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Osoro E, Awuor AO, Inwani I, Mugo C, Hunsperger E, Verani JR, Nduati R, Kinuthia J, Okutoyi L, Mwaengo D, Maugo B, Otieno NA, Mirieri H, Ombok C, Nyawanda B, Agogo GO, Ngere I, Zitomer NC, Rybak ME, Munyua P, Njenga K, Widdowson MA. Association between low maternal serum aflatoxin B1 exposure and adverse pregnancy outcomes in Mombasa, Kenya, 2017-2019: A nested matched case-control study. MATERNAL & CHILD NUTRITION 2024:e13688. [PMID: 38886171 DOI: 10.1111/mcn.13688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024]
Abstract
We examined the association between serum aflatoxin B1-lysine adduct (AFB1-lys) levels in pregnant women and adverse pregnancy outcomes (low birthweight, miscarriage and stillbirth) through a nested matched case-control study of pregnant women enroled at ≤28 weeks' gestation in Mombasa, Kenya, from 2017 to 2019. Cases comprised women with an adverse birth outcome, defined as either delivery of a singleton infant weighing <2500 g, or a miscarriage, or a stillbirth, while controls were women who delivered a singleton live infant with a birthweight of ≥2500 g. Cases were matched to controls at a ratio of 1:2 based on maternal age at enrolment, gestational age at enrolment and study site. The primary exposure was serum AFB1-lys. The study included 125 cases and 250 controls. The median gestation age when serum samples were collected was 23.0 weeks (interquartile range [IQR]: 18.1-26.0) and 23.5 (IQR: 18.1-26.5) among cases and controls, respectively. Of the 375 tested sera, 145 (38.7%) had detectable serum AFB1-lys: 36.0% in cases and 40.0% in controls. AFB1-lys adduct levels were not associated with adverse birth outcomes on multivariable analysis. Mid-upper arm circumference was associated with a 6% lower odds of adverse birth outcome for every unit increase (p = 0.023). Two-fifths of pregnant women had detectable levels of aflatoxin midway through pregnancy. However, we did not detect an association with adverse pregnancy outcomes, likely because of low serum AFB1-lys levels and low power, restricting meaningful comparison. More research is needed to understand the public health risk of aflatoxin in pregnant women to unborn children.
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Affiliation(s)
- Eric Osoro
- Washington State University Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Abigael O Awuor
- Washington State University Global Health Kenya, Nairobi, Kenya
- U.S. Centers for Disease Control and Prevention, CDC Kenya, Division of Global Health Protection, Nairobi, Kenya
| | - Irene Inwani
- Department of Paediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Cyrus Mugo
- Research and Programs Department, Kenyatta National Hospital/University of Nairobi, Nairobi, Kenya
| | - Elizabeth Hunsperger
- U.S. Centers for Disease Control and Prevention, CDC Kenya, Division of Global Health Protection, Nairobi, Kenya
| | - Jennifer R Verani
- U.S. Centers for Disease Control and Prevention, CDC Kenya, Division of Global Health Protection, Nairobi, Kenya
| | - Ruth Nduati
- Department of Paediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Research and Programs Department, Kenyatta National Hospital/University of Nairobi, Nairobi, Kenya
| | - Lydia Okutoyi
- Department of Obstetrics and Gynaecology/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Dufton Mwaengo
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Brian Maugo
- Department of Paediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Nancy A Otieno
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Harriet Mirieri
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Cynthia Ombok
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Bryan Nyawanda
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - George O Agogo
- U.S. Centers for Disease Control and Prevention, CDC Kenya, Division of Global Health Protection, Nairobi, Kenya
| | - Isaac Ngere
