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Sluder AE, Raju Paul S, Moise L, Dold C, Richard G, Silva-Reyes L, Baeten LA, Scholzen A, Reeves PM, Pollard AJ, Garritsen A, Bowen RA, De Groot AS, Rollier C, Poznansky MC. Evaluation of a Human T Cell-Targeted Multi-Epitope Vaccine for Q Fever in Animal Models of Coxiella burnetii Immunity. Front Immunol 2022; 13:901372. [PMID: 35651616 PMCID: PMC9149306 DOI: 10.3389/fimmu.2022.901372] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022] Open
Abstract
T cell-mediated immunity plays a central role in the control and clearance of intracellular Coxiella burnetii infection, which can cause Q fever. Therefore, we aimed to develop a novel T cell-targeted vaccine that induces pathogen-specific cell-mediated immunity to protect against Q fever in humans while avoiding the reactogenicity of the current inactivated whole cell vaccine. Human HLA class II T cell epitopes from C. burnetii were previously identified and selected by immunoinformatic predictions of HLA binding, conservation in multiple C. burnetii isolates, and low potential for cross-reactivity with the human proteome or microbiome. Epitopes were selected for vaccine inclusion based on long-lived human T cell recall responses to corresponding peptides in individuals that had been naturally exposed to the bacterium during a 2007-2010 Q fever outbreak in the Netherlands. Multiple viral vector-based candidate vaccines were generated that express concatemers of selected epitope sequences arranged to minimize potential junctional neo-epitopes. The vaccine candidates caused no antigen-specific reactogenicity in a sensitized guinea pig model. A subset of the vaccine epitope peptides elicited antigenic recall responses in splenocytes from C57BL/6 mice previously infected with C. burnetii. However, immunogenicity of the vaccine candidates in C57BL/6 mice was dominated by a single epitope and this was insufficient to confer protection against an infection challenge, highlighting the limitations of assessing human-targeted vaccine candidates in murine models. The viral vector-based vaccine candidates induced antigen-specific T cell responses to a broader array of epitopes in cynomolgus macaques, establishing a foundation for future vaccine efficacy studies in this large animal model of C. burnetii infection.
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Affiliation(s)
- Ann E Sluder
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Boston, MA, United States
| | - Susan Raju Paul
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Boston, MA, United States
| | | | - Christina Dold
- Oxford Vaccine Group, Department of Paediatrics, The National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | | | - Laura Silva-Reyes
- Oxford Vaccine Group, Department of Paediatrics, The National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Laurie A Baeten
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| | | | - Patrick M Reeves
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Boston, MA, United States
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, The National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | | | - Richard A Bowen
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| | | | - Christine Rollier
- Oxford Vaccine Group, Department of Paediatrics, The National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Mark C Poznansky
- Vaccine and Immunotherapy Center, Massachusetts General Hospital, Boston, MA, United States
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Chan-Cuzydlo A, Harrison DJ, Pike BL, Currie BJ, Mayo M, Salvador MG, Hulsey WR, Azzarello J, Ellis J, Kim D, King-Lewis W, Smith JN, Rodriguez B, Maves RC, Lawler JV, Schully KL. Cohort profile: a migratory cohort study of US Marines who train in Australia. BMJ Open 2021; 11:e050330. [PMID: 34526342 PMCID: PMC8444257 DOI: 10.1136/bmjopen-2021-050330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE In 2012, US Marines and Sailors began annual deployments to Australia to participate in joint training exercises with the Australian Defence Force and other partners in the region. During their training, US service members are exposed to a variety of infectious disease threats not normally encountered by American citizens. This paper describes a cohort of US Marines and Sailors enrolled during five rotations to Australia between 2016 and 2020. PARTICIPANTS Study participation is strictly voluntary. Group informational sessions are held prior to deployment to describe the study structure and goals, as well as the infectious disease threats that participants may encounter while in Australia. All participants provided written informed consent. Consented participants complete a pre-deployment questionnaire to collect data including basic demographic information, military occupational specialty, travel history, family history, basic health status and personal habits such as alcohol consumption. Blood is collected for serum, plasma and peripheral blood mononuclear cells (PBMC) processing. Data and specimen collection is repeated up to three times: before, during and after deployment. FINDINGS TO DATE From the five rotations that comprised the 2016-2020 Marine Rotational Force-Darwin, we enrolled 1289 volunteers. Enrolments during this period were overwhelmingly white male under the age of 24 years. Most of the enrollees were junior enlisted and non-commissioned officers, with a smaller number of staff non-commissioned officers and commissioned officers, and minimal warrant officers. Over half of the enrollees had occupational specialty designations for infantry. FUTURE PLANS In the future, we will screen samples for serological evidence of infection with Burkholderia pseudomallei, Coxiella burnetii, Ross River virus, SARS-CoV-2 and other operationally relevant pathogens endemic in Australia. Antigenic stimulation assays will be performed on PBMCs collected from seropositive individuals to characterise the immune response to these infections in this healthy American population.
