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Al-Qassimi MA, Al Amad M, Al-Dar A, Al Sakaf E, Al Hadad A, Raja'a YA. Circulating vaccine derived polio virus type 2 outbreak and response in Yemen, 2021-2022, a retrospective descriptive analysis. BMC Infect Dis 2024; 24:321. [PMID: 38491425 PMCID: PMC10943856 DOI: 10.1186/s12879-024-09215-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/12/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The outbreaks of circulating Vaccine Derived Polio Viruses (cVDPVs) have emerged as a major challenge for the final stage of polio eradication. In Yemen, an explosive outbreak of cVDPV2 was reported from August 2021 to December 2022. This study aims to compare the patterns of cVDPV2 outbreak, response measures taken by health authorities, and impacts in southern and northern governorates. METHOD A retrospective descriptive study of confirmed cases of VDPV2 was performed. The data related to cVDPV2 as well as stool specimens and environmental samples that were shipped to WHO-accredited labs were collected by staff of surveillance. Frequencies and percentages were used to characterize and compare the confirmed cases from the southern and northern governorates. The average delayed time as a difference in days between the date of sample collection and lab confirmation was calculated. RESULTS The cVDPV2 was isolated from 227 AFP cases reported from 19/23 Yemeni governorates and from 83% (39/47) of environmental samples with an average of 7 months delayed from sample collection. However, the non-polio AFP (NPAFP) and adequate stool specimen rates in the north were 6.7 and 87% compared to 6.4 and 87% in the south, 86% (195) and 14%(32) out of the total 227 confirmed cases were detected from northern and southern governorates, respectively. The first and second cases of genetically linked isolates experienced paralysis onset on 30 August and 1st September 2021. They respectively were from Taiz and Marib governorates ruled by southern authorities that started vaccination campaigns as a response in February 2022. Thus, in contrast to 2021, the detected cases in 2022 from the total cases detected in the south were lower accounting for 22% (7 of 32) of compared to 79% (155 of 195) of the total cases the north. CONCLUSION A new emerging cVDPV2 was confirmed in Yemen. The result of this study highlighted the impact of vaccination campaigns in containing the cVDPV2 outbreak. Maintaining a high level of immunization coverage and switching to nOPV2 instead of tOPV and mOPV2 in campaigns are recommended and environmental surveillance should be expanded in such a risky country.
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Affiliation(s)
- Mutahar Ahmed Al-Qassimi
- National Polio surveillance coordinator, Yemen Ministry of Public Health and Population, Sana'a, Yemen.
| | - Mohammed Al Amad
- Department of Community Medicine, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Ahmed Al-Dar
- Department of Community Medicine, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Ehab Al Sakaf
- General Director for Diseases Control and Surveillance, Yemen Ministry of Public Health and Population, Sana'a, Yemen
| | - Ahmed Al Hadad
- Faculty of Medicine and Health Sciences, Sana'a university, Sana'a, Yemen
- Yemen National Certification of polio eradication Committee chairperson, Sana'a, Yemen
| | - Yahia Ahmed Raja'a
- Faculty of Medicine and Health Sciences, Sana'a university, Sana'a, Yemen
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Fischer H, Lutay N, Ragnarsdóttir B, Yadav M, Jönsson K, Urbano A, Al Hadad A, Rämisch S, Storm P, Dobrindt U, Salvador E, Karpman D, Jodal U, Svanborg C. Pathogen specific, IRF3-dependent signaling and innate resistance to human kidney infection. PLoS Pathog 2010; 6:e1001109. [PMID: 20886096 PMCID: PMC2944801 DOI: 10.1371/journal.ppat.1001109] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 08/17/2010] [Indexed: 11/18/2022] Open
Abstract
The mucosal immune system identifies and fights invading pathogens, while allowing non-pathogenic organisms to persist. Mechanisms of pathogen/non-pathogen discrimination are poorly understood, as is the contribution of human genetic variation in disease susceptibility. We describe here a new, IRF3-dependent signaling pathway that is critical for distinguishing pathogens from normal flora at the mucosal barrier. Following uropathogenic E. coli infection, Irf3(-/-) mice showed a pathogen-specific increase in acute mortality, bacterial burden, abscess formation and renal damage compared to wild type mice. TLR4 signaling was initiated after ceramide release from glycosphingolipid receptors, through TRAM, CREB, Fos and Jun phosphorylation and p38 MAPK-dependent mechanisms, resulting in nuclear translocation of IRF3 and activation of IRF3/IFNβ-dependent antibacterial effector mechanisms. This TLR4/IRF3 pathway of pathogen discrimination was activated by ceramide and by P-fimbriated E. coli, which use ceramide-anchored glycosphingolipid receptors. Relevance of this pathway for human disease was supported by polymorphic IRF3 promoter sequences, differing between children with severe, symptomatic kidney infection and children who were asymptomatic bacterial carriers. IRF3 promoter activity was reduced by the disease-associated genotype, consistent with the pathology in Irf3(-/-) mice. Host susceptibility to common infections like UTI may thus be strongly influenced by single gene modifications affecting the innate immune response.
