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Zhang M, Kozlowski H, Chew R, Htun NSN, Morris SK, Akladious C, Sarker AR, Lubell Y, Peto TJ. The spectrum of health conditions in community-based cross-sectional surveys in Southeast Asia 2010-21: a scoping review. BMC Public Health 2024; 24:1853. [PMID: 38992660 PMCID: PMC11238468 DOI: 10.1186/s12889-024-19347-3] [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: 03/26/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Southeast Asia is undergoing an epidemiological transition with non-communicable illnesses becoming increasingly important, yet infectious diseases (tuberculosis, HIV, hepatitis B, malaria) remain widely prevalent in some populations, while emerging and zoonotic diseases threaten. There are also limited population-level estimates of many important heath conditions. This restricts evidence-based decision-making for disease control and prevention priorities. Cross-sectional surveys can be efficient epidemiological tools to measure the prevalence of a wide range of diseases, but no systematic assessment of their coverage of different health conditions has been produced for the region. METHODS We conducted a systematic search in Medline, Embase, Global Health, CINAHL, Scopus, Web of Science Core Collection, and Global Index Medicus, and additionally Google Scholar. Our inclusion criteria were cross-sectional surveys conducted with community-based recruitment, in Bangladesh, Cambodia, Laos, Myanmar, and Thailand, published between January 1, 2010 and January 27, 2021, and reporting the prevalence of any health condition. RESULTS 542 publications from 337 surveys were included. Non-communicable conditions (n = 205) were reported by more surveys than infectious conditions (n = 124). Disability (n = 49), self-report history of any disease or symptoms (n = 35), and self-perceived health status (n = 34), which reflect a holistic picture of health, were studied by many fewer surveys. In addition, 45 surveys studied symptomatic conditions which overlap between non-communicable and infectious conditions. The most surveyed conditions were undernutrition, obesity, hypertension, diabetes, intestinal parasites, malaria, anemia, diarrhea, fever, and acute respiratory infections. These conditions overlap with the most important causes of death and disability in the Global Burden of Disease study. However, other high-burden conditions (e.g. hearing loss, headache disorder, low back pain, chronic liver and kidney diseases, and cancers) were rarely studied. CONCLUSION There were relatively few recent surveys from which to estimate representative prevalences and trends of health conditions beyond those known to be high burden. Expanding the spectrum of health conditions in cross-sectional surveys could improve understanding of evolving disease patterns in the region.
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Affiliation(s)
- Meiwen Zhang
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Hannah Kozlowski
- University of Toronto Temerty Faculty of Medicine, Toronto, Canada
- Division of Infectious Diseases and Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Rusheng Chew
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Nan Shwe Nwe Htun
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Shaun K Morris
- Division of Infectious Diseases and Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Yoel Lubell
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Thomas J Peto
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Dighe A, Khan AI, Bhuiyan TR, Islam MT, Khan ZH, Khan II, Hulse JD, Ahmed S, Rashid M, Hossain MZ, Rashid R, Hegde ST, Gurley ES, Qadri F, Azman AS. Annual risk of hepatitis E virus infection and seroreversion: Insights from a serological cohort in Sitakunda, Bangladesh. Epidemiol Infect 2024; 152:e52. [PMID: 38497497 PMCID: PMC11022260 DOI: 10.1017/s0950268824000438] [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: 10/21/2023] [Revised: 02/01/2024] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
Hepatitis E virus (HEV) is a major cause of acute jaundice in South Asia. Gaps in our understanding of transmission are driven by non-specific symptoms and scarcity of diagnostics, impeding rational control strategies. In this context, serological data can provide important proxy measures of infection. We enrolled a population-representative serological cohort of 2,337 individuals in Sitakunda, Bangladesh. We estimated the annual risks of HEV infection and seroreversion both using serostatus changes between paired serum samples collected 9 months apart, and by fitting catalytic models to the age-stratified cross-sectional seroprevalence. At baseline, 15% (95 CI: 14-17%) of people were seropositive, with seroprevalence highest in the relatively urban south. During the study, 27 individuals seroreverted (annual seroreversion risk: 15%, 95 CI: 10-21%), and 38 seroconverted (annual infection risk: 3%, 95CI: 2-5%). Relying on cross-sectional seroprevalence data alone, and ignoring seroreversion, underestimated the annual infection risk five-fold (0.6%, 95 CrI: 0.5-0.6%). When we accounted for the observed seroreversion in a reversible catalytic model, infection risk was more consistent with measured seroincidence. Our results quantify HEV infection risk in Sitakunda and highlight the importance of accounting for seroreversion when estimating infection incidence from cross-sectional seroprevalence data.
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Affiliation(s)
- Amy Dighe
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | | | | | - Juan Dent Hulse
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shakeel Ahmed
- Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh
| | - Mamunur Rashid
- Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh
| | - Md Zakir Hossain
- Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh
| | - Rumana Rashid
- Bangladesh Institute of Tropical and Infectious Diseases, Chattogram, Bangladesh
| | - Sonia T. Hegde
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emily S. Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Firdausi Qadri
- Infectious Disease Division, icddr, b, Dhaka, Bangladesh
| | - Andrew S. Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
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3
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Chen D, Havelaar AH, Platts-Mills JA, Yang Y. Acquisition and clearance dynamics of Campylobacter spp. in children in low- and middle-income countries. Epidemics 2024; 46:100749. [PMID: 38367286 PMCID: PMC10944168 DOI: 10.1016/j.epidem.2024.100749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 11/08/2023] [Accepted: 02/06/2024] [Indexed: 02/19/2024] Open
Abstract
The prevalence of Campylobacter infection is generally high among children in low- and middle-income countries (LMIC), but the dynamics of its acquisition and clearance are understudied. We aim to quantify this process among children under two years old in eight LMIC using a statistical modeling approach, leveraging enzyme-immunoassay-based Campylobacter genus data and quantitative-PCR-based Campylobacter jejuni/coli data from the MAL-ED study. We developed a Markov model to compare the dynamics of acquisition and clearance of Campylobacter across countries and to explore the effect of antibiotic usage on Campylobacter clearance. Clearance rates were generally higher than acquisition rates, but their magnitude and temporal pattern varied across countries. For C. jejuni/coli, clearance was faster than acquisition throughout the two years at all sites. For Campylobacter spp., the acquisition rate either exceeded or stayed very close to the clearance rate after the first half year in Bangladesh, Pakistan and Tanzania, leading to high prevalence. Bangladesh had the shortest (28 and 57 days) while Brazil had the longest (328 and 306 days) mean times from last clearance to acquisition for Campylobacter spp. and C. jejuni/coli, respectively. South Africa had the shortest (10 and 8 days) while Tanzania had the longest (53 and 41 days) mean times to clearance for Campylobacter spp. and C. jejuni/col, respectively. The use of Macrolide accelerated clearance of C. jejuni/coli in Bangladesh and Peru and of Campylobacter spp. in Bangladesh and Pakistan. Fluoroquinolone showed statistically meaningful effects only in Bangladesh but for both Campylobacter groups. Higher prevalence of Campylobacter infection was mainly driven by a high acquisition rate that was close to or surpassing the clearance rate. Acquisition rate usually peaked in 11-17 months of age, indicating the importance of targeting the first year of life for effective interventions to reduce exposures.
