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Lefrancq N, Bouchez V, Fernandes N, Barkoff AM, Bosch T, Dalby T, Åkerlund T, Darenberg J, Fabianova K, Vestrheim DF, Fry NK, González-López JJ, Gullsby K, Habington A, He Q, Litt D, Martini H, Piérard D, Stefanelli P, Stegger M, Zavadilova J, Armatys N, Landier A, Guillot S, Hong SL, Lemey P, Parkhill J, Toubiana J, Cauchemez S, Salje H, Brisse S. Global spatial dynamics and vaccine-induced fitness changes of Bordetella pertussis. Sci Transl Med 2022; 14:eabn3253. [PMID: 35476597 DOI: 10.1126/scitranslmed.abn3253] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
As with other pathogens, competitive interactions between Bordetella pertussis strains drive infection risk. Vaccines are thought to perturb strain diversity through shifts in immune pressures; however, this has rarely been measured because of inadequate data and analytical tools. We used 3344 sequences from 23 countries to show that, on average, there are 28.1 transmission chains circulating within a subnational region, with the number of chains strongly associated with host population size. It took 5 to 10 years for B. pertussis to be homogeneously distributed throughout Europe, with the same time frame required for the United States. Increased fitness of pertactin-deficient strains after implementation of acellular vaccines, but reduced fitness otherwise, can explain long-term genotype dynamics. These findings highlight the role of vaccine policy in shifting local diversity of a pathogen that is responsible for 160,000 deaths annually.
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Affiliation(s)
- Noémie Lefrancq
- Insitut Pasteur, Université Paris Cité, Mathematical Modelling of Infectious Diseases Unit, UMR2000, CNRS, 75015 Paris, France.,Department of Genetics, University of Cambridge, Cambridge CB2 3EH, UK
| | - Valérie Bouchez
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, 75724 Paris, France.,National Reference Center for Whooping Cough and Other Bordetella Infections, 75724 Paris, France
| | - Nadia Fernandes
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, 75724 Paris, France
| | - Alex-Mikael Barkoff
- University of Turku UTU, Institute of Biomedicine, Research Center for Infections and Immunity, FI-20520 Turku, Finland
| | - Thijs Bosch
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, Netherlands
| | - Tine Dalby
- Statens Serum Institut, Bacteria, Parasites and Fungi/Infectious Disease Preparedness, 2300 Copenhagen, Denmark
| | - Thomas Åkerlund
- The Public Health Agency of Sweden, Unit for Laboratory Surveillance of Bacterial Pathogens, SE-171 82 Solna, Sweden
| | - Jessica Darenberg
- The Public Health Agency of Sweden, Unit for Laboratory Surveillance of Bacterial Pathogens, SE-171 82 Solna, Sweden
| | - Katerina Fabianova
- National Institute of Public Health, Department of Infectious Diseases Epidemiology, CZ-10000 Prague, Czech Republic
| | - Didrik F Vestrheim
- Norwegian Institute of Public Health, Department of Infectious Disease Control and Vaccine, N-0213 Oslo, Norway
| | - Norman K Fry
- Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England-National Infection Service, London NW9 5EQ, UK.,Immunisation and Countermeasures Division, Public Health England-National Infection Service, London NW9 5EQ, UK
| | - Juan José González-López
- University Hospital Vall d'Hebron, Microbiology Department, 08035 Barcelona, Spain.,Universitat Autònoma de Barcelona, Department of Genetics and Microbiology, 08193 Barcelona, Spain
| | - Karolina Gullsby
- Centre for Research and Development, Uppsala University/Region Gävleborg, 80187 Gävle, Sweden
| | - Adele Habington
- Molecular Microbiology Laboratory, Children's Health Ireland, Crumlin, D12 N512 Dublin, Ireland
| | - Qiushui He
- University of Turku UTU, Institute of Biomedicine, Research Center for Infections and Immunity, FI-20520 Turku, Finland.,InFLAMES Research Flagship Center, University of Turku, FI-20520 Turku, Finland
| | - David Litt
- Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England-National Infection Service, London NW9 5EQ, UK
| | - Helena Martini
- Department of Microbiology, National Reference Centre for Bordetella pertussis, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), B-1090 Brussels, Belgium
| | - Denis Piérard
- Department of Microbiology, National Reference Centre for Bordetella pertussis, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), B-1090 Brussels, Belgium
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, IT-00161 Rome, Italy
