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Mpingabo PI, Ylade M, Aogo RA, Crisostomo MV, Thiono DJ, Daag JV, Agrupis KA, Escoto AC, Raimundi-Rodriguez GL, Odio CD, Fernandez MA, White L, de Silva AM, Deen J, Katzelnick LC. Envelope-dimer epitope-like broadly protective antibodies against dengue in children following natural infection and vaccination. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.30.24306574. [PMID: 38746253 PMCID: PMC11092691 DOI: 10.1101/2024.04.30.24306574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Cross-reactive antibodies (Abs) to epitopes that span envelope proteins on the virion surface are hypothesized to protect against dengue. Here, we measured Abs targeting the quaternary envelope dimer epitope (EDE) as well as neutralizing and binding Abs and evaluate their association with dengue virus (DENV) infection, vaccine response, and disease outcome in dengue vaccinated and unvaccinated children (n=252) within a longitudinal cohort in Cebu, Philippines (n=2,996). Abs targeting EDE were prevalent and strongly associated with broad neutralization of DENV1-4 in those with baseline multitypic immunity. Subsequent natural infection and vaccination boosted EDE-like, neutralizing, and binding Abs. EDE-like Abs were associated with reduced dengue risk and mediated the protective effect of binding and neutralizing Abs on symptomatic and severe dengue. Thus, Abs targeting quaternary epitopes help explain broad cross protection in those with multiple prior DENV exposures, making them useful for evaluation and development of future vaccines and therapeutics.
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Juniour Nsubuga E, Kirabo J, Kwiringira A, Andaku L, Magona Nerima S, Nsubuga F, Nakazzi R, Kwesiga B, Bulage L, Kadobera D, Edward Okello P, Riolexus Ario A. Factors associated with acute watery diarrhea among children aged 0-59 months in Obongi District, Uganda, April 2022: A case-control study. Prev Med Rep 2024; 40:102666. [PMID: 38435417 PMCID: PMC10904186 DOI: 10.1016/j.pmedr.2024.102666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/10/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
Background Diarrheal diseases, are major concerns for Ugandan children; persistent in Obongi District despite high rotavirus vaccination rates (2019-2021). The district recorded the country's highest annual acute watery diarrhea (AWD) incidence from 2017 to 2021. Our study, conducted in April 2022, assessed AWD risk factors among 0-59-month-old children in Obongi. Methods We conducted a 1:2 (193:386) unmatched case-control study. A case was a child (0-59 months) with ≥ 3 loose/liquid stools/day, negative malaria/pneumonia tests, residing in Itula/Parolinya subcounty from 1 to 30 April 2022. Medical records from 10 facilities were reviewed. Simple random sampling identified cases, who were interviewed, and controls were randomly chosen from non-AWD neighboring households. Child health cards provided vaccination details. We used logistic regression to identify factors associated with AWD. Results Among 193 cases and 386 controls, 104 (54 %) cases and 183 (47 %) controls were male, 58 (30 %) cases and 127 (33 %) controls were aged 12-23 months, 187 (97 %) cases and 369 (96 %) controls had received at least one dose of rotavirus vaccine, 58 (30 %) cases and 120 (34 %) controls treated drinking water. Comorbidity presence (undernutrition, diabetes, HIV) (AOR = 12; CI: 2.5-53), caregiver's unwashed hands post-toilet (AOR = 3.9; CI: 1.2-13), and borehole vs. piped water (AOR = 4.0; CI: 1.7-9.6) linked to AWD. Conclusion Modifiable factors, including failure of caregivers to wash their hands with soap after visiting toilets and use of borehole water were associated with AWD, suggesting that community sensitization on handwashing at critical times, using clean water and soap, and expanded use of piped water could reduce AWD incidence in this area.
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Affiliation(s)
- Edirisa Juniour Nsubuga
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Jireh Kirabo
- Makerere University School of Public Health, Kampala, Uganda
| | - Andrew Kwiringira
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Linus Andaku
- District Health Office, Obongi District Local Government, Uganda
| | | | - Fred Nsubuga
- Uganda National Expanded Programme on Immunization, Ministry of Health, Kampala, Uganda
| | | | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Daniel Kadobera
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Paul Edward Okello
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Alex Riolexus Ario
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
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Angelin M, Sjölin J, Kahn F, Ljunghill Hedberg A, Rosdahl A, Skorup P, Werner S, Woxenius S, Askling HH. Qdenga® - A promising dengue fever vaccine; can it be recommended to non-immune travelers? Travel Med Infect Dis 2023; 54:102598. [PMID: 37271201 DOI: 10.1016/j.tmaid.2023.102598] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023]
Abstract
Qdenga® has been approved by the European Medicines Agency (EMA) for individuals > 4 years of age and for use according to national recommendations. The vaccine shows high efficacy against virologically confirmed dengue and severe dengue in clinical studies on 4-16-year old's living in endemic areas. For individuals 16-60 years old only serological data exists and there is no data for individuals > 60 years. Its use as a travel vaccine is still unclear. We present the studies behind the approval and the recommendations for travelers as issued by the Swedish Society for Infectious Diseases Physicians.
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Affiliation(s)
- Martin Angelin
- Department of Clinical Microbiology, Infectious Diseases, Umeå University, Sweden
| | - Jan Sjölin
- Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Sweden
| | - Fredrik Kahn
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Sweden
| | - Anna Ljunghill Hedberg
- Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Sweden
| | - Anja Rosdahl
- School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden
| | - Paul Skorup
- Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Sweden
| | - Simon Werner
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Region Skåne, Sweden
| | - Susanne Woxenius
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helena H Askling
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Sweden; Academic Specialist Centre, Stockholm County Health Care Services, Region Stockholm, Sweden.
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Tricou V, Eyre S, Ramjee M, Collini P, Mojares Z, Loeliger E, Mandaric S, Rauscher M, Brose M, Lefevre I, Folschweiller N, Wallace D. A randomized phase 3 trial of the immunogenicity and safety of coadministration of a live-attenuated tetravalent dengue vaccine (TAK-003) and an inactivated hepatitis a (HAV) virus vaccine in a dengue non-endemic country. Vaccine 2023; 41:1398-1407. [PMID: 36681529 DOI: 10.1016/j.vaccine.2023.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/03/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Vaccination against hepatitis A virus (HAV) is largely recommended for travelers worldwide. Concurrent dengue and HAV vaccination may be desired in parallel for travelers to countries where both diseases are endemic. This randomized, observer-blind, phase 3 trial evaluated coadministration of HAV vaccine with tetravalent dengue vaccine (TAK-003) in healthy adults aged 18-60 years living in the UK. METHODS Participants were randomized (1:1:1) to receive HAV vaccine and placebo on Day 1, and placebo on Day 90 (Group 1), TAK-003 and placebo on Day 1, and TAK-003 on Day 90 (Group 2), or TAK-003 and HAV vaccine on Day 1, and TAK-003 on Day 90 (Group 3). The primary objective was non-inferiority of HAV seroprotection rate (anti-HAV ≥ 12.5 mIU/mL) in Group 3 versus Group 1, one month post-first vaccination (Day 30) in HAV-naïve and dengue-naïve participants. Sensitivity analyses were performed on combinations of baseline HAV and dengue serostatus. Secondary objectives included dengue seropositivity one month post-second vaccination (Day 120), HAV geometric mean concentrations (GMCs), and safety. RESULTS 900 participants were randomized. On Day 30, HAV seroprotection rates were non-inferior following coadministration of HAV and TAK-003 (Group 3: 98.7 %) to HAV administration alone (Group 1: 97.1 %; difference: -1.68, 95 % CI: -8.91 to 4.28). Sensitivity analyses including participants who were neither HAV-naïve nor DENV-naïve at baseline supported this finding. Anti-HAV GMCs on Day 30 were 82.1 (95 % CI: 62.9-107.1) mIU/mL in Group 1 and 93.0 (76.1-113.6) mIU/mL in Group 3. By Day 120, 90.9-96.8 % of TAK-003 recipients were seropositive (neutralizing antibody titer > 10) to all four dengue serotypes. Coadministration of HAV vaccine and TAK-003 was well tolerated, with no important safety risks identified. CONCLUSION Immune responses following coadministration of HAV vaccine and TAK-003 were non-inferior to administration of HAV vaccine alone. The results support the coadministration of HAV vaccine and TAK-003 with no adverse impact on immunogenicity, safety, and reactogenicity of either vaccine. CLINICALTRIALS gov registration: NCT03525119.