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Affiliation(s)
- Dehao Chen
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA; Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Arie H Havelaar
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA; Department of Animal Sciences, Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL, USA; Global Food Systems Institute, University of Florida, Gainesville, FL, USA
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia Health System, Charlottesville, VA, USA
| | - Yang Yang
- Department of Statistics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, USA.
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Clutter CH, Klarman MB, Cajusma Y, Cato ET, Abu Sayeed M, Brinkley L, Jensen O, Baril C, De Rochars VMB, Azman AS, Long MT, Cummings D, Leung DT, Nelson EJ. Population-Based Serologic Survey of Vibrio cholerae Antibody Titers before Cholera Outbreak, Haiti, 2022. Emerg Infect Dis 2023; 29:1864-1867. [PMID: 37487168 PMCID: PMC10461687 DOI: 10.3201/eid2909.230174] [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] [Indexed: 07/26/2023] Open
Abstract
A Vibrio cholerae O1 outbreak emerged in Haiti in October 2022 after years of cholera absence. In samples from a 2021 serosurvey, we found lower circulating antibodies against V. cholerae lipopolysaccharide in children <5 years of age and no vibriocidal antibodies, suggesting high susceptibility to cholera, especially among young children.
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Affiliation(s)
| | | | - Youseline Cajusma
- University of Utah, Salt Lake City, Utah, USA (C.H. Clutter, O. Jensen, D.T. Leung)
- University of Florida, Gainesville, Florida, USA (M.B. Klarman, Y. Cajusma, E.T. Cato, M.A. Sayeed, L. Brinkley, V.M. Beau De Rochars, M.T. Long, D. Cummings, E.J. Nelson)
- Université d'État d'Haïti, Port au Prince, Haiti (C. Baril)
- Johns Hopkins University, Baltimore, Maryland, USA (A.S. Azman)
| | - Emilee T. Cato
- University of Utah, Salt Lake City, Utah, USA (C.H. Clutter, O. Jensen, D.T. Leung)
- University of Florida, Gainesville, Florida, USA (M.B. Klarman, Y. Cajusma, E.T. Cato, M.A. Sayeed, L. Brinkley, V.M. Beau De Rochars, M.T. Long, D. Cummings, E.J. Nelson)
- Université d'État d'Haïti, Port au Prince, Haiti (C. Baril)
- Johns Hopkins University, Baltimore, Maryland, USA (A.S. Azman)
| | - Md. Abu Sayeed
- University of Utah, Salt Lake City, Utah, USA (C.H. Clutter, O. Jensen, D.T. Leung)
- University of Florida, Gainesville, Florida, USA (M.B. Klarman, Y. Cajusma, E.T. Cato, M.A. Sayeed, L. Brinkley, V.M. Beau De Rochars, M.T. Long, D. Cummings, E.J. Nelson)
- Université d'État d'Haïti, Port au Prince, Haiti (C. Baril)
- Johns Hopkins University, Baltimore, Maryland, USA (A.S. Azman)
| | - Lindsey Brinkley
- University of Utah, Salt Lake City, Utah, USA (C.H. Clutter, O. Jensen, D.T. Leung)
- University of Florida, Gainesville, Florida, USA (M.B. Klarman, Y. Cajusma, E.T. Cato, M.A. Sayeed, L. Brinkley, V.M. Beau De Rochars, M.T. Long, D. Cummings, E.J. Nelson)
- Université d'État d'Haïti, Port au Prince, Haiti (C. Baril)
- Johns Hopkins University, Baltimore, Maryland, USA (A.S. Azman)
| | - Owen Jensen
- University of Utah, Salt Lake City, Utah, USA (C.H. Clutter, O. Jensen, D.T. Leung)
- University of Florida, Gainesville, Florida, USA (M.B. Klarman, Y. Cajusma, E.T. Cato, M.A. Sayeed, L. Brinkley, V.M. Beau De Rochars, M.T. Long, D. Cummings, E.J. Nelson)
- Université d'État d'Haïti, Port au Prince, Haiti (C. Baril)
- Johns Hopkins University, Baltimore, Maryland, USA (A.S. Azman)
| | - Chantale Baril
- University of Utah, Salt Lake City, Utah, USA (C.H. Clutter, O. Jensen, D.T. Leung)
- University of Florida, Gainesville, Florida, USA (M.B. Klarman, Y. Cajusma, E.T. Cato, M.A. Sayeed, L. Brinkley, V.M. Beau De Rochars, M.T. Long, D. Cummings, E.J. Nelson)
- Université d'État d'Haïti, Port au Prince, Haiti (C. Baril)
- Johns Hopkins University, Baltimore, Maryland, USA (A.S. Azman)
| | - V. Madsen Beau De Rochars
- University of Utah, Salt Lake City, Utah, USA (C.H. Clutter, O. Jensen, D.T. Leung)
- University of Florida, Gainesville, Florida, USA (M.B. Klarman, Y. Cajusma, E.T. Cato, M.A. Sayeed, L. Brinkley, V.M. Beau De Rochars, M.T. Long, D. Cummings, E.J. Nelson)
- Université d'État d'Haïti, Port au Prince, Haiti (C. Baril)
- Johns Hopkins University, Baltimore, Maryland, USA (A.S. Azman)
| | - Andrew S. Azman
- University of Utah, Salt Lake City, Utah, USA (C.H. Clutter, O. Jensen, D.T. Leung)
- University of Florida, Gainesville, Florida, USA (M.B. Klarman, Y. Cajusma, E.T. Cato, M.A. Sayeed, L. Brinkley, V.M. Beau De Rochars, M.T. Long, D. Cummings, E.J. Nelson)
- Université d'État d'Haïti, Port au Prince, Haiti (C. Baril)
- Johns Hopkins University, Baltimore, Maryland, USA (A.S. Azman)
| | - Maureen T. Long
- University of Utah, Salt Lake City, Utah, USA (C.H. Clutter, O. Jensen, D.T. Leung)
- University of Florida, Gainesville, Florida, USA (M.B. Klarman, Y. Cajusma, E.T. Cato, M.A. Sayeed, L. Brinkley, V.M. Beau De Rochars, M.T. Long, D. Cummings, E.J. Nelson)
- Université d'État d'Haïti, Port au Prince, Haiti (C. Baril)
- Johns Hopkins University, Baltimore, Maryland, USA (A.S. Azman)
| | - Derek Cummings
- University of Utah, Salt Lake City, Utah, USA (C.H. Clutter, O. Jensen, D.T. Leung)
- University of Florida, Gainesville, Florida, USA (M.B. Klarman, Y. Cajusma, E.T. Cato, M.A. Sayeed, L. Brinkley, V.M. Beau De Rochars, M.T. Long, D. Cummings, E.J. Nelson)
- Université d'État d'Haïti, Port au Prince, Haiti (C. Baril)
- Johns Hopkins University, Baltimore, Maryland, USA (A.S. Azman)
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5
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Kuhlmann FM, Grigura V, Vickers TJ, Prouty MG, Iannotti LL, Dulience SJL, Fleckenstein JM. Seroprevalence Study of Conserved Enterotoxigenic Escherichia coli Antigens in Globally Diverse Populations. Microorganisms 2023; 11:2221. [PMID: 37764065 PMCID: PMC10536235 DOI: 10.3390/microorganisms11092221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Enterotoxigenic Escherichia coli (ETEC) are common causes of infectious diarrhea among young children of low-and middle-income countries (LMICs) and travelers to these regions. Despite their significant contributions to the morbidity and mortality associated with childhood and traveler's diarrhea, no licensed vaccines are available. Current vaccine strategies may benefit from the inclusion of additional conserved antigens, which may contribute to broader coverage and enhanced efficacy, given their key roles in facilitating intestinal colonization and effective enterotoxin delivery. EatA and EtpA are widely conserved in diverse populations of ETEC, but their immunogenicity has only been studied in controlled human infection models and a population of children in Bangladesh. Here, we compared serologic responses to EatA, EtpA and heat-labile toxin in populations from endemic regions including Haitian children and subjects residing in Egypt, Cameroon, and Peru to US children and adults where ETEC infections are sporadic. We observed elevated IgG and IgA responses in individuals from endemic regions to each of the antigens studied. In a cohort of Haitian children, we observed increased immune responses following exposure to each of the profiled antigens. These findings reflect the wide distribution of ETEC infections across multiple endemic regions and support further evaluation of EatA and EtpA as candidate ETEC vaccine antigens.