| | - Marc Stegger
- Statens Serum Institut, Bacteria, Parasites and Fungi/Infectious Disease Preparedness, 2300 Copenhagen, Denmark
| | - Jana Zavadilova
- National Institute of Public Health, National Reference Laboratory for Pertussis and Diphtheria, 100 00 Prague, Czech Republic
| | - Nathalie Armatys
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, 75724 Paris, France.,National Reference Center for Whooping Cough and Other Bordetella Infections, 75724 Paris, France
| | - Annie Landier
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, 75724 Paris, France.,National Reference Center for Whooping Cough and Other Bordetella Infections, 75724 Paris, France
| | - Sophie Guillot
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, 75724 Paris, France.,National Reference Center for Whooping Cough and Other Bordetella Infections, 75724 Paris, France
| | - Samuel L Hong
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, 3000 Leuven, Belgium
| | - Philippe Lemey
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, 3000 Leuven, Belgium
| | - Julian Parkhill
- Department of Veterinary Medicine, University of Cambridge, Cambridge CB3 0ES, UK
| | - Julie Toubiana
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, 75724 Paris, France.,National Reference Center for Whooping Cough and Other Bordetella Infections, 75724 Paris, France.,Université Paris Cité, Department of General Paediatrics and Paediatric Infectious Diseases, Necker-Enfants Malades Hospital, APHP, 75015 Paris, France
| | - Simon Cauchemez
- Insitut Pasteur, Université Paris Cité, Mathematical Modelling of Infectious Diseases Unit, UMR2000, CNRS, 75015 Paris, France
| | - Henrik Salje
- Insitut Pasteur, Université Paris Cité, Mathematical Modelling of Infectious Diseases Unit, UMR2000, CNRS, 75015 Paris, France.,Department of Genetics, University of Cambridge, Cambridge CB2 3EH, UK
| | - Sylvain Brisse
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, 75724 Paris, France.,National Reference Center for Whooping Cough and Other Bordetella Infections, 75724 Paris, France
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2
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Bordetella pertussis in School-Age Children, Adolescents and Adults: A Systematic Review of Epidemiology and Mortality in Europe. Infect Dis Ther 2021; 10:2071-2118. [PMID: 34435338 PMCID: PMC8387212 DOI: 10.1007/s40121-021-00520-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022] Open
Abstract
Pertussis (whooping cough) epidemics persist globally despite high vaccine coverage among infants and young children. The resurgence of pertussis in high-income countries is partly due to waning vaccine immunity, resulting in a pool of unprotected adolescents and adults. However, pertussis is generally less severe in adolescents and adults, and this difference in presentation means it can often be unrecognised by healthcare professionals, meaning that it is largely under-diagnosed in older populations. A systematic search of MEDLINE, EMBASE and BIOSIS was undertaken to identify studies published between 1 January 1990 and 17 June 2019, with information on pertussis epidemiology and mortality in school-aged children, adolescents and adults in Europe. A formal statistical comparison (e.g. using meta-analyses) was not possible because of the mix of methodologies reported. There were 69 epidemiological studies and 19 mortality studies identified for review. Over the past decade, the reported incidence of notified pertussis cases varied widely between European countries, which is likely associated with differences in surveillance systems, diagnostic techniques and reporting regulations. However, several studies show that pertussis is circulating among adolescents and adults in Europe, and although pertussis-related morbidity and mortality are highest in infants, there is evidence that adults aged > 50 years are at increased risk. For example, in a hospital-based surveillance study in Portugal, between 2000 and 2015, 94% of hospitalised pertussis cases were infants aged < 1 year, with a case fatality rate (CFR) of 0.8%; however, among hospitalised adult cases of pertussis, the CFRs were 11.5% (aged 18–64 years) and 17.4% (aged > 65 years). Very few European countries currently include pertussis boosters for adults in the national immunisation strategy. In addition to increasing pertussis vaccination coverage in adolescents and adults, mitigation strategies in European countries should include improved diagnosis and treatment in these populations.
