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Price MA, Fast PE, Mshai M, Lambrick M, Machira YW, Gieber L, Chetty P, Muturi-Kioi V. Region-specific laboratory reference intervals are important: A systematic review of the data from Africa. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000783. [PMID: 36962599 PMCID: PMC10021479 DOI: 10.1371/journal.pgph.0000783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022]
Abstract
Region-specific laboratory reference intervals (RIs) are important for clinical trials and these data are often sparse in priority areas for research, including Africa. We reviewed data on RIs from Africa to identify gaps in the literature with a systematic review of PubMed for RI studies from Africa published ≥2010. Search focus included clinical analytic chemistry, hematology, immunological parameters and RIs. Data from adults, adolescents, children, pregnant women, and the elderly were included. We excluded manuscripts reporting data from persons with conditions that might preclude clinical trial participation in studies enrolling healthy volunteers. Of 179 identified manuscripts, 80 were included in this review, covering 20 countries with the largest number of studies in Ethiopia (n = 23, 29%). Most studies considered healthy, nonpregnant adults (n = 55, 69%). Nine (11%) studies included pregnant women, 13 (16%) included adolescents and 22 (28%) included children. Recruitment, screening, enrollment procedures and definition of age strata varied across studies. The most common type of RIs reported were hematology (66, 83%); 14 studies (18%) included flow cytometry and/or T cell counts. Other common tests or panels included liver function assays (32, 40%), renal function assays (30, 38%), lipid chemistries (17, 21%) and serum electrolytes (17, 21%). The number of parameters characterized ranged from only one (three studies characterized either CD4+ counts, D-dimer, or hemoglobin), to as many as 40. Statistical methods for calculating RIs varied. 56 (70%) studies compared their results to international RI databases. Though most presented their data side-by-side with international data with little accompanying analysis, nearly all reported deviation from comparator RI data, sometimes with half or more of otherwise healthy participants having an "out of range" result. We found there is limited local RI data available in sub-Saharan Africa. Studies to fill this gap are warranted, including efforts to standardize statistical methods to derive RIs, methods to compare with other RIs, and improve representative participant selection.
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Affiliation(s)
- Matt A. Price
- IAVI, New York City, New York, United States of America
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, United States of America
| | - Patricia E. Fast
- IAVI, New York City, New York, United States of America
- Division of Infectious Diseases, Stanford University School of Medicine, Palo Alto, California, United States of America
| | | | | | | | - Lisa Gieber
- IAVI, New York City, New York, United States of America
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Mbiya BM, Kalombo DK, Mukendi YN, Daubie V, Mpoyi JK, Biboyi PM, Disashi GT, Gulbis B. Improvement of SCD morbimortality in children: experience in a remote area of an African country. BMC Health Serv Res 2021; 21:294. [PMID: 33794895 PMCID: PMC8017617 DOI: 10.1186/s12913-021-06286-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/16/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is a public health problem in the Democratic Republic of Congo. While reference sickle cell centers have been implemented in capital cities of African countries and have proven to be beneficial for SCD patients. In the Democratic Republic of Congo, they have never been set up in remote areas for families with low or very low sources of income. METHOD A cohort of 143 children with SCD aged 10 years old (IQR (interquartile range): 6-15 years) (sex ratio male/female = 1.3) were clinically followed for 12 months without any specific intervention aside from the management of acute events, and then for 12 months with a monthly medical visit, biological follow-up, and chemoprophylaxis (folic acid/penicillin), adequate fluids and malaria prevention. RESULTS The median age of patients at the diagnosis of SCD was 2 years (IQR: 1-5). The implementation of standardized and regular follow-ups in a new sickle cell reference center in a remote city showed an increase in the annual mean hemoglobin level from 50 to 70 g/L (p = 0.001), and a decrease in the lymphocyte count and spleen size (p < 0.001). A significant decrease (p < 0.001) in the average annual number of hospitalizations and episodes of vaso-occlusive crises, blood transfusions, infections, and acute chest syndromes were also observed. CONCLUSIONS The creation of a sickle cell reference center and the regular follow-up of children with sickle cell disease are possible and applicable in the context of a remote city of an African country and represent simple and accessible measures that can reduce the morbimortality of children with sickle cell disease.
