were PL-CAP. Comparing before (2005-06) with after (2014-15) PCV-CIP, relative incidence reductions were 36% (95% Confidence Interval 32-40), 20% (14-25) and 16% (11-22) of AC-CAP for age groups < 2, 2-4 and 5-17 years, respectively, with similar reductions in young children with and without comorbidities. The reductions were more pronounced for PL-CAP. In the age groups 40-64, 65-74, 75-84 and ≥85 years there were relative increases of 11% (8-14), 18% (15-22), 15% (12-17) and 30% (27-34) of AC-CAP, respectively, but these increases were attenuated after adjustment for admittance practices using four control conditions. In adults with comorbidities, there was an increase in incidence of AC-CAP, and PL-CAP, in contrast to adults without reported underlying diseases where the incidence was stable or diminished for some age groups. Over the study period, there was an increased proportion of pneumonia patients with underlying diseases in all ages. CONCLUSION This emphasizes that direct preventive interventions should be targeted towards individuals with underlying diseases. Future studies should investigate reasons for the observed increased risk in adults with comorbidities, for example due to pneumococcal nonvaccine serotypes, or other pathogens, preferentially affecting subjects with underlying diseases.
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Affiliation(s)
- P Naucler
- From the, Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - B Henriques-Normark
- Public Health Agency of Sweden, Solna, Sweden.,Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.,SCELSE and LKC, Nanyang Technological University, NTU, Singapore, Singapore
| | - J Hedlund
- From the, Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - I Galanis
- Public Health Agency of Sweden, Solna, Sweden
| | - F Granath
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Å Örtqvist
- From the, Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden
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947
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Danis K, Varon E, Lepoutre A, Janssen C, Forestier E, Epaulard O, N'guyen Y, Labrunie A, Lanotte P, Gravet A, Pelloux I, Chavanet P, Levy-Bruhl D, Ploy MC, Gaillat J. Factors Associated With Severe Nonmeningitis Invasive Pneumococcal Disease in Adults in France. Open Forum Infect Dis 2019; 6:ofz510. [PMID: 31868865 PMCID: PMC6918451 DOI: 10.1093/ofid/ofz510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/28/2019] [Indexed: 11/14/2022] Open
Abstract
Background In France, pneumococcal vaccination in adults is recommended for risk groups (chronic conditions/immunosuppression). We conducted a study on invasive pneumococcal disease (IPD) in adults to identify factors associated with disease severity and death. Methods We included IPD cases, excluding meningitis, from 25 acute care hospitals in 6 regions. We defined severe cases as those with shock or severe sepsis or intensive care unit admission/mechanical ventilation. We included deaths occurring within 30 days of hospitalization. Infectious disease specialists collected clinical/microbiological data on cases. Results During 2014–2017, 908 nonmeningitis IPD cases were diagnosed; 48% were severe, 84% had comorbidities, 21% died. Ninety percent of cases with comorbidities who previously sought health care were not vaccinated against pneumococcus. Compared with previously healthy cases, the risk of severe IPD increased from 20% (adjusted risk ratio [aRR], 1.2; 95% confidence interval [CI], 1.0–1.4) in cases with 1–2 chronic diseases to 30% (aRR, 1.3; 95% CI, 1.0–7.0) in those with >2 chronic diseases. Among risk groups, 13-valent pneumococcal conjugate vaccine (PCV13) serotypes and 23-valent pneumococcal polysaccharide vaccine (PPSV23) nonPCV13 serotypes were more likely to induce severe IPD compared with nonvaccine serotypes (aRR, 1.5; 95% CI, 1.3–1.9; aRR, 1.3; 95% CI, 1.0–1.5, respectively). Conclusions We observed a cumulative effect of concurrent comorbidities on severe IPD. Vaccine serotypes were more likely to induce severe IPD among risk groups. The missed opportunities for vaccination underscore the need to enhance vaccination in risk groups.