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Affiliation(s)
- Alyssa Chan-Cuzydlo
- The Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | | | - Brian L Pike
- Naval Medical Research Center, Frederick, Maryland, USA
| | - Bart J Currie
- Department of Infectious Diseases, Menzies School of Health Research, Casuarina, Northern Territory, Australia
- Department of Infectious Diseases, Royal Darwin Hospital, Casuarina, Northern Territory, Australia
| | - Mark Mayo
- Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Mark G Salvador
- The Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - William R Hulsey
- The Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Joseph Azzarello
- 1st Marine Division, Marine Corps Base Camp Pendleton, California, USA
| | - Jeffrey Ellis
- 1st Marine Division, Marine Corps Base Camp Pendleton, California, USA
| | - Daniel Kim
- 1st Marine Division, Marine Corps Base Camp Pendleton, California, USA
| | | | | | - Barbara Rodriguez
- 1st Marine Division, Marine Corps Base Camp Pendleton, California, USA
| | - Ryan C Maves
- Division of Infectious Diseases, Naval Medical Center San Diego, San Diego, California, USA
| | - James V Lawler
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kevin L Schully
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Naval Medical Research Center, Silver Spring, Maryland, USA
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3
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Fakour S, Jamali R, Ahmadi E. Seroepidemiological study on Coxiella burnetii and associated risk factors in ruminants at Kurdistan Province, west of Iran. Comp Immunol Microbiol Infect Dis 2021; 78:101691. [PMID: 34252638 DOI: 10.1016/j.cimid.2021.101691] [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: 02/04/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022]
Abstract
Q fever is zoonotic disease caused by Coxiella burnetii. Ruminants are the main reservoir of this pathogen, which is often asymptomatic but lead to abortion. This study aims to survey the seroprevalence and risk factors of this zoonose among ruminants in Kurdistan province, the west of Iran. 480 blood samples were collected from ruminants including sheep, goats and cows, each 160 samples, in the age groups of <1, ≥1-3, >3-5 year with and without the history of abortion in two groups border and non-border cities in Kurdistan province. Serums were tested by use of indirect ELISA to determine specific antibodies against C. burnetii. The results indicate the seroprevalence of 46.6 % for Q fever. Seroprevalence in sheep, goats and cows were 28.58 % (n = 64), 45.53 % (n = 102) and 25.89 % (n = 58), respectively. Seroprevalence is significantly higher in animals with abortion than in those without such history (P < 0.05). The seroprevalence in the border cities has been significantly higher than other geographical areas (P < 0.05). Seroprevalence had no significant correlation with animal age (P> 0.05). This study is the first seroepidemiological study done on Q fever in ruminants of Kurdistan province, Iran. The results indicate the high seroprevalence of Coxiella burnetii in the area under the study. Therefore, doing an epidemiologically study aimed at isolating C. brunetii in the human population of Kurdistan province is recommended, so that the epidemiological aspect of this pathogen in the people of Kurdistan province be clarified and subsequently disease control and prevention programs be applied.
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Affiliation(s)
- Shahin Fakour
- Department of Clinical Sciences, Sanandaj Branch Islamic Azad University, Sanandaj, Iran.
| | - Rojin Jamali
- Department of Clinical Sciences, Sanandaj Branch Islamic Azad University, Sanandaj, Iran
| | - Elham Ahmadi
- Department of Pathobiology, Sanandaj Branch Islamic Azad University, Sanandaj, Iran
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Occupations at risk of contracting zoonoses of public health significance in Québec. ACTA ACUST UNITED AC 2021; 47:47-58. [PMID: 33679248 DOI: 10.14745/ccdr.v47i01a08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Introduction Climate change plays an important role in the geographic spread of zoonotic diseases. Knowing which populations are at risk of contracting these diseases is critical to informing public health policies and practices. In Québec, 14 zoonoses have been identified as important for public health to guide the climate change adaptation efforts of decision-makers and researchers. A great deal has been learned about these diseases in recent years, but information on at-risk workplaces remains incomplete. The objective of this study is to paint a portrait of the occupations and sectors of economic activity at risk for the acquisition of these zoonoses. Methods A rapid review of the scientific literature was conducted. Databases on the Ovid and EBSCO research platforms were searched for articles published between 1995 and 2018, in English and French, on 14 zoonoses (campylobacteriosis, cryptosporidiosis, verocytotoxigenic Escherichia coli, giardiasis, listeriosis, salmonellosis, Eastern equine encephalitis, Lyme disease, West Nile virus, food botulism, Q fever, avian and swine influenza, rabies, hantavirus pulmonary syndrome) and occupational health. The literature search retrieved 12,558 articles and, after elimination of duplicates, 6,838 articles were evaluated based on the title and the abstract. Eligible articles had to address both concepts of the research issue (prioritized zoonoses and worker health). Of the 621 articles deemed eligible, 110 were selected following their full reading. Results Of the diseases under study, enteric zoonoses were the most frequently reported. Agriculture, including veterinary services, public administration services and medical and social services were the sectors most frequently identified in the literature. Conclusion The results of our study will support public health authorities and decision-makers in targeting those sectors and occupations that are particularly at risk for the acquisition of zoonoses. Doing so will ultimately optimize the public health practices of those responsible for the health of workers.
