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Isabel S, Eshaghi A, Duvvuri VR, Gubbay JB, Cronin K, Li A, Hasso M, Clark ST, Hopkins JP, Patel SN, Braukmann TWA. Targeted amplification-based whole genome sequencing of Monkeypox virus in clinical specimens. Microbiol Spectr 2024; 12:e0297923. [PMID: 38047694 PMCID: PMC10783113 DOI: 10.1128/spectrum.02979-23] [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: 09/05/2023] [Accepted: 10/29/2023] [Indexed: 12/05/2023] Open
Abstract
IMPORTANCE We present a protocol to efficiently sequence genomes of the MPXV-causing mpox. This enables researchers and public health agencies to acquire high-quality genomic data using a rapid and cost-effective approach. Genomic data can be used to conduct surveillance and investigate mpox outbreaks. We present 91 mpox genomes that show the diversity of the 2022 mpox outbreak in Ontario, Canada.
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Affiliation(s)
- S. Isabel
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Ontario, Canada
| | - A. Eshaghi
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Ontario, Canada
| | - V. R. Duvvuri
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - J. B. Gubbay
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - K. Cronin
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Ontario, Canada
| | - Aimin Li
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Ontario, Canada
| | - M. Hasso
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Ontario, Canada
| | - S. T. Clark
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Ontario, Canada
| | - J. P. Hopkins
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - S. N. Patel
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - T. W. A. Braukmann
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Ontario, Canada
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2
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Hasso M, Perusini S, Eshaghi A, Tang E, Olsha R, Zhang H, Lau E, Sullivan A, Cronin K, Lee S, Obando J, DeLima C, Nagra S, Braukmann T, Duvvuri VR, Richard-Greenblatt M, Corbeil A, Kus JV, Majury A, Patel S, Gubbay JB. Monkeypox Virus Detection in Different Clinical Specimen Types. Emerg Infect Dis 2022; 28:2513-2515. [PMID: 36223653 PMCID: PMC9707591 DOI: 10.3201/eid2812.221160] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
A global monkeypox outbreak began in May 2022. Limited data exist on specimen type performance in associated molecular diagnostics. Consequently, a diverse range of specimen sources were collected in the initial weeks of the outbreak in Ontario, Canada. Our clinical evaluation identified skin lesions as the optimal diagnostic specimen source.
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3
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Aldhaheri K, Andany N, Eshaghi A, Simor AE, Palmay L, Patel SN, Lam PW. Infective endocarditis of a native aortic valve due to Pseudomonas aeruginosa complicated by progressive multi-drug resistance. J Assoc Med Microbiol Infect Dis Can 2022; 7:140-145. [PMID: 36337359 PMCID: PMC9608114 DOI: 10.3138/jammi-2021-0030] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/22/2021] [Accepted: 11/05/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Treatment of infective endocarditis secondary to Pseudomonas aeruginosa can be challenging because of this organism's ability to acquire antimicrobial resistance over time. METHODS We describe a patient with native aortic valve infective endocarditis due to P. aeruginosa who developed progressive multi-drug resistance while on therapy. The resistance mechanisms were characterized using whole-genome sequencing. RESULTS We identified two mutations in subsequent isolates (dacB and OprD) that conferred resistance to anti-pseudomonal penicillins, cephalosporins, and carbapenems. The patient was treated with combination high-dose continuous infusion meropenem and ciprofloxacin therapy, in addition to bioprosthetic aortic valve replacement and repair of ventricular septal wall defect. Antibiotics were continued for 6 weeks post-cardiac surgery and the patient remains infection free 18 months post-completion of antibiotic therapy. CONCLUSION Clinicians should be aware of the ability of P. aeruginosa to acquire resistance mechanisms in response to selective antibiotic pressures in high-inoculum infections such as infective endocarditis. The mutations identified in this case report correlated well with the evolving antimicrobial resistance profile observed.
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Affiliation(s)
- Khuloud Aldhaheri
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nisha Andany
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alireza Eshaghi
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Ontario, Canada
| | - Andrew E Simor
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lesley Palmay
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Samir N Patel
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Ontario, Canada
| | - Philip W Lam
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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4
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Marchand-Senécal X, Kozak R, Mubareka S, Salt N, Gubbay JB, Eshaghi A, Allen V, Li Y, Bastien N, Gilmour M, Ozaldin O, Leis JA. Diagnosis and Management of First Case of COVID-19 in Canada: Lessons Applied From SARS-CoV-1. Clin Infect Dis 2020; 71:2207-2210. [PMID: 32147731 PMCID: PMC7108147 DOI: 10.1093/cid/ciaa227] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/03/2020] [Indexed: 02/06/2023] Open
Abstract
We report diagnosis and management of the first laboratory-confirmed case of coronavirus disease 2019 (COVID-19) hospitalized in Toronto, Canada. No healthcare-associated transmission occurred. In the face of a potential pandemic of COVID-19, we suggest sustainable and scalable control measures developed based on lessons learned from severe acute respiratory syndrome.
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Affiliation(s)
| | - Rob Kozak
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Samira Mubareka
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Natasha Salt
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | | | - Vanessa Allen
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario Laboratory, Toronto, Ontario, Canada
| | - Yan Li
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Natalie Bastien
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Matthew Gilmour
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Omar Ozaldin
- Communicable Disease Control, Toronto Public Health, Toronto, Ontario, Canada
| | - Jerome A Leis
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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5
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Graham C, Eshaghi A, Sarabia A, Zittermann S, Stapleton P, Kus JV, Patel SN. Identification and characterization of invasive multi-drug-resistant (MDR) Bacteroides genomospecies in Canada. Access Microbiol 2020; 2:acmi000111. [PMID: 32974576 PMCID: PMC7494187 DOI: 10.1099/acmi.0.000111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/11/2020] [Indexed: 11/27/2022] Open
Abstract
We identified and characterized a genome of the multi-drug-resistant Bacteroides genomospecies recovered from an invasive specimen from a hospitalized patient in Canada. The strain was resistant to penicillin, pipercillin-tazobactam, meropenem, clindaymycin and metronidazole. The strain harboured a plasmid containing the nimE gene, which has been shown to be associated with metronidazole resistance. The study highlights the importance of being vigilant in suspecting antimicrobial drug resistance when a patient is not improving on therapy.
