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Khalid K, Poh CL. The Promising Potential of Reverse Vaccinology-Based Next-Generation Vaccine Development over Conventional Vaccines against Antibiotic-Resistant Bacteria. Vaccines (Basel) 2023; 11:1264. [PMID: 37515079 PMCID: PMC10385262 DOI: 10.3390/vaccines11071264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
The clinical use of antibiotics has led to the emergence of multidrug-resistant (MDR) bacteria, leading to the current antibiotic resistance crisis. To address this issue, next-generation vaccines are being developed to prevent antimicrobial resistance caused by MDR bacteria. Traditional vaccine platforms, such as inactivated vaccines (IVs) and live attenuated vaccines (LAVs), were effective in preventing bacterial infections. However, they have shown reduced efficacy against emerging antibiotic-resistant bacteria, including MDR M. tuberculosis. Additionally, the large-scale production of LAVs and IVs requires the growth of live pathogenic microorganisms. A more promising approach for the accelerated development of vaccines against antibiotic-resistant bacteria involves the use of in silico immunoinformatics techniques and reverse vaccinology. The bioinformatics approach can identify highly conserved antigenic targets capable of providing broader protection against emerging drug-resistant bacteria. Multi-epitope vaccines, such as recombinant protein-, DNA-, or mRNA-based vaccines, which incorporate several antigenic targets, offer the potential for accelerated development timelines. This review evaluates the potential of next-generation vaccine development based on the reverse vaccinology approach and highlights the development of safe and immunogenic vaccines through relevant examples from successful preclinical and clinical studies.
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Affiliation(s)
- Kanwal Khalid
- Centre for Virus and Vaccine Research, School of Medical and Life Sciences, Sunway University, Bandar Sunway, Subang Jaya 47500, Malaysia
| | - Chit Laa Poh
- Centre for Virus and Vaccine Research, School of Medical and Life Sciences, Sunway University, Bandar Sunway, Subang Jaya 47500, Malaysia
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2
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Otiende M, Bauni E, Nyaguara A, Amadi D, Nyundo C, Tsory E, Walumbe D, Kinuthia M, Kihuha N, Kahindi M, Nyutu G, Moisi J, Deribew A, Agweyu A, Marsh K, Tsofa B, Bejon P, Bottomley C, Williams TN, Scott JAG. Mortality in rural coastal Kenya measured using the Kilifi Health and Demographic Surveillance System: a 16-year descriptive analysis. Wellcome Open Res 2023; 6:327. [PMID: 37416502 PMCID: PMC10320326 DOI: 10.12688/wellcomeopenres.17307.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 10/30/2023] Open
Abstract
Background: The Kilifi Health and Demographic Surveillance System (KHDSS) was established in 2000 to define the incidence and prevalence of local diseases and evaluate the impact of community-based interventions. KHDSS morbidity data have been reported comprehensively but mortality has not been described. This analysis describes mortality in the KHDSS over 16 years. Methods: We calculated mortality rates from 2003-2018 in four intervals of equal duration and assessed differences in mortality across these intervals by age and sex. We calculated the period survival function and median survival using the Kaplan-Meier method and mean life expectancies using abridged life tables. We estimated trend and seasonality by decomposing a time series of monthly mortality rates. We used choropleth maps and random-effects Poisson regression to investigate geographical heterogeneity. Results: Mortality declined by 36% overall between 2003-2018 and by 59% in children aged <5 years. Most of the decline occurred between 2003 and 2006. Among adults, the greatest decline (49%) was observed in those aged 15-54 years. Life expectancy at birth increased by 12 years. Females outlived males by 6 years. Seasonality was only evident in the 1-4 year age group in the first four years. Geographical variation in mortality was ±10% of the median value and did not change over time. Conclusions: Between 2003 and 2018, mortality among children and young adults has improved substantially. The steep decline in 2003-2006 followed by a much slower reduction thereafter suggests improvements in health and wellbeing have plateaued in the last 12 years. However, there is substantial inequality in mortality experience by geographical location.
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Affiliation(s)
- Mark Otiende
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Evasius Bauni
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Amek Nyaguara
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - David Amadi
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Christopher Nyundo
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Emmanuel Tsory
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - David Walumbe
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Michael Kinuthia
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Norbert Kihuha
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Michael Kahindi
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Gideon Nyutu
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Jennifer Moisi
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Amare Deribew
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Ambrose Agweyu
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Kevin Marsh
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Benjamin Tsofa
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Philip Bejon
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Christian Bottomley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas N. Williams
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - J. Anthony G. Scott
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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3
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Muri L, Schubart A, Thorburn C, Zamurovic N, Holbro T, Kammüller M, Pluschke G, Ispasanie E. Inhibition of the different complement pathways has varying impacts on the serum bactericidal activity and opsonophagocytosis against Haemophilus influenzae type b. Front Immunol 2022; 13:1020580. [PMID: 36578495 PMCID: PMC9791579 DOI: 10.3389/fimmu.2022.1020580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/25/2022] [Indexed: 12/14/2022] Open
Abstract
Defense against Haemophilus influenzae type b (Hib) is dependent on antibodies and complement, which mediate both serum bactericidal activity (SBA) and opsonophagocytosis. Here we evaluated the influence of capsule-specific antibodies and complement inhibitors targeting the central component C3, the alternative pathway (AP; fB, fD), the lectin pathway (LP; MASP-2) and the terminal pathway (C5) on both effector functions. Findings may be relevant for the treatment of certain diseases caused by dysregulation of the complement system, where inhibitors of complement factors C3 or C5 are used. Inhibitors against other complement components are being evaluated as potential alternative treatment options that may carry a reduced risk of infection by encapsulated bacteria. Serum and reconstituted blood of healthy adults were tested for bactericidal activity before and after vaccination with the Hib capsule-conjugate vaccine ActHIB. Most sera had bactericidal activity prior to vaccination, but vaccination significantly enhanced SBA titers. Independently of the vaccination status, both C3 and C5 inhibition abrogated SBA, whereas inhibition of the LP had no effect. AP inhibition had a major inhibitory effect on SBA of pre- vaccination serum, but vaccination mitigated this inhibition for all disease isolates tested. Despite this, SBA-mediated killing of some Hib isolates remained retarded. Even for the most serum-resistant isolate, SBA was the dominating defense mechanism in reconstituted whole blood, as addition of blood cells to the serum did not enhance bacterial killing. Limited Fc receptor-mediated opsonophagocytosis was unmasked when bacterial killing by the membrane attack complex was blocked. In the presence of C3 or C5 inhibitors, addition of post-vaccination, but not of pre-vaccination serum to the blood cells triggered opsonophagocytosis, leading to suppression of bacterial multiplication. Taken together, our data indicate that for host defense against Hib, killing by SBA is more efficient than by blood cell opsonophagocytosis. However, additional defense mechanisms, such as bacterial clearance by spleen and liver, may play an important role in preventing Hib-mediated sepsis, in particular for Hib isolates with increased serum-resistance. Results indicate potentially improved safety profile of AP inhibitors over C3 and C5 inhibitors as alternative therapeutic agents in patients with increased susceptibility to Hib infection.
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Affiliation(s)
- Lukas Muri
- Molecular Immunology Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland,University of Basel, Basel, Switzerland
| | - Anna Schubart
- Department Autoimmunity, Transplantation and Inflammation, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | | | - Natasa Zamurovic
- Translational Medicine-Preclinical Safety, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Thomas Holbro
- Global Drug Development, Novartis Pharma AG, Basel, Switzerland
| | - Michael Kammüller
- Translational Medicine-Preclinical Safety, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Gerd Pluschke
- Molecular Immunology Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland,University of Basel, Basel, Switzerland,*Correspondence: Gerd Pluschke,
| | - Emma Ispasanie
- Molecular Immunology Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland,University of Basel, Basel, Switzerland
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Haemophilus influenzae serotype b seroprevalence in central Lao PDR before and after vaccine introduction. PLoS One 2022; 17:e0274558. [PMID: 36107979 PMCID: PMC9477263 DOI: 10.1371/journal.pone.0274558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 08/31/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Vaccination has dramatically reduced invasive Haemophilus influenzae type b (Hib) disease worldwide. Hib vaccination was introduced in the Lao PDR in 2009, as part of the pentavalent vaccine. To contribute to the understanding of the epidemiology of Hib in Lao PDR and the protection levels before and after the introduction of the vaccination, we tested serum samples from existing cohorts of vaccine age-eligible children and unvaccinated adolescents for antibodies against Hib.
Methods
Serum samples from 296 adolescents born before vaccine introduction and from 1017 children under 5 years (vaccinated and unvaccinated) were tested for anti-Hib antibodies by ELISA. Bivariate analyses were performed to investigate factors associated with long-term protection.
Results
The vast majority of all participants showed evidence of short- (42.7%) or long-term (56.1%) protection against Hib. Almost all of the unvaccinated adolescents had antibody titers indicating short-term protection and almost half (45.6%) were long-term protected. Nearly all children (>99.0%) were at least short-term protected, even those that were unvaccinated or whose vaccination status was unknown. Among vaccinated children, participants vaccinated more than 1 or 2 years ago and with a mid-upper arm circumference z-score < -2 were less likely to be long-term protected.
Discussion
Nearly all adolescents born before the introduction of Hib vaccination in the Lao PDR had antibody titers corresponding to at least short-term protection, indicating a high burden of Hib disease at that time. After vaccine introduction, all but four children (>99%) showed at least short-term protection. Possible explanations for the proportion of protected, yet apparently unvaccinated children, may be past infections, cross-reacting antibodies or faulty vaccination documentation. Our results highlight the need for robust surveillance and reporting of invasive Hib disease to determine the burden of disease despite vaccination.
