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Mitchell RA, Ubillos I, Requena P, Campo JJ, Ome-Kaius M, Hanieh S, Umbers A, Samol P, Barrios D, Jiménez A, Bardají A, Mueller I, Menéndez C, Rogerson S, Dobaño C, Moncunill G. Chronic malaria exposure is associated with inhibitory markers on T cells that correlate with atypical memory and marginal zone-like B cells. Clin Exp Immunol 2024; 216:172-191. [PMID: 38387476 PMCID: PMC11036110 DOI: 10.1093/cei/uxae015] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/05/2023] [Accepted: 02/22/2024] [Indexed: 02/24/2024] Open
Abstract
Chronic immune activation from persistent malaria infections can induce immunophenotypic changes associated with T-cell exhaustion. However, associations between T and B cells during chronic exposure remain undefined. We analyzed peripheral blood mononuclear cells from malaria-exposed pregnant women from Papua New Guinea and Spanish malaria-naïve individuals using flow cytometry to profile T-cell exhaustion markers phenotypically. T-cell lineage (CD3, CD4, and CD8), inhibitory (PD1, TIM3, LAG3, CTLA4, and 2B4), and senescence (CD28-) markers were assessed. Dimensionality reduction methods revealed increased PD1, TIM3, and LAG3 expression in malaria-exposed individuals. Manual gating confirmed significantly higher frequencies of PD1+CD4+ and CD4+, CD8+, and double-negative (DN) T cells expressing TIM3 in malaria-exposed individuals. Increased frequencies of T cells co-expressing multiple markers were also found in malaria-exposed individuals. T-cell data were analyzed with B-cell populations from a previous study where we reported an alteration of B-cell subsets, including increased frequencies of atypical memory B cells (aMBC) and reduction in marginal zone (MZ-like) B cells during malaria exposure. Frequencies of aMBC subsets and MZ-like B cells expressing CD95+ had significant positive correlations with CD28+PD1+TIM3+CD4+ and DN T cells and CD28+TIM3+2B4+CD8+ T cells. Frequencies of aMBC, known to associate with malaria anemia, were inversely correlated with hemoglobin levels in malaria-exposed women. Similarly, inverse correlations with hemoglobin levels were found for TIM3+CD8+ and CD28+PD1+TIM3+CD4+ T cells. Our findings provide further insights into the effects of chronic malaria exposure on circulating B- and T-cell populations, which could impact immunity and responses to vaccination.
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Affiliation(s)
- Robert A Mitchell
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Itziar Ubillos
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Pilar Requena
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Facultad de Medicina, Universidad de Granada, Granada, Spain
| | - Joseph J Campo
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Antigen Discovery Inc., Irvine, CA, USA
| | - Maria Ome-Kaius
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Sarah Hanieh
- University of Melbourne, Melbourne, VIC, Australia
| | - Alexandra Umbers
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Paula Samol
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Diana Barrios
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Alfons Jiménez
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Azucena Bardají
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Ivo Mueller
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Clara Menéndez
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Carlota Dobaño
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
| | - Gemma Moncunill
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Barcelona, Spain
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2
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González R, Goncé A, Gil MDM, Mazarico E, Ferriols‐Pérez E, Toro P, Llurba E, Saéz E, Rodríguez‐Zambrano MÁ, García‐Otero L, López M, Santacruz B, Román MÁ, Payà A, Alonso S, Cruz‐Lemini M, Pons‐Duran C, Herrera LB, Chen H, Bardají A, Quintó L, Menendez C. Efficacy and safety of hydroxychloroquine for treatment of mild SARS-CoV-2 infection and prevention of COVID-19 severity in pregnant and postpartum women: A randomized, double-blind, placebo-controlled trial. Acta Obstet Gynecol Scand 2024; 103:602-610. [PMID: 38098221 PMCID: PMC10867357 DOI: 10.1111/aogs.14745] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/18/2023] [Accepted: 11/19/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Pregnant women have an increased risk of severe COVID-19. Evaluation of drugs with a safety reproductive toxicity profile is a priority. At the beginning of the pandemic, hydroxychloroquine (HCQ) was recommended for COVID-19 treatment. MATERIAL AND METHODS A randomized, double-blind, placebo-controlled clinical trial was conducted in eight teaching hospitals in Spain to evaluate the safety and efficacy of HCQ in reducing viral shedding and preventing COVID-19 progression. Pregnant and postpartum women with a positive SARS-CoV-2 PCR (with or without mild COVID-19 signs/symptoms) and a normal electrocardiogram were randomized to receive either HCQ orally (400 mg/day for 3 days and 200 mg/day for 11 days) or placebo. PCR and electrocardiogram were repeated at day 21 after treatment start. Enrollment was stopped before reaching the target sample due to low recruitment rate. Trial registration EudraCT #: 2020-001587-29, on April 2, 2020. CLINICAL TRIALS gov # NCT04410562, registered on June 1, 2020. RESULTS A total of 116 women (75 pregnant and 41 post-partum) were enrolled from May 2020 to June 2021. The proportion of women with a positive SARS-CoV-2 PCR at day 21 was lower in the HCQ group (21.8%, 12/55) than in the placebo group (31.6%, 18/57), although the difference was not statistically significant (P = 0.499). No differences were observed in COVID-19 progression, adverse events, median change in QTc, hospital admissions, preeclampsia or poor pregnancy and perinatal outcomes between groups. CONCLUSIONS HCQ was found to be safe in pregnant and postpartum women with asymptomatic or mild SARS-CoV-2 infection. Although the prevalence of infection was decreased in the HCQ group, the statistical power was insufficient to confirm the potential beneficial effect of HCQ for COVID-19 treatment.
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Affiliation(s)
- Raquel González
- ISGlobal, Hospital Clínic‐Universitat de BarcelonaBarcelonaSpain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
- Manhiça Health Research Center (CISM)ManhiçaMozambique
| | - Anna Goncé
- BCNATAL | Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic de BarcelonaUniversitat de BarcelonaBarcelonaSpain
| | - Mª. del Mar Gil
- Obstetrics and Gynecology DepartmentHospital Universitario de TorrejónMadridSpain
- School of MedicineUniversidad Francisco de VitoriaMadridSpain
| | - Edurne Mazarico
- BCNatal | Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital ClínicUniversitat de BarcelonaBarcelonaSpain
| | | | - Paloma Toro
- Obstetrics and Gynecology DepartmentHospital General de SegoviaSegoviaSpain
| | - Elisa Llurba
- Women and Perinatal Health Research Group, Department of Obstetrics and GynecologyInstitut d'Investigació Biomèdica Sant Pau‐IIB Sant Pau, Hospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Elisa Saéz
- Obstetrics and Gynecology DepartmentHospital Universitario Infanta LeonorMadridSpain
| | | | | | - Marta López
- BCNATAL | Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic de BarcelonaUniversitat de BarcelonaBarcelonaSpain
| | - Belén Santacruz
- Obstetrics and Gynecology DepartmentHospital Universitario de TorrejónMadridSpain
- School of MedicineUniversidad Francisco de VitoriaMadridSpain
| | - Mª. Ángeles Román
- BCNatal | Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital ClínicUniversitat de BarcelonaBarcelonaSpain
| | - Antoni Payà
- Obstetrics and Gynecology DepartmentHospital del MarBarcelonaSpain
| | - Sofia Alonso
- Obstetrics and Gynecology DepartmentHospital General de SegoviaSegoviaSpain
| | - Mónica Cruz‐Lemini
- Women and Perinatal Health Research Group, Department of Obstetrics and GynecologyInstitut d'Investigació Biomèdica Sant Pau‐IIB Sant Pau, Hospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Clara Pons‐Duran
- ISGlobal, Hospital Clínic‐Universitat de BarcelonaBarcelonaSpain
| | | | - Haily Chen
- ISGlobal, Hospital Clínic‐Universitat de BarcelonaBarcelonaSpain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
| | - Azucena Bardají
- ISGlobal, Hospital Clínic‐Universitat de BarcelonaBarcelonaSpain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
- Manhiça Health Research Center (CISM)ManhiçaMozambique
| | - Llorenç Quintó
- ISGlobal, Hospital Clínic‐Universitat de BarcelonaBarcelonaSpain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
- Manhiça Health Research Center (CISM)ManhiçaMozambique
| | - Clara Menendez
- ISGlobal, Hospital Clínic‐Universitat de BarcelonaBarcelonaSpain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
- Manhiça Health Research Center (CISM)ManhiçaMozambique
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3
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Mazur NI, Terstappen J, Baral R, Bardají A, Beutels P, Buchholz UJ, Cohen C, Crowe JE, Cutland CL, Eckert L, Feikin D, Fitzpatrick T, Fong Y, Graham BS, Heikkinen T, Higgins D, Hirve S, Klugman KP, Kragten-Tabatabaie L, Lemey P, Libster R, Löwensteyn Y, Mejias A, Munoz FM, Munywoki PK, Mwananyanda L, Nair H, Nunes MC, Ramilo O, Richmond P, Ruckwardt TJ, Sande C, Srikantiah P, Thacker N, Waldstein KA, Weinberger D, Wildenbeest J, Wiseman D, Zar HJ, Zambon M, Bont L. Respiratory syncytial virus prevention within reach: the vaccine and monoclonal antibody landscape. Lancet Infect Dis 2023; 23:e2-e21. [PMID: 35952703 PMCID: PMC9896921 DOI: 10.1016/s1473-3099(22)00291-2] [Citation(s) in RCA: 108] [Impact Index Per Article: 108.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/12/2022] [Accepted: 04/28/2022] [Indexed: 02/08/2023]
Abstract
Respiratory syncytial virus is the second most common cause of infant mortality and a major cause of morbidity and mortality in older adults (aged >60 years). Efforts to develop a respiratory syncytial virus vaccine or immunoprophylaxis remain highly active. 33 respiratory syncytial virus prevention candidates are in clinical development using six different approaches: recombinant vector, subunit, particle-based, live attenuated, chimeric, and nucleic acid vaccines; and monoclonal antibodies. Nine candidates are in phase 3 clinical trials. Understanding the epitopes targeted by highly neutralising antibodies has resulted in a shift from empirical to rational and structure-based vaccine and monoclonal antibody design. An extended half-life monoclonal antibody for all infants is likely to be within 1 year of regulatory approval (from August, 2022) for high-income countries. Live-attenuated vaccines are in development for older infants (aged >6 months). Subunit vaccines are in late-stage trials for pregnant women to protect infants, whereas vector, subunit, and nucleic acid approaches are being developed for older adults. Urgent next steps include ensuring access and affordability of a respiratory syncytial virus vaccine globally. This review gives an overview of respiratory syncytial virus vaccines and monoclonal antibodies in clinical development highlighting different target populations, antigens, and trial results.
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Affiliation(s)
- Natalie I Mazur
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jonne Terstappen
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ranju Baral
- PATH, Center for Vaccine Innovation & Access, Seattle, WA, USA
| | - Azucena Bardají
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigaçao em Saúde de Manhiça, Maputo, Mozambique; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Philippe Beutels
- Centre for Health Economics Research & Modelling Infectious Diseases, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; School of Public Health, The University of New South Wales, Sydney, NSW, Australia
| | - Ursula J Buchholz
- RNA Viruses Section, Laboratory of Infectious Diseases, National Institutes of Health, Bethesda, MA, USA
| | - Cheryl Cohen
- University of the Witwatersrand, Centre for Respiratory Disease and Meningitis at the National Institute for Communicable Diseases, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - James E Crowe
- Vanderbilt Vaccine Center, Pediatrics & Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Clare L Cutland
- African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda Eckert
- Obstetrics & Gynecology, Global Health, University of Washington, Seattle, WA, USA
| | - Daniel Feikin
- Department of Immunisations, Vaccines & Biologicals, World Health Organization, Geneva, Switzerland
| | - Tiffany Fitzpatrick
- Yale School of Public Health Department of Epidemiology of Microbial Diseases, Yale University, New Haven, CT, USA
| | - Youyi Fong
- Vaccine & Infectious Disease Division, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Barney S Graham
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MA, USA
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Deborah Higgins
- PATH, Center for Vaccine Innovation & Access, Seattle, WA, USA
| | | | - Keith P Klugman
- Pneumonia Program, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | | | - Philippe Lemey
- Clinical and Epidemiological Virology, Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Leuven, Belgium
| | | | - Yvette Löwensteyn
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Flor M Munoz
- Department of Pediatrics, Division of Infectious Disease, and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Patrick K Munywoki
- Kenyan Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | | | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Marta C Nunes
- South African Medical Research Council, Wits Vaccines & Infectious Diseases Analytics Research Unit and Department of Science and Technology and National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Octavio Ramilo
- Nationwide Children's Hospital Columbus, Columbus, OH, USA
| | - Peter Richmond
- School of Medicine, Division of Paediatrics, University of Western Australia, Perth, WA, Australia
| | - Tracy J Ruckwardt
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MA, USA
| | - Charles Sande
- Kenyan Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya; Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | - Padmini Srikantiah
- Respiratory Syncytial Virus Program and Global Health, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Naveen Thacker
- Deep Children Hospital & Research Centre, Gandhidham, India
| | - Kody A Waldstein
- Department of Microbiology and Immunology, University of Iowa, Iowa, IA, USA; Interdisciplinary Graduate Program in Immunology, University of Iowa, Iowa, IA, USA
| | - Dan Weinberger
- Yale School of Public Health Department of Epidemiology of Microbial Diseases, Yale University, New Haven, CT, USA
| | - Joanne Wildenbeest
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Dexter Wiseman
- National Heart & Lung Institute, Imperial College, London, UK
| | - Heather J Zar
- Department of Pediatrics & Child Health, Red Cross Children's Hospital and SA-MRC unit of Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Maria Zambon
- Reference Microbiology, Public Health England, Faculty of Medicine, Imperial College, London, UK
| | - Louis Bont
- Department of Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands; ReSViNET Foundation, Julius Clinical, Zeist, Netherlands.
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Fehr A, Nieto-Sanchez C, Muela J, Manneh E, Baldeh D, Ceesay O, D’Alessandro U, Dabira E, Kingori P, Grietens KP, Bardají A, Bunders-Aelen J, Zuiderent-Jerak T. Doing 'reciprocity work': The role of fieldworkers in a mass drug administration trial in the Gambia. Glob Public Health 2022; 17:4116-4128. [PMID: 36183416 PMCID: PMC7614349 DOI: 10.1080/17441692.2022.2125998] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In their roles as nurses, data collectors, or other, fieldworkers undertake myriad tasks working intimately with and on the bodies of others - a type of work called 'body work'. This work further includes the micro-political relations shaping these interactions, and studies have shown the importance of these relationships in the success of clinical trials, particularly in the Gambia. This study seeks to expand the concept of body work to understand the roles and interactions of fieldworkers within the trial community, and the effect on a mass drug administration (MDA) clinical trial. We conducted a mixed-methods social science study alongside the MDA in 2018-2019, including in-depth interviews, focus group discussions, and semi-structured observations with the population involved (and not) in the MDA, as well as the MRC fieldworkers. We found that fieldworkers participated in what we call 'reciprocity work'. Through their regular tasks and interactions, they necessarily showed respect and established trust in a way that formed and contributed to reciprocal relationships, the results of which impacted the trial and individuals' autonomy in the decision-making process. Understanding the role of fieldworkers and their reciprocity work is a vital component in comprehending how research ethics are made and conducted in global health research.
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Affiliation(s)
- Alexandra Fehr
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Claudia Nieto-Sanchez
- Unit of Socio-Ecological Health Research, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Joan Muela
- Medical Anthropology Research Centre, Universitat Rovira I Virgili, Tarragona, Spain
| | - Ebrima Manneh
- Medical Research Council Unit The Gambia, Banjul, Gambia
| | - Dullo Baldeh
- Medical Research Council Unit The Gambia, Banjul, Gambia
| | - Omar Ceesay
- Medical Research Council Unit The Gambia, Banjul, Gambia
| | | | - Edgard Dabira
- Medical Research Council Unit The Gambia, Banjul, Gambia
| | | | - Koen Peeters Grietens
- Unit of Socio-Ecological Health Research, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Azucena Bardají
- IS Global, Barcelona Institute for Global Health, Barcelona, Spain
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5
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Marín-Cos A, Marbán-Castro E, Nedic I, Ferrari M, Crespo-Mirasol E, Ventura LF, Zamora BN, Fumadó V, Menéndez C, Martínez Bueno C, Llupià A, López M, Goncé A, Bardají A. "Maternal Vaccination Greatly Depends on Your Trust in the Healthcare System": A Qualitative Study on the Acceptability of Maternal Vaccines among Pregnant Women and Healthcare Workers in Barcelona, Spain. Vaccines (Basel) 2022; 10:vaccines10122015. [PMID: 36560425 PMCID: PMC9783547 DOI: 10.3390/vaccines10122015] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/14/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
The World Health Organization (WHO) identified vaccine hesitancy as one of the top 10 threats to global health in 2019. Health promotion and education have been seen to improve knowledge and uptake of vaccinations in pregnancy. This qualitative study was conducted based on phenomenology, a methodological approach to understand first-hand experiences, and grounded theory, an inductive approach to analyse data, where theoretical generalisations emerge. Data were collected through semi-structured interviews with pregnant women attending antenatal care services and healthcare workers (HCWs) in Barcelona, Spain. Interviews were audio-recorded, transcribed, and coded, and notes were taken. Inductive thematic analysis was performed, and data were manually coded. Pertussis was reported as the most trusted vaccine among pregnant women due to its long-standing background as a recommended vaccine in pregnancy. The influenza vaccine was regarded as less important since it was perceived to cause mild disease. The COVID-19 vaccine was the least trustworthy for pregnant women due to uncertainties about effectiveness, health effects in the mid- and long-term, the fast development of the vaccine mRNA technology, and the perceptions of limited data on vaccine safety. However, the necessity to be vaccinated was justified by pregnant women due to the exceptional circumstances of the COVID-19 pandemic. The recommendations provided by HCW and the established relationship between the HCW, particularly midwives, and pregnant women were the main factors affecting decision-making. The role of mass media was perceived as key to helping provide reliable messages about the need for vaccines during pregnancy. Overall, vaccines administered during pregnancy were perceived as great tools associated with better health and improved quality of life. Pregnancy was envisioned as a vulnerable period in women's lives that required risk-benefits assessments for decision-making about maternal vaccinations. A holistic approach involving the community and society was considered crucial for health education regarding maternal vaccines in support of the work conducted by HCWs.