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Affiliation(s)
- Frederick Matthew Kuhlmann
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in Saint Louis, Saint Louis, MO 63110, USA; (F.M.K.); (V.G.); (T.J.V.)
| | - Vadim Grigura
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in Saint Louis, Saint Louis, MO 63110, USA; (F.M.K.); (V.G.); (T.J.V.)
| | - Timothy J. Vickers
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in Saint Louis, Saint Louis, MO 63110, USA; (F.M.K.); (V.G.); (T.J.V.)
| | | | - Lora L. Iannotti
- Institute for Public Health, Brown School, Washington University in Saint Louis, Saint Louis, MO 63110, USA; (L.L.I.); (S.J.L.D.)
| | - Sherlie Jean Louis Dulience
- Institute for Public Health, Brown School, Washington University in Saint Louis, Saint Louis, MO 63110, USA; (L.L.I.); (S.J.L.D.)
| | - James M. Fleckenstein
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in Saint Louis, Saint Louis, MO 63110, USA; (F.M.K.); (V.G.); (T.J.V.)
- Medicine Service, Infectious Diseases, Saint Louis VA Health Care System, St. Louis, MO 63110, USA
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6
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Tedijanto C, Solomon AW, Martin DL, Nash SD, Keenan JD, Lietman TM, Lammie PJ, Aiemjoy K, Amza A, Aragie S, Arzika AM, Callahan EK, Carolan S, Dawed AA, Goodhew EB, Gwyn S, Hammou J, Kadri B, Kalua K, Maliki R, Nassirou B, Seife F, Tadesse Z, West SK, Wittberg DM, Zeru Tadege T, Arnold BF. Monitoring transmission intensity of trachoma with serology. Nat Commun 2023; 14:3269. [PMID: 37277341 PMCID: PMC10241377 DOI: 10.1038/s41467-023-38940-5] [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: 02/14/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023] Open
Abstract
Trachoma, caused by ocular Chlamydia trachomatis infection, is targeted for global elimination as a public health problem by 2030. To provide evidence for use of antibodies to monitor C. trachomatis transmission, we collated IgG responses to Pgp3 antigen, PCR positivity, and clinical observations from 19,811 children aged 1-9 years in 14 populations. We demonstrate that age-seroprevalence curves consistently shift along a gradient of transmission intensity: rising steeply in populations with high levels of infection and active trachoma and becoming flat in populations near elimination. Seroprevalence (range: 0-54%) and seroconversion rates (range: 0-15 per 100 person-years) correlate with PCR prevalence (r: 0.87, 95% CI: 0.57, 0.97). A seroprevalence threshold of 13.5% (seroconversion rate 2.75 per 100 person-years) identifies clusters with any PCR-identified infection at high sensitivity ( >90%) and moderate specificity (69-75%). Antibody responses in young children provide a robust, generalizable approach to monitor population progress toward and beyond trachoma elimination.
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Affiliation(s)
- Christine Tedijanto
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Anthony W Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Diana L Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | | | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, 94158, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, 94158, USA
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, 94158, USA
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, 94143, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Patrick J Lammie
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Atlanta, GA, 30030, USA
| | - Kristen Aiemjoy
- Division of Epidemiology, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
| | - Abdou Amza
- Programme National de Santé Oculaire, Niamey, Niger
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Solomon Aragie
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, 94158, USA
- The Carter Center Ethiopia, Addis Ababa, Ethiopia
- Infection Biology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Sydney Carolan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, 94158, USA
| | | | - E Brook Goodhew
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA
| | - Jaouad Hammou
- Service of Ocular and Otological Diseases, Epidemiology and Disease Control Directorate, Ministry of Health, Rabat, Morocco
| | - Boubacar Kadri
- Programme National de Santé Oculaire, Niamey, Niger
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Blantyre, Malawi
| | | | - Beido Nassirou
- Programme National de Santé Oculaire, Niamey, Niger
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Fikre Seife
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Sheila K West
- Johns Hopkins School of Medicine, Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Baltimore, MD, USA
| | - Dionna M Wittberg
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, 94158, USA
| | | | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, 94158, USA.
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, 94158, USA.
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7
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Tedijanto C, Solomon AW, Martin DL, Nash SD, Keenan JD, Lietman TM, Lammie PJ, Aiemjoy K, Amza A, Aragie S, Arzika AM, Callahan EK, Carolan S, Dawed AA, Goodhew EB, Gwyn S, Hammou J, Kadri B, Kalua K, Maliki R, Nassirou B, Seife F, Tadesse Z, West SK, Wittberg DM, Zeru T, Arnold BF. Monitoring transmission intensity of trachoma with serology. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.13.23285881. [PMID: 36824972 PMCID: PMC9949201 DOI: 10.1101/2023.02.13.23285881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Trachoma, caused by ocular Chlamydia trachomatis infection, is targeted for global elimination as a public health problem by 2030. To provide evidence for use of antibodies to monitor C. trachomatis transmission, we collated IgG responses to Pgp3 antigen, PCR positivity, and clinical observations from 19,811 children aged 1- 9 years in 14 populations. We demonstrate that age-seroprevalence curves consistently shift along a gradient of transmission intensity: rising steeply in populations with high levels of infection and active trachoma and becoming flat in populations near elimination. Seroprevalence (range: 0-54%) and seroconversion rates (range: 0-15 per 100 person-years) correlate with PCR prevalence (r: 0.87, 95% CI: 0.57, 0.97). A seroprevalence threshold of 13.5% (seroconversion rate 2.75 per 100 person-years) identifies clusters with any PCR-identified infection at high sensitivity (>90%) and moderate specificity (69-75%). Antibody responses in young children provide a robust, generalizable approach to monitor population progress toward and beyond trachoma elimination.
