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Glover NA, Ivanova O, Sathar F, Riess F, Shambhu RR, Mekota AM, Zurba L, Menezes C, Alexandra van Blydenstein S, Kalla I, Hoelscher M, Saathoff E, Charalambous S, Rachow A. Lung outcomes and related risk factors in patients after SARS-CoV-2 infection: a hospitalised single-centre cohort from Johannesburg, South Africa. EClinicalMedicine 2024; 71:102588. [PMID: 38623400 PMCID: PMC11016864 DOI: 10.1016/j.eclinm.2024.102588] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/17/2024] Open
Abstract
Background Sequelae post-SARS-CoV-2 infection, including lung and functional impairment, pose a significant challenge post-recovery. We explored the burden and risk factors for post-COVID-19 sequelae in an African population with prevalent comorbidities including tuberculosis (TB) and HIV. Methods We conducted an observational cohort study on hospitalised adults with confirmed SARS-CoV-2 infection from 20 March to 06 October 2021 at Chris Hani Baragwanath Academic Hospital, South Africa. We collected data on comorbidities, and COVID-19 severity using the World Health Organization (WHO) clinical progression scale. Prospectively, we followed up all participants within 40-days post-discharge to assess body mass index (BMI), COVID-19 symptoms and quality of life using St George's Respiratory Questionnaire (SGRQ), 6-min walking-test (6MWT), and spirometry. A subsequent in-depth visit assessed plethysmography, diffusing capacity for the lung for carbon monoxide (DLCO), and high-resolution chest-CT. Findings We followed up 111 participants, where 65.8% were female, median age 50.5 years, and predominantly black-African (92.8%). Relevant comorbidities included TB disease (18.9%) and HIV infection (36%). SGRQ total scores were elevated in 78.9%, median 6MWT distance was reduced at 300 m (IQR 210-400), and nearly half (49.5%) exhibited spirometry findings below the lower limit of normal (LLN). In-depth pulmonary assessment for 61 participants revealed abnormalities in total lung capacity (31.6% <80% predicted), DLCO (53.4% <80% predicted), and chest-CT (86.7% abnormal). Significant risk factors for individual abnormal outcomes, adjusted for age and sex, were TB disease, HIV with CD4 <200 cells/mm3, BMI <18.5 kg/m2 and >35 kg/m2, and initial COVID-19 severity. Interpretation This study demonstrates substantial lung and functional morbidity within the first weeks post-COVID-19, particularly in individuals with pre-existing comorbidities including TB, HIV, and low or high BMI. Chest-CT and DLCO show best early potential at reflecting COVID-19-related pathologies. Funding The Bavarian State Ministry of Science and Arts.
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Affiliation(s)
| | - Olena Ivanova
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich
| | | | - Friedrich Riess
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich
| | - Rekha Rao Shambhu
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich
| | - Anna-Maria Mekota
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich
| | | | - Colin Menezes
- University of the Witwatersrand, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Sarah Alexandra van Blydenstein
- University of the Witwatersrand, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Ismail Kalla
- University of the Witwatersrand, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Unit Global Health, Helmholtz Zentrum München, German Research Centre for Environmental Health (HMGU), Neuherberg, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Salome Charalambous
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrea Rachow
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU Munich
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Unit Global Health, Helmholtz Zentrum München, German Research Centre for Environmental Health (HMGU), Neuherberg, Germany
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Kroidl I, Winter S, Rubio-Acero R, Bakuli A, Geldmacher C, Eser TM, Déak F, Horn S, Zielke A, Ahmed MIM, Diepers P, Guggenbühl J, Frese J, Bruger J, Puchinger K, Reich J, Falk P, Markgraf A, Fensterseifer H, Paunovic I, Thomschke A, Pritsch M, Riess F, Saathoff E, Hoelscher M, Olbrich L, Castelletti N, Wieser A. Studying temporal titre evolution of commercial SARS-CoV-2 assays reveals significant shortcomings of using BAU standardization for comparison. Virol J 2023; 20:200. [PMID: 37658454 PMCID: PMC10474769 DOI: 10.1186/s12985-023-02167-z] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 08/24/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Measuring specific anti-SARS-CoV-2 antibodies has become one of the main epidemiological tools to survey the ongoing SARS-CoV-2 pandemic, but also vaccination response. The WHO made available a set of well-characterized samples derived from recovered individuals to allow normalization between different quantitative anti-Spike assays to defined Binding Antibody Units (BAU). METHODS To assess sero-responses longitudinally, a cohort of ninety-nine SARS-CoV-2 RT-PCR positive subjects was followed up together with forty-five vaccinees without previous infection but with two vaccinations. Sero-responses were evaluated using a total of six different assays: four measuring anti-Spike proteins (converted to BAU), one measuring anti-Nucleocapsid proteins and one SARS-CoV-2 surrogate virus neutralization. Both cohorts were evaluated using