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Lai X, Wahl B, Yu W, Xu T, Zhang H, Garcia C, Qin Y, Guo Y, Yin Z, Knoll MD, Fang H. National, regional, and provincial disease burden attributed to Streptococcus pneumoniae and Haemophilus influenzae type b in children in China: Modelled estimates for 2010-17. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 22:100430. [PMID: 35308577 PMCID: PMC8928075 DOI: 10.1016/j.lanwpc.2022.100430] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Vaccination against Streptococcus pneumoniae (pneumococcus) and Haemophilus influenzae type b (Hib) is not included in China's national immunization programme. To inform China's immunization polices, we estimated annual national, regional, and provincial childhood mortality and morbidity attributable to pneumococcus and Hib in 2010–17. Methods We estimated proportions of pneumonia and meningitis deaths and cases attributable to pneumococcus and Hib using evidence from vaccine clinical trials and surveillance studies of bacterial meningitis and pathogen-specific case fatality ratios (CFR). Then we applied the proportions to model provincial-level pneumonia cases and deaths, meningitis deaths and meningitis CFR in children aged 1–59 months, accounting for vaccine coverage. Non-pneumonia, non-meningitis (NPNM) invasive disease cases were derived by applying NPNM meningitis ratios to meningitis estimates. Findings In 2010–17, annual pneumococcal deaths fell by 49% from 15 600 (uncertainty range: 10 800–17 300) to 8 000 (5 500–8 900), and Hib deaths fell by 56% from 6 500 (4 500–8 800) to 2 900 (2 000–3 900). Severe pneumococcal and Hib cases decreased by 16% to 218 200 (161 500–252 200) in 2017 and 29% to 49 900 (29 000–99 100). Estimated 2017 national three-dose coverage in private market was 1·3% for PCV and 33·4% for Hib vaccine among children aged 1–59 months. Provinces in the west region had the highest disease burden. Interpretation Childhood mortality and morbidity attributable to pneumococcal and Hib has decreased in China, but still substantially varied by region and province. Higher vaccine coverage could further reduce disease burden. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- Xiaozhen Lai
- China Center for Health Development Studies, Peking University, Beijing, China.,Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Brian Wahl
- Johns Hopkins India, Lucknow, India.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Wenzhou Yu
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tingting Xu
- Department of Health Policy and Management, School of Public Health, Capital Medical University, Beijing, China
| | - Haijun Zhang
- China Center for Health Development Studies, Peking University, Beijing, China.,Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Cristina Garcia
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ying Qin
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yan Guo
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Zundong Yin
- National Immunization Programme, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maria Deloria Knoll
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China.,Peking University Health Science Center-Chinese Center for Disease Control and Prevention Joint Research Center for Vaccine Economics, Peking University, Beijing, China.,Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China
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6
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Otiende M, Bauni E, Nyaguara A, Amadi D, Nyundo C, Tsory E, Walumbe D, Kinuthia M, Kihuha N, Kahindi M, Nyutu G, Moisi J, Deribew A, Agweyu A, Marsh K, Tsofa B, Bejon P, Bottomley C, Williams TN, Scott JAG. Mortality in rural coastal Kenya measured using the Kilifi Health and Demographic Surveillance System: a 16-year descriptive analysis. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.17307.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: The Kilifi Health and Demographic Surveillance System (KHDSS) was established in 2000 to define the incidence and prevalence of local diseases and evaluate the impact of community-based interventions. KHDSS morbidity data have been reported comprehensively but mortality has not been described. This analysis describes mortality in the KHDSS over 16 years. Methods: We calculated mortality rates from 2003–2018 in four intervals of equal duration and assessed differences in mortality across these intervals by age and sex. We calculated the period survival function and median survival using the Kaplan–Meier method and mean life expectancies using abridged life tables. We estimated trend and seasonality by decomposing a time series of monthly mortality rates. We used choropleth maps and random-effects Poisson regression to investigate geographical heterogeneity. Results: Mortality declined by 36% overall between 2003–2018 and by 59% in children aged <5 years. Most of the decline occurred between 2003 and 2006. Among adults, the greatest decline (49%) was observed in those aged 15–54 years. Life expectancy at birth increased by 12 years. Females outlived males by 6 years. Seasonality was only evident in the 1–4 year age group in the first four years. Geographical variation in mortality was ±10% of the median value and did not change over time. Conclusions: Between 2003 and 2018, mortality among children and young adults has improved substantially. The steep decline in 2003–2006 followed by a much slower reduction thereafter suggests improvements in health and wellbeing have plateaued in the last 12 years. However, there is substantial inequality in mortality experience by geographical location.
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7
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Awori JO, Kamau A, Morpeth S, Kazungu S, Silaba M, Sande J, Karani A, Nyongesa S, Mwarumba S, Musyimi R, Bett A, Wande S, Shebe M, Ngama M, Munywoki PK, Muturi N, Nokes DJ, Feikin DR, Murdoch DR, Prosperi C, O’Brien KL, Deloria Knoll M, Hammitt LL, Scott JAG. The Etiology of Pneumonia in HIV-uninfected Children in Kilifi, Kenya: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study. Pediatr Infect Dis J 2021; 40:S29-S39. [PMID: 34448742 PMCID: PMC8448399 DOI: 10.1097/inf.0000000000002653] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND In the 1980s, Streptococcus pneumoniae and Haemophilus influenzae were identified as the principal causes of severe pneumonia in children. We investigated the etiology of severe childhood pneumonia in Kenya after introduction of conjugate vaccines against H. influenzae type b, in 2001, and S. pneumoniae, in 2011. METHODS We conducted a case-control study between August 2011 and November 2013 among residents of the Kilifi Health and Demographic Surveillance System 28 days to 59 months of age. Cases were hospitalized at Kilifi County Hospital with severe or very severe pneumonia according to the 2005 World Health Organization definition. Controls were randomly selected from the community and frequency matched to cases on age and season. We tested nasal and oropharyngeal samples, sputum, pleural fluid, and blood specimens and used the Pneumonia Etiology Research for Child Health Integrated Analysis, combining latent class analysis and Bayesian methods, to attribute etiology. RESULTS We enrolled 630 and 863 HIV-uninfected cases and controls, respectively. Among the cases, 282 (44%) had abnormal chest radiographs (CXR positive), 33 (5%) died in hospital, and 177 (28%) had diagnoses other than pneumonia at discharge. Among CXR-positive pneumonia cases, viruses and bacteria accounted for 77% (95% CrI: 67%-85%) and 16% (95% CrI: 10%-26%) of pneumonia attribution, respectively. Respiratory syncytial virus, S. pneumoniae and H. influenza, accounted for 37% (95% CrI: 31%-44%), 5% (95% CrI: 3%-9%), and 6% (95% CrI: 2%-11%), respectively. CONCLUSIONS Respiratory syncytial virus was the main cause of CXR-positive pneumonia. The small contribution of H. influenzae type b and pneumococcus to pneumonia may reflect the impact of vaccine introductions in this population.
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Affiliation(s)
- Juliet O. Awori
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alice Kamau
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Susan Morpeth
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Sidi Kazungu
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Micah Silaba
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | | | - Angela Karani
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Sammy Nyongesa
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Salim Mwarumba
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Robert Musyimi
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Anne Bett
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Siti Wande
- Clinical Sciences Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Mohammed Shebe
- Clinical Sciences Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Mwanajuma Ngama
- Clinical Sciences Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Patrick K. Munywoki
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - Neema Muturi
- Clinical Sciences Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
| | - D. James Nokes
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
- School of Life Sciences and WIDER, University of Warwick, Coventry, United Kingdom
| | - Daniel R. Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David R. Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Katherine L. O’Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Laura L. Hammitt
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - J. Anthony G. Scott
- From the Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, CGMR-Coast, Kilifi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Nuffield Department of Tropical Medicine, Oxford University, Oxford, United Kingdom
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Invasive Haemophilus influenzae Infections after 3 Decades of Hib Protein Conjugate Vaccine Use. Clin Microbiol Rev 2021; 34:e0002821. [PMID: 34076491 DOI: 10.1128/cmr.00028-21] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Haemophilus influenzae serotype b (Hib) was previously the most common cause of bacterial meningitis and an important etiologic agent of pneumonia in children aged <5 years. Its major virulence factor is the polyribosyl ribitol phosphate (PRP) polysaccharide capsule. In the 1980s, PRP-protein conjugate Hib vaccines were developed and are now included in almost all national immunization programs, achieving a sustained decline in invasive Hib infections. However, invasive Hib disease has not yet been eliminated in countries with low vaccine coverage, and sporadic outbreaks of Hib infection still occur occasionally in countries with high vaccine coverage. Over the past 2 decades, other capsulated serotypes have been recognized increasingly as causing invasive infections. H. influenzae serotype a (Hia) is now a major cause of invasive infection in Indigenous communities of North America, prompting a possible requirement for an Hia conjugate vaccine. H. influenzae serotypes e and f are now more common than serotype b in Europe. Significant year-to-year increases in nontypeable H. influenzae invasive infections have occurred in many regions of the world. Invasive H. influenzae infections are now seen predominantly in patients at the extremes of life and those with underlying comorbidities. This review provides a comprehensive and critical overview of the current global epidemiology of invasive H. influenzae infections in different geographic regions of the world. It discusses those now at risk of invasive Hib disease, describes the emergence of other severe invasive H. influenzae infections, and emphasizes the importance of long-term, comprehensive, clinical and microbiologic surveillance to monitor a vaccine's impact.
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9
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Slack MPE. Long Term Impact of Conjugate Vaccines on Haemophilus influenzae Meningitis: Narrative Review. Microorganisms 2021; 9:886. [PMID: 33919149 PMCID: PMC8143157 DOI: 10.3390/microorganisms9050886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/11/2021] [Accepted: 04/19/2021] [Indexed: 02/06/2023] Open
Abstract
H. influenzae serotype b (Hib) used to be the commonest cause of bacterial meningitis in young children. The widespread use of Hib conjugate vaccine has profoundly altered the epidemiology of H. influenzae meningitis. This short review reports on the spectrum of H. influenzae meningitis thirty years after Hib conjugate vaccine was first introduced into a National Immunization Program (NIP). Hib meningitis is now uncommon, but meningitis caused by other capsulated serotypes of H. influenzae and non-typeable strains (NTHi) should be considered. H. influenzae serotype a (Hia) has emerged as a significant cause of meningitis in Indigenous children in North America, which may necessitate a Hia conjugate vaccine. Cases of Hie, Hif, and NTHi meningitis are predominantly seen in young children and less common in older age groups. This short review reports on the spectrum of H. influenzae meningitis thirty years after Hib conjugate vaccine was first introduced into a NIP.
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10
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Effect of Haemophilus influenzae Type b Vaccination on Nasopharyngeal Carriage Rate in Children, Tehran, 2019. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4923852. [PMID: 33816612 PMCID: PMC7987433 DOI: 10.1155/2021/4923852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 02/21/2021] [Accepted: 03/08/2021] [Indexed: 11/19/2022]
Abstract
Background Haemophilus influenzae (H. influenzae) strains, which commonly reside as commensals within the human pharynx and can remain as an asymptomatic carrier, but become invasive leading to pneumonia, septic arthritis, or meningitis. The Pentavac (pentavalent vaccine, manufactured by India, SII (DTwP-HepB-Hib)) was introduced to the Iranian National Immunization Plan in November 2014. The aim of this study is to investigate H. influenzae type b (Hib) carrier rate among children under 6 years old in Tehran. Methods This cross-sectional study was performed on 902 children including vaccinated/unvaccinated in the age of 6 months to 6 years, in Tehran. Sampling was performed from July 2019 to September 2019. Nasopharyngeal samples were taken from children by sterile swab. The PCR method was used to extract DNA. Then, all H. influenzae isolates were initially confirmed by molecular tests. BexA was used to distinguish typeable H. influenzae strains from nontypeable Haemophilus influenzae (NTHi). Results A total of 902 children were enrolled in the study: 452 were female (51%). H. influenzae carriage rate was 267 (29%), of that 150 samples (16.6%) were typeable. The nasopharyngeal Hib carrier rate in the children was 2.6% (24/902). 262 cases did not receive Hib vaccine. Analysis in nonnursery's children aged 4 to 6 (unvaccinated) years showed that the lower educational level of father, mother, and family number correlated with increased odds of colonization of children with Hib. Conclusion Our findings showed a significant decrease (60%) in the overall Hib nasopharyngeal carriage in healthy children under six years after 5 years after the start of Hib vaccination.