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Pandolfi E, Gesualdo F, Rizzo C, Russo L, Campagna I, Carloni E, Concato C, Linardos G, Villani A, Ciampini S, Reale A, Boccuzzi E, Midulla F, Tozzi AE. The impact of pertussis in infants: insights from a hospital-based enhanced surveillance system, Lazio region, Italy, 2016 to 2019. ACTA ACUST UNITED AC 2021; 26. [PMID: 34142648 PMCID: PMC8212589 DOI: 10.2807/1560-7917.es.2021.26.24.2000562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Routine surveillance systems for pertussis often suffer from under-recognition and under-reporting. Aim Our aim was to describe the epidemiology and the clinical features of pertussis in children younger than 1 year in an Italian region, detected through an enhanced hospital surveillance system. Methods From 2016 to 2019, we monitored the incidence and the clinical characteristics of hospitalised pertussis cases younger than 1 year in two paediatric hospitals involved in the PERTINENT project. Results We detected 141 pertussis cases, corresponding to an estimated incidence of 105.8 per 100.000 in 2016, 91.7 per 100.000 in 2017, 64.5 per 100.000 in 2018 and 40.9 per 100.000 in 2019, based on the hospitals’ catchment area, roughly corresponding to the Lazio region. A total of 101 cases (77.1%) had a household member with cough or other respiratory symptoms. The most frequent combination of symptoms was paroxysmal cough with apnoea in the absence of fever. Almost 40% had been prescribed an antibiotic treatment before hospitalisation, and the median time from symptom onset to contact with the hospital was 8 days. Thirty-one (22.0%) had complications. Conclusion An enhanced surveillance system showed a high incidence of pertussis among infants in the Lazio region, where the impact of this disease may still be underestimated. Increasing the coverage of pertussis immunisation among pregnant women and improving the capacity for early detection in primary care may contribute to reducing the impact of pertussis among infants.
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Affiliation(s)
- Elisabetta Pandolfi
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
| | - Francesco Gesualdo
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
| | - Caterina Rizzo
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
| | - Luisa Russo
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
| | - Ilaria Campagna
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
| | - Emanuela Carloni
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
| | - Carlo Concato
- Bambino Gesù Children's Hospital, IRCCS, Virology Unit, Rome, Italy
| | - Giulia Linardos
- Bambino Gesù Children's Hospital, IRCCS, Virology Unit, Rome, Italy
| | - Alberto Villani
- Bambino Gesù Children's Hospital, IRCCS, Paediatric and Infectious Diseases Unit, Rome, Italy
| | - Sara Ciampini
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
| | - Antonino Reale
- Bambino Gesù Children's Hospital, IRCCS, Emergency Department, Rome, Italy
| | - Elena Boccuzzi
- Bambino Gesù Children's Hospital, IRCCS, Emergency Department, Rome, Italy
| | - Fabio Midulla
- Sapienza University, Department of Paediatrics, Rome, Italy
| | - Alberto E Tozzi
- Bambino Gesù Children's Hospital, IRCCS, Multifactorial and Complex Disease Research Area, Rome, Italy
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Alimohamadi Y, Zahraei SM, Karami M, Yaseri M, Lotfizad M, Holakouie-Naieni K. Spatio-temporal analysis of Pertussis using geographic information system among Iranian population during 2012-2018. Med J Islam Repub Iran 2020; 34:22. [PMID: 32551311 PMCID: PMC7293812 DOI: 10.34171/mjiri.34.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Indexed: 01/29/2023] Open
Abstract