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Affiliation(s)
- Kostas Danis
- Santé Publique France (SpFrance), the French National Public Health Agency, Saint-Maurice, France
| | - Emmanuelle Varon
- National Centre for Pneumococci, Centre Hospitalier Intercommunal Créteil, Créteil, France
| | - Agnès Lepoutre
- Santé Publique France (SpFrance), the French National Public Health Agency, Saint-Maurice, France
| | | | | | | | | | - Anaïs Labrunie
- University Hospital Centre Limoges, Regional Observatories for Pneumococci (Observatoires Régionaux du Pneumocoque), Limoges, France.,University Hospital Centre Limoges, CEBIMER, Limoges, France
| | | | - Alain Gravet
- Hospital Emile Müller Mulhouse, Mullhouse, France
| | | | | | - Daniel Levy-Bruhl
- Santé Publique France (SpFrance), the French National Public Health Agency, Saint-Maurice, France
| | - Marie-Cecile Ploy
- University Hospital Centre Limoges, Regional Observatories for Pneumococci (Observatoires Régionaux du Pneumocoque), Limoges, France.,University Limoges, INSERM, CHU Limoges, RESINFIT, , Limoges, France
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948
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Lucas S, Leach MJ, Kumar S, Phillips AC. Complementary And Alternative Medicine Practitioner's Management Of Acute Respiratory Tract Infections In Children - A Qualitative Descriptive Study. J Multidiscip Healthc 2019; 12:947-962. [PMID: 31819469 PMCID: PMC6875505 DOI: 10.2147/jmdh.s230845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/29/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Acute respiratory tract infection (ARTI) is one of the most prevalent types of infection among children and a common reason for hospital admission. Although parents frequently consult complementary and alternative medicine (CAM) practitioners to assist with the management of childhood ARTI, little is known about the treatments that CAM practitioners recommend and why. The aim of this research was to understand what CAM practitioners typically prescribe for the management of childhood ARTI and how practitioners formulate decisions regarding the management of this condition. METHOD The research was guided by a qualitative descriptive framework. CAM practitioners across Greater Melbourne (Victoria, Australia) who had treated children aged 0-12 years with ARTI in the past 12 months were eligible to participate. Data were captured using semi-structured interviews, which were audio-recorded and transcribed verbatim. Multiple strategies to improve trustworthiness were implemented (e.g., triangulation of data). Data were analysed using inductive content analysis. RESULTS Twenty-four CAM practitioners from ten different disciplines participated in the interviews. Most participants were female (75%), and more than half (54%) were practicing naturopaths. The treatments most commonly recommended were lifestyle modification (95%), nutrition/diet-based treatments (91%), and vitamin/mineral supplementation (87%). Practitioners' decision-making process was underpinned by four key concepts namely: the approach to management, individualisation, do no harm, and collaborative practice. Individualisation and the safety of the child are cornerstones of treatment in the practitioner's decision-making process. CONCLUSION This research sheds light on commonly used CAM interventions, many of which build on easily accessible and readily available treatments (such as soups) and are aligned with mainstream recommendations (such as rest). Practitioners' decision-making process too aligns well with mainstream health care where the focus is on safety and informed by a biopsychosocial-cultural approach.