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11
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Zaman SM, Howie SR, Ochoge M, Secka O, Bah A, Baldeh I, Sanneh B, Darboe S, Ceesay B, Camara HB, Mawas F, Ndiaye M, Hossain I, Salaudeen R, Bojang K, Ceesay S, Sowe D, Hossain MJ, Mulholland K, Kwambana-Adams BA, Okoi C, Badjie S, Ceesay L, Mwenda JM, Cohen AL, Agocs M, Mihigo R, Bottomley C, Antonio M, Mackenzie GA. Impact of routine vaccination against Haemophilus influenzae type b in The Gambia: 20 years after its introduction. J Glob Health 2021; 10:010416. [PMID: 32509291 PMCID: PMC7243067 DOI: 10.7189/jogh.10.010416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background In 1997, The Gambia introduced three primary doses of Haemophilus influenzae type b (Hib) conjugate vaccine without a booster in its infant immunisation programme along with establishment of a population-based surveillance on Hib meningitis in the West Coast Region (WCR). This surveillance was stopped in 2002 with reported elimination of Hib disease. This was re-established in 2008 but stopped again in 2010. We aimed to re-establish the surveillance in WCR and to continue surveillance in Basse Health and Demographic Surveillance System (BHDSS) in the east of the country to assess any shifts in the epidemiology of Hib disease in The Gambia. Methods In WCR, population-based surveillance for Hib meningitis was re-established in children aged under-10 years from 24 December 2014 to 31 March 2017, using conventional microbiology and Real Time Polymerase Chain Reaction (RT-PCR). In BHDSS, population-based surveillance for Hib disease was conducted in children aged 2-59 months from 12 May 2008 to 31 December 2017 using conventional microbiology only. Hib carriage survey was carried out in pre-school and school children from July 2015 to November 2016. Results In WCR, five Hib meningitis cases were detected using conventional microbiology while another 14 were detected by RT-PCR. Of the 19 cases, two (11%) were too young to be protected by vaccination while seven (37%) were unvaccinated. Using conventional microbiology, the incidence of Hib meningitis per 100 000-child-year (CY) in children aged 1-59 months was 0.7 in 2015 (95% confidence interval (CI) = 0.0-3.7) and 2.7 (95% CI = 0.7-7.0) in 2016. In BHDSS, 25 Hib cases were reported. Nine (36%) were too young to be protected by vaccination and five (20%) were under-vaccinated for age. Disease incidence peaked in 2012-2013 at 15 per 100 000 CY and fell to 5-8 per 100 000 CY over the subsequent four years. The prevalence of Hib carriage was 0.12% in WCR and 0.38% in BHDSS. Conclusions After 20 years of using three primary doses of Hib vaccine without a booster Hib transmission continues in The Gambia, albeit at low rates. Improved coverage and timeliness of vaccination are of high priority for Hib disease in settings like Gambia, and there are currently no clear indications of a need for a booster dose.
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Affiliation(s)
- Syed Ma Zaman
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Education Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Stephen Rc Howie
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia.,Department of Paediatrics, University of Auckland, Auckland, New Zealand
| | - Magnus Ochoge
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ousman Secka
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Alasana Bah
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ignatius Baldeh
- National Public Health Laboratory, Ministry of Health & Social Welfare, Kotu, The Gambia
| | - Bakary Sanneh
- National Public Health Laboratory, Ministry of Health & Social Welfare, Kotu, The Gambia
| | - Saffiatou Darboe
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Buntung Ceesay
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Haddy Bah Camara
- Edward Francis Small Teaching Hospital, Ministry of Health & Social Welfare, Banjul, The Gambia
| | - Fatme Mawas
- National Institute for Biological Standards and Control (NIBSC), Hertfordshire, UK
| | - Malick Ndiaye
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Ilias Hossain
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Rasheed Salaudeen
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Kalifa Bojang
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Samba Ceesay
- Directorate of Health Services, Ministry of Health & Social Welfare, Banjul, The Gambia
| | - Dawda Sowe
- Directorate of Health Services, Ministry of Health & Social Welfare, Banjul, The Gambia
| | - M Jahangir Hossain
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Kim Mulholland
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Brenda A Kwambana-Adams
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Catherine Okoi
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Siaka Badjie
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Lamin Ceesay
- Expanded Programme on Immunization, Ministry of Health & Social Welfare, Kotu, The Gambia
| | - Jason M Mwenda
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Adam L Cohen
- World Health Organization, Headquarters, Geneva, Switzerland
| | - Mary Agocs
- American Red Cross, Washington, D.C., USA
| | - Richard Mihigo
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Christian Bottomley
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Martin Antonio
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia.,Dept. of Pathogen Molecular Biology, London School of Hygiene & Tropical Medicine, London, UK.,Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Grant A Mackenzie
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Institut de Recherche en Sante, de Surveillance Epidemiologique et de Formation, Dakar, Senegal
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12
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Wilck MB, Jin Xu Z, Stek JE, Goveia MG, Lee AW. Protective immune responses against Haemophilus influenza type b elicited by a fully-liquid DTaP-IPV-Hib-HepB vaccine (VAXELIS™). Vaccine 2021; 39:1428-1434. [PMID: 33541794 DOI: 10.1016/j.vaccine.2021.01.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 12/09/2020] [Accepted: 01/16/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND DTaP-IPV-Hib-HepB is a fully-liquid, hexavalent combination vaccine (Vaxelis™) approved for vaccination against diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B, and invasive disease due to Haemophilus influenzae type b (Hib). Hib capsular polysaccharide, polyribosylribitol phosphate (PRP), is conjugated to Neisseria meningitidis outer membrane protein complex (OMPC). Safety and immunogenicity of DTaP-IPV-Hib-HepB were evaluated in 6 Phase III clinical studies including > 5,200 children. Studies included vaccination schedules in the United States (2, 4, 6 months of age) and Europe (2, 3, 4, 12 months of age and 2,4,11-12 months of age). METHODS Data pertaining to anti-PRP responses of DTaP-IPV-Hib-Hep B compared to control vaccines from 5 Phase III studies are summarized. RESULTS Post-infant series, the percentage of participants that achieved protective antibody thresholds for PRP (anti-PRP titer ≥ 0.15 μg/mL and ≥ 1.0 μg/mL, respectively) were higher in DTaP-IPV-Hib-HepB recipients compared to recipients who received control vaccines. A high level of protective responses (96.6% at ≥ 0.15 μg/mL [95% CI:94.8, 97.9%]; 72.9% at ≥ 1.0 μg/mL [95% CI:69.2,76.4%]) were seen post-dose 2 of the 2 + 1 vaccination schedule and met superiority criteria over comparator, p-value < 0.001. In the same schedule, prior to administration of the toddler dose (in the second year of life), anti-PRP titers were higher in DTaP-IPV-Hib-HepB recipients (91.4% at ≥ 0.15 μg/mL; 46.8% at ≥ 1.0 μg/mL) as compared to recipients who received control vaccines (63.4% at ≥ 0.15 μg/mL; 17.1% at ≥ 1.0 μg/mL). One-month post-toddler dose, high levels of anti-PRP titers were achieved in both DTaP-IPV-Hib-HepB recipients (99.8% at ≥ 0.15 μg/mL; 96.6% at ≥ 1.0 μg/mL) and recipients who received control vaccines (99.5% at ≥ 0.15 μg/mL; 94.9% at ≥ 1.0 μg/mL). CONCLUSIONS These results support that DTaP-IPV-Hib-HepB induces a robust and sustained early Hib response. During the high-risk period for Hib disease after the infant vaccine and prior to the toddler dose; >90% of recipients maintained superior protective anti-PRP levels compared to control.
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Affiliation(s)
| | - Z Jin Xu
- Merck & Co., Inc., Kenilworth, NJ, USA.
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13
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Uddén F, Filipe M, Slotved HC, Yamba-Yamba L, Fuursted K, Pintar Kuatoko P, Larsson M, Bjurgert J, Månsson V, Pelkonen T, Reimer Å, Riesbeck K. Pneumococcal carriage among children aged 4 - 12 years in Angola 4 years after the introduction of a pneumococcal conjugate vaccine. Vaccine 2020; 38:7928-7937. [PMID: 33143954 DOI: 10.1016/j.vaccine.2020.10.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
Children in Angola are affected by a high burden of disease caused by pneumococcal infections. The 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in the childhood immunization programme in 2013 but the serotype distribution of Streptococcus pneumoniae and antimicrobial susceptibility patterns are unknown. We did a cross-sectional nasopharyngeal carriage study in Luanda and Saurimo, Angola (PCV13 3rd dose coverage 67% and 84%, respectively) during November to December 2017 comprising 940 children aged 4-12 years. The main objective was to assess vaccine serotype coverage and antimicrobial susceptibility rates for S. pneumoniae. Our secondary aim was to characterize colonizinig strains of Haemophilus influenzae and Moraxella catarrhalis. Pneumococcal colonization was found in 35% (95% CI 32-39%) of children (n = 332), with 41% of serotypes covered by PCV13. The most common serotypes were 3 (8%), 18C (6%), 23F (6%), 11A (6%), 34 (6%), 19F (5%) and 16 (5%). Carriage of H. influenzae and M. catarrhalis was detected in 13% (95% CI 11-15%) and 15% (95% CI 13-17%) of children, respectively. Non-susceptibility to penicillin was common among pneumococci (40%), particularly among PCV13-included serotypes (50% vs. 33%; p = 0.003), although the median minimal inhibitory concentration was low (0.19 µg/mL, IQR 0.13-0.25 µg/mL). Most pneumococci and H. influenzae were susceptible to amoxicillin (99% and 88%, respectively). Furthermore, resistance to trimethoprim-sulfamethoxazole was>70% among all three species. Multidrug-resistant pneumococci (non-susceptible to ≥ 3 antibiotics; 7% [n = 24]) were further studied with whole genome sequencing to investigate clonality as an underlying cause for this phenotype. No clearly dominating clone(s) were, however, detected. The results indicate that continued use of PCV13 may have positive direct and herd effects on pneumococcal infections in Angola as carriage of vaccine serotypes was common in the non-vaccinated age group. Finally, amoxicillin is assessed to be a feasible empirical treatment of respiratory tract infections in Angola.