Background: In spite of existing vaccination programs in many countries, outbreaks of pertussis are still reported. In Iran, the suspected and confirmed cases of pertussis are reported annually. Due to the lack of similar studies, the purpose of the current study was to determine the Spatio-temporal distribution of Pertussis using Geographic Information System (GIS) to identify high-risk areas in Iran during 2012-2018. Methods: In the current cross-sectional study, registered data in the department of vaccine-preventable diseases in the Iranian ministry of health were used. To assess the temporal trend, the Cochran–Armitage test was used. To show the spatial distribution and to identify hotspot areas, Choropleth map and Getis-Ord Gi statistics were used. All analyses performed by Arc.map10.5, Stata 15 and Excel 2010. Results: The incidence of suspect pertussis cases had an increasing trend but did not have a linear trend (p=0.06). Most of the cases happened in under 1 year infants (62.66%). The incidence of reported cases in northern areas was higher than in the Southern areas. The Zanjan had the most reported cases during the understudied period with a median of 7.63 reported cases per 100,000. The clustering of infection and hotspots were identified in northern areas of Iran including Qazvin, Qom, Markazi, and Hamadan. Conclusion: Our results showed that the cumulative incidence of reported cases is increasing. The northern provinces had the highest incidence of Pertussis. Therefore, the causes of this spatio-temporal pattern of pertussis should be determined. Also, supervision on vaccination programs in high-risk areas is recommended.
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Affiliation(s)
- Yousef Alimohamadi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohsen Zahraei
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Manoochehr Karami
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Lotfizad
- School of Electrical & Computer Engineering, Tarbiat Modares University, Tehran, Iran
| | - Kourosh Holakouie-Naieni
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Wong A, Opinel A, Combes SJB, Toubiana J, Brisse S. Determining Factors for Pertussis Vaccination Policy: A Study in Five EU Countries. Vaccines (Basel) 2020; 8:vaccines8010046. [PMID: 31991855 PMCID: PMC7158661 DOI: 10.3390/vaccines8010046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 01/26/2023] Open
Abstract
Pertussis vaccination policy varies across Europe, not only in the type of vaccine-whole cell (wP) vs. acellular (aP1/2/3/5)-but also in the schedule and recommendation for parents. This study aims to investigate the determining factors for the type of vaccine, immunization schedule and maternal immunization recommendation. From March to May 2019, experts in national health agencies and major academic or research institutions from Denmark, France, Poland, Sweden and the UK were invited to a semi-structured interview. Thematic analysis was performed on the transcripts using a codebook formulated by three coders. Inter-coder agreement was assessed. Fifteen expert interviews were conducted. The identified driving factors for pertussis vaccine policy were classified into three domains: scientific factors, sociological factors, and pragmatic factors. The determining factors for the type of vaccine were prescriber's preference, concern of adverse events following immunization (AEFI), effectiveness, and consideration of other vaccine components in combined vaccines. The determining factors for infant schedule were immunity response and the potential to improve coverage and timeliness. The determining factors for maternal immunization were infant mortality and public acceptability. To conclude, socio-political and pragmatic factors were, besides scientific factors, important in determining the pertussis vaccine type, schedule of childhood immunization and recommendations for parents.
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Affiliation(s)
- Anabelle Wong
- Institut Pasteur/INSERM/University of Versailles Saint Quentin, UMR 1181 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases, 25 rue du Dr Roux, CEDEX 15, F-75724 Paris, France;
- EHESP French School of Public Health, F-35000 Rennes, France
- ScHARR, The University of Sheffield, 30 Regent Street, Sheffield S1 4DA, UK
- Correspondence:
| | - Annick Opinel
- Institut Pasteur/INSERM/University of Versailles Saint Quentin, UMR 1181 Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases, 25 rue du Dr Roux, CEDEX 15, F-75724 Paris, France;
| | - Simon Jean-Baptiste Combes
- Univ Rennes, EHESP, CNRS, ARENES—UMR 6051, F-35000 Rennes, France;
- French Collaborative Institute on Migration, 93322 Aubervilliers, France
| | - Julie Toubiana
- Institut Pasteur, Unit Biodiversity and Epidemiology of Bacterial Pathogens, 25 rue du Dr Roux, CEDEX 15, F-75724 Paris, France; (J.T.); (S.B.)