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Affiliation(s)
- Christopher Graham
- Trillium Health Partners, Mississauga ON, Canada.,Department of Medicine, University of Toronto, Toronto ON, Canada
| | - Alireza Eshaghi
- Public Health Ontario Laboratory, Public Health Ontario, Toronto ON, Canada
| | | | - Sandra Zittermann
- Public Health Ontario Laboratory, Public Health Ontario, Toronto ON, Canada
| | - Patrick Stapleton
- Public Health Ontario Laboratory, Public Health Ontario, Toronto ON, Canada
| | - Julianne V Kus
- Public Health Ontario Laboratory, Public Health Ontario, Toronto ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto ON, Canada
| | - Samir N Patel
- Public Health Ontario Laboratory, Public Health Ontario, Toronto ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto ON, Canada
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Alfaraidi H, Luinstra K, Eshaghi A, Smieja M, Gubbay JB, Pernica JM. Paediatric critical illness associated with respiratory infection: a single-centre, retrospective cohort study. BMJ Paediatr Open 2020; 4:e000640. [PMID: 32411832 PMCID: PMC7213883 DOI: 10.1136/bmjpo-2020-000640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To describe critically ill children with respiratory infections, classify them by infection syndrome type and determine the prevalence of Mycoplasma pneumoniae detection. STUDY DESIGN A retrospective, single-centre cohort study. All children aged 2 months-18 years with presumed respiratory infection who were admitted to a tertiary hospital paediatric intensive care unit (PICU) between September 2015 and October 2016 were eligible. Subjects were grouped by clinical syndrome (viral respiratory infection, asthma exacerbation, undifferentiated/uncomplicated pneumonia, pneumonia complicated by effusion/empyema and 'other'). All subjects had nasopharyngeal swabs tested for respiratory viruses, M. pneumoniae and Chlamydia pneumoniae. RESULTS There were 221 subjects; the median age was 3.1 years; 44% were female; and 78% had medical comorbidities. The majority (75%) was treated with antibiotics, most often ceftriaxone (90% of treated children). Those with any pneumonia were significantly less likely to have a respiratory virus identified in their nasopharynges and had significantly higher C reactive protein (CRP) values than those in the viral infection and asthma groups. There were 10 subjects in whom M. pneumoniae was detected (4.5%, 95% CI 2.2% to 8.2%). Mycoplasma-positive children were older (difference 3.5 years, 95% CI 0.66 to 6.4 years) and had fewer viral coinfections (30% compared with 69%, p=0.02). The prevalence of Mycoplasma infection in children aged >5 years with any pneumonia was 13.2% (95%CI 4.4% to 28%). CONCLUSIONS The majority of participants had respiratory viruses detected and were treated with broad-spectrum antibiotics. Differences in CRP and viral prevalence were observed between children with different infection syndrome types. M. pneumoniae infection was not rare in school-aged children with pneumonia admitted to the PICU. Attention to antibiotic treatment and rapid diagnostic testing for Mycoplasma in older, critically ill children should be considered to optimise management and avert morbidity and mortality from respiratory infection.
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Affiliation(s)
- Haifa Alfaraidi
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Kathy Luinstra
- Department of Laboratory Medicine, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Alireza Eshaghi
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Ontario, Canada
| | - Marek Smieja
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan B Gubbay
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey M Pernica
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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7
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Stapleton PJ, Eshaghi A, Seo CY, Wilson S, Harris T, Deeks SL, Bolotin S, Goneau LW, Gubbay JB, Patel SN. Evaluating the use of whole genome sequencing for the investigation of a large mumps outbreak in Ontario, Canada. Sci Rep 2019; 9:12615. [PMID: 31471545 PMCID: PMC6717193 DOI: 10.1038/s41598-019-47740-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/18/2019] [Indexed: 01/30/2023] Open
Abstract
In 2017 Ontario experienced the largest mumps outbreak in the province in 8 years, at a time when multiple outbreaks were occurring across North America. Of 259 reported cases, 143 occurred in Toronto, primarily among young adults. Routine genotyping of the small hydrophobic gene indicated that the outbreak was due to mumps virus genotype G. We performed a retrospective study of whole genome sequencing of 26 mumps virus isolates from early in the outbreak, using a tiling amplicon method. Results indicated that two of the cases were genetically divergent, with the remaining 24 cases belonging to two major clades and one minor clade. Phylogeographic analysis confirmed circulation of virus from each clade between Toronto and other regions in Ontario. Comparison with other genotype G strains from North America suggested that the presence of co-circulating major clades may have been due to separate importation events from outbreaks in the United States. A transmission network analysis performed with the software program TransPhylo was compared with previously collected epidemiological data. The transmission tree correlated with known epidemiological links between nine patients and identified new potential clusters with no known epidemiological links.
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Affiliation(s)
- P J Stapleton
- Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, ON, Canada
| | - A Eshaghi
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, ON, Canada
| | - C Y Seo
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, ON, Canada
| | - S Wilson
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - T Harris
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, ON, Canada
| | - S L Deeks
- Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - S Bolotin
- Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Applied Immunisation Research and Evaluation, Public Health Ontario, Toronto, ON, Canada
| | - L W Goneau
- Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, ON, Canada
| | - J B Gubbay
- Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, ON, Canada
| | - S N Patel
- Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada.
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, ON, Canada.
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8
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Wong W, Rawahi HA, Patel S, Yau Y, Eshaghi A, Zittermann S, Tattum L, Morris SK. The first Canadian pediatric case of extensively drug-resistant Salmonella Typhi originating from an outbreak in Pakistan and its implication for empiric antimicrobial choices. IDCases 2019; 15:e00492. [PMID: 30815359 PMCID: PMC6378779 DOI: 10.1016/j.idcr.2019.e00492] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/08/2019] [Accepted: 01/08/2019] [Indexed: 01/05/2023] Open
Abstract
We report on a three year-old male who contracted enteric fever during a visit to the Sindh province of Pakistan in the summer of 2018. He was diagnosed after returning to Canada and blood cultures isolated Salmonella enterica serovar Typhi which harbored extensive drug-resistance (XDR) to all first-line antibiotics including ceftriaxone. Empiric ceftriaxone was switched to meropenem and he was successfully treated with a two-week course. An outbreak of XDR typhoid is currently emerging from Pakistan and several outbreak-related cases have been identified in the U.K and U.S. Whole genome sequencing confirmed that our child was infected with the XDR outbreak-strain. Current empiric antimicrobial choices will result in treatment failure if an XDR strain is encountered, therefore clinicians must adapt their empiric approach for those returning from high risk regions. This is the first XDR typhoid case in Canada and the first pediatric case to be diagnosed and treated outside of Pakistan. Clinicians must be vigilant of future cases.
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Affiliation(s)
- Waison Wong
- Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Hatem Al Rawahi
- Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Samir Patel
- Public Health Ontario Laboratory, Public Health Ontario, 480 University Avenue, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 27 King’s College Circle, Toronto, ON, M5S 1A1, Canada
| | - Yvonne Yau
- Division of Microbiology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Alireza Eshaghi
- Public Health Ontario Laboratory, Public Health Ontario, 480 University Avenue, Toronto, Canada
| | - Sandra Zittermann
- Public Health Ontario Laboratory, Public Health Ontario, 480 University Avenue, Toronto, Canada
| | - Leah Tattum
- Department of General Pediatrics, The Scarborough Health Network, Scarborough, 3050 Lawrence Avenue East, ON, M1P 2V5, Canada
| | - Shaun K. Morris
- Division of Infectious Diseases, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre of Global Child Health, Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Canada
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9
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Tur C, Eshaghi A, Altmann DR, Jenkins TM, Prados F, Grussu F, Charalambous T, Schmidt A, Ourselin S, Clayden JD, Wheeler-Kingshott CAMG, Thompson AJ, Ciccarelli O, Toosy AT. Structural cortical network reorganization associated with early conversion to multiple sclerosis. Sci Rep 2018; 8:10715. [PMID: 30013173 PMCID: PMC6048099 DOI: 10.1038/s41598-018-29017-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 07/02/2018] [Indexed: 11/09/2022] Open
Abstract
Brain structural covariance networks (SCNs) based on pairwise statistical associations of cortical thickness data across brain areas reflect underlying physical and functional connections between them. SCNs capture the complexity of human brain cortex structure and are disrupted in neurodegenerative conditions. However, the longitudinal assessment of SCN dynamics has not yet been explored, despite its potential to unveil mechanisms underlying neurodegeneration. Here, we evaluated the changes of SCNs over 12 months in patients with a first inflammatory-demyelinating attack of the Central Nervous System and assessed their clinical relevance by comparing SCN dynamics of patients with and without conversion to multiple sclerosis (MS) over one year. All subjects underwent clinical and brain MRI assessments over one year. Brain cortical thicknesses for each subject and time point were used to obtain group-level between-area correlation matrices from which nodal connectivity metrics were obtained. Robust bootstrap-based statistical approaches (allowing sampling with replacement) assessed the significance of longitudinal changes. Patients who converted to MS exhibited significantly greater network connectivity at baseline than non-converters (p = 0.02) and a subsequent connectivity loss over time (p = 0.001-0.02), not observed in non-converters' network. These findings suggest SCN analysis is sensitive to brain tissue changes in early MS, reflecting clinically relevant aspects of the condition. However, this is preliminary work, indicated by the low sample sizes, and its results and conclusions should be treated with caution and confirmed with larger cohorts.