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Aljafar A, Salem M, Housawi F, Zaghawa A, Hegazy Y. Seroprevalence and risk factors of Q-fever (C. burnetii infection) among ruminants reared in the eastern region of the Kingdom of Saudi Arabia. Trop Anim Health Prod 2020; 52:2631-2638. [PMID: 32458350 DOI: 10.1007/s11250-020-02295-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/13/2020] [Indexed: 11/25/2022]
Abstract
Q-fever is a worldwide spread zoonotic disease associated with severe illness in humans and abortions and stillbirths in ruminants. Ruminants are major sources of human infection where subclinical carriers shed the bacteria in various secretions and excreta. The goal of the current study was to investigate the prevalence and risk factors of Coxiella burnetii infection among cattle, sheep, and goats in the eastern province of the Kingdom of Saudi Arabia (KSA). A total of 1310 serum samples were collected through a designed cross-sectional study from private farms and slaughterhouses in the study area and examined against antibodies of C. burnetii using ELISA. A multivariate logistic regression analysis was built to detect risk factors of C. burnetii infection among examined species. The prevalence of C. burnetii infection among examined animals was 9.2% (CI, 7.7-10.8)-15.6%, 9.1%, and 5.8% among goats, cattle, and sheep, respectively). The risk of getting C. burnetii infection among old animals (> 1 year old) was 23 times higher than the risk among young animals (< 1 year old) (95% CI, 10.04-53.01; P < 0.01). Goats were 2.27 (95% CI, 1.41-3.66; P < 0.01) and 3 times at higher risk than cattle and sheep, respectively, of getting C. burnetii infection. In conclusion, C. burnetii infection is widespread among different ruminant species of the eastern province of KSA which represents a high risk for environmental contamination and disseminating the infection to humans and animal species in that area. Also, our findings may reflect the disease status in other countries of the Arabian Gulf area.
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Affiliation(s)
- Abdullah Aljafar
- Department of Clinical Studies and King Faisal University Veterinary Teaching Hospital, College of Veterinary Medicine, King Faisal University, Al hassa, Kingdom of Saudi Arabia
| | - Mohammed Salem
- Department of Clinical Studies and King Faisal University Veterinary Teaching Hospital, College of Veterinary Medicine, King Faisal University, Al hassa, Kingdom of Saudi Arabia.,Department of Medicine and Infectious Diseases, Faculty of Veterinary Medicine, Cairo University, Cairo, Egypt
| | - Fadhel Housawi
- Department of Clinical Studies and King Faisal University Veterinary Teaching Hospital, College of Veterinary Medicine, King Faisal University, Al hassa, Kingdom of Saudi Arabia.
| | - Ahmed Zaghawa
- Department of Animal Medicine and Infectious Diseases, Faculty of Veterinary Medicine, University of Sadat City, Sadat City, Egypt
| | - Yamen Hegazy
- Department of Animal Medicine, Faculty of Veterinary Medicine, University of Kafrelsheikh, Kafr El Sheikh, Egypt
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Zemke JN, Sanchez JL, Pang J, Gray GC. The Double-Edged Sword of Military Response to Societal Disruptions: A Systematic Review of the Evidence for Military Personnel as Pathogen Transmitters. J Infect Dis 2020; 220:1873-1884. [PMID: 31519020 DOI: 10.1093/infdis/jiz400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/02/2019] [Indexed: 11/12/2022] Open
Abstract
Given their lack of immunity and increased exposure, military personnel have the potential to serve as carriers or reservoirs for infectious diseases into or out of the deployment areas, but, to our knowledge, the historical evidence for such transmission events has not previously been reviewed. Using PubMed, we performed a systematic review of published literature between 1955 and 2018, which documented evidence for military personnel transporting infectious pathogens into or out of deployment areas. Of the 439 articles screened, 67 were included for final qualitative and quantitative review. The data extracted from these articles described numerous instances in which thousands of military service members demonstrated potential or actual transmission and transportation of multiple diverse pathogens. These data underscore the immense importance preventive medical professionals play in mitigating such risk, how their public health efforts must be supported, and the importance of surveillance in protecting both military and civilian populations.