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Affiliation(s)
- Benoît Mukinayi Mbiya
- Pediatrics Department, Faculty of Medicine, University of Mbujimayi, 06201, Mbujimayi, Democratic Republic of Congo
- Sickle Cell Reference Center, Clinique Pédiatrique de Mbujimayi, Pediatrics Clinic of Mbujimayi, 06201, Mbujimayi, Democratic Republic of Congo
| | - Didier Kalenda Kalombo
- Pediatrics Department, Faculty of Medicine, University of Mbujimayi, 06201, Mbujimayi, Democratic Republic of Congo
- Sickle Cell Reference Center, Clinique Pédiatrique de Mbujimayi, Pediatrics Clinic of Mbujimayi, 06201, Mbujimayi, Democratic Republic of Congo
| | - Yannick Nkesu Mukendi
- Pediatrics Department, Faculty of Medicine, University of Mbujimayi, 06201, Mbujimayi, Democratic Republic of Congo
- Sickle Cell Reference Center, Clinique Pédiatrique de Mbujimayi, Pediatrics Clinic of Mbujimayi, 06201, Mbujimayi, Democratic Republic of Congo
| | - Valery Daubie
- Clinical Biology Department, LHUB-ULB, Université Libre de Bruxelles, 1070, Brussels, Belgium
| | - John Kalenda Mpoyi
- Sickle Cell Reference Center, Clinique Pédiatrique de Mbujimayi, Pediatrics Clinic of Mbujimayi, 06201, Mbujimayi, Democratic Republic of Congo
| | - Parola Mukendi Biboyi
- Sickle Cell Reference Center, Clinique Pédiatrique de Mbujimayi, Pediatrics Clinic of Mbujimayi, 06201, Mbujimayi, Democratic Republic of Congo
| | - Ghislain Tumba Disashi
- Internal Medicine Department, Faculty of Medicine, University of Mbujimayi, 06201, Mbujimayi, Democratic Republic of Congo
| | - Béatrice Gulbis
- Clinical Chemistry Department, Hereditary Red Blood Cell Disorders, LHUB-ULB, Université Libre de Bruxelles, 1070, Brussels, Belgium.
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Hoq M, Canterford L, Matthews S, Khanom G, Ignjatovic V, Monagle P, Donath S, Carlin J. Statistical methods used in the estimation of age-specific paediatric reference intervals for laboratory blood tests: A systematic review. Clin Biochem 2020; 85:12-19. [DOI: 10.1016/j.clinbiochem.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/06/2020] [Accepted: 08/09/2020] [Indexed: 01/01/2023]
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Jorgensen JM, Crespo-Bellido M, Dewey KG. Variation in hemoglobin across the life cycle and between males and females. Ann N Y Acad Sci 2019; 1450:105-125. [PMID: 31074518 DOI: 10.1111/nyas.14096] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/18/2019] [Accepted: 03/21/2019] [Indexed: 01/08/2023]
Abstract
WHO recommendations for hemoglobin (Hb) cutoffs to define anemia are based on a handful of studies conducted in the 1960s that did not include participants from all life stages. To evaluate whether there is a need to update Hb cutoffs, we conducted a narrative review of the literature to identify more recent studies that have reported Hb cutoffs in males and females in various life stages. We compiled information from 60 studies conducted around the globe between 1975 and 2018. Many studies reported cutoffs that were similar to WHO recommendations, but cutoffs identified in studies of infants, young children, premenopausal women, and the elderly tended to be lower than WHO recommendations, while cutoffs identified in studies of men tended to be higher than WHO cutoffs. Few studies excluded individuals with iron deficiency or inflammation, which limits the conclusions that can be drawn regarding normal reference ranges. Further research using more stringent exclusion criteria is needed to develop revised recommendations for Hb cutoffs to define anemia.