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Affiliation(s)
- C Tur
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK.
| | - A Eshaghi
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK.,Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London (UCL), London, WC1E 7JE, UK
| | - D R Altmann
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK.,Medical Statistics Department, London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - T M Jenkins
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK
| | - F Prados
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK.,Translational Imaging Group, Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, UCL, London, WC1E 7JE, UK
| | - F Grussu
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK.,Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London (UCL), London, WC1E 7JE, UK
| | - T Charalambous
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK
| | - A Schmidt
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - S Ourselin
- Translational Imaging Group, Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, UCL, London, WC1E 7JE, UK
| | - J D Clayden
- UCL Great Ormond Street Institute of Child Health, UCL, London, WC1N 1EH, UK
| | - C A M G Wheeler-Kingshott
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK.,Brain MRI 3T Research Center, C. Mondino National Neurological Institute, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - A J Thompson
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - O Ciccarelli
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - A T Toosy
- Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, University College of London (UCL), London, WC1B 5EH, UK
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10
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L’Huillier AG, Eshaghi A, Racey CS, Ogbulafor K, Lombos E, Higgins RR, Alexander DC, Kristjanson E, Maregmen J, Gubbay JB, Mazzulli T. Laboratory testing and phylogenetic analysis during a mumps outbreak in Ontario, Canada. Virol J 2018; 15:98. [PMID: 29866178 PMCID: PMC5987625 DOI: 10.1186/s12985-018-0996-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/01/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In September 2009, a mumps outbreak originated in New York and spread to Northeastern USA and Canada. This study compares the performance of different diagnostic testing methods used in Ontario and describes molecular characteristics of the outbreak strain. METHODS Between September 2009 and February 2010, specimens from suspect cases were submitted to Public Health Ontario Laboratory for mumps serology, culture and/or real-time reverse-transcriptase PCR (rRT-PCR) testing. rRT-PCR-positive specimens underwent genotyping at Canada's National Microbiology Laboratory. Whole genome sequencing was performed on four outbreak and three sporadic viral culture isolates. RESULTS Six hundred ninety-eight patients had IgM serology testing, of which 255 (37%) had culture and rRT-PCR. Among those, 35/698 (5%) were IgM positive, 39/255 (15%) culture positive and 47/255 (18%) rRT-PCR-positive. Buccal swabs had the highest rRT-PCR positivity (21%). The outbreak isolates were identical to that in the New York outbreak occurring at the same time. Nucleotide and amino acid identity with the Jeryl Lynn vaccine strain ranged from 85.0-94.5% and 82.4-99.4%, depending on the gene and coding sequences. Homology of the HN protein, the main immunogenic mumps virus protein, was found to be 94.5 and 95.3%, when compared to Jeryl Lynn vaccine major and minor components, respectively. CONCLUSIONS Despite higher sensitivity than serology, rRT-PCR testing is underutilized. Further work is needed to better understand the suboptimal match of the HN gene between the outbreak strain and the Jeryl Lynn vaccine strain.
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Affiliation(s)
- Arnaud G. L’Huillier
- Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - Alireza Eshaghi
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - C. Sarai Racey
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
- Present address: Dalla Lana School of Public Health, 155 College Street, Toronto, Ontario M5T 3M7 Canada
| | - Katherene Ogbulafor
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - Ernesto Lombos
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - Rachel R. Higgins
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - David C. Alexander
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
- Present address: Cadham Provincial Laboratory, Winnipeg, Manitoba R3C 3Y1 Canada
| | - Erik Kristjanson
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - Jocelyn Maregmen
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
| | - Jonathan B. Gubbay
- Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
- University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S 1A1 Canada
| | - Tony Mazzulli
- Public Health Ontario, 661 University Avenue, Toronto, Ontario M5G 1M1 Canada
- University of Toronto, 27 King’s College Circle, Toronto, Ontario M5S 1A1 Canada
- Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5 Canada
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11
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Stapleton P, Eshaghi A, Chong-King E, Cardona M, Masney S, Li A, Gubbay J, Patel S. Molecular Investigation of an Ontario Mumps Outbreak using Whole Genome Sequencing. Open Forum Infect Dis 2017. [PMCID: PMC5631175 DOI: 10.1093/ofid/ofx163.870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background In early 2017 an outbreak of Mumps virus affected over 100 individuals in the province of Ontario, concurrent with multiple mumps virus outbreaks across North America. Traditional genotyping of mumps outbreaks relies on sequencing a portion of the small hydrophobic (SH) gene, but has limited capability to distinguish between strains of the same genotype. Most mumps cases in Ontario in recent years are of genotype G. We used a novel whole genome sequencing (WGS) protocol to perform a molecular epidemiological investigation of the outbreak. Methods Throat (n = 5) and buccal (n = 15) swabs positive by RT-PCR for SH or Fusion (F) gene targets were cultured in primary Rhesus monkey kidney cells. Cell free viral extract underwent RT-PCR and subsequent PCR amplification using overlapping primer pairs to cover the entire 15 kilobase (kb) genome. The first 8 samples were amplified with 18 pairs of overlapping primers, which was reduced to 9 sets (average fragment size 1.9 kb, range 1.6–2.8 kb) for the final 12 samples. Mumps cDNA libraries were prepared with Nextera XT kit and WGS of the indexed fragments was performed with V2 reagent kits on the Illumina MiSeq instrument. Reference based genome assembly was performed using samtools version 1.4. Phylogenetic analysis was performed by maximum likelihood method in MEGA7. Results We identified two distinct genotype G lineages comprised of 9 patients each and closely related to a 2009–2010 outbreak in Ontario and New York (Figure 1). Inter-lineage single nucleotide polymorphism (SNP) differences ranged from 25 to 31, whereas intra-lineage SNPs ranged from 0 to 8 SNPs. Two outlying sequences, of genotype C and G respectively, may represent sporadic introduction of virus from other areas. Time from virus isolation to SNP based analysis was approximately 4 days. Conclusion WGS of Mumps virus culture isolates using the PCR fragment method identified two distinct genotype G lineages in a large provincial outbreak. This method may aid public health authorities identify separate transmission chains in the case of large outbreaks. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Patrick Stapleton
- Public Health Ontario Laboratories, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Mark Cardona
- Public Health Ontario Laboratories, Toronto, ON, Canada
| | - Steve Masney
- Public Health Ontario Laboratories, Toronto, ON, Canada
| | - Aimin Li
- Public Health Ontario Laboratories, Toronto, ON, Canada
| | - Jonathan Gubbay
- Public Health Ontario Laboratories, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Samir Patel
- Public Health Ontario Laboratories, Toronto, ON, Canada
- Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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12
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Eshaghi A, Duvvuri VR, Isabel S, Banh P, Li A, Peci A, Patel SN, Gubbay JB. Global Distribution and Evolutionary History of Enterovirus D68, with Emphasis on the 2014 Outbreak in Ontario, Canada. Front Microbiol 2017; 8:257. [PMID: 28298902 PMCID: PMC5331033 DOI: 10.3389/fmicb.2017.00257] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/07/2017] [Indexed: 11/25/2022] Open
Abstract
Despite its first appearance in 1962, human enterovirus D68 (EV-D68) has been recognized as an emerging respiratory pathogen in the last decade when it caused outbreaks and clusters in several countries including Japan, the Philippines, and the Netherlands. The most recent and largest outbreak of EV-D68 associated with severe respiratory illness took place in North America between August 2014 and January 2015. Between September 1 and October 31 2014, EV-D68 infection was laboratory confirmed among 153/907 (16.9%) persons tested for the virus in Ontario, Canada, using real time RT-PCR and subsequent genotyping by sequencing of partial VP1 gene. In order to understand the evolutionary history of the 2014 North American EV-D68 outbreak, we conducted phylogenetic and phylodynamic analyses using available partial VP1 genes (n = 469) and NCBI available whole genome sequences (WGS) (n = 38). The global EV-D68 phylogenetic tree (n = 469) reconfirms the divergence of three distinct clades A, B, and C from the prototype EV-D68 Fermon strain as previously documented. Two sub-clades (B1 and B2) were identified, with most 2014 EV-D68 outbreak strains belonging to sub-cluster B2b2 (one of the two emerging clusters within sub-clade B2), with two signature substitutions T650A and M700V in BC and DE loops of VP1 gene, respectively. The close homology between WGS of strains from Ontario (n = 2) and USA (n = 21) in the recent EV-D68 outbreak suggests genetic relatedness and also a common source for the outbreak. The time of most recent common ancestor of EV-D68 and the 2014 EV-D68 outbreak strain suggest that the viruses possibly emerged during 1960-1961 and 2012-2013, respectively. We observed lower mean evolutionary rates of global EV-D68 using WGS data than estimated with partial VP1 gene sequences. Based on WGS data, the estimated mean rate of evolution of the EV-D68 B2b cluster was 9.75 × 10-3 substitutions/site/year (95% BCI 4.11 × 10-3 to 16 × 10-3).
