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Taylor E, Artursson K, Busani L, Callegari A, Cantlay J, Caniça M, Campling E, Gavier-Widén D, van de Giessen A, Itier D, Imberechts H, Roest HJ, Jestin A, de Juan L, Jokelainen P, Kaesbohrer A, Lindberg A, Mantovani A, Mølbak K, van der Poel WH, Poirier AC, Sepe LP, Morabito S, Whitehouse J, Horton DL, La Ragione R. Communicating and disseminating One Health: successes of the One Health European Joint Programme. J Med Microbiol 2024; 73:001842. [PMID: 39057747 PMCID: PMC11317964 DOI: 10.1099/jmm.0.001842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/14/2024] [Indexed: 07/28/2024] Open
Abstract
The application of a One Health approach recognizes that human health, animal health, plant health and ecosystem health are intrinsically connected. Tackling complex challenges associated with foodborne zoonoses, antimicrobial resistance, and emerging threats is imperative. Therefore, the One Health European Joint Programme was established within the European Union research programme Horizon 2020. The One Health European Joint Programme activities were based on the development and harmonization of a One Health science-based framework in the European Union (EU) and involved public health, animal health and food safety institutes from almost all EU Member States, the UK and Norway, thus strengthening the cooperation between public, medical and veterinary organizations in Europe. Activities including 24 joint research projects, 6 joint integrative projects and 17 PhD projects, and a multicountry simulation exercise facilitated harmonization of laboratory methods and surveillance, and improved tools for risk assessment. The provision of sustainable solutions is integral to a One Health approach. To ensure the legacy of the work of the One Health European Joint Programme, focus was on strategic communication and dissemination of the outputs and engagement of stakeholders at the national, European and international levels.
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Affiliation(s)
- Emma Taylor
- University of Surrey, School of Veterinary Medicine, Daphne Jackson Road, Guildford, UK
| | | | - Luca Busani
- Centre for Gender-specific Medicine - Istituto Superiore di Sanità, Viale Regina Elena 299 00161 Rome, Italy
| | - Arnaud Callegari
- French Agency for Food, Environmental and Occupational Health & Safety, European and International Affairs Department, Maisons-Alfort, France
| | - Jennifer Cantlay
- University of Surrey, School of Veterinary Medicine, Daphne Jackson Road, Guildford, UK
| | - Manuela Caniça
- National Reference Laboratory of Antibiotic Resistances and Healthcare Associated Infections, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Elaine Campling
- University of Surrey, School of Veterinary Medicine, Daphne Jackson Road, Guildford, UK
| | | | - Arjen van de Giessen
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - David Itier
- French Ministry of Research and Higher Education, Paris, France
| | - Hein Imberechts
- Sciensano, The Belgian Institute for Health, Brussels, Belgium
| | - Hendrik-Jan Roest
- Animal Supply Chain and Animal Welfare, Ministry of Agriculture, Nature and Food Quality, The Hague, The Netherlands
- Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - André Jestin
- French Veterinary Academy, 34, rue Breguet, 75011 Paris, France
| | - Lucia de Juan
- VISAVET Health Surveillance Centre, Universidad Complutense, Madrid, Spain
- Animal Health Department, Facultad de Veterinaria, Universidad Complutense, Madrid, Spain
| | - Pikka Jokelainen
- Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Annemarie Kaesbohrer
- German Federal Institute for Risk Assessment, Department Biological Safety, Berlin, Germany
| | - Ann Lindberg
- National Veterinary Institute, SVA, 751 89 Uppsala, Sweden
| | | | - Kåre Mølbak
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Wim H.M. van der Poel
- Wageningen BioVeterinary Research, Department of Virology, Houtribweg 39, 8221 RA, Lelystad, Netherlands
| | - Aurore C. Poirier
- University of Surrey, School of Veterinary Medicine, Daphne Jackson Road, Guildford, UK
| | - Ludovico P. Sepe
- German Federal Institute for Risk Assessment, Department Biological Safety, Berlin, Germany
| | - Stefano Morabito
- Department of Food Safety, Nutrition, and Veterinary Public Health, Istituto Superiore di Sanità, Viale Regina Elena 299 00161 Rome, Italy
| | - Jack Whitehouse
- University of Surrey, School of Veterinary Medicine, Daphne Jackson Road, Guildford, UK
| | - Daniel L. Horton
- University of Surrey, School of Veterinary Medicine, Daphne Jackson Road, Guildford, UK
| | - Roberto La Ragione
- University of Surrey, School of Biosciences, Edward Jenner Building, Guildford, UK
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Maghrabi K. Temporary Transvenous Pacemaker for the Treatment of Diphtheria Myocarditis and Progressive Conduction Block: A Case Report. Cureus 2024; 16:e65508. [PMID: 39071066 PMCID: PMC11282894 DOI: 10.7759/cureus.65508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 07/30/2024] Open
Abstract
A case of severe respiratory diphtheria complicated by myocarditis is reported. Diphtheria myocarditis manifested as cardiogenic shock and progressive conduction disturbance. Temporary transvenous ventricular pacing was used to manage this complication successfully. However, this patient died from cardiogenic shock. This case highlights that sporadic cases of diphtheria still occur despite high vaccination rates in Saudi Arabia. Conduction abnormalities in diphtheria myocarditis carry a prognostic marker for the severity of cardiac injury.