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Affiliation(s)
- Juliana N Zemke
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Jose L Sanchez
- Department of Defense, Defense Health Agency, Public Health Division, Armed Forces Health Surveillance Branch, Silver Spring, Maryland
| | - Junxiong Pang
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Centre for Infectious Disease Epidemiology & Research, Saw Swee Hock School of Public Health, National University of Singapore
| | - Gregory C Gray
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Division of Infectious Diseases, Duke University, Durham, North Carolina.,Emerging Infectious Disease Program, Duke-National University of Singapore Medical School, Singapore.,Global Health Research Center, Duke-Kunshan University, Kunshan, China
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7
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Coxiella burnetii Antibody Prevalence and Risk Factors of Infection in the Human Population of Estonia. Microorganisms 2019; 7:microorganisms7120629. [PMID: 31795442 PMCID: PMC6956122 DOI: 10.3390/microorganisms7120629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/24/2019] [Accepted: 11/27/2019] [Indexed: 01/16/2023] Open
Abstract
Q fever is an emerging health problem in both humans and animals. To estimate the prevalence of Coxiella burnetii (C. burnetii) antibodies in the Estonian population, we analyzed plasma samples from 1000 individuals representing the general population and 556 individual serum samples from five population groups potentially at a higher risk (veterinary professionals, dairy cattle, beef cattle, and small ruminant stockbreeders and hunters). Additionally, 118 dairy cow bulk tank milk samples were analyzed to establish the infection status of the dairy cattle herds and the participating dairy cattle keepers. Questionnaires were used to find the potential risk factors of exposure. The effects of different variables were evaluated using binary logistic regression analysis and mixed-effects logistic analysis. The prevalence in veterinary professionals (9.62%; p = 0.003) and dairy cattle farmers (7.73%; p = 0.047) was significantly higher than in the general population (3.9%). Contact with production animals in veterinary practice and being a dairy stockbreeder in C. burnetii positive farms were risk factors for testing C. burnetii seropositive (p = 0.038 and p = 0.019, respectively). Results suggest that C. burnetii is present in Estonia and the increased risk of infection in humans is associated with farm animal contact.
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Standardized guinea pig model for Q fever vaccine reactogenicity. PLoS One 2018; 13:e0205882. [PMID: 30312355 PMCID: PMC6185858 DOI: 10.1371/journal.pone.0205882] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/03/2018] [Indexed: 11/19/2022] Open
Abstract
Historically, vaccination with Coxiella burnetii whole cell vaccines has induced hypersensitivity reactions in humans and animals that have had prior exposure to the pathogen as a result of infection or vaccination. Intradermal skin testing is routinely used to evaluate exposure in humans, and guinea pig hypersensitivity models have been developed to characterize the potential for reactogenicity in vaccine candidates. Here we describe a refinement of the guinea pig model using an alternate vaccine for positive controls. An initial comparative study used viable C. burnetii to compare the routes of sensitizing exposure of guinea pigs (intranasal vs intraperitoneal), evaluation of two time points for antigen challenge (21 and 42 days) and an assessment of two routes (intradermal and subcutaneous) of challenge using the ruminant vaccine Coxevac as the antigenic control. Animals sensitized by intraperitoneal exposure exhibited slightly larger gross reactions than did those sensitized by intranasal exposure, and reactions were more pronounced when skin challenge was performed at 42 days compared to 21 days post-sensitization. The intradermal route proved to be the optimal route of reactogenicity challenge. Histopathological changes at injection sites were similar to those previously reported and a scoring system was developed to compare reactions between groups receiving vaccine by intradermal versus subcutaneous routes. Based on the comparative study, a standardized protocol for assessment of vaccine reactogenicity in intranasally-sensitized animals was tested in a larger confirmatory study. Results suggest that screens utilizing a group size of n = 3 would achieve 90% power for detecting exposure-related reactogenic responses of the magnitude induced by Coxevac using either of two outcome measures.