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Affiliation(s)
- Fabian Uddén
- Clinical microbiology, Department of Translational Medicine, Faculty of Medicine, Lund university, Jan Waldenströms gata 59, SE-205 02 Malmö, Sweden.
| | - Matuba Filipe
- ORL-department, Hospital Josina Machel, Luanda, Angola; Faculty of Medicine, Agostinho Neto University, Luanda, Angola
| | - Hans-Christian Slotved
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark.
| | - Linda Yamba-Yamba
- Clinical microbiology, Department of Translational Medicine, Faculty of Medicine, Lund university, Jan Waldenströms gata 59, SE-205 02 Malmö, Sweden.
| | - Kurt Fuursted
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark.
| | - Palmira Pintar Kuatoko
- ORL-department, Hospital Josina Machel, Luanda, Angola; Faculty of Medicine, Agostinho Neto University, Luanda, Angola
| | - Måns Larsson
- Clinical microbiology, Department of Translational Medicine, Faculty of Medicine, Lund university, Jan Waldenströms gata 59, SE-205 02 Malmö, Sweden
| | - Jonas Bjurgert
- Clinical microbiology, Department of Translational Medicine, Faculty of Medicine, Lund university, Jan Waldenströms gata 59, SE-205 02 Malmö, Sweden
| | - Viktor Månsson
- Clinical microbiology, Department of Translational Medicine, Faculty of Medicine, Lund university, Jan Waldenströms gata 59, SE-205 02 Malmö, Sweden.
| | - Tuula Pelkonen
- Children's Hospital, Helsinki University Hospital, Helsinki, Finland; University of Helsinki, Helsinki, Finland
| | - Åke Reimer
- ENT-Outpatient Department, Slottsstadens Läkarhus, Malmö, Sweden
| | - Kristian Riesbeck
- Clinical microbiology, Department of Translational Medicine, Faculty of Medicine, Lund university, Jan Waldenströms gata 59, SE-205 02 Malmö, Sweden.
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14
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Slack M, Esposito S, Haas H, Mihalyi A, Nissen M, Mukherjee P, Harrington L. Haemophilus influenzae type b disease in the era of conjugate vaccines: critical factors for successful eradication. Expert Rev Vaccines 2020; 19:903-917. [PMID: 32962476 DOI: 10.1080/14760584.2020.1825948] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Prior to implementation of Haemophilus influenzae type b (Hib)-conjugate vaccination programs in the 1990s, Hib was the commonest cause of bacterial meningitis in children aged <5 years. While the burden of all Hib disease has significantly decreased in the post-vaccination era, Hib still accounted for >29,000 deaths worldwide in children aged <5 years in 2015. AREAS COVERED We reviewed literature data on the most widely used Hib vaccines and vaccination strategies which led to the global prevention and control of Hib disease and aim to highlight important factors for continued disease control and elimination in the future. EXPERT COMMENTARY More than 90% of countries worldwide have implemented Hib-conjugate vaccination in their national immunization programs. Vaccines containing Hib polyribosylribitol phosphate (PRP) conjugated with tetanus toxoid (Hib-TT) are the most commonly used. Neisseria meningitidis outer membrane protein complex of PRP (Hib-OMP) is also used. Although the kinetics of the immune response varies with Hib vaccine and schedule used, high control of Hib disease was observed in all settings/scenarios. Further improving global Hib vaccination coverage may result in disease elimination. Plain language summary What is the context? Haemophilus influenzae is causing a variety of diseases, from otitis media and sinusitis to invasive disease (e.g. meningitis and pneumonia). H. influenzae type b (Hib) was the most common cause of bacterial meningitis in children <5 years of age, and especially among <2-year-olds. Even with appropriate treatment, up to 40% of children with bacterial meningitis can suffer permanent disabilities and up to 5% will die. The development of vaccines to protect against Hib disease has started in the late 1970s and has culminated with the licensure of 4 Hib conjugate vaccines, of which 2 are currently widely used. What is new? In this review, we gathered evidence on the different Hib vaccines and vaccination strategies that have contributed to the global prevention and control of Hib disease. The review indicates: the incidence of Hib disease has decreased considerably due to the introduction of Hib vaccines in national immunization programs worldwide. However, Hib disease is not yet completely eradicated. the vaccines currently used offer protection against Hib over long periods of time. carriage of the pathogen by healthy individuals seem to be less frequent, but data are still needed to fully evaluate the impact of vaccination. other H. influenzae types are now more frequent. Why is this important? Despite the huge success of Hib vaccination, continuous surveillance is needed to anticipate potential re-emergences and devise the best strategies for prevention and control of disease. Hib vaccination should be considered in the few countries who have not yet implemented it, to decrease associated morbidity and mortality.
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Affiliation(s)
- Mary Slack
- School of Medicine, Griffith University, Gold Coast Campus , Queensland, Australia
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, Università Degli Studi Di Parma , Parma, Italia
| | - Hervé Haas
- Pediatric Hospital of Nice, Lenval University , France
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15
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Boula A, Senghore M, Ngoh R, Tassadjo F, Fonkoua MC, Nzouankeu A, Njiki MK, Musi J, Bebey S, Ngo Baleba M, Nkembe A, Médjina S, Ndow PS, Worwui A, Kobela M, Nimpa M, Mwenda JM, N'diaye A, Kwambana-Adams BA, Antonio M. Hospital-based Surveillance Provides Insights Into the Etiology of Pediatric Bacterial Meningitis in Yaoundé, Cameroon, in the Post-Vaccine Era. Clin Infect Dis 2020; 69:S148-S155. [PMID: 31505633 PMCID: PMC6761319 DOI: 10.1093/cid/ciz506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Meningitis is endemic to regions of Cameroon outside the meningitis belt including the capital city, Yaoundé. Through surveillance, we studied the etiology and molecular epidemiology of pediatric bacterial meningitis in Yaoundé from 2010 to 2016. Methods Lumbar puncture was performed on 5958 suspected meningitis cases; 765 specimens were further tested by culture, latex agglutination, and/or polymerase chain reaction (PCR). Serotyping/grouping, antimicrobial susceptibility testing, and/or whole genome sequencing were performed where applicable. Results The leading pathogens detected among the 126 confirmed cases were Streptococcus pneumoniae (93 [73.8%]), Haemophilus influenzae (18 [14.3%]), and Neisseria meningitidis (15 [11.9%]). We identified more vaccine serotypes (19 [61%]) than nonvaccine serotypes (12 [39%]); however, in the latter years non–pneumococcal conjugate vaccine serotypes were more common. Whole genome data on 29 S. pneumoniae isolates identified related strains (<30 single-nucleotide polymorphism difference). All but 1 of the genomes harbored a resistance genotype to at least 1 antibiotic, and vaccine serotypes harbored more resistance genes than nonvaccine serotypes (P < .05). Of 9 cases of H. influenzae, 8 were type b (Hib) and 1 was type f. However, the cases of Hib were either in unvaccinated individuals or children who had not yet received all 3 doses. We were unable to serogroup the N. meningitidis cases by PCR. Conclusions Streptococcus pneumoniae remains a leading cause of pediatric bacterial meningitis, and nonvaccine serotypes may play a bigger role in disease etiology in the postvaccine era. There is evidence of Hib disease among children in Cameroon, which warrants further investigation.
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Affiliation(s)
- Angeline Boula
- Centre Mere et Enfant de la Fondation, Yaoundé, Cameroon
| | - Madikay Senghore
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, West Africa Partnerships and Strategy, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Rose Ngoh
- Centre Mere et Enfant de la Fondation, Yaoundé, Cameroon
| | | | | | | | | | | | - Sandrine Bebey
- Centre Mere et Enfant de la Fondation, Yaoundé, Cameroon
| | | | | | | | - Peter S Ndow
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, West Africa Partnerships and Strategy, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Archibald Worwui
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, West Africa Partnerships and Strategy, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | | | | | - Jason M Mwenda
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | | | - Brenda A Kwambana-Adams
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, West Africa Partnerships and Strategy, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Martin Antonio
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, West Africa Partnerships and Strategy, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia.,Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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16
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Renner LA, Usuf E, Mohammed NI, Ansong D, Dankwah T, Kusah JT, Owusu SK, Awunyo M, Arhin B, Addo Y, Asamoah J, Biey JNM, Ndow PS, Worwui A, Senghore M, Ntsama B, Mwenda JM, Diamenu SK, Adams BK, Antonio M. Hospital-based Surveillance for Pediatric Bacterial Meningitis in the Era of the 13-Valent Pneumococcal Conjugate Vaccine in Ghana. Clin Infect Dis 2020; 69:S89-S96. [PMID: 31505622 PMCID: PMC6736167 DOI: 10.1093/cid/ciz464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Global surveillance for vaccine preventable invasive bacterial diseases has been set up by the World Health Organization to provide disease burden data to support decisions on introducing pneumococcal conjugate vaccine (PCV). We present data from 2010 to 2016 collected at the 2 sentinel sites in Ghana. Methods Data were collected from children <5 years of age presenting at the 2 major teaching hospitals with clinical signs of meningitis. Cerebrospinal fluid specimens were collected and tested first at the sentinel site laboratory with conventional microbiology methods and subsequently with molecular analysis, at the World Health Organization Regional Reference Laboratory housed at the Medical Research Council Unit The Gambia, for identification of Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, the 3 most common bacteria causing meningitis. Results There were 4008 suspected cases of meningitis during the surveillance period, of which 31 (0.8%) were laboratory confirmed. Suspected meningitis cases decreased from 923 in 2010 to 219 in 2016. Of 3817 patients with available outcome data, 226 (5.9%) died. S. pneumoniae was the most common bacterial pathogen, accounting for 68.5% of confirmed cases (50 of 73). H. influenzae and N. meningitidis accounted for 6.8% (5 of 73) and 21.9% (16 of 73), respectively. The proportion of pneumococcal vaccine serotypes causing meningitis decreased from 81.3% (13 of 16) before the introduction of 13-valent PCV (2010–2012) to 40.0% (8 of 20) after its introduction (2013–2016). Conclusions Cases of suspected meningitis decreased among children <5 years of age between 2010 and 2016, with declines in the proportion of vaccine-type pneumococcal meningitis after the introduction of 13-valent PCV in Ghana.