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Berger A, Badell E, Åhman J, Matuschek E, Zidane N, Kahlmeter G, Sing A, Brisse S. Corynebacterium diphtheriae and Corynebacterium ulcerans: development of EUCAST methods and generation of data on which to determine breakpoints. J Antimicrob Chemother 2024; 79:968-976. [PMID: 38497937 DOI: 10.1093/jac/dkae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/20/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Evidence-based clinical susceptibility breakpoints have been lacking for antimicrobial agents used for diphtheria. OBJECTIVES We aimed to evaluate broth microdilution and disc diffusion methods and create a dataset of MIC values and inhibition zone diameters (ZDs) from which breakpoints could be determined. METHODS We included 400 recent clinical isolates equally distributed by species (Corynebacterium diphtheriae and Corynebacterium ulcerans) and by national surveillance programmes (France and Germany). Non-duplicate toxigenic and non-toxigenic isolates were chosen to enable the inclusion of a diversity of susceptibility levels for the 13 agents tested. Broth microdilution and disc diffusion, using EUCAST methodology for fastidious organisms, were used. RESULTS The distributions of MIC and ZD values were largely in agreement among methods and countries. Breakpoints to allow categorization of WT isolates as susceptible, i.e. susceptible (S) or susceptible, increased exposure (I) were determined for 12 agents. The data supported a breakpoint for benzylpenicillin and amoxicillin of resistant (R) > 1 mg/L since WT isolates were inhibited by 1 mg/L or less. WT isolates were categorized as I (S ≤ 0.001 mg/L) for benzylpenicillin, emphasizing the need for increased exposure, and S (S ≤ 1 mg/L) for amoxicillin. Erythromycin breakpoints were set at S ≤ 0.06 mg/L and R > 0.06 mg/L. The corresponding ZD breakpoints were determined for all agents except amoxicillin, for which categorization was based on benzylpenicillin results. CONCLUSIONS This work provided a large set of antimicrobial susceptibility data for C. diphtheriae and C. ulcerans, using a harmonized methodology. The dataset allowed EUCAST and experts in the diphtheria field to develop evidence-based breakpoints in January 2023.
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Affiliation(s)
- Anja Berger
- National Consiliary Laboratory for Diphtheria, Bavarian Food and Health Authority (LGL), Oberschleissheim, Germany
| | - Edgar Badell
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, 25-28 rue du Docteur Roux, F-75724, Paris, France
- Institut Pasteur, National Reference Center for Corynebacteria of the Diphtheriae Complex, Paris, France
| | - Jenny Åhman
- EUCAST Development Laboratory (EDL), Växjö, Sweden
| | | | - Nora Zidane
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, 25-28 rue du Docteur Roux, F-75724, Paris, France
| | | | - Andreas Sing
- National Consiliary Laboratory for Diphtheria, Bavarian Food and Health Authority (LGL), Oberschleissheim, Germany
| | - Sylvain Brisse
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, 25-28 rue du Docteur Roux, F-75724, Paris, France
- Institut Pasteur, National Reference Center for Corynebacteria of the Diphtheriae Complex, Paris, France
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He Q, Wu Y, Hou S, Luo L, Zhang Z. Seroprevalence of Diphtheria and Tetanus Immunoglobulin G among the General Health Population in Guangzhou, China. Vaccines (Basel) 2024; 12:381. [PMID: 38675763 PMCID: PMC11053562 DOI: 10.3390/vaccines12040381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
A seroepidemiological study was conducted in 2018 to assess diphtheria and tetanus antibodies in Guangzhou, China. Diphtheria and tetanus antibody concentrations were measured with an enzyme-linked immunosorbent assay. A total of 715 subjects were enrolled in the study. The overall diphtheria and tetanus toxoid IgG-specific antibody levels were 0.126 IU/mL (95% CI: 0.115, 0.137) and 0.210 IU/mL (95% CI: 0.185, 0.240), respectively; the overall positivity rate was 61.82% (95% CI: 58.14, 65.39) and 71.61% (95% CI: 68.3, 74.92), respectively. The diphtheria and tetanus antibody concentration was decreased by age and increased by doses. The geometric mean concentrations and positivity rate of diphtheria and tetanus antibodies were lowest and below the essential protection level in people over 14 years of age. Compared to children and adolescents, middle-aged people and the aged are at much higher risk of infection with Corynebacterium diphtheriae and Clostridium tetani. The current diphtheria and tetanus immunization schedule does not provide persistent protection after childhood. There is an urgent need to adjust the current immunization schedule.
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Affiliation(s)
- Qing He
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China; (Q.H.); (Y.W.); (S.H.)
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou 511436, China
| | - Yejian Wu
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China; (Q.H.); (Y.W.); (S.H.)
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou 511436, China
| | - Shuiping Hou
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China; (Q.H.); (Y.W.); (S.H.)
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou 511436, China
| | - Lei Luo
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China; (Q.H.); (Y.W.); (S.H.)
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou 511436, China
| | - Zhoubin Zhang
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China; (Q.H.); (Y.W.); (S.H.)