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Huprikar NA, Deas SD, Skabelund AJ. Non-traumatic Pulmonary Emergencies in the Deployed Setting. CURRENT PULMONOLOGY REPORTS 2017; 6:138-145. [PMID: 32288987 PMCID: PMC7102247 DOI: 10.1007/s13665-017-0180-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Pulmonary disorders accounted for up to 8% of the over 70,000 medical evacuations conducted from Iraq and Afghanistan in the past 15 years. This review of non-traumatic pulmonary emergencies provides an overview of deployed military medical treatment capabilities and highlights pulmonary emergencies requiring aeromedical evacuation from theater. RECENT FINDINGS Recent studies have improved the epidemiologic evaluation of non-traumatic pulmonary disease, highlighted specific parenchymal diseases, and revealed infection pathologies unique to the deployed setting. Literature regarding possible chemical exposures in the current deployed environment remains limited. SUMMARY Respiratory disorders requiring medical evacuation represent a wide variety of diseases. Complications such as pulmonary emboli, infectious pathogens, and hazardous chemical exposures threaten the deployed warfighter. Adequate medical care requires an understanding of these potential environmental exposures. This review serves as a general overview of this topic; however, more research regarding epidemiologic and environmental exposures is required.
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Affiliation(s)
- Nikhil A. Huprikar
- Pulmonary/Critical Care Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Dr., Fort Sam Houston, San Antonio, TX 78234 USA
| | - Steven D. Deas
- Pulmonary/Critical Care Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Dr., Fort Sam Houston, San Antonio, TX 78234 USA
| | - Andrew J. Skabelund
- Pulmonary/Critical Care Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Dr., Fort Sam Houston, San Antonio, TX 78234 USA
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Farris CM, Pho N, Myers TE, Richards AL. Seroconversions for Coxiella and Rickettsial Pathogens among US Marines Deployed to Afghanistan, 2001-2010. Emerg Infect Dis 2016; 22:1491-3. [PMID: 27434653 PMCID: PMC4982193 DOI: 10.3201/eid2208.160221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We assessed serum samples from 1,000 US Marines deployed to Afghanistan during 2001-2010 to find evidence of 4 rickettsial pathogens. Analysis of predeployment and postdeployment samples showed that 3.4% and 0.5% of the Marines seroconverted for the causative agents of Q fever and spotted fever group rickettsiosis, respectively.
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11
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Karki S, Gidding HF, Newall AT, McIntyre PB, Liu BC. Risk factors and burden of acute Q fever in older adults in New South Wales: a prospective cohort study. Med J Aust 2016; 203:438. [PMID: 26654610 DOI: 10.5694/mja15.00391] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 10/01/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To measure the acute burden of and to identify risk factors associated with notified Q fever in older adults in New South Wales. DESIGN, SETTINGS AND PARTICIPANTS A prospective cohort of adults aged 45 years and over (the 45 and Up Study) recruited during 2006-2009 and followed using linked Q fever notifications, hospital records and death records during 2006-2012. MAIN OUTCOME MEASURES Incident cases of Q fever, based on a linked Q fever notification; proportion of cases with a Q fever-coded hospitalisation. RESULTS A total of 266 906 participants were followed up for 1 254 650 person-years (mean, 4.7 ± 1.0 years per person). In our study population, the incidence of notified Q fever during follow-up was 3.6 (95% CI, 2.7-4.8) per 100 000 person-years. After adjustments, age (≥ 65 years v 45-54 years: hazard ratio [HR], 0.39; 95% CI, 0.16-0.96), sex (women v men: HR, 0.48; 95% CI, 0.26-0.88), and area and type of residence (P < 0.001 for trend) remained significantly associated with Q fever. Compared with those living in an inner regional area but not on a farm, the risk of notified Q fever was highest for those living on a farm in outer regional or remote areas (HR, 11.98; 95% CI, 5.47-26.21), followed by those living on a farm in inner regional areas (HR, 4.95; 95% CI, 1.79-13.65). Of notified Q fever cases, 15 of 39 (38%) had been hospitalised with a diagnosis consistent with Q fever. CONCLUSIONS Adults living on a farm in outer regional and remote areas are at a substantially greater risk of contracting Q fever. This suggests that, as well as targeting specific occupational groups for vaccination, there would be benefits in increasing public awareness of Q fever and vaccination among those living on and near farms in outer regional and remote areas of Australia.
