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Silveira-Freitas JEP, Campagnolo ML, dos Santos Cortez M, de Melo FF, Zarpelon-Schutz AC, Teixeira KN. Long chikungunya? An overview to immunopathology of persistent arthralgia. World J Virol 2024; 13:89985. [DOI: 10.5501/wjv.v13.i2.89985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/09/2024] [Accepted: 04/12/2024] [Indexed: 06/24/2024] Open
Abstract
Chikungunya fever (CF) is caused by an arbovirus whose manifestations are extremely diverse, and it has evolved with significant severity in recent years. The clinical signs triggered by the Chikungunya virus are similar to those of other arboviruses. Generally, fever starts abruptly and reaches high levels, followed by severe polyarthralgia and myalgia, as well as an erythematous or petechial maculopapular rash, varying in severity and extent. Around 40% to 60% of affected individuals report persistent arthralgia, which can last from months to years. The symptoms of CF mainly represent the tissue tropism of the virus rather than the immunopathogenesis triggered by the host's immune system. The main mechanisms associated with arthralgia have been linked to an increase in T helper type 17 cells and a consequent increase in receptor activator of nuclear factor kappa-Β ligand and bone resorption. This review suggests that persistent arthralgia results from the presence of viral antigens post-infection and the constant activation of signaling lymphocytic activation molecule family member 7 in synovial macrophages, leading to local infiltration of CD4+ T cells, which sustains the inflammatory process in the joints through the secretion of pro-inflammatory cytokines. The term "long chikungunya" was used in this review to refer to persistent arthralgia since, due to its manifestation over long periods after the end of the viral infection, this clinical condition seems to be characterized more as a sequel than as a symptom, given that there is no active infection involved.
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Affiliation(s)
| | | | | | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Campus Anísio Teixeira, Vitória da Conquista, Bahia 45029-094, Brazil
| | - Ana Carla Zarpelon-Schutz
- Campus Toledo, Universidade Federal do Paraná, Toledo, Paraná 85919-899, Brazil
- Programa de Pós-graduação em Biotecnologia, Palotina, Universidade Federal do Paraná-Setor Palotina, Paraná 85950-000, Brazil
| | - Kádima Nayara Teixeira
- Campus Toledo, Universidade Federal do Paraná, Toledo, Paraná 85919-899, Brazil
- Programa Multicêntrico de Pós-graduação em Bioquímica e Biologia Molecular, Palotina, Universidade Federal do Paraná-Setor Palotina, Paraná 85950-000, Brazil
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Cerqueira-Silva T, Pescarini JM, Cardim LL, Leyrat C, Whitaker H, Antunes de Brito CA, Brickley EB, Barral-Netto M, Barreto ML, Teixeira MG, Boaventura VS, Paixão ES. Risk of death following chikungunya virus disease in the 100 Million Brazilian Cohort, 2015-18: a matched cohort study and self-controlled case series. THE LANCET. INFECTIOUS DISEASES 2024; 24:504-513. [PMID: 38342106 DOI: 10.1016/s1473-3099(23)00739-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND Chikungunya virus outbreaks have been associated with excess deaths at the ecological level. Previous studies have assessed the risk factors for severe versus mild chikungunya virus disease. However, the risk of death following chikungunya virus disease compared with the risk of death in individuals without the disease remains unexplored. We aimed to investigate the risk of death in the 2 years following chikungunya virus disease. METHODS We used a population-based cohort study and a self-controlled case series to estimate mortality risks associated with chikungunya virus disease between Jan 1, 2015, and Dec 31, 2018, in Brazil. The dataset was created by linking national databases for social programmes, notifiable diseases, and mortality. For the matched cohort design, individuals with chikungunya virus disease recorded between Jan 1, 2015, and Dec 31, 2018, were considered as exposed and those who were arbovirus disease-free and alive during the study period were considered as unexposed. For the self-controlled case series, we included all deaths from individuals with a chikungunya virus disease record, and each individual acted as their own control according to different study periods relative to the date of disease. The primary outcome was all-cause natural mortality up to 728 days after onset of chikungunya virus disease symptoms, and secondary outcomes were cause-specific deaths, including ischaemic heart diseases, diabetes, and cerebrovascular diseases. FINDINGS In the matched cohort study, we included 143 787 individuals with chikungunya virus disease who were matched, at the day of symptom onset, to unexposed individuals using sociodemographic factors. The incidence rate ratio (IRR) of death within 7 days of chikungunya symptom onset was 8·40 (95% CI 4·83-20·09) as compared with the unexposed group and decreased to 2·26 (1·50-3·77) at 57-84 days and 1·05 (0·82-1·35) at 85-168 days, with IRR close to 1 and wide CI in the subsequent periods. For the secondary outcomes, the IRR of deaths within 28 days after disease onset were: 1·80 (0·58-7·00) for cerebrovascular diseases, 3·75 (1·33-17·00) for diabetes, and 3·67 (1·25-14·00) for ischaemic heart disease, and there was no evidence of increased risk in the subsequent periods. For the self-controlled case series study, 1933 individuals died after having had chikungunya virus disease and were included in the analysis. The IRR of all-cause natural death within 7 days of symptom onset of chikungunya virus disease was 8·75 (7·18-10·66) and decreased to 1·59 (1·26-2·00) at 57-84 days and 1·09 (0·92-1·29) at 85-168 days. For the secondary outcomes, the IRRs of deaths within 28 days after disease onset were: 2·73 (1·50-4·96) for cerebrovascular diseases, 8·43 (5·00-14·21) for diabetes, and 2·38 (1·33-4·26) for ischaemic heart disease, and there was no evidence of increased risk at 85-168 days. INTERPRETATION Chikungunya virus disease is associated with an increased risk of death for up to 84 days after symptom onset, including deaths from cerebrovascular diseases, ischaemic heart diseases, and diabetes. This study highlights the need for equitable access to approved vaccines and effective anti-chikungunya virus therapeutics and reinforces the importance of robust vector-control efforts to reduce viral transmission. FUNDING Brazilian National Research Council (CNPq), Fundação de Amparo à Pesquisa do Estado da Bahia, Wellcome Trust, and UK Medical Research Council. TRANSLATION For the Portuguese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Thiago Cerqueira-Silva
- Centro de Integração de Dados e Conhecimentos para a Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil; Laboratório de Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz, Salvador, Brazil.
| | - Julia M Pescarini
- Centro de Integração de Dados e Conhecimentos para a Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Luciana L Cardim
- Centro de Integração de Dados e Conhecimentos para a Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Clémence Leyrat
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Elizabeth B Brickley
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Manoel Barral-Netto
- Centro de Integração de Dados e Conhecimentos para a Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil; Laboratório de Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Maurício L Barreto
- Centro de Integração de Dados e Conhecimentos para a Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Maria G Teixeira
- Centro de Integração de Dados e Conhecimentos para a Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Viviane S Boaventura
- Laboratório de Medicina e Saúde Pública de Precisão, Fundação Oswaldo Cruz, Salvador, Brazil; Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Enny S Paixão
- Centro de Integração de Dados e Conhecimentos para a Saúde (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
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Auzenbergs M, Maure C, Kang H, Clark A, Brady O, Sahastrabuddhe S, Abbas K. Programmatic considerations and evidence gaps for chikungunya vaccine introduction in countries at risk of chikungunya outbreaks: Stakeholder analysis. PLoS Negl Trop Dis 2024; 18:e0012075. [PMID: 38574163 PMCID: PMC11020901 DOI: 10.1371/journal.pntd.0012075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 04/16/2024] [Accepted: 03/15/2024] [Indexed: 04/06/2024] Open
Abstract
Chikungunya can have longstanding effects on health and quality of life. Alongside the recent approval of the world's first chikungunya vaccine by the US Food and Drug Administration in November 2023 and with new chikungunya vaccines in the pipeline, it is important to understand the perspectives of stakeholders before vaccine rollout. Our study aim is to identify key programmatic considerations and gaps in Evidence-to-Recommendation criteria for chikungunya vaccine introduction. We used purposive and snowball sampling to identify global, national, and subnational stakeholders from outbreak prone areas, including Latin America, Asia, and Africa. Semi-structured in-depth interviews were conducted and analysed using qualitative descriptive methods. We found that perspectives varied between tiers of stakeholders and geographies. Unknown disease burden, diagnostics, non-specific disease surveillance, undefined target populations for vaccination, and low disease prioritisation were critical challenges identified by stakeholders that need to be addressed to facilitate rolling out a chikungunya vaccine. Future investments should address these challenges to generate useful evidence for decision-making on new chikungunya vaccine introduction.