- National Reference Center for Whooping Cough and OtherBordetella Infections, Institut Pasteur, 25 rue du Dr Roux, CEDEX 15, F-75724 Paris, France
- Department of General Paediatrics and Infectious Diseases, Necker-Enfants malades University Hospital, Université de Paris, AP-HP, 135 rue de Sevres, 75015 Paris, France
| | - Sylvain Brisse
- Institut Pasteur, Unit Biodiversity and Epidemiology of Bacterial Pathogens, 25 rue du Dr Roux, CEDEX 15, F-75724 Paris, France; (J.T.); (S.B.)
- National Reference Center for Whooping Cough and OtherBordetella Infections, Institut Pasteur, 25 rue du Dr Roux, CEDEX 15, F-75724 Paris, France
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Dienstbier A, Pouchnik D, Wildung M, Amman F, Hofacker IL, Parkhill J, Holubova J, Sebo P, Vecerek B. Comparative genomics of Czech vaccine strains of Bordetella pertussis. Pathog Dis 2018; 76:5089975. [PMID: 30184175 DOI: 10.1093/femspd/fty071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 08/30/2018] [Indexed: 11/13/2022] Open
Abstract
Bordetella pertussis is a strictly human pathogen causing the respiratory infectious disease called whooping cough or pertussis. B. pertussis adaptation to acellular pertussis vaccine pressure has been repeatedly highlighted, but recent data indicate that adaptation of circulating strains started already in the era of the whole cell pertussis vaccine (wP) use. We sequenced the genomes of five B. pertussis wP vaccine strains isolated in the former Czechoslovakia in the pre-wP (1954-1957) and early wP (1958-1965) eras, when only limited population travel into and out of the country was possible. Four isolates exhibit a similar genome organization and form a distinct phylogenetic cluster with a geographic signature. The fifth strain is rather distinct, both in genome organization and SNP-based phylogeny. Surprisingly, despite isolation of this strain before 1966, its closest sequenced relative appears to be a recent isolate from the US. On the genome content level, the five vaccine strains contained both new and already described regions of difference. One of the new regions contains duplicated genes potentially associated with transport across the membrane. The prevalence of this region in recent isolates indicates that its spread might be associated with selective advantage leading to increased strain fitness.
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Affiliation(s)
- Ana Dienstbier
- Institute of Microbiology v.v.i., Laboratory of post-transcriptional control of gene expression, 14220 Prague, Czech Republic
| | - Derek Pouchnik
- Laboratory for Biotechnology and Bioanalysis, Center for Reproductive Biology, Washington State University, Pullman, Washington 99164-7520
| | - Mark Wildung
- Laboratory for Biotechnology and Bioanalysis, Center for Reproductive Biology, Washington State University, Pullman, Washington 99164-7520
| | - Fabian Amman
- University of Vienna, Institute for Theoretical Chemistry, Währinger Straße 17, A-1090 Vienna, Austria
| | - Ivo L Hofacker
- University of Vienna, Institute for Theoretical Chemistry, Währinger Straße 17, A-1090 Vienna, Austria.,University of Vienna, Research group BCB, Faculty of Computer Science, Währinger Straße 24, 1090 Vienna, Austria
| | - Julian Parkhill
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, CB10 1SA Cambridge, UK
| | - Jana Holubova
- Institute of Microbiology v.v.i, Laboratory of molecular biology of bacterial pathogens, 14220 Prague, Czech Republic
| | - Peter Sebo
- Institute of Microbiology v.v.i, Laboratory of molecular biology of bacterial pathogens, 14220 Prague, Czech Republic
| | - Branislav Vecerek
- Institute of Microbiology v.v.i., Laboratory of post-transcriptional control of gene expression, 14220 Prague, Czech Republic
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