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Manuel E, Armando A, Francisco M, Paixão J, Aramburu J, de Oliveira MDS, Freitas H, Pedro AM, Jandondo D, Carderon PB, Lamezon SL, Fortes F, Mariscal J, Cardoso Y, Moreira R, Morais J, Francisco NM. Assessment of the yellow fever outbreak in Angola from December 2015 through December 2016: A retrospective study. Health Sci Rep 2024; 7:e1924. [PMID: 38444843 PMCID: PMC10913757 DOI: 10.1002/hsr2.1924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 01/15/2024] [Accepted: 01/31/2024] [Indexed: 03/07/2024] Open
Abstract
Background and Aims The acute tropical infectious disease known as yellow fever (YF) is caused by an arbovirus and is characterized by fever, jaundice, hemorrhage, headache, muscle pain, nausea, vomiting, and fatigue. Angola experienced a yellow fever virus (YFV) outbreak that was documented in December 2015. However, little is known about the outcome of this outbreak. We aimed to demonstrate epidemic features and lessons learned during the YF epidemic in Angola. Methods A total of 4618 blood samples from suspected YF cases were sent to the Instituto Nacional de Investigação em Saúde (INIS), a national referral and public health laboratory, between December 5, 2015, and December 23, 2016. Sample analyses were conducted using enzyme-linked immunosorbent assay (ELISA) and reverse transcription polymerase chain reaction (RT-PCR) assays. Blood samples were sent from 16 out of the 18 provinces of Angola. Results We detected 884 (19.1%) cases that were positive for ELISA, which were confirmed by RT-PCR assay. Considering the positive cases, the incidence among male patients was around three times higher (n = 223; 10.9%) than in female patients (n = 59; 2.6%) in the 20-29 age group, followed by the age group 10-19 with n = 211 (6.8%) in males versus n = 108 (3.3%) in females; and the age group 30-39 had n = 68 (4.8%) in males versus n = 28 (1.8%) in females. The other groups had an incidence below 3.0%. The case fatality ratio for YF was in young adults in the age group 20-29 with n = 39 cases, followed by the age group 10-19 with n = 16 cases, and finally the age group 0-9 with n = 13 cases. The other age groups had several deaths by YF below 10 cases. Conclusions This study demonstrates features of the YF epidemic that occurred in Angola. Also, it demonstrates that YF causes deaths in young people but is preventable by high vaccine coverage. Thus, public health laboratory surveillance must be strengthened to reduce the possibility of emerging and re-emerging human infections.
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Affiliation(s)
- Eusebio Manuel
- Faculdade de MedicinaUniversidade Agostinho NetoLuandaAngola
- Direcção Nacional de Saúde PúblicaMinistério da SaúdeLuandaAngola
| | - António Armando
- Direcção Nacional de Saúde PúblicaMinistério da SaúdeLuandaAngola
| | - Moisés Francisco
- Grupo de Investigação Microbiana e ImunológicaInstituto Nacional de Investigação em Saúde (National Institute for Health Research)LuandaAngola
| | - Joana Paixão
- Grupo de Investigação Microbiana e ImunológicaInstituto Nacional de Investigação em Saúde (National Institute for Health Research)LuandaAngola
| | | | | | - Helga Freitas
- Direcção Nacional de Saúde PúblicaMinistério da SaúdeLuandaAngola
| | | | - Domingos Jandondo
- Grupo de Investigação Microbiana e ImunológicaInstituto Nacional de Investigação em Saúde (National Institute for Health Research)LuandaAngola