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Affiliation(s)
- Christine Tedijanto
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
| | - Anthony W. Solomon
- Global Neglected Tropical Diseases Programme, World Health Organization, Geneva, Switzerland
| | - Diana L. Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA 30329
| | | | - Jeremy D. Keenan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA, 94158
| | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA, 94158
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA 94143
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143
| | - Patrick J. Lammie
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Atlanta, GA, USA, 30030
| | - Kristen Aiemjoy
- Division of Epidemiology, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
| | - Abdou Amza
- Programme National de Santé Oculaire, Niamey, Niger
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Solomon Aragie
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
- The Carter Center Ethiopia, Addis Ababa, Ethiopia
- Infection Biology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Sydney Carolan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
| | | | - E. Brook Goodhew
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA 30329
| | - Sarah Gwyn
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA 30329
| | - Jaouad Hammou
- Service of Ocular and Otological Diseases, Epidemiology and Disease Control Directorate, Ministry of Health, Morocco
| | - Boubacar Kadri
- Programme National de Santé Oculaire, Niamey, Niger
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Malawi
| | | | - Beido Nassirou
- Programme National de Santé Oculaire, Niamey, Niger
- Programme National de Lutte Contre la Cecité, Niamey, Niger
| | - Fikre Seife
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Sheila K. West
- Johns Hopkins School of Medicine, Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Baltimore MD USA
| | - Dionna M. Wittberg
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
| | - Taye Zeru
- Amhara Public Health Institute, Bahir-Dar, Ethiopia
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA, 94158
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA, 94158
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Clutter CH, Klarman MB, Cajusma Y, Cato ET, Sayeed A, Brinkley L, Jensen O, Baril C, De Rochars VMB, Azman AS, Long MT, Cummings D, Leung DT, Nelson EJ. A population-based serological survey of Vibrio cholerae antibody titers in Ouest Department, Haiti in the year prior to the 2022 cholera outbreak. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.06.23285537. [PMID: 36798289 PMCID: PMC9934795 DOI: 10.1101/2023.02.06.23285537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
After three years with no confirmed cholera cases in Haiti, an outbreak of Vibrio cholerae O1 emerged in October 2022. Levels of pre-existing antibodies provide an estimate of prior immunologic exposure, reveal potentially relevant immune responses, and set a baseline for future serosurveillance. We analyzed dried blood spots collected in 2021 from a population-weighted representative cross-sectional serosurvey in two communes in the Ouest Department of Haiti. We found lower levels of circulating IgG and IgA antibodies against V. cholerae lipopolysaccharide (LPS, IgG and IgA p<0.0001) in those below 5 years of age compared to those five years and older. Among a subset of patients with higher titers of antibodies, we were unable to detect any functional (vibriocidal) antibodies. In conclusion, the lack of detectable functional antibodies, and age-discordant levels of V. cholerae LPS IgG, suggest that populations in Haiti may be highly susceptible to cholera disease, especially among young children.
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Affiliation(s)
- Christy H. Clutter
- Division of Infectious Disease, University of Utah, Salt Lake City, Utah, USA
- Division of Microbiology & Immunology, University of Utah, Salt Lake City, Utah, USA
| | - Molly B. Klarman
- University of Florida, Departments of Pediatrics and Environmental and Global Health, Gainesville, Florida, USA
| | - Youseline Cajusma
- University of Florida, Departments of Pediatrics and Environmental and Global Health, Gainesville, Florida, USA
| | - Emilie T. Cato
- University of Florida, Departments of Pediatrics and Environmental and Global Health, Gainesville, Florida, USA
| | - Abu Sayeed
- University of Florida, Departments of Pediatrics and Environmental and Global Health, Gainesville, Florida, USA
| | - Lindsey Brinkley
- University of Florida, Departments of Pediatrics and Environmental and Global Health, Gainesville, Florida, USA
| | - Owen Jensen
- Division of Microbiology & Immunology, University of Utah, Salt Lake City, Utah, USA
| | | | - V. Madsen Beau De Rochars
- Department of Health Services Research, Management and Policy, School of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Andrew S. Azman
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Maureen T. Long
- Department of Comparative Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
- University of Florida, Emerging Pathogens Institute, Gainesville, Florida, USA
| | - Derek Cummings
- Department of Comparative Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
- University of Florida, Emerging Pathogens Institute, Gainesville, Florida, USA
| | - Daniel T. Leung
- Division of Infectious Disease, University of Utah, Salt Lake City, Utah, USA
- Division of Microbiology & Immunology, University of Utah, Salt Lake City, Utah, USA
| | - Eric J. Nelson
- Department of Comparative Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
- University of Florida, Emerging Pathogens Institute, Gainesville, Florida, USA
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Building an integrated serosurveillance platform to inform public health interventions: Insights from an experts' meeting on serum biomarkers. PLoS Negl Trop Dis 2022; 16:e0010657. [PMID: 36201428 PMCID: PMC9536637 DOI: 10.1371/journal.pntd.0010657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The use of biomarkers to measure immune responses in serum is crucial for understanding population-level exposure and susceptibility to human pathogens. Advances in sample collection, multiplex testing, and computational modeling are transforming serosurveillance into a powerful tool for public health program design and response to infectious threats. In July 2018, 70 scientists from 16 countries met to perform a landscape analysis of approaches that support an integrated serosurveillance platform, including the consideration of issues for successful implementation. Here, we summarize the group's insights and proposed roadmap for implementation, including objectives, technical requirements, ethical issues, logistical considerations, and monitoring and evaluation.