the Euroimmun Anti-SARS-CoV-2-ELISA anti-S1 IgG and the Roche Elecsys Anti-SARS-CoV-2 anti-S1 assay. RESULTS In SARS-CoV-2-convalesce subjects, the BAU-sero-responses of Euroimmun Anti-SARS-CoV-2-ELISA anti-S1 IgG and Roche Elecsys Anti-SARS-CoV-2 anti-S1 peaked both at 47 (43-51) days, the first assay followed by a slow decay thereafter (> 208 days), while the second assay not presenting any decay within one year. Both assay values in BAUs are only equivalent a few months after infection, elsewhere correction factors up to 10 are necessary. In contrast, in infection-naive vaccinees the assays perform similarly. CONCLUSION The results of our study suggest that the establishment of a protective correlate or vaccination booster recommendation based on different assays, although BAU-standardised, is still challenging. At the moment the characteristics of the available assays used are not related, and the BAU-standardisation is unable to correct for that.
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Affiliation(s)
- Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Simon Winter
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Raquel Rubio-Acero
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- Max-von-Pettenkofer Institute, LMU Munich, Munich, Germany
| | - Abhishek Bakuli
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Tabea M Eser
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Flora Déak
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Sacha Horn
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Anna Zielke
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Mohamed I M Ahmed
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Paulina Diepers
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Jessica Guggenbühl
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Jonathan Frese
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Jan Bruger
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Kerstin Puchinger
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Jakob Reich
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Philine Falk
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Alisa Markgraf
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Heike Fensterseifer
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Ivana Paunovic
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- Max-von-Pettenkofer Institute, LMU Munich, Munich, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology, Infection and Pandemic Research, Türkenstraße 87, 80799, Munich, Germany
| | - Angelika Thomschke
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Michael Pritsch
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Friedrich Riess
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology, Infection and Pandemic Research, Türkenstraße 87, 80799, Munich, Germany
- Center for International Health (CIH), University Hospital, LMU Munich, 80336, Munich, Germany
| | - Laura Olbrich
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Noemi Castelletti
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology, Infection and Pandemic Research, Türkenstraße 87, 80799, Munich, Germany
- Institute of Radiation Medicine, Helmholtz Zentrum München, 85764, Neuherberg, Germany
| | - Andreas Wieser
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany.
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany.
- Max-von-Pettenkofer Institute, LMU Munich, Munich, Germany.
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology, Infection and Pandemic Research, Türkenstraße 87, 80799, Munich, Germany.
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Mnkai J, Ritter M, Maganga L, Maboko L, Olomi W, Clowes P, Minich J, Lelo AE, Kariuki D, Debrah AY, Geldmacher C, Hoelscher M, Saathoff E, Chachage M, Pfarr K, Hoerauf A, Kroidl I. Increased HIV Incidence in Wuchereria bancrofti Microfilaria Positive Individuals in Tanzania. Pathogens 2023; 12:pathogens12030387. [PMID: 36986309 PMCID: PMC10054595 DOI: 10.3390/pathogens12030387] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023] Open
Abstract
Background: Infections with Wuchereria bancrofti are associated with reduced immunity against concomitant infections. Indeed, our previous study described a 2.3-fold increased HIV incidence among individuals with W. bancrofti infection, as measured by the circulating filarial antigen of the adult worm. This new study aimed to retrospectively determine microfilariae status of the participants to assess if the previously described increased HIV susceptibility was associated with the presence of MF in the same cohort. Methods: CFA positive but HIV negative biobanked human blood samples (n = 350) were analyzed for W. bancrofti MF chitinase using real time PCR. Results: The PCR provided a positive signal in 12/350 (3.4%) samples. During four years of follow-up (1109 person years (PY)), 22 study participants acquired an HIV infection. In 39 PY of W. bancrofti MF chitinase positive individuals, three new HIV infections occurred (7.8 cases per 100 PY), in contrast to 19 seroconversions in 1070 PY of W. bancrofti MF chitinase negative individuals (1.8 cases per 100 PY, p = 0.014). Conclusions: In the subgroup of MF-producing Wb-infected individuals, the HIV incidence exceeded the previously described moderate increased risk for HIV seen in all Wb-infected individuals (regardless of MF status) compared with uninfected persons from the same area.