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Affiliation(s)
- Alireza Eshaghi
- Department of Clinical Laboratory and Microbiology Sciences, Public Health Ontario, TorontoON, Canada
| | - Venkata R. Duvvuri
- Department of Clinical Laboratory and Microbiology Sciences, Public Health Ontario, TorontoON, Canada
| | - Sandra Isabel
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, TorontoON, Canada
| | - Philip Banh
- Department of Clinical Laboratory and Microbiology Sciences, Public Health Ontario, TorontoON, Canada
| | - Aimin Li
- Department of Clinical Laboratory and Microbiology Sciences, Public Health Ontario, TorontoON, Canada
| | - Adriana Peci
- Department of Clinical Laboratory and Microbiology Sciences, Public Health Ontario, TorontoON, Canada
| | - Samir N. Patel
- Department of Clinical Laboratory and Microbiology Sciences, Public Health Ontario, TorontoON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, TorontoON, Canada
| | - Jonathan B. Gubbay
- Department of Clinical Laboratory and Microbiology Sciences, Public Health Ontario, TorontoON, Canada
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, TorontoON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, TorontoON, Canada
- Department of Microbiology, Mount Sinai Hospital, TorontoON, Canada
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Kariyawasam R, Lau R, Eshaghi A, Patel SN, Sider D, Gubbay JB, Boggild AK. Spectrum of Viral Pathogens in Blood of Malaria-Free Ill Travelers Returning to Canada. Emerg Infect Dis 2016; 22:854-61. [PMID: 27089008 PMCID: PMC4861526 DOI: 10.3201/eid2205.151875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Malaria is the most common specific cause of fever in returning travelers, but many other vectorborne infections and viral infections are emerging and increasingly encountered by travelers. We documented common and emerging viral pathogens in malaria-negative specimens from ill travelers returning to Canada. Anonymized, malaria-negative specimens were examined for various viral pathogens by real-time PCR. Samples were positive for herpes simplex viruses 1 or 2 (n = 21, 1.6%), cytomegalovirus (n = 4, 0.3%), Epstein-Barr virus (n = 194, 14.9%), dengue virus types 1-4 (n = 27, 2.1%), chikungunya virus (n = 5, 0.4%), and hepatitis A virus (n = 12, 0.9%). Travel-acquired viral pathogens were documented in >20% of malaria-negative specimens, of which 2.5% were infected with dengue and chikungunya viruses. Our findings support the anecdotal impression that these vectorborne pathogens are emerging among persons who travel from Canada to other countries.
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14
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Candon H, Matukas L, Patel S, Melano R, Tijet N, Eshaghi A, Mcgeer A, Johnstone J. Transmission of Verona Integron-Encoded Metallo-β-Lactamase-Producing Enterobacteriaceae Over a Two-Year Period Linked to Contaminated Drains. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Heather Candon
- Infection Control, St. Joseph's Health Centre, Toronto, ON, Canada
| | | | - Samir Patel
- Public Health Ontario Laboratories, Toronto, Ontario, Canada
| | - Roberto Melano
- Public Health Ontario Laboratories, Toronto, Ontario, Canada
| | - Nathalie Tijet
- Public Health Ontario Laboratories, Toronto, Ontario, Canada
| | - Alireza Eshaghi
- Public Health Ontario Laboratories, Toronto, Ontario, Canada
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Chambers C, Skowronski DM, Sabaiduc S, Winter AL, Dickinson JA, De Serres G, Gubbay JB, Drews SJ, Martineau C, Eshaghi A, Krajden M, Bastien N, Li Y. Interim estimates of 2015/16 vaccine effectiveness against influenza A(H1N1)pdm09, Canada, February 2016. ACTA ACUST UNITED AC 2016; 21:30168. [PMID: 27020673 DOI: 10.2807/1560-7917.es.2016.21.11.30168] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 03/17/2016] [Indexed: 11/20/2022]
Abstract
Using a test-negative design, the Canadian Sentinel Practitioner Surveillance Network (SPSN) assessed interim 2015/16 vaccine effectiveness (VE) against influenza A(H1N1)pdm09 viruses. Adjusted VE showed significant protection of 64% (95% confidence interval (CI): 44-77%) overall and 56% (95%CI: 26-73%) for adults between 20 and 64 years-old against medically attended, laboratory-confirmed A(H1N1)pdm09 illness. Among the 67 A(H1N1)pdm09-positive specimens that were successfully sequenced, 62 (> 90%) belonged to the emerging genetic 6B.1 subclade, defined by S162N (potential gain of glycosylation) and I216T mutations in the haemagglutinin protein. Findings from the Canadian SPSN indicate that the 2015/16 northern hemisphere vaccine provided significant protection against A(H1N1)pdm09 illness despite genetic evolution in circulating viruses.
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16
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Skowronski DM, Sabaiduc S, Chambers C, Eshaghi A, Gubbay JB, Krajden M, Drews SJ, Martineau C, De Serres G, Dickinson JA, Winter AL, Bastien N, Li Y. Mutations acquired during cell culture isolation may affect antigenic characterisation of influenza A(H3N2) clade 3C.2a viruses. ACTA ACUST UNITED AC 2016; 21:30112. [PMID: 26836031 DOI: 10.2807/1560-7917.es.2016.21.3.30112] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 01/21/2016] [Indexed: 11/20/2022]
Abstract
As elsewhere, few (< 15%) sentinel influenza A(H3N2) clade 3C.2a viruses that dominated in Canada during the 2014/15 season could be antigenically characterised by haemagglutination inhibition (HI) assay. Clade 3C.2a viruses that could be HI-characterised had acquired genetic mutations during in vitro cell culture isolation that modified the potential glycosylation motif found in original patient specimens and the consensus sequence of circulating viruses at amino acid positions 158-160 of the haemagglutinin protein. Caution is warranted in extrapolating antigenic relatedness based on limited HI findings for clade 3C.2a viruses that continue to circulate globally.