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Affiliation(s)
- Lorna Awo Renner
- University of Ghana School of Medicine and Dentistry, Accra, United Kingdom
| | - Effua Usuf
- Regional Reference Laboratory, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Diseases, Fajara, United Kingdom.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Nuredin Ibrahim Mohammed
- Regional Reference Laboratory, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Diseases, Fajara, United Kingdom
| | | | | | - Jonas Tettey Kusah
- University of Ghana School of Medicine and Dentistry, Accra, United Kingdom
| | | | | | | | | | | | - Joseph Nsiari-Muzeyi Biey
- World Health Organization (WHO) Inter-country Support Team, Ouagadougou, West Africa, Republic of Congo
| | - Peter Slyvanus Ndow
- Regional Reference Laboratory, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Diseases, Fajara, United Kingdom
| | - Archibald Worwui
- Regional Reference Laboratory, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Diseases, Fajara, United Kingdom
| | - Madikay Senghore
- Regional Reference Laboratory, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Diseases, Fajara, United Kingdom
| | - Bernard Ntsama
- World Health Organization (WHO) Inter-country Support Team, Ouagadougou, West Africa, Republic of Congo
| | - Jason M Mwenda
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | | | - Brenda Kwanbana Adams
- Regional Reference Laboratory, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Diseases, Fajara, United Kingdom.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Martin Antonio
- Regional Reference Laboratory, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Diseases, Fajara, United Kingdom.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom.,Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Hoang VT, Dao TL, Ly TDA, Belhouchat K, Larbi Chaht K, Yezli S, Alotaibi B, Raoult D, Parola P, Pommier de Santi V, Fournier PE, Gautret P. Dynamics and genetic diversity of Haemophilus influenzae carriage among French pilgrims during the 2018 Hajj: A prospective cohort survey. Travel Med Infect Dis 2020; 38:101883. [PMID: 32956850 DOI: 10.1016/j.tmaid.2020.101883] [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: 01/02/2020] [Revised: 07/01/2020] [Accepted: 08/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND To investigate the genetic diversity of Haemophilus influenzae positive samples among French pilgrims attending the 2018 Hajj pilgrimage. METHOD After screening by qPCR, multilocus sequence typing was performed for all H. influenzae-positive samples. The following housekeeping genes were amplified and assigned: adk, atpG, frdB, fucK, mdh, pgi and recA. RESULTS 121 pilgrims were included. H. influenzae was positive in 35.5% pre-Hajj samples, 12.4% at day five post-arrival, 15.7% at day 12 post-arrival, and 43.0% post-Hajj. Of the 129 positive swabs for H. influenzae, only one sample at D12 was negative for all seven genes amplified by standard PCR. The adk, atpG, frdB, mdh, pgi, recA and fucK genes were positive in 123, 107, 122, 70, 127, 118 and 69 samples, respectively. One sequence of atpG and two of recA genes were not possible to assign. None of the sequences of fucK gene was successfully obtained. Consequently, a complete sequence type characterisation was not possible. Of the 128 obtained strains, 111 had distinct patterns of alleles. CONCLUSION H. influenzae genotypes acquired were completely different from those present at pre-Hajj. We observed a great biodiversity and a lack of clonality of H. influenzae among French pilgrims during the 2018 Hajj. Further studies aiming at studying the genome of Hajj-acquired H. influenzae isolates are needed to define the clinical burden of H. influenzae infection during Hajj and to evaluate the potential interest of vaccination in Hajj pilgrims.
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Affiliation(s)
- Van-Thuan Hoang
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France; Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Thi-Loi Dao
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France; Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Tran Duc Anh Ly
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | - Khadidja Belhouchat
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | - Kamel Larbi Chaht
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | - Saber Yezli
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Badriah Alotaibi
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Didier Raoult
- IHU-Méditerranée Infection, Marseille, France; Aix Marseille Univ, MEPHI, Marseille, France
| | - Philippe Parola
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | - Vincent Pommier de Santi
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France; French Military Center for Epidemiology and Public Health Marseille, France
| | - Pierre-Edouard Fournier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | - Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France.
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Schiavo R, Basu Roy U, Faroul L, Solodunova G. Grounding evaluation design in the socio-ecological model of health: a logic framework for the assessment of a national routine immunization communication initiative in Kyrgyzstan. Glob Health Promot 2020; 27:59-68. [PMID: 32400250 DOI: 10.1177/1757975920914550] [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] [Indexed: 11/15/2022]
Abstract
Childhood routine immunization (RI) is a highly effective public health intervention for the prevention of infectious diseases. Despite high immunization rates, a 2018 Knowledge, Attitudes, and Practices (KAP) study by the United Nations Children's Fund (UNICEF) noted a growing practice of vaccine refusal among parents and primary caregivers as well as clusters of significantly lower immunization coverage in some provinces. Moreover, a 2018 Joint Appraisal report by GAVI (Global Vaccine Alliance) has highlighted a decrease in immunization rates among children under 1 year of age from 96.1% to 92% for some vaccines. As a result, UNICEF is spearheading a national communication initiative to increase the rates of RI in Kyrgyzstan. This initiative includes strengthening interpersonal communication skills of local healthcare workers, improving the quality and accuracy of media coverage via a tailored outreach to the Kyrgyz media, as well as fostering community engagement to give voice to local champions and engage hesitant parents and vaccine refuters. UNICEF has also partnered with a research team for the design phase of a suitable evaluation framework. Grounded in the socio-ecological model (SEM) of health, the framework recognizes the interconnection of behavioral, social, and policy change, and includes not only activity-specific indicators (process indicators) but also progress, outcome, and impact indicators to document results among key groups and stakeholders at different levels of the SEM, and, ultimately, on immunization rates in Kyrgyzstan. The framework reflects the importance of an integrated and multilevel approach to intervention and communication design, and integrates the SEM with a logic model that connects different components of the initiative. This paper introduces this evaluation framework, including implications for the evaluation of child health programs, and other public health, communication, and international development interventions.
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Affiliation(s)
- Renata Schiavo
- Strategic Communication Resources, New York, USA.,Columbia University Mailman School of Public Health, New York, USA.,Health Equity Initiative, New York, USA
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León ME, Kawabata A, Nagai M, Rojas L, Chamorro G, Zárate N, Gómez G, Leguizamón M, Irala J, Ortellado J, Franco R, Segovia N. Epidemiologic study of Haemophilus influenzae causing invasive and non-invasive disease in Paraguay (1999-2017). Enferm Infecc Microbiol Clin 2020; 39:59-64. [PMID: 32197798 DOI: 10.1016/j.eimc.2020.02.020] [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: 10/04/2019] [Revised: 01/25/2020] [Accepted: 02/09/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Haemophilus influenzae is a cause of mild and severe invasive infections, especially among children under 5 years old. Serotype b (Hib) was very frequent before the introduction of the vaccine, which was introduced in Paraguay in 2004. METHODS A total of 523 isolates of H. influenzae obtained from 1999 to 2017 and referred to the National Reference Laboratory in Paraguay were studied by conventional microbiological methods and molecular techniques. RESULTS The most frequent serotype was non-typeable (HiNT) (51.8%; 271/523), followed by Hib (43%; 225/523), Hia and Hif (1.5%; 8/523, respectively), Hic (1%; 5/523), Hie (0.8%; 4/523), and Hid (0.4%; 2/523). A total of 48.4% invasive infections were caused by HiNT, and 46.1% by Hib; 88.6% of isolates corresponded to meningitis, 70.8% to sepsis and 50.9% to pneumonia in children under 5 years. A total of 84% (181/217) of isolates corresponded to invasive infections caused by Hib in children under 5 years, with the highest proportion observed between 2001 and 2003. The most prevalent biotypes were biotype I (29%), biotype II (12%), biotype III (24%), and biotype IV (13%). Among the total of isolates, 13% (68/523) of isolates were resistant to ampicillin. CONCLUSION After the introduction of the Hib vaccine in Paraguay, the number of invasive Hib cases decreased in children under 5 years old, although we observed an increase of HiNT in children over 5 years. Continuous surveillance is necessary in order to monitor the effectiveness of the vaccine and for the development of preventive interventions.
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Affiliation(s)
- María Eugenia León
- Sección Enfermedades Respiratorias y Meníngeas, Laboratorio Central de Salud Pública, Asunción, Paraguay.
| | - Aníbal Kawabata
- Sección Enfermedades Respiratorias y Meníngeas, Laboratorio Central de Salud Pública, Asunción, Paraguay
| | - Minako Nagai
- Sección Enfermedades Respiratorias y Meníngeas, Laboratorio Central de Salud Pública, Asunción, Paraguay
| | - Liliana Rojas
- Sección Enfermedades Respiratorias y Meníngeas, Laboratorio Central de Salud Pública, Asunción, Paraguay
| | - Gustavo Chamorro
- Sección Enfermedades Respiratorias y Meníngeas, Laboratorio Central de Salud Pública, Asunción, Paraguay
| | - Noemí Zárate
- Servicio de Bacteriología y Micología, Hospital General Pediátrico Niños de Acosta Ñu, San Lorenzo, Paraguay
| | - Gloria Gómez
- Servicio de Microbiología, Hospital Nacional de Itauguá, Itauguá, Paraguay
| | - Myrian Leguizamón
- Servicio de Microbiología, Instituto de Previsión Social, Asunción, Paraguay
| | - Juan Irala
- Sección de Microbiología, Instituto de Medicina Tropical, Asunción, Paraguay
| | - Juana Ortellado
- Departamento de Microbiología, Hospital de Clínicas, San Lorenzo, Paraguay
| | - Rossana Franco
- Servicio de Microbiología, Instituto Nacional de Enfermedades Respiratorias y del Ambiente, Asunción, Paraguay
| | - Nancy Segovia
- Laboratorio de Microbiología, Hospital Regional Ciudad del Este, Ciudad del Este, Paraguay
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High diversity of invasive Haemophilus influenzae isolates in France and the emergence of resistance to third generation cephalosporins by alteration of ftsI gene. J Infect 2019; 79:7-14. [DOI: 10.1016/j.jinf.2019.05.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/17/2019] [Accepted: 05/10/2019] [Indexed: 01/09/2023]
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Sambala EZ, Wiyeh AB, Ngcobo N, Machingaidze S, Wiysonge CS. New vaccine introductions in Africa before and during the decade of vaccines - Are we making progress? Vaccine 2019; 37:3290-3295. [PMID: 31076160 DOI: 10.1016/j.vaccine.2019.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 04/11/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022]
Abstract
Vaccines are excellent investments with far-reaching rewards beyond individual and population health, but their introduction into national programs has been historically slow in Africa. We provide an overview of the introduction of new and underutilized vaccines in countries of the WHO African Region by 2017, using data from the WHO-UNICEF Joint Reporting Form. By 2017, all 47 countries had introduced vaccines containing hepatitis B (compared to 11% in 2000 and 98% in 2010) and Haemophilus influenzae type b (Hib) (compared to 4% in 2000 and 91% in 2010). The proportion of countries that had introduced other vaccines by 2017 was 83% for pneumococcal conjugate vaccine (PCV) from 7% in 2010, 72% for rotavirus vaccine from 2% in 2010, 55% for the second dose of a measles-containing vaccine (MCV2) (compared to 11% in 2000 and 17% in 2010), and 45% for rubella-containing vaccines (RCV) (compared to 4% in 2000 and 7% in 2010). From 2000 to 2010, there was no significant difference between countries eligible (N = 36) and those not eligible (N = 10) for Gavi support in the introduction of hepatitis B and PCV. However, Gavi eligible countries were more likely to introduce Hib and non-Gavi eligible countries were more likely to introduce MCV2 and RCV. From 2010 to 2017, the only significant differences that remained between the two groups of countries were with mumps, inactivated polio and seasonal influenza vaccines; which non-Gavi eligible countries were more likely to have introduced. There has been significant progress in the introduction of new childhood vaccines in Africa, mostly driven by Gavi support. As many countries are expected to transition out of Gavi support soon, there is need for countries in the region to identify predictable, reliable and sustainable immunization funding mechanisms. This requires commitments and actions that go beyond the purchase of vaccines.