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10
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Aiemjoy K, Seidman JC, Saha S, Munira SJ, Islam Sajib MS, Sium SMA, Sarkar A, Alam N, Zahan FN, Kabir MS, Tamrakar D, Vaidya K, Shrestha R, Shakya J, Katuwal N, Shrestha S, Yousafzai MT, Iqbal J, Dehraj IF, Ladak Y, Maria N, Adnan M, Pervaiz S, Carter AS, Longley AT, Fraser C, Ryan ET, Nodoushani A, Fasano A, Leonard MM, Kenyon V, Bogoch II, Jeon HJ, Haselbeck A, Park SE, Zellweger RM, Marks F, Owusu-Dabo E, Adu-Sarkodie Y, Owusu M, Teunis P, Luby SP, Garrett DO, Qamar FN, Saha SK, Charles RC, Andrews JR. Estimating typhoid incidence from community-based serosurveys: a multicohort study. THE LANCET. MICROBE 2022; 3:e578-e587. [PMID: 35750069 PMCID: PMC9329131 DOI: 10.1016/s2666-5247(22)00114-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The incidence of enteric fever, an invasive bacterial infection caused by typhoidal Salmonellae (Salmonella enterica serovars Typhi and Paratyphi), is largely unknown in regions without blood culture surveillance. The aim of this study was to evaluate whether new diagnostic serological markers for typhoidal Salmonella can reliably estimate population-level incidence. METHODS We collected longitudinal blood samples from patients with blood culture-confirmed enteric fever enrolled from surveillance studies in Bangladesh, Nepal, Pakistan, and Ghana between 2016 and 2021 and conducted cross-sectional serosurveys in the catchment areas of each surveillance site. We used ELISAs to measure quantitative IgA and IgG antibody responses to hemolysin E and S Typhi lipopolysaccharide. We used Bayesian hierarchical models to fit two-phase power-function decay models to the longitudinal antibody responses among enteric fever cases and used the joint distributions of the peak antibody titres and decay rate to estimate population-level incidence rates from cross-sectional serosurveys. FINDINGS The longitudinal antibody kinetics for all antigen-isotypes were similar across countries and did not vary by clinical severity. The seroincidence of typhoidal Salmonella infection among children younger than 5 years ranged between 58·5 per 100 person-years (95% CI 42·1-81·4) in Dhaka, Bangladesh, to 6·6 per 100 person-years (4·3-9·9) in Kavrepalanchok, Nepal, and followed the same rank order as clinical incidence estimates. INTERPRETATION The approach described here has the potential to expand the geographical scope of typhoidal Salmonella surveillance and generate incidence estimates that are comparable across geographical regions and time. FUNDING Bill & Melinda Gates Foundation. TRANSLATIONS For the Nepali, Bengali and Urdu translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Kristen Aiemjoy
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA; Division of Epidemiology, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA.
| | | | - Senjuti Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | - Syed Muktadir Al Sium
- Child Health Research Foundation, Dhaka, Bangladesh; Bangladesh Council of Scientific and Industrial Research, Dhaka, Bangladesh
| | - Anik Sarkar
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Nusrat Alam
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | - Dipesh Tamrakar
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Krista Vaidya
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Rajeev Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Jivan Shakya
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Nishan Katuwal
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Sony Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | | | - Junaid Iqbal
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Irum Fatima Dehraj
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Yasmin Ladak
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Noshi Maria
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Mehreen Adnan
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sadaf Pervaiz
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Ashley T Longley
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Clare Fraser
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ariana Nodoushani
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Alessio Fasano
- Center for Celiac Research and Treatment, MassGeneral Hospital for Children, Boston, MA, USA; Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Maureen M Leonard
- Center for Celiac Research and Treatment, MassGeneral Hospital for Children, Boston, MA, USA; Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Victoria Kenyon
- Center for Celiac Research and Treatment, MassGeneral Hospital for Children, Boston, MA, USA
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul, South Korea; Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | | | - Se Eun Park
- International Vaccine Institute, Seoul, South Korea
| | | | - Florian Marks
- International Vaccine Institute, Seoul, South Korea; Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK; Department of Microbiology and Parasitology, University of Antananarivo, Antananarivo, Madagascar; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Ellis Owusu-Dabo
- School of Medical Sciences, Kwame Nkrumah University for Science and Technology, Kumasi, Ghana
| | - Yaw Adu-Sarkodie
- School of Medical Sciences, Kwame Nkrumah University for Science and Technology, Kumasi, Ghana
| | - Michael Owusu
- School of Medical Sciences, Kwame Nkrumah University for Science and Technology, Kumasi, Ghana
| | - Peter Teunis
- Center for Global Safe Water, Sanitation and Hygiene, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Farah Naz Qamar
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Richelle C Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
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11
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Chan Y, Martin D, Mace KE, Jean SE, Stresman G, Drakeley C, Chang MA, Lemoine JF, Udhayakumar V, Lammie PJ, Priest JW, Rogier EW. Multiplex Serology for Measurement of IgG Antibodies Against Eleven Infectious Diseases in a National Serosurvey: Haiti 2014-2015. Front Public Health 2022; 10:897013. [PMID: 35757611 PMCID: PMC9218545 DOI: 10.3389/fpubh.2022.897013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Integrated surveillance for multiple diseases can be an efficient use of resources and advantageous for national public health programs. Detection of IgG antibodies typically indicates previous exposure to a pathogen but can potentially also serve to assess active infection status. Serological multiplex bead assays have recently been developed to simultaneously evaluate exposure to multiple antigenic targets. Haiti is an island nation in the Caribbean region with multiple endemic infectious diseases, many of which have a paucity of data for population-level prevalence or exposure. Methods A nationwide serosurvey occurred in Haiti from December 2014 to February 2015. Filter paper blood samples (n = 4,438) were collected from participants in 117 locations and assayed for IgG antibodies on a multiplex bead assay containing 15 different antigens from 11 pathogens: Plasmodium falciparum, Toxoplasma gondii, lymphatic filariasis roundworms, Strongyloides stercoralis, chikungunya virus, dengue virus, Chlamydia trachomatis, Treponema pallidum, enterotoxigenic Escherichia coli, Entamoeba histolytica, and Cryptosporidium parvum. Results Different proportions of the Haiti study population were IgG seropositive to the different targets, with antigens from T. gondii, C. parvum, dengue virus, chikungunya virus, and C. trachomatis showing the highest rates of seroprevalence. Antibody responses to T. pallidum and lymphatic filariasis were the lowest, with <5% of all samples IgG seropositive to antigens from these pathogens. Clear trends of increasing seropositivity and IgG levels with age were seen for all antigens except those from chikungunya virus and E. histolytica. Parametric models were able to estimate the rate of seroconversion and IgG acquisition per year for residents of Haiti. Conclusions Multiplex serological assays can provide a wealth of information about population exposure to different infectious diseases. This current Haitian study included IgG targets for arboviral, parasitic, and bacterial infectious diseases representing multiple different modes of host transmission. Some of these infectious diseases had a paucity or complete absence of published serological studies in Haiti. Clear trends of disease burden with respect to age and location in Haiti can be used by national programs and partners for follow-up studies, resource allocation, and intervention planning.