| | | | | | - Filomeno Fortes
- Instituto de Higiene e Medicina TropicalUniversidade Nova de LisboaLisboaPortugal
| | - Jorge Mariscal
- Direcção Nacional de Saúde PúblicaMinistério da SaúdeLuandaAngola
| | - Yolanda Cardoso
- Faculdade de MedicinaUniversidade Agostinho NetoLuandaAngola
| | - Rosa Moreira
- Direcção Nacional de Saúde PúblicaMinistério da SaúdeLuandaAngola
| | - Joana Morais
- Faculdade de MedicinaUniversidade Agostinho NetoLuandaAngola
- Grupo de Investigação Microbiana e ImunológicaInstituto Nacional de Investigação em Saúde (National Institute for Health Research)LuandaAngola
| | - Ngiambudulu M. Francisco
- Grupo de Investigação Microbiana e ImunológicaInstituto Nacional de Investigação em Saúde (National Institute for Health Research)LuandaAngola
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Najimi N, Tajount L, Regragui Z, Remz C, Ait-Lhaj-Mhand R, Kadi C, Belayachi L, Seghrouchni F, Nadia dakka, El Hassani RA, Elharti E, Oumzil H, Bakri Y. Pre-pandemic antibodies screening against SARS-CoV-2 and virus detection among children diagnosed with eruptive fevers. Int J Immunopathol Pharmacol 2024; 38:3946320241260633. [PMID: 38836458 PMCID: PMC11155355 DOI: 10.1177/03946320241260633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/22/2024] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVES This study aims to assess the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG antibodies against the spike (S) and nucleocapsid (NP) proteins, as well as neutralizing antibodies against the receptor-binding domain (RBD). Additionally, it aims to detect viral RNA of SARS-CoV-2 in pre-pandemic archival pediatric specimens collected before the announcement of the COVID-19 pandemic spread on March 20th, 2020, in Morocco. The objective is to investigate the existence of pre-pandemic immunity to SARS-CoV-2. METHODS We conducted a cross-sectional study, to analyze IgG antibody levels in a cohort of 106 pre-pandemic pediatric participants. Using an indirect enzyme-linked immunosorbent assay (ELISA), we measured the IgG levels against the S and NP proteins of SARS-CoV-2. Additionally, we staged a competitive ELISA assay to evaluate the neutralizing capability of these antibodies. We used reverse transcription polymerase chain reaction (rRT-PCR) to detect viral NP and ORF1ab genes of SARS-CoV-2 in oropharyngeal swabs. Moreover, we conducted on the same specimens a multiplexed RT-PCR to detect RNA of the most common 27 pathogens involved in lower respiratory tract infections. RESULTS Among the 106 serum samples, 13% (nn = =14) tested positive for SARS-CoV-2 IgG antibodies using ELISA. Temporal analysis indicated varying IgG positivity levels across 2019. Neutralizing antibodies were found in 21% of the 28 samples analyzed, including two with high inhibition rates (93%). The SARS-CoV-2 RNA was detected using rRT-PCR in 14 samples. None of the samples tested positive for the other 27 pathogens associated with lower respiratory tract infections, using multiplexed RT-PCR. CONCLUSION Our study addresses the possibility, that COVID-19 infections occurred in Morocco before the recognized outbreak. On the other hand, some of the cases might reflect cross-reactivity with other coronaviruses or be influenced by previous viral exposures or vaccinations. Understanding these factors is crucial to comprehending pediatric immune responses to newly emerging infectious diseases.
