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Damtie D, Gelaw A, Wondimeneh Y, Aleka Y, Tarekegn ZS, Sack U, Vlasova AN, Tessema B. Evaluation of the diagnostic performance of EpiTuub® Fecal Rotavirus Antigen Rapid Test Kit in Amhara National Regional State, Ethiopia: A multi-center cross-sectional study. PLoS One 2023; 18:e0295170. [PMID: 38033097 PMCID: PMC10688889 DOI: 10.1371/journal.pone.0295170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/16/2023] [Indexed: 12/02/2023] Open
Abstract
Rotavirus is the leading cause of morbidity and mortality due to acute gastroenteritis among children under five years globally. Early diagnosis of rotavirus infection minimizes its spread and helps to determine the appropriate management of diarrhea. The aim of this study was to evaluate the performance of EpiTuub® Fecal Rotavirus Antigen Rapid Test Kit for the diagnosis of rotavirus infection among diarrheic children under five years in Ethiopian healthcare settings. A total of 537 children with diarrhea were enrolled from three referral hospitals in Amhara National Regional State, Ethiopia. The samples were tested using one-step RT-PCR and EpiTuub® Fecal Rotavirus Antigen Rapid Test Kit (KTR-917, Epitope Diagnostics, San Diego USA) in parallel. Diagnostic performance of the rapid test kit was evaluated using the one-step RT-PCR as a gold standard. The sensitivity, specificity, and predictive values of the rapid test kit were determined. Moreover, the agreement of the rapid test kit with one step RT-PCR was determined by kappa statistics and receiver operators' curve (ROC) analysis was done to assess the overall diagnostic accuracy of the rapid test kit. Fecal Rotavirus Antigen Rapid Test Kit has shown a sensitivity of 75.5% and specificity of 98.2%. The kit was also found to have 89.9% and 95.0% positive and negative predictive values, respectively. The Fecal Rotavirus Antigen Rapid Test Kit has shown a substantial agreement (78.7%, p = 0.0001) with one-step RT-PCR. The overall accuracy of the Fecal Rotavirus Antigen Rapid Test Kit was excellent with the area under the ROC curve of 86.9% (95% CI = 81.6, 92.1%) (p = .0001). Thus, Fecal Rotavirus Antigen Rapid Test is a sensitive, specific, user-friendly, rapid, and equipment-free option to be used at points of care in Ethiopian health care settings where resource is limited precluding the use of one step RT-PCR. Furthermore, the kit could be used in the evaluation and monitoring of rotavirus vaccine effectiveness in the aforementioned settings.
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Affiliation(s)
- Debasu Damtie
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Ohio State University Global One Health Initiative LLC, Eastern Africa Regional Office, Addis Ababa, Ethiopia
| | - Aschalew Gelaw
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yitayih Wondimeneh
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yetemwork Aleka
- Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zewdu Siyoum Tarekegn
- Department of Veterinary Paraclinical Studies, College of Veterinary Medicine and Animal Sciences, University of Gondar, Gondar, Ethiopia
| | - Ulrich Sack
- Institute of Clinical Immunology, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Anastasia N. Vlasova
- Center for Food Animal Health, Department of Animal Sciences, College of Food Agricultural and Environmental Sciences, The Ohio State University, Wooster, OH, United States of America
- Department of Veterinary Preventive Medicine, The College of Veterinary Medicine, The Ohio State University, Wooster, OH, United States of America
| | - Belay Tessema
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Institute of Clinical Immunology, Faculty of Medicine, University of Leipzig, Leipzig, Germany
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Biswas S, Devi YD, Sarma D, Namsa ND, Nath P. Gold nanoparticle decorated blu-ray digital versatile disc as a highly reproducible surface-enhanced Raman scattering substrate for detection and analysis of rotavirus RNA in laboratory environment. JOURNAL OF BIOPHOTONICS 2022; 15:e202200138. [PMID: 36054627 DOI: 10.1002/jbio.202200138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
Detection and estimation of various biomolecular samples are often required in research and clinical laboratory applications. Present work demonstrates the functioning of a surface-enhanced Raman scattering (SERS) substrate that has been obtained by drop-casting of citrate-reduced gold nanoparticles (AuNPs) of average dimension of 23 nm on a bare blu-ray digital versatile disc (BR-DVD) substrate. The performance of the proposed SERS substrate has been initially evaluated with standard Raman active samples, namely malachite green (MG) and 1,2-bis(4-pyridyl)ethylene (BPE). The designed SERS substrate yields an average enhancement factor of 3.2 × 106 while maintaining reproducibility characteristics as good as 94% over the sensing region of the substrate. The usability of the designed SERS substrate has been demonstrated through the detection and analysis of purified rotavirus double-stranded RNA (dsRNA) samples in the laboratory environment condition. Rotavirus RNA concentrations as low as 10 ng/μL could be detected with the proposed sensing scheme.
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Affiliation(s)
- Sritam Biswas
- Applied Photonics and Nanophotonics Lab, Department of Physics, Tezpur University, Assam, India
| | | | - Dipjyoti Sarma
- Applied Photonics and Nanophotonics Lab, Department of Physics, Tezpur University, Assam, India
| | - Nima D Namsa
- Department of Molecular Biology and Biotechnology, Tezpur University, Napaam, Assam, India
| | - Pabitra Nath
- Applied Photonics and Nanophotonics Lab, Department of Physics, Tezpur University, Assam, India
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Recent Advances in Early Diagnosis of Viruses Associated with Gastroenteritis by Biosensors. BIOSENSORS 2022; 12:bios12070499. [PMID: 35884302 PMCID: PMC9313180 DOI: 10.3390/bios12070499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Abstract
Gastroenteritis, as one of the main worldwide health challenges, especially in children, leads to 3–6 million deaths annually and causes nearly 20% of the total deaths of children aged ˂5 years, of which ~1.5 million gastroenteritis deaths occur in developing nations. Viruses are the main causative agent (~70%) of gastroenteritis episodes and their specific and early diagnosis via laboratory assays is very helpful for having successful antiviral therapy and reduction in infection burden. Regarding this importance, the present literature is the first review of updated improvements in the employing of different types of biosensors such as electrochemical, optical, and piezoelectric for sensitive, simple, cheap, rapid, and specific diagnosis of human gastroenteritis viruses. The Introduction section is a general discussion about the importance of viral gastroenteritis, types of viruses that cause gastroenteritis, and reasons for the combination of conventional diagnostic tests with biosensors for fast detection of viruses associated with gastroenteritis. Following the current laboratory detection tests for human gastroenteritis viruses and their limitations (with subsections: Electron Microscope (EM), Cell Culture, Immunoassay, and Molecular Techniques), structural features and significant aspects of various biosensing methods are discussed in the Biosensor section. In the next sections, basic information on viruses causing gastroenteritis and recent developments for fabrication and testing of different biosensors for each virus detection are covered, and the prospect of future developments in designing different biosensing platforms for gastroenteritis virus detection is discussed in the Conclusion and Future Directions section as well.
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Hasan H, Nasirudeen NA, Ruzlan MAF, Mohd Jamil MA, Ismail NAS, Wahab AA, Ali A. Acute Infectious Gastroenteritis: The Causative Agents, Omics-Based Detection of Antigens and Novel Biomarkers. CHILDREN (BASEL, SWITZERLAND) 2021; 8:1112. [PMID: 34943308 PMCID: PMC8700514 DOI: 10.3390/children8121112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 12/25/2022]
Abstract
Acute infectious gastroenteritis (AGE) is among the leading causes of mortality in children less than 5 years of age worldwide. There are many causative agents that lead to this infection, with rotavirus being the commonest pathogen in the past decade. However, this trend is now being progressively replaced by another agent, which is the norovirus. Apart from the viruses, bacteria such as Salmonella and Escherichia coli and parasites such as Entamoeba histolytica also contribute to AGE. These agents can be recognised by their respective biological markers, which are mainly the specific antigens or genes to determine the causative pathogen. In conjunction to that, omics technologies are currently providing crucial insights into the diagnosis of acute infectious gastroenteritis at the molecular level. Recent advancement in omics technologies could be an important tool to further elucidate the potential causative agents for AGE. This review will explore the current available biomarkers and antigens available for the diagnosis and management of the different causative agents of AGE. Despite the high-priced multi-omics approaches, the idea for utilization of these technologies is to allow more robust discovery of novel antigens and biomarkers related to management AGE, which eventually can be developed using easier and cheaper detection methods for future clinical setting. Thus, prediction of prognosis, virulence and drug susceptibility for active infections can be obtained. Case management, risk prediction for hospital-acquired infections, outbreak detection, and antimicrobial accountability are aimed for further improvement by integrating these capabilities into a new clinical workflow.
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Affiliation(s)
- Haziqah Hasan
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (H.H.); (N.A.N.); (M.A.F.R.); (M.A.M.J.)
| | - Nor Ashika Nasirudeen
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (H.H.); (N.A.N.); (M.A.F.R.); (M.A.M.J.)
| | - Muhammad Alif Farhan Ruzlan
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (H.H.); (N.A.N.); (M.A.F.R.); (M.A.M.J.)
| | - Muhammad Aiman Mohd Jamil
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (H.H.); (N.A.N.); (M.A.F.R.); (M.A.M.J.)
| | - Noor Akmal Shareela Ismail
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia;
| | - Asrul Abdul Wahab
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia;
| | - Adli Ali
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur 56000, Malaysia; (H.H.); (N.A.N.); (M.A.F.R.); (M.A.M.J.)
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Ghapoutsa RN, Boda M, Gautam R, Ndze VN, Mugyia AE, Etoa FX, Bowen MD, Esona MD. Detection of diarrhoea associated rotavirus and co-infection with diarrhoeagenic pathogens in the Littoral region of Cameroon using ELISA, RT-PCR and Luminex xTAG GPP assays. BMC Infect Dis 2021; 21:614. [PMID: 34182936 PMCID: PMC8237514 DOI: 10.1186/s12879-021-06318-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/14/2021] [Indexed: 12/16/2022] Open
Abstract
Background Despite the global roll-out of rotavirus vaccines (RotaTeq/Rotarix / ROTAVAC/Rotasiil), mortality and morbidity due to group A rotavirus (RVA) remains high in sub-Saharan Africa, causing 104,000 deaths and 600,000 hospitalizations yearly. In Cameroon, Rotarix™ was introduced in March 2014, but, routine laboratory diagnosis of rotavirus infection is not yet a common practice, and vaccine effectiveness studies to determine the impact of vaccine introduction have not been done. Thus, studies examining RVA prevalence post vaccine introduction are needed. The study aim was to determine RVA prevalence in severe diarrhoea cases in Littoral region, Cameroon and investigate the role of other diarrheagenic pathogens in RVA-positive cases. Methods We carried out a study among hospitalized children < 5 years of age, presenting with acute gastroenteritis in selected hospitals of the Littoral region of Cameroon, from May 2015 to April 2016. Diarrheic stool samples and socio-demographic data including immunization and breastfeeding status were collected from these participating children. Samples were screened by ELISA (ProSpecT™ Rotavirus) for detection of RVA antigen and by gel-based RT-PCR for detection of the VP6 gene. Co-infection was assessed by multiplexed molecular detection of diarrheal pathogens using the Luminex xTAG GPP assay. Results The ELISA assay detected RVA antigen in 54.6% (71/130) of specimens, with 45, positive by VP6 RT-PCR and 54, positive using Luminex xTAG GPP. Luminex GPP was able to detect all 45 VP6 RT-PCR positive samples. Co-infections were found in 63.0% (34/54) of Luminex positive RVA infections, with Shigella (35.3%; 12/34) and ETEC (29.4%; 10/34) detected frequently. Of the 71 ELISA positive RVA cases, 57.8% (41/71) were fully vaccinated, receiving two doses of Rotarix. Conclusion This study provides insight on RVA prevalence in Cameroon, which could be useful for post-vaccine epidemiological studies, highlights higher than expected RVA prevalence in vaccinated children hospitalized for diarrhoea and provides the trend of RVA co-infection with other enteric pathogens. RVA genotyping is needed to determine circulating rotavirus genotypes in Cameroon, including those causing disease in vaccinated children.