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Affiliation(s)
- Megan Auzenbergs
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Clara Maure
- International Vaccine Institute, Seoul, South Korea
| | - Hyolim Kang
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andrew Clark
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oliver Brady
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Kaja Abbas
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Doran C, Duits AJ, Gerstenbluth I, Tami A, Bailey A. Adaptive coping strategies among individuals living with long-term chikungunya disease: a qualitative study in Curaçao. BMJ Open 2024; 14:e076352. [PMID: 38326245 PMCID: PMC10860096 DOI: 10.1136/bmjopen-2023-076352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVE Long-term chikungunya disease is characterised by persistent rheumatic symptoms following chikungunya virus infection. As there is no specific treatment available, affected individuals need strategies to adapt. However, research on these is scarce. This study aimed to explore which adaptive coping strategies are employed to manage persistent rheumatic symptoms in daily life. SETTING The study was conducted in Curaçao. DESIGN AND PARTICIPANTS An explorative qualitative study was conducted between September and October 2020, among a purposive sample of adults, 19 women and 4 men affected by long-term chikungunya disease. In-depth interviews were semi-structured and transcribed verbatim. The data were analysed using inductive thematic analysis. RESULTS The disease duration for all participants ranged between 68 and 74 months (6 years). In narrating their experiences of coping with long-term chikungunya disease, four themes were identified: (1) learning to live with the disease; (2) resilience for dealing with pain; (3) maintaining positive self-image and attitude; and (4) coping through spirituality. CONCLUSION To live with long-term chikungunya disease with dignity in spite of physical pain and discomfort, participants tried to retain a sense of control of oneself and one's lives, to not let the disease take over, focusing on the positive in their lives, and finding strength and remain hopeful. Interventions such as cognitive-behavioural therapy and mindfulness exercises may be effective in strengthening or regain affected individual's sense of competence and control by fostering adaptive coping skills and resilience. Subsequently, these interventions may improve health-related quality of life when rheumatic symptoms persist following chikungunya virus infection.
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Affiliation(s)
- Churnalisa Doran
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, The Netherlands
| | - Ashley J Duits
- Department of Immunology, Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
| | - Izzy Gerstenbluth
- Department of Epidemiology, Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
| | - Adriana Tami
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, The Netherlands
| | - Ajay Bailey
- Department of Human Geography and Spatial Planning, University of Utrecht, Utrecht, The Netherlands
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Doran C, Duits A, Tami A, Gerstenbluth I, Bailey A. "It's very saddening, you keep on wondering when the symptoms will be over": A qualitative study exploring the long-term chikungunya disease impact on daily life and well-being, 6 years after disease onset. PLoS Negl Trop Dis 2023; 17:e0011793. [PMID: 38055664 DOI: 10.1371/journal.pntd.0011793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Long-term chikungunya is a mosquito-borne disease, characterized by disabling rheumatic symptoms persisting for years, after infection with the chikungunya virus. Previous studies focused on assessing the well-being of affected individuals from a quantitative perspective using generic instruments, and have reported physical and psychological impairment. However, a common critique is that generic instrument's structured responses and pre-defined health domains selected by health professionals, may not capture the full extent of well-being impairment experienced by patients. This study aimed to explore in-depth to which extent long-term chikungunya disease impacts daily living and the physical, psychological, and social well-being from the experiences and perspective of affected individuals. METHODOLOGY/PRINCIPAL FINDINGS Using open-ended questions, in-depth interviews were conducted with 20 purposively selected individuals with long-term chikungunya disease, in Curaçao. Interview audio-recordings were transcribed verbatim. The data were thematically analyzed. Living with persistent rheumatic symptoms affected the participant's daily living and well-being in several ways: experience of physical impact (restricted physical functioning and limitations in activities of daily life); experience of psychological impact (altered emotional state, fear of walking and running, psychosocial aspects of footwear adaptations, and uncertainty about disease progression and future health); and experience of social impact (social isolation and impaired relational maintenance, social dependency, challenges of social support, at-work productivity loss, and giving up leisure activities after work). CONCLUSIONS/SIGNIFICANCE This study, the first of its kind, indicated that the adverse impact of long-term chikungunya disease is currently underreported. The persistent rheumatic symptoms had a negative effect on functional ability, which in turn impacted broad aspects of daily life and well-being, beyond what is captured by generic instruments. In the view of the findings, physical exercise programs including manual therapy, aerobics, resistance and stretching exercises, and orthopaedic footwear interventions in a multidisciplinary patient-centred approach may improve physical function and subsequently overall well-being.
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Affiliation(s)
- Churnalisa Doran
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, The Netherlands
- Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
| | - Ashley Duits
- Red Cross Blood Bank Foundation, Willemstad, Curaçao
- Department of Immunology, Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
- Institute for Medical Education, University Medical Center Groningen, Groningen, The Netherlands
| | - Adriana Tami
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, The Netherlands
| | - Izzy Gerstenbluth
- Department of Epidemiology, Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
| | - Ajay Bailey
- Department of Human Geography and Spatial Planning, University of Utrecht, Utrecht, The Netherlands
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Doran C, Duits A, Gerstenbluth I, Tami A, Bailey A. "What will the doctor give me, the same painkiller?": a qualitative study exploring health-care seeking and symptoms self-management among patients for the treatment of long-term chikungunya disease, in Curaçao. BMC Health Serv Res 2023; 23:1247. [PMID: 37957621 PMCID: PMC10641972 DOI: 10.1186/s12913-023-10254-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Long-term chikungunya disease, characterized by persistent disabling rheumatic symptoms, including poly-arthralgia/arthritis of severe pain intensity, can persist for years after infection with the re-emerging mosquito-borne chikungunya virus. Although persistent symptoms and pain severity are important determinants of health-care seeking and self-management of symptoms, research on these in relation to long-term chikungunya disease is scarce. This study aimed to explore the perceived benefits and perceived barriers concerning health-care seeking, based on the Health Belief Model, and the symptoms self-management strategies used for health outcome improvement among individuals affected by long-term chikungunya disease. METHODS An exploratory qualitative descriptive study was conducted with 20 purposively selected adults (17 females and 3 males) with persistent rheumatic symptoms, recruited from an ongoing longitudinal chikungunya cohort, in Curaçao. Semi-structured interviews were carried out, audio-recorded, and transcribed. An iterative coding process was used for themes identification through inductive thematic analyses. RESULTS No perceived benefits in health-care seeking were reported. Identified themes in relation to perceived barriers were: (1) health-care seeking at disease onset; (2) general practitioners (GPs) perceptions and awareness of persistent symptoms; (3) challenges for medical referrals and support; (4) no validation of symptoms and challenges accessing therapy; (5) health system restrictions; and (6) social stigmatization of psychological help. These perceived barriers have led participants to self-manage persistent symptoms. Over-the-counter pharmacological and/or non-pharmacological treatments were used without consulting GPs. Identified themes were: (1) self-medication of symptoms; and (2) self-management true non-pharmacological treatments. CONCLUSIONS To promote the benefits of long-term health-care seeking and subsequently reduce the possible harmful use of analgesics, a collaborative physician-patient therapeutic relationship need to be encouraged. To facilitate this, important shifts may be needed in chikungunya sequalae education of both patients and health-care professionals, and policy makers need to revise health systems for the long-term provision of multidisciplinary care to achieve beneficial health outcomes in long-term chikungunya disease.
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Affiliation(s)
- Churnalisa Doran
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, Netherlands.
| | - Ashley Duits
- Department of Immunology, Curaçao Biomedical and Health Research Institute, Pater Eeuwensweg 36, Willemstad, Curaçao, Curaçao
| | - Izzy Gerstenbluth
- Department of Epidemiology, Curaçao Biomedical and Health Research Institute, Pater Eeuwensweg 36, Willemstad, Curaçao, Curaçao
| | - Adriana Tami
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, Netherlands
| | - Ajay Bailey
- Department of Human Geography and Spatial Planning, University of Utrecht, Heidelberglaan 8, Utrecht, 3584 CS, Netherlands
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Elsinga J, Kuodi P, Shibli H, Gorelik Y, Zayyad H, Wertheim O, Abu Jabal K, Dror A, Nazzal S, Glikman D, Edelstein M. Changes in Quality of Life Following SARS-CoV-2 Infection Among Jewish and Arab Populations in Israel: A Cross-Sectional Study. Int J Public Health 2023; 68:1605970. [PMID: 37378302 PMCID: PMC10291044 DOI: 10.3389/ijph.2023.1605970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Objectives: The long-term impact of COVID-19 on health inequalities is under-researched. We investigated changes in health-related inequalities following SARS-CoV-2 infection between the Jewish majority and the Arab/Druze minority in Israel. Methods: Patients with a positive SARS-CoV-2 RT-PCR test processed from one of the Northern-Israeli government hospitals between 03/2021 and 05/2022 were invited to participate. We collected socio-demographic, COVID-19-related, and health-related quality of life (HRQoL) information using a validated questionnaire. We compared pre- and post COVID-19 HRQoL changes between Jews and Arabs/Druze, up to 12+ months post-infection using an adjusted linear regression model. Results: Among the 881 included participants the average post-COVID HRQoL score was lower among Arabs/Druze than Jews (0.83 vs. 0.88; p = 0.005). Until 12 months post-infection, HRQoL changes were similar for Arabs/Druze and Jews. After 12 months, HRQoL dropped significantly more among Arabs/Druze than among Jews (0.11 points difference between the groups; p = 0.014), despite adjusting for socioeconomic variables. Conclusion: 12 months post-infection, COVID-19 affected the HRQoL of Arabs/Druze more than Jews, with the gap not fully explained by socio-economic differences. The COVID-19 pandemic may widen pre-existing long-term health inequalities.