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Affiliation(s)
| | | | | | - Peter B McIntyre
- National Centre for Immunisation Research and Surveillance, Sydney, NSW
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12
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Perdue CL, Cost AAE, Rubertone MV, Lindler LE, Ludwig SL. Description and utilization of the United States department of defense serum repository: a review of published studies, 1985-2012. PLoS One 2015; 10:e0114857. [PMID: 25723497 PMCID: PMC4344338 DOI: 10.1371/journal.pone.0114857] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 11/14/2014] [Indexed: 11/19/2022] Open
Abstract
Specimens in the United States Department of Defense (DoD) Serum Repository have accumulated in frozen storage since 1985 when the DoD began universal screening for human immunodeficiency virus. Use of the stored serum for health research has been carefully controlled, but the resulting publications have never been systematically identified or described. The Armed Forces Health Surveillance Center (AFHSC) information systems and open (online) sites were used as data sources. Through 2012, the repository contained 54,542,658 serum specimens, of which 228,610 (0.42%) have been accessed for any purpose. Between 2001 (the first year that comprehensive, digital records were available) and 2012, 65.2% of all approved requests for serum were for healthcare or public health investigations, but greater than 99% of all shipped samples were for research. Using two different methods – a structure search of PubMed and an exhaustive online search based on records from AFHSC – we identified 76 articles published between October 1988 and March 2013 that covered a multitude of infectious diseases, injuries, environmental exposures and mental health conditions through analysis of antibodies, biological metabolic, signaling and regulatory substances, Vitamin D, organochlorines, dioxin, omega-3-fatty acid, and portions of human deoxyribonucleic acid. Despite its operational and scientific value, it appears that the DoD Serum Repository has been underutilized. Changes to policy and increased capacity for specimen processing could increase use of the repository without risking privacy or the availability of specimens for the healthcare of individual service members in the future.
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Affiliation(s)
- Christopher L. Perdue
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, United States of America
- * E-mail:
| | - Angelia A. Eick Cost
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, United States of America
| | - Mark V. Rubertone
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, United States of America
| | - Luther E. Lindler
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, United States of America
| | - Sharon L. Ludwig
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, United States of America
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Ruiz S, Wolfe DN. Vaccination against Q fever for biodefense and public health indications. Front Microbiol 2014; 5:726. [PMID: 25566235 PMCID: PMC4267281 DOI: 10.3389/fmicb.2014.00726] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/03/2014] [Indexed: 01/02/2023] Open
Abstract
Coxiella burnetii is the etiological agent of Q fever, a disease that is often spread to humans via inhalational exposure to the bacteria from contaminated agricultural sources. Outbreaks have been observed all over the world with larger foci generating interest in vaccination programs, most notably in Australia and the Netherlands. Importantly, exposure rates among military personnel deployed to the Middle East can be relatively high as measured by seroconversion to C. burnetii-specific antibodies. Q fever has been of interest to the biodefense community over the years due to its low infectious dose and environmental stability. Recent advances in cell-free growth and genetics of C. burnetii also make this organism easier to culture and manipulate. While there is a vaccine that is licensed for use in Australia, the combination of biodefense- and public health-related issues associated with Q fever warrant the development of a safer and more effective vaccine against this disease.
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Affiliation(s)
- Sara Ruiz
- Center for Aerobiological Sciences, U.S. Army Medical Research Institute of Infectious Diseases Fort Detrick, MD USA
| | - Daniel N Wolfe
- Chemical and Biological Technologies Department, Defense Threat Reduction Agency Fort Belvoir, VA USA
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Affiliation(s)
- Joshua D Hartzell
- Infectious Diseases Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
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15
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Gürtler L, Bauerfeind U, Blümel J, Burger R, Drosten C, Gröner A, Heiden M, Hildebrandt M, Jansen B, Offergeld R, Pauli G, Seitz R, Schlenkrich U, Schottstedt V, Strobel J, Willkommen H. Coxiella burnetii - Pathogenic Agent of Q (Query) Fever. Transfus Med Hemother 2014; 41:60-72. [PMID: 24659949 PMCID: PMC3949614 DOI: 10.1159/000357107] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 05/09/2013] [Indexed: 12/25/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Rainer Seitz
- Arbeitskreis Blut, Untergruppe «Bewertung Blutassoziierter Krankheitserreger»
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16
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Royal J, Riddle MS, Mohareb E, Monteville MR, Porter CK, Faix DJ. Seroepidemiologic survey for Coxiella burnetii among US military personnel deployed to Southwest and Central Asia in 2005. Am J Trop Med Hyg 2013; 89:991-5. [PMID: 24043692 DOI: 10.4269/ajtmh.12-0174] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We used a seroepidemiologic study to estimate Q fever (Coxiella burnetii) seroprevalence, seroincidence, and risk factors for seroconversion in two deployed military populations in 2005. The first study group resided in an area with a known Q fever outbreak history (Al Asad, Iraq). Of this population, 7.2% seroconverted for an incidence rate of 10.6 seroconversions per 1,000 person-months. The second population included personnel transiting through Qatar on mid-deployment leave from southwest/central Asia. In this group, we found 2.1% prevalence with 0.92 seroconversions per 1,000 person-months. However, no significant risk factors for Q fever seroconversion were found in either population.