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Affiliation(s)
- Rahinatou N Ghapoutsa
- Department of Biochemistry, Faculty of Science, The University of Yaoundé 1, Yaoundé, Cameroon
| | - Maurice Boda
- Department of Microbiology, Faculty of Science, The University of Yaoundé 1, Yaoundé, Cameroon.
| | - Rashi Gautam
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Diseases Control and Prevention, Atlanta, Georgia, USA
| | | | - Akongnwi E Mugyia
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
| | - Francois-Xavier Etoa
- Department of Microbiology, Faculty of Science, The University of Yaoundé 1, Yaoundé, Cameroon
| | - Michael D Bowen
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Diseases Control and Prevention, Atlanta, Georgia, USA
| | - Mathew D Esona
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Diseases Control and Prevention, Atlanta, Georgia, USA
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Manouana GP, Nguema-Moure PA, Mbong Ngwese M, Bock CT, Kremsner PG, Borrmann S, Eibach D, Mordmüller B, Velavan TP, Niendorf S, Adegnika AA. Genetic Diversity of Enteric Viruses in Children under Five Years Old in Gabon. Viruses 2021; 13:545. [PMID: 33805214 PMCID: PMC8064335 DOI: 10.3390/v13040545] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 12/17/2022] Open
Abstract
Enteric viruses are the leading cause of diarrhea in children globally. Identifying viral agents and understanding their genetic diversity could help to develop effective preventive measures. This study aimed to determine the detection rate and genetic diversity of four enteric viruses in Gabonese children aged below five years. Stool samples from children <5 years with (n = 177) and without (n = 67) diarrhea were collected from April 2018 to November 2019. Norovirus, astrovirus, sapovirus, and aichivirus A were identified using PCR techniques followed by sequencing and phylogenetic analyses. At least one viral agent was identified in 23.2% and 14.9% of the symptomatic and asymptomatic participants, respectively. Norovirus (14.7%) and astrovirus (7.3%) were the most prevalent in children with diarrhea, whereas in the healthy group norovirus (9%) followed by the first reported aichivirus A in Gabon (6%) were predominant. The predominant norovirus genogroup was GII, consisting mostly of genotype GII.P31-GII.4 Sydney. Phylogenetic analysis of the 3CD region of the aichivirus A genome revealed the presence of two genotypes (A and C) in the study cohort. Astrovirus and sapovirus showed a high diversity, with five different astrovirus genotypes and four sapovirus genotypes, respectively. Our findings give new insights into the circulation and genetic diversity of enteric viruses in Gabonese children.
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Affiliation(s)
- Gédéon Prince Manouana
- Institute of Tropical Medicine, Universitätsklinikum Tübingen, 72074 Tübingen, Germany; (G.P.M.); (P.A.N.-M.); (M.M.N.); (C.-T.B.); (P.G.K.); (S.B.); (T.P.V.); (A.A.A.)
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné BP 242, Gabon
| | - Paul Alvyn Nguema-Moure
- Institute of Tropical Medicine, Universitätsklinikum Tübingen, 72074 Tübingen, Germany; (G.P.M.); (P.A.N.-M.); (M.M.N.); (C.-T.B.); (P.G.K.); (S.B.); (T.P.V.); (A.A.A.)
| | - Mirabeau Mbong Ngwese
- Institute of Tropical Medicine, Universitätsklinikum Tübingen, 72074 Tübingen, Germany; (G.P.M.); (P.A.N.-M.); (M.M.N.); (C.-T.B.); (P.G.K.); (S.B.); (T.P.V.); (A.A.A.)
| | - C.-Thomas Bock
- Institute of Tropical Medicine, Universitätsklinikum Tübingen, 72074 Tübingen, Germany; (G.P.M.); (P.A.N.-M.); (M.M.N.); (C.-T.B.); (P.G.K.); (S.B.); (T.P.V.); (A.A.A.)
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany
| | - Peter G. Kremsner
- Institute of Tropical Medicine, Universitätsklinikum Tübingen, 72074 Tübingen, Germany; (G.P.M.); (P.A.N.-M.); (M.M.N.); (C.-T.B.); (P.G.K.); (S.B.); (T.P.V.); (A.A.A.)
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné BP 242, Gabon
- German Center for Infection Research (DZIF), 72074 Tübingen, Germany
| | - Steffen Borrmann
- Institute of Tropical Medicine, Universitätsklinikum Tübingen, 72074 Tübingen, Germany; (G.P.M.); (P.A.N.-M.); (M.M.N.); (C.-T.B.); (P.G.K.); (S.B.); (T.P.V.); (A.A.A.)
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné BP 242, Gabon
- German Center for Infection Research (DZIF), 72074 Tübingen, Germany
| | - Daniel Eibach
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany;
| | - Benjamin Mordmüller
- Department of Medical Microbiology, Radboudumc, 6524 GA Nijmegen, The Netherlands;
| | - Thirumalaisamy P. Velavan
- Institute of Tropical Medicine, Universitätsklinikum Tübingen, 72074 Tübingen, Germany; (G.P.M.); (P.A.N.-M.); (M.M.N.); (C.-T.B.); (P.G.K.); (S.B.); (T.P.V.); (A.A.A.)
- Vietnamese-German Center for Medical Research (VG-CARE), Hanoi 100000, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang 550000, Vietnam
| | - Sandra Niendorf
- Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany
| | - Ayola Akim Adegnika
- Institute of Tropical Medicine, Universitätsklinikum Tübingen, 72074 Tübingen, Germany; (G.P.M.); (P.A.N.-M.); (M.M.N.); (C.-T.B.); (P.G.K.); (S.B.); (T.P.V.); (A.A.A.)
- Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné BP 242, Gabon
- German Center for Infection Research (DZIF), 72074 Tübingen, Germany
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Keceli Basaran M, Dogan C, Bal M, Geylani Gulec S, Urganci N. Does Having Rotavirus Infection in Early Childhood Increase the Risk of Celiac Disease? J PEDIAT INF DIS-GER 2021. [DOI: 10.1055/s-0041-1726074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abstract
Objective With the increasing prevalence of celiac disease (CD) in the population, possible risk factors are under investigation. Environmental and genetic factors that trigger the immune response have been analyzed for many years. This study investigates the presence of CD in children with rotavirus infection. Rotavirus infection is thought to be a risk factor for CD.
Methods Included in the study were 105 of 160 pediatric patients hospitalized due to symptomatic rotavirus infection between 2012 and 2018. These children were screened for CD 45.6 ± 18.2 (14–90) months following the rotavirus infection diagnosed with CD as per ESPGHAN guidelines.
Results A total of 105 pediatric patients who had rotavirus gastroenteritis were included in the study. The age of the children with rotavirus infection was 3.98 ± 1 (2–6) months. In terms of CD, it was 45.6 ± 18.2 months. Around 14 to 90 months later, patients were called for control. CD developed in four (3.8%) of the children with rotavirus, whereas none of the children in the control group developed CD.
Conclusion Rotavirus infection may be a risk factor for CD through immune mechanisms. There are genetic and various environmental factors for the development of CD. Although the CD's occurrence on children who had rotavirus gastroenteritis in our study also supported this situation, there was no statistically significant difference.
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Affiliation(s)
- Meryem Keceli Basaran
- Division of Pediatric Gastroenterology, Department of Pediatrics, Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey
| | - Caner Dogan
- Department of Pediatrics, Gaziosmanpaşa and Research Hospital, Istanbul, Turkey
| | - Mahmut Bal
- Department of Pediatrics, Gaziosmanpaşa and Research Hospital, Istanbul, Turkey
| | - Seda Geylani Gulec
- Department of Pediatrics, Gaziosmanpaşa and Research Hospital, Istanbul, Turkey
| | - Nafiye Urganci
- Department of Pediatrics, Division of Pediatric Gastroenterology, Sariyer Etfal Education and Research Hospital, Istanbul, Turkey
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Celma CC, Beard S, Douglas A, Wong S, Osafo NK, Hannah M, Hale A, Huggins G, Ladhani S, Dunning J. Retrospective analysis on confirmation rates for referred positive rotavirus samples in England, 2016 to 2017: implications for diagnosis and surveillance. ACTA ACUST UNITED AC 2020; 25. [PMID: 33124554 PMCID: PMC7596921 DOI: 10.2807/1560-7917.es.2020.25.43.1900375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Rapid diagnostic tests are commonly used by hospital laboratories in England to detect rotavirus (RV), and results are used to inform clinical management and support national surveillance of the infant rotavirus immunisation programme since 2013. In 2017, the Public Health England (PHE) national reference laboratory for enteric viruses observed that the presence of RV could not be confirmed by PCR in a proportion of RV-positive samples referred for confirmatory detection. Aim We aimed to compare the positivity rate of detection methods used by hospital laboratories with the PHE confirmatory test rate. Methods Rotavirus specimens testing positive at local hospital laboratories were re-tested at the PHE national reference laboratory using a PCR test. Confirmatory results were compared to original results from the PHE laboratory information management system. Results Hospital laboratories screened 70.1% (2,608/3,721) of RV samples using immunochromatographic assay (IC) or rapid tests, 15.5% (578/3,721) using enzyme immunoassays (EIA) and 14.4% (535/3,721) using PCR. Overall, 1,011/3,721 (27.2%) locally RV-positive samples referred to PHE in 2016 and 2017 failed RV detection using the PHE reference laboratory PCR test. Confirmation rates were 66.9% (1,746/2,608) for the IC tests, 87.4% (505/578) for the EIA and 86.4% (465/535) for the PCR assays. Seasonal confirmation rate discrepancies were also evident for IC tests. Conclusions This report highlights high false positive rates with the most commonly used RV screening tests and emphasises the importance of implementing verified confirmatory tests for RV detections. This has implications for clinical diagnosis and national surveillance.
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Affiliation(s)
- Cristina C Celma
- These authors contributed equally to this work.,Enteric Virus Unit, National Infection Service Laboratories, Public Health England, London, United Kingdom
| | - Stuart Beard
- These authors contributed equally to this work.,Enteric Virus Unit, National Infection Service Laboratories, Public Health England, London, United Kingdom
| | - Amy Douglas
- Gastrointestinal Pathogens Unit, National Infection Service Laboratories, Public Health England, London, United Kingdom
| | - Shan Wong
- Enteric Virus Unit, National Infection Service Laboratories, Public Health England, London, United Kingdom
| | - Nana-Kwame Osafo
- Enteric Virus Unit, National Infection Service Laboratories, Public Health England, London, United Kingdom
| | - Matthew Hannah
- High Containment Microbiology, National Infection Service Laboratories, Public Health England, London, United Kingdom
| | - Ashleigh Hale
- Enteric Virus Unit, National Infection Service Laboratories, Public Health England, London, United Kingdom
| | - Gabrielle Huggins
- Enteric Virus Unit, National Infection Service Laboratories, Public Health England, London, United Kingdom
| | - Shamez Ladhani
- Immunisations and Countermeasures, National Infection Service, Public Health England, London, United Kingdom
| | - Jake Dunning
- Gastrointestinal Pathogens Unit, National Infection Service Laboratories, Public Health England, London, United Kingdom.,Enteric Virus Unit, National Infection Service Laboratories, Public Health England, London, United Kingdom
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Khagayi S, Omore R, Otieno GP, Ogwel B, Ochieng JB, Juma J, Apondi E, Bigogo G, Onyango C, Ngama M, Njeru R, Owor BE, Mwanga MJ, Addo Y, Tabu C, Amwayi A, Mwenda JM, Tate JE, Parashar UD, Breiman RF, Nokes DJ, Verani JR. Effectiveness of Monovalent Rotavirus Vaccine Against Hospitalization With Acute Rotavirus Gastroenteritis in Kenyan Children. Clin Infect Dis 2020; 70:2298-2305. [PMID: 31326980 PMCID: PMC7245145 DOI: 10.1093/cid/ciz664] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/17/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Rotavirus remains a leading cause of pediatric diarrheal illness and death worldwide. Data on rotavirus vaccine effectiveness in sub-Saharan Africa are limited. Kenya introduced monovalent rotavirus vaccine (RV1) in July 2014. We assessed RV1 effectiveness against rotavirus-associated hospitalization in Kenyan children. METHODS Between July 2014 and December 2017, we conducted surveillance for acute gastroenteritis (AGE) in 3 Kenyan hospitals. From children age-eligible for ≥1 RV1 dose, with stool tested for rotavirus and confirmed vaccination history we compared RV1 coverage among rotavirus positive (cases) vs rotavirus negative (controls) using multivariable logistic regression and calculated effectiveness based on adjusted odds ratio. RESULTS Among 677 eligible children, 110 (16%) were rotavirus positive. Vaccination data were available for 91 (83%) cases; 51 (56%) had 2 RV1 doses and 33 (36%) 0 doses. Among 567 controls, 418 (74%) had vaccination data; 308 (74%) had 2 doses and 69 (16%) 0 doses. Overall 2-dose effectiveness was 64% (95% confidence interval [CI], 35%-80%); effectiveness was 67% (95% CI, 30%-84%) for children aged <12 months and 72% (95% CI, 10%-91%) for children aged ≥12 months. Significant effectiveness was seen in children with normal weight for age, length/height for age and weight for length/height; however, no protection was found among underweight, stunted, or wasted children. CONCLUSIONS RV1 in the Kenyan immunization program provides significant protection against rotavirus-associated hospitalization which persisted beyond infancy. Malnutrition appears to diminish vaccine effectiveness. Efforts to improve rotavirus uptake and nutritional status are important to maximize vaccine benefit.