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Affiliation(s)
- Vianney Tricou
- Takeda Pharmaceuticals International AG, 8152 Glattpark-Opfikon (Zurich), Switzerland.
| | - Susannah Eyre
- Medical Operations, Synexus Merseyside Clinical Research Centre, Liverpool, L22 0LG Merseyside, UK
| | - Mahadev Ramjee
- Synexus Lancashire Clinical Research Centre, Chorley, PR7 7NA Lancashire, UK
| | - Paul Collini
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield Medical School, S10 2RX Sheffield, UK
| | - Zenaida Mojares
- Takeda Pharmaceuticals International AG, 8152 Glattpark-Opfikon (Zurich), Switzerland
| | - Edde Loeliger
- Takeda Pharmaceuticals International AG, 8152 Glattpark-Opfikon (Zurich), Switzerland
| | - Sanja Mandaric
- Takeda Pharmaceuticals International AG, 8152 Glattpark-Opfikon (Zurich), Switzerland
| | - Martina Rauscher
- Takeda Pharmaceuticals International AG, 8152 Glattpark-Opfikon (Zurich), Switzerland
| | - Manja Brose
- Takeda Pharmaceuticals International AG, 8152 Glattpark-Opfikon (Zurich), Switzerland
| | - Inge Lefevre
- Takeda Pharmaceuticals International AG, 8152 Glattpark-Opfikon (Zurich), Switzerland
| | - Nicolas Folschweiller
- Takeda Pharmaceuticals International AG, 8152 Glattpark-Opfikon (Zurich), Switzerland
| | - Derek Wallace
- Global Dengue Program, Takeda Vaccines, Inc., Boston, 02139 MA, USA
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Ashinyo ME, Amegah KE, Kariyo PC, Ackon A, Asrat S, Dubik SD. Status of patient safety in selected Ghanaian hospitals: a national cross-sectional study. BMJ Open Qual 2022; 11:bmjoq-2022-001938. [PMID: 36261212 PMCID: PMC9582382 DOI: 10.1136/bmjoq-2022-001938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Safety is one of the dimensions of healthcare quality and is core to achieving universal health coverage and healthcare delivery worldwide. In Ghana, the status of patient safety in the last 7 years has remained unknown. Therefore, this study aims to assess the patient safety status in selected hospitals in Ghana. METHODS Using the WHO Patient Safety Long Form, a mixed methodology was used to assess the patient safety status in 27 hospitals in Ghana. Data were analysed using descriptive statistics and axial codes for thematic analysis. RESULTS The average national patient safety score was high (85%). However, there were variations in the performance of the hospitals across the WHO patient safety action areas. Knowledge and learning in patient safety (97%) was the highest-rated patient safety action area. Patient safety surveillance, patient safety funding, patient safety partnerships and national patient safety policy had mean scores lower than the national average score (85%). Less than half (42%) of the hospitals had a dedicated budget for patient safety activities. The means of continuous education for health professionals include clinical sessions, and in-service training, while the system of clinical audits in the hospitals were maternal mortality, perinatal mortality, stillbirth and general mortality audits. The hospitals use posters, leaflets, public address systems and health education sessions to inform patients about their rights. Patient safety issues are reported through suggestion boxes, designated desks and the use of contacts of core management staff. CONCLUSION The current patient safety status in the hospitals was generally good, with the highest score in the knowledge and learning in the patient safety domain. Patient safety surveillance was identified as the weakest action area. The findings of this study will form the scientific basis for initiating the development of a national patient safety policy in Ghana. This is crucial for ensuring resilient and sustainable health systems that guarantee safer care to all patients in Ghana.
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Affiliation(s)
- Mary Eyram Ashinyo
- Department of Quality Assurance, Ghana Health Service, Accra, Ghana,Department of Maternal and Child Health, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Kingsley E Amegah
- Department of Data Science and Economic Policy, University of Cape Coast, School of Economics, Cape Coast, Western, Ghana
| | | | - Angela Ackon
- World Health Organization Country Office, Accra, Ghana
| | | | - Stephen Dajaan Dubik
- School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
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Abera W, Gintamo B, Shitemaw T, Mekuria ZN, Gizaw Z. Prevalence of intestinal parasites and associated factors among food handlers in food establishments in the Lideta subcity of Addis Ababa, Ethiopia: an institution-based, cross-sectional study. BMJ Open 2022; 12:e061688. [PMID: 35858725 PMCID: PMC9305799 DOI: 10.1136/bmjopen-2022-061688] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study was conducted to assess the prevalence of intestinal parasites and the associated factors among food handlers in the Lideta subcity of Addis Ababa, Ethiopia. DESIGN An institution-based, cross-sectional study design was used. Stool samples were collected from food handlers and examined using direct wet mount and formalin-ether concentration techniques. Personal and establishment-related information was collected using a pretested questionnaire, with a structured observation. Multivariable binary logistic regression was used to identify factors associated with the prevalence of intestinal parasites on the basis of adjusted OR (AOR) and 95% CI and p values <0.05. SETTING Food establishments in the Lideta subcity of Addis Ababa, Ethiopia. PARTICIPANTS 411 food handlers participated in the study. OUTCOME MEASURES The primary outcome was the prevalence of intestinal parasites, defined as the presence of one or more intestinal parasitic species in stool samples. RESULTS One or more intestinal parasites were detected in 171 (41.6%; 95% CI 36.6% to 46.4%) stool samples. The most common intestinal parasites were Entamoeba histolytica/dispar (12.7%), Giardia duodenalis (11.2%) and Ascaris lumbricoides (8.3%). The presence of intestinal parasites among food handlers was associated with low monthly income (AOR: 2.83, 95% CI 1.50 to 8.84), untrimmed fingernails (AOR: 4.36, 95% CI 1.98 to 11.90), no food safety training (AOR: 2.51, 95% CI 1.20 to 5.58), low level of education (AOR: 3.13, 95% CI 1.34 to 7.44), poor handwashing practice (AOR: 2.16, 95% CI 1.03 to 4.22) and lack of medical check-up (AOR: 2.31, 95% CI 1.18 to 6.95). CONCLUSION The prevalence of intestinal parasites among food handlers in food establishments in the Lideta subcity of Addis Ababa was high. The presence of intestinal parasites was linked to socioeconomic conditions, poor hand hygiene conditions and absence of food safety training. It is crucially important to promote handwashing practices and provide food hygiene and safety training in these settings.