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Affiliation(s)
- Evanson Z Sambala
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
| | - Alison B Wiyeh
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Ntombenhle Ngcobo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Shingai Machingaidze
- European and Developing Countries Clinical Trials Partnership (EDCTP), Cape Town, South Africa
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Centre for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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22
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Burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines: global, regional, and national estimates for 2000-15. LANCET GLOBAL HEALTH 2019; 6:e744-e757. [PMID: 29903376 PMCID: PMC6005122 DOI: 10.1016/s2214-109x(18)30247-x] [Citation(s) in RCA: 661] [Impact Index Per Article: 132.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/28/2018] [Accepted: 04/30/2018] [Indexed: 12/25/2022]
Abstract
Background Pneumococcal conjugate vaccine (PCV) and Haemophilus influenzae type b (Hib) vaccine are now used in most countries. To monitor global and regional progress towards improving child health and to inform national policies for disease prevention and treatment, we prepared global, regional, and national disease burden estimates for these pathogens in children from 2000 to 2015. Methods Using WHO and Maternal and Child Epidemiology Estimation collaboration country-specific estimates of pneumonia and meningitis mortality and pneumonia morbidity from 2000 to 2015, we applied pneumococcal and Hib cause-specific proportions to estimate pathogen-specific deaths and cases. Summary estimates of the proportion of pneumonia deaths and cases attributable to these pathogens were derived from four Hib vaccine and six PCV efficacy and effectiveness study values. The proportion of meningitis deaths due to each pathogen was derived from bacterial meningitis aetiology and adjusted pathogen-specific meningitis case–fatality data. Pneumococcal and Hib meningitis cases were inferred from modelled pathogen-specific meningitis deaths and literature-derived case–fatality estimates. Cases of pneumococcal and Hib syndromes other than pneumonia and meningitis were estimated using the ratio of pathogen-specific non-pneumonia, non-meningitis cases to pathogen-specific meningitis cases from the literature. We accounted for annual HIV infection prevalence, access to care, and vaccine use. Findings We estimated that there were 294 000 pneumococcal deaths (uncertainty range [UR] 192 000–366 000) and 29 500 Hib deaths (18 400–40 700) in HIV-uninfected children aged 1–59 months in 2015. An additional 23 300 deaths (15 300–28 700) associated with pneumococcus and fewer than 1000 deaths associated Hib were estimated to have occurred in children infected with HIV. We estimate that pneumococcal deaths declined by 51% (7–74) and Hib deaths by 90% (78–96) from 2000 to 2015. Most children who died of pneumococcus (81%) and Hib (76%) presented with pneumonia. Less conservative assumptions result in pneumococcccal death estimates that could be as high as 515 000 deaths (302 000–609 000) in 2015. Approximately 50% of all pneumococcal deaths in 2015 occurred in four countries in Africa and Asia: India (68 700 deaths, UR 44 600–86 100), Nigeria (49 000 deaths, 32 400–59 000), the Democratic Republic of the Congo (14 500 deaths, 9300–18 700), and Pakistan (14 400 deaths, 9700–17 000]). India (15 600 deaths, 9800–21 500), Nigeria (3600 deaths, 2200–5100), China (3400 deaths, 2300–4600), and South Sudan (1000 deaths, 600–1400) had the greatest number of Hib deaths in 2015. We estimated 3·7 million episodes (UR 2·7 million–4·3 million) of severe pneumococcus and 340 000 episodes (196 000–669 000) of severe Hib globally in children in 2015. Interpretation The widespread use of Hib vaccine and the recent introduction of PCV in countries with high child mortality is associated with reductions in Hib and pneumococcal cases and deaths. Uncertainties in the burden of pneumococcal disease are largely driven by the fraction of pneumonia deaths attributable to pneumococcus. Progress towards further reducing the global burden of Hib and pneumococcal disease burden will depend on the efforts of a few large countries in Africa and Asia. Funding Bill & Melinda Gates Foundation.
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Yang Y, Wang Y, Yang D, Dong S, Yang Y, Zhu X, Chen Y, Zhou Y, Jiang Q. Factors associated with uptake of Haemophilus influenzae type b vaccination in Shanghai, China. BMC Pediatr 2019; 19:8. [PMID: 30616637 PMCID: PMC6323772 DOI: 10.1186/s12887-018-1374-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/18/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Haemophilus influenzae type b (Hib) vaccine is effective in reducing the burden of Hib related diseases, but little is known about factors influencing the uptake of Hib vaccine. This study aimed to assess the uptake of Hib vaccination and its associated factors in Shanghai City, China. METHODS We used data from a retrospective cohort of 183,246 children born in 2012-2016 obtained from the Shanghai Immunization Program Information System, which provided information on the uptake of Hib vaccination. We conducted a cross-sectional study of 451 children to collect information on demographic and other factors that might be associated with Hib vaccination. RESULTS In the retrospective cohort study, the proportions of Hib dose-1 coverage, vaccination completion and timeliness were 67.7, 52.2 and 29.4%, respectively. These measures were better among local children and increased with birth year, while there were regional differences. Hib vaccine uptake was significantly associated with maternal occupation (non-health vs health workers, OR = 2.33, 95% CI: 1.32-4.13, P = 0.004) and caregivers' awareness of Hib (yes vs no, OR = 1.75, 95% CI: 1.12-2.74, P = 0.013). CONCLUSIONS We found low levels of coverage of dose-1 Hib vaccine, timeliness and completion, suggesting inadequate protection against Hib disease for children in Shanghai. Non-local children and those of health workers should be targeted for interventions. The inclusion of Hib vaccine into the national immunization program could help improve the uptake of Hib vaccines.
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Affiliation(s)
- Ya Yang
- Key Laboratory of Public Health Safety, Ministry of Education, Tropical Disease Research Center, Department of Epidemiology, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai, 200032 China
| | - Yingjian Wang
- Key Laboratory of Public Health Safety, Ministry of Education, Tropical Disease Research Center, Department of Epidemiology, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai, 200032 China
| | - Dongjian Yang
- Key Laboratory of Public Health Safety, Ministry of Education, Tropical Disease Research Center, Department of Epidemiology, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai, 200032 China
| | - Shurong Dong
- Key Laboratory of Public Health Safety, Ministry of Education, Tropical Disease Research Center, Department of Epidemiology, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai, 200032 China
| | - Yu Yang
- Key Laboratory of Public Health Safety, Ministry of Education, Tropical Disease Research Center, Department of Epidemiology, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai, 200032 China
| | - Xu Zhu
- China Office of United Nations Children’s Fund, Beijing, China
| | - Yue Chen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Yibiao Zhou
- Key Laboratory of Public Health Safety, Ministry of Education, Tropical Disease Research Center, Department of Epidemiology, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai, 200032 China
| | - Qingwu Jiang
- Key Laboratory of Public Health Safety, Ministry of Education, Tropical Disease Research Center, Department of Epidemiology, School of Public Health, Fudan University, 130 Dong’an Road, Shanghai, 200032 China
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Adetifa IMO, Karia B, Mutuku A, Bwanaali T, Makumi A, Wafula J, Chome M, Mwatsuma P, Bauni E, Hammitt LL, Mataza C, Tabu C, Kamau T, Williams TN, Scott JAG. Coverage and timeliness of vaccination and the validity of routine estimates: Insights from a vaccine registry in Kenya. Vaccine 2018; 36:7965-7974. [PMID: 30416017 PMCID: PMC6288063 DOI: 10.1016/j.vaccine.2018.11.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 10/31/2018] [Accepted: 11/01/2018] [Indexed: 11/02/2022]
Abstract
BACKGROUND The benefits of childhood vaccines are critically dependent on vaccination coverage. We used a vaccine registry (as gold standard) in Kenya to quantify errors in routine coverage methods (surveys and administrative reports), to estimate the magnitude of survivor bias, contrast coverage with timeliness and use both measures to estimate population immunity. METHODS Vaccination records of children in the Kilifi Health and Demographic Surveillance System (KHDSS), Kenya were combined with births, deaths, migration and residence data from 2010 to 17. Using inverse survival curves, we estimated up-to-date and age-appropriate vaccination coverage, calculated mean vaccination coverage in infancy as the area under the inverse survival curves, and estimated the proportion of fully immunised children (FIC). Results were compared with published coverage estimates. Risk factors for vaccination were assessed using Cox regression models. RESULTS We analysed data for 49,090 infants and 48,025 children aged 12-23 months in 6 birth cohorts and 6 cross-sectional surveys respectively, and found 2nd year of life surveys overestimated coverage by 2% compared to birth cohorts. Compared to mean coverage in infants, static coverage at 12 months was exaggerated by 7-8% for third doses of oral polio, pentavalent (Penta3) and pneumococcal conjugate vaccines, and by 24% for the measles vaccine. Surveys and administrative coverage also underestimated the proportion of the fully immunised child by 10-14%. For BCG, Penta3 and measles, timeliness was 23-44% higher in children born in a health facility but 20-37% lower in those who first attended during vaccine stock outs. CONCLUSIONS Standard coverage surveys in 12-23 month old children overestimate protection by ignoring timeliness, and survivor and recall biases. Where delayed vaccination is common, up-to-date coverage will give biased estimates of population immunity. Surveys and administrative methods also underestimate FIC prevalence. Better measurement of coverage and more sophisticated analyses are required to control vaccine preventable diseases.
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Affiliation(s)
- Ifedayo M O Adetifa
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya; Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK.
| | - Boniface Karia
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya.
| | - Alex Mutuku
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya
| | - Tahreni Bwanaali
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya
| | - Anne Makumi
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya
| | - Jackline Wafula
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya.
| | - Martina Chome
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya.
| | - Pauline Mwatsuma
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya
| | - Evasius Bauni
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya
| | - Laura L Hammitt
- Centre for International Health, Johns Hopkins University, Baltimore, MD, United States.
| | - Christine Mataza
- County Department of Health, Kilifi County Hospital, PO Box 491-80108, Kilifi, Kenya.
| | - Collins Tabu
- National Vaccines and Immunisations Programme, Ministry of Health, Kenya
| | - Tatu Kamau
- Vector Borne Diseases Control Unit, Ministry of Health, Kenya
| | - Thomas N Williams
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya; Department of Medicine, Imperial College, St Mary's Hospital, Praed Street, London, United Kingdom; INDEPTH Network, Accra, Ghana.
| | - J Anthony G Scott
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, PO Box 230-80108, Kilifi, Kenya; Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, WC1E 7HT London, UK; INDEPTH Network, Accra, Ghana.