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Affiliation(s)
- Anna Marín-Cos
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
| | | | - Ivana Nedic
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
| | - Mara Ferrari
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
| | - Esther Crespo-Mirasol
- BCNatal—Barcelona Center of Maternal-Fetal and Neonatal Medicine, Department of Maternal-Fetal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Laia Ferrer Ventura
- ASSIR Esquerra, Gerència Territorial de Barcelona, Institut Català de la Salut, 08015 Barcelona, Spain
| | - Berta Noya Zamora
- ASSIR Esquerra, Gerència Territorial de Barcelona, Institut Català de la Salut, 08015 Barcelona, Spain
| | - Victoria Fumadó
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
| | - Clara Menéndez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Barcelona, Spain
| | - Cristina Martínez Bueno
- ASSIR Barcelona Ciutat, Gerència Territorial de Barcelona, Institut Català de la Salut i Universitat de Barcelona, 08007 Barcelona, Spain
| | - Anna Llupià
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
- Department of Preventive Medicine and Epidemiology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Marta López
- BCNatal—Barcelona Center of Maternal-Fetal and Neonatal Medicine, Department of Maternal-Fetal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Anna Goncé
- BCNatal—Barcelona Center of Maternal-Fetal and Neonatal Medicine, Department of Maternal-Fetal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Azucena Bardají
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Barcelona, Spain
- Correspondence:
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6
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Marbán-Castro E, Nedic I, Ferrari M, Crespo-Mirasol E, Ferrer L, Noya B, Marin A, Fumadó V, López M, Menéndez C, Martínez Bueno C, Llupià A, Goncé A, Bardají A. Perceptions of COVID-19 Maternal Vaccination among Pregnant Women and Healthcare Workers and Factors That Influence Vaccine Acceptance: A Cross-Sectional Study in Barcelona, Spain. Vaccines (Basel) 2022; 10:vaccines10111930. [PMID: 36423025 PMCID: PMC9692476 DOI: 10.3390/vaccines10111930] [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] [Received: 10/13/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/17/2022] Open
Abstract
COVID-19 is associated with poor maternal and pregnancy outcomes. COVID-19 vaccination is recommended in Spain, yet vaccination rates in pregnancy are suboptimal. This study investigates the perceptions of pregnant women and healthcare workers (HCW) regarding COVID-19 vaccination. A web-based cross-sectional quantitative study was conducted in 2021–2022 among 302 pregnant women and 309 HCWs in the Catalan public health system. Most pregnant women (83%) and HCWs (86%) were aware of COVID-19 maternal vaccines. The recommendation of the COVID-19 vaccination by an HCW was identified as the greatest facilitator for maternal vaccine uptake, while the fear of harming the foetus was the most significant barrier reported for rejecting vaccination. HCWs recognised they received limited information and training about COVID-19 vaccination in pregnancy, which hindered them from providing informed recommendations. This study highlights that information and education on COVID-19 vaccines to pregnant women and health professionals are pivotal to ensuring informed decision-making and increasing vaccine uptake.
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Affiliation(s)
| | - Ivana Nedic
- ISGlobal, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Mara Ferrari
- ISGlobal, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Esther Crespo-Mirasol
- Department of Maternal-Fetal Medicine, BCNatal—Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Laia Ferrer
- ASSIR Esquerra, Gerència Territorial de Barcelona, Institut Català de la Salut, 08015 Barcelona, Spain
| | - Berta Noya
- ASSIR Esquerra, Gerència Territorial de Barcelona, Institut Català de la Salut, 08015 Barcelona, Spain
| | - Anna Marin
- ISGlobal, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Victoria Fumadó
- ISGlobal, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Marta López
- Department of Maternal-Fetal Medicine, BCNatal—Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Clara Menéndez
- ISGlobal, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Cristina Martínez Bueno
- ASSIR Barcelona Ciutat, Gerència Territorial de Barcelona, Institut Català de la Salut, Universitat de Barcelona, 08007 Barcelona, Spain
| | - Anna Llupià
- ISGlobal, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain
- Department of Preventive Medicine and Epidemiology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Anna Goncé
- Department of Maternal-Fetal Medicine, BCNatal—Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Azucena Bardají
- ISGlobal, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Correspondence:
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Mancebo-Pérez C, Vidal M, Aguilar R, Barrios D, Bardají A, Ome-Kaius M, Menéndez C, Rogerson SJ, Dobaño C, Moncunill G, Requena P. Eotaxin-2 and eotaxin-3 in malaria exposure and pregnancy. Malar J 2022; 21:336. [DOI: 10.1186/s12936-022-04372-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Eotaxin-1 concentrations in plasma have been inversely associated with malaria exposure, malaria infection and pregnancy, but the effect of these conditions on the levels of the related chemokines eotaxin-2 and eotaxin-3 remains unknown.
Methods
Eotaxin-2 and -3 concentrations were measured in 310 peripheral or placental plasma samples from pregnant and non-pregnant individuals from Papua New Guinea (malaria-endemic country) and Spain (malaria-naïve individuals) with previous data on eotaxin-1 concentrations. Correlations between eotaxin concentrations were examined with the Spearman’s test. Differences in eotaxin concentrations among groups were evaluated with the Kruskal–Wallis or Mann Whitney tests. The pairwise Wilcoxon test was performed to compare eotaxin-2 concentration between peripheral and placental matched plasmas. Univariable and multivariable linear regression models were estimated to assess the association between eotaxins and Plasmodium infection or gestational age.
Results
Eotaxin-2 concentrations in plasma showed a weak positive correlation with eotaxin-3 (rho = 0.35, p < 0.05) concentrations. Eotaxin-2 concentrations in the malaria-exposed non-pregnant group were significantly lower than the in the malaria-naive non-pregnant and the malaria-exposed pregnant groups. Eotaxin-3 plasma concentrations were lower in malaria-exposed than in non-exposed groups (p < 0.05), but no differences were found associated to pregnancy. Eotaxin-2 and eotaxin-3 plasma concentrations were negatively correlated with anti-Plasmodium IgG levels: PfDBL5ε-IgG (rhoEo2 = − 0.35, p = 0.005; rhoEo3 =− 0.37, p = 0.011), and eotaxin-3 was negatively correlated with PfDBL3x-IgG levels (rhoEo3 =− 0.36; p = 0.011). Negative correlations of eotaxin-2 and 3 in plasma were also observed with atypical memory B cells (rhoEo2 = − 0.37, p < 0.001; rhoEo3= − 0.28, p = 0.006), a B cell subset expanded in malaria-exposed individuals. In addition, a borderline negative association was observed between eotaxin-3 concentrations and Plasmodium infection (adjusted effect estimate, β = − 0.279, 95% CI − 0.605; 0.047, p = 0.091). Moreover, eotaxin-2 placental concentrations were significantly increased compared to peripheral concentrations in the malaria-exposed pregnant group whereas the contrary was observed in the non-exposed pregnant group (p < 0.005).
Conclusion
Although a clear epidemiological negative association is observed between eotaxins concentrations and malaria exposure and/or infection, pregnancy may alter this association for eotaxin-2. Further research is required to understand the role of these chemokines in this disease and in combination with pregnancy.
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Marbán-Castro E, Vazquez Guillamet LJ, Pantoja PE, Casellas A, Maxwell L, Mulkey SB, Menéndez C, Bardají A. Neurodevelopment in Normocephalic Children Exposed to Zika Virus in Utero with No Observable Defects at Birth: A Systematic Review with Meta-Analysis. Int J Environ Res Public Health 2022; 19:ijerph19127319. [PMID: 35742566 PMCID: PMC9223424 DOI: 10.3390/ijerph19127319] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 12/10/2022]
Abstract
Zika virus (ZIKV) infection during pregnancy is a cause of pregnancy loss and multiple clinical and neurological anomalies in children. This systematic review aimed to assess the effect of ZIKV exposure in utero on the long-term neurodevelopment of normocephalic children born to women with ZIKV infection in pregnancy. This review was conducted according to the PRISMA guidelines for systematic reviews and meta-analyses. We performed a random effects meta-analysis to estimate the cross-study prevalence of neurodevelopmental delays in children using the Bayley Scales for Infant and Toddler Development (BSID-III). The risk of bias was assessed using Cochrane’s Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Full-text reviews were performed for 566 articles, and data were extracted from 22 articles corresponding to 20 studies. Nine articles including data from 476 children found 6.5% (95% CI: 4.1–9.3) of infants and children to have any type of non-language cognitive delay; 29.7% (95% CI: 21.7–38.2) to have language delay; and 11.5% (95% CI: 4.8–20.1) to have any type of motor delay. The pooled estimates had a high level of heterogeneity; thus, results should be interpreted with caution. Larger prospective studies that include a non-exposed control group are needed to confirm whether ZIKV exposure in utero is associated with adverse child neurodevelopmental outcomes.
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Affiliation(s)
- Elena Marbán-Castro
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 132 Rosselló Street, 08036 Barcelona, Spain; (L.J.V.G.); (A.C.); (C.M.); (A.B.)
- Correspondence: ; Tel.: +34-932-271851
| | - Laia J. Vazquez Guillamet
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 132 Rosselló Street, 08036 Barcelona, Spain; (L.J.V.G.); (A.C.); (C.M.); (A.B.)
| | - Percy Efrain Pantoja
- Health Services Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain;
| | - Aina Casellas
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 132 Rosselló Street, 08036 Barcelona, Spain; (L.J.V.G.); (A.C.); (C.M.); (A.B.)
| | - Lauren Maxwell
- Heidelberg Institute for Global Health, Heidelberg University, 69120 Heidelberg, Germany;
| | - Sarah B. Mulkey
- Children’s National Hospital, Washington, DC 20010, USA;
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA
| | - Clara Menéndez
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 132 Rosselló Street, 08036 Barcelona, Spain; (L.J.V.G.); (A.C.); (C.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Centro de Investigaçâo em Saúde de Manhiça (CISM), Rua 12, Cambeve CP 1929, Maputo 1929, Mozambique
| | - Azucena Bardají
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 132 Rosselló Street, 08036 Barcelona, Spain; (L.J.V.G.); (A.C.); (C.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Centro de Investigaçâo em Saúde de Manhiça (CISM), Rua 12, Cambeve CP 1929, Maputo 1929, Mozambique
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9
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Gonçalves BP, Procter SR, Paul P, Chandna J, Lewin A, Seedat F, Koukounari A, Dangor Z, Leahy S, Santhanam S, John HB, Bramugy J, Bardají A, Abubakar A, Nasambu C, Libster R, Sánchez Yanotti C, Horváth-Puhó E, Sørensen HT, van de Beek D, Bijlsma MW, Gardner WM, Kassebaum N, Trotter C, Bassat Q, Madhi SA, Lambach P, Jit M, Lawn JE. Group B streptococcus infection during pregnancy and infancy: estimates of regional and global burden. Lancet Glob Health 2022; 10:e807-e819. [PMID: 35490693 PMCID: PMC9090904 DOI: 10.1016/s2214-109x(22)00093-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 02/10/2022] [Accepted: 02/24/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Group B streptococcus (GBS) colonisation during pregnancy can lead to invasive GBS disease (iGBS) in infants, including meningitis or sepsis, with a high mortality risk. Other outcomes include stillbirths, maternal infections, and prematurity. There are data gaps, notably regarding neurodevelopmental impairment (NDI), especially after iGBS sepsis, which have limited previous global estimates. In this study, we aimed to address this gap using newly available multicountry datasets. METHODS We collated and meta-analysed summary data, primarily identified in a series of systematic reviews published in 2017 but also from recent studies on NDI and stillbirths, using Bayesian hierarchical models, and estimated the burden for 183 countries in 2020 regarding: maternal GBS colonisation, iGBS cases and deaths in infants younger than 3 months, children surviving iGBS affected by NDI, and maternal iGBS cases. We analysed the proportion of stillbirths with GBS and applied this to the UN-estimated stillbirth risk per country. Excess preterm births associated with maternal GBS colonisation were calculated using meta-analysis and national preterm birth rates. FINDINGS Data from the seven systematic reviews, published in 2017, that informed the previous burden estimation (a total of 515 data points) were combined with new data (17 data points) from large multicountry studies on neurodevelopmental impairment (two studies) and stillbirths (one study). A posterior median of 19·7 million (95% posterior interval 17·9-21·9) pregnant women were estimated to have rectovaginal colonisation with GBS in 2020. 231 800 (114 100-455 000) early-onset and 162 200 (70 200-394 400) late-onset infant iGBS cases were estimated to have occurred. In an analysis assuming a higher case fatality rate in the absence of a skilled birth attendant, 91 900 (44 800-187 800) iGBS infant deaths were estimated; in an analysis without this assumption, 58 300 (26 500-125 800) infant deaths from iGBS were estimated. 37 100 children who recovered from iGBS (14 600-96 200) were predicted to develop moderate or severe NDI. 40 500 (21 500-66 200) maternal iGBS cases and 46 200 (20 300-111 300) GBS stillbirths were predicted in 2020. GBS colonisation was also estimated to be potentially associated with considerable numbers of preterm births. INTERPRETATION Our analysis provides a comprehensive assessment of the pregnancy-related GBS burden. The Bayesian approach enabled coherent propagation of uncertainty, which is considerable, notably regarding GBS-associated preterm births. Our findings on both the acute and long-term consequences of iGBS have public health implications for understanding the value of investment in maternal GBS immunisation and other preventive strategies. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Bronner P Gonçalves
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK.
| | - Simon R Procter
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Proma Paul
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Jaya Chandna
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Alexandra Lewin
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Farah Seedat
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Artemis Koukounari
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Ziyaad Dangor
- South African Medical Research Council, Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon Leahy
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Hima B John
- Neonatology Department, Christian Medical College, Vellore, India
| | - Justina Bramugy
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Azucena Bardají
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Amina Abubakar
- Neuroscience Research Group, Department of Clinical Sciences, Kenyan Medical Research Institute, Wellcome Trust, Kilifi, Kenya; Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Carophine Nasambu
- Neuroscience Research Group, Department of Clinical Sciences, Kenyan Medical Research Institute, Wellcome Trust, Kilifi, Kenya
| | | | | | | | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Merijn W Bijlsma
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - William M Gardner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nicholas Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Departments of Global Health and Health Metrics Sciences, University of Washington, Seattle, WA, USA; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Caroline Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Catalan Institution for Research and Advanced Studies, Barcelona, Spain; Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Shabir A Madhi
- South African Medical Research Council, Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology and National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Joy E Lawn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
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10
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Paul P, Chandna J, Procter SR, Dangor Z, Leahy S, Santhanam S, John HB, Bassat Q, Bramugy J, Bardají A, Abubakar A, Nasambu C, Libster R, Yanotti CS, Seedat F, Horváth-Puhó E, Hossain AT, Sadeq-ur Rahman Q, Jit M, Newton CR, Milner K, Gonçalves BP, Lawn JE. Neurodevelopmental and growth outcomes after invasive Group B Streptococcus in early infancy: A multi-country matched cohort study in South Africa, Mozambique, India, Kenya, and Argentina. EClinicalMedicine 2022; 47:101358. [PMID: 35747160 PMCID: PMC9142788 DOI: 10.1016/j.eclinm.2022.101358] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/04/2022] [Accepted: 03/03/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Data are limited regarding long-term consequences of invasive GBS (iGBS) disease in early infancy, especially from low- and middle-income countries (LMIC) where most cases occur. We aimed to estimate risk of neurodevelopmental impairment (NDI) in children with a history of iGBS disease. METHODS A multi-country matched cohort study was undertaken in South Africa, India, Mozambique, Kenya, and Argentina from October 2019 to April 2021. The exposure of interest was defined as a history of iGBS disease (sepsis or meningitis) before 90 days of age, amongst children now aged 1·5-18 years. Age and sex-matched, children without history of GBS were also recruited. Age-appropriate, culturally-adapted assessments were used to define NDI across multiple domains (cognitive, motor, hearing, vision, emotional-behaviour, growth). Pooled NDI risk was meta-analysed across sites. Association of iGBS exposure and NDI outcome was estimated using modified Poisson regression with robust variance estimator. FINDINGS Amongst 138 iGBS survivors and 390 non-iGBS children, 38·1% (95% confidence interval [CI]: 30·0% - 46·6%) of iGBS children had any NDI, compared to 21·7% (95% CI: 17·7% - 26·0%) of non- iGBS children, with notable between-site heterogeneity. Risk of moderate/severe NDI was 15·0% (95% CI: 3·4% - 30·8%) among GBS-meningitis, 5·6% (95% CI: 1·5% - 13·7%) for GBS-sepsis survivors. The adjusted risk ratio (aRR) for moderate/severe NDI among iGBS survivors was 1.27 (95% CI: 0.65, 2.45), when compared to non-GBS children. Mild impairment was more frequent in iGBS (27.6% (95% CI: 20.3 - 35.5%)) compared to non-GBS children (12.9% (95% CI: 9.7% - 16.4%)). The risk of emotional-behavioural problems was similar irrespective of iGBS exposure (aRR=0.98 (95% CI: 0.55, 1.77)). INTERPRETATION Our findings suggest that iGBS disease is on average associated with a higher risk of moderate/severe NDI, however substantial variation in risk was observed between sites and data are consistent with a wide range of values. Our study underlines the importance of long-term follow-up for at-risk neonates and more feasible, standardised assessments to facilitate diagnosis in research and clinical practice. FUNDING This work was supported by a grant (INV-009018) from the Bill & Melinda Gates Foundation to the London School of Hygiene &Tropical Medicine.