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Affiliation(s)
- Joseph Royal
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Naval Medical Research Center, Silver Spring, Maryland; US Naval Medical Research Unit, No. 3, Cairo, Egypt; Naval Health Research Center, San Diego, California
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17
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Abstract
BACKGROUND AND OBJECTIVES Infection due to Coxiella burnetii (C burnetii), the causative agent of Q fever is rarely sought for in clinical practice. This study was performed to detect C burnetii infection in patients with pyrexia of undetermined cause (PUC). DESIGN AND SETTINGS This is a prospective study conducted at King Khalid University Hospital, Riyadh be.tween March 2011 and January 2013. PATIENTS AND METHODS A total of 3 mL venous blood was collected from 51 patients with PUC at King Khalid University Hospital, Riyadh. This group of patients included 30 males and 21 females (mean age 33.9 [21.3] years) with the history of febrile illness ranging between 4 and 8 weeks. A control group of 50 healthy individuals comprising 39 males and 11 females (mean age 27 [9] years) was also included in the study. Detection of phase II C burnetii-specific IgG antibodies was performed by immunofluorescence assay, and a titer of > 1:64 was considered positive. RESULTS Phase II C burnetii-specific IgG antibodies were detected in 18 (35.2%) patients out of the total 51 tested. Two (4%) individuals out of 50 in the control group tested positive for anti-C burnetii IgG antibodies. The proportion of positive results among the patients was significantly higher than the controls (P < .0002, 95% CI, 15.09-46.25). The antibody titer range was between 1:128 and 1:1024 where 6 patients had titers of 1:256, 5 had 1:512, 4 had 1024, and 3 had 1:128. CONCLUSION The evidence of C burnetii infection in a sizable number of patients emphasizes the need for inclusion of serologic investigations for Q fever in patients with PUC.
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Affiliation(s)
- Adel Almogren
- Dr. Adel Almogren, Pathology, Immunology Unit,, College of Medicine, King Saud University,, PO Box 2925 Riyadh 11461,, Saudi Arabia, T:966-11-467-1843, F:966-11-467-1925,
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18
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Snedeker KG, Sikora C. Q Fever in Alberta, Canada: 1998-2011. Zoonoses Public Health 2013; 61:124-30. [DOI: 10.1111/zph.12053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - C. Sikora
- Alberta Health Services; Edmonton Alberta Canada
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19
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Abstract
Coxiella burnetii, the agent of Q fever, is an obligate intracellular pathogen typically associated with exposure to livestock. This organism may present with acute or chronic manifestations, the most typical chronic manifestation being endocarditis. We report a highly unusual case of Q fever endocarditis acquired in the United States marked by atypical cardiac manifestations.
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20
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Nett RJ, Helgerson SD, Anderson AD. Clinician Assessment forCoxiella burnetiiInfection in Hospitalized Patients with Potentially Compatible Illnesses During Q Fever Outbreaks and Following a Health Alert, Montana, 2011. Vector Borne Zoonotic Dis 2013; 13:128-30. [DOI: 10.1089/vbz.2012.1007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Randall J. Nett
- Career Epidemiology Field Officer Program, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
- Public Health and Safety Division, Montana Department of Public Health and Human Services, Helena, Montana
| | - Steven D. Helgerson
- Public Health and Safety Division, Montana Department of Public Health and Human Services, Helena, Montana
| | - Alicia D. Anderson
- Rickettsial Zoonoses Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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21
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White B, Brooks T, Seaton RA. Q fever in military and paramilitary personnel in conflict zones: case report and review. Travel Med Infect Dis 2012; 11:134-7. [PMID: 23218785 DOI: 10.1016/j.tmaid.2012.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 10/24/2012] [Accepted: 11/01/2012] [Indexed: 01/29/2023]
Abstract
We present the case of a 44-year-old civilian security officer medically evacuated from Iraq with acalculous cholecystitis and Guillain-Barré syndrome and subsequently found to have acute Q fever. The presenting features of Q fever in military and related personnel deployed to Iraq and Afghanistan are reviewed and the use of PCR in early diagnosis of Q fever is discussed. The atypical presentation in this case encourages clinicians to have a low threshold for considering Q fever as part of the differential diagnosis in soldiers and related personnel returning from these areas of high endemicity.
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Affiliation(s)
- B White
- Brownlee Centre, Gartnavel General Hospital, Glasgow, United Kingdom.