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangzhou 511436, China
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Fauzi IS, Nuraini N, Sari AM, Wardani IB, Taurustiati D, Simanullang PM, Lestari BW. Assessing the impact of booster vaccination on diphtheria transmission: Mathematical modeling and risk zone mapping. Infect Dis Model 2024; 9:245-262. [PMID: 38312350 PMCID: PMC10837633 DOI: 10.1016/j.idm.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/23/2023] [Accepted: 01/11/2024] [Indexed: 02/06/2024] Open
Abstract
The COVID-19 pandemic caused significant disruptions in the healthcare system, affecting vaccinations and the management of diphtheria cases. As a consequence of these disruptions, numerous countries have experienced a resurgence or an increase in diphtheria cases. West Java province in Indonesia is identified as one of the high-risk areas for diphtheria, experiencing an upward trend in cases from 2021 to 2023. To analyze the situation, we developed an SIR model, which integrated DPT and booster vaccinations to determine the basic reproduction number, an essential parameter for infectious diseases. Through spatial analysis of geo-referenced data, we identified hotspots and explained diffusion in diphtheria case clusters. The calculation of R0 resulted in an R0 = 1.17, indicating the potential for a diphtheria outbreak in West Java. To control the increasing cases, one possible approach is to raise the booster vaccination coverage from the current 64.84% to 75.15%, as suggested by simulation results. Furthermore, the spatial analysis revealed that hot spot clusters were present in the western, central, and southern regions, posing a high risk not only in densely populated areas but also in rural regions. The diffusion pattern of diphtheria clusters displayed an expansion-contagious pattern. Understanding the rising trend of diphtheria cases and their geographic distribution can offer crucial insights for government and health authorities to manage the number of diphtheria cases and make informed decisions regarding the best prevention and intervention strategies.
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Affiliation(s)
| | - Nuning Nuraini
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, Institut Teknologi Bandung, Bandung, Indonesia
- Center for Mathematical Modeling and Simulation, Institut Teknologi Bandung, Bandung, Indonesia
| | - Ade Maya Sari
- Department of Mathematics, Faculty of Mathematics and Natural Sciences, Institut Teknologi Bandung, Bandung, Indonesia
| | - Imaniah Bazlina Wardani
- Study Program of Biology Education, Faculty of Education and Teacher Training, UIN Kiai Haji Achmad Siddiq Jember, Jember, Indonesia
| | | | | | - Bony Wiem Lestari
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
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Al-Ashwal MA, Atroosh WM, Al-Adhroey AH, Al-Subbary AA, Yee-Ling L, Al-Mekhlafi HM. A disfiguring neglected tropical disease sweeps war-torn Yemen: a community-based study of prevalence and risk factors of cutaneous leishmaniasis among rural communities in the western highlands. Trans R Soc Trop Med Hyg 2023; 117:823-838. [PMID: 37486252 DOI: 10.1093/trstmh/trad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/03/2023] [Accepted: 06/30/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is a major health problem in Yemen and is endemic in many rural areas across the country. METHODS A community-based cross-sectional survey followed by unmatched case-control comparisons was conducted among 612 participants in Utmah district, western Yemen. A total of 223 participants were included in the case-control analysis to identify the significant risk factors. Skin scrapping samples were examined by microscopy and internal transcribed spacer 1 nested polymerase chain reaction. RESULTS Overall, 33% (202/612) of the participants had active skin lesions and/or scars that met the clinical criteria for CL. A total of 90 (14.7%) participants had suspected active CL lesions; however, a prevalence of 8.7% (53/612) was obtained based on molecular and parasitological examination, with Leishmania tropica being the only causative agent identified. Multivariable logistic regression analyses showed that being ≤10 y old, being female, living in houses with cracked walls, living in the presence of other family members with typical ulcerating skin diseases and sleeping outside were factors significantly associated with an increased likelihood of having CL. Moreover, keeping livestock on the ground floor of the house was significantly associated with a decreased likelihood of having CL. CONCLUSION The study reveals an alarmingly high prevalence of CL among the studied population. Therefore there is an urgent need for effective control measures and improved treatment efforts against this devastating disease.
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Affiliation(s)
- Manal A Al-Ashwal
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Wahib M Atroosh
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
- Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
| | - Abdulelah H Al-Adhroey
- Department of Community Medicine, Faculty of Medicine and Health Sciences, Thamar University, Dhamar, Yemen
| | - Assia A Al-Subbary
- National Centre of Public Health Laboratories, Ministry of Public Health and Population, Dhamar, Yemen
| | - Lau Yee-Ling
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Hesham M Al-Mekhlafi
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
- Department of Epidemiology, Faculty of Public Health and Tropical Medicine, Jazan University, Jazan 45142, Saudi Arabia
- Department of Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a 1247, Yemen
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Brémont S, Passet V, Hennart M, Fonteneau L, Toubiana J, Badell E, Brisse S. Multidrug-resistant Corynebacterium diphtheriae in people with travel history from West Africa to France, March to September 2023. Euro Surveill 2023; 28:2300615. [PMID: 37971662 PMCID: PMC10655204 DOI: 10.2807/1560-7917.es.2023.28.46.2300615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 11/19/2023] Open
Abstract
We describe 10 unlinked cases of Corynebacterium diphtheriae infection (nine cutaneous, one respiratory) in France in 2023 in persons travelling from Guinea, Mali, Senegal, Niger or Nigeria and Central African Republic. Four isolates were toxigenic. Seven genomically unrelated isolates were multidrug-resistant, including a toxigenic respiratory isolate with high-level resistance to macrolides and beta-lactams. The high rates of resistance, including against first-line agents, call for further microbiological investigations to guide clinical management and public health response in ongoing West African outbreaks.