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Affiliation(s)
- Nouhaila Najimi
- Laboratory of Human Pathologies Biology, Faculty of Sciences, Mohammed V University in Rabat, Rabat, Morocco
- Mohammed VI Center for Research & Innovation, Rabat, Morocco and Mohammed VI University of Sciences and Health, Casablanca, Morocco
| | - Latifa Tajount
- Laboratory of Spectroscopy, Molecular Modeling, Materials, Nanomaterials, Water and Environment, Materials for Environment Team, ENSAM, Mohammed V University in Rabat, Rabat, Morocco
| | - Zakia Regragui
- Virology Department, Institut National d’Hygiène, Rabat, Morocco
| | - Chaimae Remz
- Virology Department, Institut National d’Hygiène, Rabat, Morocco
| | | | - Chaimae Kadi
- Mohammed VI Center for Research & Innovation, Rabat, Morocco and Mohammed VI University of Sciences and Health, Casablanca, Morocco
- Laboratory of Biology and Health, Faculty of Sciences of Tetouan, Abdelmalek Essaadi University, Tetouan, Morocco
| | - Lamiae Belayachi
- International University of Rabat (UIR), Faculty of Medicine, Centre de Recherche en Sciences de la Santé (CreSS), Faculty of Medecine, Health Sciences Research Centre (CReSS), International University of Rabat (UIR), Rabat, Morocco
| | - Fouad Seghrouchni
- Mohammed VI Center for Research & Innovation, Rabat, Morocco and Mohammed VI University of Sciences and Health, Casablanca, Morocco
| | - Nadia dakka
- Laboratory of Human Pathologies Biology, Faculty of Sciences, Mohammed V University in Rabat, Rabat, Morocco
- Center of Genomic of Human Pathologies Biology Faculty of Medicine, Mohammed V University in Rabat, Rabat, Morocco
| | - Rabii Ameziane El Hassani
- Laboratory of Human Pathologies Biology, Faculty of Sciences, Mohammed V University in Rabat, Rabat, Morocco
- Center of Genomic of Human Pathologies Biology Faculty of Medicine, Mohammed V University in Rabat, Rabat, Morocco
| | - Elmir Elharti
- Virology Department, Institut National d’Hygiène, Rabat, Morocco
| | - Hicham Oumzil
- Center of Genomic of Human Pathologies Biology Faculty of Medicine, Mohammed V University in Rabat, Rabat, Morocco
- Medical Biotechnology Laboratory, Faculty of Medicine at Mohammed V University in Rabat, Rabat, Morocco
| | - Youssef Bakri
- Laboratory of Human Pathologies Biology, Faculty of Sciences, Mohammed V University in Rabat, Rabat, Morocco
- Center of Genomic of Human Pathologies Biology Faculty of Medicine, Mohammed V University in Rabat, Rabat, Morocco
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Francisco NM, van Wyk S, Moir M, San JE, Sebastião CS, Tegally H, Xavier J, Maharaj A, Neto Z, Afonso P, Jandondo D, Paixão J, Miranda J, David K, Inglês L, Pereira A, Paulo A, Carralero RR, Freitas HR, Mufinda F, Lutucuta S, Ghafari M, Giovanetti M, Giandhari J, Pillay S, Naidoo Y, Singh L, Tshiabuila D, Martin DP, Chabuka L, Choga W, Wanjohi D, Mwangi S, Pillay Y, Kebede Y, Shumba E, Ondoa P, Baxter C, Wilkinson E, Tessema SK, Katzourakis A, Lessells R, de Oliveira T, Morais J. Insights into SARS-CoV-2 in Angola during the COVID-19 peak: Molecular epidemiology and genome surveillance. Influenza Other Respir Viruses 2023; 17:e13198. [PMID: 37744993 PMCID: PMC10515134 DOI: 10.1111/irv.13198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 09/26/2023] Open
Abstract
Background In Angola, COVID-19 cases have been reported in all provinces, resulting in >105,000 cases and >1900 deaths. However, no detailed genomic surveillance into the introduction and spread of the SARS-CoV-2 virus has been conducted in Angola. We aimed to investigate the emergence and epidemic progression during the peak of the COVID-19 pandemic in Angola. Methods We generated 1210 whole-genome SARS-CoV-2 sequences, contributing West African data to the global context, that were phylogenetically compared against global strains. Virus movement events were inferred using ancestral state reconstruction. Results The epidemic in Angola was marked by four distinct waves of infection, dominated by 12 virus lineages, including VOCs, VOIs, and the VUM C.16, which was unique to South-Western Africa and circulated for an extended period within the region. Virus exchanges occurred between Angola and its neighboring countries, and strong links with Brazil and Portugal reflected the historical and cultural ties shared between these countries. The first case likely originated from southern Africa. Conclusion A lack of a robust genome surveillance network and strong dependence on out-of-country sequencing limit real-time data generation to achieve timely disease outbreak responses, which remains of the utmost importance to mitigate future disease outbreaks in Angola.