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Affiliation(s)
- Sammy Khagayi
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu
| | - Richard Omore
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu
| | - Grieven P Otieno
- Centre for Geographic Medicine Research–Coast, KEMRI–Wellcome Trust Research Programme, Kilifi, and
| | - Billy Ogwel
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu
| | - John B Ochieng
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu
| | - Jane Juma
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu
| | - Evans Apondi
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu
| | - Godfrey Bigogo
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu
| | - Clayton Onyango
- Division of Global Health Protection, Centers for Disease Control and Prevention (CDC)–Kenya, Kisumu, Kenya
| | - Mwanajuma Ngama
- Centre for Geographic Medicine Research–Coast, KEMRI–Wellcome Trust Research Programme, Kilifi, and
| | - Regina Njeru
- Centre for Geographic Medicine Research–Coast, KEMRI–Wellcome Trust Research Programme, Kilifi, and
| | - Betty E Owor
- Centre for Geographic Medicine Research–Coast, KEMRI–Wellcome Trust Research Programme, Kilifi, and
| | - Mike J Mwanga
- Centre for Geographic Medicine Research–Coast, KEMRI–Wellcome Trust Research Programme, Kilifi, and
| | - Yaw Addo
- Emory Global Health Institute, Emory University, Atlanta, Georgia
| | - Collins Tabu
- National Vaccines and Immunisations Programme, and
| | - Anyangu Amwayi
- Disease Surveillance and Response Unit, Ministry of Health, Nairobi, Kenya
| | - Jason M Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Jacqueline E Tate
- Viral Gastroenteritis Branch, Division of Viral Diseases, CDC, Atlanta, Georgia
| | - Umesh D Parashar
- Viral Gastroenteritis Branch, Division of Viral Diseases, CDC, Atlanta, Georgia
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia
| | - D James Nokes
- Centre for Geographic Medicine Research–Coast, KEMRI–Wellcome Trust Research Programme, Kilifi, and
- School of Life Sciences, and Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, University of Warwick, Coventry, United Kingdom
| | - Jennifer R Verani
- Division of Global Health Protection, CDC–Kenya, Nairobi, Kenya; and
- Division of Global Health Protection, CDC, Atlanta, Georgia
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10
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Mitra S, Nayak MK, Majumdar A, Sinha A, Chatterjee S, Deb A, Chawla-Sarkar M, Dutta S. Development and evaluation of a multiplex conventional reverse-transcription polymerase chain reaction assay for detection of common viral pathogens causing acute gastroenteritis. Diagn Microbiol Infect Dis 2020; 97:115061. [PMID: 32585545 DOI: 10.1016/j.diagmicrobio.2020.115061] [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: 01/13/2020] [Revised: 03/27/2020] [Accepted: 04/12/2020] [Indexed: 12/11/2022]
Abstract
Timely identification of etiological agents of enteric infections is necessary to reduce the burden of infantile diarrheal mortality. Nucleic acid amplification-based detection methods offer a quick, reliable way for diagnosis of microbes in clinical specimens. This study was undertaken to evaluate an easy-to-use, cost-effective multiplex conventional reverse-transcription polymerase chain reaction (RT-PCR) assay developed at the Indian Council of Medical Research-National Institute of Cholera and Enteric Diseases virology laboratory to identify 4 common enteric viruses (rotavirus, norovirus, adenovirus, astrovirus) in stool samples from patients who were being evaluated for acute diarrhea. On comparison with a commercially available real-time PCR method, significant agreement in sensitivity and specificity was observed. Though the turnaround time for RT-PCR was 6-8 h compared to 5-6 h for real-time PCR, the real-time PCR has high test cost (approximately 28 USD/2000 INR) for Fast-Track Diagnostics kit-based quantitative RT-PCR versus 6 USD or 400 INR for conventional multiplex RT-PCR/sample. Thus, the conventional RT-PCR method is expected to be adaptable at local hospitals and health cares in resource-poor settings.
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Affiliation(s)
- Suvrotoa Mitra
- Division of Virology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, WB, India
| | | | - Agniva Majumdar
- Regional Virus Research and Diagnostic Lab (VRDL), ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, WB, India
| | - Avisek Sinha
- Division of Virology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, WB, India
| | - Soumyadipta Chatterjee
- Division of Virology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, WB, India
| | - Alok Deb
- Division of Epidemiology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, WB, India
| | - Mamta Chawla-Sarkar
- Division of Virology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, WB, India.
| | - Shanta Dutta
- Regional Virus Research and Diagnostic Lab (VRDL), ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, WB, India
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11
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Msolo L, Iweriebor BC, Okoh AI. Rotavirus and Cryptosporidium pathogens as etiological proxies of gastroenteritis in some pastoral communities of the Amathole District Municipality, Eastern Cape, South Africa. BMC Res Notes 2020; 13:187. [PMID: 32228662 PMCID: PMC7106725 DOI: 10.1186/s13104-020-05024-2] [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: 11/13/2019] [Accepted: 03/17/2020] [Indexed: 01/04/2023] Open
Abstract
Objective Cryptosporidium and Rotavirus agents have been associated with severe diarrheal illnesses and remain as one of the worst human health burdens in most developing regions. In the present study, we evaluated the incidences of Cryptosporidium and Rotavirus in diarrheal stool specimens of patients in some rural settlements of the Amathole District Municipality in the Eastern Cape Province, South Africa. Stool specimens from diarrheal children and elderly individuals were collected from clinics and hospitals within the rural communities of the region over a period of 21 months (February 2017–November 2018). Commercial enzyme-immuno-assays were used for the detection of Rotavirus and Cryptosporidium pathogens from processed diarrheal stool specimens. Results A total of 53 fresh stool samples from diarrheal patients were screened and 36% of the diarrheagenic stool specimens tested positive for Group A Rotavirus antigens, while 5.7% tested positive for Cryptosporidium antigens. Our findings reveal Rotavirus and Cryptosporidium pathogens as important etiological agents associated with diarrheal illnesses in children, among the rural hinterlands of the Amathole District Municipality.
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Affiliation(s)
- Luyanda Msolo
- SA-MRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Private Bag X1314, Alice, 5700, Eastern Cape, South Africa. .,Applied and Environmental Microbiology Research Group, Department of Biochemistry and Microbiology, University of Fort Hare, Alice, 5700, Eastern Cape, South Africa.
| | - Benson C Iweriebor
- Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, Gauteng, South Africa
| | - Anthony I Okoh
- SA-MRC Microbial Water Quality Monitoring Centre, University of Fort Hare, Private Bag X1314, Alice, 5700, Eastern Cape, South Africa.,Applied and Environmental Microbiology Research Group, Department of Biochemistry and Microbiology, University of Fort Hare, Alice, 5700, Eastern Cape, South Africa
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12
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Pérez-Ortín R, Santiso-Bellón C, Vila-Vicent S, Carmona-Vicente N, Rodríguez-Díaz J, Buesa J. Rotavirus symptomatic infection among unvaccinated and vaccinated children in Valencia, Spain. BMC Infect Dis 2019; 19:998. [PMID: 31771522 PMCID: PMC6880582 DOI: 10.1186/s12879-019-4550-x] [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: 12/18/2018] [Accepted: 10/03/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Human group A rotavirus is the leading cause of severe acute gastroenteritis in young children worldwide. Immunization programs have reduced the disease burden in many countries. Vaccination coverage in the Autonomous Region of Valencia, Spain, is around 40%, as the rotavirus vaccine is not funded by the National Health System. Despite this low-medium vaccine coverage, rotavirus vaccination has substantially reduced hospitalizations due to rotavirus infection and hospital-related costs. However, there are very few studies evaluating symptomatic rotavirus infections not requiring hospitalization in vaccinated children. The objective of this study was to investigate symptomatic rotavirus infections among vaccinated children in the health area served by the Hospital Clínico Universitario of Valencia, Spain, from 2013 to 2015. METHODS A total of 133 children younger than 5 years of age with rotavirus infection were studied. Demographic and epidemiological data were collected and informed consent from their caretakers obtained. Rotavirus infection was detected by immunological methods and G/P rotavirus genotypes were determined by RT-PCR, following standard procedures from the EuroRotaNet network. RESULTS Forty infants (30.1%; 95% CI: 22.3-37.9) out of 133 were diagnosed with symptomatic rotavirus infection despite having been previously vaccinated, either with RotaTeq (85%) or with Rotarix (15%). Children fully vaccinated against rotavirus (24.8%), partially vaccinated (5.3%) and unvaccinated (69.9%) were found. The infecting genotypes showed high G-type diversity, although no significant differences were found between the G/P genotypes infecting vaccinated and unvaccinated children during the same time period. G9P[8], G12P[8] and G1P[8] were the most prevalent genotypes. Severity of gastroenteritis symptoms required 28 (66.6%) vaccinated and 67 (73.6%) unvaccinated children to be attended at the Emergency Room. CONCLUSION Rotavirus vaccine efficacy in reducing the incidence of severe rotavirus infection has been well documented, but symptomatic rotavirus infection can sometimes occur in vaccinees.
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Affiliation(s)
- Raúl Pérez-Ortín
- Department of Microbiology, School of Medicine, University of Valencia and Microbiology Service, Hospital Clínico Universitario and Instituto de Investigación INCLIVA, Avda. Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Cristina Santiso-Bellón
- Department of Microbiology, School of Medicine, University of Valencia and Microbiology Service, Hospital Clínico Universitario and Instituto de Investigación INCLIVA, Avda. Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Susana Vila-Vicent
- Department of Microbiology, School of Medicine, University of Valencia and Microbiology Service, Hospital Clínico Universitario and Instituto de Investigación INCLIVA, Avda. Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Noelia Carmona-Vicente
- Department of Microbiology, School of Medicine, University of Valencia and Microbiology Service, Hospital Clínico Universitario and Instituto de Investigación INCLIVA, Avda. Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Jesús Rodríguez-Díaz
- Department of Microbiology, School of Medicine, University of Valencia and Microbiology Service, Hospital Clínico Universitario and Instituto de Investigación INCLIVA, Avda. Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Javier Buesa
- Department of Microbiology, School of Medicine, University of Valencia and Microbiology Service, Hospital Clínico Universitario and Instituto de Investigación INCLIVA, Avda. Blasco Ibañez, 17, 46010, Valencia, Spain.