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Affiliation(s)
- YuYen Chan
- The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Diana Martin
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kimberly E Mace
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Samuel E Jean
- Population Services International/Organization Haïtienne de Marketing Social Pour la Santé, Port-au-Prince, Haiti
| | - Gillian Stresman
- The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Chris Drakeley
- The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Michelle A Chang
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jean F Lemoine
- Programme National de Contrôle de la Malaria/MSPP, Port-au-Prince, Haiti
| | - Venkatachalam Udhayakumar
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Patrick J Lammie
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jeffrey W Priest
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Eric William Rogier
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
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12
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Effect of biannual azithromycin distribution on antibody responses to malaria, bacterial, and protozoan pathogens in Niger. Nat Commun 2022; 13:976. [PMID: 35190534 PMCID: PMC8861117 DOI: 10.1038/s41467-022-28565-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 02/02/2022] [Indexed: 11/30/2022] Open
Abstract
The MORDOR trial in Niger, Malawi, and Tanzania found that biannual mass distribution of azithromycin to children younger than 5 years led to a 13.5% reduction in all-cause mortality (NCT02048007). To help elucidate the mechanism for mortality reduction, we report IgG responses to 11 malaria, bacterial, and protozoan pathogens using a multiplex bead assay in pre-specified substudy of 30 communities in the rural Niger placebo-controlled trial over a three-year period (n = 5642 blood specimens, n = 3814 children ages 1–59 months). Mass azithromycin reduces Campylobacter spp. force of infection by 29% (hazard ratio = 0.71, 95% CI: 0.56, 0.89; P = 0.004) but serological measures show no significant differences between groups for other pathogens against a backdrop of high transmission. Results align with a recent microbiome study in the communities. Given significant sequelae of Campylobacter infection among preschool aged children, our results support an important mechanism through which biannual mass distribution of azithromycin likely reduces mortality in Niger. In a randomized placebo-controlled trial in rural Niger, biannual azithromycin distribution to children 1-59 months reduced all-cause mortality. Based on serology, Arzika et al. here report a reduction of Campylobacter infection, supporting one mechanism for the intervention’s impact on mortality.
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13
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Recreational water exposure and waterborne infections in a prospective salivary antibody study at a Lake Michigan beach. Sci Rep 2021; 11:20540. [PMID: 34654825 PMCID: PMC8519948 DOI: 10.1038/s41598-021-00059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/29/2021] [Indexed: 12/03/2022] Open
Abstract
In a prospective observational study, seroconversion to a specific pathogen can serve as a marker of an incident infection, whether or not that infection is symptomatic or clinically diagnosed. While self-reported symptoms can be affected by reporting bias, seroconversion is likely to be free of this bias as it is based on objective measurements of antibody response. Non-invasive salivary antibody tests can be used instead of serum tests to detect seroconversions in prospective studies. In the present study, individuals and families were recruited at a Lake Michigan beach in Wisconsin in August 2011. Data on recreational water exposure and baseline saliva samples (S1) were collected at recruitment. Follow-up data on gastrointestinal symptoms were collected via a telephone interview approximately 10 days post-recruitment. Follow-up saliva samples were self-collected approximately 2 weeks (S2) and 30–40 days post-recruitment (S3) and mailed to the study laboratory. Samples were analyzed for immunoglobulin (Ig) G responses to recombinant antigens of three noroviruses and Cryptosporidium, as well as protein purification tags as internal controls, using an in-house multiplex suspension immunoassay on the Luminex platform. Responses were defined as ratios of antibody reactivities with a target protein and its purification tag. Seroconversions were defined as at least four-fold and three-fold increases in responses in S2 and S3 samples compared to S1, respectively. In addition, an S2 response had to be above the upper 90% one-sided prediction limit of a corresponding spline function of age. Among 872 study participants, there were seven (0.8%) individuals with seroconversions, including six individuals with seroconversions to noroviruses and two to Cryptosporidium (one individual seroconverted to both pathogens). Among 176 (20%) individuals who reported swallowing lake water, there were six (3.4%) seroconversions compared to one (0.14%) seroconversion among the remaining 696 individuals: the crude and age-standardized risk differences per 1000 beachgoers were 32.7 (95% confidence limits 5.7; 59.6) and 94.8 (4.6; 276), respectively. The age-adjusted odds ratio of seroconversion in those who swallowed water vs. all others was 49.5 (4.5; 549), p = 0.001. Individuals with a norovirus seroconversion were more likely to experience vomiting symptoms within 4 days of the index beach visit than non-converters with an odds ratio of 34 (3.4, 350), p = 0.003. This study contributed further evidence that recreational water exposure is associated with symptomatic and asymptomatic waterborne infections, and that salivary antibody assays can be used in epidemiological surveys of norovirus and Cryptosporidium infections.
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14
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Zweigart MR, Becker-Dreps S, Bucardo F, González F, Baric RS, Lindesmith LC. Serological Humoral Immunity Following Natural Infection of Children with High Burden Gastrointestinal Viruses. Viruses 2021; 13:2033. [PMID: 34696463 PMCID: PMC8538683 DOI: 10.3390/v13102033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/01/2021] [Accepted: 10/03/2021] [Indexed: 12/14/2022] Open
Abstract
Acute gastroenteritis (AGE) is a major cause of morbidity and mortality worldwide, resulting in an estimated 440,571 deaths of children under age 5 annually. Rotavirus, norovirus, and sapovirus are leading causes of childhood AGE. A successful rotavirus vaccine has reduced rotavirus hospitalizations by more than 50%. Using rotavirus as a guide, elucidating the determinants, breath, and duration of serological antibody immunity to AGE viruses, as well as host genetic factors that define susceptibility is essential for informing development of future vaccines and improving current vaccine candidates. Here, we summarize the current knowledge of disease burden and serological antibody immunity following natural infection to inform further vaccine development for these three high-burden viruses.
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Affiliation(s)
- Mark R. Zweigart
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC 27599, USA; (M.R.Z.); (S.B.-D.)
| | - Sylvia Becker-Dreps
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC 27599, USA; (M.R.Z.); (S.B.-D.)
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Filemón Bucardo
- Department of Microbiology, National Autonomous University of Nicaragua, León 21000, Nicaragua; (F.B.); (F.G.)
| | - Fredman González
- Department of Microbiology, National Autonomous University of Nicaragua, León 21000, Nicaragua; (F.B.); (F.G.)
| | - Ralph S. Baric
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC 27599, USA; (M.R.Z.); (S.B.-D.)
| | - Lisa C. Lindesmith
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC 27599, USA; (M.R.Z.); (S.B.-D.)
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15
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Hatherell HA, Simpson H, Baggaley RF, Hollingsworth TD, Pullan RL. Sustainable Surveillance of Neglected Tropical Diseases for the Post-Elimination Era. Clin Infect Dis 2021; 72:S210-S216. [PMID: 33977302 PMCID: PMC8201586 DOI: 10.1093/cid/ciab211] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The World Health Organization’s (WHO’s) 2030 road map for neglected tropical diseases (NTDs) emphasizes the importance of strengthened, institutionalized “post-elimination” surveillance. The required shift from disease-siloed, campaign-based programming to routine, integrated surveillance and response activities presents epidemiological, logistical, and financial challenges, yet practical guidance on implementation is lacking. Nationally representative survey programs, such as demographic and health surveys (DHS), may offer a platform for the integration of NTD surveillance within national health systems and health information systems. Here, we describe characteristics of DHS and other surveys conducted within the WHO Africa region in terms of frequency, target populations, and sample types and discuss applicability for post-validation and post-elimination surveillance. Maximizing utility depends not only on the availability of improved diagnostics but also on better understanding of the spatial and temporal dynamics of transmission at low prevalence. To this end, we outline priorities for obtaining additional data to better characterize optimal post-elimination surveillance platforms.