- Washington State University Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Nicholas C Zitomer
- National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Division of Laboratory Sciences, Atlanta, Georgia, USA
| | - Michael E Rybak
- National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Division of Laboratory Sciences, Atlanta, Georgia, USA
| | - Peninah Munyua
- U.S. Centers for Disease Control and Prevention, CDC Kenya, Division of Global Health Protection, Nairobi, Kenya
| | - Kariuki Njenga
- Washington State University Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Marc-Alain Widdowson
- U.S. Centers for Disease Control and Prevention, CDC Kenya, Division of Global Health Protection, Nairobi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
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Mirieri H, Nduati R, Dawa J, Okutoyi L, Osoro E, Mugo C, Wamalwa D, Jin H, Mwaengo D, Otieno N, Marwanga D, Shabibi M, Munyua P, Kinuthia J, Clancey E, Widdowson MA, Njenga MK, Verani JR, Inwani I. Risk factors of adverse birth outcomes among a cohort of pregnant women in Coastal Kenya, 2017-2019. BMC Pregnancy Childbirth 2024; 24:127. [PMID: 38347445 PMCID: PMC10860222 DOI: 10.1186/s12884-024-06320-6] [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: 04/05/2023] [Accepted: 02/05/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Adverse birth outcomes particularly preterm births and congenital anomalies, are the leading causes of infant mortality globally, and the burden is highest in developing countries. We set out to determine the frequency of adverse birth outcomes and the risk factors associated with such outcomes in a cohort of pregnant women in Kenya. METHODS From October 2017 to July 2019, pregnant women < 28 weeks gestation were enrolled and followed up until delivery in three hospitals in coastal Kenya. Newborns were examined at delivery. Among women with birth outcome data, we assessed the frequency of congenital anomalies defined as gastroschisis, umbilical hernia, limb abnormalities and Trisomy 21, and adverse birth outcomes, defined as either stillbirth, miscarriage, preterm birth, small for gestational age, or microcephaly. We used log-binomial regression to identify maternal characteristics associated with the presence of at least one adverse outcome. RESULTS Among the 2312 women enrolled, 1916 (82.9%) had birth outcome data. Overall, 402/1916 (20.9%; 95% confidence interval (CI): 19.1-22.8) pregnancies had adverse birth outcomes. Specifically, 66/1916 (3.4%; 95% CI: 2.7-4.4) were stillbirths, 34/1916 (1.8%; 95% CI: 1.2-2.4) were miscarriages and 23/1816 (1.2%; 95% CI: 0.8-1.9) had congenital anomalies. Among the participants with anthropometric measurements data, 142/1200 (11.8%; 95% CI: 10.1 - 13.8) were small for gestational age and among the participants with ultrasound records, 143/1711 (8.4%; 95% CI: 7.1-9.8) were preterm. Febrile illnesses in current pregnancy (adjusted risk ratio (aRR): 1.7; 95% CI: 1.1-2.8), a history of poor birth outcomes in prior pregnancy (aRR: 1.8; 95% CI: 1.3-2.4) and high blood pressure in pregnancy (aRR: 3.9, 95% CI: (1.7-9.2) were independently associated with adverse birth outcomes in a model that included age, education, human immunodeficiency virus status and high blood pressure at enrolment. CONCLUSION We found similar rates of overall adverse birth outcomes, congenital anomalies, and small for gestational age but higher rates of stillbirths and lower rates of prematurity compared to the rates that have been reported in the sub-Saharan Africa region. However, the rates of adverse birth outcomes in this study were comparable to other studies conducted in Kenya. Febrile illnesses during the current pregnancy, previous history of poor birth outcomes and high blood pressure in pregnancy are predictive of an increased risk of adverse birth outcomes.
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Affiliation(s)
- Harriet Mirieri
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya.