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13
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Philip CO, Koech M, Kipkemoi N, Kirera R, Ndonye J, Ombogo A, Kirui M, Kipkirui E, Danboise B, Hulseberg C, Bateman S, Flynn A, Swierczewski B, Magiri E, Odundo E. Evaluation of the performance of a multiplex reverse transcription polymerase chain reaction kit as a potential diagnostic and surveillance kit for rotavirus in Kenya. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2019; 5:12. [PMID: 31346474 PMCID: PMC6631878 DOI: 10.1186/s40794-019-0087-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/21/2019] [Indexed: 12/12/2022]
Abstract
Background Diarrhea is a serious concern worldwide, especially in developing countries. Rotavirus is implicated in approximately 400,000 infant deaths annually. It is highly contagious elevating the risk of outbreaks especially in enclosed settings such as daycare centers, hospitals, and boarding schools. Reliable testing methods are critical for early detection of infections, better clinical management, pathogen surveillance and evaluation of interventions such as vaccines. Enzyme immunoassays have proved to be reliable and practical in most settings; however, newer multiplex reverse transcription polymerase assays have been introduced in the Kenya market but have not been evaluated locally. Methods Stool samples collected from an ongoing Surveillance of Enteric Pathogens Causing diarrheal illness in Kenya (EPS) study were used to compare an established enzyme immunoassay, Premier™ Rotaclone® (Meridian Bioscience, Cincinnati, Ohio, U.S.A.), that can only detect group A rotavirus against a novel multiplex reverse transcription polymerase chain reaction kit, Seeplex® Diarrhea-V ACE Detection (Seegene, Seoul, Republic of Korea), that can detect rotavirus, astrovirus, adenovirus, and norovirus genogroups I and II. Detection frequency, sensitivity, specificity, turnaround time, and cost were compared to determine the suitability of each assay for clinical work in austere settings versus public health work in well-funded institutes in Kenya. Results The Premier™ Rotaclone® kit had a detection frequency of 11.2%, sensitivity of 77.8%, specificity of 100%, turnaround time of 93 min and an average cost per sample of 13.33 United States dollars (USD). The Seeplex® Diarrhea-V ACE Detection kit had a detection frequency of 16.0%, sensitivity of 100%, specificity of 98.1%, turnaround time of 359 min and an average cost per samples 32.74 United States dollars respectively. The detection frequency sensitivity and specificity of the Seeplex® Diarrhea-V ACE Detection kit mentioned above are for rotavirus only. Conclusions The higher sensitivity and multiplex nature of the Seeplex® Diarrhea-V ACE Detection kit make it suitable for surveillance of enteric viruses circulating in Kenya. However, its higher cost, longer turnaround time and complexity favor well-resourced clinical labs and research applications. The Premier™ Rotaclone®, on the other hand, had a higher specificity, shorter turnaround time, and lower cost making it more attractive for clinical work in low complexity labs in austere regions of the country. It is important to continuously evaluate assay platforms' performance, operational cost, turnaround time, and usability in different settings so as to ensure quality results that are useful to the patients and public health practitioners.
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Affiliation(s)
| | - Margaret Koech
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Nancy Kipkemoi
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Ronald Kirera
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Janet Ndonye
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Abigael Ombogo
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Mary Kirui
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Erick Kipkirui
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | | | - Christine Hulseberg
- 3Center for Genome Sciences, US Army Medical Research Institute of Infectious Diseases, Frederick, Maryland USA
| | | | - Alexander Flynn
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | | | - Esther Magiri
- 6Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | - Elizabeth Odundo
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
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14
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Arowolo KO, Ayolabi CI, Lapinski B, Santos JS, Raboni SM. Epidemiology of enteric viruses in children with gastroenteritis in Ogun State, Nigeria. J Med Virol 2019; 91:1022-1029. [PMID: 30636345 DOI: 10.1002/jmv.25399] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/17/2018] [Accepted: 01/07/2019] [Indexed: 12/31/2022]
Abstract
Acute gastroenteritis (AGE) remains a global public health concern and Nigeria is one of the two countries accounting for 42% of global under-5 deaths attributable to gastroenteritis. This study aimed to determine the prevalence, seasonality, and risk factors of enteric viruses (EVs) in children with AGE in Ogun State, Nigeria. Stool samples collected from children under-5 from three different hospitals between February 2015 and April 2017 were analyzed using molecular methods for the presence of four EVs (group A rotavirus [RVA], norovirus [NoV], human astrovirus [HAstV], and human adenovirus [HAdV]). Among the 175 samples analyzed, 63 (36%) were positive for at least one EV. The most prevalent was HAstV (19.4%), followed by RVA (16.6%), NoV (5.1%), and HAdV (5.1%). Mixed infections were found in 17 cases. No significant association was observed with age, sex, and risk factors. Though not significant, EV prevalence was higher in the dry season. Positive cases (asides HAdV) had no correlation with temperature and/or humidity. This study provides information on the prevalence and seasonal fluctuations of EVs, which will be of value in the effective management of patients and control strategies for viral gastroenteritis in the country.
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Affiliation(s)
- Kafayat Olushola Arowolo
- Department of Microbiology, University of Lagos, Lagos, Nigeria.,Virology Laboratory, Infectious Diseases Division, Hospital de Clinicas, Universidade Federal do Parana, Curitiba, Brazil.,Department of Biological Sciences, Lagos State Polytechnic, Lagos, Nigeria
| | | | - Bruna Lapinski
- Virology Laboratory, Infectious Diseases Division, Hospital de Clinicas, Universidade Federal do Parana, Curitiba, Brazil
| | - Jucielia Stadinicki Santos
- Virology Laboratory, Infectious Diseases Division, Hospital de Clinicas, Universidade Federal do Parana, Curitiba, Brazil
| | - Sonia Mara Raboni
- Virology Laboratory, Infectious Diseases Division, Hospital de Clinicas, Universidade Federal do Parana, Curitiba, Brazil
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15
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Hwang NR, Kim JK. Relationship between asymptomatic rotavirus infection and jaundice in neonates: a retrospective study. BMC Pediatr 2018; 18:376. [PMID: 30501619 PMCID: PMC6267884 DOI: 10.1186/s12887-018-1352-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 11/19/2018] [Indexed: 12/05/2022] Open
Abstract
Background Rotavirus (RV) infection in neonates can be mild or even asymptomatic. In RV infection, jaundice is often reported, but the relationship between jaundice and RV infection has not been studied. This study aimed to determine the importance of asymptomatic RV screening in neonates with jaundice. Methods Neonates from the neonatal intensive care unit (NICU) of Chonbuk National University Hospital, those transferred from local obstetrics and gynecology hospitals and outpatient clinics were selected from 2014 to 2017. The study included only infants aged between 3 and 28 days. Jaundice was defined according to gestational age and birth age, in accordance with the American Academy of Pediatrics guidelines criteria. RV infection was confirmed by a stool test, and RV screening and laboratory tests were performed at admission. Results Among 596 patients, 166 patients had jaundice. RV infection was observed in 70 (42%) jaundice patients. There were 36 (22%) jaundice patients with asymptomatic RV infection. Patients with onset of jaundice 3–7 days after birth had a high incidence of RV infection. When the RV test was positive, the risk of jaundice was significantly high [odds ratio (OR) 1.89; 95% confidence interval (CI), 1.20–2.98; p = 0.006]. Conclusions Infants with the onset of jaundice > 3 days after birth were likely to have RV infection. Therefore, we suggest that screening tests for RV infection be included as part of the evaluation of jaundiced infants presenting to NICU. Electronic supplementary material The online version of this article (10.1186/s12887-018-1352-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nu Ri Hwang
- Department of Pediatrics, Chonbuk National University Medical School, 20, Geonjiro Deokjin-gu, Jeonju-si, Jeollabuk-do, 54907, South Korea
| | - Jin Kyu Kim
- Department of Pediatrics, Chonbuk National University Medical School, 20, Geonjiro Deokjin-gu, Jeonju-si, Jeollabuk-do, 54907, South Korea. .,Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.
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16
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Kim JS, Lee SK, Ko DH, Hyun J, Kim HS. Performance Evaluation of the Automated Fluorescent Immunoassay System Rotavirus Assay in Clinical Samples. Ann Lab Med 2018; 39:50-57. [PMID: 30215230 PMCID: PMC6143470 DOI: 10.3343/alm.2019.39.1.50] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 04/05/2018] [Accepted: 08/16/2018] [Indexed: 11/19/2022] Open
Abstract
Background The Automated Fluorescent Immunoassay System (AFIAS) rotavirus assay (Boditech Med Inc., Chuncheon, Korea) is a new rapid antigen test for rotavirus detection. We evaluated the performance of this assay for detecting rotaviruses and their specific genotypes in clinical stool samples. Methods AFIAS rotavirus assay was performed in 103 rotavirus-positive and 103 rotavirus-negative stool samples (confirmed by both PCR and ELISA), and its results were compared with those of PCR, ELISA, and immunochromatographic assay (ICA). We evaluated diagnostic sensitivity/specificity, the detectability of rotavirus subtypes, lower limit of detection (LLOD), reproducibility, cross-reactivity, and interference of AFIAS rotavirus assay. Results Based on PCR and ELISA results, diagnostic sensitivity and specificity of the AFIAS rotavirus assay were both 99.0%. LLOD results showed that the AFIAS assay had sensitivity similar to or greater than ICA and ELISA. High reproducibility was confirmed, and no cross-reactivity or interference was detected. This assay could detect genotypes G1P[8], G2P[4], G3P[8], G4P[6], G4P[8], G8P[4], G8P[8], G9P[4], and G9P[8]. Conclusions The AFIAS rotavirus assay showed high reproducibility, sensitivity, and specificity as well as excellent agreement with ELISA, PCR, and ICA. It detected the most common as well as unusual genotypes of rotavirus prevalent in Korea. It could be a useful on-site assay for rapid, convenient, and cost-effective detection of rotavirus infection.
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Affiliation(s)
- Jae Seok Kim
- Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Su Kyung Lee
- Department of Laboratory Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Dae Hyun Ko
- Department of Laboratory Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Jungwon Hyun
- Department of Laboratory Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Hyun Soo Kim
- Department of Laboratory Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
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17
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Knee J, Sumner T, Adriano Z, Berendes D, de Bruijn E, Schmidt WP, Nalá R, Cumming O, Brown J. Risk factors for childhood enteric infection in urban Maputo, Mozambique: A cross-sectional study. PLoS Negl Trop Dis 2018; 12:e0006956. [PMID: 30419034 PMCID: PMC6258421 DOI: 10.1371/journal.pntd.0006956] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/26/2018] [Accepted: 10/29/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Enteric infections are common where public health infrastructure is lacking. This study assesses risk factors for a range of enteric infections among children living in low-income, unplanned communities of urban Maputo, Mozambique. METHODS & FINDINGS We conducted a cross-sectional survey in 17 neighborhoods of Maputo to assess the prevalence of reported diarrheal illness and laboratory-confirmed enteric infections in children. We collected stool from children aged 1-48 months, independent of reported symptoms, for molecular detection of 15 common enteric pathogens by multiplex RT-PCR. We also collected survey and observational data related to water, sanitation, and hygiene (WASH) characteristics; other environmental factors; and social, economic, and demographic covariates. We analyzed stool from 759 children living in 425 household clusters (compounds) representing a range of environmental conditions. We detected ≥1 enteric pathogens in stool from most children (86%, 95% confidence interval (CI): 84-89%) though diarrheal symptoms were only reported for 16% (95% CI: 13-19%) of children with enteric infections and 13% (95% CI: 11-15%) of all children. Prevalence of any enteric infection was positively associated with age and ranged from 71% (95% CI: 64-77%) in children 1-11 months to 96% (95% CI: 93-98%) in children 24-48 months. We found poor sanitary conditions, such as presence of feces or soiled diapers around the compound, to be associated with higher risk of protozoan infections. Certain latrine features, including drop-hole covers and latrine walls, and presence of a water tap on the compound grounds were associated with a lower risk of bacterial and protozoan infections. Any breastfeeding was also associated with reduced risk of infection. CONCLUSIONS We found a high prevalence of enteric infections, primarily among children without diarrhea, and weak associations between bacterial and protozoan infections and environmental risk factors including WASH. Findings suggest that environmental health interventions to limit infections would need to be transformative given the high prevalence of enteric pathogen shedding and poor sanitary conditions observed. TRIAL REGISTRATION ClinicalTrials.gov NCT02362932.
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Affiliation(s)
- Jackie Knee
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Trent Sumner
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Zaida Adriano
- We Consult, Maputo, Mozambique
- Departamento de Geografia, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - David Berendes
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Wolf-Peter Schmidt
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rassul Nalá
- Ministério da Saúde, Instituto Nacional de Saúde Maputo, Maputo, Republic of Mozambique
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Joe Brown
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
- * E-mail:
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Muendo C, Laving A, Kumar R, Osano B, Egondi T, Njuguna P. Prevalence of rotavirus infection among children with acute diarrhoea after rotavirus vaccine introduction in Kenya, a hospital cross-sectional study. BMC Pediatr 2018; 18:323. [PMID: 30309343 PMCID: PMC6180366 DOI: 10.1186/s12887-018-1291-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rotavirus infection is the most common cause of acute gastroenteritis globally in children under 5 years of age and is responsible for approximately 5% of all child deaths yearly. Rotavirus vaccination is considered an effective public health strategy to prevent infection and reduce the severity of disease. Multi-centre country trials on rotavirus vaccines demonstrated efficacy rates of more than 85% in developed countries but only about 65% in developing nations. Rotavirus vaccination was introduced into the Kenya Expanded Programme on Immunization (KEPI) in 2014. The objective of our study was to determine the prevalence of rotavirus infection, severity of acute diarrhoea and to determine the rotavirus vaccination status among children aged 3-24 months presenting with acute diarrhoea at Kenyatta National Hospital after introduction of rotavirus vaccine in Kenya. METHODS A total of 365 children aged 3-24 months presenting with acute diarrhoea at KNH were recruited from August 2016 to April 2017. Data on rotavirus vaccination status, nutritional status, feeding practices and sociodemographic characteristics were obtained and a full clinical evaluation of the patients was done. Severity of the gastroenteritis was assessed using the 20 point Vesikari Clinical Severity Scoring System. The children who were admitted were followed up for 7 days using hospital ward registers. Comorbid conditions were established from patient's clinical records and physical examination. Stool specimens from study participants were tested for rotavirus using a commercially available enzyme linked immunosorbent immunoassay kit- ProSpecT Rotavirus Microplate Assay. RESULTS Majority of the children (96.7%) had received rotavirus vaccinations. The overall rotavirus prevalence was 14.5% and was higher among 17-24 months at 19.5%. The prevalence somewhat differed by gender, nutritional status, exclusive breastfeeding status, age and education level of mother/caregiver. Overall, a half of the children had severe acute diarrhoea and there were some differences in severity by child/mother characteristics. CONCLUSION There is still burden of rotavirus diarrhoea after introduction of rotavirus vaccine and the prevalence varies by child characteristics.