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Affiliation(s)
- Sylvie Brémont
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
- Institut Pasteur, National Reference Center for Corynebacteria of the Diphtheriae Complex, Paris, France
| | - Virginie Passet
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | - Mélanie Hennart
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
| | | | - Julie Toubiana
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
- Institut Pasteur, National Reference Center for Corynebacteria of the Diphtheriae Complex, Paris, France
- General pediatric and infectious diseases, Necker-enfants malades hospital, Université Paris Cité, Paris, France
| | - Edgar Badell
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
- Institut Pasteur, National Reference Center for Corynebacteria of the Diphtheriae Complex, Paris, France
| | - Sylvain Brisse
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
- Institut Pasteur, National Reference Center for Corynebacteria of the Diphtheriae Complex, Paris, France
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Salih MA. The Meryon Lecture at the 24th annual meeting of the Meryon Society, St. Anne's College, Oxford, UK, 15th July 2022: Neuromuscular diseases in the Arab population. Neuromuscul Disord 2023; 33:792-799. [PMID: 37679229 DOI: 10.1016/j.nmd.2023.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Affiliation(s)
- Mustafa A Salih
- Consultant Pediatric Neurologist, Health Sector, King Abdulaziz City for Science and Technology, Riyadh 11442, Saudi Arabia.
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9
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Xiaoli L, Peng Y, Williams MM, Lawrence M, Cassiday PK, Aneke JS, Pawloski LC, Shil SR, Rashid MO, Bhowmik P, Weil LM, Acosta AM, Shirin T, Habib ZH, Tondella ML, Weigand MR. Genomic characterization of cocirculating Corynebacterium diphtheriae and non-diphtheritic Corynebacterium species among forcibly displaced Myanmar nationals, 2017-2019. Microb Genom 2023; 9:001085. [PMID: 37712831 PMCID: PMC10569726 DOI: 10.1099/mgen.0.001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/23/2023] [Indexed: 09/16/2023] Open
Abstract
Respiratory diphtheria is a serious infection caused by toxigenic Corynebacterium diphtheriae, and disease transmission mainly occurs through respiratory droplets. Between 2017 and 2019, a large diphtheria outbreak among forcibly displaced Myanmar nationals densely settled in Bangladesh was investigated. Here we utilized whole-genome sequencing (WGS) to characterize recovered isolates of C. diphtheriae and two co-circulating non-diphtheritic Corynebacterium (NDC) species - C. pseudodiphtheriticum and C. propinquum. C. diphtheriae isolates recovered from all 53 positive cases in this study were identified as toxigenic biovar mitis, exhibiting intermediate resistance to penicillin, and formed four phylogenetic clusters circulating among multiple refugee camps. Additional sequenced isolates collected from two patients showed co-colonization with non-toxigenic C. diphtheriae biovar gravis, one of which exhibited decreased susceptibility to the first-line antibiotics and harboured a novel 23-kb multidrug resistance plasmid. Results of phylogenetic reconstruction and virulence-related gene contents of the recovered NDC isolates indicated they were likely commensal organisms, though 80.4 %(45/56) were not susceptible to erythromycin, and most showed high minimum inhibition concentrations against azithromycin. These results demonstrate the high resolution with which WGS can aid molecular investigation of diphtheria outbreaks, through the quantification of bacterial genetic relatedness, as well as the detection of virulence factors and antibiotic resistance markers among case isolates.
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Affiliation(s)
- Lingzi Xiaoli
- ASRT, Inc, Atlanta, GA, USA
- Present address: Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yanhui Peng
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Margaret M. Williams
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Present address: Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marlon Lawrence
- Laboratory Leadership Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Present address: Public Health Laboratory, Virgin Islands Department of Health, US Virgin Islands, USA
| | - Pamela K. Cassiday
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Janessa S. Aneke
- IHRC, Inc., Atlanta, GA, USA
- Present address: Université de Paris Cité, Learning Planet Institute, Paris, France
| | - Lucia C. Pawloski
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sadhona Rani Shil
- Institute of Epidemiology, Disease Control & Research, National Influenza Center, Dhaka, Bangladesh
| | - Mamun Or Rashid
- Institute of Epidemiology, Disease Control & Research, National Influenza Center, Dhaka, Bangladesh
| | - Proshanta Bhowmik
- Institute of Epidemiology, Disease Control & Research, National Influenza Center, Dhaka, Bangladesh
| | - Lauren M. Weil
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Present address: Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anna M. Acosta
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Present address: Director of Medical and Clinical Affairs, GSK Vaccines, USA
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control & Research, National Influenza Center, Dhaka, Bangladesh
| | - Zakir Hossain Habib
- Institute of Epidemiology, Disease Control & Research, National Influenza Center, Dhaka, Bangladesh
| | - M. Lucia Tondella
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael R. Weigand
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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10
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Tessier E, Hennart M, Badell E, Passet V, Toubiana J, Biron A, Gourinat AC, Merlet A, Colot J, Brisse S. Genomic Epidemiology of Corynebacterium diphtheriae in New Caledonia. Microbiol Spectr 2023; 11:e0461622. [PMID: 37042786 PMCID: PMC10269643 DOI: 10.1128/spectrum.04616-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/16/2023] [Indexed: 04/13/2023] Open
Abstract