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Affiliation(s)
- Woinishet Abera
- Department of Public Health, Yanet Health College, Addis Ababa, Ethiopia
| | - Binyam Gintamo
- Department of Public Health, Yanet Health College, Addis Ababa, Ethiopia
- Department of Public Health, Addis Ababa Medical and Business College, Addis Ababa, Ethiopia
| | - Tewoderos Shitemaw
- Department of Public Health, Yanet Health College, Addis Ababa, Ethiopia
- Anesthesia Department, Menelik II Health and Medical Science College, Kotebe Metropolitan University, Addis Ababa, Ethiopia
| | - Zelalem Negash Mekuria
- Department of Public Health, Yanet Health College, Addis Ababa, Ethiopia
- Department of Public Health, Addis Ababa Medical and Business College, Addis Ababa, Ethiopia
| | - Zemichael Gizaw
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Hammami S, Hmida F, Gharbi H, Ben Salah A, Hamouda C. Implementation of the 5S-KAIZEN-TQM approach in a public hospital in Tunisia. LA TUNISIE MEDICALE 2022; 100:503-513. [PMID: 36571738 PMCID: PMC9703905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The 5S-Kaizen-TQM is a step-by-step approach, originally implemented in the Japanese industry as a continuous improvement strategy. AIM To underline the positive impact of its implementation in three pilot departments in Tunisia public hospital. METHODS The 5S-KAIZEN-TQM introduced into three clinical departments lasted 6 months from February 2021 to July 2021. Firstly, we organized seminar to introduce this approach and training sessions on 5S and Kaizen activities to each department staff members. To collect data, we conduct satisfaction surveys, face to face interviews, meetings, and brainstorming sessions. To present these data, checklists, Analytic Hierarchy Process (AHP), Ishikawa chart, Value stream mapping (VSM) charts and visual management techniques were adopted. Then, with the participation of the staff members, we implemented the two steps of this approach and evaluated their performance by the identification of indicators related to each step and to each Departement. RESULTS The project had positive implications on employee and patient satisfaction. 5S step activities leaded to the reduction of the item research time and the releases of space. Improving the working environment increased staff satisfaction. Kaizen activities conducted to the reduction of process lead time and the error reductions which increased patient satisfaction. CONCLUSION This project, first in Tunisia, was undertaken by Tunisian National Health Evaluation and Accreditation Agency (INEAS) and partners as part of the program for the research on organizational innovation in health. The fundings of this project can be disseminated and perpetuated the 5S-KAIZEN-TQM approach in the health sector in countrywide.
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Affiliation(s)
- Sondes Hammami
- 1. Ecole Nationale d’ingenieurs de Carthage/ Université Carthage
| | - Fehmi Hmida
- 1. Ecole Nationale d’ingenieurs de Carthage/ Université Carthage
| | - Houda Gharbi
- 2. Abderrahmane Mami Hospital / Université ElManar
| | - Amel Ben Salah
- 3. Tunisian National Health Evaluation and Accreditation Agency /Université ElManar
| | - Chokri Hamouda
- 3. Tunisian National Health Evaluation and Accreditation Agency /Université ElManar
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Dengue Seroprevalence and Factors Associated with Dengue Seropositivity in Petaling District, Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127170. [PMID: 35742419 PMCID: PMC9223214 DOI: 10.3390/ijerph19127170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 02/01/2023]
Abstract
Dengue virus (DENV) infection is a major public health concern, posing huge economic and disease burdens globally. In Malaysia, the incidence of DENV infections has increased significantly over the years. Nevertheless, the passive surveillance mechanism applied may not capture the actual magnitude of DENV infection. There was also a paucity of community-based studies exploring DENV seroprevalence. This study aimed to determine the DENV seroprevalence and the associated factors among the urban population in Petaling district, Malaysia. A population-based cross-sectional study was conducted from 18 August to 26 October 2018 with 533 participants recruited. Blood samples were collected and analysed for DENV seropositivity using a composite reference standard comprised of three dengue serological tests. Associated factors were identified by fitting Generalised Linear Mixed Models with binomial error structure and logit link function. DENV seroprevalence obtained was 79.0% (95% CI: 75.2–82.4%). The age-specific DENV seroprevalence showed an increasing trend with advancing age, from 22.7% (95% CI: 9.6–45.0%) for those aged below five years old to 94.9% (95% CI: 81.3–98.7%) for those aged ≥60 years old. Only age group and house level were found to be significant factors associated with DENV seropositivity. The odds of being DENV seropositive generally increased with age, from 13.43 (95% CI: 2.77–65.22) for the 5–9 years old age group to 384.77 (95% CI: 39.27–3769.97) for the ≥60 years old age group, as compared to those aged below 5 years old. For house level, those who lived on the first and second floor (OR: 8.98, 95% CI: 3.16–25.12) and the third floor and above (OR: 4.82, 95% CI: 1.89–12.32) had greater odds of being DENV seropositive compared to those living on the ground floor. This study demonstrated the persistently high DENV seroprevalence among the urban population in Petaling district, which could be useful to evaluate dengue control measures taken and estimate more accurate disease incidence. The associated factors with DENV seropositivity identified could also contribute to undertaking more targeted preventive and control measures.
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Kundu S, Kundu S, Banna MHA, Ahinkorah BO, Seidu AA, Okyere J. Prevalence of and factors associated with childhood diarrhoeal disease and acute respiratory infection in Bangladesh: an analysis of a nationwide cross-sectional survey. BMJ Open 2022; 12:e051744. [PMID: 35387807 PMCID: PMC8987759 DOI: 10.1136/bmjopen-2021-051744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 03/17/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study aimed to estimate the prevalence of childhood diarrhoeal diseases (CDDs) and acute respiratory infections (ARIs) and also to determine the factors associated with these conditions at the population level in Bangladesh. SETTING The study entailed an analysis of nationally representative cross-sectional secondary data from the most recent Bangladesh Demographic and Health Survey conducted in 2017-2018. PARTICIPANTS A total of 7222 children aged below 5 years for CDDs and 7215 children aged below 5 years for ARIs during the survey from mothers aged between 15 and 49 years were the participants of this study. In the bivariate and multivariable analyses, we used Pearson χ2 test and binary logistic regression, respectively, for both outcomes. RESULTS The overall prevalence of CDD and ARI among children aged below 5 years was found to be 4.91% and 3.03%, respectively. Younger children were more likely to develop both CDDs and ARIs compared with their older counterparts. Children belonging to households classified as poorest and with unimproved floor materials had a higher prevalence of diarrhoea than those from households identified as richest and with improved floor material, respectively. Stunted children had 40.8% higher odds of diarrhoea than normal children. Being male and having mothers aged below 20 years were 48.9% and two times more likely to develop ARI than female counterparts and children of mothers aged 20-34 years, respectively. Children whose mothers had no formal education or had primary and secondary education had higher odds of ARI compared with children of mothers having higher education. CONCLUSION This study found that children aged below 24 months were at higher risk of having CDDs and ARIs. Thus, programmes targeting these groups should be designed and emphasis should be given to those from poorest wealth quintile to reduce CDDs and ARIs.
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Affiliation(s)
- Satyajit Kundu
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
- School of Public Health, Southeast University, Nanjing, China
| | - Subarna Kundu
- Statistics Discipline, Khulna University, Khulna, Bangladesh
| | - Md Hasan Al Banna
- Department of Food Microbiology, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Abdul-Aziz Seidu
- Faculty of Built and Natural Environment, Department of Estate Management, Takoradi Technical University, Takoradi, Ghana
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Anasir MI, Poh CL. Discovery of B-cell epitopes for development of dengue vaccines and antibody therapeutics. Med Microbiol Immunol 2022; 211:1-18. [PMID: 35059822 DOI: 10.1007/s00430-021-00726-1] [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: 07/21/2021] [Accepted: 12/04/2021] [Indexed: 10/19/2022]
Abstract
Dengue is one of the most frequently transmitted viral infections globally which creates a serious burden to the healthcare system in many countries in the tropical and subtropical regions. To date, no vaccine has demonstrated balanced protection against the four dengue serotypes. Dengvaxia as the only vaccine that has been licensed for use in endemic areas has shown an increased risk in dengue-naïve vaccines to develop severe dengue. A crucial element in protection from dengue infection is the neutralizing antibody responses. Therefore, the identification of protective linear B-cell epitopes can guide vaccine design and facilitate the development of monoclonal antibodies as dengue therapeutics. This review summarizes the identification of dengue B-cell epitopes within the envelope (E) protein of dengue that can be incorporated into peptide vaccine constructs. These epitopes have been identified through approaches such as bioinformatics, three-dimensional structure analysis of antibody-dengue complexes, mutagenesis/alanine scanning and escape mutant studies. Additionally, the therapeutic potential of monoclonal antibodies targeting the E protein of dengue is reviewed. This can provide a basis for the design of future dengue therapies.
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Affiliation(s)
- Mohd Ishtiaq Anasir
- Virology Unit, Infectious Disease Research Centre, Institute for Medical Research, National Institutes of Health, Setia Alam, Shah Alam, Selangor, Malaysia
- Centre for Virus and Vaccine Research, Sunway University, 5, Jalan Universiti, 47500, Bandar Sunway, Selangor, Malaysia
| | - Chit Laa Poh
- Centre for Virus and Vaccine Research, Sunway University, 5, Jalan Universiti, 47500, Bandar Sunway, Selangor, Malaysia.