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Affiliation(s)
| | - Ahmed Laving
- Department of Paediatrics and Child Health, University of Nairobi, P.O. Box 19676–00202, Nairobi, Kenya
| | - Rashmi Kumar
- Department of Paediatrics and Child Health, University of Nairobi, P.O. Box 19676–00202, Nairobi, Kenya
| | - Boniface Osano
- Department of Paediatrics and Child Health, University of Nairobi, P.O. Box 19676–00202, Nairobi, Kenya
| | - Thaddaeus Egondi
- Drugs for Neglected Diseases initiative, P.O. Box 21936–00505, Nairobi, Kenya
| | - Pamela Njuguna
- Public Health Specialist, Afya Resource Associates, P. O. Box 238–00202, Nairobi, Kenya
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Seid L, Stokes W, Bayih AG, Getie S, Abere A, Tesfa H, Pillai DR. Molecular detection of Enteropathogens from diarrheic stool of HIV positive patients in Gondar, Ethiopia. BMC Infect Dis 2018; 18:354. [PMID: 30064366 PMCID: PMC6069753 DOI: 10.1186/s12879-018-3265-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 07/23/2018] [Indexed: 01/25/2023] Open
Abstract
Background Infectious diarrhea is a common problem in the developing world, especially among people living with HIV/AIDS. Traditional diagnostic methods such as stool culture and microscopic examination are limited by resources and poor sensitivity. The use of molecular diagnostics for enteropathogen detection in this region of sub-Saharan Africa has not been fully explored. We sought to identify risk factors and characterize enteropathogens from diarrheic stools of HIV-positive patients in Gondar, Ethiopia using multiplex molecular panels targeting key infectious agents. Methods A cross-sectional study of 100 stool samples was performed. Samples were collected consecutively from HIV- positive patients presenting with diarrhea at University of Gondar Hospital clinic, a major center in NW Ethiopia. Genomic DNA was extracted from stool and processed using a multiplex molecular panel Allplex™ [Seegene, Canada]. Correlations between patient characteristics, symptoms, public health risk factors, and enteropathogen type (s) were studied. Eighty-six samples were successfully analyzed by molecular methods. Results The mean age was 35 with 43% male. Eighty percent lived in an urban area, 18% had access to well water only, and 81% practiced proper hand hygiene. The majority of patients (72%) were receiving HAART with a median CD4 cell count of 362/μL. Multiple pathogens were detected in 94% of specimens, with an average of 5 enteropathogens per sample. Common bacteria, viruses, and parasites detected were Shigella spp./enteroinvasive E. coli (80%), enterotoxigenic E. coli (73%), Norovirus (16%) and B. hominis (62%). CD4 cell count < 500/ μL was associated with the presence of viruses (p = 0.004) and the absence of STEC (p = 0.010). The use of HAART or CD4 levels was not associated with the number of enteropathogens detected. Conclusions Diarrheic stool from HIV-positive outpatients in Gondar, Ethiopia had on average 5 enteropathogens present in their stool. Shigellaspp./enteroinvasive E. coli and enterotoxigenic E. coli are the major pathogens, not dissimilar to immunocompetent individuals in low income countries.
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Affiliation(s)
- Lubaba Seid
- Department of Medical Parasitology; School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - William Stokes
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Abebe Genetu Bayih
- Department of Medical Parasitology; School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sisay Getie
- Department of Medical Parasitology; School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Aberham Abere
- Department of Medical Parasitology; School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habtie Tesfa
- Department of Medical Parasitology; School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dylan R Pillai
- Department of Medical Parasitology; School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. .,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada. .,Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada. .,Departments of Pathology, Medicine, and MIID, University of Calgary, 9-3535 Research Road NW, Calgary, AB, 1W-416 T2L2K8, Canada.
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Bentes GA, Guimarães JR, Volotão EDM, Fialho AM, Hooper C, Ganime AC, Gardinali NR, Lanzarini NM, da Silva ADS, Pitcovski J, Leite JP, Pinto MA. Cynomolgus Monkeys ( Macaca fascicularis) as an Experimental Infection Model for Human Group A Rotavirus. Viruses 2018; 10:v10070355. [PMID: 29973483 PMCID: PMC6071073 DOI: 10.3390/v10070355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/23/2018] [Accepted: 04/27/2018] [Indexed: 12/25/2022] Open
Abstract
Group A rotaviruses (RVA) are one of the most common causes of severe acute gastroenteritis in infants worldwide. Rotaviruses spread from person to person, mainly by faecal–oral transmission. Almost all unvaccinated children may become infected with RVA in the first two years of life. The establishment of an experimental monkey model with RVA is important to evaluate new therapeutic approaches. In this study, we demonstrated viral shedding and viraemia in juvenile–adult Macaca fascicularis orally inoculated with Wa RVA prototype. Nine monkeys were inoculated orally: seven animals with human RVA and two control animals with saline solution. During the study, the monkeys were clinically monitored, and faeces and blood samples were tested for RVA infection. In general, the inoculated animals developed an oligosymptomatic infection pattern. The main clinical symptoms observed were diarrhoea in two monkeys for three days, associated with a reduction in plasmatic potassium content. Viral RNA was detected in seven faecal and five sera samples from inoculated animals, suggesting virus replication. Cynomolgus monkeys are susceptible hosts for human Wa RVA infection. When inoculated orally, they presented self-limited diarrhoea associated with presence of RVA infectious particles in faeces. Thus, cynomolgus monkeys may be useful as animal models to evaluate the efficacy of new antiviral approaches.
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Affiliation(s)
- Gentil Arthur Bentes
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro/RJ 21.040-360, Brazil.
| | - Juliana Rodrigues Guimarães
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro/RJ 21.040-360, Brazil.
| | - Eduardo de Mello Volotão
- Laboratório de Virologia Comparada e Ambiental, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro/RJ 21.040-360, Brazil.
| | - Alexandre Madi Fialho
- Laboratório de Virologia Comparada e Ambiental, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro/RJ 21.040-360, Brazil.
| | - Cleber Hooper
- Serviço de Controle da Qualidade Animal, Instituto de Ciência e Tecnologia em Biomodelos, Fiocruz, Rio de Janeiro/RJ 21.040-360, Brazil.
| | - Ana Carolina Ganime
- Laboratório de Virologia Comparada e Ambiental, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro/RJ 21.040-360, Brazil.
| | - Noemi Rovaris Gardinali
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro/RJ 21.040-360, Brazil.
| | - Natália Maria Lanzarini
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro/RJ 21.040-360, Brazil.
| | - Alexandre Dos Santos da Silva
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro/RJ 21.040-360, Brazil.
| | - Jacob Pitcovski
- Virology and Vaccine Development Laboratory, MIGAL Technology Center, Kiryat Shmona 11016, Israel.
| | - José Paulo Leite
- Laboratório de Virologia Comparada e Ambiental, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro/RJ 21.040-360, Brazil.
| | - Marcelo Alves Pinto
- Laboratório de Desenvolvimento Tecnológico em Virologia, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro/RJ 21.040-360, Brazil.
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Samdan A, Ganbold S, Guntev O, Orosoo S, Javzandorj N, Gongor A, Enkhtuvshin A, Demberelsuren S, Abdul W, Jee Y, Grabovac V, Kirkwood C, Fox K, Nyambat B. Hospital-based surveillance for rotavirus diarrhea in Ulaanbaatar, Mongolia, April 2009 through March 2016. Vaccine 2018; 36:7883-7887. [PMID: 29429811 DOI: 10.1016/j.vaccine.2018.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/17/2017] [Accepted: 02/01/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Diarrheal disease is one of the leading causes of illness and death in young children in the world, especially the developing countries. Diarrheal disease results in about half a million childhood death per year, ranking second among all causes worldwide. Diarrheal disease due to rotavirus infection is currently the most common cause of severe diarrhea in infants and young children worldwide. Rotavirus immunization of infants is a safe and effective public health intervention for rotavirus infection control and expected to lead to a reduction of childhood morbidity and mortality. METHODS We conducted hospital-based surveillance at two representative hospitals in Mongolia to estimate the burden of hospitalizations for rotavirus diarrhea among children aged <5 years and to describe strain distribution patterns during 6-year study period. Fecal specimens were tested by rotavirus antigen detection enzyme immunoassay (EIA). Specimens that tested positive for rotavirus were further characterized to determine the genotype of strains by reverse-transcriptase polymerase chain reaction. RESULTS Between April 2009 and March 2016, among 7076 eligible children with diarrhea 6078 patients were enrolled nationally. Forty-six percent (2794/6078) of EIA a specimens were positive for rotavirus. Ninety-three percent (5649/6078) of hospitalizations for diarrhea involved children less than 2 years. No deaths were recorded due to rotavirus diarrhea. The most common genotype was G3P [8] (47.7%) followed by G9P [6] (14.4%), G2P [4] (12%), and G9P [8] (7.1%). CONCLUSIONS This study found a relatively high prevalence of severe rotavirus-associated diarrhea disease in Mongolia and infants were the most affected. It highlights the urgent need for introduction of rotavirus vaccine into the national immunization program. Continued surveillance is crucial and pre-vaccine introduction rotavirus genotype patterns in Mongolia are valuable and can be followed post-introduction to assess vaccine impact.
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Affiliation(s)
| | - Sarangua Ganbold
- National Center for Communicable Diseases, Ulaanbaatar, Mongolia
| | | | - Solongo Orosoo
- National Center for Mother and Child Health, Ulaanbaatar, Mongolia
| | | | - Amar Gongor
- National Center for Mother and Child Health, Ulaanbaatar, Mongolia
| | | | | | - Wajid Abdul
- World Health Organization (WHO) Country Office, Ulaanbaatar, Mongolia
| | - Youngmee Jee
- Korea Centers for Disease Control & Prevention, Osong, South Korea
| | - Varja Grabovac
- Expanded Programme on Immunization, Division of Communicable Diseases, Western Pacific Regional Office, Manila, Philippines
| | | | - Kimberley Fox
- Expanded Programme on Immunization, Division of Communicable Diseases, Western Pacific Regional Office, Manila, Philippines
| | - Batmunkh Nyambat
- Expanded Programme on Immunization, Division of Communicable Diseases, Western Pacific Regional Office, Manila, Philippines.
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Balsalobre-Arenas L, Alarcón-Cavero T. Rapid diagnosis of gastrointestinal tract infections due to parasites, viruses, and bacteria. Enferm Infecc Microbiol Clin 2017; 35:367-376. [PMID: 28238506 PMCID: PMC7103346 DOI: 10.1016/j.eimc.2017.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 01/14/2017] [Indexed: 12/31/2022]
Abstract
Rapid diagnostic techniques are valuable tools in the diagnosis of gastrointestinal infections, especially for the detection of some microorganisms and in certain groups of patients. While antigen detection techniques are widely used in Clinical Microbiology laboratories, for the diagnosis of viruses, some parasites and some bacteria, molecular techniques are routinely used only for some pathogens (such as Clostridium difficile). However, molecular techniques are constantly evolving, and they allow a rapid diagnosis for an increasing number of pathogens, with high sensitivity and specificity. In addition, they are also able to detect virulence factors or resistance mechanisms. Syndromic surveillance systems, which detect different pathogens simultaneously, are very promising because they enable the most frequent pathogens to be diagnosed in a few hours and they can be very useful in certain patients. For the diagnosis of Helicobacter pylori infection, molecular techniques are able to detect bacteria and its resistance to clarithromycin and levofloxacin, allowing the most appropriate treatment to be selected for each patient when bacterial culture is not possible.