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Affiliation(s)
- Josh M Jorgensen
- Program in International and Community Nutrition, Department of Nutrition, University of California Davis, Davis, California
| | - Mayra Crespo-Bellido
- Nutrition Program, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - Kathryn G Dewey
- Program in International and Community Nutrition, Department of Nutrition, University of California Davis, Davis, California
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Bæk O, Jensen KJ, Andersen A, Balé C, Martins C, Biering-Sørensen S, Poulsen A, Benn CS. Seasonal and sex-specific variations in haematological parameters in 4 to 5.5-month-old infants in Guinea-Bissau, West Africa. Trans R Soc Trop Med Hyg 2018; 111:30-37. [PMID: 28371872 PMCID: PMC5914425 DOI: 10.1093/trstmh/trx014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 03/22/2017] [Indexed: 12/02/2022] Open
Abstract
Objective This study investigated seasonal and sex-specific variations in the haematological parameters and established reference ranges for these parameters in healthy 4 to 5.5-month-old infants in Guinea-Bissau. Methods Within a randomised trial of early measles vaccination, over a period of 13 months blood samples were collected from infants aged 4 to 5.5 months. Haematological parameters were determined by an automated cell counter and compared in linear regression models providing geometric mean ratios (GMR). Results Blood samples from 501 infants (n=248 boys, 49.5%) were obtained, and 285 (56.9%) were collected in the rainy season. Median age was 4.7 months (range 3.7 to 7.2 months). Eosinophil and platelet counts were lower in the dry season (December to May) than in the rainy season (GMR 0.79 [95% CI 0.68–0.92]) and 0.93 [0.87–1.00], respectively). The calculated reference ranges were wider and generally higher than those from a US population of comparable age, but neutrophil levels were notably lower in Guinea-Bissau. Conclusions The study indicated that eosinophil and platelet counts of infants were subject to seasonal variations. The reference ranges for haematological values were comparable to other African populations and corroborated that neutropenia regularly occurs in African infants.
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Affiliation(s)
- Ole Bæk
- Bandim Health Project, Indepth Network, codex 1004, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Hvidovre Hospital, DK-2650 Copenhagen, Denmark
| | - Kristoffer Jarlov Jensen
- Bandim Health Project, Indepth Network, codex 1004, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, DK-2300 Copenhagen, Denmark
| | - Andreas Andersen
- Bandim Health Project, Indepth Network, codex 1004, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, DK-2300 Copenhagen, Denmark
| | - Carlito Balé
- Bandim Health Project, Indepth Network, codex 1004, Bissau, Guinea-Bissau
| | - Cesario Martins
- Bandim Health Project, Indepth Network, codex 1004, Bissau, Guinea-Bissau
| | - Sofie Biering-Sørensen
- Bandim Health Project, Indepth Network, codex 1004, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, DK-2300 Copenhagen, Denmark
| | - Anja Poulsen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Christine Stabell Benn
- Bandim Health Project, Indepth Network, codex 1004, Bissau, Guinea-Bissau
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, DK-2300 Copenhagen, Denmark
- OPEN, University of Southern Denmark/Odense University Hospital, DK-4000 Odense, Denmark
- Corresponding author: Present address: Research Center for Vitamins and Vaccines, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark; Tel: +45 3268 8354; E-mail:
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Prentice S, Kamushaaga Z, Nash SB, Elliott AM, Dockrell HM, Cose S. Post-immunization leucocytosis and its implications for the management of febrile infants. Vaccine 2018; 36:2870-2875. [PMID: 29655624 PMCID: PMC5937853 DOI: 10.1016/j.vaccine.2018.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/11/2018] [Accepted: 03/12/2018] [Indexed: 12/12/2022]
Abstract
Aims Clinical guidelines for management of infants with fever but no evident focus of infection recommend that those aged 1–3 months with a white cell count >15 × 109/l have a full septic screen and be admitted for parenteral antibiotics. However, there is limited information about leucocyte changes following routine immunization, a common cause of fever. We investigated white cell counts shortly after routine immunization in Ugandan infants under 3 months of age. Methods White cell counts were measured in 212 healthy infants following routine immunizations (DTwP-HepB-Hib, oral polio and pneumococcal conjugate 7 vaccines) received prior to 3 months of age. Results Mean leucocyte counts increased from 9.03 × 109/l (95% confidence interval 8.59–9.47 × 109/l) pre-immunizations to 16.46 × 109/l (15.4–17.52 × 109/l) at one-day post-immunizations at 6 weeks of age, and 15.21 × 109/l (14.07–16.36 × 109/l) at one-day post-immunizations at 10 weeks of age. The leucocytosis was primarily a neutrophilia, with neutrophil percentages one-day post-immunization of 49% at 6 weeks of age and 46% at 10 weeks of age. White cell parameters returned to baseline by two-days post-immunization. No participant received antibiotics when presenting with isolated fever post-immunization and all remained well at follow-up. Conclusions In our study almost half the children <3 months old presenting with fever but no evident focus of infection at one-day post-immunization met commonly used criteria for full septic screen and admission for parenteral antibiotics, despite having no serious bacterial infection. These findings add to the growing body of literature that questions the utility of white blood cell measurement in identification of young infants at risk of serious bacterial infections, particularly in the context of recent immunizations, and suggest that further exploration of the effect of different immunization regimes on white cell counts is needed. This observational work was nested within a clinical trial, registration number ISRCTN59683017.