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Affiliation(s)
- Hollie-Ann Hatherell
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hope Simpson
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rebecca F Baggaley
- Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom
| | | | - Rachel L Pullan
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Determining seropositivity-A review of approaches to define population seroprevalence when using multiplex bead assays to assess burden of tropical diseases. PLoS Negl Trop Dis 2021; 15:e0009457. [PMID: 34181665 PMCID: PMC8270565 DOI: 10.1371/journal.pntd.0009457] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 07/09/2021] [Accepted: 05/10/2021] [Indexed: 11/19/2022] Open
Abstract
Background Serological surveys with multiplex bead assays can be used to assess seroprevalence to multiple pathogens simultaneously. However, multiple methods have been used to generate cut-off values for seropositivity and these may lead to inconsistent interpretation of results. A literature review was conducted to describe the methods used to determine cut-off values for data generated by multiplex bead assays. Methodology/Principal findings A search was conducted in PubMed that included articles published from January 2010 to January 2020, and 308 relevant articles were identified that included the terms “serology”, “cut-offs”, and “multiplex bead assays”. After application of exclusion of articles not relevant to neglected tropical diseases (NTD), vaccine preventable diseases (VPD), or malaria, 55 articles were examined based on their relevance to NTD or VPD. The most frequently applied approaches to determine seropositivity included the use of presumed unexposed populations, mixture models, receiver operating curves (ROC), and international standards. Other methods included the use of quantiles, pre-exposed endemic cohorts, and visual inflection points. Conclusions/Significance For disease control programmes, seropositivity is a practical and easily interpretable health metric but determining appropriate cut-offs for positivity can be challenging. Considerations for optimal cut-off approaches should include factors such as methods recommended by previous research, transmission dynamics, and the immunological backgrounds of the population. In the absence of international standards for estimating seropositivity in a population, the use of consistent methods that align with individual disease epidemiological data will improve comparability between settings and enable the assessment of changes over time. Serological surveys can provide information regarding population-level disease exposure by assessing immune responses created during infection. Multiplex bead assays (MBAs) allow for an integrated serological platform to monitor antibody responses to multiple pathogens concurrently. As programs adopt integrated disease control strategies, MBAs are especially advantageous since many of these diseases may be present in the same population and antibodies against all pathogens of interest can be detected simultaneously from a single blood sample. Interpreting serological data in a programmatic context typically involves classifying individuals as seronegative or seropositive using a ‘cut-off’, whereby anyone with a response above the defined threshold is considered to be seropositive. Although studies increasingly test blood samples with MBAs, published studies have applied different methods of determining seropositivity cut-offs, making results difficult to compare across settings and over time. The lack of harmonized methods for defining seropositivity is due to the absence of international standards, pathogen biology, or assay-specific methods that may impact resulting data. This review highlights the need for a standardized approach for which cut-off methods to use per pathogen when applied to integrated disease surveillance using platforms such as MBAs.
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Goddard FB, Ban R, Barr DB, Brown J, Cannon J, Colford JM, Eisenberg JNS, Ercumen A, Petach H, Freeman MC, Levy K, Luby SP, Moe C, Pickering AJ, Sarnat JA, Stewart J, Thomas E, Taniuchi M, Clasen T. Measuring Environmental Exposure to Enteric Pathogens in Low-Income Settings: Review and Recommendations of an Interdisciplinary Working Group. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2020; 54:11673-11691. [PMID: 32813503 PMCID: PMC7547864 DOI: 10.1021/acs.est.0c02421] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 05/06/2023]
Abstract
Infections with enteric pathogens impose a heavy disease burden, especially among young children in low-income countries. Recent findings from randomized controlled trials of water, sanitation, and hygiene interventions have raised questions about current methods for assessing environmental exposure to enteric pathogens. Approaches for estimating sources and doses of exposure suffer from a number of shortcomings, including reliance on imperfect indicators of fecal contamination instead of actual pathogens and estimating exposure indirectly from imprecise measurements of pathogens in the environment and human interaction therewith. These shortcomings limit the potential for effective surveillance of exposures, identification of important sources and modes of transmission, and evaluation of the effectiveness of interventions. In this review, we summarize current and emerging approaches used to characterize enteric pathogen hazards in different environmental media as well as human interaction with those media (external measures of exposure), and review methods that measure human infection with enteric pathogens as a proxy for past exposure (internal measures of exposure). We draw from lessons learned in other areas of environmental health to highlight how external and internal measures of exposure can be used to more comprehensively assess exposure. We conclude by recommending strategies for advancing enteric pathogen exposure assessments.
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Affiliation(s)
- Frederick
G. B. Goddard
- Gangarosa
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, United States
| | - Radu Ban
- Bill and
Melinda Gates Foundation, Seattle, Washington 98109, United States
| | - Dana Boyd Barr
- Gangarosa
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, United States
| | - Joe Brown
- School of
Civil and Environmental Engineering, Georgia
Institute of Technology, Atlanta, Georgia 30332, United States
| | - Jennifer Cannon
- Centers
for Disease Control and Prevention Foundation, Atlanta, Georgia 30308, United States
| | - John M. Colford
- Division
of Epidemiology and Biostatistics, School of Public Health, University of California−Berkeley, Berkeley, California 94720, United States
| | - Joseph N. S. Eisenberg
- Department
of Epidemiology, University of Michigan
School of Public Health, Ann Arbor, Michigan 48109, United States
| | - Ayse Ercumen
- Department
of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Helen Petach
- U.S. Agency
for International Development, Washington, DC 20004, United States
| | - Matthew C. Freeman
- Gangarosa
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, United States
| | - Karen Levy
- Department
of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington 98105, United States
| | - Stephen P. Luby
- Division
of Infectious Diseases and Geographic Medicine, Stanford University, California 94305, United States
| | - Christine Moe
- Center
for
Global Safe Water, Sanitation and Hygiene, Rollins School of Public
Health, Emory University, Atlanta, Georgia 30322, United States
| | - Amy J. Pickering
- Department
of Civil and Environmental Engineering, School of Engineering, Tufts University, Medford, Massachusetts 02155, United States
| | - Jeremy A. Sarnat
- Gangarosa
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, United States
| | - Jill Stewart
- Department
of Environmental Sciences and Engineering, Gillings School of Global
Public Health, University of North Carolina, Chapel Hill, North Carolina 27599, United States
| | - Evan Thomas
- Mortenson
Center in Global Engineering, University
of Colorado Boulder, Boulder, Colorado 80303, United States
| | - Mami Taniuchi
- Division
of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia 22903, United States
| | - Thomas Clasen
- Gangarosa
Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, United States
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18