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Affiliation(s)
- Luz Balsalobre-Arenas
- Servicio de Microbiología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, España
| | - Teresa Alarcón-Cavero
- Servicio de Microbiología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, España; Departamento de Medicina Preventiva, Salud Publica y Microbiologia, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España.
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Balsalobre-Arenas L, Alarcón-Cavero T. Rapid diagnosis of gastrointestinal tract infections due to parasites, viruses, and bacteria. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2017. [PMCID: PMC7172322 DOI: 10.1016/j.eimce.2017.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Rapid diagnostic techniques are valuable tools in the diagnosis of gastrointestinal infections, especially for the detection of some microorganisms and in certain groups of patients. While antigen detection techniques are widely used in Clinical Microbiology laboratories, for the diagnosis of viruses, some parasites and some bacteria, molecular techniques are routinely used only for some pathogens (such as Clostridium difficile). However, molecular techniques are constantly evolving, and they allow a rapid diagnosis for an increasing number of pathogens, with high sensitivity and specificity. In addition, they are also able to detect virulence factors or resistance mechanisms. Syndromic surveillance systems, which detect different pathogens simultaneously, are very promising because they enable the most frequent pathogens to be diagnosed in a few hours and they can be very useful in certain patients. For the diagnosis of Helicobacter pylori infection, molecular techniques are able to detect bacteria and its resistance to clarithromycin and levofloxacin, allowing the most appropriate treatment to be selected for each patient when bacterial culture is not possible.
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Mohanty E, Dwibedi B, Kar SK, Acharya AS. Epidemiological features and genetic characterization of virus strains in rotavirus associated gastroenteritis in children of Odisha in Eastern India. INFECTION GENETICS AND EVOLUTION 2017; 53:77-84. [PMID: 28438670 DOI: 10.1016/j.meegid.2017.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 03/22/2017] [Accepted: 04/14/2017] [Indexed: 12/18/2022]
Abstract
We have studied the clinical characteristics, severity and seasonality of rotavirus infection and prevalent genotypes in 652 non-rota vaccinated children in Odisha in eastern India. P genotypes were analysed for their association with host blood group antigens. P type of the virus is determined by the VP8* gene, and specific recognition of A - type of Histo - blood group antigen by P[14]VP8* has been reported. VP4, VP7 and VP6 genes of commonly identified G1P[8] strain were compared with genes of the same strain isolated from other parts of India, elsewhere and strains used for Rotarix and Rotateq vaccines. In 54.75% of children with gastroenteritis, rota virus was found. 9.65% of children had moderate, 78.07% severe, and 12.28% very severe disease as assessed using the Vesikari scoring system. The incidence of infection was highest during winter months. There was no association between any blood group and specific P genotypes. G1P[8] was the commonest cause of gastroenteritis, followed by G1P[11], G3P[8], G9P[8], G2P[4], G2P[6], G9P[4], G9P[11] and G1P[6]. Predominant G genotypes identified were G1 (72.9%), G9 (10.81%), G2 (8.10%) and G3 (8.10%). Sequence analysis of the VP7 gene, placed the G1P[8] strain in lineage 1 and of VP6 gene placed nine G1P[8] strains in subgroup II and one in subgroup I. The VP7 gene segment of two Odisha G1P[8] strains were found to cluster relatively close to the VP7 sequences of Rotarix vaccine. Antigenic differences were found with vaccine strains. Ten G1P[8] strains sequenced for the VP4 gene had 91-93% nucleotide and 92-96% amino acid identity with Rotateq vaccine P[8]). Rotarix vaccine VP4 had 89-91% nucleotide and 90-92% amino acid identity. Our findings indicate genetic variability of rotavirus strains circulating in the region and are significant, given the introduction of rota vaccination in the State.
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Affiliation(s)
- Eileena Mohanty
- Viral Diagnostic and Research Laboratory, Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar 751023, Odisha, India
| | - Bhagirathi Dwibedi
- Viral Diagnostic and Research Laboratory, Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar 751023, Odisha, India.
| | - S K Kar
- Viral Diagnostic and Research Laboratory, Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar 751023, Odisha, India
| | - A S Acharya
- Viral Diagnostic and Research Laboratory, Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar 751023, Odisha, India
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Ouedraogo N, Ngangas SMT, Bonkoungou IJO, Tiendrebeogo AB, Traore KA, Sanou I, Traore AS, Barro N. Temporal distribution of gastroenteritis viruses in Ouagadougou, Burkina Faso: seasonality of rotavirus. BMC Public Health 2017; 17:274. [PMID: 28327111 PMCID: PMC5359802 DOI: 10.1186/s12889-017-4161-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 03/02/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Acute gastroenteritis is one of the most common diseases among children and adults, and continues to cause a major problem of public health in Burkina Faso. The temporal pattern of rotavirus, norovirus, sapovirus, astrovirus, adenovirus and Aichivirus A was studied by examining prevalence of gastroenteritis viruses in association with meteorological variables in Ouagadougou, Burkina Faso. METHODS Stool samples from 263 children under 5 years of age and 170 older children patients, adolescent and adults with gastroenteritis were collected in Ouagadougou, Burkina Faso from November 2011 to September 2012. Enteric viruses were detected using real-time or end-point (RT-) PCR. Temperature, humidity and monthly rainfall were recorded from the National Meteorological Direction. Categorical data were compared by Chi-square tests and the effect of weather variables and monthly prevalence were analyzed using Pearson Correlation Coefficient test. RESULTS The prevalence of rotavirus infections was significantly higher in the dry season (Season S1) compared to the wet season (season S2) (p = 0.03) among the population of children under 5 years of age. No statistically significant difference was observed regarding other gastroenteritis viruses comparing the dry season and the wet season. Positive cases of rotavirus, norovirus, adenovirus and sapovirus in children under 5 years of age were correlated with temperature (r = -0.68, p = 0.01; r = -0.74, p < 0.001; r = -0.68, p = 0.01; r = -0.65, p = 0.02, respectively) and only rotavirus, adenovirus and astrovirus were correlated with relative humidity (r = -0.61, p = 0.04; r = -0.54, p = 0.08; r = -0.51, p = 0.1 respectively). No correlation was observed with rainfall. In older children, adolescent and adults patients, rotavirus and norovirus correlated with relative humidity (r = -0.58, p = 0.05; r = 0.54, p = 0.08 respectively), but, no correlation was observed between the temperature and the rainfall. CONCLUSION This study extends knowledge on the monthly fluctuations on the prevalence of viral gastroenteritis. These results can provide valuable information necessary to alert health care providers when a period of infection in the community is likely to occur. The transmission of these viruses in Burkina Faso could depends on multiple factors including climatic variables.
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Affiliation(s)
- Nafissatou Ouedraogo
- Laboratoire de Biologie Moléculaire, d'Epidémiologie et de Surveillance des Bactéries et Virus Transmis par les Aliments, Centre de Recherche en Sciences Biologiques Alimentaires et Nutritionnelles (CRSBAN), Université Ouaga I Joseph KI-ZERBO, Ouagadougou, Burkina Faso.
| | - Stephanie Moustapha Tomba Ngangas
- Laboratoire de Biologie Moléculaire, d'Epidémiologie et de Surveillance des Bactéries et Virus Transmis par les Aliments, Centre de Recherche en Sciences Biologiques Alimentaires et Nutritionnelles (CRSBAN), Université Ouaga I Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Isidore Juste Ouindguèta Bonkoungou
- Laboratoire de Biologie Moléculaire, d'Epidémiologie et de Surveillance des Bactéries et Virus Transmis par les Aliments, Centre de Recherche en Sciences Biologiques Alimentaires et Nutritionnelles (CRSBAN), Université Ouaga I Joseph KI-ZERBO, Ouagadougou, Burkina Faso.,Laboratoire National de Santé Publique, Direction de la Biologie médicale (DBM), Ouagadougou, Burkina Faso
| | - Aissatou Bénéwendé Tiendrebeogo
- Laboratoire de Biologie Moléculaire, d'Epidémiologie et de Surveillance des Bactéries et Virus Transmis par les Aliments, Centre de Recherche en Sciences Biologiques Alimentaires et Nutritionnelles (CRSBAN), Université Ouaga I Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Kuan Abdoulaye Traore
- Laboratoire de Biologie Moléculaire, d'Epidémiologie et de Surveillance des Bactéries et Virus Transmis par les Aliments, Centre de Recherche en Sciences Biologiques Alimentaires et Nutritionnelles (CRSBAN), Université Ouaga I Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Idrissa Sanou
- Laboratoire de Bactériologie-Virologie de l'Hôpital National BLAISE COMPAORE, Ouagadougou, Burkina Faso.,UFR Sciences de la Santé, Université Ouaga I Joseph KI ZERBO, Ouagadougou, Burkina Faso
| | - Alfred Sababénédjo Traore
- Laboratoire de Biologie Moléculaire, d'Epidémiologie et de Surveillance des Bactéries et Virus Transmis par les Aliments, Centre de Recherche en Sciences Biologiques Alimentaires et Nutritionnelles (CRSBAN), Université Ouaga I Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Nicolas Barro
- Laboratoire de Biologie Moléculaire, d'Epidémiologie et de Surveillance des Bactéries et Virus Transmis par les Aliments, Centre de Recherche en Sciences Biologiques Alimentaires et Nutritionnelles (CRSBAN), Université Ouaga I Joseph KI-ZERBO, Ouagadougou, Burkina Faso
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Schwartz LM, Halloran ME, Rowhani-Rahbar A, Neuzil KM, Victor JC. Rotavirus vaccine effectiveness in low-income settings: An evaluation of the test-negative design. Vaccine 2016; 35:184-190. [PMID: 27876198 PMCID: PMC5154240 DOI: 10.1016/j.vaccine.2016.10.077] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/24/2016] [Accepted: 10/28/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The test-negative design (TND), an epidemiologic method currently used to measure rotavirus vaccine (RV) effectiveness, compares the vaccination status of rotavirus-positive cases and rotavirus-negative controls meeting a pre-defined case definition for acute gastroenteritis. Despite the use of this study design in low-income settings, the TND has not been evaluated to measure rotavirus vaccine effectiveness. METHODS This study builds upon prior methods to evaluate the use of the TND for influenza vaccine using a randomized controlled clinical trial database. Test-negative vaccine effectiveness (VE-TND) estimates were derived from three large randomized placebo-controlled trials (RCTs) of monovalent (RV1) and pentavalent (RV5) rotavirus vaccines in sub-Saharan Africa and Asia. Derived VE-TND estimates were compared to the original RCT vaccine efficacy estimates (VE-RCTs). The core assumption of the TND (i.e., rotavirus vaccine has no effect on rotavirus-negative diarrhea) was also assessed. RESULTS TND vaccine effectiveness estimates were nearly equivalent to original RCT vaccine efficacy estimates. Neither RV had a substantial effect on rotavirus-negative diarrhea. CONCLUSIONS This study supports the TND as an appropriate epidemiologic study design to measure rotavirus vaccine effectiveness in low-income settings.