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Affiliation(s)
- Jelte Elsinga
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Amsterdam, Netherlands
| | - Paul Kuodi
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Haneen Shibli
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Yanay Gorelik
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Hiba Zayyad
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- The Baruch Padeh Medical Center, Poriya, Poriah, Israel
| | - Ofir Wertheim
- The Baruch Padeh Medical Center, Poriya, Poriah, Israel
| | - Kamal Abu Jabal
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Ziv Medical Center, Safed, Israel
| | - Amiel Dror
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Galilee Medical Center, Nahariya, Israel
| | - Saleh Nazzal
- The Baruch Padeh Medical Center, Poriya, Poriah, Israel
| | - Daniel Glikman
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- The Baruch Padeh Medical Center, Poriya, Poriah, Israel
| | - Michael Edelstein
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Ziv Medical Center, Safed, Israel
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Otache AE, Ezenwosu IL, Ossai EN, Nwobi EA, Abah SO, Uzochukwu BS. Disease perception, impacts and coping strategies for onchocerciasis in Southeast Nigeria: a qualitative study among patients and program managers. BMC Public Health 2023; 23:841. [PMID: 37165379 PMCID: PMC10170812 DOI: 10.1186/s12889-023-15821-6] [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: 07/18/2022] [Accepted: 05/05/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Onchocerciasis is a disease of public health concern due to the devastating consequences of the disease which impacts negatively on the lives of the people. The negative impact of the disease may affect its perception and lead to the adoption of some coping strategies. Therefore, understanding the disease perception, impacts and coping strategies used by onchocerciasis patients will help plan health interventions aimed at improving their general well-being. METHODS This was a community-based study that employed a qualitative method through Key informant interviews (KII) with program managers and focus group discussions (FGD) among people who had Onchocerciasis. Four sessions of FGDs with a total of thirty-two (32) participants and eleven KIIs were conducted to ascertain their in-depth experience in five thematic areas. RESULTS In these communities, onchocerciasis is perceived to have been caused mainly by the bite of blackflies. Other presumed causes by the patients included drinking polluted water, poor environmental sanitation and witchcraft. The disease had a significant detrimental influence on both the physical and financial aspects of life with limited emotional and social impacts. The long-term clinical manifestations of onchocerciasis triggered pain and insufficient mobility. Thus, onchocerciasis patients experienced impairment in normal daily life activities (farming, etc.), dependency, depression and inability to participate in social events. These manifestations stimulated various coping strategies, mainly, nodulectomy by traditional healers. Others included self-medication, taking an overdose of ivermectin, and the use of alcohol. CONCLUSION Misconceptions about the cause of onchocerciasis still exist among people with the disease. The consequences of the disease impact negatively on various aspects of their lives and stimulate various coping strategies. Therefore, health promotion messages to the public should aim at dispelling misconceptions about the disease and promote healthy coping strategies.
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Affiliation(s)
- Adah E Otache
- Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria
- Department of Community Medicine, Federal Medical Center, Makurdi, Benue State, Nigeria
| | - Ifeyinwa L Ezenwosu
- Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria.
| | - Edmund N Ossai
- Department of Community Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - Emmanuel A Nwobi
- Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria
| | - Stephen O Abah
- Department of Community Medicine, Federal University of Health Sciences, Otukpo, Benue State, Nigeria
| | - Benjamin Sc Uzochukwu
- Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu, Enugu State, Nigeria
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Associations between reported post-COVID-19 symptoms and subjective well-being, Israel, July 2021 - April 2022. Epidemiol Infect 2023; 151:e16. [PMID: 36698161 PMCID: PMC9990392 DOI: 10.1017/s0950268822001996] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The impact of individual symptoms reported post-COVID-19 on subjective well-being (SWB) is unknown. We described associations between SWB and selected reported symptoms following SARS-CoV-2 infection. We analysed reported symptoms and subjective well being from 2295 participants (of which 576 reporting previous infection) in an ongoing longitudinal cohort study taking place in Israel. We estimated changes in SWB associated with reported selected symptoms at three follow-up time points (3-6, 6-12 and 12-18 months post infection) among participants reporting previous SARS-CoV-2 infection, adjusted for key demographic variables, using linear regression. Our results suggest that the biggest and most sustained changes in SWB stems from non-specific symptoms (fatigue -7.7 percentage points (pp), confusion/ lack of concentration -10.7 pp, and sleep disorders -11.5pp, P < 0.005), whereas the effect of system-specific symptoms, such as musculoskeletal symptoms (weakness in muscles and muscle pain) on SWB, are less profound and more transient. Taking a similar approach for other symptoms and following individuals over time to describe trends in SWB changes attributable to specific symptoms will help understand the post-acute phase of COVID-19 and how it should be defined and better managed. Post-acute COVID19 symptoms were associated with a significant decrease in subjective well being up to 18 months after initial infection.
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Simon F, Bossy R, Federico D, Dezaunay J, Demoux AL, Rugard N, Calusi G, Nizzardo A, Watson H, Gane-Troplent F. Determinants of Health-Related Quality of Life in Chronic Chikungunya Disease in Guadeloupe. Pathogens 2022; 11:pathogens11090989. [PMID: 36145421 PMCID: PMC9504273 DOI: 10.3390/pathogens11090989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic chikungunya disease is associated with a poor quality of life and a variety of symptoms, not restricted to the musculoskeletal system. Patients with chronic chikungunya disease in Guadeloupe were evaluated in order to identify the main factors determining the quality of life. Patients were followed up at a mean of 36 months after chikungunya infection, undergoing detailed clinical examination for musculoskeletal involvement, with assessment of subjective symptoms and the impact on mood, physical activity, and quality of life (SF12). Patients had extensive musculoskeletal involvement shown by tenderness in 9 ± 4 joints and stiffness in 5 ± 4 joints. SF12 physical and mental component scores showed a poor health-related quality of life. Measures of joint pain, stiffness, and inflammation contributed to impaired quality of life scores. In addition, fatigue and interrupted sleep appeared to be important predictors for physical aspects of quality of life. The emergence of anxiodepressive syndromes post-chikungunya infection was associated with both physical and mental component scores of SF12. These data confirm that musculoskeletal symptoms are not the only determinants of quality of life in chronic chikungunya disease. Follow-up of patients should include assessment and management of fatigue, poor sleep quality, and anxiodepressive syndromes.
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Affiliation(s)
- Fabrice Simon
- Emerging Virus Unit, University of Aix-Marseille, 13284 Marseille, France
| | - Rémi Bossy
- Faculty of Medicine Hyacinthe Bastaraud, Université des Antilles, 97157 Guadeloupe, France
| | - Denise Federico
- Pharmacometrics Department, Aptuit Srl., 37135 Verona, Italy
| | - Julien Dezaunay
- Faculty of Medicine Hyacinthe Bastaraud, Université des Antilles, 97157 Guadeloupe, France
| | | | - Nadia Rugard
- Faculty of Medicine Hyacinthe Bastaraud, Université des Antilles, 97157 Guadeloupe, France
| | - Giulia Calusi
- Pharmacometrics Department, Aptuit Srl., 37135 Verona, Italy
| | - Andrea Nizzardo
- Pharmacometrics Department, Aptuit Srl., 37135 Verona, Italy
| | - Hugh Watson
- Antiviral Research Unit, Evotec ID, 69007 Lyon, France
- Correspondence: ; Tel.: +33-(0)6-71-87-86-19
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11
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Doran C, Elsinga J, Fokkema A, Berenschot K, Gerstenbluth I, Duits A, Lourents N, Halabi Y, Burgerhof J, Bailey A, Tami A. Long-term Chikungunya sequelae and quality of life 2.5 years post-acute disease in a prospective cohort in Curaçao. PLoS Negl Trop Dis 2022; 16:e0010142. [PMID: 35231033 PMCID: PMC8887759 DOI: 10.1371/journal.pntd.0010142] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Little is known about the persistence and impact of non-rheumatic symptoms after acute chikungunya disease. We have studied the clinical presentation and long-term impact of rheumatic and non-rheumatic symptoms on health related quality of life (QoL) 2.5 years after disease onset. Additionally, the validity of the Curaçao Long-Term Chikungunya Sequelae (CLTCS) score in classifying disease severity over time was evaluated. Methodology/Principal findings This prospective cohort study followed 248 chikungunya patients. Symptoms and SF-36 QoL were evaluated during baseline and follow-up at 2.5 years using questionnaires. Chikungunya disease status was classified using the CLTCS-score. At 2.5 years after disease onset patients were classified as being recovered (43%), mildly (35%) or highly (22%) affected. In comparison to mildly affected, highly affected patients reported the highest prevalence of ongoing rheumatic and non-rheumatic/psychological symptoms, with increased prevalence of arthralgia in the lower extremities (p = .01) and fatigue (p = .049) over time, and higher pain intensity (p < .001). Compared to mildly affected, being highly affected was associated with weakness in the lower extremities (OR: 1.90; CI: 1.29–2.80, p = .001) and worsened physical and mental QoL impairment. Conclusions Patients are both physically and psychologically affected by rheumatic and non-rheumatic symptoms of long-term chikungunya disease. The CLTCS-score is an easy to use instrument for classifying long-term chikungunya disease severity and impact and can facilitate health care providers in identifying highly affected patients who are prone to develop severe QoL impairment. Highly affected patients are recommended to be treated in a multidisciplinary setting to improve physical and psychological functioning, and QoL. Chikungunya disease manifestation is characterized by a sudden onset of non-rheumatic flu-like symptoms and debilitating rheumatic symptoms in the acute phase. Little is known about the persistence of non-rheumatic symptoms after acute disease. In this prospective cohort study we investigated the clinical manifestations and persistence of baseline rheumatic and non-rheumatic/psychological symptoms and their impact on health related quality of life (QoL) 2.5 years after disease onset. Moreover, we investigated the performance of the classification instrument the Curaçao Long-Term Chikungunya Sequelae (CLTCS) score in classifying chikungunya disease severity over time. We found that 57% of the patients were still affected 2.5 years after disease onset. An increase of mainly recurrent rheumatic and non-rheumatic/psychological symptoms including fatigue, insomnia, sombreness, and loss of vitality were reported, with a significantly higher symptom recurrence and pain intensity reported by highly affected patients. In addition, QoL assessment indicates that the disease burden impaired the physiological well-being of these patients. We also showed that the CLTCS-score can be used to easily identify highly affected patients. This study demonstrates that disease severity increases non-rheumatic symptoms and subsequent physiological impairments and suggests a multidisciplinary treatment approach to treat the psychological effects of long-term chikungunya disease.