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Affiliation(s)
- Ngiambudulu M. Francisco
- Grupo de Investigação Microbiana e ImunológicaInstituto Nacional de Investigação em SaúdeLuandaAngola
| | - Stephanie van Wyk
- Center for Epidemic Response and Innovation (CERI), School of Data Science and Computational ThinkingStellenbosch UniversityStellenboschSouth Africa
| | - Monika Moir
- Center for Epidemic Response and Innovation (CERI), School of Data Science and Computational ThinkingStellenbosch UniversityStellenboschSouth Africa
| | - James Emmanuel San
- Center for Epidemic Response and Innovation (CERI), School of Data Science and Computational ThinkingStellenbosch UniversityStellenboschSouth Africa
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of MedicineUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Cruz S. Sebastião
- Grupo de Investigação Microbiana e ImunológicaInstituto Nacional de Investigação em SaúdeLuandaAngola
- Centro de Investigação em Saúde de Angola (CISA)CaxitoAngola
| | - Houriiyah Tegally
- Center for Epidemic Response and Innovation (CERI), School of Data Science and Computational ThinkingStellenbosch UniversityStellenboschSouth Africa
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of MedicineUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Joicymara Xavier
- Center for Epidemic Response and Innovation (CERI), School of Data Science and Computational ThinkingStellenbosch UniversityStellenboschSouth Africa
| | - Akhil Maharaj
- Center for Epidemic Response and Innovation (CERI), School of Data Science and Computational ThinkingStellenbosch UniversityStellenboschSouth Africa
| | | | - Pedro Afonso
- Grupo de Investigação Microbiana e ImunológicaInstituto Nacional de Investigação em SaúdeLuandaAngola
| | - Domingos Jandondo
- Grupo de Investigação Microbiana e ImunológicaInstituto Nacional de Investigação em SaúdeLuandaAngola
| | - Joana Paixão
- Grupo de Investigação Microbiana e ImunológicaInstituto Nacional de Investigação em SaúdeLuandaAngola
| | - Julio Miranda
- Grupo de Investigação Microbiana e ImunológicaInstituto Nacional de Investigação em SaúdeLuandaAngola
| | - Kumbelembe David
- Grupo de Investigação Microbiana e ImunológicaInstituto Nacional de Investigação em SaúdeLuandaAngola
| | - Luzia Inglês
- Grupo de Investigação Microbiana e ImunológicaInstituto Nacional de Investigação em SaúdeLuandaAngola
| | - Amilton Pereira
- Grupo de Investigação Microbiana e ImunológicaInstituto Nacional de Investigação em SaúdeLuandaAngola
| | - Agostinho Paulo
- Grupo de Investigação Microbiana e ImunológicaInstituto Nacional de Investigação em SaúdeLuandaAngola
| | - Raisa Rivas Carralero
- Grupo de Investigação Microbiana e ImunológicaInstituto Nacional de Investigação em SaúdeLuandaAngola
| | | | | | | | - Mahan Ghafari
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of MedicineUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Marta Giovanetti
- Reference Laboratory of FlavivirusOswaldo Cruz FoundationRio de JaneiroBrazil
| | - Jennifer Giandhari
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of MedicineUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Sureshnee Pillay
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of MedicineUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Yeshnee Naidoo
- Center for Epidemic Response and Innovation (CERI), School of Data Science and Computational ThinkingStellenbosch UniversityStellenboschSouth Africa
| | - Lavanya Singh
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of MedicineUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Derek Tshiabuila
- Center for Epidemic Response and Innovation (CERI), School of Data Science and Computational ThinkingStellenbosch UniversityStellenboschSouth Africa
| | - Darren Patrick Martin
- Division of Computational Biology, Department of Integrative Biomedical SciencesUniversity of Cape TownCape TownSouth Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape TownCape TownSouth Africa
| | - Lucious Chabuka
- Center for Epidemic Response and Innovation (CERI), School of Data Science and Computational ThinkingStellenbosch UniversityStellenboschSouth Africa
| | - Wonderful Choga
- Center for Epidemic Response and Innovation (CERI), School of Data Science and Computational ThinkingStellenbosch UniversityStellenboschSouth Africa
| | - Dorcas Wanjohi
- Africa CDC Institute of Pathogen GenomicsAfrica Centre for Disease Control and PreventionAddis AbabaEthiopia
| | - Sarah Mwangi
- Africa CDC Institute of Pathogen GenomicsAfrica Centre for Disease Control and PreventionAddis AbabaEthiopia