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Nadugala MN, Jeewandara C, Jadi RS, Malavige GN, de Silva AM, Premaratne PH, Goonasekara CL. Natural immunogenic properties of bioinformatically predicted linear B-cell epitopes of dengue envelope and pre-membrane proteins. BMC Immunol 2021; 22:71. [PMID: 34732126 PMCID: PMC8567598 DOI: 10.1186/s12865-021-00462-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background The natural antibody responses to B-cell epitopes from dengue structural proteins were assessed using immune sera from people having well-defined past dengue infections with one of the four serotypes. Method Based on an immune-computational analysis previously conducted, nineteen epitopes from the envelope (E) and eight epitopes from pre-membrane (prM), which were more than 50% conserved across all the four DENV serotypes, were selected. Peptides to represent these B-cell epitopes were obtained from commercially available arrays, and were subjected to enzyme linked immunosorbent assay with sera obtained from dengue seropositive healthy volunteers (DENV1 n = 12: DENV2 n = 12: DENV3 n = 12 and DENV4 n = 12), and 10 dengue seronegative healthy volunteers from Sri Lanka. The cut-off value for the positive antibody response was set by taking the mean response of a peptide to the negative sera plus three standard deviations. The peptides (N = 7) showing the broad immune responses were used to generate antibodies in three mice (Balb/c) batches. The mice antisera were then subjected to microneutralization assays against all the four DENV serotypes. An EC50 viral neutralization ≥ 40 times the serum dilution was considered as neutralizing. Results Five of the E-peptide and two prM peptides were recognised by most individuls exposed to infections with each of the four serotypes, showing a serotype cross-reactive broad antibody response. The mice immune sera against the peptides representing the five E protein epitopes neutralized all the four DENV serotypes. Two of these five epitopes are from the Domain II, whereas one of them includes the whole bc-loop region. Conclusion The antibody responses of highly conserved epitopes across the serotypes, were broadly responsive with sera of all four DENV serotypes collected from individuals infected with only one DENV serotype. Weakly conserved epitopes showed rather specific antibody responses dominated by one or few serotypes. Supplementary Information The online version contains supplementary material available at 10.1186/s12865-021-00462-4.
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Affiliation(s)
- Mahesha N Nadugala
- Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Chandima Jeewandara
- Allergy Immunology and Cell Biology Unit, University of Sri Jayewardanapura, Gangodawila, Sri Lanka
| | - Ramesh S Jadi
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Gathsaurie N Malavige
- Centre for Dengue Research, University of Sri Jayawardanapura, Gangodawila, Sri Lanka
| | - Aravinda M de Silva
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Prasad H Premaratne
- Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Charitha L Goonasekara
- Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka.
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12
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Evaluation of the extended efficacy of the Dengvaxia vaccine against symptomatic and subclinical dengue infection. Nat Med 2021; 27:1395-1400. [PMID: 34168334 PMCID: PMC8364868 DOI: 10.1038/s41591-021-01392-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/10/2021] [Indexed: 02/06/2023]
Abstract
More than half of the world's population lives in areas at risk for dengue virus infection. A vaccine will be pivotal to controlling spread, however, the only licensed vaccine, Dengvaxia, has been shown to increase the risk of severe disease in a subset of individuals. Vaccine efforts are hampered by a poor understanding of antibody responses, including those generated by vaccines, and whether antibody titers can be used as a marker of protection from infection or disease. Here we present the results of an ancillary study to a phase III vaccine study (n = 611). All participants received three doses of either Dengvaxia or placebo and were followed for 6 years. We performed neutralization tests on annual samples and during confirmed dengue episodes (n = 16,508 total measurements). We use mathematical models to reconstruct long-term antibody responses to vaccination and natural infection, and to identify subclinical infections. There were 87 symptomatic infections reported, and we estimated that there were a further 351 subclinical infections. Cumulative vaccine efficacy was positive for both subclinical and symptomatic infection, although the protective effect of the vaccine was concentrated in the first 3 years following vaccination. Among individuals with the same antibody titer, we found no difference between the risk of subsequent infection or disease between placebo and vaccine recipients, suggesting that antibody titers are a good predictor of both protection and disease risk.
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13
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Fagbamigbe AF, Adebola OG, Dukhi N, Fagbamigbe OS, Uthman OA. Exploring the socio-economic determinants of educational inequalities in diarrhoea among under-five children in low- and middle-income countries: a Fairlie decomposition analysis. Arch Public Health 2021; 79:114. [PMID: 34167581 PMCID: PMC8223382 DOI: 10.1186/s13690-021-00639-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 06/15/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND What explains the underlying causes of educational inequalities in diarrhoea among under-five children in low- and middle-income countries (LMIC) is poorly exploited, operationalized, studied and understood. This paper aims to assess the magnitude of educational-related inequalities in the development of diarrhoea and decompose risk factors that contribute to these inequalities among under-five children (U5C) in LMIC. METHODS Secondary data of 796,150 U5C from 63,378 neighbourhoods in 57 LMIC was pooled from the Demographic and Health Surveys (DHS) conducted between 2010 and 2019. The main determinate variable in this decomposition study was mothers' literacy levels. Descriptive and inferential statistics comprising of bivariable analysis and binary logistic multivariable Fairlie decomposition techniques were employed at p = 0.05. RESULTS Of the 57 countries, we found a statistically significant pro-illiterate odds ratio in 6 countries, 14 showed pro-literate inequality while the remaining 37 countries had no statistically significant educational-related inequality. The countries with pro-illiterate inequalities are Burundi (OR = 1.11; 95% CI: 1.01-1.21), Cameroon (OR = 1.84; 95% CI: 1.66-2.05), Egypt (OR = 1.26; 95% CI: 1.12-1.43), Ghana (OR = 1.24; 95% CI: 1.06-1.47), Nigeria (OR = 1.80; 95% CI: 1.68-1.93), and Togo (OR = 1.21; 95% CI: 1.06-1.38). Although there are variations in factors that contribute to pro-illiterate inequality across the 6 countries, the overall largest contributors to the inequality are household wealth status, maternal age, neighbourhood SES, birth order, toilet type, birth interval and place of residence. The widest pro-illiterate risk difference (RD) was in Cameroon (118.44/1000) while the pro-literate risk difference was widest in Albania (- 61.90/1000). CONCLUSIONS The study identified educational inequalities in the prevalence of diarrhoea in children with wide variations in magnitude and contributions of the risk factors to pro-illiterate inequalities. This suggests that diarrhoea prevention strategies is a must in the pro-illiterate inequality countries and should be extended to educated mothers as well, especially in the pro-educated countries. There is a need for further studies to examine the contributions of structural and compositional factors associated with pro-educated inequalities in the prevalence of diarrhoea among U5C in LMIC.