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Affiliation(s)
- Churnalisa Doran
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, The Netherlands
- Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
- * E-mail:
| | - Jelte Elsinga
- Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Ante Fokkema
- University of Groningen, Groningen, The Netherlands
| | | | - Izzy Gerstenbluth
- Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
- Department of Epidemiology and Research, Medical and Public Health Service Curaçao, Willemstad, Curaçao
| | - Ashley Duits
- Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
- Red Cross Blood Bank Foundation, Willemstad, Curaçao
| | - Norediz Lourents
- Department of Epidemiology and Research, Medical and Public Health Service Curaçao, Willemstad, Curaçao
| | - Yaskara Halabi
- Department of Epidemiology and Research, Medical and Public Health Service Curaçao, Willemstad, Curaçao
| | - Johannes Burgerhof
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - Ajay Bailey
- Department of Human Geography and Spatial Planning, University of Utrecht, Utrecht, The Netherlands
| | - Adriana Tami
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, The Netherlands
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12
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Otache AE, Ezenwosu IL, Ossai EN, Aniwada EC, Nwobi EA, Uzochukwu BSC. Health-related quality of life and associated factors among Onchocerciasis patients in southeast Nigeria: A cross-sectional comparative study. PLoS Negl Trop Dis 2022; 16:e0010182. [PMID: 35139077 PMCID: PMC8827426 DOI: 10.1371/journal.pntd.0010182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/19/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Onchocerciasis, a neglected tropical disease of public health importance, causes chronic morbidity and severe disability that may impact on health-related quality of life (HRQoL) of the infected people. This study assessed the HRQoL and associated factors among onchocerciasis patients in southeast Nigeria. METHODS This was a community-based cross-sectional comparative study. Using a multistage sampling technique, 340 onchocerciasis patients were selected and matched for age and gender with the healthy population in the same neighbourhood. The respondents were interviewed using the short-form-36 (SF-36) questionnaire to determine their HRQoL. WHO Disability Assessment Schedule 2.0 tool (WHODAS 2.0) was used to assess disability in persons with onchocerciasis. Means were compared with independent student t-test while Chi-square test was used to compare proportions. Also, correlation analysis and logistic regression were used in the analyses. RESULTS A significantly lower proportion of people living with onchocerciasis had a good quality of life when compared with the healthy subjects (69.4% vs 93.5%, p<0.001). Also, an inverse relationship was seen between disability and quality of life in the onchocerciasis group (r = -0.647, p<0.001). Predictors of poor quality of life among respondents with onchocerciasis were: respondents aged ≥48 years (AOR = 2.5, 95% CI: 1.4-5.0), those with some disability associated with onchocerciasis (AOR = 3.33, 95%CI: 1.4-5.0) and respondents who perceived themselves as a burden to people (AOR = 10, 95%CI: 2.5-20). CONCLUSION Onchocerciasis impacted negatively on HRQoL of persons with onchocerciasis when compared with the healthy population. The quality of life of persons affected with onchocerciasis reduces with increasing disability. There is the need to increase community awareness on onchocerciasis to ensure early diagnosis and prompt treatment as this will reduce disability among those affected with the disease thus enhancing their HRQoL.
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Affiliation(s)
- Adah E. Otache
- Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu State, Nigeria
| | - Ifeyinwa L. Ezenwosu
- Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu State, Nigeria
| | - Edmund N. Ossai
- Department of Community Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - Elias C. Aniwada
- Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu State, Nigeria
| | - Emmanuel A. Nwobi
- Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu State, Nigeria
| | - Benjamin SC. Uzochukwu
- Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu State, Nigeria
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13
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van Goudoever MJF, Mulderij-Jansen VIC, Duits AJ, Tami A, Gerstenbluth II, Bailey A. The Impact of Health Risk Communication: A Study on the Dengue, Chikungunya, and Zika Epidemics in Curaçao, Analyzed by the Social Amplification of Risk Framework (SARF). QUALITATIVE HEALTH RESEARCH 2021; 31:1801-1811. [PMID: 33926311 PMCID: PMC8446899 DOI: 10.1177/10497323211007815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Epidemics of dengue, chikungunya, and Zika have been threatening the Caribbean. Since risk communication (RC) plays a fundamental role in preventing and controlling diseases understanding how RC works is essential for enabling risk-reducing behavior. This multimethod qualitative study compares news reports with local's and health professional's perspectives, currently lacking in RC research. It was found that RC strategies were obstructed by a lack of governmental structure, organization, and communication. The content analysis showed that the majority of newspaper articles contained negative reporting on the government. Furthermore, this study shows how trust and heuristics attenuate or amplify people's risk perceptions and possibly positively and negatively influence people's risk-reducing behavior. A transcending approach (e.g., structural, cooperative, and multidisciplinary) of the prevention and control of vector-borne diseases and the corresponding RC is recommended.
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Affiliation(s)
| | - Vaitiare I. C. Mulderij-Jansen
- Utrecht University, Utrecht, The
Netherlands
- Curaçao Biomedical & Health
Research Institute, Willemstad, Curaçao
- University Medical Center
Groningen, Groningen, The Netherlands
| | - Ashley J. Duits
- Curaçao Biomedical & Health
Research Institute, Willemstad, Curaçao
- Red Cross Blood Bank Foundation,
Willemstad, Curaçao
| | - Adriana Tami
- University Medical Center
Groningen, Groningen, The Netherlands
| | - Izzy I. Gerstenbluth
- Curaçao Biomedical & Health
Research Institute, Willemstad, Curaçao
- Ministry of Health Environment
and Nature of Curaçao, Willemstad, Curaçao
| | - Ajay Bailey
- Utrecht University, Utrecht, The
Netherlands
- Manipal Academy of Higher
Education, Manipal, India
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14
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Rodriguez-Morales AJ, Paniz-Mondolfi AE, Faccini-Martínez ÁA, Henao-Martínez AF, Ruiz-Saenz J, Martinez-Gutierrez M, Alvarado-Arnez LE, Gomez-Marin JE, Bueno-Marí R, Carrero Y, Villamil-Gomez WE, Bonilla-Aldana DK, Haque U, Ramirez JD, Navarro JC, Lloveras S, Arteaga-Livias K, Casalone C, Maguiña JL, Escobedo AA, Hidalgo M, Bandeira AC, Mattar S, Cardona-Ospina JA, Suárez JA. The Constant Threat of Zoonotic and Vector-Borne Emerging Tropical Diseases: Living on the Edge. FRONTIERS IN TROPICAL DISEASES 2021; 2:676905. [PMID: 34010366 PMCID: PMC8132189 DOI: 10.3389/fitd.2021.676905] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/06/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- Alfonso J. Rodriguez-Morales
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundacion Universitaria Autonoma de las Americas, Pereira, Colombia
- Emerging Infectious Diseases and Tropical Medicine Research Group, Instituto para la Investigación en Ciencias Biomédicas - Sci-Help, Pereira, Colombia
- Coordinación Nacional de Investigación, Universidad Privada Franz Tamayo (UNIFRANZ), Cochabamba, Bolivia
- Master Program on Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru
| | - Alberto E. Paniz-Mondolfi
- Department of Pathology, Molecular and Cell-Based Medicine, Laboratory of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Instituto de Investigaciones Biomédicas IDB/Incubadora Venezolana de la Ciencia, Barquisimeto, Venezuela
| | | | - Andrés F. Henao-Martínez
- Department of Medicine, Division of Infectious Diseases, School of Medicine, University of Colorado Denver, Aurora, CO, United States
| | - Julian Ruiz-Saenz
- Grupo de Investigación en Ciencias Animales - GRICA, Facultad de Medicina Veterinaria y Zootecnia, Universidad Cooperativa de Colombia, Bucaramanga, Colombia
| | - Marlen Martinez-Gutierrez
- Grupo de Investigación en Ciencias Animales - GRICA, Facultad de Medicina Veterinaria y Zootecnia, Universidad Cooperativa de Colombia, Bucaramanga, Colombia
- Infettare, Facultad de Medicina, Universidad Cooperativa de Colombia, Medellín, Colombia
| | - Lucia E. Alvarado-Arnez
- Coordinación Nacional de Investigación, Universidad Privada Franz Tamayo (UNIFRANZ), Cochabamba, Bolivia
| | - Jorge E. Gomez-Marin
- Grupo de Estudio en Parasitologia Molecular (GEPAMOL) Group, Facultad de Ciencias de la Salud, Universidad del Quindío, Armenia, Colombia
| | - Ruben Bueno-Marí
- Departamento de Investigación y Desarrollo (I+D), Laboratorios Lokímica, Paterna, Spain
- Área de Parasitología, Departamento de Farmacia y Tecnología Farmaceútica y Parasitología, Universidad de Valencia, Burjasot, Spain
| | - Yenddy Carrero
- Facultad de Ciencias de la Salud, Carrera de Medicina, Universidad Técnica de Ambato, Ambato, Ecuador
| | - Wilmer E. Villamil-Gomez
- Infectious Diseases and Infection Control Research Group, Hospital Universitario de Sincelejo, Sincelejo, Colombia
- Programa Del Doctorado de Medicina Tropical, SUE Caribe, Universidad Del Atlántico, Barranquilla, Colombia
| | - D. Katterine Bonilla-Aldana