| | - Yusasha Pillay
- Center for Epidemic Response and Innovation (CERI), School of Data Science and Computational ThinkingStellenbosch UniversityStellenboschSouth Africa
| | - Yenew Kebede
- Africa CDC Institute of Pathogen GenomicsAfrica Centre for Disease Control and PreventionAddis AbabaEthiopia
| | - Edwin Shumba
- African Society for Laboratory MedicineAddis AbabaEthiopia
| | - Pascale Ondoa
- African Society for Laboratory MedicineAddis AbabaEthiopia
| | - Cheryl Baxter
- Center for Epidemic Response and Innovation (CERI), School of Data Science and Computational ThinkingStellenbosch UniversityStellenboschSouth Africa
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of MedicineUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Eduan Wilkinson
- Center for Epidemic Response and Innovation (CERI), School of Data Science and Computational ThinkingStellenbosch UniversityStellenboschSouth Africa
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of MedicineUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Sofonias Kifle Tessema
- Africa CDC Institute of Pathogen GenomicsAfrica Centre for Disease Control and PreventionAddis AbabaEthiopia
| | - Aris Katzourakis
- Department of BiologyOxford UniversityOxfordUK
- Big Data Institute, Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Richard Lessells
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of MedicineUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Tulio de Oliveira
- Center for Epidemic Response and Innovation (CERI), School of Data Science and Computational ThinkingStellenbosch UniversityStellenboschSouth Africa
- KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of MedicineUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Joana Morais
- Grupo de Investigação Microbiana e ImunológicaInstituto Nacional de Investigação em SaúdeLuandaAngola
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Amendola A, Canuti M, Bianchi S, Kumar S, Fappani C, Gori M, Colzani D, Kosakovsky Pond SL, Miura S, Baggieri M, Marchi A, Borghi E, Zuccotti G, Raviglione MC, Magurano F, Tanzi E. Molecular evidence for SARS-CoV-2 in samples collected from patients with morbilliform eruptions since late 2019 in Lombardy, northern Italy. ENVIRONMENTAL RESEARCH 2022; 215:113979. [PMID: 36029839 PMCID: PMC9404229 DOI: 10.1016/j.envres.2022.113979] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/07/2022] [Accepted: 07/21/2022] [Indexed: 05/12/2023]
Abstract
As a reference laboratory for measles and rubella surveillance in Lombardy, we evaluated the association between SARS-CoV-2 infection and measles-like syndromes, providing preliminary evidence for undetected early circulation of SARS-CoV-2. Overall, 435 samples from 156 cases were investigated. RNA from oropharyngeal swabs (N = 148) and urine (N = 141) was screened with four hemi-nested PCRs and molecular evidence for SARS-CoV-2 infection was found in 13 subjects. Two of the positive patients were from the pandemic period (2/12, 16.7%, March 2020-March 2021) and 11 were from the pre-pandemic period (11/44, 25%, August 2019-February 2020). Sera (N = 146) were tested for anti-SARS-CoV-2 IgG, IgM, and IgA antibodies. Five of the RNA-positive individuals also had detectable anti-SARS-CoV-2 antibodies. No strong evidence of infection was found in samples collected between August 2018 and July 2019 from 100 patients. The earliest sample with evidence of SARS-CoV-2 RNA was from September 12, 2019, and the positive patient was also positive for anti-SARS-CoV-2 antibodies (IgG and IgM). Mutations typical of B.1 strains previously reported to have emerged in January 2020 (C3037T, C14408T, and A23403G), were identified in samples collected as early as October 2019 in Lombardy. One of these mutations (C14408T) was also identified among sequences downloaded from public databases that were obtained by others from samples collected in Brazil in November 2019. We conclude that a SARS-CoV-2 progenitor capable of producing a measles-like syndrome may have emerged in late June-late July 2019 and that viruses with mutations characterizing B.1 strain may have been spreading globally before the first Wuhan outbreak. Our findings should be complemented by high-throughput sequencing to obtain additional sequence information. We highlight the importance of retrospective surveillance studies in understanding the early dynamics of COVID-19 spread and we encourage other groups to perform retrospective investigations to seek confirmatory proofs of early SARS-CoV-2 circulation.