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Affiliation(s)
- Sarah Prentice
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; MRC/UVRI Uganda Research Unit, 51-59 Nakiwogo Road, Entebbe, PO Box 49, Uganda.
| | | | - Stephen B Nash
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
| | - Alison M Elliott
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; MRC/UVRI Uganda Research Unit, 51-59 Nakiwogo Road, Entebbe, PO Box 49, Uganda.
| | - Hazel M Dockrell
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
| | - Stephen Cose
- MRC/UVRI Uganda Research Unit, 51-59 Nakiwogo Road, Entebbe, PO Box 49, Uganda; Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
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7
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Mensah VA, Roetynck S, Kanteh EK, Bowyer G, Ndaw A, Oko F, Bliss CM, Jagne YJ, Cortese R, Nicosia A, Roberts R, D’Alessio F, Leroy O, Faye B, Kampmann B, Cisse B, Bojang K, Gerry S, Viebig NK, Lawrie AM, Clarke E, Imoukhuede EB, Ewer KJ, Hill AVS, Afolabi MO. Safety and Immunogenicity of Malaria Vectored Vaccines Given with Routine Expanded Program on Immunization Vaccines in Gambian Infants and Neonates: A Randomized Controlled Trial. Front Immunol 2017; 8:1551. [PMID: 29213269 PMCID: PMC5702785 DOI: 10.3389/fimmu.2017.01551] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/31/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Heterologous prime-boost vaccination with chimpanzee adenovirus 63 (ChAd63) and modified vaccinia virus Ankara (MVA) encoding multiple epitope string thrombospondin-related adhesion protein (ME-TRAP) has shown acceptable safety and promising immunogenicity in African adult and pediatric populations. If licensed, this vaccine could be given to infants receiving routine childhood immunizations. We therefore evaluated responses to ChAd63 MVA ME-TRAP when co-administered with routine Expanded Program on Immunization (EPI) vaccines. METHODS We enrolled 65 Gambian infants and neonates, aged 16, 8, or 1 week at first vaccination and randomized them to receive either ME-TRAP and EPI vaccines or EPI vaccines only. Safety was assessed by the description of vaccine-related adverse events (AEs). Immunogenicity was evaluated using IFNγ enzyme-linked immunospot, whole-blood flow cytometry, and anti-TRAP IgG ELISA. Serology was performed to confirm all infants achieved protective titers to EPI vaccines. RESULTS The vaccines were well tolerated in all age groups with no vaccine-related serious AEs. High-level TRAP-specific IgG and T cell responses were generated after boosting with MVA. CD8+ T cell responses, previously found to correlate with protection, were induced in all groups. Antibody responses to EPI vaccines were not altered significantly. CONCLUSION Malaria vectored prime-boost vaccines co-administered with routine childhood immunizations were well tolerated. Potent humoral and cellular immunity induced by ChAd63 MVA ME-TRAP did not reduce the immunogenicity of co-administered EPI vaccines, supporting further evaluation of this regimen in infant populations. CLINICAL TRIAL REGISTRATION The clinical trial was registered on http://Clinicaltrials.gov (NCT02083887) and the Pan-African Clinical Trials Registry (PACTR201402000749217).