- Semillero de Investigación en Zoonosis (SIZOO), Grupo de Investigación BIOECOS, Fundacion Universitaria Autonoma de las Americas, Pereira, Colombia
| | - Ubydul Haque
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, United States
| | - Juan D. Ramirez
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Juan-Carlos Navarro
- Research Group of Emerging Diseases, Ecoepidemiology and Biodiversity, Health Sciences Faculty, Universidad Internacional SEK, Quito, Ecuador
| | - Susana Lloveras
- Sección Zoopatología Médica, Hospital de Infecciosas FJ Muñiz, Buenos Aires, Argentina
| | - Kovy Arteaga-Livias
- Master Program on Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru
- Faculty of Medicine, Universidad Nacional Hermilio Valdizán, Huánuco, Peru
| | | | - Jorge L. Maguiña
- Master Program on Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru
| | - Angel A. Escobedo
- Department of Epidemiology, Institute of Gastroenterology, Havana, Cuba
| | - Marylin Hidalgo
- Infectious Diseases Group, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Salim Mattar
- Instituto de Investigaciones Biologicas del Tropico, Universidad de Cordoba, Monteria, Colombia
| | - Jaime A. Cardona-Ospina
- Grupo de Investigación Biomedicina, Faculty of Medicine, Fundacion Universitaria Autonoma de las Americas, Pereira, Colombia
- Emerging Infectious Diseases and Tropical Medicine Research Group, Instituto para la Investigación en Ciencias Biomédicas - Sci-Help, Pereira, Colombia
| | - Jose A. Suárez
- Investigador SNI Senacyt Panamá, Instituto Conmemorativo Gorgas de Estudios de la Salud (ICGES), Panama, Panama
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15
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Silva MMO, Kikuti M, Anjos RO, Portilho MM, Santos VC, Gonçalves TSF, Tauro LB, Moreira PSS, Jacob-Nascimento LC, Santana PM, Campos GS, Siqueira AM, Kitron U, Reis MG, Ribeiro GS. Risk of chronic arthralgia and impact of pain on daily activities in a cohort of patients with chikungunya virus infection from Brazil. Int J Infect Dis 2021; 105:608-616. [PMID: 33684559 DOI: 10.1016/j.ijid.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/17/2021] [Accepted: 03/02/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To investigate risk factors for persistent arthralgia in patients with chikungunya, and describe its impact on daily activities. METHODS From September 2014 to July 2016, a surveillance study enrolled patients with acute febrile illness in Salvador, Brazil, and detected those with chikungunya virus infection using IgM enzyme-linked immunosorbent assay or reverse transcriptase polymerase chain reaction. Telephone follow-ups were performed to ascertain the progression of disease. RESULTS Of 153 followed cases, 65 (42.5%) reported chronic arthralgia that lasted >3 months, and 47 (30.7%) were still symptomatic at the time of the interview (approximately 1.5 years after symptom onset). Limitations in daily activities and mental distress were reported by 93.8% and 61.5% of those with chronic arthralgia, respectively. Female sex [risk ratio (RR) 1.79, 95% confidence interval (CI) 1.95-2.69] and age (RR 1.02 for each 1-year increase, 95% CI 1.01-1.03) were independent risk factors for chronic arthralgia. Chronic arthralgia was not associated with co-infection with dengue virus (RR 0.97, 95% CI 0.48-1.94) or chikungunya viral load at diagnosis (median chikungunya virus RNA of 5.60 and 5.52 log10 copies/μL for those with and without chronic arthralgia, respectively; P = 0.75). CONCLUSIONS These findings reinforce the high frequency of chronic chikungunya arthralgia, and highlight the substantial disability associated with the persistence of pain. Development of novel strategies to mitigate the transmission of chikungunya virus and to provide long-term medical assistance for patients with chikungunya are needed urgently.
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Affiliation(s)
| | - Mariana Kikuti
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Moyra M Portilho
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Viviane C Santos
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | | | - Laura B Tauro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Instituto de Biologia Subtropical, CONICET-UNAM, Puerto Iguazú, Argentina
| | | | | | - Perla M Santana
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Gúbio S Campos
- Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | - André M Siqueira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Uriel Kitron
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Emory University, Atlanta, GA, USA
| | - Mitermayer G Reis
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil; Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Guilherme S Ribeiro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.
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16
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de Macêdo SF, Silva KA, de Vasconcelos RB, de Sousa IV, Mesquita LPS, Barakat RDM, Fernandes HMC, Queiroz ACM, Santos GPG, Filho VCB, Carrasquilla G, Caprara A, de Oliveira Lima JW. Scaling up of Eco-Bio-Social Strategy to Control Aedes aegypti in Highly Vulnerable Areas in Fortaleza, Brazil: A Cluster, Non-Randomized Controlled Trial Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031278. [PMID: 33572650 PMCID: PMC7908398 DOI: 10.3390/ijerph18031278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/23/2021] [Accepted: 01/25/2021] [Indexed: 11/17/2022]
Abstract
Aedes aegypti is a cosmopolitan vector for arboviruses dengue, Zika and chikungunya, disseminated in all Brazilian states. The Eco-Bio-Social (EBS) strategy is vital in Aedes aegypti control as it mobilizes stakeholders (government, professionals, society, and academics) to promote healthy environments. This paper describes the rationale and methods of expanding the EBS strategy for Aedes aegypti control in Fortaleza, Northeast Brazil. A cluster, non-randomized controlled clinical trial was developed to analyze the strategy’s effectiveness in vulnerable territories (high incidence of dengue and violent deaths; low HDI; substandard urban infrastructure, high population density, and water scarcity). We selected two intervention and two control groups, resulting in a sample of approximately 16,000 properties. The intervention consisted of environmental management by sealing large elevated water tanks, introduction of beta fish in waterholes, elimination of potential breeding sites, and mobilization and training of schoolchildren, endemic disease workers, health workers, social mobilizers, and community leaders; community surveillance of arboviruses; construction and validation of a booklet for the prevention of arboviruses in pregnant women. We analyzed the costs of arboviruses to government and households, the intervention cost-effectiveness, chikungunya’s chronicity, and acceptance, sustainability, and governance of vector control actions. The primary outcome (infestation) was analyzed using the house, container, and Breteau indices. We hope that this study will help us understand how to scale up strategies to fight Aedes aegypti in vulnerable areas.
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Affiliation(s)
- Suyanne Freire de Macêdo
- Collective Health Postgraduate Program, State University of Ceará, Fortaleza 60714-903, Brazil; (K.A.S.); (R.B.d.V.); (I.V.d.S.); (L.P.S.M.); (R.D.M.B.); (H.M.C.F.); (A.C.M.Q.); (G.P.G.S.); (V.C.B.F.); (A.C.); (J.W.d.O.L.)
- Nursing Department, Federal University of Piauí, Picos 64607-670, Brazil
- Correspondence:
| | - Kellyanne Abreu Silva
- Collective Health Postgraduate Program, State University of Ceará, Fortaleza 60714-903, Brazil; (K.A.S.); (R.B.d.V.); (I.V.d.S.); (L.P.S.M.); (R.D.M.B.); (H.M.C.F.); (A.C.M.Q.); (G.P.G.S.); (V.C.B.F.); (A.C.); (J.W.d.O.L.)
| | - Renata Borges de Vasconcelos
- Collective Health Postgraduate Program, State University of Ceará, Fortaleza 60714-903, Brazil; (K.A.S.); (R.B.d.V.); (I.V.d.S.); (L.P.S.M.); (R.D.M.B.); (H.M.C.F.); (A.C.M.Q.); (G.P.G.S.); (V.C.B.F.); (A.C.); (J.W.d.O.L.)
| | - Izautina Vasconcelos de Sousa
- Collective Health Postgraduate Program, State University of Ceará, Fortaleza 60714-903, Brazil; (K.A.S.); (R.B.d.V.); (I.V.d.S.); (L.P.S.M.); (R.D.M.B.); (H.M.C.F.); (A.C.M.Q.); (G.P.G.S.); (V.C.B.F.); (A.C.); (J.W.d.O.L.)
| | - Lyvia Patrícia Soares Mesquita
- Collective Health Postgraduate Program, State University of Ceará, Fortaleza 60714-903, Brazil; (K.A.S.); (R.B.d.V.); (I.V.d.S.); (L.P.S.M.); (R.D.M.B.); (H.M.C.F.); (A.C.M.Q.); (G.P.G.S.); (V.C.B.F.); (A.C.); (J.W.d.O.L.)
| | - Roberta Duarte Maia Barakat
- Collective Health Postgraduate Program, State University of Ceará, Fortaleza 60714-903, Brazil; (K.A.S.); (R.B.d.V.); (I.V.d.S.); (L.P.S.M.); (R.D.M.B.); (H.M.C.F.); (A.C.M.Q.); (G.P.G.S.); (V.C.B.F.); (A.C.); (J.W.d.O.L.)
| | - Hélida Melo Conrado Fernandes
- Collective Health Postgraduate Program, State University of Ceará, Fortaleza 60714-903, Brazil; (K.A.S.); (R.B.d.V.); (I.V.d.S.); (L.P.S.M.); (R.D.M.B.); (H.M.C.F.); (A.C.M.Q.); (G.P.G.S.); (V.C.B.F.); (A.C.); (J.W.d.O.L.)
| | - Ana Carolina Melo Queiroz
- Collective Health Postgraduate Program, State University of Ceará, Fortaleza 60714-903, Brazil; (K.A.S.); (R.B.d.V.); (I.V.d.S.); (L.P.S.M.); (R.D.M.B.); (H.M.C.F.); (A.C.M.Q.); (G.P.G.S.); (V.C.B.F.); (A.C.); (J.W.d.O.L.)
| | - Gerarlene Ponte Guimarães Santos
- Collective Health Postgraduate Program, State University of Ceará, Fortaleza 60714-903, Brazil; (K.A.S.); (R.B.d.V.); (I.V.d.S.); (L.P.S.M.); (R.D.M.B.); (H.M.C.F.); (A.C.M.Q.); (G.P.G.S.); (V.C.B.F.); (A.C.); (J.W.d.O.L.)
| | - Valter Cordeiro Barbosa Filho
- Collective Health Postgraduate Program, State University of Ceará, Fortaleza 60714-903, Brazil; (K.A.S.); (R.B.d.V.); (I.V.d.S.); (L.P.S.M.); (R.D.M.B.); (H.M.C.F.); (A.C.M.Q.); (G.P.G.S.); (V.C.B.F.); (A.C.); (J.W.d.O.L.)