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17
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Skowronski DM, Chambers C, Sabaiduc S, De Serres G, Winter AL, Dickinson JA, Krajden M, Gubbay JB, Drews SJ, Martineau C, Eshaghi A, Kwindt TL, Bastien N, Li Y. A Perfect Storm: Impact of Genomic Variation and Serial Vaccination on Low Influenza Vaccine Effectiveness During the 2014-2015 Season. Clin Infect Dis 2016; 63:21-32. [PMID: 27025838 PMCID: PMC4901864 DOI: 10.1093/cid/ciw176] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/07/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The 2014-2015 influenza season was distinguished by an epidemic of antigenically-drifted A(H3N2) viruses and vaccine components identical to 2013-2014. We report 2014-2015 vaccine effectiveness (VE) from Canada and explore contributing agent-host factors. METHODS VE against laboratory-confirmed influenza was derived using a test-negative design among outpatients with influenza-like illness. Sequencing identified amino acid mutations at key antigenic sites of the viral hemagglutinin protein. RESULTS Overall, 815/1930 (42%) patients tested influenza-positive: 590 (72%) influenza A and 226 (28%) influenza B. Most influenza A viruses with known subtype were A(H3N2) (570/577; 99%); 409/460 (89%) sequenced viruses belonged to genetic clade 3C.2a and 39/460 (8%) to clade 3C.3b. Dominant clade 3C.2a viruses bore the pivotal mutations F159Y (a cluster-transition position) and K160T (a predicted gain of glycosylation) compared to the mismatched clade 3C.1 vaccine. VE against A(H3N2) was -17% (95% confidence interval [CI], -50% to 9%) overall with clade-specific VE of -13% (95% CI, -51% to 15%) for clade 3C.2a but 52% (95% CI, -17% to 80%) for clade 3C.3b. VE against A(H3N2) was 53% (95% CI, 10% to 75%) for patients vaccinated in 2014-2015 only, significantly lower at -32% (95% CI, -75% to 0%) if also vaccinated in 2013-2014 and -54% (95% CI, -108% to -14%) if vaccinated each year since 2012-2013. VE against clade-mismatched B(Yamagata) viruses was 42% (95% CI, 10% to 62%) with less-pronounced reduction from prior vaccination compared to A(H3N2). CONCLUSIONS Variation in the viral genome and negative effects of serial vaccination likely contributed to poor influenza vaccine performance in 2014-2015.
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Affiliation(s)
- Danuta M Skowronski
- British Columbia Centre for Disease Control
- University of British Columbia, Vancouver
| | | | | | - Gaston De Serres
- Institut National de Santé Publique du Québec
- Laval University
- Centre Hospitalier Universitaire de Québec
| | | | | | - Mel Krajden
- British Columbia Centre for Disease Control
- University of British Columbia, Vancouver
| | | | - Steven J Drews
- University of Alberta
- Alberta Provincial Laboratory, Edmonton
| | | | | | | | - Nathalie Bastien
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg
| | - Yan Li
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg
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18
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Duvvuri VR, Granados A, Rosenfeld P, Bahl J, Eshaghi A, Gubbay JB. Genetic diversity and evolutionary insights of respiratory syncytial virus A ON1 genotype: global and local transmission dynamics. Sci Rep 2015; 5:14268. [PMID: 26420660 PMCID: PMC4588507 DOI: 10.1038/srep14268] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/21/2015] [Indexed: 12/04/2022] Open
Abstract
Human respiratory syncytial virus (RSV) A ON1 genotype, first detected in 2010 in Ontario, Canada, has been documented in 21 countries to date. This study investigated persistence and transmission dynamics of ON1 by grouping 406 randomly selected RSV-positive specimens submitted to Public Health Ontario from August 2011 to August 2012; RSV-A-positive specimens were genotyped. We identified 370 RSV-A (181 NA1, 135 NA2, 51 ON1 3 GA5) and 36 RSV-B positive specimens. We aligned time-stamped second hypervariable region (330 bp) of G-gene sequence data (global, n = 483; and Ontario, n = 60) to evaluate transmission dynamics. Global data suggests that the most recent common ancestor of ON1 emerged during the 2008–2009 season. Mean evolutionary rate of the global ON1 was 4.10 × 10−3 substitutions/site/year (95% BCI 3.1–5.0 × 10−3), not significantly different to that of Ontario ON1. The estimated mean reproductive number (R0 = ∼ 1.01) from global and Ontario sequences showed no significant difference and implies stability among global RSV-A ON1. This study suggests that local epidemics exhibit similar underlying evolutionary and epidemiological dynamics to that of the persistent global RSV-A ON1 population. These findings underscore the importance of continual molecular surveillance of RSV in order to gain a better understanding of epidemics.
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Affiliation(s)
- Venkata R Duvvuri
- Public Health Ontario, Toronto, Ontario, Canada.,University of Waterloo, Waterloo, Ontario, Canada (MPH student)
| | - Andrea Granados
- Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Ontario, Canada
| | | | - Justin Bahl
- Center for Infectious Diseases, The University of Texas School of Public Health, Houston, Texas, United States of America
| | | | - Jonathan B Gubbay
- Public Health Ontario, Toronto, Ontario, Canada.,University of Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
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19
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Riley A, Eshaghi A, Olsha R, Allen VG, Patel SN. Antibiotic susceptibility of clinical isolates of Campylobacter jejuni and Campylobacter coli in Ontario, Canada during 2011-2013. Diagn Microbiol Infect Dis 2015; 83:292-4. [PMID: 26320936 DOI: 10.1016/j.diagmicrobio.2015.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 04/24/2015] [Revised: 07/07/2015] [Accepted: 07/26/2015] [Indexed: 01/09/2023]
Abstract
A total of 219 clinical isolates of Campylobacter spp. including 180 Campylobacter jejuni and 39 Campylobacter coli were assessed for in vitro antimicrobial susceptibility. Resistance among C. coli was higher for ciprofloxacin (41% versus 30.80%), erythromycin (12.80% versus 3.90%) and lower for tetracycline (53.80% versus 64.60%) compared to C. jejuni.
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Affiliation(s)
- Andrew Riley
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Canada
| | - Alireza Eshaghi
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Canada
| | - Romy Olsha
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Canada
| | - Vanessa G Allen
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Samir N Patel
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.
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20
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Skowronski DM, Chambers C, Sabaiduc S, De Serres G, Winter AL, Dickinson JA, Gubbay J, Fonseca K, Charest H, Krajden M, Petric M, Mahmud SM, Van Caeseele P, Bastien N, Eshaghi A, Li Y. Integrated Sentinel Surveillance Linking Genetic, Antigenic, and Epidemiologic Monitoring of Influenza Vaccine-Virus Relatedness and Effectiveness During the 2013-2014 Influenza Season. J Infect Dis 2015; 212:726-39. [PMID: 25784728 DOI: 10.1093/infdis/jiv177] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/04/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Canada's Sentinel Physician Surveillance Network links genetic, antigenic, and vaccine effectiveness (VE) measures in an integrated platform of influenza monitoring, described here for the 2013-2014 influenza season of resurgent A(H1N1)pdm09 and late-season type B activity. METHODS VE was estimated as [1 - odds ratio] × 100% and compared vaccination status between individuals who tested positive (cases) and those who tested negative (controls) for influenza virus. Vaccine-virus relatedness was assessed by genomic sequence analysis and hemagglutination inhibition assays. RESULTS Analyses included 1037 controls (of whom 33% were vaccinated) and 663 cases (of whom 14% were vaccinated). A total of 415 cases tested positive for A(H1N1)pdm09 virus, 15 tested positive for A(H3N2) virus, 191 tested positive for B/Yamagata-lineage virus, 6 tested positive for B/Victoria-lineage virus, and 36 tested positive for viruses of unknown subtype or lineage. A(H1N1)pdm09 viruses belonged to clade 6B, distinguished by a K163Q substitution, but remained antigenically similar to the A/California/07/2009-like vaccine strain, with an adjusted VE of 71% (95% confidence interval [CI], 58%-80%). Most B/Yamagata-lineage viruses (83%) clustered phylogenetically with the prior (ie, 2012-2013) season's B/Wisconsin/01/2010-like clade 3 vaccine strain, while only 17% clustered with the current (ie, 2013-2014) season's B/Massachusetts/02/2012-like clade 2 vaccine strain. The adjusted VE for B/Yamagata-lineage virus was 73% (95% CI, 57%-84%), with a lower VE obtained after partial calendar-time adjustment for clade-mismatched B/Wisconsin/01/2010-like virus (VE, 63%; 95% CI, 41%-77%), compared with that for clade-matched B/Massachusetts/02/2012-like virus (VE, 88%; 95% CI, 48%-97%). No A(H3N2) viruses clustered with the A/Texas/50/2012-like clade 3C.1 vaccine strain, and more than half were antigenically mismatched, but sparse data did not support VE estimation. CONCLUSIONS VE corresponded with antigenically conserved A(H1N1)pdm09 and lineage-matched B/Yamagata viruses with clade-level variation. Surveillance linking genotypic, phenotypic, and epidemiologic measures of vaccine-virus relatedness and effectiveness could better inform predictions of vaccine performance and reformulation.