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Affiliation(s)
- Adeniyi Francis Fagbamigbe
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- Warwick Centre for Global Health, Division of Health Sciences, University of Warwick, Coventry, UK.
| | - Olukemi Grace Adebola
- General Studies Unit, School of Sciences, Federal University of Technology, Akure, Nigeria
| | - Natisha Dukhi
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa
| | - Omon Stellamaris Fagbamigbe
- Techmodia, West Sussex, UK
- Portsmouth Business School, Faculty of Business and Law, University of Portsmouth, Portsmouth, UK
| | - Olalekan A Uthman
- Warwick Centre for Global Health, Division of Health Sciences, University of Warwick, Coventry, UK
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa
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Acklin JA, Cattle JD, Moss AS, Brown JA, Foster GA, Krysztof D, Stramer SL, Lim JK. Evaluating the Safety of West Nile Virus Immunity During Congenital Zika Virus Infection in Mice. Front Immunol 2021; 12:686411. [PMID: 34220838 PMCID: PMC8250419 DOI: 10.3389/fimmu.2021.686411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/24/2021] [Indexed: 12/19/2022] Open
Abstract
Antibody-dependent enhancement (ADE) is a phenomenon that occurs when cross-reactive antibodies generated from a previous flaviviral infection increase the pathogenesis of a related virus. Zika virus (ZIKV) is the most recent flavivirus introduced to the Western Hemisphere and has become a significant public health threat due to the unanticipated impact on the developing fetus. West Nile virus (WNV) is the primary flavivirus that circulates in North America, and we and others have shown that antibodies against WNV are cross-reactive to ZIKV. Thus, there is concern that WNV immunity could increase the risk of severe ZIKV infection, particularly during pregnancy. In this study, we examined the extent to which WNV antibodies could impact ZIKV pathogenesis in a murine pregnancy model. To test this, we passively transferred WNV antibodies into pregnant Stat2-/- mice on E6.5 prior to infection with ZIKV. Evaluation of pregnant dams showed weight loss following ZIKV infection; however, no differences in maternal weights or viral loads in the maternal brain, spleen, or spinal cord were observed in the presence of WNV antibodies. Resorption rates, and other fetal parameters, including fetal and placental size, were similarly unaffected. Further, the presence of WNV antibodies did not significantly alter the viral load or the inflammatory response in the placenta or the fetus in response to ZIKV. Our data suggest that pre-existing WNV immunity may not significantly impact the pathogenesis of ZIKV infection during pregnancy. Our findings are promising for the safety of implementing WNV vaccines in the continental US.
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Affiliation(s)
- Joshua A Acklin
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Javier D Cattle
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Arianna S Moss
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Julia A Brown
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Gregory A Foster
- Scientific Affairs, American Red Cross, Gaithersburg, MD, United States
| | - David Krysztof
- Scientific Affairs, American Red Cross, Gaithersburg, MD, United States
| | - Susan L Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, MD, United States
| | - Jean K Lim
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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15
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Hussen MO, Sayed ASM, Abushahba MFN. Sero-epidemiological study on Dengue fever virus in humans and camels at Upper Egypt. Vet World 2020; 13:2618-2624. [PMID: 33487979 PMCID: PMC7811540 DOI: 10.14202/vetworld.2020.2618-2624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/02/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIM Dengue fever (DF) is an important mosquito-borne viral zoonosis affecting over 100 countries worldwide and putting about 3.9 billion people at risk of infection. The disease has re-emerged in Egypt since 2011; however, there is a paucity of recent epidemiological data available. Therefore, in this study, we employed a cross-sectional study to determine DF prevalence in humans and camels in Asyut and Sohag Governorates, Egypt, during 2019. MATERIALS AND METHODS A total of 91 humans and a similar number of dromedary camels were utilized in this study. Sera were obtained and analyzed for the presence of specific antibodies against DF virus using enzyme-linked immunosorbent assay. Related epidemiological data affecting the disease spread in humans and camels were recorded and statistically analyzed. RESULTS The seroprevalence of DF in humans and camels was 12.09% and 3.3%, respectively. The disease varied significantly by the species examined as humans were found to be at a higher risk of acquiring the infection compared to camels. Nearly equal odds of exposure (odds ratio [OR]) were seen in the individuals with close contact with camels compared to those without; however, individuals exposed to mosquitoes were at approximately 3 times higher risk of infection (OR=2.95 [95% confidence interval [CI], 0.73-11.93]) compared to individuals who were not exposed to mosquitoes (OR=0.033 [95% CI, 0.084-1.37]). Interestingly, DF seropositivity in camels was significantly related to the presence or absence of symptoms within 2 weeks before sampling (p=0.02) where symptomatic animals had higher odds of exposure (OR=19.51 [95%, 0.97-392.3]) compared to asymptomatic ones (OR=0.05 [95%, 0.002-1.03]). CONCLUSION The current study reports the presence of specific antibodies against dengue virus (DENV) in humans residing within Asyut and Sohag Governorates, Egypt. Furthermore, it provides the first serological evidence of DENV circulation in camels which is alarming. A more comprehensive study is needed; however, this baseline investigation underscores the urgent need for increasing awareness among people residing in the area as well as application of the appropriate mosquito control measures to avoid further spread of the disease.
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Affiliation(s)
| | - Amal S. M. Sayed
- Department of Zoonoses, Faculty of Veterinary Medicine, Assiut University, Asyut 71526, Egypt
| | - Mostafa F. N. Abushahba
- Department of Zoonoses, Faculty of Veterinary Medicine, Assiut University, Asyut 71526, Egypt
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16
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Ullah MA, Araf Y, Faruqui NA, Mowna SA, Prium DH, Sarkar B. Dengue Outbreak is a Global Recurrent Crisis: Review of the Literature. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2020. [DOI: 10.29333/ejgm/8948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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Wijesinghe A, Gamage J, Goonewardena H, Gomes L, Jayathilaka D, Wijeratne DT, de Alwis R, Jeewandara C, Wijewickrama A, Ogg GS, Malavige GN. Phenotype and functionality of follicular helper T cells in patients with acute dengue infection. J Biomed Sci 2020; 27:50. [PMID: 32264870 PMCID: PMC7140349 DOI: 10.1186/s12929-020-00641-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/13/2020] [Indexed: 12/31/2022] Open
Abstract
Background The association of functionality and phenotype of follicular helper T cells (Tfh) with dengue virus (DENV) specific antibody responses and clinical disease severity has not been well studied. Methods We investigated the phenotype and functionality of Tfh cells and plasmablasts in adult patients (DF = 18, DHF = 22) with acute dengue (day 4 to 8 since onset of fever) of varying severity using multiparametric flowcytometry. The properties of Tfh cells were correlated with viraemia, disease severity, plasmablast responses and DENV-specific serum antibody responses. We further evaluated the kinetics of neutralizing antibodies (Neut50) throughout the course of illness in order to evaluate their association with clinical disease severity and viraemia. Results Tfh cells (especially those producing IL-21 and co-expressing PD-1 and ICOS) were found to be significantly expanded (p < 0.0001) and highly activated in patients with DHF compared to those with DF. The frequency of Tfh cells significantly correlated with DENV-specific IgG, NS1-specific antibodies and Neut50 antibody titres in patients with DHF but not in those with DF. Although the Neut50 titres increased during the course of acute secondary DENV infection, they showed differences based on serotype. For instance, the Neut50 titres were significantly higher during the latter part of illness in patients with DF compared to DHF in DENV1 infection, while in DENV2, patients with DHF had significantly higher titres. The viral loads during early illness did not correlate with the subsequent rise in the Neut50 antibody titres during any time point of illness. Conclusions The expansion of Tfh cells is associated with DHF and DENV-specific IgG, NS1-specific and neutralizing antibodies. Neut50 titres did not associate with disease severity or viraemia at the point of first presentation during the febrile phase, but later titres do show differential association with severity in patients with DENV1 compared to DENV2.
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Affiliation(s)
- Ayesha Wijesinghe
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Jayani Gamage
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | - Laksiri Gomes
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Deshni Jayathilaka
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Dulharie T Wijeratne
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Ruklanthi de Alwis
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore.,Viral Research & Experimental Medicine Centre, SingHealth/Duke-NUS, Singapore, Singapore
| | - Chandima Jeewandara
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | - Graham S Ogg
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Gathsaurie Neelika Malavige
- Centre for Dengue Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka. .,MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK.
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18
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Non-Human Primate Models of Dengue Virus Infection: A Comparison of Viremia Levels and Antibody Responses during Primary and Secondary Infection among Old World and New World Monkeys. Pathogens 2020; 9:pathogens9040247. [PMID: 32230836 PMCID: PMC7238212 DOI: 10.3390/pathogens9040247] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/21/2020] [Accepted: 03/24/2020] [Indexed: 12/16/2022] Open
Abstract
Due to the global burden of dengue disease, a vaccine is urgently needed. One of the key points in vaccine development is the development of a robust and reliable animal model of dengue virus infection. Characteristics including the ability to sustain viral replication, demonstration of clinical signs, and immune response that resemble those of human dengue virus infection are vital in animal models. Preclinical studies in vaccine development usually include parameters such as safety evaluation, induction of viremia and antigenemia, immunogenicity, and vaccine effectiveness. Although mice have been used as a model, non-human primates have an advantage over mice because of their relative similarity to humans in their genetic composition and immune responses. This review compares the viremia kinetics and antibody responses of cynomolgus macaques (Macaca fasicularis), common marmosets (Callithrix jacchus), and tamarins (Saguinus midas and Saguinus labitus) and summarize the perspectives and the usefulness along with challenges in dengue vaccine development.