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Affiliation(s)
- Antonella Amendola
- Department of Health Sciences, University of Milan, 20142, Milan, Italy; Coordinated Research Center "EpiSoMI", University of Milan, 20133, Milan, Italy.
| | - Marta Canuti
- Department of Health Sciences, University of Milan, 20142, Milan, Italy.
| | - Silvia Bianchi
- Department of Health Sciences, University of Milan, 20142, Milan, Italy; Coordinated Research Center "EpiSoMI", University of Milan, 20133, Milan, Italy.
| | - Sudhir Kumar
- Institute for Genomics and Evolutionary Medicine, Temple University, 19122, Philadelphia, USA; Department of Biology, Temple University, 19122, Philadelphia, USA; Center for Excellence in Genome Medicine and Research, King Abdulaziz University, 22252, Jeddah, Saudi Arabia.
| | - Clara Fappani
- Department of Health Sciences, University of Milan, 20142, Milan, Italy; Coordinated Research Center "EpiSoMI", University of Milan, 20133, Milan, Italy.
| | - Maria Gori
- Department of Health Sciences, University of Milan, 20142, Milan, Italy; Coordinated Research Center "EpiSoMI", University of Milan, 20133, Milan, Italy.
| | - Daniela Colzani
- Department of Health Sciences, University of Milan, 20142, Milan, Italy; Coordinated Research Center "EpiSoMI", University of Milan, 20133, Milan, Italy.
| | - Sergei L Kosakovsky Pond
- Institute for Genomics and Evolutionary Medicine, Temple University, 19122, Philadelphia, USA; Department of Biology, Temple University, 19122, Philadelphia, USA.
| | - Sayaka Miura
- Institute for Genomics and Evolutionary Medicine, Temple University, 19122, Philadelphia, USA; Department of Biology, Temple University, 19122, Philadelphia, USA.
| | - Melissa Baggieri
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161, Rome, Italy.
| | - Antonella Marchi
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161, Rome, Italy.
| | - Elisa Borghi
- Department of Health Sciences, University of Milan, 20142, Milan, Italy; Coordinated Research Center "EpiSoMI", University of Milan, 20133, Milan, Italy.
| | - Gianvincenzo Zuccotti
- Department of Paediatrics, Children Hospital V. Buzzi, University of Milan, 20154, Milan, Italy; Romeo and Enrica Invernizzi Pediatric Research Center, University of Milan, 20154, Milan, Italy.
| | - Mario C Raviglione
- Centre for Multidisciplinary Research in Health Science, University of Milan, 20122, Milan, Italy.
| | - Fabio Magurano
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161, Rome, Italy.
| | - Elisabetta Tanzi
- Department of Health Sciences, University of Milan, 20142, Milan, Italy; Coordinated Research Center "EpiSoMI", University of Milan, 20133, Milan, Italy.
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