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Adetifa IMO, Bwanaali T, Wafula J, Mutuku A, Karia B, Makumi A, Mwatsuma P, Bauni E, Hammitt LL, Nokes DJ, Maree E, Tabu C, Kamau T, Mataza C, Williams TN, Scott JAG. Cohort Profile: The Kilifi Vaccine Monitoring Study. Int J Epidemiol 2018; 46:792-792h. [PMID: 27789669 PMCID: PMC5654374 DOI: 10.1093/ije/dyw202] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ifedayo M O Adetifa
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Tahreni Bwanaali
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Jackline Wafula
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Alex Mutuku
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Boniface Karia
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Anne Makumi
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Pauline Mwatsuma
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Evasius Bauni
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Laura L Hammitt
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - D James Nokes
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,School of Life Sciences and WIDER, University of Warwick, Coventry, UK
| | | | | | - Tatu Kamau
- Vector Borne Diseases Control Unit, Ministry of Health, Nairobi, Kenya
| | | | - Thomas N Williams
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Medicine, Imperial College, St Mary's Hospital, London, UK.,INDEPTH Network, Accra, Ghana
| | - J Anthony G Scott
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,INDEPTH Network, Accra, Ghana
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Ali M, Chang BA, Johnson KW, Morris SK. Incidence and aetiology of bacterial meningitis among children aged 1-59 months in South Asia: systematic review and meta-analysis. Vaccine 2018; 36:5846-5857. [PMID: 30145101 DOI: 10.1016/j.vaccine.2018.07.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/22/2018] [Accepted: 07/15/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Bacterial meningitis is a significant cause of morbidity and mortality worldwide among children aged 1-59 months. We aimed to describe its burden in South Asia, focusing on vaccine-preventable aetiologies. METHODS We searched five databases for studies published from January 1, 1990, to April 25, 2017. We estimated incidence and aetiology-specific proportions using random-effects meta-analysis. In secondary analyses, we described vaccine impact and pneumococcal meningitis serotypes. RESULTS We included 48 articles cumulatively reporting 20,707 cases from 1987 to 2013. Mean annual incidence was 105 (95% confidence interval [CI], 53-173) cases per 100,000 children. On average, Haemophilus influenzae type b (Hib) accounted for 13% (95% CI, 8-19%) of cases, pneumococcus for 10% (95% CI, 6-15%), and meningococcus for 1% (95% CI, 0-2%). These meta-analyses had substantial between-study heterogeneity (I2 > 78%, P < 0.0001). Among studies reporting only confirmed cases, these three bacteria caused a median of 78% cases (IQR, 50-87%). Hib meningitis incidence declined by 72-83% at sentinel hospitals in Pakistan and Bangladesh, respectively, within two years of implementing nationwide vaccination. On average, PCV10 covered 49% (95% CI, 39-58%), PCV13 covered 51% (95% CI, 40-61%), and PPSV23 covered 74% (95% CI, 67-80%) of pneumococcal meningitis serotypes. Lower PCV10 and PCV13 serotype coverage in Bangladesh was associated with higher prevalence of serotype 2, compared to India and Pakistan. CONCLUSIONS South Asia has relatively high incidence of bacterial meningitis among children aged 1-59 months, with vaccine-preventable bacteria causing a substantial proportion. These estimates are likely underestimates due to multiple epidemiological and microbiological factors. Further research on vaccine impact and distribution of pneumococcal serotypes will inform vaccine policymaking and implementation.
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Affiliation(s)
- Mohsin Ali
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Brian A Chang
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kipp W Johnson
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA; Institute for Next Generation Healthcare, Icahn Institute for Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Shaun K Morris
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Canada; Centre for Global Child Health, Hospital for Sick Children Research Institute, Toronto, Canada; Department of Paediatrics, University of Toronto, Toronto, Canada.
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Munguambe AM, de Almeida AECC, Nhantumbo AA, Come CE, Zimba TF, Paulo Langa J, de Filippis I, Gudo ES. Characterization of strains of Neisseria meningitidis causing meningococcal meningitis in Mozambique, 2014: Implications for vaccination against meningococcal meningitis. PLoS One 2018; 13:e0197390. [PMID: 30089105 PMCID: PMC6082507 DOI: 10.1371/journal.pone.0197390] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 05/01/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION In sub Saharan Africa, the epidemiology, including the distribution of serogroups of strains of N. meningitidis is poorly investigated in countries outside "the meningitis belt". This study was conducted with the aim to determine the distribution of serogroups of strains of N. meningitidis causing meningococcal meningitis in children and adults in Mozambique. METHODS A total of 106 PCR confirmed Neisseria meningitidis Cerebrospinal Fluid (CSF) samples or isolates were obtained from the biobank of acute bacterial meningitis (ABM) surveillance being implemented by the National Institute of Health, at three central hospitals in Mozambique, from January to December 2014. Serogroups of N. meningitidis were determined using conventional PCR, targeting siaD gene for Neisseria meningitidis. Outer Membrane Proteins (OMP) Genotyping was performed by amplifying porA gene in nine samples. RESULTS Of the 106 PCR confirmed Neisseria meningitidis samples, the most frequent serotype was A (50.0%, 53/106), followed by W/Y (18.9%, 20/106), C (8.5%, 9/106), X (7.5%, 8/106) and B (0.9%, 1/106). We found non-groupable strains in a total of 15 (14.2%) samples. PorA genotypes from nine strains showed expected patterns with the exception of two serogroup C strains with P1.19,15,36 and P1.19-36,15 and one serogroup X with P1.19,15,36, variants frequently associated to serogroup B. CONCLUSION Our data shows that the number of cases of meningococcal meningitis routinely reported in central hospitals in Mozambique is significant and the most dominant serogroup is A. In conclusion, although serogroup A has almost been eliminated from the "meningitis belt", this serogroup remains a major concern in countries outside the belt such as Mozambique.
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Affiliation(s)
- Alcides Moniz Munguambe
- Microbiology Laboratory, National Institute of Health, Ministry of Health, Maputo, Mozambique
| | | | - Aquino Albino Nhantumbo
- Microbiology Laboratory, National Institute of Health, Ministry of Health, Maputo, Mozambique
| | | | | | - José Paulo Langa
- Microbiology Laboratory, National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Ivano de Filippis
- Laboratory of Reference Microorganisms, National Institute of Quality Control of Health (INCQS); Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Eduardo Samo Gudo
- National Institute of Health, Ministry of Health, Maputo, Mozambique
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Sakanishi Y, Yamamoto Y, Hara M, Fukumori N, Goto Y, Kusaba T, Tanaka K, Sugioka T, Vaccine Project Team JPCA, Fukuhara S. Public subsidies and the recommendation of child vaccines among primary care physicians: a nationwide cross-sectional study in Japan. BMJ Open 2018; 8:e020923. [PMID: 30030315 PMCID: PMC6059295 DOI: 10.1136/bmjopen-2017-020923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Although public subsidies and physician recommendations for vaccination play key roles in increasing childhood vaccination coverage, the association between them remains uncertain. This study aimed to identify the association between awareness of public subsidies and recommendations for Haemophilus influenzae type b (Hib), Streptococcus pneumoniae (pneumococcal conjugate vaccine (PCV)) and human papillomavirus (HPV) vaccinations among primary care physicians in Japan. DESIGN This is a cross-sectional study. SETTING In 2012, a questionnaire was distributed among 3000 randomly selected physicians who were members of the Japan Primary Care Association. PARTICIPANTS From the questionnaire, participants were limited to physicians who administered childhood vaccinations. PRIMARY AND SECONDARY OUTCOME MEASURES The primary measures were participants' awareness of public subsidies and their recommendation levels for Hib, PCV and HPV vaccines. Multiple logistic regression analysis was performed to investigate the association between awareness and recommendation, with adjustment for possible confounders. RESULTS The response rate was 25.8% (743/2880). Of 743 physician respondents, 434 were included as analysis subjects. The proportions of those who recommended vaccinations were 57.1% for Hib, 54.1% for PCV and 58.1% for HPV. For each vaccine, multivariable analyses showed physicians who were aware of the subsidy were more likely to recommend vaccination than those who were not aware: the adjusted ORs were 4.21 (95% CI 2.47 to 7.15) for Hib, 4.96 (95% CI 2.89 to 8.53) for PCV and 4.17 (95% CI 2.00 to 8.70) for HPV. CONCLUSIONS Primary care physicians' awareness of public subsidies was found to be associated with their recommendations for the Hib, PCV and HPV vaccines. Provision of information about public subsidies to these physicians may increase their likelihood to recommend vaccination.
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Affiliation(s)
- Yuta Sakanishi
- Faculty of Medicine, Community Medical Support Institute, Saga University, Saga, Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Megumi Hara
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Norio Fukumori
- Faculty of Medicine, Community Medical Support Institute, Saga University, Saga, Japan
| | - Yoshihito Goto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tesshu Kusaba
- The Hokkaido Centre for Family Medicine, Sapporo, Japan
| | - Keitaro Tanaka
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Takashi Sugioka
- Faculty of Medicine, Community Medical Support Institute, Saga University, Saga, Japan
| | | | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
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Benamrouche N, Tali Maamar H, Chemli S, Senouci H, Rahal K. Immune responses to vaccine-preventable diseases among toddlers and preschool children after primary immunization and first booster in Northwestern Algiers, Algeria. Heliyon 2018; 4:e00664. [PMID: 29998194 PMCID: PMC6039293 DOI: 10.1016/j.heliyon.2018.e00664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/20/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine immune responses to selected vaccine-preventable communicable diseases: pertussis, diphtheria and Haemophilus influenzae type b (Hib) in Algerian toddlers and preschool children after primary vaccination and first booster, recruited from three local healthcare facilities in Northwestern Algiers. METHODS The information of demographic characteristics and vaccination status were collected for each subject by questionnaire. Specific antibody levels and Hib antibody avidity were determined using commercial ELISA kits. RESULTS A total of eighty-one subjects aged between 19 and 55 months were studied. Almost all subjects were fully protected against diphtheria (76/81; 93.83%; 95% CI: 86.35-97.33) and invasive Hib disease (29/30; 96.67%; 95% CI: 83.33-99.41), while only 20/78 (25.64%; 95% CI: 17.26-36.31) had anti-PT (pertussis toxin) antibody levels above 25 IU/ml. A significant decrease of anti-PT antibody levels was observed until the age of 36 months (p = 0.02). GMTs (geometric mean titers) of anti-PT antibodies were low, but remain significantly higher in children ≤36 months of age (p = 0.02). Both GMT and rates of ≥0.15 μg/ml, ≥1 μg/ml, and ≥5 μg/ml titers were significantly higher in Hib-vaccinated subjects (p < 0.01). Relative Hib-avidity index (≥50%) and GMAI (geometric mean avidity index) were high in both Hib-vaccinated and -unvaccinated groups. CONCLUSIONS As shown in the present study, young children were fully protected against diphtheria and Hib, but showed low immunity to pertussis. Further sero-epidemiological studies including a large number of subjects with a wider range of age are needed to explore the immunity level in older children, adolescents and adults.