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Affiliation(s)
- Danuta M Skowronski
- British Columbia Centre for Disease Control University of British Columbia, Vancouver
| | | | | | - Gaston De Serres
- Institut national de santé publique du Québec Laval University, Québec
| | | | | | | | - Kevin Fonseca
- University of Calgary Provincial Laboratory of Public Health, Calgary, Alberta
| | - Hugues Charest
- Institut national de santé publique du Québec Universite de Montréal, Québec
| | - Mel Krajden
- British Columbia Centre for Disease Control University of British Columbia, Vancouver
| | | | | | | | | | | | - Yan Li
- University of Manitoba National Microbiology Laboratory, Winnipeg, Canada
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21
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Eshaghi A, Shahinas D, Patel SN, Kus JV. First draft genome sequence of Aureimonas altamirensis, isolated from patient blood culture. FEMS Microbiol Lett 2015; 362:fnv016. [PMID: 25714548 DOI: 10.1093/femsle/fnv016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Aureimonas altamirensis (A. altamirensis) is a recently described aerobic Gram-negative bacillus related to Brucella species, which is a potential opportunistic pathogen of humans. Aureimonas altamirensis ON-56566 was isolated from the blood culture of a patient who presented with cellulitis. This brief report describes a short case report and the first draft genome (13 contigs) of A. altamirensis ON-56566 which consists of 4,202,944 nucleotides with G+C content of 65.2%.
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Affiliation(s)
| | - Dea Shahinas
- Public Health Ontario, Toronto, Ontario, Canada M5G 1M1
| | - Samir N Patel
- Public Health Ontario, Toronto, Ontario, Canada M5G 1M1 Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada M9P 3T1
| | - Julianne V Kus
- Public Health Ontario, Toronto, Ontario, Canada M5G 1M1 Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada M9P 3T1
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22
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Skowronski DM, Chambers C, Sabaiduc S, De Serres G, Dickinson JA, Winter AL, Drews SJ, Fonseca K, Charest H, Gubbay JB, Petric M, Krajden M, Kwindt TL, Martineau C, Eshaghi A, Bastien N, Li Y. Interim estimates of 2014/15 vaccine effectiveness against influenza A(H3N2) from Canada's Sentinel Physician Surveillance Network, January 2015. ACTA ACUST UNITED AC 2015; 20. [PMID: 25655053 DOI: 10.2807/1560-7917.es2015.20.4.21022] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- D M Skowronski
- British Columbia Centre for Disease Control, Vancouver, Canada
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23
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Skowronski DM, Janjua NZ, De Serres G, Sabaiduc S, Eshaghi A, Dickinson JA, Fonseca K, Winter AL, Gubbay JB, Krajden M, Petric M, Charest H, Bastien N, Kwindt TL, Mahmud SM, Van Caeseele P, Li Y. Low 2012-13 influenza vaccine effectiveness associated with mutation in the egg-adapted H3N2 vaccine strain not antigenic drift in circulating viruses. PLoS One 2014; 9:e92153. [PMID: 24667168 PMCID: PMC3965421 DOI: 10.1371/journal.pone.0092153] [Citation(s) in RCA: 313] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 02/17/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Influenza vaccine effectiveness (VE) is generally interpreted in the context of vaccine match/mismatch to circulating strains with evolutionary drift in the latter invoked to explain reduced protection. During the 2012-13 season, however, detailed genotypic and phenotypic characterization shows that low VE was instead related to mutations in the egg-adapted H3N2 vaccine strain rather than antigenic drift in circulating viruses. METHODS/FINDINGS Component-specific VE against medically-attended, PCR-confirmed influenza was estimated in Canada by test-negative case-control design. Influenza A viruses were characterized genotypically by amino acid (AA) sequencing of established haemagglutinin (HA) antigenic sites and phenotypically through haemagglutination inhibition (HI) assay. H3N2 viruses were characterized in relation to the WHO-recommended, cell-passaged vaccine prototype (A/Victoria/361/2011) as well as the egg-adapted strain as per actually used in vaccine production. Among the total of 1501 participants, influenza virus was detected in 652 (43%). Nearly two-thirds of viruses typed/subtyped were A(H3N2) (394/626; 63%); the remainder were A(H1N1)pdm09 (79/626; 13%), B/Yamagata (98/626; 16%) or B/Victoria (54/626; 9%). Suboptimal VE of 50% (95%CI: 33-63%) overall was driven by predominant H3N2 activity for which VE was 41% (95%CI: 17-59%). All H3N2 field isolates were HI-characterized as well-matched to the WHO-recommended A/Victoria/361/2011 prototype whereas all but one were antigenically distinct from the egg-adapted strain as per actually used in vaccine production. The egg-adapted strain was itself antigenically distinct from the WHO-recommended prototype, and bore three AA mutations at antigenic sites B [H156Q, G186V] and D [S219Y]. Conversely, circulating viruses were identical to the WHO-recommended prototype at these positions with other genetic variation that did not affect antigenicity. VE was 59% (95%CI:16-80%) against A(H1N1)pdm09, 67% (95%CI: 30-85%) against B/Yamagata (vaccine-lineage) and 75% (95%CI: 29-91%) against B/Victoria (non-vaccine-lineage) viruses. CONCLUSIONS These findings underscore the need to monitor vaccine viruses as well as circulating strains to explain vaccine performance. Evolutionary drift in circulating viruses cannot be regulated, but influential mutations introduced as part of egg-based vaccine production may be amenable to improvements.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Canada
- Case-Control Studies
- Child
- Child, Preschool
- DNA, Viral/genetics
- Female
- Hemagglutinin Glycoproteins, Influenza Virus/genetics
- Hemagglutinin Glycoproteins, Influenza Virus/immunology
- Humans
- Immunization
- Infant
- Infant, Newborn
- Influenza A Virus, H3N2 Subtype/genetics
- Influenza A Virus, H3N2 Subtype/immunology
- Influenza A Virus, H3N2 Subtype/isolation & purification
- Influenza Vaccines/administration & dosage
- Influenza Vaccines/immunology
- Influenza, Human/genetics
- Influenza, Human/immunology
- Influenza, Human/prevention & control
- Influenza, Human/virology
- Male
- Middle Aged
- Molecular Sequence Data
- Mutation/genetics
- Protein Conformation
- Seasons
- Young Adult
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Affiliation(s)
- Danuta M. Skowronski
- Communicable Disease Prevention and Control Service, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naveed Z. Janjua
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Gaston De Serres
- Department of Biological and Occupational Risks, Institut National de Santé Publique du Québec, Québec (Québec), Canada
- Department of Social and Preventive Medicine, Laval University, Québec (Québec), Canada
| | - Suzana Sabaiduc
- Communicable Disease Prevention and Control Service, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Alireza Eshaghi
- Department of Molecular Research, Public Health Ontario, Toronto, Ontario, Canada
| | - James A. Dickinson
- Family Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Fonseca
- Department of Virology, Provincial Laboratory of Public Health, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Anne-Luise Winter
- Communicable Disease Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada
| | - Jonathan B. Gubbay
- Department of Microbiology, Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mel Krajden
- Communicable Disease Prevention and Control Service, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Martin Petric
- Communicable Disease Prevention and Control Service, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Hugues Charest