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19
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Meena DS, Kumar D, Bohra GK, Garg MK, Midha N, Yadav T, Yadav P. Concurrent Methicillin-Resistant Staphylococcus aureus Septicemia and Thyroid Abscess in a Young Male with Dengue. Infect Disord Drug Targets 2020; 21:156-160. [PMID: 32164519 DOI: 10.2174/1871526520666200312160701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Dengue fever is an arthropod-borne viral infection with a very high incidence rate in Southeast Asia. Most patients present with self-limiting febrile illness, while some patients may develop complications like acute kidney injury, acute liver failure, myocarditis or Guillain- Barre syndrome. The coexistence of Dengue and MRSA (Methicillin-resistant Staphylococcus aureus ) is rarely reported in the literature. CASE A 28-year-old male is presented with high-grade fever, polyserositis and thrombocytopenia. The patient was treated symptomatically for dengue infection. During the course of hospitalization, patient developed neck swelling (thyroid abscess) and left forearm abscess. MRSA was isolated from blood culture and pus, and successfully treated with iv antibiotics (Vancomycin). CONCLUSION High anticipation and vigilance are required to detect concurrent bacteremia in dengue patients. Early recognition of warning signs with readily antibiotic therapy is important to prevent mortality and morbidity in these patients. Our report also highlights the MRSA as a rare cause of thyroid abscess, with only 5 cases reported in the literature so far.
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Affiliation(s)
- Durga Shankar Meena
- Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Deepak Kumar
- Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Gopal Krishana Bohra
- Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Mahendra Kumar Garg
- Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Naresh Midha
- Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Taruna Yadav
- Department of Intervention and Diagnostic Radiology, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Prakrati Yadav
- Department of Internal Medicine, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
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20
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Aliyu IA, Ling KH, Md Hashim NF, Lam JY, Chee HY. Annexin II as a Dengue Virus Serotype 2 Interacting Protein Mediating Virus Interaction on Vero Cells. Viruses 2019; 11:v11040335. [PMID: 30970587 PMCID: PMC6520844 DOI: 10.3390/v11040335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/21/2019] [Indexed: 01/01/2023] Open
Abstract
Recent evidence has demonstrated that dengue virus requires active filopodia formation for a successful infection. However, the cellular factor involved in the interaction has not been fully elucidated. We used a combination of virus overlay protein binding assay and LC-MS/MS, and identified annexin II as a dengue virus serotype 2 (DENV2) interacting protein on Vero cells, upon filopodia induction. Flow cytometry analysis showed annexin II on the Vero cells surface increased when DENV2 was added. The amount of annexin II in the plasma membrane fraction was reduced as the infection progressed. Antibody-mediated inhibition of infection and siRNA-mediated knockdown of annexin II expression significantly reduced DENV2 infection and production levels. Collectively, we demonstrated that annexin II is one of the host factor involved in DENV2 binding on Vero cells.
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Affiliation(s)
- Isah Abubakar Aliyu
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia.
- Department of Medical Laboratory Science, Faculty of Allied Health Science, College of Health Science, Bayero University Kano, PMB 3011 Kano State, Nigeria.
| | - King-Hwa Ling
- NeuroBiology & Genetics Group, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, 43400 UPM Serdang, Selangor, Malaysia.
- Genetics and Regenerative Medicine Research Centre, Faculty of Medicine and Health Sciences, 43400 UPM Serdang, Selangor, Malaysia.
| | - Nur Fariesha Md Hashim
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, 43400 UPM Serdang, Selangor, Malaysia.
| | - Jia-Yong Lam
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia.
| | - Hui-Yee Chee
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia.
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Dengue and Chikungunya Infections in Children : Guest Editor: Bhim S. Pandhi. Indian J Pediatr 2019; 86:287-295. [PMID: 30511272 DOI: 10.1007/s12098-018-2794-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 12/15/2022]
Abstract
Dengue and Chikungunya are two important mosquito-borne acute febrile illnesses in children. With increased urbanization and newer strains of chikungunya virus with improved transmission with Aedes albopictus, the at-risk population for these infections has greatly increased. Dengue fever has been classified by WHO as dengue with/ without warning signs and severe dengue. Severe dengue is associated with hemorrhagic manifestations, hypovolemia and hypotension secondary to third space loss due to capillary leak or severe end organ dysfunction. NS1 antigen detection and dengue polymerase chain reaction, [polymerase chain reaction (PCR during first 5 d)] and IgM for dengue (6th day of fever onwards) are commonly utilized diagnostic tests. Appropriate fluid therapy with timely tapering of intravenous fluid rate with hematocrit, treatment of hemorrhagic manifestations and clinical monitoring are the mainstay of dengue treatment. Chikungunya has less severe course with shorter febrile phase with prominent and persistent joint symptoms. PCR and IgM against chikungunya are appropriate investigations. Treatment is supportive for chikungunya infection with appropriate joint pain relief.
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Zala D, Khan V, Kakadiya M, Sanghai A, Das V. Circulation of dengue serotypes in the Union Territory of Dadra & Nagar Haveli (India). Parasite Epidemiol Control 2018; 3:e00069. [PMID: 29988334 PMCID: PMC6020105 DOI: 10.1016/j.parepi.2018.e00069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/13/2018] [Accepted: 04/12/2018] [Indexed: 11/20/2022] Open
Abstract
The presence of chronological infection by the multi serotype of dengue virus (DENV) is a major contributing factor for the induction of Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). The results indicate that all serotype of dengue along with concurrent infection were reported from the third smallest Union Territory of India furthermore, rare serotype DENV 4, gradually spreads in new areas of India. Therefore, a need to understand the epidemiology of locally circulating serotype and accordingly the control strategy can be implemented. The study was conducted during 2014-2017 in the Union Territory of Dadra & Nagar Haveli (India).
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Rajarethinam J, Ang LW, Ong J, Ycasas J, Hapuarachchi HC, Yap G, Chong CS, Lai YL, Cutter J, Ho D, Lee V, Ng LC. Dengue in Singapore from 2004 to 2016: Cyclical Epidemic Patterns Dominated by Serotypes 1 and 2. Am J Trop Med Hyg 2018; 99:204-210. [PMID: 29848407 PMCID: PMC6085773 DOI: 10.4269/ajtmh.17-0819] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Singapore has experienced periodic dengue epidemics despite maintaining a low Aedes house index. Each epidemic was associated with a switch in the predominant serotype. We investigated the temporal dynamics of dengue fever and dengue virus (DENV) and analyzed the epidemiological and entomological patterns of dengue in Singapore from 2004 to 2016. The case surveillance is based on a mandatory notification system that requires all medical practitioners to report clinically suspected and laboratory-confirmed cases. Circulating (DENV) serotypes are monitored through a virus surveillance program. Entomological surveillance involves inspections for larval breeding and monitoring of adults using gravitraps. Singapore experienced a similar epidemic pattern during 2004–2007 and 2013–2016. The pattern involved a 2-year DENV-1 epidemic occurring after a switch in the predominant serotype from DENV-2 to DENV-1, followed by a “lull” year. Thereafter, the predominant serotype switched back to DENV-2, tailed by a small-scale epidemic. Across the years, the highest incidence group was in the 25–44 years age group. The incidence rate of those aged ≥ 55 years was about half of that of the 15–24 years age group during DENV-1 predominant years. However, it was almost equal to the younger age group in DENV-2 predominant years. Types of Aedes aegypti breeding habitats remained similar. Dengue incidence was significantly higher in areas with high breeding percentage (BP) than areas with low BP (P < 0.05). In conclusion, the oscillation of DENV-1 and DENV-2, throughout the 13-year period, led to a cyclical epidemic pattern and older adults were more affected by DENV-2 than DENV-1.