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Affiliation(s)
| | | | | | - Georgina Bowyer
- The Jenner Institute Laboratories, University of Oxford, Oxford, United Kingdom
| | - Amy Ndaw
- Université Cheikh Anta Diop, Dakar, Senegal
| | - Francis Oko
- Medical Research Council Unit, Fajara, Gambia
| | - Carly M. Bliss
- The Jenner Institute Laboratories, University of Oxford, Oxford, United Kingdom
| | | | | | - Alfredo Nicosia
- ReiThera, Rome, Italy
- CEINGE, Naples, Italy
- Department of Molecular Medicine and Medical Biotechnology, University Federico II, Naples, Italy
| | - Rachel Roberts
- Centre for Clinical Vaccinology and Tropical Medicine, The Jenner Institute, Churchill Hospital, Oxford, United Kingdom
| | - Flavia D’Alessio
- European Vaccine Initiative, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Odile Leroy
- European Vaccine Initiative, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | | | - Beate Kampmann
- Medical Research Council Unit, Fajara, Gambia
- Centre for International Child Health, Imperial College London, London, United Kingdom
| | | | | | - Stephen Gerry
- Centre for Statistics in Medicine, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Nicola K. Viebig
- European Vaccine Initiative, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Alison M. Lawrie
- Centre for Clinical Vaccinology and Tropical Medicine, The Jenner Institute, Churchill Hospital, Oxford, United Kingdom
| | - Ed Clarke
- Medical Research Council Unit, Fajara, Gambia
| | - Egeruan B. Imoukhuede
- Centre for Clinical Vaccinology and Tropical Medicine, The Jenner Institute, Churchill Hospital, Oxford, United Kingdom
| | - Katie J. Ewer
- The Jenner Institute Laboratories, University of Oxford, Oxford, United Kingdom
| | - Adrian V. S. Hill
- The Jenner Institute Laboratories, University of Oxford, Oxford, United Kingdom
- Centre for Clinical Vaccinology and Tropical Medicine, The Jenner Institute, Churchill Hospital, Oxford, United Kingdom
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Gitaka J, Ogwang C, Ngari M, Akoo P, Olotu A, Kerubo C, Fegan G, Njuguna P, Nyakaya G, Otieno T, Mwambingu G, Awuondo K, Lowe B, Chilengi R, Berkley JA. Clinical laboratory reference values amongst children aged 4 weeks to 17 months in Kilifi, Kenya: A cross sectional observational study. PLoS One 2017; 12:e0177382. [PMID: 28493930 PMCID: PMC5426761 DOI: 10.1371/journal.pone.0177382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 04/26/2017] [Indexed: 12/24/2022] Open
Abstract
Reference intervals for clinical laboratory parameters are important for assessing eligibility, toxicity grading and management of adverse events in clinical trials. Nonetheless, haematological and biochemical parameters used for clinical trials in sub-Saharan Africa are typically derived from industrialized countries, or from WHO references that are not region-specific. We set out to establish community reference values for haematological and biochemical parameters amongst children aged 4 weeks to 17 months in Kilifi, Kenya. We conducted a cross sectional study nested within phase II and III trials of RTS, S malaria vaccine candidate. We analysed 10 haematological and 2 biochemical parameters from 1,070 and 423 community children without illness prior to experimental vaccine administration. Statistical analysis followed Clinical and Laboratory Standards Institute EP28-A3c guidelines. 95% reference ranges and their respective 90% confidence intervals were determined using non-parametric methods. Findings were compared with published ranges from Tanzania, Europe and The United States. We determined the reference ranges within the following age partitions: 4 weeks to <6 months, 6 months to less than <12 months, and 12 months to 17 months for the haematological parameters; and 4 weeks to 17 months for the biochemical parameters. There were no gender differences for all haematological and biochemical parameters in all age groups. Hb, MCV and platelets 95% reference ranges in infants largely overlapped with those from United States or Europe, except for the lower limit for Hb, Hct and platelets (lower); and upper limit for platelets (higher) and haematocrit(lower). Community norms for common haematological and biochemical parameters differ from developed countries. This reaffirms the need in clinical trials for locally derived reference values to detect deviation from what is usual in typical children in low and middle income countries.