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada
- Département De Microbiologie, Infectiologie et Immunologie, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada
| | - Nathalie Bastien
- Influenza and Respiratory Virus Section, National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Trijntje L. Kwindt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Salaheddin M. Mahmud
- Community Health Sciences and Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Van Caeseele
- Cadham Provincial Laboratory, Manitoba Health, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Yan Li
- Influenza and Respiratory Virus Section, National Microbiology Laboratory, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
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Skowronski D, Chambers C, Sabaiduc S, De Serres G, Dickinson J, Winter A, Fonseca K, Gubbay J, Charest H, Petric M, Krajden M, Mahmud S, Van Caeseele P, Kwindt T, Eshaghi A, Bastien N, Li Y. Interim estimates of 2013/14 vaccine effectiveness against influenza A(H1N1)pdm09 from Canada s sentinel surveillance network, January 2014. ACTA ACUST UNITED AC 2014; 19. [PMID: 24524234 DOI: 10.2807/1560-7917.es2014.19.5.20690] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The 2013/14 influenza season to date in Canada has been characterised by predominant (90%) A(H1N1)pdm09 activity. Vaccine effectiveness (VE) was assessed in January 2014 by Canada's sentinel surveillance network using a test-negative case-control design. Interim adjusted-VE against medically-attended laboratory-confirmed influenza A(H1N1)pdm09 infection was 74% (95% CI: 58-83). Relative to vaccine, A(H1N1)pdm09 viruses were antigenically similar and genetically well conserved, with most showing just three mutations across the 50 amino acids comprising antigenic sites of the haemagglutinin protein.
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Affiliation(s)
- Dm Skowronski
- British Columbia Centre for Disease Control, Vancouver, Canada
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Eshaghi A, Duvvuri VR, Li A, Patel SN, Bastien N, Li Y, Low DE, Gubbay JB. Genetic characterization of seasonal influenza A (H3N2) viruses in Ontario during 2010-2011 influenza season: high prevalence of mutations at antigenic sites. Influenza Other Respir Viruses 2013; 8:250-7. [PMID: 24313991 PMCID: PMC4186474 DOI: 10.1111/irv.12219] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The direct effect of antigenic site mutations in influenza viruses on antigenic drift and vaccine effectiveness is poorly understood. OBJECTIVE To investigate the genetic and antigenic characteristics of human influenza A (H3N2) viruses circulating in Ontario during the early 2010-2011 winter season. STUDY DESIGN We sequenced the hemagglutinin (HA) and neuraminidase (NA) genes from 41 A(H3N2) viruses detected in nasopharyngeal specimens. Strain typing was performed by hemagglutination inhibition (HI) assay. Molecular and phylogenetic tree analyses were conducted. RESULTS HA and NA genes showed high similarity to the 2010-2011 vaccine strain, A/Perth/16/2009 (H3N2)-like virus (97·7-98·5% and 98·7-99·5% amino acid (AA) identity, respectively). Compared to A/Perth/16/2009 strain, HA gene mutations were documented at 28 different AA positions across all five H3 antigenic sites, with a range of 5-11 mutations in individual viruses. Thirty-six (88%) viruses had 8 AA substitutions in common; none of these had reduced HI titer. Among Ontario isolates, 11 antigenic site AAs were positively selected with an increase in glycosylation sites. CONCLUSION The presence of antigenic site mutations with high frequency among 2010-2011 influenza H3N2 isolates confirms ongoing adaptive H3N2 evolution. These may represent early phylogenetic changes that could cause antigenic drift with further mutations. Clinical relevance of antigenic site mutations not causing drift in HI assays is unknown and requires further investigation. In addition, viral sequencing information will assist with vaccine strain planning and may facilitate early detection of vaccine escape.
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Affiliation(s)
- Alireza Eshaghi
- Ontario Agency for Health Protection and Promotion, Toronto, ON, Canada
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26
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Skowronski DM, Janjua NZ, De Serres G, Dickinson JA, Winter AL, Mahmud SM, Sabaiduc S, Gubbay JB, Charest H, Petric M, Fonseca K, Van Caeseele P, Kwindt TL, Krajden M, Eshaghi A, Li Y. Interim estimates of influenza vaccine effectiveness in 2012/13 from Canada's sentinel surveillance network, January 2013. ACTA ACUST UNITED AC 2013; 18. [PMID: 23399422 DOI: 10.2807/ese.18.05.20394-en] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The 2012/13 influenza season in Canada has been characterised to date by early and moderately severe activity, dominated (90%) by the A(H3N2) subtype. Vaccine effectiveness (VE) was assessed in January 2013 by Canada's sentinel surveillance network using a test-negative case-control design. Interim adjusted-VE against medically attended laboratory-confirmed influenza A(H3N2) infection was 45% (95% CI: 13-66). Influenza A(H3N2) viruses in Canada are similar to the vaccine, based on haemagglutination inhibition; however, antigenic site mutations are described in the haemagglutinin gene.
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Affiliation(s)
- D M Skowronski
- British Columbia Centre for Disease Control, Vancouver, Canada.
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27
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Borgia S, Lastovetska O, Richardson D, Eshaghi A, Xiong J, Chung C, Baqi M, McGeer A, Ricci G, Sawicki R, Pantelidis R, Low DE, Patel SN, Melano RG. Outbreak of carbapenem-resistant enterobacteriaceae containing blaNDM-1, Ontario, Canada. Clin Infect Dis 2012; 55:e109-17. [PMID: 22997214 DOI: 10.1093/cid/cis737] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND New Delhi metallo-ß-lactamase (NDM) has emerged worldwide in clinically relevant gram-negative bacteria. We report an outbreak of NDM-producing Klebsiella pneumoniae in patients with no prior travel history to endemic regions. METHODS Five NDM-1-producing K. pneumoniae colonizing and/or clinically infecting patients in a community tertiary hospital were detected between October and November 2011. NDM-1-producing Enterobacteriaceae (K. pneumoniae and Escherichia coli) were clinically and epidemiologically characterized, including susceptibility profiles, molecular typing, and molecular characterization of plasmids and resistant determinants. RESULTS Five patients were identified carrying NDM-1-producing K. pneumoniae, all of them epidemiologically linked with each other. K. pneumoniae were confirmed to belong to the same clone, exhibiting multidrug-resistant phenotypes. One patient was positive for NDM-1-producing E. coli in blood and E. coli and K. pneumoniae in rectal specimens, both containing the same bla(NDM) plasmid, suggesting horizontal transfer between species in the patient. No environmental sources of these strains were found. Detection of positive isolates directly from rectal specimens allowed the rapid identification and isolation of colonized patients. CONCLUSIONS We report a NDM-1-producing K. pneumoniae outbreak in Ontario, Canada. Implementation of standard infection control practices, including active screening was able to contain the spread of this organism in the hospital setting. Of concern is the potential loss of a travel history to identify patients that are at high risk of being colonized or infected with this organism and the lack of an accurate, cost-effective test that can be implemented in the hospital setting to identify these multidrug-resistant organisms.