| | - Ruth Nduati
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Jeanette Dawa
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Lydia Okutoyi
- Department of Health Care Quality, Kenyatta National Hospital, Nairobi, Kenya
| | - Eric Osoro
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Cyrus Mugo
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Dalton Wamalwa
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Hafsa Jin
- Coast General Teaching and Referral Hospital, Mombasa, Kenya
| | - Dufton Mwaengo
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
| | - Nancy Otieno
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Doris Marwanga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | | | - Peninah Munyua
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Erin Clancey
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Marc-Alain Widdowson
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
| | - M Kariuki Njenga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Jennifer R Verani
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Irene Inwani
- Department of Paediatrics, Kenyatta National Hospital, Nairobi, Kenya
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Hunsperger E, Osoro E, Munyua P, Njenga MK, Mirieri H, Kikwai G, Odhiambo D, Dayan M, Omballa V, Agogo GO, Mugo C, Widdowson MA, Inwani I. Seroconversion and seroprevalence of TORCH infections in a pregnant women cohort study, Mombasa, Kenya, 2017-2019. Epidemiol Infect 2024; 152:e68. [PMID: 38305089 PMCID: PMC11077605 DOI: 10.1017/s0950268824000165] [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: 01/03/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
Women infected during pregnancy with TORCH (Toxoplasmosis, Other, Rubella, Cytomegalovirus, and Herpes simplex viruses) pathogens have a higher risk of adverse birth outcomes including stillbirth / miscarriage because of mother-to-child transmission. To investigate these risks in pregnant women in Kenya, we analyzed serum specimens from a pregnancy cohort study at three healthcare facilities. A sample of 481 participants was selected for TORCH pathogen antibody testing to determine seroprevalence. A random selection of 285 from the 481 participants was selected to measure seroconversion. These sera were tested using an IgG enzyme-linked immunosorbent assay against 10 TORCH pathogens. We found that the seroprevalence of all but three of the 10 TORCH pathogens at enrollment was >30%, except for Bordetella pertussis (3.8%), Treponema pallidum (11.4%), and varicella zoster virus (0.5%). Conversely, very few participants seroconverted during their pregnancy and were herpes simplex virus type 2 (n = 24, 11.2%), parvovirus B19 (n = 14, 6.2%), and rubella (n = 12, 5.1%). For birth outcomes, 88% of the participant had live births and 12% had stillbirths or miscarriage. Cytomegalovirus positivity at enrolment had a statistically significant positive association with a live birth outcome (p = 0.0394). Of the 10 TORCH pathogens tested, none had an association with adverse pregnancy outcome.
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Affiliation(s)
- Elizabeth Hunsperger
- Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Eric Osoro
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University (WSU), Pullman, WA, USA
| | - Peninah Munyua
- Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - M. Kariuki Njenga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
- Paul G. Allen School for Global Health, Washington State University (WSU), Pullman, WA, USA
| | - Harriet Mirieri
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
| | - Gilbert Kikwai
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Nairobi, Kenya
| | - Dennis Odhiambo
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Nairobi, Kenya
| | - Moshe Dayan
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Nairobi, Kenya
| | - Victor Omballa
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research, Nairobi, Kenya
| | - George O. Agogo
- Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Cyrus Mugo
- Department of Paediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Marc-Alain Widdowson
- Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Irene Inwani
- Department of Paediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
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George AM, Ansumana R, de Souza DK, Niyas VKM, Zumla A, Bockarie MJ. Climate change and the rising incidence of vector-borne diseases globally. Int J Infect Dis 2024; 139:143-145. [PMID: 38096974 DOI: 10.1016/j.ijid.2023.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023] Open
Affiliation(s)
- Angella M George
- College of Medical Sciences, Njala University, Bo Campus, Sierra Leone.
| | - Rashid Ansumana
- College of Medical Sciences, Njala University, Bo Campus, Sierra Leone; School of Public Health and Tropical Medicine, Tulane University, US.
| | - Dziedzom K de Souza
- Department of Parasitology and Department of Clinical Pathology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana.
| | - Vettakkara Kandy Muhammed Niyas
- Department of Infectious Diseases, KIMSHEALTH, International Society for Infectious Diseases, Thiruvananthapuram, Kerala, India; International Society for Infectious Diseases.
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London; NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK.
| | - Moses J Bockarie
- College of Medical Sciences, Njala University, Bo Campus, Sierra Leone; International Society for Infectious Diseases.