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Affiliation(s)
- Proma Paul
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Corresponding author.
| | - Jaya Chandna
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Simon R. Procter
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ziyaad Dangor
- Medical Research Council: Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon Leahy
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Hima B. John
- Neonatology Department, Christian Medical College, Vellore, India
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Justina Bramugy
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Azucena Bardají
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Amina Abubakar
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Carophine Nasambu
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
| | | | | | - Farah Seedat
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - A.K.M. Tanvir Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Qazi Sadeq-ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Charles R. Newton
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Kate Milner
- Neurodisability & Rehabilitation Research Group, Murdoch Children's Research Institute
- Department of Paediatrics, University of Melbourne
| | - Bronner P. Gonçalves
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joy E. Lawn
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
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11
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Marbán-Castro E, Enguita-Fernàndez C, Romero-Acosta KC, Arrieta GJ, Marín-Cos A, Mattar S, Menéndez C, Maixenchs M, Bardají A. “One feels anger to know there is no one to help us!”. Perceptions of mothers of children with Zika virus-associated microcephaly in Caribbean Colombia: A qualitative study. PLoS Negl Trop Dis 2022; 16:e0010328. [PMID: 35436298 PMCID: PMC9015150 DOI: 10.1371/journal.pntd.0010328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 04/30/2021] [Accepted: 03/14/2022] [Indexed: 01/07/2023] Open
Abstract
Background
The epidemic of Zika virus (ZIKV) was associated with a sudden and unprecedented increase in infants born with microcephaly. Colombia was the second most affected country by the epidemic in the Americas. Primary caregivers of children with ZIKV-associated microcephaly, their mothers mainly, were at higher risk of suffering anxiety and depression. Often, these women were stigmatized and abandoned by their partners, relatives, and communities.
Methodology/Principal findings
This study aimed to understand the perceptions about ZIKV infection among mothers of children born with microcephaly during the ZIKV epidemic in Caribbean Colombia, and the barriers and facilitators affecting child health follow-up. An exploratory qualitative study, based on Phenomenology and Grounded Theory, was conducted in Caribbean Colombia. Data were collected through In-Depth Interviews (IDI) from women who delivered a baby with microcephaly during the ZIKV epidemic at Clínica Salud Social, Sincelejo, Sucre District (N = 11). The themes that emerged during the interviews included experiences from their lives before pregnancy; knowledge about ZIKV; experiences and perceptions when diagnosed; considering a possible termination of pregnancy, and children’s clinical follow-up. In some cases, women reported having been told they were having a baby with microcephaly but decided not to terminate the pregnancy; while in other cases, women found out about their newborn’s microcephaly condition only at birth. The main barriers encountered by participants during children’s follow-up included the lack of psychosocial and economic support, the stigmatization and abandonment by some partners and relatives, and the frustration of seeing the impaired development of their children.
Conclusions
This study contributed to identifying the social, medical, psychological, and economic needs of families with children affected by the ZIKV epidemic. Commitment and action by local and national governments, and international bodies, is required to ensure sustained and quality health services by affected children and their families.
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Affiliation(s)
- Elena Marbán-Castro
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- * E-mail:
| | | | | | - Germán J. Arrieta
- Corporación Universitaria del Caribe (CECAR), Group of Public Health, Sincelejo, Sucre, Colombia
- Clínica Salud Social, Sincelejo, Sucre, Colombia
- Universidad de Córdoba—Instituto de investigaciones biológicas del Trópico, Montería, Córdoba, Colombia
| | - Anna Marín-Cos
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Salim Mattar
- Clínica Salud Social, Sincelejo, Sucre, Colombia
- Universidad de Córdoba—Instituto de investigaciones biológicas del Trópico, Montería, Córdoba, Colombia
| | - Clara Menéndez
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Maria Maixenchs
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Azucena Bardají
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
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12
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Bramugy J, Mucasse H, Massora S, Vitorino P, Aerts C, Mandomando I, Paul P, Chandna J, Seedat F, Lawn JE, Bardají A, Bassat Q. Short- and Long-term Outcomes of Group B Streptococcus Invasive Disease in Mozambican Children: Results of a Matched Cohort and Retrospective Observational Study and Implications for Future Vaccine Introduction. Clin Infect Dis 2022; 74:S14-S23. [PMID: 34725690 PMCID: PMC8776307 DOI: 10.1093/cid/ciab793] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Invasive group B Streptococcus disease (iGBS) in infancy, including meningitis or sepsis, carries a high risk of mortality and neurodevelopmental impairment (NDI). We present data on iGBS from 2 decades of surveillance in Manhiça, Mozambique, with a focus on NDI. METHODS Morbidity surveillance databases in a rural Mozambican district hospital were screened for iGBS cases. From February 2020 to March 2021, surviving iGBS patients (n = 39) plus age- and sex-matched children without iGBS (n = 119) were assessed for neurocognitive development, vision, and hearing. The role of GBS in stillbirths and infant deaths was investigated using minimally invasive tissue sampling (MITS). RESULTS Ninety iGBS cases were included, with most children being <3 months of age (85/90). The in-hospital case fatality rate was 14.4% (13/90), increasing to 17.8% (3 additional deaths) when considering mortality during the 6 months postdiagnosis. Fifty percent of the iGBS exposed infants and 10% of those unexposed showed any NDI. Surviving GBS conferred a 11-fold increased adjusted odds of moderate/severe NDI (odds ratio, 2.8 [95% confidence interval, .92-129.74]; P = .06) in children aged 0-5 years. For older children (6-18 years), no differences in NDI were found between exposed and unexposed. Motor domain was the most affected among young GBS survivors. Three stillbirths and 4 early neonatal deaths (of the 179 MITS performed) were attributed to iGBS. CONCLUSIONS In absence of preventive strategies, such as intrapartum antibiotics, iGBS remains a significant cause of perinatal and infant disease and death. GBS also causes major longer-term neurodevelopmental sequelae, altogether justifying the need for maternal GBS vaccination strategies to increase perinatal and infant survival.
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Affiliation(s)
- Justina Bramugy
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - Sergio Massora
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Pio Vitorino
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Céline Aerts
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Proma Paul
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jaya Chandna
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Farah Seedat
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Joy E Lawn
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Azucena Bardají
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
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13
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Aerts C, Leahy S, Mucasse H, Lala S, Bramugy J, Tann CJ, Madhi SA, Bardají A, Bassat Q, Dangor Z, Lawn JE, Jit M, Procter SR. Quantifying the Acute Care Costs of Neonatal Bacterial Sepsis and Meningitis in Mozambique and South Africa. Clin Infect Dis 2022; 74:S64-S69. [PMID: 34725702 PMCID: PMC8776306 DOI: 10.1093/cid/ciab815] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Sepsis and meningitis are among the leading causes of neonatal deaths in sub-Saharan Africa (SSA). Neonatal sepsis caused ~400 000 deaths globally in 2015, half occurring in Africa. Despite this, there are few published data on the acute costs of neonatal sepsis or meningitis, with none in SSA. METHODS We enrolled neonates admitted to 2 hospitals in South Africa and Mozambique between 16 April 2020 and 1 April 2021. In South Africa all cases were microbiologically confirmed, but in Mozambique both clinically suspected and microbiologically confirmed cases were included. Data were collected on healthcare resource use and length of stay, along with information on household expenditure and caregiving. We used unit costs of healthcare resources in local currencies to estimate healthcare provider costs per patient and costs per household. Results were converted to 2019 international dollars (I$). RESULTS We enrolled 11 neonates in Mozambique and 18 neonates in South Africa. Mean length of stay was 10 days (median, 9 [interquartile range {IQR}, 4-14) and 16 days (median, 15 [IQR, 13-18]), respectively. In Mozambique we estimated mean household costs of I$49.62 (median, 10.19 [IQR, 5.10-95.12]) and hospitalization costs of I$307.58 (median, 275.12 [IQR, 149.43-386.12]). In South Africa these costs were I$52.31 (median, 30.82 [IQR, 19.25-73.08]) and I$684.06 (median, 653.62 [IQR, 543.33-827.53]), respectively. CONCLUSIONS We found substantial costs associated with acute neonatal bacterial (all-cause) sepsis and meningitis in SSA. Our estimates will inform economic evaluations of interventions to prevent neonatal invasive bacterial infections.
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Affiliation(s)
- Céline Aerts
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Shannon Leahy
- Paediatric Education and Research Ladder, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Sanjay Lala
- Paediatric Education and Research Ladder, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Justina Bramugy
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Cally J Tann
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Neonatal Medicine, University College London Hospitals, London, United Kingdom
| | - Shabir A Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of the Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Azucena Bardají
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Ziyaad Dangor
- Paediatric Education and Research Ladder, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joy E Lawn
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Simon R Procter
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Correspondence: S. R. Procter, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK ()
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14
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Fehr A, Muela J, Nieto-Sanchez C, Manneh E, Baldeh D, Ceesay O, Bardají A, Zuiderent-Jerak T, Bunders-Aelen J. The role of social cohesion in the implementation and coverage of a mass drug administration trial for malaria control in the Gambia: An in-depth comparison of two intervention villages. Soc Sci Med 2021; 291:114487. [PMID: 34715624 DOI: 10.1016/j.socscimed.2021.114487] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
Mass drug administration (MDA), used increasingly in malaria eradication efforts, involves administering medication to an entire target population regardless of individual-level disease status. This strategy requires high levels of coverage and compliance. Previous studies have assessed individual and structural factors affecting MDA coverage, but there is a need to better understand the influence and expressions of community dynamics and social structures, such as social cohesion. We conducted a social science study concurrent to an MDA clinical trial for malaria control in The Gambia; ethnographic research was conducted prior to, throughout, and between MDA implementation July-November 2018, January-March 2019, and July-November 2019. We assessed how social cohesion, as expressed by the trial population, affects trial coverage through an in-depth ethnographic analysis of two trial villages, using observations, interviews, and focus group discussions with community members who took the trial medication and those who did not. We found that the villages had unique expressions of social cohesion. This was reflected through community participation in the trial implementation and may have affected coverage and compliance. The village with low coverage expressed a form of social cohesion where members followed advice to participate through a hierarchal system but did not actively participate in the MDA or its implementation. The village with high coverage expressed social cohesion as more participatory: individuals took the directive to participate but contextualized the trial implementation to their needs and wants. We analyze these different expressions of social cohesion and the important differences they make for the coverage and compliance levels reached in the two different villages.
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Affiliation(s)
- Alexandra Fehr
- Athena Institute, Faculty of Science, Vrije Universitiet Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands; Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Kronenburgstraat 43, 2000, Antwerpen, Belgium; Medical Anthropology Research Center, Universitat Rovira I Virgili, Carrer de l'Escorxador, 43003, Tarragona, Spain.
| | - Joan Muela
- Medical Anthropology Research Center, Universitat Rovira I Virgili, Carrer de l'Escorxador, 43003, Tarragona, Spain.
| | - Claudia Nieto-Sanchez
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Kronenburgstraat 43, 2000, Antwerpen, Belgium.
| | - Ebrima Manneh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Atlantic Blvd, Serrekunda, Gambia.
| | - Dullo Baldeh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Atlantic Blvd, Serrekunda, Gambia.
| | - Omar Ceesay
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Atlantic Blvd, Serrekunda, Gambia.
| | - Azucena Bardají
- ISGlobal, Barcelona Institute for Global Health - Campus Clinic, Hospital Clinic - Universitat de Barcelona, Carrer Rosselló, 08036, Barcelona, Spain.
| | - Teun Zuiderent-Jerak
- Athena Institute, Faculty of Science, Vrije Universitiet Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands.
| | - Joske Bunders-Aelen
- Athena Institute, Faculty of Science, Vrije Universitiet Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands.
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15
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Patel KM, Vazquez Guillamet L, Pischel L, Ellingson MK, Bardají A, Omer SB. Strategies to increase uptake of maternal pertussis vaccination. Expert Rev Vaccines 2021; 20:779-796. [PMID: 34129416 DOI: 10.1080/14760584.2021.1940146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Pertussis is a highly contagious respiratory disease that results in disproportionate morbidity and mortality in infants who have yet to receive the primary diphtheria-tetanus-pertussis vaccine series. In the preceding decades numerous countries began to pursue either prenatal vaccination of pregnant women or postpartum vaccination of caregivers to protect infants. Despite proven benefit, maternal uptake of pertussis vaccine continues to remain suboptimal. AREAS COVERED Many studies have been conducted to address the suboptimal uptake of maternal pertussis vaccination. This systematic review was undertaken to systematically identify those studies, highlight the most successful strategies and find the knowledge gaps that need to be filled over the coming years to improve vaccine uptake. Twenty-five studies were identified from six different databases. EXPERT OPINION Five different interventions were shown to be successful in promoting uptake of pertussis vaccination: (1) standing orders, (2) opt-in orders, (3) provider education, (4) on-site vaccination and (5) interactive patient education. Three major knowledge gaps were also identified that need to be filled over the coming years: (1) lack of studies in low- and middle-income countries, (2) lack of studies targeting midwives and/or home birth and (3) lack of studies on the process of vaccine communication.
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Affiliation(s)
- Kavin M Patel
- Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Lauren Pischel
- Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mallory K Ellingson
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Azucena Bardají
- ISGlobal, Hospital Clínic-Universitat De Barcelona, Barcelona, Spain.,Manhiça Health Research Centre - Centro De Investigação Em Saúde De Manhiça (CISM), Maputo, Mozambique.,Consorcio De Investigación Biomédica En Red De Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Saad B Omer
- Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA.,Yale School of Nursing, Orange, Connecticut, USA.,Yale Institute for Global Health, New Haven, Connecticut, USA
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16
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Paul P, Procter SR, Dangor Z, Bassat Q, Abubakar A, Santhanam S, Libster R, Gonçalves BP, Madhi SA, Bardají A, Mwangome E, Mabrouk A, John HB, Sánchez Yanotti C, Chandna J, Sithole P, Mucasse H, Katana PV, Koukounari A, Harden LM, Aerts C, Ghoor A, Leahy S, Mbatha S, Lowick S, Lala SG, Bramugy J, Newton C, Hossain AKMT, Sadeq-ur Rahman Q, Lambach P, Jit M, Lawn JE. Quantifying long-term health and economic outcomes for survivors of group B Streptococcus invasive disease in infancy: protocol of a multi-country study in Argentina, India, Kenya, Mozambique and South Africa. Gates Open Res 2021; 4:138. [PMID: 34368637 PMCID: PMC8313848 DOI: 10.12688/gatesopenres.13185.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 01/26/2023] Open
Abstract
Sepsis and meningitis due to invasive group B Streptococcus (iGBS) disease during early infancy is a leading cause of child mortality. Recent systematic estimates of the worldwide burden of GBS suggested that there are 319,000 cases of infant iGBS disease each year, and an estimated 147,000 stillbirths and young-infant deaths, with the highest burden occurring in Sub-Saharan Africa. The following priority data gaps were highlighted: (1) long-term outcome data after infant iGBS, including mild disability, to calculate quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) and (2) economic burden for iGBS survivors and their families. Geographic data gaps were also noted with few studies from low- and middle- income countries (LMIC), where the GBS burden is estimated to be the highest. In this paper we present the protocol for a multi-country matched cohort study designed to estimate the risk of long-term neurodevelopmental impairment (NDI), socioemotional behaviors, and economic outcomes for children who survive invasive GBS disease in Argentina, India, Kenya, Mozambique, and South Africa. Children will be identified from health demographic surveillance systems, hospital records, and among participants of previous epidemiological studies. The children will be aged between 18 months to 17 years. A tablet-based custom-designed application will be used to capture data from direct assessment of the child and interviews with the main caregiver. In addition, a parallel sub-study will prospectively measure the acute costs of hospitalization due to neonatal sepsis or meningitis, irrespective of underlying etiology. In summary, these data are necessary to characterize the consequences of iGBS disease and enable the advancement of effective strategies for survivors to reach their developmental and economic potential. In particular, our study will inform the development of a full public health value proposition on maternal GBS immunization that is being coordinated by the World Health Organization.