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Affiliation(s)
- Sandra Lucas
- School of Health Sciences, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Matthew J Leach
- Department of Rural Health, University of South Australia, Adelaide, SA, Australia
| | - Saravana Kumar
- School of Health Sciences, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Anna C Phillips
- School of Health Sciences, Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
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949
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Puggioni F, Alves-Correia M, Mohamed MF, Stomeo N, Mager R, Marinoni M, Racca F, Paoletti G, Varricchi G, Giorgis V, Melioli G, Canonica GW, Heffler E. Immunostimulants in respiratory diseases: focus on Pidotimod. Multidiscip Respir Med 2019; 14:31. [PMID: 31700623 PMCID: PMC6827234 DOI: 10.1186/s40248-019-0195-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/23/2019] [Indexed: 12/18/2022] Open
Abstract
Usefulness of Pidotimod and its role as immunostimulant, has been discussed, we know, for several decades. Nevertheless, there is still much to know. Understanding its mechanisms and its potential usefulness in airway infections and its prevention, asthma both Th2 and non Th2 type, bronchiectasis, as adjuvant in vaccination and in allergen immunotherapy still remains to clearly unveil. The aim of this paper was to provide a useful updated review of the role of the main available immunostimulants, giving particular focus on Pidotimod use and its potentials utility in respiratory diseases. Pidotimod showed its usefulness in reducing need for antibiotics in airway infections, increasing the level of immunoglobulins (IgA, IgM, IgG) and T-lymphocyte subsets (CD3+, CD4+) endowed with immunomodulatory activity that affect both innate and adaptive immune responses. Higher expression of TLR2 and of HLA-DR molecules, induction of dendritic cell maturation and release of pro-inflammatory molecules, stimulation of T lymphocyte proliferation and differentiation toward a Th1 phenotype, as well as an increase of the phagocytosis have been demonstrated to be associated with Pidotimod in in vitro studies. All these activities are potentially useful for several respiratory conditions such as asthma, COPD, and recurrent respiratory tract infections.
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Affiliation(s)
- Francesca Puggioni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
- Personalized Medicine, Allergy and Asthma - Humanitas Clinical and Research Center – IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy
| | - Magna Alves-Correia
- Personalized Medicine, Allergy and Asthma - Humanitas Clinical and Research Center – IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy
- Central Hospital of Funchal, SESARAM, EPE, Madeira, Portugal
| | - Manar-Farouk Mohamed
- Personalized Medicine, Allergy and Asthma - Humanitas Clinical and Research Center – IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy
- Ain Shams University, Faculty of Medicine, Cairo, Egypt
| | - Niccolò Stomeo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
| | - Riccardo Mager
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
| | | | - Francesca Racca
- Personalized Medicine, Allergy and Asthma - Humanitas Clinical and Research Center – IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy
| | - Giovanni Paoletti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
- Personalized Medicine, Allergy and Asthma - Humanitas Clinical and Research Center – IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy
| | - Gilda Varricchi
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Veronica Giorgis
- Personalized Medicine, Allergy and Asthma - Humanitas Clinical and Research Center – IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy
| | - Giovanni Melioli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
- Personalized Medicine, Allergy and Asthma - Humanitas Clinical and Research Center – IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
- Personalized Medicine, Allergy and Asthma - Humanitas Clinical and Research Center – IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI Italy
- Personalized Medicine, Allergy and Asthma - Humanitas Clinical and Research Center – IRCCS, Via Alessandro Manzoni 56, 20089 Rozzano, MI Italy
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950
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Nexus between Air Pollution and Neonatal Deaths: A Case of Asian Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214148. [PMID: 31661852 PMCID: PMC6861973 DOI: 10.3390/ijerph16214148] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/15/2019] [Accepted: 10/21/2019] [Indexed: 12/17/2022]
Abstract
The rapid economic growth in Asian countries has witnessed a persistent increase in air pollution complementing adverse health challenges for children in these countries. Quantification of health effects attributable to air pollution (PM2.5) is important in policy implications to tackle air pollution and associated health problems. This study aims to explore the nexus between air pollution and neonates’ deaths embedded in acute respiratory infection. We collected panel data from the 12 most vulnerable Asian countries over the period of 2000–2017 and analyzed through the fixed-effect model. Empirical results show a positive relation between air pollution, temperature, and neonates’ deaths in the studied Asian countries. The results have attested negative impacts of income and education while positive effect of population density on neonates’ deaths due to acute respiratory infection. Diagnostic and prognostic measures have checked the pace of the respiratory diseases caused by PM2.5 and resultant deaths in Asian countries; yet alarming factors, like mounting industrial air pollution and rapid expansion of industrial zones in urban areas, need to be addressed in policy implications for long term sustainable solutions.
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