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Affiliation(s)
- Sergio Borgia
- Division of Infectious Diseases, William Osler Health System, Brampton, Canada
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28
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Sahraian MA, Radue EW, Eshaghi A, Besliu S, Minagar A. Progressive multifocal leukoencephalopathy: a review of the neuroimaging features and differential diagnosis. Eur J Neurol 2011; 19:1060-9. [PMID: 22136455 DOI: 10.1111/j.1468-1331.2011.03597.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Progressive multifocal leukoencephalopathy (PML) is an uncommon and often fatal demyelinating disease of human central nervous system, which is caused by reactivation of the polyomavirus JC (JCV). PML generally occurs in patients with profound immunosuppression such as AIDS patients. Recently, a number of PML cases have been associated with administration of natalizumab for treatment of multiple sclerosis (MS) patients. Diagnosis and management of PML became a major concern after its occurrence in multiple sclerosis patients treated with natalizumab. Diagnosis of PML usually rests on neuroimaging in the appropriate clinical context and is further confirmed by cerebrospinal fluid polymerase chain reaction (PCR) for JCV DNA. Treatment with antiretroviral therapies in HIV-seropositive patients or discontinuing natalizumab in MS patients with PML may lead to the development of immune reconstitution inflammatory syndrome (IRIS) which presents with deterioration of the previous symptoms and may lead to death. In patients under treatment with monoclonal antibodies in routine practice, or new ones in ongoing clinical trials, differentiating PML from new MS lesions on brain MRI is critical for both the neurologists and neuroradiologists. In this review, we discuss the clinical features, neuroimaging manifestations of PML, IRIS and neuroimaging clues to differentiate new MS lesions from PML. In addition, various neuroimaging features of PML on the non-conventional MR techniques such as diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), and MR spectroscopy (MRS) are discussed.
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Affiliation(s)
- M A Sahraian
- Sina MS Research Center, Brain and Spinal Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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29
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Longtin J, Marchand-Austin A, Winter AL, Patel S, Eshaghi A, Jamieson F, Low DE, Gubbay JB. Rhinovirus outbreaks in long-term care facilities, Ontario, Canada. Emerg Infect Dis 2010; 16:1463-5. [PMID: 20735934 PMCID: PMC3294989 DOI: 10.3201/eid1609.100476] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Diagnostic difficulties may have led to underestimation of rhinovirus infections in long-term care facilities. Using surveillance data, we found that rhinovirus caused 59% (174/297) of respiratory outbreaks in these facilities during 6 months in 2009. Disease was sometimes severe. Molecular diagnostic testing can differentiate these outbreaks from other infections such as influenza.
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Affiliation(s)
- Jean Longtin
- Ontario Agency for Health Protection and Promotion, Toronto, Ontario, Canada.
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Longtin J, Winter AL, Heng D, Marchand-Austin A, Eshaghi A, Patel S, Jamieson F, Weir E, Low DE, Gubbay JB. Severe human rhinovirus outbreak associated with fatalities in a long-term care facility in Ontario, Canada. J Am Geriatr Soc 2010; 58:2036-8. [PMID: 20929481 PMCID: PMC7166897 DOI: 10.1111/j.1532-5415.2010.03091.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Eshaghi A, Blair J, Burton L, Lombos E, Choi K, De Lima C, Drews SJ. A paucity of co-infecting respiratory viral pathogens in nasopharyngeal specimens from patients infected with H274Y-positive influenza A (H1N1) strains. Int J Infect Dis 2009; 13:e319-20. [PMID: 19095481 PMCID: PMC7129537 DOI: 10.1016/j.ijid.2008.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 07/28/2008] [Indexed: 11/17/2022] Open
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Bolotin S, Lombos E, Yeung R, Eshaghi A, Blair J, Drews SJ. Verification of the Combimatrix influenza detection assay for the detection of influenza A subtype during the 2007-2008 influenza season in Toronto, Canada. Virol J 2009; 6:37. [PMID: 19321005 PMCID: PMC2664794 DOI: 10.1186/1743-422x-6-37] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 03/25/2009] [Indexed: 11/13/2022] Open
Abstract
The increase in adamantine resistance in influenza A (H3N2) and the emergence of oseltamivir resistance in influenza A (H1N1) has necessitated the use of rapid methodologies to detect influenza subtype. The purpose of this study was to evaluate the CombiMatrix influenza detection system compared to the FDA approved Luminex Respiratory virus panel (RVP) assay for influenza A subtyping. Verification of the CombiMatrix influenza detection system was carried out using the Luminex RVP assay as a reference method. A limit of detection (LOD) series was performed using the Luminex and CombiMatrix systems with both influenza A H3N2 and H1N1 viruses. Seventy-five clinical specimens were used in the study. Of these, 16 were influenza A (H3N2) positive and five were influenza A (H1N1) positive. Fifty-four specimens were influenza A negative or "no call" (inconclusive) or could not be subtyped. The LOD of the Luminex RVP assay was found to be 0.3 TCID50s/mL for influenza A (H3N2) and 16 TCID50s/mL for influenza A (H1N1). The LOD of the CombiMatrix influenza detection system was 200 TCID50s/mL for influenza A (H3N2) and 16 000 TCID50s/mL for influenza A (H1N1). The sensitivity of the CombiMatrix influenza detection system was 95.2% and the specificity was 100%. The CombiMatrix influenza detection system is an effective methodology for influenza A subtype analysis, specifically in laboratories with a constrained budget or limited molecular capabilities.
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Affiliation(s)
- Shelly Bolotin
- Ontario Agency for Health Protection and Promotion, 81 Resources Road, Toronto, Ontario, M9P 3T1, Canada.
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34
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Bolotin S, Robertson AV, Eshaghi A, De Lima C, Lombos E, Chong-King E, Burton L, Mazzulli T, Drews SJ. Development of a novel real-time reverse-transcriptase PCR method for the detection of H275Y positive influenza A H1N1 isolates. J Virol Methods 2009; 158:190-4. [PMID: 19428589 PMCID: PMC7119558 DOI: 10.1016/j.jviromet.2009.01.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 01/15/2009] [Accepted: 01/21/2009] [Indexed: 11/10/2022]
Abstract
During the 2007–2008 influenza season global strain surveillance for antiviral resistance revealed the sudden emergence of oseltamivir resistance in influenza A H1N1 isolates. Although oseltamivir resistance rates vary from region to region, 16% of isolates tested globally were found to be oseltamivir resistant by a histidine to tyrosine mutation of residue 275 of the neuraminidase gene of influenza A. In order to implement effective resistance testing locally a novel real-time reverse-transcriptase PCR (RT-PCR) assay was developed for the detection of the H275Y mutation. To evaluate this method, 40 oseltamivir resistant and 61 oseltamivir sensitive H1N1 influenza isolates were tested using Sanger sequencing, which is the reference method for detection of resistance, pyrosequencing and the novel H275Y RT-PCR assay. In comparison to Sanger sequencing, the sensitivity and specificity of the H275Y RT-PCR assay were 100% (40/40) and 100% (61/61) respectively, while the sensitivity and specificity of pyrosequencing were 100% (40/40) and 97.5% (60/61) respectively. Although all three methods were effective in detecting the H275Y mutation associated with oseltamivir resistance, the H275Y RT-PCR assay was the most rapid and could easily be incorporated into an influenza subtyping protocol.
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Affiliation(s)
- S Bolotin
- Ontario Agency for Health Protection and Promotion, Toronto, Ontario, Canada.
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