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Aiemjoy K, Aragie S, Wittberg DM, Tadesse Z, Callahan EK, Gwyn S, Martin D, Keenan JD, Arnold BF. Seroprevalence of antibodies against Chlamydia trachomatis and enteropathogens and distance to the nearest water source among young children in the Amhara Region of Ethiopia. PLoS Negl Trop Dis 2020; 14:e0008647. [PMID: 32877398 PMCID: PMC7491729 DOI: 10.1371/journal.pntd.0008647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/15/2020] [Accepted: 07/27/2020] [Indexed: 11/19/2022] Open
Abstract
The transmission of trachoma, caused by repeat infections with Chlamydia trachomatis, and many enteropathogens are linked to water quantity. We hypothesized that children living further from a water source would have higher exposure to C. trachomatis and enteric pathogens as determined by antibody responses. We used a multiplex bead assay to measure IgG antibody responses to C. trachomatis, Giardia intestinalis, Cryptosporidium parvum, Entamoeba histolytica, Salmonella enterica, Campylobacter jejuni, enterotoxigenic Escherichia coli (ETEC) and Vibrio cholerae in eluted dried blood spots collected from 2267 children ages 0-9 years in 40 communities in rural Ethiopia in 2016. Linear distance from the child's house to the nearest water source was calculated. We derived seroprevalence cutoffs using external negative control populations, if available, or by fitting finite mixture models. We used targeted maximum likelihood estimation to estimate differences in seroprevalence according to distance to the nearest water source. Seroprevalence among 1-9-year-olds was 43% for C. trachomatis, 28% for S. enterica, 70% for E. histolytica, 54% for G. intestinalis, 96% for C. jejuni, 76% for ETEC and 94% for C. parvum. Seroprevalence increased with age for all pathogens. Median distance to the nearest water source was 473 meters (IQR 268, 719). Children living furthest from a water source had a 12% (95% CI: 2.6, 21.6) higher seroprevalence of S. enterica and a 12.7% (95% CI: 2.9, 22.6) higher seroprevalence of G. intestinalis compared to children living nearest. Seroprevalence for C. trachomatis and enteropathogens was high, with marked increases for most enteropathogens in the first two years of life. Children living further from a water source had higher seroprevalence of S. enterica and G. intestinalis indicating that improving access to water in the Ethiopia's Amhara region may reduce exposure to these enteropathogens in young children.
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Affiliation(s)
- Kristen Aiemjoy
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | | | - Dionna M. Wittberg
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America
| | | | | | - Sarah Gwyn
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Diana Martin
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jeremy D. Keenan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America
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19
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Arnold BF, Martin DL, Juma J, Mkocha H, Ochieng JB, Cooley GM, Omore R, Goodhew EB, Morris JF, Costantini V, Vinjé J, Lammie PJ, Priest JW. Enteropathogen antibody dynamics and force of infection among children in low-resource settings. eLife 2019; 8:45594. [PMID: 31424386 PMCID: PMC6746552 DOI: 10.7554/elife.45594] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 08/15/2019] [Indexed: 01/22/2023] Open
Abstract
Little is known about enteropathogen seroepidemiology among children in low-resource settings. We measured serological IgG responses to eight enteropathogens (Giardia intestinalis, Cryptosporidium parvum, Entamoeba histolytica, Salmonella enterica, enterotoxigenic Escherichia coli, Vibrio cholerae, Campylobacter jejuni, norovirus) in cohorts from Haiti, Kenya, and Tanzania. We studied antibody dynamics and force of infection across pathogens and cohorts. Enteropathogens shared common seroepidemiologic features that enabled between-pathogen comparisons of transmission. Overall, exposure was intense: for most pathogens the window of primary infection was <3 years old; for highest transmission pathogens primary infection occurred within the first year. Longitudinal profiles demonstrated significant IgG boosting and waning above seropositivity cutoffs, underscoring the value of longitudinal designs to estimate force of infection. Seroprevalence and force of infection were rank-preserving across pathogens, illustrating the measures provide similar information about transmission heterogeneity. Our findings suggest antibody response can be used to measure population-level transmission of diverse enteropathogens in serologic surveillance. Diarrhea, which is caused by bacteria such as Salmonella or by viruses like norovirus, is the fourth leading cause of death among children worldwide, with children in low-resource settings being at highest risk. The pathogens that cause diarrhea spread when stool from infected people comes into contact with new hosts, for example, through inadequate sanitation or by drinking contaminated water. Currently, the best way to track these infections is to collect stool samples from people and test them for the presence of the pathogens. Unfortunately, this is costly and difficult to do on a large scale outside of clinical settings, making it hard to track the spread of diarrhea-causing pathogens. The body produces antibodies – small proteins that can detect specific pathogens – in response to an infection. These antibodies help ward off future infections by the same pathogen, so if they are present in the blood, this indicates a current or previous infection. Scientists already collect blood samples to track malaria, HIV and vaccine-preventable diseases in low-resource settings. These samples could be tested more broadly to measure the levels of antibodies against diarrhea-causing pathogens. Now, Arnold et al. have used blood samples collected from children in Haiti, Kenya, and Tanzania to measure antibody responses to 8 diarrhea-causing pathogens. The results showed that many children in these settings had been infected with all 8 pathogens before age three, and that all of the pathogens shared similar age-dependent patterns of antibody response. This finding enabled Arnold et al. to combine antibody measurements with statistical models to estimate each pathogen’s force of infection, that is, the rate at which susceptible individuals in the population become infected. This is a key step for epidemiologists to understand which pathogens cause the most infections in a population. The experiments show that testing blood samples for antibodies could provide scientists with a new tool to track the transmission of diarrhea-causing pathogens in low-resource settings. This information could help public health officials design and test efforts to prevent diarrhea, for example, by improving water treatment or developing vaccines.
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Affiliation(s)
- Benjamin F Arnold
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, United States.,Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, United States.,Department of Ophthalmology, University of California, San Francisco, San Francisco, United States
| | - Diana L Martin
- Division of Parasitic Diseases and Malaria, United States Centers for Disease Control and Prevention, Atlanta, United States
| | - Jane Juma
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Harran Mkocha
- Kongwa Trachoma Project, Kongwa, United Republic of Tanzania
| | - John B Ochieng
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Gretchen M Cooley
- Division of Parasitic Diseases and Malaria, United States Centers for Disease Control and Prevention, Atlanta, United States
| | - Richard Omore
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - E Brook Goodhew
- Division of Parasitic Diseases and Malaria, United States Centers for Disease Control and Prevention, Atlanta, United States
| | - Jamae F Morris
- Department of African-American Studies, Georgia State University, Atlanta, United States
| | - Veronica Costantini
- Division of Viral Diseases, United States Centers for Disease Control and Prevention, Atlanta, United States
| | - Jan Vinjé
- Division of Viral Diseases, United States Centers for Disease Control and Prevention, Atlanta, United States
| | - Patrick J Lammie
- Division of Parasitic Diseases and Malaria, United States Centers for Disease Control and Prevention, Atlanta, United States.,Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, United States
| | - Jeffrey W Priest
- Division of Foodborne, Waterborne, and Environmental Diseases, United States Centers for Disease Control and Prevention, Atlanta, United States
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