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Affiliation(s)
- Jesse Gitaka
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Clinical Medicine, School of Health Sciences, Mount Kenya University, Thika, Kenya
| | - Caroline Ogwang
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Moses Ngari
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya.,The Childhood Acute Illness & Nutrition Network (CHAIN), Nairobi, Kenya
| | - Pauline Akoo
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ally Olotu
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Christine Kerubo
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Greg Fegan
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, United Kingdom.,Swansea Trials Unit, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Patricia Njuguna
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Godfrey Nyakaya
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Tuda Otieno
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Gabriel Mwambingu
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ken Awuondo
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Brett Lowe
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, United Kingdom
| | - Roma Chilengi
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - James A Berkley
- Clinical Trials Facility, Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya.,The Childhood Acute Illness & Nutrition Network (CHAIN), Nairobi, Kenya.,Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, United Kingdom
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Odutola A, Ota MO, Ogundare EO, Antonio M, Owiafe P, Worwui A, Greenwood B, Alderson M, Traskine M, Verlant V, Dobbelaere K, Borys D. Reactogenicity, safety and immunogenicity of a protein-based pneumococcal vaccine in Gambian children aged 2-4 years: A phase II randomized study. Hum Vaccin Immunother 2016; 12:393-402. [PMID: 26618243 PMCID: PMC5049746 DOI: 10.1080/21645515.2015.1111496] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Pneumococcal conjugate vaccines (PCVs) have been successful in preventing invasive pneumococcal disease but effectiveness has been challenged by replacement of vaccine serotypes with non-vaccine serotypes. Vaccines targeting common pneumococcal protein(s) found in most/all pneumococci may overcome this limitation. This phase II study assessed safety and immunogenicity of a new protein-based pneumococcal vaccine containing polysaccharide conjugates of 10 pneumococcal serotypes combined with pneumolysin toxoid(dPly) and pneumococcal histidine triad protein D(PhtD) (PHiD-CV/dPly/PhtD-30) in African children. 120 Gambian children (2–4 years, not previously vaccinated against Streptococcus pneumoniae) randomized (1:1) received a single dose of PHiD-CV/dPly/PhtD-30 or PCV13. Adverse events occurring over 4 d post-vaccination were reported, and blood samples obtained pre- and 1-month post-vaccination. Serious adverse events were reported for 6 months post-vaccination. Solicited local and systemic adverse events were reported at similar frequency in each group. One child (PHiD-CV/dPly/PhtD-30 group) reported a grade 3 local reaction to vaccination. Haematological and biochemical parameters seemed similar pre- and 1-month post-vaccination in each group. High pre-vaccination Ply and PhtD antibody concentrations were observed in each group, but only increased in PHiD-CV/dPly/PhtD-30 vaccinees one month post-vaccination. One month post-vaccination, for each vaccine serotype ≥96.2% of PHiD-CV/dPly/PhtD-30 vaccinees had serotype-specific polysaccharide antibody concentrations ≥0.20µg/mL except serotypes 6B (80.8%) and 23F (65.4%), and ≥94.1% had OPA titres of ≥8 except serotypes 1 (51.9%), 5 (38.5%) and 6B (78.0%), within ranges seen in PCV13-vaccinated children. A single dose of PHiD-CV/dPly/PhtD-30 vaccine, administered to Gambian children aged 2–4 y not previously vaccinated with a pneumococcal vaccine, was well-tolerated and immunogenic.