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Affiliation(s)
- Lauren M Schwartz
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States.
| | - M Elizabeth Halloran
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States; Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, United States; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States; Center for Inference and Dynamics of Infectious Diseases, Seattle, WA, United States
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States
| | - Kathleen M Neuzil
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, United States
| | - John C Victor
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, United States
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Diagnostic performance of the Luminex xTAG gastrointestinal pathogens panel to detect rotavirus in Ghanaian children with and without diarrhoea. Virol J 2016; 13:132. [PMID: 27473598 PMCID: PMC4966796 DOI: 10.1186/s12985-016-0588-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 07/24/2016] [Indexed: 02/04/2023] Open
Abstract
Background Rotavirus is one of the leading causes of childhood diarrhoea worldwide. The highest disease burden is seen in resource-constrained settings of sub-Saharan Africa. Recently, commercial multiplex PCR panels proved their accuracy to diagnose infectious gastroenteritis in Europe and the USA. However, data on their performance using samples from tropical regions in general and to detect rotavirus in particular remains scant. We aimed to analyse the diagnostic performance of the Luminex xTAG gastrointestinal pathogens panel, a multiplex PCR, to detect rotavirus in stool samples from Ghanaian children. Methods A total of 682 stool samples were collected in the Ashanti region of Ghana between 2007 and 2008. Of these, 341 were from cases (children with diarrhoea), and another 341 from controls (children without diarrhoea). All samples were analysed using the Luminex xTAG assay and compared to a rotavirus quantitative reverse-transcription PCR (reference assay). Rotavirus reference assay positive samples were P and G genotyped by sequencing the rotavirus VP4 and VP7 genes. Results Overall agreement between the Luminex xTAG and the reference assay was excellent (kappa 0.93). The sensitivity and specificity was 88.2 % (95 % confidence interval [CI] 78.2–94.1) and 100 % (95 % CI 99.2–100), respectively. Of 76 rotavirus reference assay positive samples, 64 were successfully genotyped and the Luminex xTAG assay was able to detect all rotavirus genotypes present in the study. Conclusion The Luminex xTAG assay proved a sensitive and highly specific tool to detect rotavirus and may aid clinicians and public health authorities in the diagnosis and surveillance of rotavirus.
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Abstract
BACKGROUND Rotavirus and norovirus are among the leading causes of pediatric gastroenteritis. We examined the relative burden of pediatric gastroenteritis by etiology and compared the clinical severity of rotavirus and norovirus cases after the November 2011 implementation of publicly funded rotavirus vaccination program in Quebec. METHODS Prospective, active surveillance for acute gastroenteritis among children aged 8 weeks to less than 3 years of age was implemented at 3 hospitals. Participant demographics, clinical histories and stools were collected; stools were tested for rotavirus, norovirus and sapovirus. Risk and absolute differences of several clinical severity outcomes were compared by etiology with adjustment for patient age. RESULTS From February 2012 to May 2014, 734 eligible active surveillance patients were recruited, and stools from 705 (96.0%) were tested and included in study analyses. Of these, 20.4% [95% confidence interval (CI): 16.5-24.3%] were rotavirus positive and 25.5% (95% CI: 21.3-29.8%) were norovirus positive, representing a difference of 5.1% (95% CI: 0.1-10.1%). When stratified by year, rotavirus and norovirus prevalence were similar from June 2012 to May 2013, but rotavirus prevalence was 21.4% (95% CI: 14.3-28.5%) lower than norovirus from June 2013 to May 2014. On average, rotavirus patients were more likely to be febrile, dehydrated, hospitalized and report more diarrheal episodes at the height of illness in comparison with norovirus patients of the same age. CONCLUSIONS Norovirus infections were more prevalent than rotavirus infections among pediatric gastroenteritis cases hospitalized or seeking emergency care. Rotavirus cases were, on average, more clinically severe than norovirus cases among participants of the same age.
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McAtee CL, Webman R, Gilman RH, Mejia C, Bern C, Apaza S, Espetia S, Pajuelo M, Saito M, Challappa R, Soria R, Ribera JP, Lozano D, Torrico F. Burden of Norovirus and Rotavirus in Children After Rotavirus Vaccine Introduction, Cochabamba, Bolivia. Am J Trop Med Hyg 2015; 94:212-7. [PMID: 26598569 DOI: 10.4269/ajtmh.15-0203] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 10/15/2015] [Indexed: 01/14/2023] Open
Abstract
The effectiveness of rotavirus vaccine in the field may set the stage for a changing landscape of diarrheal illness affecting children worldwide. Norovirus and rotavirus are the two major viral enteropathogens of childhood. This study describes the prevalence of norovirus and rotavirus 2 years after widespread rotavirus vaccination in Cochabamba, Bolivia. Stool samples from hospitalized children with acute gastroenteritis (AGE) and outpatients aged 5-24 months without AGE were recruited from an urban hospital serving Bolivia's third largest city. Both viruses were genotyped, and norovirus GII.4 was further sequenced. Norovirus was found much more frequently than rotavirus. Norovirus was detected in 69/201 (34.3%) of specimens from children with AGE and 13/71 (18.3%) of those without diarrhea. Rotavirus was detected in 38/201 (18.9%) of diarrheal specimens and 3/71 (4.2%) of non-diarrheal specimens. Norovirus GII was identified in 97.8% of norovirus-positive samples; GII.4 was the most common genotype (71.4% of typed specimens). Rotavirus G3P[8] was the most prevalent rotavirus genotype (44.0% of typed specimens) and G2P[4] was second most prevalent (16.0% of typed specimens). This community is likely part of a trend toward norovirus predominance over rotavirus in children after widespread vaccination against rotavirus.
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Affiliation(s)
- Casey L McAtee
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana; Department of Surgery, New York University, New York; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Asociación Benéfica PRISMA, Lima, Peru; CEADES Salud y Medio Ambiente, Cochabamba, Bolivia; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francico, California; Hospital Albina R. de Patiño, Cochabamba, Bolivia
| | - Rachel Webman
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana; Department of Surgery, New York University, New York; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Asociación Benéfica PRISMA, Lima, Peru; CEADES Salud y Medio Ambiente, Cochabamba, Bolivia; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francico, California; Hospital Albina R. de Patiño, Cochabamba, Bolivia
| | - Robert H Gilman
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana; Department of Surgery, New York University, New York; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Asociación Benéfica PRISMA, Lima, Peru; CEADES Salud y Medio Ambiente, Cochabamba, Bolivia; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francico, California; Hospital Albina R. de Patiño, Cochabamba, Bolivia
| | - Carolina Mejia
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana; Department of Surgery, New York University, New York; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Asociación Benéfica PRISMA, Lima, Peru; CEADES Salud y Medio Ambiente, Cochabamba, Bolivia; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francico, California; Hospital Albina R. de Patiño, Cochabamba, Bolivia
| | - Caryn Bern
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana; Department of Surgery, New York University, New York; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Asociación Benéfica PRISMA, Lima, Peru; CEADES Salud y Medio Ambiente, Cochabamba, Bolivia; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francico, California; Hospital Albina R. de Patiño, Cochabamba, Bolivia
| | - Sonia Apaza
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana; Department of Surgery, New York University, New York; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Asociación Benéfica PRISMA, Lima, Peru; CEADES Salud y Medio Ambiente, Cochabamba, Bolivia; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francico, California; Hospital Albina R. de Patiño, Cochabamba, Bolivia
| | - Susan Espetia
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana; Department of Surgery, New York University, New York; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Asociación Benéfica PRISMA, Lima, Peru; CEADES Salud y Medio Ambiente, Cochabamba, Bolivia; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francico, California; Hospital Albina R. de Patiño, Cochabamba, Bolivia
| | - Mónica Pajuelo
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana; Department of Surgery, New York University, New York; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Asociación Benéfica PRISMA, Lima, Peru; CEADES Salud y Medio Ambiente, Cochabamba, Bolivia; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francico, California; Hospital Albina R. de Patiño, Cochabamba, Bolivia
| | - Mayuko Saito
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana; Department of Surgery, New York University, New York; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Asociación Benéfica PRISMA, Lima, Peru; CEADES Salud y Medio Ambiente, Cochabamba, Bolivia; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francico, California; Hospital Albina R. de Patiño, Cochabamba, Bolivia
| | - Roxanna Challappa
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana; Department of Surgery, New York University, New York; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Asociación Benéfica PRISMA, Lima, Peru; CEADES Salud y Medio Ambiente, Cochabamba, Bolivia; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francico, California; Hospital Albina R. de Patiño, Cochabamba, Bolivia
| | - Richard Soria
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana; Department of Surgery, New York University, New York; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Asociación Benéfica PRISMA, Lima, Peru; CEADES Salud y Medio Ambiente, Cochabamba, Bolivia; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francico, California; Hospital Albina R. de Patiño, Cochabamba, Bolivia
| | - Jose P Ribera
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana; Department of Surgery, New York University, New York; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Asociación Benéfica PRISMA, Lima, Peru; CEADES Salud y Medio Ambiente, Cochabamba, Bolivia; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francico, California; Hospital Albina R. de Patiño, Cochabamba, Bolivia
| | - Daniel Lozano
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana; Department of Surgery, New York University, New York; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Asociación Benéfica PRISMA, Lima, Peru; CEADES Salud y Medio Ambiente, Cochabamba, Bolivia; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francico, California; Hospital Albina R. de Patiño, Cochabamba, Bolivia
| | - Faustino Torrico
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana; Department of Surgery, New York University, New York; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Asociación Benéfica PRISMA, Lima, Peru; CEADES Salud y Medio Ambiente, Cochabamba, Bolivia; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francico, California; Hospital Albina R. de Patiño, Cochabamba, Bolivia
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Diagnostic Accuracy of Seven Commercial Assays for Rapid Detection of Group A Rotavirus Antigens. J Clin Microbiol 2015; 53:3670-3. [PMID: 26378280 DOI: 10.1128/jcm.01984-15] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/03/2015] [Indexed: 01/20/2023] Open
Abstract
Seven commercial immunochromatographic assays intended for the detection of group A rotavirus antigens in human stool samples were evaluated. These assays showed similar levels of diagnostic accuracy and were suitable for the detection of rotavirus in patients with acute gastroenteritis but missed some asymptomatic rotavirus shedding identified by real-time reverse transcription-PCR.
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Large increase of rotavirus diarrhoea in the hospital setting associated with emergence of G12 genotype in a highly vaccinated population in Nicaragua. Clin Microbiol Infect 2015; 21:603.e1-7. [DOI: 10.1016/j.cmi.2015.01.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 01/20/2015] [Accepted: 01/25/2015] [Indexed: 02/08/2023]
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Osborne CM, Montano AC, Robinson CC, Schultz-Cherry S, Dominguez SR. Viral gastroenteritis in children in Colorado 2006-2009. J Med Virol 2015; 87:931-9. [PMID: 25776578 PMCID: PMC7166904 DOI: 10.1002/jmv.24022] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2014] [Indexed: 02/04/2023]
Abstract
Acute gastroenteritis accounts for a significant burden of medically attended illness in children under the age of five. For this study, four multiplex reverse transcription PCR assays were used to determine the incidence of adenovirus, astrovirus, coronavirus, norovirus GI and GII, rotavirus, and sapovirus in stool samples submitted for viral electron microscopy (EM) to the Children's Hospital Colorado. Of 1105 stool samples available, viral RNA/DNA was detected in 247 (26.2%) of 941 pediatric samples (median age = 2.97 years, 54% male) with 28 (3.0%) positive for more than one virus. Adenovirus, astrovirus, norovirus GI, norovirus GII, rotavirus, and sapovirus were detected in 95 (10.0%), 33 (3.5%), 8 (0.9%), 90 (9.6%), 49 (5.2%), and 2 (0.2%) of the pediatric samples, respectively. No coronaviruses were identified. Sequencing of norovirus positive samples indicated an outbreak of norovirus strain GII.4 in 2006 with evidence of numerous circulating strains. Multiple samples from the same immunocompromised patients demonstrated symptomatic shedding of norovirus for up to 32 weeks and astrovirus for 12 weeks. RT-PCR detected 99 of 111 (89%) adenovirus-positive samples versus 12 (11%) by EM, and 186 of 192 (97%) sapovirus/astrovirus/norovirus-positive samples versus 21 (11%) by EM. Noroviruses and adenoviruses are common causes of gastroenteritis in children. Immunocompromised patients can be infected with multiple viruses and shed viruses in their stools for prolonged periods. This data support the superiority of RT-PCR compared to EM for diagnosis of viral gastroenteritis.