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Affiliation(s)
- Proma Paul
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Simon R. Procter
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ziyaad Dangor
- Medical Research Council: Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ICREA, Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Amina Abubakar
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
- Institute of Human Development, Aga Khan University, Nairobi, Kenya
| | | | - Romina Libster
- Fundación INFANT, Buenos Aires, Argentina
- National Technical and Scientific Research Council, Buenos Aires, Argentina
| | - Bronner P. Gonçalves
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Shabir A. Madhi
- Medical Research Council: Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Azucena Bardají
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Eva Mwangome
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
| | - Adam Mabrouk
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
| | - Hima B. John
- Neonatology Department, Christian Medical College, Vellore, India
| | | | - Jaya Chandna
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Pamela Sithole
- Medical Research Council: Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Humberto Mucasse
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Patrick V. Katana
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
| | - Artemis Koukounari
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Lois M. Harden
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Celine Aerts
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Azra Ghoor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon Leahy
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Mbatha
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah Lowick
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanjay G. Lala
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Justina Bramugy
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Charles Newton
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
| | - A. K. M. Tanvir Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Qazi Sadeq-ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Modelling and Economics Unit, Public Health England, London, UK
- Division of Epidemiology and Biostatistics, School of Public Health, University of Hong Kong, Hong Kong SAR, China
| | - Joy E. Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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17
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Bardají A, Sevene E, Cutland C, Menéndez C, Omer SB, Aguado T, Muñoz FM. The need for a global COVID-19 maternal immunisation research plan. Lancet 2021; 397:e17-e18. [PMID: 33508228 PMCID: PMC8055754 DOI: 10.1016/s0140-6736(21)00146-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 12/29/2020] [Accepted: 01/12/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Azucena Bardají
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, 08036, Barcelona, Spain; Manhiça Health Research Centre, Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.
| | - Esperança Sevene
- Manhiça Health Research Centre, Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Department of Physiological Sciences, Clinical Pharmacology, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Clare Cutland
- African Leadership in Vaccinology Expertise (ALIVE), Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
| | - Clara Menéndez
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, 08036, Barcelona, Spain; Manhiça Health Research Centre, Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Saad B Omer
- Yale Institute for Global Health, Department of Internal Medicine, Yale School of Medicine, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale School of Nursing, New Haven, CT, USA
| | - Teresa Aguado
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, 08036, Barcelona, Spain
| | - Flor M Muñoz
- Department of Pediatrics and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
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18
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Vignier N, Bouchaud O, Angheben A, Bottieau E, Calleri G, Salas-Coronas J, Martin C, Ramos JM, Mechain M, Rapp C, Nothdurft HD, Velasco M, Bardají A, Rojo-Marcos G, Visser LG, Hatz C, Bisoffi Z, Jelinek T, Duparc S, Bourhis Y, Tommasini S, Iannucelli M, Bacchieri A, Mattera GG, Merlo Pich E, Behrens RH. Longitudinal study based on a safety registry for malaria patients treated with artenimol-piperaquine in six European countries. Malar J 2021; 20:214. [PMID: 33964945 PMCID: PMC8105939 DOI: 10.1186/s12936-021-03750-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/29/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background European travellers to endemic countries are at risk of malaria and may be affected by a different range of co-morbidities than natives of endemic regions. The safety profile, especially cardiac issues, of artenimol (previously dihydroartemisinin)–piperaquine (APQ) Eurartesim® during treatment of uncomplicated imported falciparum malaria is not adequately described due to the lack of longitudinal studies in this population. The present study was conducted to partially fill this gap. Methods Participants were recruited through Health Care Provider’s safety registry in 15 centres across 6 European countries in the period 2013–2016. Adverse events (AE) were collected, with a special focus on cardiovascular safety by including electrocardiogram QT intervals evaluated after correction with either Bazett’s (QTcB) or Fridericia’s (QTcF) methods, at baseline and after treatment. QTcB and/or QTcF prolongation were defined by a value > 450 ms for males and children and > 470 ms for females. Results Among 294 participants, 30.3% were women, 13.7% of Caucasian origin, 13.5% were current smoker, 13.6% current alcohol consumer and 42.2% declared at least one illness history. The mean (SD) age and body mass index were 39.8 years old (13.2) and 25.9 kg/m2 (4.7). Among them, 75 reported a total of 129 AE (27 serious), 46 being suspected to be related to APQ (11 serious) and mostly labelled as due to haematological, gastrointestinal, or infection. Women and Non-African participants had significantly (p < 0.05) more AEs. Among AEs, 21 were due to cardiotoxicity (7.1%), mostly QT prolongation, while 6 were due to neurotoxicity (2.0%), mostly dizziness. Using QTcF correction, QT prolongation was observed in 17/143 participants (11.9%), only 2 of them reporting QTcF > 500 ms (milliseconds) but no clinical symptoms. Using QTcB correction increases of > 60 ms were present in 9 participants (6.3%). A trend towards increased prolongation was observed in those over 65 years of age but only a few subjects were in this group. No new safety signal was reported. The overall efficacy rate was 255/257 (99.2%). Conclusions APQ appears as an effective and well-tolerated drug for treatment of malaria in patients recruited in European countries. AEs and QT prolongation were in the range of those obtained in larger cohorts from endemic countries. Trial registration This study has been registered in EU Post-Authorization Studies Register as EUPAS6942 Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03750-x.
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Affiliation(s)
- Nicolas Vignier
- Department of Infectious and Tropical Diseases, and Laboratoire Éducations et Pratiques de Santé (LEPS EA 3412), Sorbonne Paris Nord University, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Bobigny, France. .,Centre D'Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, France. .,INSERM, Sorbonne Université, Institut Pierre Louis D'Épidémiologie et de Santé Publique IPLESP, Paris, France.
| | - Olivier Bouchaud
- Department of Infectious and Tropical Diseases, and Laboratoire Éducations et Pratiques de Santé (LEPS EA 3412), Sorbonne Paris Nord University, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Bobigny, France.,TropNet, A European Network for Tropical and Travel Medicine, Verona, Italy
| | - Andrea Angheben
- TropNet, A European Network for Tropical and Travel Medicine, Verona, Italy.,Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Emmanuel Bottieau
- TropNet, A European Network for Tropical and Travel Medicine, Verona, Italy.,Institute of Tropical Medicine, Antwerp, Belgium
| | - Guido Calleri
- Azienda Sanitaria Locale "Cità Di Torino", Torino, Italy
| | - Joaquín Salas-Coronas
- TropNet, A European Network for Tropical and Travel Medicine, Verona, Italy.,Tropical Medicine Unit, Hospital de Poniente, El Ejido, Almería, Spain
| | | | - José Manuel Ramos
- Consulta de Enfermedades Importadas Y Parasitología Clínica, Unidad de Enfermedades Infecciosas, Hospital General Universitario Alicante, Alicante, Spain
| | | | | | | | - Maria Velasco
- Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Azucena Bardají
- TropNet, A European Network for Tropical and Travel Medicine, Verona, Italy.,ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação Em Saúde de Manhiça, Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Gerardo Rojo-Marcos
- Hospital Universitario Príncipe de Asturias, Alcalà de Henares, Madrid, Spain
| | - Leo G Visser
- TropNet, A European Network for Tropical and Travel Medicine, Verona, Italy.,Department of Infectious Diseases, Leiden University Medical Centre, Leiden, Netherlands
| | - Christoph Hatz
- TropNet, A European Network for Tropical and Travel Medicine, Verona, Italy.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Zeno Bisoffi
- TropNet, A European Network for Tropical and Travel Medicine, Verona, Italy.,Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Tomas Jelinek
- TropNet, A European Network for Tropical and Travel Medicine, Verona, Italy.,Berliner Centrum Fürr Reise- Und Tropenmedizin, Berlin, Germany
| | | | | | | | | | | | | | | | - Ronald H Behrens
- TropNet, A European Network for Tropical and Travel Medicine, Verona, Italy.,Clinical Research Dept, Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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19
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Marbán-Castro E, Goncé A, Fumadó V, Martínez MJ, López M, García-Otero L, Salazar L, Esteve C, Salvia D, Fortuny C, Eixarch E, Fuente-Moreno M, Pinazo MJ, Oliveira I, Rodríguez-Valero N, Requena-Méndez A, Camprubí D, Saco A, Castillo P, Vázquez A, de Ory F, Navero-Castillejos J, Casellas A, González R, Muñoz J, Gascón J, Ordi J, Menéndez C, Bardají A. Zika virus infection in pregnant travellers and impact on childhood neurodevelopment in the first two years of life: A prospective observational study. Travel Med Infect Dis 2021; 40:101985. [PMID: 33601028 DOI: 10.1016/j.tmaid.2021.101985] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 03/28/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The emergence of Zika virus (ZIKV) represents a threat with consequences on maternal and children's health. We aimed to assess the clinical and epidemiological characteristics of pregnant women returning from ZIKV affected areas, and the effects of maternal ZIKV infection on birth outcomes and children's health. METHODS This was a hospital-based prospective observational study conducted at the Hospital Clínic of Barcelona and Hospital Sant Joan de Déu, Barcelona, Spain, from January 2016 to February 2020. RESULTS One hundred and ninety-five pregnant women who had travelled to ZIKV affected areas during pregnancy were recruited. Four women (2.1%) had a confirmed ZIKV infection, 40 women (20.5%) a probable infection, and 151 (77.4%) were negative for ZIKV. Among the ZIKV confirmed cases, a pregnant woman suffered a miscarriage, highly plausible to be associated with ZIKV infection. Brain cysts and microcalcifications were detected in 7% of fetuses or infants from women with confirmed or probable ZIKV infection. Neurodevelopmental delay in the language function was found in 33.3% out of the 21 children evaluated. CONCLUSIONS These findings contribute to the understanding of ZIKV prevalence estimates, and the impact of maternal ZIKV infection on pregnancy outcomes and children's health. Results highlight the importance of long-term surveillance in pregnant travellers and their children.
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Affiliation(s)
| | - Anna Goncé
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Victoria Fumadó
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Department of Tropical Pathology and Imported Diseases, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Miguel J Martínez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Department of Clinical Microbiology, Hospital Clínic, Barcelona, Spain
| | - Marta López
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Laura García-Otero
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Laura Salazar
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Carolina Esteve
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Dolors Salvia
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Claudia Fortuny
- Department of Tropical Pathology and Imported Diseases, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Elisenda Eixarch
- Department of Maternal-Fetal Medicine, BCNatal - Barcelona Center of Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | | | - María Jesús Pinazo
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Inés Oliveira
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Ana Requena-Méndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Department of Global Public Health, Karolinska Institutet, Sweden
| | - Daniel Camprubí
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Adela Saco
- Department of Pathology, Hospital Clínic, Barcelona, Spain
| | - Paola Castillo
- Department of Pathology, Hospital Clínic, Barcelona, Spain
| | - Ana Vázquez
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando de Ory
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Aina Casellas
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Raquel González
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - José Muñoz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Joaquim Gascón
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jaume Ordi
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Department of Global Public Health, Karolinska Institutet, Sweden
| | - Clara Menéndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Azucena Bardají
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
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20
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Marbán-Castro E, Arrieta GJ, Martínez MJ, González R, Bardají A, Menéndez C, Mattar S. High Seroprevalence of Antibodies against Arboviruses among Pregnant Women in Rural Caribbean Colombia in the Context of the Zika Virus Epidemic. Antibodies (Basel) 2020; 9:antib9040056. [PMID: 33096597 PMCID: PMC7709128 DOI: 10.3390/antib9040056] [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] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/27/2020] [Accepted: 09/09/2020] [Indexed: 12/03/2022] Open
Abstract
Mosquito-borne viruses such as dengue (DENV), chikungunya (CHIKV), and Zika (ZIKV) have spread in recent decades. We aimed to assess seroprevalence of arboviral infections in pregnant women living in Cereté, Caribbean Colombia. In 2016 a cross-sectional facility-based sero-survey study was performed among pregnant women (N = 90). Most of them (66%) reported at least one symptom or sign compatible with arboviral infection over the previous 15 days. All screened women had a positive IgG for DENV, 89% for ZIKV, and 82% for CHIKV. One woman tested positive for ZIKV IgM. This study shows the high exposure among pregnant women to arboviruses in endemic areas, shown by the high seroprevalence of past arboviral infections. Given the evidence on the potential risks of these arboviral infections on pregnancy and infant outcomes, these results highlight the need for continuous epidemiological surveillance of arboviral diseases, particularly among those most of risk of their harmful consequences.
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Affiliation(s)
- Elena Marbán-Castro
- ISGlobal, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (M.J.M.); (R.G.); (A.B.); (C.M.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-93-227-5400 (ext. 4142)
| | - Germán J. Arrieta
- Corporación Universitaria del Caribe (CECAR), Grupo de Salud Pública, Sincelejo 700001, Colombia;
- Clínica Salud Social, Sincelejo 700001, Colombia;
| | - Miguel J. Martínez
- ISGlobal, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (M.J.M.); (R.G.); (A.B.); (C.M.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Raquel González
- ISGlobal, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (M.J.M.); (R.G.); (A.B.); (C.M.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Azucena Bardají
- ISGlobal, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (M.J.M.); (R.G.); (A.B.); (C.M.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça 1929, Mozambique
| | - Clara Menéndez
- ISGlobal, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (M.J.M.); (R.G.); (A.B.); (C.M.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça 1929, Mozambique
| | - Salim Mattar
- Clínica Salud Social, Sincelejo 700001, Colombia;
- Instituto de Investigaciones Biológicas del Trópico, Universidad de Córdoba, Montería 230002, Colombia
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21
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Marbán-Castro E, Villén-Gonzalvo A, Enguita-Fernàndez C, Romero-Acosta KC, Marín-Cos A, Arrieta GJ, Mattar S, Menéndez C, Maixenchs M, Bardají A. Acceptability of a Hypothetical Zika Vaccine among Women from Colombia and Spain Exposed to ZIKV: A Qualitative Study. Vaccines (Basel) 2020; 8:vaccines8040580. [PMID: 33022907 PMCID: PMC7711833 DOI: 10.3390/vaccines8040580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/30/2020] [Revised: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 12/20/2022] Open
Abstract
Zika virus (ZIKV) can cause pregnancy loss and congenital Zika syndrome, among other poor health outcomes. The ZIKV epidemic in 2015-2017 disproportionately affected pregnant women in poor-resource settings. We aimed to understand perceptions and attitudes towards a hypothetical ZIKV vaccine, women's willingness to be vaccinated, and potential barriers and facilitators for vaccine acceptance in 1) migrant women living in Spain who travelled to their countries of origin and were diagnosed with ZIKV infection during pregnancy, and their healthcare providers, and 2) women living in Colombia who delivered a child with microcephaly. An exploratory qualitative study based on phenomenology and grounded theory was conducted. Data were collected through in-depth, paired and semi-structured interviews. Overall, women from both sites were willing to receive a hypothetical ZIKV vaccine. However, some expressed concerns of being vaccinated during pregnancy, yet they would accept it if the vaccine was recommended by a healthcare professional they trust. Main fears towards vaccination were related to vaccine safety and potential adverse effects on child's health. Women reported feeling hesitant to participate in a ZIKV vaccine trial. These results may contribute to guiding the effective delivery of future ZIKV vaccines among populations most at risk and particularly vulnerable.
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Affiliation(s)
- Elena Marbán-Castro
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-93-227-1851
| | - Ana Villén-Gonzalvo
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
| | - Cristina Enguita-Fernàndez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Kelly Carolina Romero-Acosta
- Faculty of Humanities and Education, Corporación Universitaria del Caribe (CECAR), Sincelejo, Sucre 700001, Colombia; (K.C.R.-A.); (G.J.A.)
| | - Anna Marín-Cos
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
| | - Germán J. Arrieta
- Faculty of Humanities and Education, Corporación Universitaria del Caribe (CECAR), Sincelejo, Sucre 700001, Colombia; (K.C.R.-A.); (G.J.A.)
- Clínica Salud Social, Sincelejo, Sucre 700001, Colombia;
| | - Salim Mattar
- Clínica Salud Social, Sincelejo, Sucre 700001, Colombia;
- Instituto de Investigaciones Biológicas del Trópico, Universidad de Córdoba, Montería 230002, Córdoba, Colombia
| | - Clara Menéndez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique
| | - Maria Maixenchs
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Azucena Bardají
- ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique
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22
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Paul P, Procter SR, Dangor Z, Bassat Q, Abubakar A, Santhanam S, Libster R, Gonçalves BP, Madhi SA, Bardají A, Mwangome E, Mabrouk A, John HB, Sánchez Yanotti C, Chandna J, Sithole P, Mucasse H, Katana PV, Koukounari A, Harden LM, Aerts C, Ghoor A, Leahy S, Mbatha S, Lowick S, Lala SG, Bramugy J, Newton C, Hossain AKMT, Sadeq-ur Rahman Q, Lambach P, Jit M, Lawn JE. Quantifying long-term health and economic outcomes for survivors of group B Streptococcus invasive disease in infancy: protocol of a multi-country study in Argentina, India, Kenya, Mozambique and South Africa. Gates Open Res 2020; 4:138. [PMID: 34368637 PMCID: PMC8313848 DOI: 10.12688/gatesopenres.13185.1] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 09/05/2023] Open
Abstract
Sepsis and meningitis due to invasive group B Streptococcus (iGBS) disease during early infancy is a leading cause of child mortality. Recent systematic estimates of the worldwide burden of GBS suggested that there are 319,000 cases of infant iGBS disease each year, and an estimated 147,000 stillbirths and young-infant deaths, with the highest burden occurring in Sub-Saharan Africa. The following priority data gaps were highlighted: (1) long-term outcome data after infant iGBS, including mild disability, to calculate quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) and (2) economic burden for iGBS survivors and their families. Geographic data gaps were also noted with few studies from low- and middle- income countries (LMIC), where the GBS burden is estimated to be the highest. In this paper we present the protocol for a multi-country matched cohort study designed to estimate the risk of long-term neurodevelopmental impairment (NDI), socioemotional behaviors, and economic outcomes for children who survive invasive GBS disease in Argentina, India, Kenya, Mozambique, and South Africa. Children will be identified from health demographic surveillance systems, hospital records, and among participants of previous epidemiological studies. The children will be aged between 18 months to 17 years. A tablet-based custom-designed application will be used to capture data from direct assessment of the child and interviews with the main caregiver. In addition, a parallel sub-study will prospectively measure the acute costs of hospitalization due to neonatal sepsis or meningitis, irrespective of underlying etiology. In summary, these data are necessary to characterize the consequences of iGBS disease and enable the advancement of effective strategies for survivors to reach their developmental and economic potential. In particular, our study will inform the development of a full public health value proposition on maternal GBS immunization that is being coordinated by the World Health Organization.