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22
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Khan JN, Tapp LD, Glancy JM, Prasad N, Bailey MS, Graham TR. Successful surgical treatment of Q fever endocarditis with mitral valve repair. J ROY ARMY MED CORPS 2012; 158:132-4. [PMID: 22860505 DOI: 10.1136/jramc-158-02-13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We report a case of successful surgical treatment of Q fever endocarditis with mitral valve repair in a 66-year old retired British soldier. Valve replacement is invariably undertaken in Q fever endocarditis due to the degree of valvular damage and concerns about eradicating the organism, Coxiella burnetii. Our unique case allowed valve repair since pre-existing myxomatous degeneration and subsequent posterior mitral valve leaflet prolapse resulted in significant excess valve tissue, allowing quadrangular resection of the damaged and perforated P2 portion of this leaflet. Follow-up at four years (including three years of antibiotic treatment) has confirmed excellent valve repair, with no echocardiographic, clinical or microbiological evidence of recurrence. We are only the second group to describe valve repair in a patient with chronic Q fever endocarditis. Valve repair is preferable to valve replacement for Q fever endocarditis, if technically possible.
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Affiliation(s)
- J N Khan
- Hereford County Hospital, Wye Valley NHS Trust, Hereford, England, UK
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23
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Whelan J, Schimmer B, Schneeberger P, Meekelenkamp J, Ijff A, van der Hoek W, Robert-Du Ry van Beest Holle M. Q fever among culling workers, the Netherlands, 2009-2010. Emerg Infect Dis 2012; 17:1719-23. [PMID: 21888803 PMCID: PMC3322078 DOI: 10.3201/eid1709.110051] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In 2009, dairy goat farms in the Netherlands were implicated in >2,300 cases of Q fever; in response, 51,820 small ruminants were culled. Among 517 culling workers, despite use of personal protective equipment, 17.5% seroconverted for antibodies to Coxiella burnetii. Vaccination of culling workers could be considered.
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Affiliation(s)
- Jane Whelan
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
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24
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Epidemic Q fever in humans in the Netherlands. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 984:329-64. [PMID: 22711640 DOI: 10.1007/978-94-007-4315-1_17] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In 2005, Q fever was diagnosed on two dairy goat farms and 2 years later it emerged in the human population in the south of the Netherlands. From 2007 to 2010, more than 4,000 human cases were notified with an annual seasonal peak. The outbreaks in humans were mainly restricted to the south of the country in an area with intensive dairy goat farming. In the most affected areas, up to 15% of the population may have been infected. The epidemic resulted in a serious burden of disease, with a hospitalisation rate of 20% of notified cases and is expected to result in more cases of chronic Q fever among risk groups in the coming years. The most important risk factor for human Q fever is living close (<5 km) to an infected dairy goat farm. Occupational exposure plays a much smaller role. In 2009 several veterinary control measures were implemented including mandatory vaccination of dairy goats and dairy sheep, improved hygiene measures, and culling of pregnant animals on infected farms. The introduction of these drastic veterinary measures has probably ended the Q fever outbreak, for which the Netherlands was ill-prepared.
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Abstract
PURPOSE OF REVIEW Bacterial zoonoses are increasingly described in association with travel. Some bacterial zoonoses constitute important causes of post-travel illness. We focus on leptospirosis and rickettsiosis - the most common travel-associated bacterial zoonoses. RECENT FINDINGS Leptospirosis is regarded to be the most common zoonotic disease worldwide. In industrialized countries recreational exposures, both domestic and overseas, are increasingly becoming a major source of infection. Asymptomatic infection is rare among travelers. Rickettsial diseases account for approximately 1.5-3.5% of febrile travelers. In several series of travel-related rickettsioses, the most common travel-related rickettsial disease is Rickettsia africae. Other rickettsioses including Q fever, scrub typhus and murine typhus are considered rare among travelers. Whereas timely diagnosis of both diseases is still based on exposure history, antigen detection tools to aid the diagnosis during the acute illness are under research and far from being available. Due to these constrains, currently, the true incidence of both diseases is probably underestimated. SUMMARY Both leptospirosis and spotted fever may be rapidly fatal. Empiric doxycycline in severely ill febrile travelers should be considered. There is an urgent need for widely available antigen detection diagnostic tools to improve the detection of leptospirosis and rickettsial infections during the acute illness.
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Burke RL, Kronmann KC, Daniels CC, Meyers M, Byarugaba DK, Dueger E, Klein TA, Evans BP, Vest KG. A Review of Zoonotic Disease Surveillance Supported by the Armed Forces Health Surveillance Center. Zoonoses Public Health 2011; 59:164-75. [DOI: 10.1111/j.1863-2378.2011.01440.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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