- Federal Institute of Education, Science and Technology of Ceará, Aracati Campus, Aracati 62800-000, Brazil
| | | | - Andrea Caprara
- Collective Health Postgraduate Program, State University of Ceará, Fortaleza 60714-903, Brazil; (K.A.S.); (R.B.d.V.); (I.V.d.S.); (L.P.S.M.); (R.D.M.B.); (H.M.C.F.); (A.C.M.Q.); (G.P.G.S.); (V.C.B.F.); (A.C.); (J.W.d.O.L.)
| | - José Wellington de Oliveira Lima
- Collective Health Postgraduate Program, State University of Ceará, Fortaleza 60714-903, Brazil; (K.A.S.); (R.B.d.V.); (I.V.d.S.); (L.P.S.M.); (R.D.M.B.); (H.M.C.F.); (A.C.M.Q.); (G.P.G.S.); (V.C.B.F.); (A.C.); (J.W.d.O.L.)
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Chikungunya Virus Replication Rate Determines the Capacity of Crossing Tissue Barriers in Mosquitoes. J Virol 2021; 95:JVI.01956-20. [PMID: 33148794 DOI: 10.1128/jvi.01956-20] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022] Open
Abstract
Chikungunya virus (CHIKV) is a reemerging and rapidly spreading pathogen transmitted by mosquitoes. The emergence of new epidemic variants of the virus is associated with genetic evolutionary traits, including duplication of repeated RNA elements in the 3' untranslated region (UTR) that seemingly favor transmission by mosquitoes. The transmission potential of a given variant results from a complex interplay between virus populations and anatomical tissue barriers in the mosquito. Here, we used the wild-type CHIKV Caribbean strain and an engineered mutant harboring a deletion in the 3' UTR to dissect the interactions of virus variants with the anatomical barriers that impede transmission during the replication cycle of the virus in Aedes mosquitoes. Compared to the 3'-UTR mutant, we observed that the wild-type virus had a short extrinsic incubation period (EIP) after an infectious blood meal and was expectorated into mosquito saliva much more efficiently. We found that high viral titers in the midgut are not sufficient to escape the midgut escape barrier. Rather, viral replication kinetics play a crucial role in determining midgut escape and the transmission ability of CHIKV. Finally, competition tests in mosquitoes coinfected with wild-type and mutant viruses revealed that both viruses successfully colonized the midgut, but wild-type viruses effectively displaced mutant viruses during systemic infection due to their greater efficiency of escaping from the midgut into secondary tissues. Overall, our results uncover a link between CHIKV replication kinetics and the effect of bottlenecks on population diversity, as slowly replicating variants are less able to overcome the midgut escape barrier.IMPORTANCE It is well established that selective pressures in mosquito vectors impose population bottlenecks for arboviruses. Here, we used a CHIKV Caribbean lineage mutant carrying a deletion in the 3' UTR to study host-virus interactions in vivo in the epidemic mosquito vector Aedes aegypti We found that the mutant virus had a delayed replication rate in mosquitoes, which lengthened the extrinsic incubation period (EIP) and reduced fitness relative to the wild-type virus. As a result, the mutant virus displayed a reduced capacity to cross anatomical barriers during the infection cycle in mosquitoes, thus reducing the virus transmission rate. Our findings show how selective pressures act on CHIKV noncoding regions to select variants with shorter EIPs that are preferentially transmitted by the mosquito vector.
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de Moraes L, Cerqueira-Silva T, Nobrega V, Akrami K, Santos LA, Orge C, Casais P, Cambui L, Rampazzo RDCP, Trinta KS, Montalbano CA, Teixeira MJ, Cavalcante LP, Andrade BB, da Cunha RV, Krieger MA, Barral-Netto M, Barral A, Khouri R, Boaventura VS. A clinical scoring system to predict long-term arthralgia in Chikungunya disease: A cohort study. PLoS Negl Trop Dis 2020; 14:e0008467. [PMID: 32693402 PMCID: PMC7373495 DOI: 10.1371/journal.pntd.0008467] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 06/09/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Chikungunya virus (CHIKV) has caused worldwide epidemics that impose a major burden on health systems. Approximately half of infected individuals develop chronic debilitating arthralgia, affecting their quality of life. Here, we identified the relevant clinical and demographic variables in the acute phase of CHIKV infection prospectively linked to chronic arthralgia to elaborate a prognostic scoring system. METHODS Acute CHIKV infection cases (n = 134) confirmed by serology or molecular test were examined <10 days of disease onset and followed for one year to evaluate for disease progression. Potential risk factors for chronic arthralgia were evaluated by multivariate analysis to develop a prognostic scoring system, which was subsequently tested in an independent validation cohort consisting of 42 individuals. RESULTS A total of 107 out of 134 (80%) acute CHIKV-confirmed cases from the derivation cohort were re-examined one year after enrollment. Chronic arthralgia post-CHIKV infection was diagnosed in 64 (60%). Five of the 12 parameters evaluated in the acute phase were statistically associated with persistent arthralgia and were further tested by Bayesian analysis. These variables were weighted to yield a prognosis score denominated SHERA (Sex, Hypertension, Edema, Retroocular pain, Age), which exhibited 81.3% accuracy in predicting long-term arthralgia post-CHIKV infection in the derivation cohort, and 76.5% accuracy in the validation cohort. CONCLUSIONS The simplified and externally validated prognostic scoring system, SHERA, is a useful method to screen acutely CHIKV-infected patients at elevated risk of chronic arthralgia who will benefit from specific interventions. This tool could guide public health policies, particularly in resource-constrained settings.
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Affiliation(s)
- Laise de Moraes
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
| | - Thiago Cerqueira-Silva
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
| | - Victor Nobrega
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
| | - Kevan Akrami
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- University of California, San Diego, Division of Infectious Disease, Department of Medi- cine, San Diego, California, United States of America
| | | | - Cibele Orge
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
| | - Paula Casais
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
| | - Lais Cambui
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
| | | | | | | | | | | | - Bruno B. Andrade
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
| | - Rivaldo Venâncio da Cunha
- Faculdade de Medicina, Universidade do Mato Grosso do Sul, Campo Grande- MS, Brazil
- Fiocruz, Campo Grande, MS, Brazil
| | - Marco Aurélio Krieger
- Instituto de Biologia Molecular do Paraná, Curitiba, PR, Brasil
- Instituto Carlos Chagas—ICC/Fiocruz, Curitiba-PR, Brazil
| | - Manoel Barral-Netto
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
- Instituto Nacional de Ciência e Tecnologia de Investigação em Imunologia, São Paulo- SP, Brazil
| | - Aldina Barral
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
- Instituto Nacional de Ciência e Tecnologia de Investigação em Imunologia, São Paulo- SP, Brazil
| | - Ricardo Khouri
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
- Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Viviane Sampaio Boaventura
- Instituto Gonçalo Moniz (IGM)—Fundação Oswaldo Cruz (Fiocruz) Bahia
- Faculdade de Medicina da Bahia—Universidade Federal da Bahia, Salvador-BA, Brazil
- Serviço de Otorrinolaringologia do Hospital Santa Izabel/Santa Casa de Misericórdia da Bahia (HIS/SCMBa), Salvador, Brazil
- * E-mail:
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Mulderij-Jansen V, Elsinga J, Gerstenbluth I, Duits A, Tami A, Bailey A. Understanding risk communication for prevention and control of vector-borne diseases: A mixed-method study in Curaçao. PLoS Negl Trop Dis 2020; 14:e0008136. [PMID: 32282848 PMCID: PMC7153856 DOI: 10.1371/journal.pntd.0008136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 02/11/2020] [Indexed: 11/30/2022] Open
Abstract
Background Risk communication (RC) is an essential tool for the prevention and control of diseases as it impacts risk perception, increases awareness and might change behaviour. It is the interactive exchange of information about risks among experts and people. Effective RC can minimize the impact that diseases such as dengue, chikungunya and Zika have on populations. This study aimed to understand RC regarding vector-borne diseases in its social context and from the viewpoint of the audience to strengthen RC strategies in Curaçao. Methods In 2015, a cross-sectional mixed-method study applying focus group discussions (n = 7), in-depth interviews (n = 20) and a structured survey questionnaire (n = 339) was done in Curaçao. The study was designed based on the Health Belief Model and the Theory of Planned Behaviour. In addition, the Social Amplification of Risk Framework and the theory of cultural schemas were applied to understand RC in the social context. Results Television, radio and newspapers were the most important channels of information regarding dengue and chikungunya. Moreover, individuals also reported receiving information via social media, the internet and family/friends. Interestingly, the use of internet to obtain information diminished with age, while females were more likely to use internet compared to men. These key findings were statistically significant. An important outcome was that the risk perception towards chikungunya at the beginning of the outbreak was attenuated. This might be due to the (perceived) lack of RC before the epidemic. This same risk perception was amplified later during the outbreak by the increased exposure to information. Lastly, we show how cultural schemas influence people’s perception regarding preventive measures and treatment of chikungunya and dengue. Conclusions Data obtained emphasise the importance of understanding the user of media platforms and sharing information in a timely fashion through a transparent process with the content that convinces people of the seriousness of the matter. Vector-borne diseases (VBDs) such as dengue, chikungunya and Zika are an increasing public health concern worldwide. The mentioned VBDs are transmitted to humans through the bite of an infected mosquito from the Aedes species. Preventing or reducing VBDs continues to depend mainly on vector control and interrupting human-vector contact. Risk communication (RC) is the interactive exchange of information about hazards among experts and individuals. As it influences individuals’ behaviour, a better understanding of how it works is vital to improving RC strategies in the context of VBD prevention and control strategies. Our study highlighted the complexity of this matter as we found that there are multiple factors, including the volume of information, trust, experience with a similar disease and cultural schemas that determine how people cope with risk and information. We recommend broadening the use and scope of media platforms to share information and to customise the messages taking the cultural schemas of the community into account.