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Affiliation(s)
- Proma Paul
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Simon R. Procter
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ziyaad Dangor
- Medical Research Council: Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ICREA, Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Amina Abubakar
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
- Institute of Human Development, Aga Khan University, Nairobi, Kenya
| | | | - Romina Libster
- Fundación INFANT, Buenos Aires, Argentina
- National Technical and Scientific Research Council, Buenos Aires, Argentina
| | - Bronner P. Gonçalves
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Shabir A. Madhi
- Medical Research Council: Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Azucena Bardají
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Eva Mwangome
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
| | - Adam Mabrouk
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
| | - Hima B. John
- Neonatology Department, Christian Medical College, Vellore, India
| | | | - Jaya Chandna
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Pamela Sithole
- Medical Research Council: Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Humberto Mucasse
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Patrick V. Katana
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
| | - Artemis Koukounari
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Lois M. Harden
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Celine Aerts
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Azra Ghoor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shannon Leahy
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sibongile Mbatha
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah Lowick
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanjay G. Lala
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Justina Bramugy
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Charles Newton
- Neuroscience Research Group, Department of Clinical Sciences, KEMRI-Wellcome Trust, Kilifi, Kenya
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
| | - A. K. M. Tanvir Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Qazi Sadeq-ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Philipp Lambach
- Department of Immunization, Vaccines and Biologicals (IVB), World Health Organization, Geneva, Switzerland
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Modelling and Economics Unit, Public Health England, London, UK
- Division of Epidemiology and Biostatistics, School of Public Health, University of Hong Kong, Hong Kong SAR, China
| | - Joy E. Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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23
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Marbán-Castro E, Villén-Gonzalvo A, Enguita-Fernàndez C, Marín-Cos A, Menéndez C, Maixenchs M, Bardají A. Uncertainties, Fear and Stigma: Perceptions of Zika Virus among Pregnant Women in Spain. Int J Environ Res Public Health 2020; 17:ijerph17186643. [PMID: 32933007 PMCID: PMC7559627 DOI: 10.3390/ijerph17186643] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/28/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023]
Abstract
Similar to other epidemics, knowledge about Zika virus (ZIKV) relies upon information often coming from outside the health system. This study aimed to explore views, perceptions and attitudes towards ZIKV among migrant women from Central and South America, diagnosed with ZIKV infection during pregnancy, and to comprehend healthcare professionals’ perceptions of ZIKV. An exploratory qualitative study, based on phenomenology and grounded theory, was conducted in Barcelona, Spain. Data were collected through in-depth and paired interviews with women diagnosed with ZIKV infection during pregnancy, and semi-structured interviews with healthcare professionals. Women showed good level of awareness of ZIKV, despite some knowledge gaps. The most consulted source of information about ZIKV was the Internet. Women expressed they suffered from anxiety and depression due to potential effects of ZIKV on their babies. They conveyed their sources of support came primarily from their partners and relatives, as well as healthcare professionals. This study stresses the dramatic health, social and emotional burden that the epidemic imposed on migrant women infected with ZIKV during pregnancy. These results may help guide psychosocial support and health measures for pregnant women and their children as part of the public health emergency response in emergent epidemics.
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Affiliation(s)
- Elena Marbán-Castro
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Correspondence:
| | - Ana Villén-Gonzalvo
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
| | - Cristina Enguita-Fernàndez
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Anna Marín-Cos
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
| | - Clara Menéndez
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique
| | - Maria Maixenchs
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Azucena Bardají
- ISGlobal, Hospital Clínic—Universitat de Barcelona, 08036 Barcelona, Spain; (A.V.-G.); (C.E.-F.); (A.M.-C.); (C.M.); (M.M.); (A.B.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique
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24
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Menendez YA, Cambaco O, Mindú C, Nhantumbo H, Uamusse T, Matsinhe G, Matsinhe B, Manjate RM, Bardají A, Menendez C, Sevene E, Munguambe K. Lay knowledge of cervical cancer in Manhiça district, Mozambique: a qualitative study. Reprod Health 2020; 17:130. [PMID: 32831101 PMCID: PMC7444028 DOI: 10.1186/s12978-020-00980-1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 08/10/2020] [Indexed: 11/16/2022] Open
Abstract
Background Mozambique has one of the highest cervical cancer incidence rates in the world. Health interventions are still being conceived solely from a non-communicable disease standpoint despite that it is also a sexual and reproductive health problem. The objective of this study was to assess the extent to which lay perceptions of cervical cancer align with biomedical knowledge from the standpoint of sexual and reproductive health. Methods 10 focus group discussions were carried out with 10 target groups in Manhiça. The target groups were diverse in terms of age, sex, educational level and occupation. There were a total of 116 participants. The focus groups discussions were applied to obtain verbal information and trigger debates around beliefs and attitudes about cervical cancer as well as to explore notions of transmission and aetiology of the disease. The discussions were recorded for later transcription and analysis, following a combination of content and thematic analysis. Results Participants were familiar with the biomedical term ‘cervical cancer’ but knowledge of its aetiology and transmission was limited. Cervical cancer was readily associated to sexual transmission and sexually transmitted infections, and conceived as a ‘wound that does not heal’. The term ‘cancer’ caused confusion, as it was perceived to happen only in limbs, understood as hereditary, not transmissible and as an illness of the West. Conclusions Lay perceptions of cervical cancer do, to a large extent, align with biomedical ones, thus, there is common ground to frame future health interventions from a sexual and reproductive health standpoint. Some misperceptions were identified which could be reduced through social behaviour change communication initiatives.
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Affiliation(s)
| | - Olga Cambaco
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique
| | - Carolina Mindú
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique
| | - Hoticha Nhantumbo
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique
| | - Titos Uamusse
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique
| | - Graça Matsinhe
- Extended Program on Immunization (PAV), Ministry of Health (MISAU), Maputo, Mozambique
| | - Benigna Matsinhe
- National Directorate for Public Health (DNSP), Ministry of Health (MISAU), Maputo, Mozambique
| | - Rosa Marlene Manjate
- National Directorate for Public Health (DNSP), Ministry of Health (MISAU), Maputo, Mozambique
| | - Azucena Bardají
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique
| | - Clara Menendez
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique.,Barcelona Institute for Global Health (ISGLOBAL)/Hospital Clinic-Universitat de Barcelona, Barcelona, Spain
| | - Esperança Sevene
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique.,Faculty of Medicine, Eduardo Mondlane University (UEM), Maputo, Mozambique
| | - Khátia Munguambe
- Manhiça Health Research Centre (CISM), Rua 12 - Cambeve, Manhiça, Mozambique. .,Faculty of Medicine, Eduardo Mondlane University (UEM), Maputo, Mozambique.
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25
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Fonseca AM, González R, Bardají A, Jairoce C, Rupérez M, Jiménez A, Quintó L, Cisteró P, Vala A, Sacoor C, Gupta H, Hegewisch-Taylor J, Brew J, Ndam NT, Kariuki S, López M, Dobaño C, Chitnis CE, Ouma P, Ramharter M, Abdulla S, Aponte JJ, Massougbodji A, Briand V, Mombo-Ngoma G, Desai M, Cot M, Nhacolo A, Sevene E, Macete E, Menéndez C, Mayor A. VAR2CSA Serology to Detect Plasmodium falciparum Transmission Patterns in Pregnancy. Emerg Infect Dis 2020; 25:1851-1860. [PMID: 31538557 PMCID: PMC6759269 DOI: 10.3201/eid2510.181177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Pregnant women constitute a promising sentinel group for continuous monitoring of malaria transmission. To identify antibody signatures of recent Plasmodium falciparum exposure during pregnancy, we dissected IgG responses against VAR2CSA, the parasite antigen that mediates placental sequestration. We used a multiplex peptide-based suspension array in 2,354 samples from pregnant women from Mozambique, Benin, Kenya, Gabon, Tanzania, and Spain. Two VAR2CSA peptides of limited polymorphism were immunogenic and targeted by IgG responses readily boosted during infection and with estimated half-lives of <2 years. Seroprevalence against these peptides reflected declines and rebounds of transmission in southern Mozambique during 2004–2012, reduced exposure associated with use of preventive measures during pregnancy, and local clusters of transmission that were missed by detection of P. falciparum infections. These data suggest that VAR2CSA serology can provide a useful adjunct for the fine-scale estimation of the malaria burden among pregnant women over time and space.
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MESH Headings
- Adult
- Antibodies, Protozoan/immunology
- Antigens, Protozoan/blood
- Antigens, Protozoan/immunology
- Benin/epidemiology
- Female
- Gabon/epidemiology
- Humans
- Immunoglobulin G/immunology
- Kenya/epidemiology
- Malaria, Falciparum/complications
- Malaria, Falciparum/diagnosis
- Malaria, Falciparum/epidemiology
- Malaria, Falciparum/transmission
- Mozambique/epidemiology
- Plasmodium falciparum/immunology
- Pregnancy
- Pregnancy Complications, Parasitic/blood
- Pregnancy Complications, Parasitic/diagnosis
- Pregnancy Complications, Parasitic/epidemiology
- Serologic Tests/methods
- Spain/epidemiology
- Tanzania/epidemiology
- Young Adult
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26
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González R, Pons-Duran C, Bardají A, Leke RGF, Clark R, Menendez C. Systematic review of artemisinin embryotoxicity in animals: Implications for malaria control in human pregnancy. Toxicol Appl Pharmacol 2020; 402:115127. [PMID: 32622917 DOI: 10.1016/j.taap.2020.115127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 03/06/2020] [Revised: 05/31/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
Pregnant women are one of the most susceptible and vulnerable groups to malaria, the most important parasitic disease worldwide. Artemisinin-based combination therapies (ACTs) are recommended for the treatment of uncomplicated malaria in all population groups including pregnant women. However, due to the embryotoxicity observed in animal studies, ACTs have long been contraindicated during the first trimester in pregnant women. Despite the safety concerns raised in pre-clinical studies, recent findings on ACTs's use in pregnant women appear to be reassuring regarding safety and have prompted a revision of malaria treatment guidelines for first trimester of pregnancy. To contribute to the risk-benefit assessment of ACTs, we conducted a systematic literature review of animal studies published between 2007 and 2019, which evaluated the embryotoxic effects of artemisinin and its derivatives among pregnant mammals. Eighteen experimental studies fitted the inclusion criteria. These studies confirmed and further characterized the severe embryolethal and embryotoxic dose-dependent effects of artemisinin and its derivatives when administered during the organogenesis period in rats, rabbits and monkeys. Timing of administration and dosage of the drug were found to be key factors in the appearance of embryo damage. Overall, the translation of the findings of artemisinin derivatives use in animal studies to pregnant women remains disturbing. Thus, a policy change in the use of ACTs during the first trimester in pregnant women for the treatment of uncomplicated malaria does not seem pertinent and if implemented, it should be accompanied by solid pharmacovigilance systems, which are challenging to establish in malaria endemic countries.
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Affiliation(s)
- Raquel González
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain.
| | - Clara Pons-Duran
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Azucena Bardají
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Manhiça Health Research Center (CISM), Manhiça, Mozambique
| | - Rose G F Leke
- Department of Microbiology, Immunology and Haematology, Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon
| | - Robert Clark
- Artemis Pharmaceutical Research, Jacksonville, Florida, USA
| | - Clara Menendez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Manhiça Health Research Center (CISM), Manhiça, Mozambique
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27
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González R, García-Otero L, Pons-Duran C, Marbán-Castro E, Goncé A, Llurba E, Gil MDM, Rodríguez-Zambrano MÁ, Chen H, Ramírez M, Bardají A, Menendez C. Hydroxychloroquine efficacy and safety in preventing SARS-CoV-2 infection and COVID-19 disease severity during pregnancy (COVID-Preg): a structured summary of a study protocol for a randomised placebo controlled trial. Trials 2020; 21:607. [PMID: 32616063 PMCID: PMC7330539 DOI: 10.1186/s13063-020-04557-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 12/02/2022] Open
Abstract
Objectives The primary objectives of the study are: 1. To assess the effect of hydroxychloroquine (HCQ) in reducing SARS-CoV-2 viral shedding by PCR in infected pregnant women with mild symptoms. 2. To assess the efficacy of HCQ to prevent SARS-CoV-2 infection in pregnant women in contact with an infected or suspected case. 3. To evaluate the effect of HCQ in preventing the development of the COVID-19 disease in asymptomatic SARS-CoV-2-infected pregnant women. The secondary objectives are: 1. To determine the effect of HCQ on the clinical course and duration of the COVID-19 disease in SARS-CoV-2-infected pregnant women. 2. To determine the impact of HCQ on the risk of hospitalization and mortality of SARS-CoV-2-infected pregnant women. 3. To assess the safety and tolerability of HCQ in pregnant women. 4. To describe the clinical presentation of SARS-CoV-2 infection during pregnancy. 5. To describe the effects of maternal SARS-CoV-2 infection on pregnancy and perinatal outcomes by treatment group. 6. To determine the risk of vertical transmission (intra-utero and intra-partum) of SARS-CoV-2. Trial design Randomized double-blind placebo-controlled two-arm multicentre clinical trial to evaluate the safety and efficacy of HCQ to prevent and/or minimize SARS-CoV-2 infection during pregnancy. Participants will be randomized to receive a 14-day oral treatment course of HCQ or placebo, ratio 1:1. Participants Study population: pregnant women undergoing routine prenatal follow up or attending emergency units at the participating hospitals who report either symptoms/signs suggestive of COVID-19 disease or close contact with a suspected or confirmed COVID-19 case. Inclusion criteria Women will be invited to participate in the trial and sign an informed consent if they meet the following inclusion criteria. • Presenting with fever (≥37.5°C) and/or one mild symptom suggestive of COVID-19 disease (cough, dyspnoea, chills, odynophagia, diarrhoea, muscle pain, anosmia, dysgeusia, headache) OR being contact* of a SARS-CoV-2 confirmed or suspected case in the past 14 days • More than 12 weeks of gestation (dated by ultrasonography) • Agreement to deliver in the study hospitals Exclusion criteria • Known hypersensitivity to HCQ or other 4-amonoquinoline compounds • History of retinopathy of any aetiology • Concomitant use of digoxin, cyclosporine, cimetidine • Known liver disease • Clinical history of cardiac pathology including known long QT syndrome • Unable to cooperate with the requirements of the study • Participating in other intervention studies • Delivery onset (characterized by painful uterine contractions and variable changes of the cervix, including some degree of effacement and slower progression of dilatation up to 5 cm for first and subsequent labours) The study participants will be stratified by clinical presentation and SARS-CoV-2 PCR results. Assignment of participants to study groups will be as follows: • SARS-CoV-2-PCR confirmed, infected pregnant women: a. symptomatic (n=100) b. asymptomatic (n=100) • SARS-CoV-2 PCR negative pregnant women in contact* with a SARS-CoV-2-infected confirmed or suspected case (n=514). *The ECDC definition of close contact will be followed. The trial will be conducted in five hospitals in Spain: Hospital Clínic of Barcelona, Hospital Sant Joan de Déu and Hospital de la Santa Creu i Sant Pau, in Barcelona, and HM Puerta del Sur and Hospital Universitario de Torrejón, in Madrid. Intervention and comparator Participants will be randomized to HCQ (400 mg/day for three days, followed by 200 mg/day for 11 days) or placebo (2 tablets for three days, followed by one tablet for 11 days). Main outcomes The primary outcome is the number of PCR-confirmed infected pregnant women assessed from collected nasopharyngeal and oropharyngeal swabs at day 21 after treatment start (one week after treatment is completed). Randomisation Allocation of participants to study arms will be done centrally by the trial’s Sponsor (the Barcelona Institute for Global Health, ISGlobal) by block randomization. This method will ensure balanced allocation to both arms. The electronic CRF will automatically assign a study number to each participant, depending on her study group and recruitment site. Each number will be related to a treatment number, which assigns them to one of the study arms. Blinding (masking) Participants, caregivers, investigators and those assessing the outcomes will be blinded to group assignment. Study tablets (HCQ and placebo) will be identically packaged in small opaque bottles. Numbers to be randomised (sample size) This study requires 200 SARS-CoV-2 infected and 514 contact pregnant women, randomised 1:1 with 100 and 227 respectively in each study arm. Trial Status Protocol version 1.0, from May 8th, 2020. Recruitment is ongoing (first patient recruited the 19th May 2020 and recruitment end anticipated by December 2020). Trial registration EudraCT number: 2020-001587-29, registered 2 April 2020. Clinicaltrials.gov identifier: NCT04410562, retrospectively registered 1 June 2020. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
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Affiliation(s)
- Raquel González
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain. .,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. .,Manhiça Health Research Center (CISM), Manhiça, Mozambique.
| | - Laura García-Otero
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Manhiça Health Research Center (CISM), Manhiça, Mozambique
| | - Clara Pons-Duran
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Elena Marbán-Castro
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Anna Goncé
- BCNATAL
- Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Elisa Llurba
- Obstetrics and Gynecology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maria Del Mar Gil
- Obstetrics and Gynecology Department, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain.,School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | | | - Haily Chen
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Máximo Ramírez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Azucena Bardají
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Manhiça Health Research Center (CISM), Manhiça, Mozambique
| | - Clara Menendez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Manhiça Health Research Center (CISM), Manhiça, Mozambique
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28
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Eckert LO, Jones CE, Kachikis A, Bardají A, Silva FTD, Absalon J, Rouse CE, Khalil A, Cutland CL, Kochhar S, Munoz FM. Obstetrics risk Assessment: Evaluation of selection criteria for vaccine research studies in pregnant women. Vaccine 2020; 38:4542-4547. [PMID: 32448618 PMCID: PMC7211583 DOI: 10.1016/j.vaccine.2020.05.022] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/18/2020] [Accepted: 05/06/2020] [Indexed: 10/31/2022]
Abstract
Vaccines designed for use in pregnancy and vaccine trials specifically involving pregnant women are rapidly expanding. One of the key challenges in designing maternal immunization trials is that developing exclusion criteria requires understanding and quantifying the background risk for adverse pregnancy outcomes in the pregnancy being studied, which can occur independent of any intervention and be unrelated to vaccine administration. The Global Alignment of Immunization Safety Assessment in Pregnancy (GAIA) project has developed and published case definitions and guidelines for data collection, analysis, and evaluation of maternal immunization safety in trials involving pregnant women. Complementing this work, we sought to understand how to best assess obstetric risk of adverse outcomes and differentiate it from the assessment of vaccine safety. Quantification of obstetric risk is based on prior and current obstetric, and maternal medical history. We developed a step-wise approach to evaluate and quantify obstetric and maternal risk factors in pregnancy based on review of published literature and guidelines, and critically assessed these factors in the context of designing inclusion and exclusion criteria for maternal vaccine studies. We anticipate this risk assessment evaluation may assist clinical trialists with study design decisions, including selection of exclusion criteria for vaccine trials involving pregnant women, consideration of sub-group classification, such as high or low risk subjects, or schedule considerations, such as preferred trimester of gestation for an intervention during pregnancy. Additionally, this tool may be utilized in data stratification at time of study analyses.