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Affiliation(s)
- A Odutola
- a Medical Research Council Unit ; Banjul , The Gambia
| | - M O Ota
- a Medical Research Council Unit ; Banjul , The Gambia
| | - E O Ogundare
- a Medical Research Council Unit ; Banjul , The Gambia
| | - M Antonio
- a Medical Research Council Unit ; Banjul , The Gambia
| | - P Owiafe
- a Medical Research Council Unit ; Banjul , The Gambia
| | - A Worwui
- a Medical Research Council Unit ; Banjul , The Gambia
| | - B Greenwood
- b London School of Hygiene & Tropical Medicine ; London , UK
| | | | | | | | | | - D Borys
- d GSK Vaccines ; Wavre , Belgium
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Okebe J, Mwesigwa J, Agbla SC, Sanya-Isijola F, Abubakar I, D'Alessandro U, Jaye A, Bojang K. Seasonal variation in haematological and biochemical reference values for healthy young children in The Gambia. BMC Pediatr 2016; 16:5. [PMID: 26754650 PMCID: PMC4710011 DOI: 10.1186/s12887-016-0545-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 01/08/2016] [Indexed: 11/18/2022] Open
Abstract
Background Haematological and biochemistry reference values for children are important for interpreting clinical and research results however, differences in demography and environment poses a challenge when comparing results. The study defines reference intervals for haematological and biochemistry parameters and examines the effect of seasonality in malaria transmission. Methods Blood samples collected from clinically healthy children, aged 12–59 months, in two surveys during the dry and wet season in the Upper River region of The Gambia were processed and the data analysed to generate reference intervals based on the 2.5th and 97.5th percentiles of the data. Results Analysis was based on data from 1141 children with median age of 32 months. The mean values for the total white cell count and differentials; lymphocyte, monocyte and neutrophil decreased with increasing age, were lower in males and higher in the wet season survey. However, platelet values declined with age (p < 0.0001). There was no evidence of effect of gender on mean values of AST, ALT, lymphocytes, monocytes, platelets and haemoglobin. Conclusion Mean estimates for haematological and biochemistry reference intervals are affected by age and seasonality in the first five years of life. This consistency is important for harmonisation of reference values for clinical care and interpretation of trial results. Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0545-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | - Umberto D'Alessandro
- Medical Research Council Unit, Fajara, Gambia.,Institute of Tropical Medicine, Antwerp, Belgium.,London school of Hygiene and Tropical Medicine, London, UK
| | - Assan Jaye
- Medical Research Council Unit, Fajara, Gambia
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Palacpac NMQ, Ntege E, Balikagala B, Yeka A, Shirai H, Suzuki N, Nsereko C, Kanoi BN, Okada T, Egwang TG, Horii T. Hematological and biochemical data obtained in rural northern Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:4870-85. [PMID: 24806194 PMCID: PMC4053919 DOI: 10.3390/ijerph110504870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/21/2014] [Accepted: 04/30/2014] [Indexed: 11/17/2022]
Abstract
Reference intervals for common hematological and clinical chemistry parameters constitute an important basis for health care. Moreover, with increasing priority in drug and vaccine development for infectious diseases in Africa, the first priority is the safety evaluation and tolerability of the candidate interventions in healthy populations. To accurately assess health status and address adverse events, clinical reference intervals in the target population are necessary. We report on hematological and biochemical indices from healthy volunteers who participated in a clinical trial in Lira, northern Uganda. Median and nonparametric 95% percentiles on five hematology and 15 biochemistry analytes are shown. Although most hematological analytes conformed to reported reference intervals and trends in Africa, literature review from different African countries highlight the need for a region-specific children reference interval that can be appropriate for the population.
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Affiliation(s)
- Nirianne M Q Palacpac
- Department of Molecular Protozoology, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka 565-0871, Japan.
| | - Edward Ntege
- Med Biotech Laboratories, P.O. Box 9364, Kampala, Uganda.
| | | | - Adoke Yeka
- Med Biotech Laboratories, P.O. Box 9364, Kampala, Uganda.
| | - Hiroki Shirai
- The Research Foundation for Microbial Diseases of Osaka University, 2-9-41 Yahata-cho, Kanonji, Kagawa 768-0061, Japan.
| | - Nahoko Suzuki
- The Research Foundation for Microbial Diseases of Osaka University, 2-9-41 Yahata-cho, Kanonji, Kagawa 768-0061, Japan.
| | | | | | - Takuya Okada
- The Research Foundation for Microbial Diseases of Osaka University, 2-9-41 Yahata-cho, Kanonji, Kagawa 768-0061, Japan.
| | | | - Toshihiro Horii
- Department of Molecular Protozoology, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka 565-0871, Japan.
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