An increasing number of isolations of Corynebacterium diphtheriae has been observed in recent years in the archipelago of New Caledonia. We aimed to analyze the clinical and microbiological features of samples with C. diphtheriae. All C. diphtheriae isolates identified in New Caledonia from May 2015 to May 2019 were included. For each case, a retrospective consultation of the patient files was conducted. Antimicrobial susceptibility phenotypes, tox gene and diphtheria toxin expression, biovar, and the genomic sequence were determined. Core genome multilocus sequence typing (cgMLST), 7-gene MLST, and search of genes of interest were performed from genomic assemblies. Fifty-eight isolates were included, with a median age of patients of 28 years (range: 9 days to 78 years). Cutaneous origin accounted for 51 of 58 (87.9%) isolates, and C. diphtheriae was associated with Staphylococcus aureus and/or Streptococcus pyogenes in three-quarters of cases. Half of cases came either from the main city Noumea (24%, 14/58) or from the sparsely populated island of Lifou (26%, 15/58). Six tox-positive isolates were identified, associated with recent travel to Vanuatu; 5 of these cases were linked and cgMLST confirmed recent transmission. Two cases of endocarditis in young female patients with a history of rheumatic fever involved tox-negative isolates. The 58 isolates were mostly susceptible to commonly used antibiotics. In particular, no isolate was resistant to the first-line molecules amoxicillin or erythromycin. Resistance to tetracycline was found in a genomic cluster of 17 (29%) isolates, 16 of which carried the tetO gene. There were 13 cgMLST sublineages, most of which were also observed in the neighboring country Australia. Cutaneous infections may harbor nontoxigenic C. diphtheriae isolates, which circulate largely silently in nonspecific wounds. The possible introduction of tox-positive strains from a neighboring island illustrates that diphtheria surveillance should be maintained in New Caledonia, and that immunization in neighboring islands must be improved. Genomic sequencing uncovers how genotypes circulate locally and across neighboring countries. IMPORTANCE The analysis of C. diphtheriae from the tropical archipelago of New Caledonia revealed a high genetic diversity with sublineages that may be linked to Polynesia, Australia, or metropolitan France. Genomic typing allowed confirming or excluding suspected transmission events among cases and contacts. A highly prevalent tetracycline-resistant sublineage harboring the tetO gene was uncovered. Toxigenic isolates were observed from patients returning from Vanuatu, showing the importance of improving vaccination coverage in settings where it is insufficient. This study also illustrates the importance for diphtheria surveillance of the inclusion of isolates from cutaneous sources in addition to respiratory cases, in order to provide a more complete epidemiological picture of the diversity and transmission of C. diphtheriae.
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Affiliation(s)
- Eve Tessier
- CHU Nantes, Service de Bactériologie et des Contrôles Microbiologiques, Nantes, France
- Microbiology Laboratory, Centre Hospitalier Territorial Gaston Bourret, Nouméa, New Caledonia
| | - Melanie Hennart
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
- Sorbonne Université, Collège doctoral, Paris, France
| | - Edgar Badell
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
- National Reference Center for the Corynebacteria of the diphtheriae complex, Paris, France
| | - Virginie Passet
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
- National Reference Center for the Corynebacteria of the diphtheriae complex, Paris, France
| | - Julie Toubiana
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
- National Reference Center for the Corynebacteria of the diphtheriae complex, Paris, France
- Université Paris Cité, Department of General Pediatrics and Pediatric Infectious Diseases, Hôpital Necker–Enfants Malades, APHP, Paris, France
| | - Antoine Biron
- Microbiology Laboratory, Centre Hospitalier Territorial Gaston Bourret, Nouméa, New Caledonia
| | - Ann-Claire Gourinat
- Microbiology Laboratory, Centre Hospitalier Territorial Gaston Bourret, Nouméa, New Caledonia
| | - Audrey Merlet
- Infectious diseases unit, Centre Hospitalier Territorial Gaston Bourret, Nouméa, New Caledonia
| | - Julien Colot
- Microbiology Laboratory, Centre Hospitalier Territorial Gaston Bourret, Nouméa, New Caledonia
- Institut Pasteur de Nouvelle Calédonie, Groupe de Bactériologie médicale et environnementale Nouméa, New Caledonia
| | - Sylvain Brisse
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
- National Reference Center for the Corynebacteria of the diphtheriae complex, Paris, France
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11
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Melnikov VG, Berger A, Dangel A, Sing A. Lateral flow immunoassay-based laboratory algorithm for rapid diagnosis of diphtheria. OPEN RESEARCH EUROPE 2023; 3:62. [PMID: 37645492 PMCID: PMC10445807 DOI: 10.12688/openreseurope.15038.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 08/31/2023]
Abstract
Background: In industrialised countries diphtheria is a rare but still life-threatening disease with a recent increase in cases due to migration and zoonotic aspects. Due to the rarity of the disease, laboratory diagnosis of diphtheria is often carried out in central reference laboratories and involves the use of sophisticated equipment and specially trained personnel. The result of the diphtheria agent detection can usually be obtained after 5-6 days or more. Authors suggest a Lateral Flow Immunoassay (LFIA)-based laboratory algorithm for the diagnosis of diphtheria, which may render less time in issuing a result and could promote the testing be performed in laboratories closer to the patient. Methods: LFIA for diphtheria toxin (DT) detection was designed using a pair of monoclonal antibodies to receptor-binding subunit B of the DT, and validated with 322 corynebacterial cultures as well as 360 simulated diphtheria specimens. Simulated diphtheria specimens were obtained by spiking of human pharyngeal samples with test strains of corynebacteria. The simulated specimens were plated on selective tellurite agar and after 18-24 hours of incubation, grey/black colonies characteristic of the diphtheria corynebacteria were examined for the DT using LFIA. Results: The diagnostic sensitivity of the LFIA for DT detection on bacterial cultures was 99.35%, and the specificity was 100%. Also, the LFIA was positive for all pharyngeal samples with toxigenic strains and negative for all samples with non-toxigenic strains. For setting LFIA, a 6-hour culture on Elek broth was used; thus, under routine conditions, the causative agent of diphtheria could be detected within two working days after plating of the clinical specimen on the tellurite medium of primary inoculation. Conclusions: The availability of such a simple and reliable methodology will speed up and increase the accuracy of diphtheria diagnosis globally.