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Ravindran S, Lahon A. Tropism and immune response of chikungunya and zika viruses: An overview. Cytokine 2023; 170:156327. [PMID: 37579710 DOI: 10.1016/j.cyto.2023.156327] [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: 10/10/2022] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023]
Abstract
Zika virus (ZIKV) and chikungunya virus (CHIKV) are two medically important vector-borne viruses responsible for causing significant disease burden in humans, including neurological sequelae/complications. Besides sharing some common clinical features, ZIKV has major shares in causing microcephaly and brain malformations in developing foetus, whereas CHIKV causes chronic joint pain/swelling in infected individuals. Both viruses have a common route of entry to the host body. i.e., dermal site of inoculation through the bite of an infected mosquito and later taken up by different immune cells for further dissemination to other areas of the host body that lead to a range of immune responses via different pathways. The immune responses generated by both viruses have similar characteristics with varying degrees of inflammation and activation of immune cells. However, the overall response of immune cells is not fully explored in the context of ZIKV and CHIKV infection. The knowledge of cellular tropism and the immune response is the key to understanding the mechanisms of viral immunity and pathogenesis, which may allow to develop novel therapeutic strategies for these viral infections. This review aims to discuss recent advancements and identify the knowledge gaps in understanding the mechanism of cellular tropism and immune response of CHIKV and ZIKV.
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Affiliation(s)
- Shilpa Ravindran
- Institute of Advanced Virology, Thiruvananthapuram, Kerala 695317, India
| | - Anismrita Lahon
- Institute of Advanced Virology, Thiruvananthapuram, Kerala 695317, India.
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Liu B, Zhang Y, Ren H, Yao Q, Ba J, Luan J, Zhao P, Qin Z, Qi Z. mTOR signaling regulates Zika virus replication bidirectionally through autophagy and protein translation. J Med Virol 2023; 95:e28422. [PMID: 36546404 DOI: 10.1002/jmv.28422] [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: 10/07/2022] [Revised: 12/10/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Zika virus (ZIKV) reemerged in 2016 and attracted much more attention worldwide. To date, the limited knowledge of ZIKV interactions with host cells in the early stages of infection impedes the prevention of viral epidemics and the treatment of ZIKV disease. The mammalian target of rapamycin (mTOR) signaling pathway plays an essential role in the regulation of autophagy and protein synthesis during multiple viral infections. This study aimed to investigate the functional role of mTOR signaling in ZIKV replication in human umbilical vein endothelial cells. Immunoblotting demonstrated that ZIKV infection inhibited mTORC1 signaling, enhancing autophagy but obstructing protein translation. Drugs or siRNA for interfering with mTOR signaling molecules were utilized to demonstrate that AKT/TSC2/mTORC1 signaling was involved in ZIKV infection and that autophagy promoted ZIKV production, but viral protein expression was regulated by mTORC1 signaling. Moreover, confocal microscopy indicated a robust correlation between autophagy and viral RNA transcription. This study clarifies the dual functions of mTOR signaling during ZIKV infection and provides theoretical support for developing potential anti-ZIKV drugs based on mTOR signaling molecules and deeper insights to better understand the mechanism between ZIKV and host cells.
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Affiliation(s)
- Bin Liu
- Department of Microbiology, Naval Medical University, Shanghai Key Laboratory of Medical Biodefense, Shanghai, China.,Naval Medical Center, Naval Medical University, Shanghai, China
| | - Yahui Zhang
- Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Hao Ren
- Department of Microbiology, Naval Medical University, Shanghai Key Laboratory of Medical Biodefense, Shanghai, China
| | - Qiufeng Yao
- Department of Microbiology, Naval Medical University, Shanghai Key Laboratory of Medical Biodefense, Shanghai, China
| | - Jianbo Ba
- Naval Medical Center, Naval Medical University, Shanghai, China
| | - Jie Luan
- Naval Medical Center, Naval Medical University, Shanghai, China
| | - Ping Zhao
- Department of Microbiology, Naval Medical University, Shanghai Key Laboratory of Medical Biodefense, Shanghai, China
| | - Zhaoling Qin
- Department of Microbiology, Naval Medical University, Shanghai Key Laboratory of Medical Biodefense, Shanghai, China
| | - Zhongtian Qi
- Department of Microbiology, Naval Medical University, Shanghai Key Laboratory of Medical Biodefense, Shanghai, China
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