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Affiliation(s)
| | - Li-Wei Ang
- Public Health Group, Ministry of Health, Singapore, Singapore
| | - Janet Ong
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
| | - Joyce Ycasas
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
| | | | - Grace Yap
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
| | - Chee-Seng Chong
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
| | - Yee-Ling Lai
- Environmental Health Institute, National Environment Agency, Singapore, Singapore
| | - Jeffery Cutter
- Public Health Group, Ministry of Health, Singapore, Singapore
| | - Derek Ho
- Environmental Public Health Division, National Environment Agency, Singapore, Singapore
| | - Vernon Lee
- Public Health Group, Ministry of Health, Singapore, Singapore
| | - Lee-Ching Ng
- Environmental Health Institute, National Environment Agency, Singapore, Singapore.,School of Biological Sciences, Nanyang Technological University, Singapore
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Azami NAM, Moi ML, Ami Y, Suzaki Y, Lim CK, Taniguchi S, Saijo M, Takasaki T, Kurane I. Genotype-specific and cross-reactive neutralizing antibodies induced by dengue virus infection: detection of antibodies with different levels of neutralizing activities against homologous and heterologous genotypes of dengue virus type 2 in common marmosets (Callithrix jacchus). Virol J 2018; 15:51. [PMID: 29587780 PMCID: PMC5870686 DOI: 10.1186/s12985-018-0967-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 03/19/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND A vaccine against all four dengue virus (DENV) serotypes includes the formulation of one genotype of each serotype. Although genetic similarities among genotypes within a serotype are higher as compared to those among serotypes, differences in the immunogenicity of the included genotypes would be a critical issue in maximizing successful dengue vaccine development. Thus, we determined the neutralizing antibody responses against three genotypes of dengue virus serotype 2 (DENV-2), namely Cosmopolitan, Asian I, and Asian/American, after primary and secondary inoculation with DENV-2 in a dengue animal model, the common marmoset (Callithrix jacchus). METHODS A total of fifty-four plasma samples were obtained from thirty-four marmosets that were inoculated with clinically-isolated DENV strains or DENV candidate vaccines, were used in this study. Plasma samples were obtained from marmosets after primary inoculation with DENV-2 infection, secondary inoculation with homologous or heterologous genotypes, and tertiary inoculation with heterologous DENV. Neutralizing antibody titers against DENV-2 (Cosmopolitan, Asian I, and Asian/American genotypes) and DENV-1 were determined using a conventional plaque reduction neutralization assay. RESULTS In marmosets that were inoculated with the Cosmopolitan genotype in primary infection, neutralizing antibody neutralized 3 genotypes, and the titers to Asian I genotype were significantly higher than those to homologous Cosmopolitan genotype. After secondary DENV-2 infection with heterologous genotype (Asian I in primary and Asian/American in secondary), neutralizing antibody titers to Asian/American genotype was significantly higher than those against Cosmopolitan and Asian I genotypes. Following tertiary infection with DENV-1 following DENV-2 Asian I and Cosmopolitan genotypes, neutralizing antibody titers to Asian/American were also significantly higher than those against Cosmopolitan and Asian I genotypes. CONCLUSION The present study demonstrated that different levels of neutralizing antibodies were induced against variable DENV-2 genotypes after primary, secondary and tertiary infections, and that neutralizing antibody titers to some heterologous genotypes were higher than those to homologous genotypes within a serotype. The results indicate that heterogeneity and homogeneity of infecting genotypes influence the levels and cross-reactivity of neutralizing antibodies induced in following infections. The results also suggest that certain genotypes may possess advantage in terms of breakthrough infections against vaccination.
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Affiliation(s)
- Nor Azila Muhammad Azami
- Department of Virology 1, National Institute of Infectious Diseases, Tokyo, Japan
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Meng Ling Moi
- Department of Virology 1, National Institute of Infectious Diseases, Tokyo, Japan
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Yasushi Ami
- Division of Experimental Animal Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yuriko Suzaki
- Division of Experimental Animal Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Chang-Kweng Lim
- Department of Virology 1, National Institute of Infectious Diseases, Tokyo, Japan
| | - Satoshi Taniguchi
- Department of Virology 1, National Institute of Infectious Diseases, Tokyo, Japan
| | - Masayuki Saijo
- Department of Virology 1, National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Ichiro Kurane
- National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo, 162-8640 Japan
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Hernandez-Morales I, Van Loock M. An Industry Perspective on Dengue Drug Discovery and Development. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1062:333-353. [DOI: 10.1007/978-981-10-8727-1_23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Reginald K, Chan Y, Plebanski M, Poh CL. Development of Peptide Vaccines in Dengue. Curr Pharm Des 2018; 24:1157-1173. [PMID: 28914200 PMCID: PMC6040172 DOI: 10.2174/1381612823666170913163904] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/30/2017] [Accepted: 09/06/2017] [Indexed: 12/11/2022]
Abstract
Dengue is one of the most important arboviral infections worldwide, infecting up to 390 million people and causing 25,000 deaths annually. Although a licensed dengue vaccine is available, it is not efficacious against dengue serotypes that infect people living in South East Asia, where dengue is an endemic disease. Hence, there is an urgent need to develop an efficient dengue vaccine for this region. Data from different clinical trials indicate that a successful dengue vaccine must elicit both neutralizing antibodies and cell mediated immunity. This can be achieved by designing a multi-epitope peptide vaccine comprising B, CD8+ and CD4+ T cell epitopes. As recognition of T cell epitopes are restricted by human leukocyte antigens (HLA), T cell epitopes which are able to recognize several major HLAs will be preferentially included in the vaccine design. While peptide vaccines are safe, biocompatible and cost-effective, it is poorly immunogenic. Strategies to improve its immunogenicity by the use of long peptides, adjuvants and nanoparticle delivery mechanisms are discussed.
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Affiliation(s)
| | | | | | - Chit Laa Poh
- Address correspondence to this author at the Research Centre for Biomedical Sciences, School of Science and Technology, Sunway University, 5 Jalan University, Bandar Sunway, 47500 Subang Jaya, Selangor, Malaysia; Tel: +60-3-7491 8622 ext. 7338; E-mail:
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Sprokholt JK, Kaptein TM, van Hamme JL, Overmars RJ, Gringhuis SI, Geijtenbeek TBH. RIG-I-like receptor activation by dengue virus drives follicular T helper cell formation and antibody production. PLoS Pathog 2017; 13:e1006738. [PMID: 29186193 PMCID: PMC5724900 DOI: 10.1371/journal.ppat.1006738] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 12/11/2017] [Accepted: 11/07/2017] [Indexed: 12/27/2022] Open
Abstract
Follicular T helper cells (TFH) are fundamental in orchestrating effective antibody-mediated responses critical for immunity against viral infections and effective vaccines. However, it is unclear how virus infection leads to TFH induction. We here show that dengue virus (DENV) infection of human dendritic cells (DCs) drives TFH formation via crosstalk of RIG-I-like receptor (RLR) RIG-I and MDA5 with type I Interferon (IFN) signaling. DENV infection leads to RLR-dependent IKKε activation, which phosphorylates IFNα/β receptor-induced STAT1 to drive IL-27 production via the transcriptional complex ISGF3. Inhibiting RLR activation as well as neutralizing antibodies against IL-27 prevented TFH formation. DENV-induced CXCR5+PD-1+Bcl-6+ TFH cells secreted IL-21 and activated B cells to produce IgM and IgG. Notably, RLR activation by synthetic ligands also induced IL-27 secretion and TFH polarization. These results identify an innate mechanism by which antibodies develop during viral disease and identify RLR ligands as potent adjuvants for TFH-promoting vaccination strategies.