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Affiliation(s)
- Vaitiare Mulderij-Jansen
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, The Netherlands
- International Development Studies, Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
- Curaçao Biomedical & Health Research Institute, Department of Epidemiology, Willemstad, Curaçao
- * E-mail:
| | - Jelte Elsinga
- International Development Studies, Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
| | - Izzy Gerstenbluth
- Curaçao Biomedical & Health Research Institute, Department of Epidemiology, Willemstad, Curaçao
- Epidemiology and Research Unit, Ministry of Health Environment and Nature of Curaçao, Willemstad, Curaçao
| | - Ashley Duits
- Red Cross Blood Bank Foundation, Willemstad, Curaҫao
- Curaçao Biomedical & Health Research Institute, Department of Immunology, Willemstad, Curaçao
| | - Adriana Tami
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, The Netherlands
| | - Ajay Bailey
- International Development Studies, Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
- Transdisciplinary Centre for Qualitative Methods, Manipal Academy of Higher Education, Manipal, India
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Stiffness, pain, and joint counts in chronic chikungunya disease: relevance to disability and quality of life. Clin Rheumatol 2020; 39:1679-1686. [PMID: 31916107 DOI: 10.1007/s10067-019-04919-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/20/2019] [Accepted: 12/27/2019] [Indexed: 01/05/2023]
Abstract
INTRODUCTION/OBJECTIVES To characterize the importance of musculoskeletal stiffness in a cohort of chikungunya patients with chronic joint symptoms. METHOD Eighty-two patients were followed up 3 years after chikungunya infection. Tender and swollen joint counts, a pain intensity scale, Health Assessment Questionnaire-Disability Index (HAQ-DI), and the EuroQol EQ-5D quality of life instrument were completed. A musculoskeletal stiffness questionnaire provided scores for overall stiffness and its components: stiffness severity, physical impact, and psychosocial impact. RESULTS Patients had a mean age 51 ± 14 years. Sixty-seven patients were still experiencing chronic arthralgia. Musculoskeletal stiffness was reported by 43/67 patients with arthralgia and 3/15 patients without arthralgia. A physical impact of stiffness was reported by 87% patients and psychosocial impact by 71% patients. Mean tender joint count in patients reporting arthralgia was 6 ± 7, mean pain intensity 65 ± 20 out of 100, mean HAQ-DI was 0.54 ± 0.52, and mean EQ-VAS global health perception was 68 ± 62 out of 100. Stiffness severity was correlated with tender joint counts (ρ = 0.46) and pain intensity (ρ = 0.40). All three measures were equally well correlated with the EuroQol-VAS global health perception. Pain and tender joints were better correlated with the HAQ-DI (ρ = 0.68 and ρ = 0.63), but stiffness was more strongly correlated with several quality of life domains, including mobility. Swollen joints were a poor predictor of outcomes. CONCLUSIONS Musculoskeletal stiffness following chikungunya infection is distinct from arthralgia. It does not always occur in the same patients or with a corresponding intensity. Joint pain and stiffness may be independently associated with disability and quality of life assessments.
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James PB, Wardle J, Steel A, Adams J. Post-Ebola psychosocial experiences and coping mechanisms among Ebola survivors: a systematic review. Trop Med Int Health 2019; 24:671-691. [PMID: 30843627 DOI: 10.1111/tmi.13226] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE A myriad of physical and psychosocial sequelae have been reported among Ebola survivors from previous Ebola virus disease (EVD) outbreaks, including the most recent in West Africa. This review examines the various forms of psychological distress experienced by EVD survivors, family and community reactions to EVD survivors and EVD survivors' coping mechanisms. METHODS We conducted a literature search of original articles employing Medline (Ovid), PubMed, Web of Science, Scopus, CINAHL, EBSCO host academic search complete, PsycINFO (EBSCO) and Embase databases. RESULTS Our search identified 1890 articles of which 24 met our inclusion criteria. Various forms of psychological distress were prevalent among EVD survivors including depression, anxiety, anger, grief, guilt, flashbacks, sadness, worthlessness, substance addiction, suicidal tendencies and self-stigmatisation. Family and community responses to EVD survivors ranged from acceptance to rejection, isolation, stigmatisation and discrimination. EVD survivors' coping strategies included engagement with religious faith, EVD survivors associations and involvement in EVD prevention and control interventions. CONCLUSION Psychological distress, including that resulting from family and community stigma and discrimination, appears common among EVD survivors. Community-based mental health and psychosocial interventions integrated within a broader package of care for EVD survivors that also recognises the physical health challenges are required. Well-designed longitudinal studies can provide clear insights on the nature and trajectory of the psychosocial issues currently experienced by EVD survivors.
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Affiliation(s)
- P B James
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - J Wardle
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - A Steel
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - J Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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van Enter BJD, Huibers MHW, van Rooij L, Steingrover R, van Hensbroek MB, Voigt RR, Hol J. Perinatal Outcomes in Vertically Infected Neonates During a Chikungunya Outbreak on the Island of Curaçao. Am J Trop Med Hyg 2018; 99:1415-1418. [PMID: 30328407 PMCID: PMC6283481 DOI: 10.4269/ajtmh.17-0957] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 08/16/2018] [Indexed: 12/28/2022] Open
Abstract
Recent outbreaks of Chikungunya virus (CHIKV) infection confirm the vulnerability of neonates after vertical transmission. In 2014, CHIKV was reported for the first time in the Americas, including the island of Curaçao. We describe the outcomes of symptomatic neonates with vertically transmitted CHIKV infection during the CHIKV epidemic, who were admitted in the Saint Elisabeth Hospital, Willemstad, Curaçao. There were three symptomatic neonates with serologically confirmed infection. Two neonates developed neurological complications, including convulsions and intracerebral bleeding. One newborn, in whom maternal infection occurred 7 weeks before delivery, had a fatal outcome after birth. Maternal-fetal transmission of CHIKV may cause severe neonatal complications. There is a need to share experiences and to implement protocols toward the management of perinatal CHIKV infection.