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Affiliation(s)
- Linda O Eckert
- Department of Obstetrics and Gynecology University of Washington, School of Medicine Seattle, WA; Department of Global Health, University of Washington School of Medicine, Seattle, WA.
| | - Christine E Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alisa Kachikis
- Department of Obstetrics and Gynecology University of Washington, School of Medicine Seattle, WA
| | - Azucena Bardají
- ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | - Caroline E Rouse
- Department of Obstetrics & Gynecology, Indiana University, Indianapolis, IN
| | - Asma Khalil
- Department of Obstetrics & Gynecology, St. George's Hospital, University of London, London, UK
| | - Clare L Cutland
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, African Leadership Iin Vaccinology Expertise, Faculty of Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sonali Kochhar
- Department of Global Health, University of Washington School of Medicine, Seattle, WA; Global Healthcare Consulting, India; Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Flor M Munoz
- Department of Pediatrics and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, United States.
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29
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Abstract
BACKGROUND Mandatory vaccination has been effective in maintaining high vaccination coverage in countries such as the United States. However, there are no peer-reviewed analyses of the association between mandates and both coverage and subsequent incidence of vaccine-preventable disease in Europe. METHODS Using data from the European Centre for Disease Prevention and Control and the World Health Organization, we evaluated the relationship between country-level mandatory vaccination policies and (1) measles and pertussis vaccine coverage and (2) the annual incidence of these diseases in 29 European countries. Multivariate negative binomial and linear regression models were used to quantify these associations. RESULTS Mandatory vaccination was associated with a 3.71 (95% confidence interval [CI]: 1.68 to 5.74) percentage point higher prevalence of measles vaccination and a 2.14 (95% CI: 0.13 to 4.15) percentage point higher prevalence of pertussis vaccination when compared with countries that did not have mandatory vaccination. Mandatory vaccination was only associated with decreased measles incidence for countries without nonmedical exemptions (adjusted incidence rate ratio = 0.14; 95% CI: 0.05 to 0.36). We did not find a significant association between mandatory vaccination and pertussis incidence. CONCLUSIONS Mandatory vaccination and the magnitude of fines were associated with higher vaccination coverage. Moreover, mandatory vaccination was associated with lower measles incidence for countries with mandatory vaccination without nonmedical exemptions. These findings can inform legislative policies aimed at increasing vaccination coverage.
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Affiliation(s)
- Olivia M. Vaz
- Departments of Epidemiology, Emory University, Atlanta, Georgia
| | - Mallory K. Ellinǵson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Paul Weiss
- Biostatistics and Bioinformatics, Emory University, Atlanta, Georgi
| | | | - Azucena Bardají
- Hospital Clinic, Barcelona Institute for Global Health, Universitat de Barcelona, Barcelona, Spain
| | - Robert A. Bednarczyk
- Departments of Epidemiology, Emory University, Atlanta, Georgia,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia,Emory Vaccine Center, Emory University, Atlanta, Georgia,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Saad B. Omer
- Departments of Epidemiology, Emory University, Atlanta, Georgia,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia,Emory Vaccine Center, Emory University, Atlanta, Georgia,Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
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Kachikis A, Eckert LO, Walker C, Bardají A, Varricchio F, Lipkind HS, Diouf K, Huang WT, Mataya R, Bittaye M, Cutland C, Boghossian NS, Mallett Moore T, McCall R, King J, Mundle S, Munoz FM, Rouse C, Gravett M, Katikaneni L, Ault K, Klein NP, Roberts DJ, Kochhar S, Chescheir N. Chorioamnionitis: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2019; 37:7610-7622. [PMID: 31783982 PMCID: PMC6891229 DOI: 10.1016/j.vaccine.2019.05.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/09/2019] [Indexed: 12/26/2022]
Affiliation(s)
| | | | | | - Azucena Bardají
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | | | - Khady Diouf
- Brigham and Women's Hospital, Boston, MA, USA
| | | | - Ronald Mataya
- Loma Linda University, Loma Linda, CA, USA; University of Malawi College of Medicine, Malawi
| | - Mustapha Bittaye
- Edward Francis Small Teaching Hospital, Banjul, The Gambia; Medical Research Council - The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia; University of The Gambia School of Medicine & Allied Health Sciences, The Gambia
| | - Clare Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa; Department of Science and Technology National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nansi S Boghossian
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | | | | | | | | | | | - Caroline Rouse
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Kevin Ault
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Centre, Oakland, CA, USA
| | | | - Sonali Kochhar
- Global Healthcare Consulting, India; Erasmus University Medical Center, Rotterdam, the Netherlands; University of Washington, Seattle, WA, USA
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31
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Ubillos I, Campo JJ, Requena P, Ome-Kaius M, Hanieh S, Rose H, Samol P, Barrios D, Jiménez A, Bardají A, Mueller I, Menéndez C, Rogerson S, Moncunill G, Dobaño C. Corrigendum: Chronic Exposure to Malaria Is Associated with Inhibitory and Activation Markers on Atypical Memory B Cells and Marginal Zone-Like B Cells. Front Immunol 2019; 10:2427. [PMID: 31681313 PMCID: PMC6811778 DOI: 10.3389/fimmu.2019.02427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 09/27/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Itziar Ubillos
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Joseph J Campo
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Antigen Discovery Inc., Irvine, CA, United States
| | - Pilar Requena
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Facultad de Medicina, Universidad de Granada, Granada, Spain
| | - Maria Ome-Kaius
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Sarah Hanieh
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Honor Rose
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Paula Samol
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Diana Barrios
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Alfons Jiménez
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Azucena Bardají
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Ivo Mueller
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.,Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Clara Menéndez
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | | | - Gemma Moncunill
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Carlota Dobaño
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
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32
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Valmaseda A, Macete E, Nhabomba A, Guinovart C, Aide P, Bardají A, Bassat Q, Nhampossa T, Maculuve S, Casellas A, Quintó L, Sanz S, Jiménez A, Feng G, Langer C, Reiling L, Reddy KS, Pandey A, Chitnis CE, Chauhan VS, Aguilar R, Aponte JJ, Dobaño C, Beeson JG, Gaur D, Menéndez C, Alonso PL, Mayor A. Identifying Immune Correlates of Protection Against Plasmodium falciparum Through a Novel Approach to Account for Heterogeneity in Malaria Exposure. Clin Infect Dis 2019; 66:586-593. [PMID: 29401272 DOI: 10.1093/cid/cix837] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 07/12/2017] [Accepted: 09/16/2017] [Indexed: 12/16/2022] Open
Abstract
Background A main criterion to identify malaria vaccine candidates is the proof that acquired immunity against them is associated with protection from disease. The age of the studied individuals, heterogeneous malaria exposure, and assumption of the maintenance of a baseline immune response can confound these associations. Methods Immunoglobulin G/immunoglobulin M (IgG/ IgM) levels were measured by Luminex® in Mozambican children monitored for clinical malaria from birth until 3 years of age, together with functional antibodies. Studied candidates were pre-erythrocytic and erythrocytic antigens, including EBAs/PfRhs, MSPs, DBLs, and novel antigens merely or not previously studied in malaria-exposed populations. Cox regression models were estimated at 9 and 24 months of age, accounting for heterogeneous malaria exposure or limiting follow-up according to the antibody's decay. Results Associations of antibody responses with higher clinical malaria risk were avoided when accounting for heterogeneous malaria exposure or when limiting the follow-up time in the analyses. Associations with reduced risk of clinical malaria were found only at 24 months old, but not younger children, for IgG breadth and levels of IgG targeting EBA140III-V, CyRPA, DBL5ε and DBL3x, together with C1q-fixation activity by antibodies targeting MSP119. Conclusions Malaria protection correlates were identified, only in children aged 24 months old when accounting for heterogeneous malaria exposure. These results highlight the relevance of considering age and malaria exposure, as well as the importance of not assuming the maintenance of a baseline immune response throughout the follow-up. Results may be misleading if these factors are not considered.
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Affiliation(s)
- Aida Valmaseda
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Spain
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Mozambique
| | | | - Caterina Guinovart
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Spain
| | - Pedro Aide
- Centro de Investigação em Saúde de Manhiça (CISM), Mozambique
| | - Azucena Bardají
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Mozambique.,Catalan Institution for Research and Advanced Studies (ICREA).,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona)
| | | | - Sonia Maculuve
- Centro de Investigação em Saúde de Manhiça (CISM), Mozambique
| | - Aina Casellas
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Spain
| | - Llorenç Quintó
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Spain
| | - Sergi Sanz
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Spain
| | - Alfons Jiménez
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBEREsp), Madrid, Spain
| | | | | | | | - K Sony Reddy
- Malaria Group, International Centre for Genetic Engineering and Biotechnology (ICGEB)
| | - Alok Pandey
- Malaria Group, International Centre for Genetic Engineering and Biotechnology (ICGEB)
| | - Chetan E Chitnis
- Department of Parasites and Insect Vectors, Malaria Parasite Biology and Vaccines Unit, Institut Pasteur, Paris, France
| | - Virander S Chauhan
- Malaria Group, International Centre for Genetic Engineering and Biotechnology (ICGEB)
| | - Ruth Aguilar
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Spain
| | - John J Aponte
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Mozambique
| | - Carlota Dobaño
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Spain
| | - James G Beeson
- Burnet Institute.,Central Clinical School and Department of Microbiology, Monash University, Melbourne, Australia
| | - Deepak Gaur
- Laboratory of Malaria and Vaccine Research, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
| | - Clara Menéndez
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Mozambique.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBEREsp), Madrid, Spain
| | - Pedro L Alonso
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Mozambique
| | - Alfredo Mayor
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Mozambique
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33
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Dobaño C, Bardají A, Kochar S, Kochar SK, Padilla N, López M, Unger HW, Ome-Kaius M, Castellanos ME, Arévalo-Herrera M, Hans D, Martínez-Espinosa FE, Bôtto-Menezes C, Malheiros A, Desai M, Casellas A, Chitnis CE, Rogerson S, Mueller I, Menéndez C, Requena P. Blood cytokine, chemokine and growth factor profiling in a cohort of pregnant women from tropical countries. Cytokine 2019; 125:154818. [PMID: 31514106 DOI: 10.1016/j.cyto.2019.154818] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 12/28/2022]
Abstract
The immune status of women changes during and after pregnancy, differs between blood compartments at delivery and is affected by environmental factors particularly in tropical areas endemic for multiple infections. We quantified the plasma concentration of a set of thirty-one TH1, TH2, TH17 and regulatory cytokines, pro-inflammatory and anti-inflammatory cytokines and chemokines, and growth factors (altogether biomarkers), in a cohort of 540 pregnant women from five malaria-endemic tropical countries. Samples were collected at recruitment (first antenatal visit), delivery (periphery, cord and placenta) and postpartum, allowing a longitudinal analysis. We found the lowest concentration of biomarkers at recruitment and the highest at postpartum, with few exceptions. Among them, IL-6, HGF and TGF-β had the highest levels at delivery, and even higher concentrations in the placenta compared to peripheral blood. Placental concentrations were generally higher than peripheral, except for eotaxin that was lower. We also compared plasma biomarker concentrations between the tropical cohort and a control group from Spain at delivery, presenting overall higher biomarker levels the tropical cohort, particularly pro-inflammatory cytokines and growth factors. Only IL-6 presented lower levels in the tropical group. Moreover, a principal component analysis of biomarker concentrations at delivery showed that women from Spain grouped more homogenously, and that IL-6 and IL-8 clustered together in the tropical cohort but not in the Spanish one. Plasma cytokine concentrations correlated with Plasmodium antibody levels at postpartum but not during pregnancy. This basal profiling of immune mediators over gestation and in different compartments at delivery is important to subsequently understand response to infections and clinical outcomes in mothers and infants in tropical areas.
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Affiliation(s)
- Carlota Dobaño
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Carrer del Rosselló, 132, 08036 Barcelona, Spain.
| | - Azucena Bardají
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Carrer del Rosselló, 132, 08036 Barcelona, Spain
| | - Swati Kochar
- Medical College, PBM Hospital, Bikaner, Rajasthan 334001, India
| | - Sanjay K Kochar
- Medical College, PBM Hospital, Bikaner, Rajasthan 334001, India
| | - Norma Padilla
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Avenida 11-95, Guatemala 01015, Guatemala
| | - Marta López
- Department of Maternal-Fetal Medicine, Hospital Clínic-IDIBAPS, CIBER-ER, Carrer del Rosselló, 149, 08036 Barcelona, Spain
| | - Holger W Unger
- Papua New Guinea Institute of Medical Research, P.O. Box 378, Madang 511, Papua New Guinea
| | - Maria Ome-Kaius
- Papua New Guinea Institute of Medical Research, P.O. Box 378, Madang 511, Papua New Guinea
| | - Maria Eugenia Castellanos
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, 18 Avenida 11-95, Guatemala 01015, Guatemala
| | | | - Dhiraj Hans
- International Center for Genetic Engineering and Biotechnology, Jawaharlal Nehru University, Aruna Asaf Ali Marg, New Delhi, Delhi 110067, India
| | - Flor E Martínez-Espinosa
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av. Pedro Teixeira, s/n - Dom Pedro, Manaus, AM 69040-000, Brazil; Instituto Leônidas e Maria Deane, Rua Teresina, 476 - Adrianópolis, Manaus 69.057-070, Brazil
| | - Camila Bôtto-Menezes
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av. Pedro Teixeira, s/n - Dom Pedro, Manaus, AM 69040-000, Brazil; Universidade do Estado do Amazonas, 69850-000, R. Bloco Um e Três, 4-40 - Platô do Piquiá, Boca do Acre, AM 69850-000, Brazil
| | - Adriana Malheiros
- Instituto de Ciências Biológicas, Universidade Federal do Amazonas, Av. Jauary Marinho - Setor Sul - Coroado, Manaus, AM, Brazil
| | - Meghna Desai
- Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Malaria Branch, 1600 Clifton Rd, Atlanta, GA 30333, USA
| | - Aina Casellas
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Carrer del Rosselló, 132, 08036 Barcelona, Spain
| | - Chetan E Chitnis
- International Center for Genetic Engineering and Biotechnology, Jawaharlal Nehru University, Aruna Asaf Ali Marg, New Delhi, Delhi 110067, India; Malaria Parasite Biology and Vaccines Unit, Institut Pasteur, 25-28 Rue du Dr Roux, 75015 Paris, France
| | | | - Ivo Mueller
- Walter and Eliza Hall Institute, 1G, Royal Parade, Parkville, VIC 3052, Australia
| | - Clara Menéndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Carrer del Rosselló, 132, 08036 Barcelona, Spain
| | - Pilar Requena
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Carrer del Rosselló, 132, 08036 Barcelona, Spain; Departmento de Medicina Preventiva y Salud Pública, Universidad de Granada, Facultad de Farmacia, Campus de Cartuja, 18071 Granada, Spain.
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34
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Hamal M, Heiter K, Schoenmakers L, Smid M, de Cock Buning T, De Brouwere V, Bardají A, Nepal C, Dieleman M. Social Accountability in Maternal Health Services in the Far-Western Development Region in Nepal: An Exploratory Study. Int J Health Policy Manag 2019; 8:280-291. [PMID: 31204444 PMCID: PMC6571494 DOI: 10.15171/ijhpm.2019.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 02/25/2018] [Accepted: 02/02/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Social accountability or citizen-led accountability has been promoted in many low- and middle-income countries to improve the quality, access to and use of maternal health services. Experiences with social accountability in maternal health services in Nepal have not yet been documented. This study identifies existing social accountability structures and activities in maternal health services in two districts of Far-Western Nepal and explores their functions, implementation and gaps/challenges.