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Affiliation(s)
- Joris K. Sprokholt
- Department of Experimental Immunology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Infection & Immunity Institute, Amsterdam, the Netherlands
| | - Tanja M. Kaptein
- Department of Experimental Immunology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Infection & Immunity Institute, Amsterdam, the Netherlands
| | - John L. van Hamme
- Department of Experimental Immunology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Infection & Immunity Institute, Amsterdam, the Netherlands
| | - Ronald J. Overmars
- Department of Experimental Immunology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Infection & Immunity Institute, Amsterdam, the Netherlands
| | - Sonja I. Gringhuis
- Department of Experimental Immunology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Infection & Immunity Institute, Amsterdam, the Netherlands
| | - Teunis B. H. Geijtenbeek
- Department of Experimental Immunology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Infection & Immunity Institute, Amsterdam, the Netherlands
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Mathew A. Humanized mouse models to study human cell-mediated and humoral responses to dengue virus. Curr Opin Virol 2017; 25:76-80. [PMID: 28802204 DOI: 10.1016/j.coviro.2017.07.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/19/2017] [Accepted: 07/25/2017] [Indexed: 11/20/2022]
Abstract
Several candidate dengue virus vaccines are in clinical trials and show promise as an effective measure to control dengue. However, it is becoming clear that additional vaccine candidates may be needed as there is concern about the durability of the immune response to all four serotypes of vaccine components and efficacy varies dependent on the immune status of the individual. The lack of an appropriate animal model to mimic human dengue has deterred the development of vaccines and anti-viral therapies to dengue virus. The focus of this review is to discuss advances in the development of humanized animal models and to highlight how they could be used for antiviral and dengue vaccine testing if limitations with cell-mediated immunity and seroconversion to IgG are overcome.
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Affiliation(s)
- Anuja Mathew
- Institute for Immunology and Informatics, University of Rhode Island, Providence, RI, USA.
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Malisheni M, Khaiboullina SF, Rizvanov AA, Takah N, Murewanhema G, Bates M. Clinical Efficacy, Safety, and Immunogenicity of a Live Attenuated Tetravalent Dengue Vaccine (CYD-TDV) in Children: A Systematic Review with Meta-analysis. Front Immunol 2017; 8:863. [PMID: 28824613 PMCID: PMC5543029 DOI: 10.3389/fimmu.2017.00863] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 07/07/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dengue hemorrhagic fever is the leading cause of hospitalization and death in children living in Asia and Latin America. There is an urgent need for an effective and safe dengue vaccine to reduce morbidity and mortality in this high-risk population given the lack of dengue specific treatment at present. This review aims to determine the efficacy, safety, and immunogenicity of CYD-TDV vaccine in children. METHODS This is a systematic review including meta-analysis of randomized controlled clinical trial data from Embase, Medline, the Cochrane Library, Web of Science, and ClinicalTrials.gov. Studies that assessed CYD-TDV vaccine efficacy [(1 - RR)*100], safety (RR), and immunogenicity (weighted mean difference) in children were included in this study. Random effects model was employed to analyze patient-level data extracted from primary studies. RESULTS The overall efficacy of CYD-TDV vaccine was 54% (40-64), while serotype-specific efficacy was 77% (66-85) for DENV4, 75% (65-82) for DENV3, 50% (36-61) for DENV1, and 34% (14-49) for DENV2. 15% (-174-74) vaccine efficacy was obtained for the unknown serotype. Meta-analysis of included studies with longer follow-up time (25 months) revealed that CYD-TDV vaccine significantly increased the risk of injection site reactions (RR = 1.1: 1.04-1.17; p-value = 0.001). Immunogenicity (expressed as geometric mean titers) in descending order was 439.7 (331.7-547.7), 323 (247 - 398.7), 144.1 (117.9-170.2), and 105 (88.7-122.8) for DENV3, DENV2, DENV1, and DENV4, respectively. CONCLUSION CYD-TDV vaccine is effective and immunogenic in children overall. Reduced efficacy of CYD-TDV vaccine against DENV2 notoriously known for causing severe dengue infection and dengue outbreaks cause for serious concern. Post hoc meta-analysis of long-term follow-up data (≥25 months) from children previously vaccinated with CYD-TDV vaccine is needed to make a conclusion regarding CYD-TDV vaccine safety in children. However, CYD-TDV vaccine should be considered for use in regions where DENV2 is not endemic as currently there is no specific treatment for dengue infection.
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Affiliation(s)
- Moffat Malisheni
- Ministry of Health, Lusaka, Zambia
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Department of Microbiology and Immunology, National University of Singapore, Singapore, Singapore
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore, Singapore
| | - Svetlana F Khaiboullina
- Department of Microbiology and Immunology, University of Nevada Reno, Reno, NV, United States
- Kazan Federal University, Kazan, Russia
| | | | - Noah Takah
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Ministry of Health, Yaounde, Cameroon
| | - Grant Murewanhema
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Matthew Bates
- University College London Research & Training Programme, University of Zambia, University Teaching Hospital, Lusaka, Zambia
- HerpeZ, University Teaching Hospital, Lusaka, Zambia
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Reddy MN, Dungdung R, Valliyott L, Pilankatta R. Occurrence of concurrent infections with multiple serotypes of dengue viruses during 2013-2015 in northern Kerala, India. PeerJ 2017; 5:e2970. [PMID: 28316881 PMCID: PMC5354076 DOI: 10.7717/peerj.2970] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/30/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Dengue is a global human public health threat, causing severe morbidity and mortality. The occurrence of sequential infection by more than one serotype of dengue virus (DENV) is a major contributing factor for the induction of Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS), two major medical conditions caused by DENV infection. However, there is no specific drug or vaccine available against dengue infection. There are reports indicating the increased incidence of concurrent infection of dengue in several tropical and subtropical regions. Recently, increasing number of DHF and DSS cases were reported in India indicating potential enhancement of concurrent DENV infections. Therefore, accurate determination of the occurrence of DENV serotype co-infections needs to be conducted in various DENV prone parts of India. In this context, the present study was conducted to analyse the magnitude of concurrent infection in northern Kerala, a southwest state of India, during three consecutive years from 2013 to 2015. METHODS A total of 120 serum samples were collected from the suspected dengue patients. The serum samples were diagnosed for the presence of dengue NS1 antigen followed by the isolation of dengue genome from NS1 positive samples. The isolated dengue genome was further subjected to RTPCR based molecular serotyping. The phylogenetic tree was constructed based on the sequence of PCR amplified products. RESULTS Out of the total number of samples collected, 100 samples were positive for dengue specific antigen (NS1) and 26 of them contained the dengue genome. The RTPCR based molecular serotyping of the dengue genome revealed the presence of all four serotypes with different combinations. However, serotypes 1 and 3 were predominant combinations of concurrent infection. Interestingly, there were two samples with all four serotypes concurrently infected in 2013. DISCUSSION All samples containing dengue genome showed the presence of more than one serotype, indicating 100% concurrent infection. However, the combination of serotypes 1 and 3 was predominant. To the best of our knowledge, this is the first report indicating the concurrent infection of dengue in the northern Kerala, India. The phylogenetic analysis of dengue serotype 1 identified in this study shows a close relationship with the strain isolated in Delhi and South Korea during the 2006 and 2015 epidemics respectively. Similarly this study indicates that the phylogeny of dengue serotype 3 of northern Kerala is more closely related to dengue isolate of Rajasthan state, India. The geographical and climatic conditions of Kerala favours the breeding of both the mosquito vectors of dengue (Aedes albopictus and Aedes aegypti), which may enhance the severity of dengue in the future. Therefore, the study provides an alarming message for the urgent need of an antiviral strategy or other health management systems to curb the spread of dengue infection.
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Affiliation(s)
- Manchala Nageswar Reddy
- Department of Biochemistry and Molecular Biology, Central University of Kerala , Kasargod , Kerala , India
| | - Ranjeet Dungdung
- Department of Biochemistry and Molecular Biology, Central University of Kerala , Kasargod , Kerala , India
| | - Lathika Valliyott
- Department of Biochemistry and Molecular Biology, Central University of Kerala , Kasargod , Kerala , India
| | - Rajendra Pilankatta
- Department of Biochemistry and Molecular Biology, Central University of Kerala , Kasargod , Kerala , India
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