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Affiliation(s)
- Jonathan Mnkai
- National Institute of Medical Research (NIMR), Mbeya Medical Research Center (MMRC), Mbeya P.O. Box 2410, Tanzania
| | - Manuel Ritter
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), 53127 Bonn, Germany
| | - Lucas Maganga
- National Institute of Medical Research (NIMR), Mbeya Medical Research Center (MMRC), Mbeya P.O. Box 2410, Tanzania
| | - Leonard Maboko
- National Institute of Medical Research (NIMR), Mbeya Medical Research Center (MMRC), Mbeya P.O. Box 2410, Tanzania
- Tanzania Commission for AIDS, Dodoma P.O. Box 2904, Tanzania
| | - Willyhelmina Olomi
- National Institute of Medical Research (NIMR), Mbeya Medical Research Center (MMRC), Mbeya P.O. Box 2410, Tanzania
| | - Petra Clowes
- National Institute of Medical Research (NIMR), Mbeya Medical Research Center (MMRC), Mbeya P.O. Box 2410, Tanzania
| | - Jessica Minich
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), 53127 Bonn, Germany
| | - Agola Eric Lelo
- Kenya Medical Research Institute (KEMRI), KNH, Nairobi, Kenya
| | - Daniel Kariuki
- College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology (JKUAT), Juja, Kenya
| | - Alexander Yaw Debrah
- Kumasi Centre for Collaborative Research (KCCR), Kwame Nkrumah University of Science and Technology, UPO, PMB, Kumasi, Ghana
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, University Hospital of the University of Munich (LMU), 80802 Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, 80802 Munich, Germany
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, University Hospital of the University of Munich (LMU), 80802 Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, 80802 Munich, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, University Hospital of the University of Munich (LMU), 80802 Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, 80802 Munich, Germany
| | - Mkunde Chachage
- National Institute of Medical Research (NIMR), Mbeya Medical Research Center (MMRC), Mbeya P.O. Box 2410, Tanzania
- Mbeya College of Health and Allied Sciences (UDSM-MCHAS), University of Dar es Salaam, Mbeya 608, Tanzania
| | - Kenneth Pfarr
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), 53127 Bonn, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, 53127 Bonn, Germany
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), 53127 Bonn, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, 53127 Bonn, Germany
- German-West African Centre for Global Health and Pandemic Prevention (G-WAC), Partner Site Bonn, 53127 Bonn, Germany
| | - Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital of the University of Munich (LMU), 80802 Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, 80802 Munich, Germany
- Correspondence:
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Puchinger K, Castelletti N, Rubio-Acero R, Geldmacher C, Eser TM, Deák F, Paunovic I, Bakuli A, Saathoff E, von Meyer A, Markgraf A, Falk P, Reich J, Riess F, Girl P, Müller K, Radon K, Guggenbuehl Noller JM, Wölfel R, Hoelscher M, Kroidl I, Wieser A, Olbrich L, Alamoudi E, Anderson J, Baumann M, Behlen M, Beyerl J, Böhnlein R, Brauer A, Britz V, Bruger J, Caroli F, Contento L, Diekmannshemke J, Do A, Dobler G, Eberle U, Eckstein J, Frese J, Forster F, Frahnow T, Fröschl G, Geisenberger O, Gillig K, Heiber A, Hinske C, Hoefflin J, Hofberger T, Höfinger M, Hofmann L, Horn S, Huber K, Janke C, Kappl U, Kiani C, Kroidl A, Laxy M, Leidl R, Lindner F, Mayrhofer R, Mekota AM, Müller H, Metaxa D, Pattard L, Pletschette M, Prückner S, Pusl K, Raimúndez E, Rothe C, Schäfer N, Schandelmaier P, Schneider L, Schultz S, Schunk M, Schwettmann L, Seibold H, Sothmann P, Stapor P, Theis F, Thiel V, Thiesbrummel S, Thur N, Waibel J, Wallrauch C, Winter S, Wolff J, Wullinger P, Yaqine H, Zange S, Zeggini E, Zimmermann T, Zielke A, Ibraheem M, Ahmed M, Becker M, Diepers P, Schälte Y, Garí M, Pütz P, Pritsch M, Fingerle V, Le Gleut R, Gilberg L, Brand I, Diefenbach M, Eser T, Weinauer F, Martin S, Quenzel EM, Durner J, Girl P, Müller K, Radon K, Fuchs C, Hasenauer J. The interplay of viral loads, clinical presentation, and serological responses in SARS-CoV-2 – Results from a prospective cohort of outpatient COVID-19 cases. Virology 2022; 569:37-43. [PMID: 35245784 PMCID: PMC8855229 DOI: 10.1016/j.virol.2022.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 11/24/2022]