Methods: An exploratory study was conducted that included in-depth interviews with purposively selected policy advisors (8), healthcare officials (11), healthcare providers (12) and non-governmental staff (3); and focus group discussions (FGDs) with 54 women. Data analysis was conducted using thematic content analysis based on George’s information, dialogue and negotiation framework.
Results: Social accountability in maternal health existed in terms of structures such as mothers’ groups (MGs), female community health volunteers (FCHVs) and Health Facility Operation and Management Committees (HFOMCs); and activities such as social audits and community health score board (CHSB). MGs and FCHVs were perceived as trusted intermediaries, but their functioning was limited to information. HFOMCs were not fully functional. Social audits and CHSBs were implemented in limited sites and with poor participation by women. Health-sector responses were mainly found at the local level. Factors contributing to these challenges were the absence of a mandate and limited capacity, including resources.
Conclusion: Formal structures and activities existed for social accountability in maternal health services in the Far-Western Development Region of Nepal, but there were limitations pertaining to their implementation. The main recommendations are: for clear policy mandates on the social accountability roles of MGs and FCHVs; wider implementation of social audits and CHSBs, with emphasis on the participation of women from disadvantaged groups; improved capacity of HFOMCs; and improved engagement of the health sector at all levels to listen and respond to women’s concerns.
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Affiliation(s)
- Mukesh Hamal
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences (VU University), Amsterdam, The Netherlands.,Maternal and Reproductive Health, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Kalina Heiter
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences (VU University), Amsterdam, The Netherlands
| | - Lian Schoenmakers
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences (VU University), Amsterdam, The Netherlands
| | - Myonne Smid
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences (VU University), Amsterdam, The Netherlands
| | - Tjard de Cock Buning
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences (VU University), Amsterdam, The Netherlands
| | - Vincent De Brouwere
- Maternal and Reproductive Health, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Azucena Bardají
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | | | - Marjolein Dieleman
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences (VU University), Amsterdam, The Netherlands.,KIT Health, Amsterdam, The Netherlands
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35
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Bardají A, MacDonald NE, Omer SB, Aguado T. Maternal immunization: A call to accelerate progress. Vaccine 2019; 37:2882-2883. [PMID: 31014962 DOI: 10.1016/j.vaccine.2019.04.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/24/2019] [Revised: 03/26/2019] [Accepted: 04/08/2019] [Indexed: 11/16/2022]
Abstract
Maternal immunization provides an excellent evidence-based strategy for preventing severe disease and decreasing neonatal and infant mortality. A substantial proportion of these deaths are due to infectious diseases, most of them vaccine-preventable, then, there is a real opportunity for intervention. Maternal immunization has been an underexploited area for many years, with the exception of neonatal tetanus. There are now programs for influenza and acellular pertussis vaccination in many countries and two maternal vaccine targets under development are focused on decreasing the burden of infant respiratory syncytial virus (RSV) and Group B Streptococcus (GBS). Bodies like the Strategic Advisory Group of Experts (SAGE) on Immunization established by the WHO, the Global Vaccine Action Plan (GVAP) and Gavi, The Vaccine Alliance, have recognized the relevance of maternal immunization on several occasions. However, why is the field not moving faster, as one might expect? Major initiatives and programs should consider spelling out more clearly the role and benefits of this intervention and calling for specific actions, including future strategic approaches for the post 2020 immunization strategy following the GVAP; and single out the area as one of its priorities as a key component of immunization across the life course. While waiting for the new vaccines like RSV and GBS and optimizing the use of influenza and pertussis there is momentum now to coordinate efforts, address the missing information and action gaps, and call to accelerate progress.
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Affiliation(s)
- Azucena Bardají
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
| | | | - Saad B Omer
- Emory University, School of Public Health and Medicine. Emory Vaccine Center, Atlanta, GA, USA
| | - Teresa Aguado
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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36
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Abejirinde IOO, De Brouwere V, van Roosmalen J, van der Heiden M, Apentibadek N, Bardají A, Zweekhorst M. Viability of diagnostic decision support for antenatal care in rural settings: findings from the Bliss4Midwives Intervention in Northern Ghana. J Glob Health 2019; 9:010420. [PMID: 30937164 PMCID: PMC6437754 DOI: 10.7189/jogh.09.010420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/16/2022] Open
Abstract
Background Antenatal screening is useful for early identification and management of high-risk pregnancies. In low-resource settings, provision of the full complement of tests is limited and diagnostic referrals incure additional costs for pregnant women. We assessed the viability of Bliss4Midwives (B4M) - a point-of-care diagnostic decision support device for decentralized screening of pre-eclampsia, gestational diabetes and anaemia during antenatal care (ANC). Methods The device was piloted in seven health facilities across two districts in Northern Ghana over a ten-month period. Health workers were expected to screen women at each ANC visit till delivery. All screening records from the device were automatically archived digitally and later downloaded. After removing duplicates or invalid entries, descriptive quantitative analysis was carried out with IBM SPSS Statistics (version 23). B4M usage behavior, diagnostic and referral outcome were analyzed. Results Health workers conducted 1323 partial or full antenatal screening on 940 women, resulting in decision support for 835 (88.8%) B4M beneficiaries. Diagnostic referral was eliminated for 708 (84.7%) beneficiaries, with 335 (40.1%) of these from facilities without on-site diagnostic alternatives. Of visits with complete data, 92/559 (16.4%) women were screened in their first trimester, 28/940 (2.9%) had 4+ B4M visits and 107/835 (12.8%) women were recommended for urgent referral to a higher-level facility on the first visit. Follow-up screenings flagged an additional 17 women for urgent referral with 10 cases of repeated alerts in five women. Wide variations between high (9 months use) and low adopting (1.5 months use) facilities were observed, with some similarities in usage trend. Conclusions B4M helped decentralize ANC screening and decrease unnecessary referrals. Project outcomes were influenced by implementation strategy, technical features and behavioural dispositions of users and beneficiaries.
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Affiliation(s)
- Ibukun-Oluwa Omolade Abejirinde
- Athena Institute, Vrije Universiteit, Amsterdam, the Netherlands.,Institute of Tropical Medicine, Maternal and Reproductive Health Unit, Department of Public Health, Antwerp, Belgium.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Vincent De Brouwere
- Institute of Tropical Medicine, Maternal and Reproductive Health Unit, Department of Public Health, Antwerp, Belgium
| | - Jos van Roosmalen
- Athena Institute, Vrije Universiteit, Amsterdam, the Netherlands.,Leiden University Medical Centre, Department of Obstetrics, the Netherlands
| | - Maurits van der Heiden
- the Netherlands Organisation for Applied Scientific Research (TNO), Delft, the Netherlands
| | | | - Azucena Bardají
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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37
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Goncé A, Martínez MJ, Marbán-Castro E, Saco A, Soler A, Alvarez-Mora MI, Peiro A, Gonzalo V, Hale G, Bhatnagar J, López M, Zaki S, Ordi J, Bardají A. Spontaneous Abortion Associated with Zika Virus Infection and Persistent Viremia. Emerg Infect Dis 2019; 24:933-935. [PMID: 29664372 PMCID: PMC5938776 DOI: 10.3201/eid2405.171479] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report a case of spontaneous abortion associated with Zika virus infection in a pregnant woman who traveled from Spain to the Dominican Republic and developed a rash. Maternal Zika viremia persisted at least 31 days after onset of symptoms and 21 days after uterine evacuation.
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Abejirinde IOO, Zweekhorst M, Bardají A, Abugnaba-Abanga R, Apentibadek N, De Brouwere V, van Roosmalen J, Marchal B. Unveiling the Black Box of Diagnostic and Clinical Decision Support Systems for Antenatal Care: Realist Evaluation. JMIR Mhealth Uhealth 2018; 6:e11468. [PMID: 30578177 PMCID: PMC6320439 DOI: 10.2196/11468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/29/2018] [Accepted: 10/04/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Digital innovations have shown promise for improving maternal health service delivery. However, low- and middle-income countries are still at the adoption-utilization stage. Evidence on mobile health has been described as a black box, with gaps in theoretical explanations that account for the ecosystem of health care and their effect on adoption mechanisms. Bliss4Midwives, a modular integrated diagnostic kit to support antenatal care service delivery, was piloted for 1 year in Northern Ghana. Although both users and beneficiaries valued Bliss4Midwives, results from the pilot showed wide variations in usage behavior and duration of use across project sites. OBJECTIVE To strengthen the design and implementation of an improved prototype, the study objectives were two-fold: to identify causal factors underlying the variation in Bliss4Midwives usage behavior and understand how to overcome or leverage these in subsequent implementation cycles. METHODS Using a multiple case study design, a realist evaluation of Bliss4Midwives was conducted. A total of 3 candidate program theories were developed and empirically tested in 6 health facilities grouped into low and moderate usage clusters. Quantitative and qualitative data were collected and analyzed using realist thinking to build configurations that link intervention, context, actors, and mechanisms to program outcomes, by employing inductive and deductive reasoning. Nonparametric t test was used to compare the perceived usefulness and perceived ease of use of Bliss4Midwives between usage clusters. RESULTS We found no statistically significant differences between the 2 usage clusters. Low to moderate adoption of Bliss4Midwives was better explained by fear, enthusiasm, and high expectations for service delivery, especially in the absence of alternatives. Recognition from pregnant women, peers, supervisors, and the program itself was a crucial mechanism for device utilization. Other supportive mechanisms included ownership, empowerment, motivation, and adaptive responses to the device, such as realignment and negotiation. Champion users displayed high adoption-utilization behavior in contexts of participative or authoritative supervision, yet used the device inconsistently. Intervention-related (technical challenges, device rotation, lack of performance feedback, and refresher training), context-related (staff turnover, competing priorities, and workload), and individual factors (low technological self-efficacy, baseline knowledge, and internal motivation) suppressed utilization mechanisms. CONCLUSIONS This study shed light on optimal conditions necessary for Bliss4Midwives to thrive in a complex social and organizational setting. Beyond usability and viability studies, advocates of innovative technologies for maternal care need to consider how implementation strategies and contextual factors, such as existing collaborations and supervision styles, trigger mechanisms that influence program outcomes. In addition to informing scale-up of the Bliss4Midwives prototype, our results highlight the need for interventions that are guided by research methods that account for complexity.
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Affiliation(s)
- Ibukun-Oluwa Omolade Abejirinde
- Athena Institute, Faculty of Science, Vrije Universiteit, Amsterdam, Netherlands.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,ISGlobal, Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Marjolein Zweekhorst
- Athena Institute, Faculty of Science, Vrije Universiteit, Amsterdam, Netherlands
| | - Azucena Bardají
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | | | - Vincent De Brouwere
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jos van Roosmalen
- Athena Institute, Faculty of Science, Vrije Universiteit, Amsterdam, Netherlands.,Department of Obstetrics, Leiden University Medical Centre, Leiden, Netherlands
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Oostdam S, Hamal M, Dieleman M, De Brouwere V, Bardají A, Tiwari DP, de Cock Buning T. Social accountability in maternal health services in Baglung district, Nepal: a qualitative study. Journal of Global Health Reports 2018. [DOI: 10.29392/joghr.2.e2018041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Kachikis A, Eckert L, Bardají A, Walker C, Varricchio F, Munoz F, Rouse C, Kochhar S, Bonhoeffer J, Chescheir N. Chorioamnionitis: development of a maternal outcome definition for international immunization research through the GAIA project. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2018.10.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Martínez-Pérez G, Lansana DP, Omeonga S, Gupta H, Breeze-Barry B, González R, Bardají A, Sarukhan A, Goteh JDK, Tody E, Cisteró P, Benda B, Kercula JD, Kibungu FD, Meyer García-Sípido A, Bassat Q, Tarr-Attia CK, Mayor A. Prevalence of Plasmodium falciparum infection among pregnant women at first antenatal visit in post-Ebola Monrovia, Liberia. Malar J 2018; 17:357. [PMID: 30314489 PMCID: PMC6186138 DOI: 10.1186/s12936-018-2506-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 01/10/2018] [Accepted: 10/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disruption of malaria control strategies during the West African 2014-2016 Ebola epidemic led to an increase in malaria-attributable mortality. However, recent data on malaria infection in vulnerable groups, such as pregnant women, are lacking in this post-Ebola scenario. This cross-sectional study aimed to assess the prevalence of Plasmodium falciparum infection and of molecular markers of drug resistance among pregnant women attending antenatal care in Monrovia, capital of Liberia. METHODS From October 2016 to June 2017, all pregnant women attending their first antenatal care visit at the Saint Joseph's Catholic Hospital, Monrovia, were invited to participate in the study. In addition to their routine antenatal care tests, capillary blood spotted onto filter papers were collected from all consenting participants to determine presence of P. falciparum by real-time quantitative PCR. Molecular markers of anti-malarial drug resistance were assessed through Sanger sequencing and quantitative PCR in specimens positive for P. falciparum analysis. RESULTS Of the 195 women participants, 24 (12.3%) were P. falciparum-positive by qPCR. Infected women tended to be more commonly primigravidae and younger than uninfected ones. Parasite densities were higher in primigravidae. Fever was more frequently detected among the infected women. No statistically significant association between P. falciparum infection and haemoglobin levels or insecticide-treated net use was found. While high prevalence of genetic polymorphisms associated with chloroquine and amodiaquine resistance were detected, no molecular markers of artemisinin resistance were observed. CONCLUSION Plasmodium falciparum infections are expected to occur in at least one in every eight women attending first ANC at private clinics in Monrovia and outside the peak of the rainy season. Young primigravidae are at increased risk of P. falciparum infection. Molecular analyses did not provide evidence of resistance to artemisinins among the P. falciparum isolates tested. Further epidemiological studies involving pregnant women are necessary to describe the risk of malaria in this highly susceptible group outside Monrovia, as well as to closely monitor the emergence of resistance to anti-malarials, as recommended by the Liberian National Malaria Control Programme.
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Affiliation(s)
- Guillermo Martínez-Pérez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain. .,Saint Joseph's Catholic Hospital, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia.
| | - Dawoh Peter Lansana
- Saint Joseph's Catholic Hospital, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | - Senga Omeonga
- Saint Joseph's Catholic Hospital, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | - Himanshu Gupta
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Bondey Breeze-Barry
- Saint Joseph's Catholic Hospital, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | - Raquel González
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Azucena Bardají
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Adelaida Sarukhan
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - James D K Goteh
- Liberia Medicines and Health Products Regulatory Authority, Monrovia, Liberia
| | - Edith Tody
- Saint Joseph's Catholic Hospital, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | - Pau Cisteró
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Benard Benda
- Saint Joseph's Catholic Hospital, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | - Juwe D Kercula
- Liberia Medicines and Health Products Regulatory Authority, Monrovia, Liberia
| | - Fanta D Kibungu
- Saint Joseph's Catholic Hospital, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | | | - Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain.,Pediatrics Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
| | - Christine K Tarr-Attia
- Saint Joseph's Catholic Hospital, Oldest Congo Town, PO Box 10-512, 1100, Monrovia, Liberia
| | - Alfredo Mayor
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
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Hamal M, de Cock Buning T, De Brouwere V, Bardají A, Dieleman M. How does social accountability contribute to better maternal health outcomes? A qualitative study on perceived changes with government and civil society actors in Gujarat, India. BMC Health Serv Res 2018; 18:653. [PMID: 30134881 PMCID: PMC6106761 DOI: 10.1186/s12913-018-3453-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 11/15/2017] [Accepted: 08/07/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Social accountability mechanisms have been highlighted as making a contribution to improving maternal health outcomes and reducing inequities. But there is a lack of evidence on how they contribute to such improvements. This study aims to explore social accountability mechanisms in selected districts of the Indian state of Gujarat in relation to maternal health, the factors they address and how the results of these mechanisms are perceived. METHODS We conducted qualitative research through in-depth interviews and focus group discussions with actors of civil society and government health system. Data were analyzed using a framework of social determinants of maternal health in terms of structural and intermediary determinants. RESULTS There are social accountability mechanisms in the government and civil society in terms of structure and activities. But those that were perceived to influence maternal health were mainly from civil society, particularly women's groups, community monitoring and a maternal death review. The social accountability mechanisms influenced structural determinants - governance, policy, health beliefs, women's status, and intermediary determinants - social capital, maternal healthcare behavior, and availability, accessibility and the quality of the health service delivery system. These further positively influenced the increased use of maternal health services. The social accountability mechanisms, through the process of information, dialogue and negotiation, particularly empowered women to make collective demands of the health system and brought about changed perceptions of women among actors in the system. It ultimately improved relations between women and the health system in terms of trust and collaboration, and generated appropriate responses from the health system to meeting women's groups' demands. CONCLUSION Social accountability mechanisms in Gujarat were perceived to improve interaction between communities and the health system and contribute to improvements in access to and use of maternal health services. The influence of social accountability appeared to be limited to the local/district level and there was lack of capacity and ownership of the government structures.