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MESH Headings
- Adult
- Animals
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Blotting, Western
- Case-Control Studies
- Cell Nucleus/metabolism
- Ceramides/metabolism
- Child
- Escherichia coli/pathogenicity
- Escherichia coli Infections/etiology
- Escherichia coli Infections/mortality
- Escherichia coli Infections/prevention & control
- Fimbriae, Bacterial
- Gene Expression Profiling
- Humans
- Immunity, Innate/physiology
- Interferon Regulatory Factor-3/genetics
- Interferon Regulatory Factor-3/metabolism
- Interferon Regulatory Factor-3/physiology
- Kidney/metabolism
- Kidney/pathology
- Kidney/virology
- Kidney Neoplasms/etiology
- Kidney Neoplasms/mortality
- Kidney Neoplasms/prevention & control
- Lung Neoplasms/etiology
- Lung Neoplasms/mortality
- Lung Neoplasms/prevention & control
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Oligonucleotide Array Sequence Analysis
- Phosphorylation
- Polymorphism, Genetic/genetics
- Promoter Regions, Genetic/genetics
- Prospective Studies
- Protein Transport
- Pyelonephritis/etiology
- Pyelonephritis/mortality
- Pyelonephritis/pathology
- RNA, Messenger/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- Signal Transduction
- Toll-Like Receptor 4/genetics
- Toll-Like Receptor 4/metabolism
- Tumor Cells, Cultured
- Urinary Tract Infections/etiology
- Urinary Tract Infections/mortality
- Urinary Tract Infections/prevention & control
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Affiliation(s)
- Hans Fischer
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Nataliya Lutay
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Bryndís Ragnarsdóttir
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Manisha Yadav
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Klas Jönsson
- Singapore Immunology Network (SIgN), Biomedical Sciences Institutes, Agency for Science, Technology, and Research (A*STAR), Immunos, BIOPOLIS, Singapore, Singapore
| | - Alexander Urbano
- Singapore Immunology Network (SIgN), Biomedical Sciences Institutes, Agency for Science, Technology, and Research (A*STAR), Immunos, BIOPOLIS, Singapore, Singapore
| | - Ahmed Al Hadad
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Sebastian Rämisch
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Petter Storm
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
| | - Ulrich Dobrindt
- Institute for Molecular Biology of Infectious Diseases, Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Ellaine Salvador
- Institute for Molecular Biology of Infectious Diseases, Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Diana Karpman
- Department of Pediatrics, Clinical Sciences Lund, Lund University, and Lund University Hospital, Lund, Sweden
| | - Ulf Jodal
- Pediatric-Uronephrology Center, Queen Silvia Children's Hospital, University of Gothenburg, Sweden
| | - Catharina Svanborg
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden
- Singapore Immunology Network (SIgN), Biomedical Sciences Institutes, Agency for Science, Technology, and Research (A*STAR), Immunos, BIOPOLIS, Singapore, Singapore
- * E-mail:
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