Abstract
Risk factors for disease progression and severity of SARS-CoV-2 infections require an understanding of acute and long-term virological and immunological dynamics. Fifty-one RT-PCR positive COVID-19 outpatients were recruited between May and December 2020 in Munich, Germany, and followed up at multiple defined timepoints for up to one year. RT-PCR and viral culture were performed and seroresponses measured. Participants were classified applying the WHO clinical progression scale. Short symptom to test time (median 5.0 days; p = 0.0016) and high viral loads (VL; median maximum VL: 3∙108 copies/mL; p = 0.0015) were indicative for viral culture positivity. Participants with WHO grade 3 at baseline had significantly higher VLs compared to those with WHO 1 and 2 (p = 0.01). VLs dropped fast within 1 week of symptom onset. Maximum VLs were positively correlated with the magnitude of Ro-N-Ig seroresponse (p = 0.022). Our results describe the dynamics of VLs and antibodies to SARS-CoV-2 in mild to moderate cases that can support public health measures during the ongoing global pandemic.
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Mcharo R, Lennemann T, France J, Torres L, Garí M, Mbuya W, Mwalongo W, Mahenge A, Bauer A, Mnkai J, Glasmeyer L, Judick M, Paul M, Schroeder N, Msomba B, Sembo M, Chiwerengo N, Hoelscher M, Geisenberger O, Lelle RJ, Saathoff E, Maboko L, Chachage M, Kroidl A, Geldmacher C. HPV Type Distribution in HIV Positive and Negative Women With or Without Cervical Dysplasia or Cancer in East Africa. Front Oncol 2021; 11:763717. [PMID: 34917506 PMCID: PMC8669270 DOI: 10.3389/fonc.2021.763717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundWomen living with HIV in sub-Saharan Africa are at increased risk to develop cervical cancer (CC), which is caused by persistent infection with 13 oncogenic human papilloma viruses (HR-HPVs). It is important to accurately identify and target HIV-positive women at highest risk to develop CC for early therapeutic intervention.MethodsA total of 2,134 HIV+ and HIV− women from South-West Tanzania were prospectively screened for cervical cancer and precancerous lesions. Women with cervical cancer (n=236), high- and low-grade squamous intraepithelial lesions (HSIL: n=68, LSIL: n=74), and without lesion (n=426) underwent high-resolution HPV genotyping.ResultsEighty percent of women who were diagnosed with HSIL or LSIL were living with HIV. Any lesion, young age, HIV status, and depleted CD4 T cell counts were independent risk factors for HPV infections, which were predominantly caused by HR-HPV types. While multiple HR-HPV type infections were predominant in HIV+ women with HSIL, single-type infections predominated in HIV+ CC cases (p=0.0006). HPV16, 18, and 45 accounted for 85% (68/80) and 75% (82/110) of HIV+ and HIV− CC cases, respectively. Of note, HPV35, the most frequent HPV type in HSIL-positive women living with HIV, was rarely detected as a single-type infection in HSIL and cancer cases.ConclusionHPV16, 18, and 45 should receive special attention for molecular diagnostic algorithms during CC prevention programs for HIV+ women from sub-Saharan Africa. HPV35 may have a high potential to induce HSIL in women living with HIV, but less potential to cause cervical cancer in single-type infections.