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Affiliation(s)
- Mukesh Hamal
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences (VU University), De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
- Maternal and Reproductive Health, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Tjard de Cock Buning
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences (VU University), De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Vincent De Brouwere
- Maternal and Reproductive Health, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Azucena Bardají
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Marjolein Dieleman
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences (VU University), De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
- KIT Health, PO Box 95001, 1090 HA Amsterdam, The Netherlands
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Abejirinde IOO, Douwes R, Bardají A, Abugnaba-Abanga R, Zweekhorst M, van Roosmalen J, De Brouwere V. Pregnant women's experiences with an integrated diagnostic and decision support device for antenatal care in Ghana. BMC Pregnancy Childbirth 2018; 18:209. [PMID: 29871596 PMCID: PMC5989381 DOI: 10.1186/s12884-018-1853-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 01/24/2018] [Accepted: 05/25/2018] [Indexed: 11/10/2022] Open
Abstract
Background Quality antenatal care (ANC) is recognised as an opportunity for screening and early identification of pregnancy-related complications. In rural Ghana, challenges with access to diagnostic services demotivate women from ANC attendance and referral compliance, leading to absent or late identification and management of high-risk women. In 2016, an integrated diagnostic and clinical decision support system tagged ‘Bliss4Midwives’ (B4M), was piloted in Northern Ghana. The device facilitated non-invasive screening of pre-eclampsia, gestational diabetes and anaemia at the point-of-care. This study aimed to explore the experiences of pregnant women with B4M, and its influence on service utilisation (“pull effect”) and woman-provider relationships (“woman engagement”). Methods Through an embedded study design, qualitative methods including individual semi-structured interviews and non-participant observation were employed. Interviews were conducted with 20 pregnant women and 10 health workers, supplemented by ANC observations in intervention facilities. Secondary data on ANC registrations over a one-year period were extracted from health facility records to support findings on the perceived influence of B4M on service utilisation. Results Women’s first impressions of the device were mostly emotive (excitement, fear), but sometimes neutral. Although it is inconclusive whether B4M increased ANC registration, pregnant women generally valued the availability of diagnostic services at the point-of-care. Additionally, by fostering some level of engagement, the intervention made women feel listened to and cared for. Process outcomes of the B4M encounter also showed that it was perceived as improving the skills and knowledge of the health worker, which facilitated trust in diagnostic recommendations and was therefore believed to motivate referral compliance. Conclusions This study suggests that mHealth diagnostic and decision support devices enhance woman engagement and trust in health workers skills. There is need for further inquiry into how these interventions influence maternal health service utilization and women’s expectations of pregnancy care. Electronic supplementary material The online version of this article (10.1186/s12884-018-1853-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ibukun-Oluwa Omolade Abejirinde
- Athena Institute, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands. .,Department of Public Health, Institute of Tropical Medicine, Maternal and Reproductive Health Unit, Antwerp, Belgium. .,ISGlobal, Hospital Clínic- Universitat de Barcelona, Barcelona, Spain.
| | | | - Azucena Bardají
- ISGlobal, Hospital Clínic- Universitat de Barcelona, Barcelona, Spain
| | | | - Marjolein Zweekhorst
- Athena Institute, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jos van Roosmalen
- Athena Institute, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands.,Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Vincent De Brouwere
- Department of Public Health, Institute of Tropical Medicine, Maternal and Reproductive Health Unit, Antwerp, Belgium
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Ilozumba O, Dieleman M, Van Belle S, Mukuru M, Bardají A, Broerse JE. Multistakeholder Perspectives on Maternal Text Messaging Intervention in Uganda: Qualitative Study. JMIR Mhealth Uhealth 2018; 6:e119. [PMID: 29748159 PMCID: PMC5968211 DOI: 10.2196/mhealth.9565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 03/02/2018] [Accepted: 03/19/2018] [Indexed: 11/25/2022] Open
Abstract
Background Despite continued interest in the use of mobile health for improving maternal health outcomes, there have been limited attempts to identify relevant program theories. Objectives This study had two aims: first, to explicate the assumptions of program designers, which we call the program theory and second, to contrast this program theory with empirical data to gain a better understanding of mechanisms, facilitators, and barriers related to the program outcomes. Methods To achieve the aforementioned objectives, we conducted a retrospective qualitative study of a text messaging (short message service) platform geared at improving individual maternal health outcomes in Uganda. Through interviews with program designers (n=3), we elicited 3 main designers’ assumptions and explored these against data from qualitative interviews with primary beneficiaries (n=26; 15 women and 11 men) and health service providers (n=6), as well as 6 focus group discussions with village health team members (n=50) who were all involved in the program. Results Our study results highlighted that while the program designers’ assumptions were appropriate, additional mechanisms and contextual factors, such as the importance of incentives for village health team members, mobile phone ownership, and health system factors should have been considered. Conclusions Our results indicate that text messages could be an effective part of a more comprehensive maternal health program when context and system barriers are identified and addressed in the program theories.
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Affiliation(s)
- Onaedo Ilozumba
- Health Systems Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain.,Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marjolein Dieleman
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Sara Van Belle
- Health Systems Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Moses Mukuru
- Uganda National Health Consumers' Organization, Kampala, Uganda
| | - Azucena Bardají
- Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain
| | - Jacqueline Ew Broerse
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Sicuri E, Bardají A, Sanz S, Alonso S, Fernandes S, Hanson K, Arevalo-Herrera M, Menéndez C. Patients' costs, socio-economic and health system aspects associated with malaria in pregnancy in an endemic area of Colombia. PLoS Negl Trop Dis 2018; 12:e0006431. [PMID: 29718903 PMCID: PMC5951590 DOI: 10.1371/journal.pntd.0006431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/28/2017] [Revised: 05/14/2018] [Accepted: 04/06/2018] [Indexed: 11/18/2022] Open
Abstract
Malaria in pregnancy threatens birth outcomes and the health of women and their newborns. This is also the case in low transmission areas, such as Colombia, where Plasmodium vivax is the dominant parasite species. Within the Colombian health system, which underwent major reforms in the 90s, malaria treatment is provided free of charge to patients. However, patients still incur costs, such as transportation and value of time lost due to the disease. We estimated such costs among 40 pregnant women with clinical malaria (30% Plasmodium falciparum, 70% Plasmodium vivax) in the municipality of Tierralta, Northern Colombia. In a cross-sectional study, women were interviewed after an outpatient or inpatient laboratory confirmed malaria episode. Women were asked to report all types of cost incurred before (including prevention), during and immediately after the contact with the health facility. Median total cost was over 16US$ for an outpatient visit, rising to nearly 30US$ if other treatments were sought before reaching the health facility. Median total inpatient cost was 26US$ or 54US$ depending on whether costs incurred prior to admission were excluded or included. For both outpatients and inpatients, direct costs were largely due to transportation and indirect costs constituted the largest share of total costs. Estimated costs are likely to represent only one of the constraints that women face when seeking treatment in an area characterized, at the time of the study, by armed conflict, displacement, and high vulnerability of indigenous women, the group at highest risk of malaria. Importantly, the Colombian peace process, which culminated with the cease-fire in August 2016, may have a positive impact on achieving universal access to healthcare in conflict areas. The current study can inform malaria elimination initiatives in Colombia. Malaria in pregnancy is a harsh and undesirable illness and is the cause of adverse effects on birth outcomes and on the health of women and newborns. Despite the low transmission, the predominance of Plasmodium vivax over Plasmodium falciparum and free treatment, estimated costs incurred by pregnant women seeking malaria care in an endemic area of Northern Colombia are considerable. Importantly, these costs are likely to represent only one of the constraints that women face when seeking treatment in an area characterized, at the time of the study, by armed conflict, displacement, and high vulnerability of indigenous women, the group at highest risk of malaria in the area. Important advances may result from the current peace process, potentially able to support the efforts made since the 90s to reform the health system towards achieving universal health coverage. Within this context, the current study can inform malaria elimination initiatives in Colombia.
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Affiliation(s)
- Elisa Sicuri
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- * E-mail: ,
| | - Azucena Bardají
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Sergi Sanz
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Biostatistics Unit, Department of Public Health, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Sergi Alonso
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Silke Fernandes
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, England
| | - Kara Hanson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, England
| | | | - Clara Menéndez
- ISGlobal, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
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Ilozumba O, Abejirinde IOO, Dieleman M, Bardají A, Broerse JEW, Van Belle S. Targeting strategies of mHealth interventions for maternal health in low and middle-income countries: a systematic review protocol. BMJ Open 2018; 8:e019345. [PMID: 29478019 PMCID: PMC5855310 DOI: 10.1136/bmjopen-2017-019345] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Recently, there has been a steady increase in mobile health (mHealth) interventions aimed at improving maternal health of women in low-income and middle-income countries. While there is evidence indicating that these interventions contribute to improvements in maternal health outcomes, other studies indicate inconclusive results. This uncertainty has raised additional questions, one of which pertains to the role of targeting strategies in implementing mHealth interventions and the focus on pregnant women and health workers as target groups. This review aims to assess who is targeted in different mHealth interventions and the importance of targeting strategies in maternal mHealth interventions. METHODS AND ANALYSIS We will search for peer-reviewed, English-language literature published between 1999 and July 2017 in PubMed, Web of Knowledge (Science Direct, EMBASE) and Cochrane Central Registers of Controlled Trials. The study scope is defined by the Population, Intervention, Comparison and Outcomes framework: P, community members with maternal or reproductive needs; I, electronic health or mHealth programmes geared at improving maternal or reproductive health; C, other non-electronic health or mHealth-based interventions; O, maternal health measures including family planning, antenatal care attendance, health facility delivery and postnatal care attendance. ETHICS AND DISSEMINATION This study is a review of already published or publicly available data and needs no ethical approval. Review results will be published in a peer-reviewed journal and presented at international conferences. PROSPERO REGISTRATION NUMBER CRD42017072280.
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Affiliation(s)
- Onaedo Ilozumba
- Faculty of Sciences, Vrije universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Public Health, Instituut voor Tropische Geneeskunde, Antwerpen, Belgium
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Ibukun-Oluwa Omolade Abejirinde
- Faculty of Sciences, Vrije universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Public Health, Instituut voor Tropische Geneeskunde, Antwerpen, Belgium
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Marjolein Dieleman
- Faculty of Sciences, Vrije universiteit Amsterdam, Amsterdam, The Netherlands
| | - Azucena Bardají
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Sara Van Belle
- Department of Public Health, Instituut voor Tropische Geneeskunde, Antwerpen, Belgium
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Cutland CL, Lackritz EM, Mallett-Moore T, Bardají A, Chandrasekaran R, Lahariya C, Nisar MI, Tapia MD, Pathirana J, Kochhar S, Muñoz FM. Low birth weight: Case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine 2017; 35:6492-6500. [PMID: 29150054 PMCID: PMC5710991 DOI: 10.1016/j.vaccine.2017.01.049] [Citation(s) in RCA: 188] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/13/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Clare L Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa; Department of Science and Technology National Research Foundation, Vaccine Preventable Diseases, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Eve M Lackritz
- Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), Seattle Children's Research Institute, Seattle, WA, USA
| | | | - Azucena Bardají
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - University of Barcelona, Barcelona, Spain
| | | | - Chandrakant Lahariya
- Department of Community Medicine, GR Medical College and Associated Hospitals, Gwalior, MP, India
| | - Muhammed Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Milagritos D Tapia
- University of Maryland School of Medicine, Center for Vaccine Development, MD, USA
| | - Jayani Pathirana
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa; Department of Science and Technology National Research Foundation, Vaccine Preventable Diseases, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sonali Kochhar
- Global Healthcare Consulting, India; Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Flor M Muñoz
- Baylor College of Medicine, Departments of Pediatrics, Molecular Virology and Microbiology, Houston, TX, USA
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DeSilva M, Munoz FM, Sell E, Marshall H, Tse Kawai A, Kachikis A, Heath P, Klein NP, Oleske JM, Jehan F, Spiegel H, Nesin M, Tagbo BN, Shrestha A, Cutland CL, Eckert LO, Kochhar S, Bardají A. Congenital microcephaly: Case definition & guidelines for data collection, analysis, and presentation of safety data after maternal immunisation. Vaccine 2017; 35:6472-6482. [PMID: 29150052 PMCID: PMC5710988 DOI: 10.1016/j.vaccine.2017.01.044] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/13/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Malini DeSilva
- Health Partners Institute for Education and Research, United States
| | | | - Erick Sell
- Children's Hospital of Eastern Ontario, Canada
| | - Helen Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network and Robinson Research Institute and School of Medicine, University of Adelaide, South Adelaide, Australia
| | - Alison Tse Kawai
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health, United States
| | - Alisa Kachikis
- Department of Obstetrics and Gynecology, University of Washington, School of Medicine, Seattle, WA, United States
| | - Paul Heath
- St. Georges Vaccine Institute, Institute of Infection & Immunity, St. Georges University of London, London, UK
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Centre, Oakland, CA, United States
| | - James M Oleske
- Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Fyezah Jehan
- Department of Paediatrics and Child Health, Aga Khan University, Pakistan
| | - Hans Spiegel
- Kelly Government Solutions (KGS), Contractor to DAIDS/NIAID/NIH, Rockville, United States
| | - Mirjana Nesin
- National Institutes of Health/National Institute of Allergy and Infectious Disease, United States
| | - Beckie N Tagbo
- Institute of Child Health & Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Anju Shrestha
- Sanofi Pasteur, Global Pharmacovigilance, Sanofi Pasteur, United States
| | - Clare L Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Johannesburg, Department of Science and Technology National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda O Eckert
- St. Georges Vaccine Institute, Institute of Infection & Immunity, St. Georges University of London, London, UK
| | - Sonali Kochhar
- Global Healthcare Consulting, Delhi, India; Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Azucena Bardají
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - University of Barcelona, Barcelona, Spain.
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49
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Quintó L, García-Basteiro AL, Bardají A, González R, Padilla N, Martinez-Espinosa FE, Arévalo-Herrera M, Macete E, Menéndez C. The Challenge of Assessing Microcephaly in the Context of the Zika Virus Epidemic. J Trop Pediatr 2017; 63:495-498. [PMID: 28335029 DOI: 10.1093/tropej/fmx015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The present article examines the impact of the current limitations of the microcephaly definition in the context of the Zika virus outbreak. It highlights its dependence on the method used for determining gestational age and other anthropometric parameters, and includes original results of prevalence of microcephaly in four countries from two different continents (Mozambique, Brazil, Guatemala and Colombia). Alternative definitions of microcephaly are proposed to allow the identification of true cases of microcephaly in a more accurate manner.
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Affiliation(s)
- Llorenç Quintó
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Alberto L García-Basteiro
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
| | - Azucena Bardají
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Raquel González
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Norma Padilla
- Centro de Estudios en Salud, Universidad del Valle da Guatemala (CES-UVG), Guatemala, Guatemala
| | - Flor E Martinez-Espinosa
- Gerência de Malária, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil.,Instituto Leônidas e Maria Deane, FIOCRUZ, Amazônia, Brazil
| | - Myriam Arévalo-Herrera
- Centro Internacional de Vacunas (CIV)/Facultad de Salud, Universidad del Valle, Cali, Colombia
| | - Eusébio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,National Directare of Health, Ministry of Health, Maputo, Mozambique
| | - Clara Menéndez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
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50
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Ubillos I, Campo JJ, Requena P, Ome-Kaius M, Hanieh S, Rose H, Samol P, Barrios D, Jiménez A, Bardají A, Mueller I, Menéndez C, Rogerson S, Moncunill G, Dobaño C. Chronic Exposure to Malaria Is Associated with Inhibitory and Activation Markers on Atypical Memory B Cells and Marginal Zone-Like B Cells. Front Immunol 2017; 8:966. [PMID: 28878766 PMCID: PMC5573441 DOI: 10.3389/fimmu.2017.00966] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 06/28/2017] [Accepted: 07/28/2017] [Indexed: 11/24/2022] Open
Abstract
In persistent infections that are accompanied by chronic immune activation, such as human immunodeficiency virus, hepatitis C virus, and malaria, there is an increased frequency of a phenotypically distinct subset of memory B cells lacking the classic memory marker CD27 and showing a reduced capacity to produce antibodies. However, critical knowledge gaps remain on specific B cell changes and immune adaptation in chronic infections. We hypothesized that expansion of atypical memory B cells (aMBCs) and reduction of activated peripheral marginal zone (MZ)-like B cells in constantly exposed individuals might be accompanied by phenotypic changes that would confer a tolerogenic profile, helping to establish tolerance to infections. To better understand malaria-associated phenotypic abnormalities on B cells, we analyzed peripheral blood mononuclear cells from 55 pregnant women living in a malaria-endemic area of Papua Nueva Guinea and 9 Spanish malaria-naïve individuals using four 11-color flow cytometry panels. We assessed the expression of markers of B cell specificity (IgG and IgM), activation (CD40, CD80, CD86, b220, TACI, and CD150), inhibition (PD1, CD95, and CD71), and migration (CCR3, CXCR3, and CD62l). We found higher frequencies of active and resting aMBC and marked reduction of MZ-like B cells, although changes in absolute cell counts could not be assessed. Highly exposed women had higher PD1+-, CD95+-, CD40+-, CD71+-, and CD80+-activated aMBC frequencies than non-exposed subjects. Malaria exposure increased frequencies of b220 and proapoptotic markers PD1 and CD95, and decreased expression of the activation marker TACI on MZ-like B cells. The increased frequencies of inhibitory and apoptotic markers on activated aMBCs and MZ-like B cells in malaria-exposed adults suggest an immune-homeostatic mechanism for maintaining B cell development and function while simultaneously downregulating hyperreactive B cells. This mechanism would keep the B cell activation threshold high enough to control infection but impaired enough to tolerate it, preventing systemic inflammation.
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Affiliation(s)
- Itziar Ubillos
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Joseph J Campo
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Antigen Discovery Inc., Irvine, CA, United States
| | - Pilar Requena
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Facultad de Medicina, Universidad de Granada, Granada, Spain
| | - Maria Ome-Kaius
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Sarah Hanieh
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Honor Rose
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Paula Samol
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Diana Barrios
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Alfons Jiménez
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Azucena Bardají
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Ivo Mueller
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.,Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Clara Menéndez
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | | | - Gemma Moncunill
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Carlota Dobaño
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
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