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Lipson SM, Ozen FS, Louis S, Karthikeyan L. Comparison of α-glucosyl hesperidin of citrus fruits and epigallocatechin gallate of green tea on the Loss of Rotavirus Infectivity in Cell Culture. Front Microbiol 2015; 6:359. [PMID: 25972850 PMCID: PMC4413797 DOI: 10.3389/fmicb.2015.00359] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 04/09/2015] [Indexed: 12/02/2022] Open
Abstract
A number of secondary plant metabolites (e.g., flavonoids) possess antiviral/antimicrobial activity. Most flavonoids, however, are difficult to study, as they are immiscible in water-based systems. The relatively new semisynthetic α-glucosyl hesperitin (GH), and the natural plant product epigallocatechin gallate (EGCG) are unique among most flavonoids, as these flavonoids are highly soluble. The antiviral activity of these plant metabolites were investigated using the rotavirus as a model enteric virus system. Direct loss of virus structural integrity in cell-free suspension and titration of amplified RTV in host cell cultures was measured by a quantitative enzyme-linked immunosorbent assay (qEIA). After 30 min. 100 × 10(3) μg/ml GH reduced RTV antigen levels by ca. 90%. The same compound reduced infectivity (replication in cell culture) by a similar order of magnitude 3 to 4 days post inoculation. After 3 days in culture, EGCG concentrations of 80, 160, and 320 μg/ml reduced RTV infectivity titer levels to ca. 50, 20, and 15% of the control, respectively. Loss of RTV infectivity titers occurred following viral treatment by parallel testing of both GH and EGCG, with the latter, markedly more effective. Cytotoxicity testing showed no adverse effects by the phenolic concentrations used in this study. The unique chemical structure of each flavonoid rather than each phenolic's inherent solubility may be ascribed to those marked differences between each molecule's antiviral (anti-RTV) effects. The solubility of EGCG and GH obviated our need to use potentially confounding or obfuscating carrier molecules (e.g., methanol, ethanol, DMSO) denoting our use of a pure system environ. Our work further denotes the need to address the unique chemical nature of secondary plant metabolites before any broad generalizations in flavonoid (antiviral) activity may be proposed.
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Affiliation(s)
- Steven M. Lipson
- Department of Biology and Health Promotions, St. Francis College, BrooklynNY, USA
| | - Fatma S. Ozen
- Department of Biology and Health Promotions, St. Francis College, BrooklynNY, USA
| | - Samantha Louis
- Department of Biology and Health Promotions, St. Francis College, BrooklynNY, USA
| | - Laina Karthikeyan
- Department of Biology, New York City College of Technology, The City University of New YorkBrooklyn, NY, USA
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The burden of different pathogens in acute diarrhoeal episodes among a cohort of Egyptian children less than five years old. GASTROENTEROLOGY REVIEW 2015; 10:173-80. [PMID: 26516385 PMCID: PMC4607694 DOI: 10.5114/pg.2015.51186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 11/12/2014] [Accepted: 12/07/2014] [Indexed: 11/29/2022]
Abstract
Introduction Diarrhoea continues to cause significant morbidity in Egypt. Aim To determine the frequency and distribution of different enteropathogens in acute diarrhoeal episodes, utilising an expanded testing regimen, and to correlate clinical signs and symptoms associated with the detected pathogens. Material and methods The case-control study enrolled 356 patients < 5 years old with acute diarrhoea and 356 age and sex-matched healthy controls. Both cases and controls underwent a full history and physical examination, and provided two rectal swab specimens and a stool sample. Laboratory analysis included stool culture, microscopy, and indirect methods. Results Rotavirus was detected in 11% of patients. Enterotoxigenic Escherichia coli (ETEC), Campylobacter, Shigella, and Salmonella were detected in 7%, 3.7%, 1.1%, and 1.4% of patients, respectively; and in 11.1%, 3.1%, 0.6%, and 0.6% of controls, respectively, with no significant statistical difference. Cryptosporidium was detected in 3.9% of cases. Mixed infection was detected in 5.9% of cases and 0.9% of controls, with a significant difference (p < 0.001). No pathogen was detected in 66.3% of cases and in 83.5% of controls. Rotavirus infection was associated with recurrent vomiting, dehydration, and hospitalisation. Bacterial diarrhoea was associated with vomiting (52%) in ETEC infections, fever (80%) in Salmonella infections, mucus (100%) and blood (50%) in stools of Shigella infections, and convulsions (15%) in Campylobacter infections. Conclusions Rotavirus is a prominent cause of diarrhoea among Egyptian children. Despite utilising an expanded testing regimen, more work is still needed for identification of other enteropathogens that constitute other causative agents of diarrhoea.
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Babji S, Arumugam R, Sarvanabhavan A, Gentsch JR, Kang G. Approach to molecular characterization of partially and completely untyped samples in an Indian rotavirus surveillance program. Vaccine 2015; 32 Suppl 1:A84-8. [PMID: 25091686 PMCID: PMC7934339 DOI: 10.1016/j.vaccine.2014.04.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Surveillance networks for rotavirus document the burden of the disease using the proportion of children hospitalized with gastroenteritis positive for rotavirus by enzyme immunoassay. They also describe genotypes of circulating viruses by polymerase chain reaction for the VP7 and VP4 genes, which determine G and P types, respectively. A proportion of samples cannot be genotyped based on initial testing and laboratories need to assess further testing strategies based on resources and feasibility. To 365 samples obtained from an Indian rotavirus strain surveillance program, we applied an approach to determine the G and P types in antigen positive samples that failed to type initially with the standard laboratory protocol. Fifty-eight samples (19%) were negative for the VP6 gene, indicating that the antigen test was likely to have been false positive. Alternative extraction and priming approaches resulted in the identification of G and P types for 264 strains. The identity of one strain was determined by sequencing the first-round amplicons. Thirty-five strains were partially typed and seven strains could not be typed at all. The distribution of G and P types among strains that had initially failed to type, except one strain, did not differ from that in strains that were typed using the standard laboratory protocol.
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Affiliation(s)
- Sudhir Babji
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India.
| | - Rajesh Arumugam
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | | | - Jon R Gentsch
- Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
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Mo QH, Wang HB, Tan H, Wu BM, Feng ZL, Wang Q, Lin JC, Yang Z. Comparative detection of rotavirus RNA by conventional RT-PCR, TaqMan RT-PCR and real-time nucleic acid sequence-based amplification. J Virol Methods 2015; 213:1-4. [DOI: 10.1016/j.jviromet.2014.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/06/2014] [Accepted: 11/18/2014] [Indexed: 12/01/2022]
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Jackson ML, Rothman KJ. Effects of imperfect test sensitivity and specificity on observational studies of influenza vaccine effectiveness. Vaccine 2015; 33:1313-6. [PMID: 25659280 DOI: 10.1016/j.vaccine.2015.01.069] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/23/2014] [Accepted: 01/27/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND The recently developed test-negative design is now standard for observational studies of influenza vaccine effectiveness (VE). It is unclear how influenza test misclassification biases test-negative VE estimates relative to VE estimates from traditional cohort or case-control studies. METHODS We simulated populations whose members may develop acute respiratory illness (ARI) due to influenza and to non-influenza pathogens. In these simulations, vaccination reduces the risk of influenza but not of non-influenza ARI. Influenza test sensitivity and specificity, risks of influenza and non-influenza ARI, and VE were varied across the simulations. In each simulation, we estimated influenza VE using a cohort design, a case-control design, and a test-negative design. RESULTS In the absence of influenza test misclassification, all three designs accurately estimated influenza VE. In the presence of misclassification, all three designs underestimated VE. Bias in VE estimates was slightly greater in the test-negative design than in cohort or case-control designs. Assuming the use of highly sensitive and specific reverse-transcriptase polymerase chain reaction tests for influenza, bias in the test-negative studies was trivial across a wide range of realistic values for VE. DISCUSSION Although influenza test misclassification causes more bias in test-negative studies than in traditional cohort or case-control studies, the difference is trivial for realistic combinations of attack rates, test sensitivity/specificity, and VE.
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Affiliation(s)
- Michael L Jackson
- Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1448, USA.
| | - Kenneth J Rothman
- Research Triangle Institute, 200 Park Office Drive, Research Triangle Park, Durham, NC 27709, USA.
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Multicenter evaluation of the BioFire FilmArray gastrointestinal panel for etiologic diagnosis of infectious gastroenteritis. J Clin Microbiol 2015; 53:915-25. [PMID: 25588652 DOI: 10.1128/jcm.02674-14] [Citation(s) in RCA: 337] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The appropriate treatment and control of infectious gastroenteritis depend on the ability to rapidly detect the wide range of etiologic agents associated with the disease. Clinical laboratories currently utilize an array of different methodologies to test for bacterial, parasitic, and viral causes of gastroenteritis, a strategy that suffers from poor sensitivity, potentially long turnaround times, and complicated ordering practices and workflows. Additionally, there are limited or no testing methods routinely available for most diarrheagenic Escherichia coli strains, astroviruses, and sapoviruses. This study assessed the performance of the FilmArray Gastrointestinal (GI) Panel for the simultaneous detection of 22 different enteric pathogens directly from stool specimens: Campylobacter spp., Clostridium difficile (toxin A/B), Plesiomonas shigelloides, Salmonella spp., Vibrio spp., Vibrio cholerae, Yersinia enterocolitica, enteroaggregative E. coli, enteropathogenic E. coli, enterotoxigenic E. coli, Shiga-like toxin-producing E. coli (stx1 and stx2) (including specific detection of E. coli O157), Shigella spp./enteroinvasive E. coli, Cryptosporidium spp., Cyclospora cayetanensis, Entamoeba histolytica, Giardia lamblia, adenovirus F 40/41, astrovirus, norovirus GI/GII, rotavirus A, and sapovirus. Prospectively collected stool specimens (n = 1,556) were evaluated using the BioFire FilmArray GI Panel and tested with conventional stool culture and molecular methods for comparison. The FilmArray GI Panel sensitivity was 100% for 12/22 targets and ≥94.5% for an additional 7/22 targets. For the remaining three targets, sensitivity could not be calculated due to the low prevalences in this study. The FilmArray GI Panel specificity was ≥97.1% for all panel targets. The FilmArray GI Panel provides a comprehensive, rapid, and streamlined alternative to conventional methods for the etiologic diagnosis of infectious gastroenteritis in the laboratory setting. The potential advantages include improved performance parameters, a more extensive menu of pathogens, and a turnaround time of as short as 1 h.
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Elyan D, Wasfy M, El Mohammady H, Hassan K, Monestersky J, Noormal B, Oyofo B. Non-bacterial etiologies of diarrheal diseases in Afghanistan. Trans R Soc Trop Med Hyg 2014; 108:461-5. [PMID: 24942900 DOI: 10.1093/trstmh/tru096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Microbial diarrheal diseases are one of the leading causes of child morbidity and mortality in developing countries. This study aimed to identify the main causes of non-bacterial diarrhea in Afghanistan. METHODS A total of 699 stools were collected from children aged under 5 years who presented with diarrhea at Indira Gandhi and Kandahar hospitals. Frozen aliquots were preserved for screening against rotavirus, astrovirus, adenovirus, norovirus, Cryptosporidium and Giardia, when bacterial cultures tested negative. Tests were performed at the hospitals after laboratory staff were trained and provided with enzyme-immunoassays and equipment. Results were confirmed at the U.S. Naval Medical Research Unit No. 3, Cairo, Egypt. RESULTS Of the samples tested, 71.9% (503/699) were infected with one or more pathogens. However, the majority (85.8%; 432/503) showed single infections: rotavirus (72.2%; 329/432), Cryptosporidium (14.1%; 61/432), Giardia (5.1%; 22/432), astrovirus (2.3%; 10/432), adenovirus (1.6%; 7/432) and norovirus (0.7%; 3/432). The remaining 14% (71/503) showed mixed infections of the tested pathogens. CONCLUSIONS Non-bacterial pathogens were identified that could enable health officials to adopt more effective treatment and control measures for diarrhea in Afghanistan.
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Affiliation(s)
- Diaa Elyan
- U.S. Naval Medical Research Unit No. 3 (NAMRU-3), PSC 452, Box 5000, FPO AE 09835-0007, Cairo, Egypt
| | - Momtaz Wasfy
- U.S. Naval Medical Research Unit No. 3 (NAMRU-3), PSC 452, Box 5000, FPO AE 09835-0007, Cairo, Egypt
| | - Hanan El Mohammady
- U.S. Naval Medical Research Unit No. 3 (NAMRU-3), PSC 452, Box 5000, FPO AE 09835-0007, Cairo, Egypt
| | - Khaled Hassan
- U.S. Naval Medical Research Unit No. 3 (NAMRU-3), PSC 452, Box 5000, FPO AE 09835-0007, Cairo, Egypt
| | - Jesse Monestersky
- U.S. Naval Medical Research Unit No. 3 (NAMRU-3), PSC 452, Box 5000, FPO AE 09835-0007, Cairo, Egypt
| | - Bashir Noormal
- Afghanistan Public Health Institute (APHI) - Ministry of Public Health (MoPH), Islamic Republic of Afghanistan
| | - Buhari Oyofo
- U.S. Naval Medical Research Unit No. 3 (NAMRU-3), PSC 452, Box 5000, FPO AE 09835-0007, Cairo, Egypt
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