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Affiliation(s)
- Ruby Mcharo
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Tessa Lennemann
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | - John France
- Department of Obstetrics and Gynecology, Mbeya Zonal Referral Hospital, Mbeya, Tanzania
| | - Liseth Torres
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Mercè Garí
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Wilbert Mbuya
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Wolfram Mwalongo
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Anifrid Mahenge
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Asli Bauer
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Jonathan Mnkai
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Laura Glasmeyer
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Mona Judick
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Matilda Paul
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Nicolas Schroeder
- Institute for Pathology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Bareke Msomba
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Magreth Sembo
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Nhamo Chiwerengo
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Otto Geisenberger
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Ralph J. Lelle
- Department of Gynecology and Obstetrics, University of Muenster, Muenster, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Leonard Maboko
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Mkunde Chachage
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- University of Dar es Salaam–Mbeya College of Health and Allied Sciences (UDSM-MCHAS), Mbeya, Tanzania
| | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- *Correspondence: Christof Geldmacher,
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Mbuya W, Held K, Mcharo RD, Haule A, Mhizde J, Mnkai J, Mahenge A, Mwakatima M, Sembo M, Mwalongo W, Agrea P, Hoelscher M, Maboko L, Saathoff E, Geisenberger O, Rwegoshora F, Torres L, Koup RA, Kroidl A, Chachage M, Geldmacher C. Depletion of Human Papilloma Virus E6- and E7-Oncoprotein-Specific T-Cell Responses in Women Living With HIV. Front Immunol 2021; 12:742861. [PMID: 34759925 PMCID: PMC8573218 DOI: 10.3389/fimmu.2021.742861] [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: 07/16/2021] [Accepted: 10/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background Cervical cancer - caused by persistent High Risk Human Papilloma Virus (HR HPV) infections - is the second most common cancer affecting women globally. HIV infection increases the risk for HPV persistence, associated disease progression and malignant cell transformation. We therefore hypothesized that this risk increase is directly linked to HIV infection associated dysfunction or depletion of HPV-oncoprotein-specific T-cell responses. Methods The 2H study specifically included HIV+ and HIV- women with and without cervical lesions and cancer to analyze HPV oncogene-specific T cell responses in relation to HPV infection, cervical lesion status and HIV status. Oncoprotein E6 and E7 specific T-cell responses were quantified for the most relevant types HPV16, 18 and 45 and control antigens (CMV-pp65) and M.tb-PPD in 373 women, using fresh peripheral blood mononuclear cells in an IFN-γ release ELISpot assay. Results Overall, systemic E6- and E7-oncoprotein-specific T-cell responses were infrequent and of low magnitude, when compared to CMV-pp65 and M.tb-PPD (p < 0.001 for all HR HPV types). Within HIV negative women infected with either HPV16, 18 or 45, HPV16 infected women had lowest frequency of autologous-type-E6/E7-specific T-cell responses (33%, 16/49), as compared to HPV18 (46% (6/13), p = 0.516) and HPV45 (69% (9/13), p = 0.026) infected women. Prevalent HPV18 and 45, but not HPV16 infections were linked to detectable oncoprotein-specific T-cell responses, and for these infections, HIV infection significantly diminished T-cell responses targeting the autologous infecting genotype. Within women living with HIV, low CD4 T-cell counts, detectable HIV viremia as well as cancerous and precancerous lesions were significantly associated with depletion of HPV oncoprotein-specific T-cell responses. Discussion Depletion of HPV-oncoprotein-specific T-cell responses likely contributes to the increased risk for HR HPV persistence and associated cancerogenesis in women living with HIV. The low inherent immunogenicity of HPV16 oncoproteins may contribute to the exceptional potential for cancerogenesis associated with HPV16 infections.