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Affiliation(s)
- Vyacheslav G. Melnikov
- National Conciliary Laboratory on Diphtheria, Bavarian Health and Food Safety Authority, Oberschleißheim, 85764, Germany
| | - Anja Berger
- Public Health Microbiology, National Conciliary Laboratory on Diphtheria, Bavarian Health and Food Safety Authority, Oberschleißheim, 85764, Germany
| | - Alexandra Dangel
- Public Health Microbiology, National Conciliary Laboratory on Diphtheria, Bavarian Health and Food Safety Authority, Oberschleißheim, 85764, Germany
| | - Andreas Sing
- Public Health Microbiology, National Conciliary Laboratory on Diphtheria, Bavarian Health and Food Safety Authority, Oberschleißheim, 85764, Germany
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12
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Arcari G, Hennart M, Badell E, Brisse S. Multidrug-resistant toxigenic Corynebacterium diphtheriae sublineage 453 with two novel resistance genomic islands. Microb Genom 2023; 9:mgen000923. [PMID: 36748453 PMCID: PMC9973851 DOI: 10.1099/mgen.0.000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Antimicrobial therapy is important for case management of diphtheria, but knowledge on the emergence of multidrug-resistance in Corynebacterium diphtheriae is scarce. We report on the genomic features of two multidrug-resistant toxigenic isolates sampled from wounds in France 3 years apart. Both isolates were resistant to spiramycin, clindamycin, tetracycline, kanamycin and trimethoprim-sulfamethoxazole. Genes ermX, cmx, aph(3')-Ib, aph(6)-Id, aph(3')-Ic, aadA1, dfrA15, sul1, cmlA, cmlR and tet(33) were clustered in two genomic islands, one consisting of two transposons and one integron, the other being flanked by two IS6100 insertion sequences. One isolate additionally presented mutations in gyrA and rpoB and was resistant to ciprofloxacin and rifampicin. Both isolates belonged to sublineage 453 (SL453), together with 25 isolates from 11 other countries (https://bigsdb.pasteur.fr/diphtheria/). SL453 is a cosmopolitan toxigenic sublineage of C. diphtheriae, a subset of which acquired multidrug resistance. Even though penicillin, amoxicillin and erythromycin, recommended as the first line in the treatment of diphtheria, remain active, surveillance of diphtheria should consider the risk of dissemination of multidrug-resistant strains and their genetic elements.
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Affiliation(s)
- Gabriele Arcari
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France.,Department of Molecular Medicine, Sapienza Università di Roma, Rome, Italy
| | - Mélanie Hennart
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France.,Collège doctoral, Sorbonne Université, F-75005 Paris, France
| | - Edgar Badell
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France.,Institut Pasteur, National Reference Center for Corynebacteria of the Diphtheriae Complex, Paris, France
| | - Sylvain Brisse
- Institut Pasteur, Université Paris Cité, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France.,Institut Pasteur, National Reference Center for Corynebacteria of the Diphtheriae Complex, Paris, France
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13
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Kitamura N, Bahkali K, Chem ED, Quilty BJ, Edwards T, Toizumi M, Yoshida LM. Waning rate of immunity and duration of protective immunity against diphtheria toxoid as a function of age and number of doses: Systematic review and quantitative data analysis. Hum Vaccin Immunother 2022; 18:2099700. [PMID: 35862651 DOI: 10.1080/21645515.2022.2099700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Although the burden of diphtheria has declined greatly since the introduction of vaccines, sporadic outbreaks continue to be reported. WHO recommends booster doses after a primary series, but questions remain about the optimal interval between these doses. We conducted a systematic review and quantitative data analysis to quantify the duration of protective immunity after different numbers of doses. Fifteen cross-sectional seroprevalence studies provided data on geometric mean concentration (GMC). Single-year age-stratified GMCs were analyzed using a mixed-effect linear regression model with a random intercept incorporating the between-country variability. GMC was estimated to decline to 0.1 IU/ml in 2.5 years (95% CI: 0.9-4.0), 10.3 years (95% CI: 7.1-13.6), and 25.1 years (95% CI: 7.6-42.6) after receiving three, four and five doses, respectively. The results drawn from cross-sectional data collected in countries with different epidemiologies, vaccines, and schedules had several limitations. However, these analyses contribute to the discussion of optimal timing between booster doses of diphtheria toxoid-containing vaccine.
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Affiliation(s)
- Noriko Kitamura
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.,Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Khawater Bahkali
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Department of Public Health Intelligence, Public Health Authority, Riyadh, Saudi Arabia
| | - Elvis D Chem
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Billy J Quilty
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Tansy Edwards
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Michiko Toizumi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.,Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Lay-Myint Yoshida
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.,Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.,Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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14
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Badenschier F, Berger A, Dangel A, Sprenger A, Hobmaier B, Sievers C, Prins H, Dörre A, Wagner-Wiening C, Külper-Schiek W, Wichmann O, Sing A. Outbreak of imported diphtheria with Corynebacterium diphtheriae among migrants arriving in Germany, 2022. Euro Surveill 2022; 27:2200849. [PMID: 36398576 PMCID: PMC9673234 DOI: 10.2807/1560-7917.es.2022.27.46.2200849] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/17/2022] [Indexed: 07/25/2023] Open
Abstract
From July 2022, cases of imported diphtheria with toxigenic Corynebacterium diphtheriae remarkably increased among migrants arriving in Germany. Up to 30 September 2022, 44 cases have been reported to the national public health institute, all laboratory-confirmed, male, and mainly coming from Syria (n = 21) and Afghanistan (n = 17). Phylogeny and available journey information indicate that most cases (n = 19) were infected along the Balkan route. Active case finding, increased laboratory preparedness and epicentre localisation in countries along this route are important.