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Wanjiku HW, Adetifa IM. Serological Surveys for complementing assessments of vaccination coverage in sub-Saharan Africa: A systematic review. Wellcome Open Res 2018. [DOI: 10.12688/wellcomeopenres.13880.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Serosurveys of biomarkers of infection/vaccination are widely used for evaluating vaccine-induced immunity and monitoring the effectiveness of immunisation programmes in developed countries. In sub-Saharan Africa (sSA) where vaccination coverage (VC) estimates are often incomplete, inaccurate and overestimate effective population immunity, the use of serosurveys is limited. Methods: We conducted a review of the use of serosurveys to assess/complement assessments of VC in sSA by searching electronic databases (PubMed, Embase, Web of Science, Popline, Ovid and Africa Wide Information) for English language articles published from 1st January 1940 to 31st January 2017. We also searched the references of retrieved articles. SSA was defined as all of Africa excluding the countries in North Africa. We included only articles that measured VC and assessed the quality of these studies using the Newcastle-Ottawa Scale. Results: We found 1056 unique records, reviewed 20 eligible studies of which just 12 met our inclusion criteria. These 12 studies were serosurveys of measles, tetanus, polio and yellow fever. Antibodies induced by natural infection confounded serological test results and there was significant discordance between vaccination history and the presence of antibodies in all except for tetanus vaccine. No study looked at Hepatitis B. Conclusions: Serosurveys for tetanus or tetanus containing vaccines may be directly useful for ascertainment of vaccination exposure or reliably complement current survey methods that measure VC. Given the limited experience in using serosurveys for this purpose in sSA, well-designed serosurveys of tetanus and possibly hepatitis B are required to further validate/evaluate their performance.
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Opatowski L, Baguelin M, Eggo RM. Influenza interaction with cocirculating pathogens and its impact on surveillance, pathogenesis, and epidemic profile: A key role for mathematical modelling. PLoS Pathog 2018; 14:e1006770. [PMID: 29447284 PMCID: PMC5814058 DOI: 10.1371/journal.ppat.1006770] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Evidence is mounting that influenza virus interacts with other pathogens colonising or infecting the human respiratory tract. Taking into account interactions with other pathogens may be critical to determining the real influenza burden and the full impact of public health policies targeting influenza. This is particularly true for mathematical modelling studies, which have become critical in public health decision-making. Yet models usually focus on influenza virus acquisition and infection alone, thereby making broad oversimplifications of pathogen ecology. Herein, we report evidence of influenza virus interactions with bacteria and viruses and systematically review the modelling studies that have incorporated interactions. Despite the many studies examining possible associations between influenza and Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Neisseria meningitidis, respiratory syncytial virus (RSV), human rhinoviruses, human parainfluenza viruses, etc., very few mathematical models have integrated other pathogens alongside influenza. The notable exception is the pneumococcus-influenza interaction, for which several recent modelling studies demonstrate the power of dynamic modelling as an approach to test biological hypotheses on interaction mechanisms and estimate the strength of those interactions. We explore how different interference mechanisms may lead to unexpected incidence trends and possible misinterpretation, and we illustrate the impact of interactions on public health surveillance using simple transmission models. We demonstrate that the development of multipathogen models is essential to assessing the true public health burden of influenza and that it is needed to help improve planning and evaluation of control measures. Finally, we identify the public health, surveillance, modelling, and biological challenges and propose avenues of research for the coming years.
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Affiliation(s)
- Lulla Opatowski
- Université de Versailles Saint Quentin, Institut Pasteur, Inserm, Paris, France
| | - Marc Baguelin
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Public Health England, London, United Kingdom
| | - Rosalind M. Eggo
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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Charania NA, Moghadas SM. Modelling the effects of booster dose vaccination schedules and recommendations for public health immunization programs: the case of Haemophilus influenzae serotype b. BMC Public Health 2017; 17:705. [PMID: 28903749 PMCID: PMC5598080 DOI: 10.1186/s12889-017-4714-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/05/2017] [Indexed: 12/26/2022] Open
Abstract
Background Haemophilus influenzae serotype b (Hib) has yet to be eliminated despite the implementation of routine infant immunization programs. There is no consensus regarding the number of primary vaccine doses and an optimal schedule for the booster dose. We sought to evaluate the effect of a booster dose after receiving the primary series on the long-term disease incidence. Methods A stochastic model of Hib transmission dynamics was constructed to compare the long-term impact of a booster vaccination and different booster schedules after receiving the primary series on the incidence of carriage and symptomatic disease. We parameterized the model with available estimates for the efficacy of Hib conjugate vaccine and durations of both vaccine-induced and naturally acquired immunity. Results We found that administering a booster dose substantially reduced the population burden of Hib disease compared to the scenario of only receiving the primary series. Comparing the schedules, the incidence of carriage for a 2-year delay (on average) in booster vaccination was comparable or lower than that observed for the scenario of booster dose within 1 year after primary series. The temporal reduction of symptomatic disease was similar in the two booster schedules, suggesting no superiority of one schedule over the other in terms of reducing the incidence of symptomatic disease. Conclusions The findings underscore the importance of a booster vaccination for continued decline of Hib incidence. When the primary series provides a high level of protection temporarily, delaying the booster dose (still within the average duration of protection conferred by the primary series) may be beneficial to maintain longer-term protection levels and decelerate the decline of herd immunity in the population. Electronic supplementary material The online version of this article (10.1186/s12889-017-4714-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nadia A Charania
- Department of Public Health, Auckland University of Technology, 640 Great South Road, Manukau, Auckland, 2025, New Zealand
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
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Abstract
OBJECTIVES To determine the prevalence of bacteria in the cerebrospinal fluid (CSF), and the antibiogram profile in pediatric patients with suspected meningitis. Methods: This descriptive study was conducted between January 2014 and January 2016 in the Hevi Paediatric Teaching Hospital in Duhok, Iraq. The CSF samples were withdrawn from 432 pediatric patients suspected of meningitis. The samples were cultured, and antibiotic sensitivity tests were performed. Results: There were 33 (7.6%) culture positive cases among 432 CSF samples. Among the positives cases, there were 18 culture positive for Streptococcus pneumoniae (S. pneumoniae). There were 4 cases of Viridans streptococci. In addition, there were 2 cases each of Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), and Non-coagulase staphylococci. There was only one case each of Staphylococcus aureus, Streptococcus pyogenes, Enterococcus species, Haemophilus influenzae, and Pseudomonas aeruginosa (P. aeruginosa). The isolated S. pneumoniae strains showed 47% sensitivity against penicillin, 13% against cefotaxime, but 100% of sensitivity against vancomycin. Isolates of gram-negative bacilli (E. coli, K. pneumoniae, and P. aeruginosa) were 100% sensitive to imipenem and amikacin, but had 0% sensitivity to cefotaxime and vancomycin. All isolates of Staphylococci were sensitive to vancomycin, gentamicin, and clindamycin but were resistant to penicillin and cefotaxime. Conclusion: Streptococcus pneumoniae is currently the leading cause of meningitis among children in Duhok city. The antimicrobial resistance pattern indicates that all isolates of S. pneumoniae were sensitive to vancomycin.
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Affiliation(s)
- Abdulrahman T Saadi
- Department of Microbiology, College of Medicine, University of Duhok, Iraq. E-mail.
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Olson D, Lamb MM, Lopez MR, Paniagua-Avila MA, Zacarias A, Samayoa-Reyes G, Cordon-Rosales C, Asturias EJ. A Rapid Epidemiological Tool to Measure the Burden of Norovirus Infection and Disease in Resource-Limited Settings. Open Forum Infect Dis 2017; 4:ofx049. [PMID: 28730158 PMCID: PMC5510458 DOI: 10.1093/ofid/ofx049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/07/2017] [Indexed: 02/06/2023] Open
Abstract
Background Rapid, cost-effective tools are needed to estimate the disease burden of acute gastroenteritis (AGE) and norovirus (NoV) in resource-limited settings. Methods Households with children (6 weeks–17 years) in rural Guatemala were randomly enrolled into 2 parallel AGE surveillance systems: (1) a prospective cohort, which included an enrollment visit followed by 1 year of prospective observation using a smartphone-based weekly symptom diary; and (2) 2 sequential cross-sectional rapid active sampling (RAS) surveys. Norovirus testing was performed during enrollment (all subjects) and for prospective AGE episodes (prospective cohort only). Results The prospective cohort enrolled 207 households (469 children) from April to September 2015 followed by 471 person-years of observation; RAS survey 1 enrolled 210 households (402 children) during October to November 2015, and RAS survey 2 enrolled 210 separate households (368 children) during January to February 2016. The prospective cohort detected a NoV+ AGE prevalence of 11% and a population-attributable fraction (PAF) of −1.6% at enrollment, followed by an incidence of 1.4 episodes/100 person-years. Rapid active sampling surveys 1 and 2 identified a NoV+ AGE prevalence of 14%–21% and a PAF of 3.2%–12.4%. Conclusions Rapid active sampling surveys were practical and identified more cases of NoV infection and disease compared with a parallel prospective cohort in rural Guatemala.
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Affiliation(s)
- Daniel Olson
- Departments ofPediatrics and.,Department of Epidemiology, Colorado School of Public Health, Aurora.,Center for Global Health and.,Children's Hospital Colorado, Aurora
| | - Molly M Lamb
- Center for Global Health and.,Department of Epidemiology, Colorado School of Public Health, Aurora
| | - Maria Renee Lopez
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - M Alejandra Paniagua-Avila
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos,Coatepeque, Quetzaltenango, Guatemala; and.,Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Alma Zacarias
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos,Coatepeque, Quetzaltenango, Guatemala; and
| | - Gabriela Samayoa-Reyes
- Center for Global Health and.,Microbiology and Immunology, University of Colorado School of Medicine, Aurora
| | - Celia Cordon-Rosales
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Edwin J Asturias
- Departments ofPediatrics and.,Center for Global Health and.,Department of Epidemiology, Colorado School of Public Health, Aurora.,Children's Hospital Colorado, Aurora
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Global Hib vaccination: reasons to cheer and fear. LANCET GLOBAL HEALTH 2016; 4:e142-3. [DOI: 10.1016/s2214-109x(16)00006-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 01/06/2016] [Indexed: 11/21/2022]
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