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Affiliation(s)
- Bert J. D. van Enter
- Department of Obstetrics and Gynecology, Saint Elisabeth Hospital, Willemstad, Curaçao
| | - Minke H. W. Huibers
- Department of Pediatrics, Saint Elisabeth Hospital, Willemstad, Curaçao
- Global Child Health Group, Emma Children’s Hospital, Amsterdam Medical Centre (AMC), Amsterdam, The Netherlands
| | - Linda van Rooij
- Department of Pediatrics, Saint Elisabeth Hospital, Willemstad, Curaçao
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Radjinkoemar Steingrover
- Department of Clinical Microbiology and Infection Prevention, Saint Elisabeth Hospital, Willemstad, Curaçao
- Analytic Diagnostic Center, Willemstad, Curaçao
| | - Michael Boele van Hensbroek
- Global Child Health Group, Emma Children’s Hospital, Amsterdam Medical Centre (AMC), Amsterdam, The Netherlands
| | - Ralph R. Voigt
- Department of Obstetrics and Gynecology, Saint Elisabeth Hospital, Willemstad, Curaçao
| | - Jeroen Hol
- Department of Pediatrics, Saint Elisabeth Hospital, Willemstad, Curaçao
- Department of Pediatrics, Noordwest Ziekenhuis, Alkmaar, The Netherlands
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Hossain MS, Hasan MM, Islam MS, Islam S, Mozaffor M, Khan MAS, Ahmed N, Akhtar W, Chowdhury S, Arafat SMY, Khaleque MA, Khan ZJ, Dipta TF, Asna SMZH, Hossain MA, Aziz KMS, Mosabbir AA, Raheem E. Chikungunya outbreak (2017) in Bangladesh: Clinical profile, economic impact and quality of life during the acute phase of the disease. PLoS Negl Trop Dis 2018; 12:e0006561. [PMID: 29874242 PMCID: PMC6025877 DOI: 10.1371/journal.pntd.0006561] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 06/29/2018] [Accepted: 05/24/2018] [Indexed: 11/30/2022] Open
Abstract
Background Chikungunya virus causes mosquito-transmitted infection that leads to extensive morbidity affecting substantial quality of life. Disease associated morbidity, quality of life, and financial loss are seldom reported in resources limited countries, such as Bangladesh. We reported the acute clinical profile, quality of life and consequent economic burden of the affected individuals in the recent chikungunya outbreak (May to September 2017) in Dhaka city, Bangladesh. Methods We conducted a cross-sectional study during the peak of chikungunya outbreak (July 24 to August 5, 2017) to document the clinical profiles of confirmed cases (laboratory test positive) and probable cases diagnosed by medical practitioners. Data related to clinical symptoms, treatment cost, loss of productivity due to missing work days, and quality of life during their first two-weeks of symptom onset were collected via face to face interview using a structured questionnaire. World Health Organization endorsed questionnaire was used to assess the quality of life. Results A total of 1,326 chikungunya cases were investigated. Multivariate analysis of major clinical variables showed no statistically significant differences between confirmed and probable cases. All the patients reported joint pain and fever. Other more frequently reported symptoms include headache, loss of appetite, rash, myalgia, and itching. Arthralgia was polyarticular in 56.3% of the patients. Notably, more than 70% patients reported joint pain as the first presenting symptom. About 83% of the patients reported low to very low overall quality of life. Nearly 30% of the patients lost more than 10 days of productivity due to severe arthropathy. Conclusions This study represents one of the largest samples studied so far around the world describing the clinical profile of chikungunya infection. Our findings would contribute to establish an effective syndromic surveillance system for early detection and timely public health intervention of future chikungunya outbreaks in resource-limited settings like Bangladesh. A major outbreak of chikungunya virus occurred for the first time in Dhaka, Bangladesh between May and September 2017. In this study, a face-to-face interview with a structured questionnaire was conducted to collect data to investigate the clinical symptoms, quality of life, and economic aspects of 1,326 chikungunya patients during the first two weeks of infection. The severity of the disease was similar to previously reported severe outbreaks elsewhere but joint pain prior to fever emerged as a unique symptom in the Dhaka outbreak. This unique clinical feature was consistent across age and sex of the patients. Some clinical symptoms varied with age. For instance, a higher proportion of skin rash were found among children (under 15) while morning stiffness, severity, and duration of pain were proportionally higher among other age groups. Joint swelling was most commonly noted in elderly patients (60+ years). About 83% of the patients reported low to very low overall quality of life (QoL) during first two weeks of chikungunya infection. Elderly patients reported lower average QoL scores compared to <60 years. Interestingly, housewives reported higher QoL score compared to those of businessmen and service holders. In particular, patients in the highest monthly income category bracket (BDT 50,000 per month; >$606 per month) reported the lowest average overall score. Nearly 95% of the patients have mostly confined to sickbed and approximately 30% of them lost more than 10 days of productivity due to severe arthropathy. Our study would contribute to establishing an effective syndromic surveillance system for early detection and timely public health intervention of future chikungunya outbreaks in resource-limited countries like Bangladesh.
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Affiliation(s)
- Mohammad Sorowar Hossain
- Biomedical Research Foundation, Dhaka, Bangladesh
- School of Environmental Science and Management, Independent University, Dhaka, Bangladesh
- Bangladesh University of Health Sciences, Dhaka, Bangladesh
- * E-mail:
| | - Md. Mahbub Hasan
- Biomedical Research Foundation, Dhaka, Bangladesh
- Department of Genetic Engineering and Biotechnology, University of Chittagong, Chittagong, Bangladesh
| | | | - Salequl Islam
- Biomedical Research Foundation, Dhaka, Bangladesh
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Miliva Mozaffor
- Biomedical Research Foundation, Dhaka, Bangladesh
- Uttara Women Medical College, Dhaka, Bangladesh
| | - Md. Abdullah Saeed Khan
- Biomedical Research Foundation, Dhaka, Bangladesh
- Department of Medicine, Rajshahi Medical College Hospital, Rajshahi, Bangladesh
| | - Nova Ahmed
- Biomedical Research Foundation, Dhaka, Bangladesh
| | - Waheed Akhtar
- Biomedical Research Foundation, Dhaka, Bangladesh
- National Institute of Cancer Research and Hospital, Dhaka, Bangladesh
| | | | - S. M. Yasir Arafat
- Biomedical Research Foundation, Dhaka, Bangladesh
- Department of Psychiatry, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md. Abdul Khaleque
- School of Environmental Science and Management, Independent University, Dhaka, Bangladesh
| | - Zohora Jameela Khan
- Biomedical Research Foundation, Dhaka, Bangladesh
- Dhaka Medical College and Hospital, Dhaka, Bangladesh
| | - Tashmim Farhana Dipta
- Biomedical Research Foundation, Dhaka, Bangladesh
- Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | | | - Md. Akram Hossain
- Department of Microbiology, National Institute of Preventive & Social Medicine, Dhaka, Bangladesh
| | | | - Abdullah Al Mosabbir
- Biomedical Research Foundation, Dhaka, Bangladesh
- Sir Salimullah Medical College Mitford Hospital, Dhaka, Bangladesh
| | - Enayetur Raheem
- Biomedical Research Foundation, Dhaka, Bangladesh
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
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Elsinga J, Halabi Y, Gerstenbluth I, Tami A, Grobusch MP. Consequences of a recent past dengue infection for acute and long-term chikungunya outcome: A retrospective cohort study in Curaçao. Travel Med Infect Dis 2018; 23:34-43. [PMID: 29614385 DOI: 10.1016/j.tmaid.2018.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/12/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Dengue and chikungunya co-infections are an emerging threat to public health in tropical and sub-tropical areas. This study investigates acute and long-term clinical presentation patterns of chikungunya against a backdrop of preceding dengue infection and determines predicting factors for long-term chikungunya sequelae. METHODS A retrospective cohort study was performed in 2015, including 299 previously confirmed chikungunya cases, of which 162 subjects were assessed for dengue serology at disease onset. RESULTS Those with previous dengue infection (35.2% of the examined population) had a similar acute disease presentation, and suffered (not statistically significantly) more frequently from long-term musculoskeletal and neuropsychological symptoms compared to chikungunya-only patients. Patients with a preceding dengue infection (vs. those without) (OR = 4.17; p = 0.004), female sex (OR = 3.17; p = 0.034) and pre-existing joint disease (OR = 2.95; p = 0.031) had a higher risk of developing aggravated long-term chikungunya. Chronic disease (sequelae lasting >90 days) was predicted by an age between 41 and 60 (OR = 3.07; p = 0.009) and concomitant cardiovascular disease (OR = 4.08; p = 0.010), but not by a preceding dengue infection. CONCLUSIONS This study suggests several predicting factors of, and a possible link between preceding dengue and chikungunya infection and aggravated long-term sequelae, which should be interpreted in the light of the limitations of this study.
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Affiliation(s)
- Jelte Elsinga
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Yaskara Halabi
- Medical and Health Service Curaçao, Department of Epidemiology and Research, Curaçao.
| | - Izzy Gerstenbluth
- Medical and Health Service Curaçao, Department of Epidemiology and Research, Curaçao; Curaçao Biomedical & Health Research Institute, Curaçao.
| | - Adriana Tami
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, The Netherlands.
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25
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Prow NA, Tang B, Gardner J, Le TT, Taylor A, Poo YS, Nakayama E, Hirata TDC, Nakaya HI, Slonchak A, Mukhopadhyay P, Mahalingam S, Schroder WA, Klimstra W, Suhrbier A. Lower temperatures reduce type I interferon activity and promote alphaviral arthritis. PLoS Pathog 2017; 13:e1006788. [PMID: 29281739 PMCID: PMC5770078 DOI: 10.1371/journal.ppat.1006788] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/16/2018] [Accepted: 12/04/2017] [Indexed: 12/28/2022] Open
Abstract
Chikungunya virus (CHIKV) belongs to a group of mosquito-borne alphaviruses associated with acute and chronic arthropathy, with peripheral and limb joints most commonly affected. Using a mouse model of CHIKV infection and arthritic disease, we show that CHIKV replication and the ensuing foot arthropathy were dramatically reduced when mice were housed at 30°C, rather than the conventional 22°C. The effect was not associated with a detectable fever, but was dependent on type I interferon responses. Bioinformatics analyses of RNA-Seq data after injection of poly(I:C)/jetPEI suggested the unfolded protein response and certain type I interferon responses are promoted when feet are slightly warmer. The ambient temperature thus appears able profoundly to effect anti-viral activity in the periphery, with clear consequences for alphaviral replication and the ensuing arthropathy. These observations may provide an explanation for why alphaviral arthropathies are largely restricted to joints of the limbs and the extremities.
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Affiliation(s)
- Natalie A. Prow
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Australian Infectious Disease Research Centre, Brisbane, Queensland, Australia
| | - Bing Tang
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Joy Gardner
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Thuy T. Le
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Adam Taylor
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Yee S. Poo
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Eri Nakayama
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Thiago D. C. Hirata
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Helder I. Nakaya
- School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Andrii Slonchak
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, Queensland, Australia
| | | | - Suresh Mahalingam
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Wayne A. Schroder
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - William Klimstra
- Department of Microbiology and Molecular Genetics Center for Vaccine Research University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Andreas Suhrbier
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Australian Infectious Disease Research Centre, Brisbane, Queensland, Australia
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