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Affiliation(s)
- Franziska Badenschier
- Department of Infectious Disease Epidemiology, Postgraduate Training for Applied Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
- ECDC Fellowship Programme, EPIET Associated Programme, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Anja Berger
- National Consiliary Laboratory for Diphtheria, Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
- Unit of Bacteriology, Public Health Microbiology, Bavarian Health and Food Safety Authority (LGL), Oberschleißheim, Germany
| | - Alexandra Dangel
- NGS Core Unit, Public Health Microbiology, Bavarian Health and Food Safety Authority (LGL), Oberschleißheim, Germany
| | - Annika Sprenger
- NGS Core Unit, Public Health Microbiology, Bavarian Health and Food Safety Authority (LGL), Oberschleißheim, Germany
| | - Bernhard Hobmaier
- Unit of Bacteriology, Public Health Microbiology, Bavarian Health and Food Safety Authority (LGL), Oberschleißheim, Germany
| | - Claudia Sievers
- Department of Infectious Disease Epidemiology, Postgraduate Training for Applied Epidemiology, Robert Koch Institute (RKI), Berlin, Germany
- ECDC Fellowship Programme, EPIET Associated Programme, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Henrieke Prins
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Achim Dörre
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | - Wiebe Külper-Schiek
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Ole Wichmann
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Andreas Sing
- National Consiliary Laboratory for Diphtheria, Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
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15
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Nguyen Thi Nguyen T, Parry CM, Campbell JI, Vinh PV, Kneen R, Baker S. Endemic erythromycin resistant Corynebacterium diphtheriae in Vietnam in the 1990s. Microb Genom 2022; 8:mgen000861. [PMID: 36259695 PMCID: PMC9676054 DOI: 10.1099/mgen.0.000861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/10/2022] [Indexed: 11/18/2022] Open
Abstract
Diphtheria is a potentially fatal respiratory disease caused by toxigenic forms of the Gram-positive bacterium Corynebacterium diphtheriae. Despite the availability of treatments (antitoxin and antimicrobials) and effective vaccines, the disease still occurs sporadically in low-income countries and in higher income where use of diphtheria vaccine is inconsistent. Diphtheria was highly endemic in Vietnam in the 1990s; here, we aimed to provide some historical context to the circulation of erythromycin resistant organisms in Vietnam during this period. After recovering 54 C. diphtheriae isolated from clinical cases of diphtheria in Ho Chi Minh City between 1992 and 1998 we conducted whole genome sequencing and analysis. Our data outlined substantial genetic diversity among the isolates, illustrated by seven distinct Sequence Types (STs), but punctuated by the sustained circulation of ST67 and ST209. With the exception of one isolate, all sequences contained the tox gene, which was classically located on a corynebacteriophage. All erythromycin resistant isolates, accounting for 13 % of organisms in this study, harboured a novel 18 kb erm(X)-carrying plasmid, which exhibited limited sequence homology to previously described resistance plasmids in C. diphtheriae. Our study provides historic context for the circulation of antimicrobial resistant C. diphtheriae in Vietnam; these data provide a framework for the current trajectory in global antimicrobial resistance trends.
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Affiliation(s)
- To Nguyen Thi Nguyen
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Department of Microbiology, Monash University, Melbourne, Victoria, Australia
| | - Christopher M. Parry
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Pl, Liverpool L3 5QA, UK
- Alder Hey Children’s Hospital, NHS Foundation Trust, Liverpool, UK
| | - James I. Campbell
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Phat Voong Vinh
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Rachel Kneen
- Alder Hey Children’s Hospital, NHS Foundation Trust, Liverpool, UK
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 3BX, UK
| | - Stephen Baker
- University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
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16
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Talbird SE, Carrico J, La EM, Carias C, Marshall GS, Roberts CS, Chen YT, Nyaku MK. Impact of Routine Childhood Immunization in Reducing Vaccine-Preventable Diseases in the United States. Pediatrics 2022; 150:188495. [PMID: 35821599 DOI: 10.1542/peds.2021-056013] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Current routine immunizations for children aged ≤10 years in the United States in 2019 cover 14 vaccine-preventable diseases. We characterize the public-health impact of vaccination by providing updated estimates of disease incidence with and without universally recommended pediatric vaccines. METHODS Prevaccine disease incidence was obtained from published data or calculated using annual case estimates from the prevaccine period and United States population estimates during the same period. Vaccine-era incidence was calculated as the average incidence over the most recent 5 years of available surveillance data or obtained from published estimates (if surveillance data were not available). We adjusted for underreporting and calculated the percent reduction in overall and age-specific incidence for each disease. We multiplied prevaccine and vaccine-era incidence rates by 2019 United States population estimates to calculate annual number of cases averted by vaccination. RESULTS Routine immunization reduced the incidence of all targeted diseases, leading to reductions in incidence ranging from 17% (influenza) to 100% (diphtheria, Haemophilus influenzae type b, measles, mumps, polio, and rubella). For the 2019 United States population of 328 million people, these reductions equate to >24 million cases of vaccine-preventable disease averted. Vaccine-era disease incidence estimates remained highest for influenza (13 412 per 100 000) and Streptococcus pneumoniae-related acute otitis media (2756 per 100 000). CONCLUSIONS Routine childhood immunization in the United States continues to yield considerable sustained reductions in incidence across all targeted diseases. Efforts to maintain and improve vaccination coverage are necessary to continue experiencing low incidence levels of vaccine-preventable diseases.
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Affiliation(s)
| | - Justin Carrico
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - Elizabeth M La
- RTI Health Solutions, Research Triangle Park, North Carolina
| | | | - Gary S Marshall
- Norton Children's and University of Louisville School of Medicine, Louisville, Kentucky
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17
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Nassar AAH, Abdullah Al-Amad M, Ghaleb YA. Risk factors for diphtheria in Sana'a, Yemen, 2019: a matched case–control study. IJID REGIONS 2022; 2:40-44. [PMID: 35757080 PMCID: PMC9216703 DOI: 10.1016/j.ijregi.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/25/2022]
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18
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Guglielmini J, Hennart M, Badell E, Toubiana J, Criscuolo A, Brisse S. Genomic Epidemiology and Strain Taxonomy of Corynebacterium diphtheriae. J Clin Microbiol 2021; 59:e0158121. [PMID: 34524891 PMCID: PMC8601238 DOI: 10.1128/jcm.01581-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/03/2021] [Indexed: 12/13/2022] Open
Abstract
Corynebacterium diphtheriae is highly transmissible and can cause large diphtheria outbreaks where vaccination coverage is insufficient. Sporadic cases or small clusters are observed in high-vaccination settings. The phylogeography and short timescale evolution of C. diphtheriae are not well understood, in part due to a lack of harmonized analytical approaches of genomic surveillance and strain tracking. We combined 1,305 genes with highly reproducible allele calls into a core genome multilocus sequence typing (cgMLST) scheme. We analyzed cgMLST gene diversity among 602 isolates from sporadic clinical cases, small clusters, or large outbreaks. We defined sublineages based on the phylogenetic structure within C. diphtheriae and strains based on the highest number of cgMLST mismatches within documented outbreaks. We performed time-scaled phylogenetic analyses of major sublineages. The cgMLST scheme showed high allele call rate in C. diphtheriae and the closely related species C. belfantii and C. rouxii. We demonstrate its utility to delineate epidemiological case clusters and outbreaks using a 25 mismatches threshold and reveal a number of cryptic transmission chains, most of which are geographically restricted to one or a few adjacent countries. Subcultures of the vaccine strain PW8 differed by up to 20 cgMLST mismatches. Phylogenetic analyses revealed a short-timescale evolutionary gain or loss of the diphtheria toxin and biovar-associated genes. We devised a genomic taxonomy of strains and deeper sublineages (defined using a 500-cgMLST-mismatch threshold), currently comprising 151 sublineages, only a few of which are geographically widespread based on current sampling. The cgMLST genotyping tool and nomenclature was made publicly accessible (https://bigsdb.pasteur.fr/diphtheria). Standardized genome-scale strain genotyping will help tracing transmission and geographic spread of C. diphtheriae. The unified genomic taxonomy of C. diphtheriae strains provides a common language for studies of ecology, evolution, and virulence heterogeneity among C. diphtheriae sublineages.
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Affiliation(s)
- Julien Guglielmini
- Institut Pasteur, Université de Paris, Bioinformatics and Biostatistics Hub, Department of Computational Biology, Paris, France
| | - Melanie Hennart
- Institut Pasteur, Université de Paris, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
- Sorbonne Université, Collège Doctoral, Paris, France
| | - Edgar Badell
- Institut Pasteur, Université de Paris, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
- National Reference Center for the Corynebacteria of the Diphtheriae Complex, Paris, France
| | - Julie Toubiana
- Institut Pasteur, Université de Paris, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
- National Reference Center for the Corynebacteria of the Diphtheriae Complex, Paris, France
- Université de Paris, Service de Pédiatrie Générale et Maladies Infectieuses, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexis Criscuolo
- Institut Pasteur, Université de Paris, Bioinformatics and Biostatistics Hub, Department of Computational Biology, Paris, France
| | - Sylvain Brisse
- Institut Pasteur, Université de Paris, Biodiversity and Epidemiology of Bacterial Pathogens, Paris, France
- National Reference Center for the Corynebacteria of the Diphtheriae Complex, Paris, France
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19
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Gao H, Lau EHY, Cowling BJ. Waning immunity after receipt of Pertussis, Diphtheria, Tetanus and Polio-related vaccines: a systematic review and meta-analysis. J Infect Dis 2021; 225:557-566. [PMID: 34543411 DOI: 10.1093/infdis/jiab480] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/16/2021] [Indexed: 11/12/2022] Open
Abstract
DTP-containing (pertussis, diphtheria and tetanus) combined with polio vaccines are recommended by WHO as part of routine immunization programs. The decline of immunity after vaccination has been considered as a possible reason for the re-emergence of vaccine-preventable diseases worldwide. In this study, we evaluated the potential duration of protective immunity of pertussis, diphtheria, tetanus and polio through a systematic review and meta-analysis. We examined data on immunological and clinical outcomes. We observed evidence of waning post-vaccination immunity for pertussis and diphtheria, while tetanus and polio vaccines provided sustained protection. Further research on the risk factors of waning immunity after vaccination and the optimal timing of booster doses for pertussis and diphtheria are needed.
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Affiliation(s)
- Huizhi Gao
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eric H Y Lau
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.,Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.,Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
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