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Affiliation(s)
- Wilbert Mbuya
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania.,Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany
| | - Kathrin Held
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Ruby D Mcharo
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Antelmo Haule
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Jacklina Mhizde
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Jonathan Mnkai
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Anifrid Mahenge
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Maria Mwakatima
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Margareth Sembo
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Wolfram Mwalongo
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Peter Agrea
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Leonard Maboko
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania.,Tanzania Commission for AIDS (TACAIDS), Dar es Salaam, Tanzania
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Otto Geisenberger
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - France Rwegoshora
- Pathology Department, Mbeya Zonal Referral Hospital, Mbeya, Tanzania
| | - Liset Torres
- Pathology Department, Mbeya Zonal Referral Hospital, Mbeya, Tanzania
| | - Richard A Koup
- Vaccine Research Centre, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Mkunde Chachage
- National Institute for Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania.,Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,Microbiology and Immunology Department, University of Dar es Salaam -Mbeya College of Health and Allied Sciences (UDSM-MCHAS), Mbeya, Tanzania
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University (LMU) Munich, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
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7
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Olbrich L, Castelletti N, Schälte Y, Garí M, Pütz P, Bakuli A, Pritsch M, Kroidl I, Saathoff E, Guggenbuehl Noller JM, Fingerle V, Le Gleut R, Gilberg L, Brand I, Falk P, Markgraf A, Deák F, Riess F, Diefenbach M, Eser T, Weinauer F, Martin S, Quenzel EM, Becker M, Durner J, Girl P, Müller K, Radon K, Fuchs C, Wölfel R, Hasenauer J, Hoelscher M, Wieser A. Head-to-head evaluation of seven different seroassays including direct viral neutralisation in a representative cohort for SARS-CoV-2. J Gen Virol 2021; 102:001653. [PMID: 34623233 PMCID: PMC8604188 DOI: 10.1099/jgv.0.001653] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/20/2021] [Indexed: 12/21/2022] Open
Abstract
A number of seroassays are available for SARS-CoV-2 testing; yet, head-to-head evaluations of different testing principles are limited, especially using raw values rather than categorical data. In addition, identifying correlates of protection is of utmost importance, and comparisons of available testing systems with functional assays, such as direct viral neutralisation, are needed.We analysed 6658 samples consisting of true-positives (n=193), true-negatives (n=1091), and specimens of unknown status (n=5374). For primary testing, we used Euroimmun-Anti-SARS-CoV-2-ELISA-IgA/IgG and Roche-Elecsys-Anti-SARS-CoV-2. Subsequently virus-neutralisation, GeneScriptcPass, VIRAMED-SARS-CoV-2-ViraChip, and Mikrogen-recomLine-SARS-CoV-2-IgG were applied for confirmatory testing. Statistical modelling generated optimised assay cut-off thresholds. Sensitivity of Euroimmun-anti-S1-IgA was 64.8%, specificity 93.3% (manufacturer's cut-off); for Euroimmun-anti-S1-IgG, sensitivity was 77.2/79.8% (manufacturer's/optimised cut-offs), specificity 98.0/97.8%; Roche-anti-N sensitivity was 85.5/88.6%, specificity 99.8/99.7%. In true-positives, mean and median Euroimmun-anti-S1-IgA and -IgG titres decreased 30/90 days after RT-PCR-positivity, Roche-anti-N titres decreased significantly later. Virus-neutralisation was 80.6% sensitive, 100.0% specific (≥1:5 dilution). Neutralisation surrogate tests (GeneScriptcPass, Mikrogen-recomLine-RBD) were >94.9% sensitive and >98.1% specific. Optimised cut-offs improved test performances of several tests. Confirmatory testing with virus-neutralisation might be complemented with GeneScriptcPassTM or recomLine-RBD for certain applications. Head-to-head comparisons given here aim to contribute to the refinement of testing strategies for individual and public health use.
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Affiliation(s)
- Laura Olbrich
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany
- German Center for Infection Research (DZIF), Partner site Munich, Germany
| | - Noemi Castelletti
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany
- Institute of Radiation Medicine, Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Yannik Schälte
- Institute of Computational Biology, Helmholtz Zentrum München, 85764 Neuherberg, Germany
- Center for Mathematics, Technische Universität München, 85748 Garching, Germany
| | - Mercè Garí
- Institute of Computational Biology, Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Peter Pütz
- Institute of Computational Biology, Helmholtz Zentrum München, 85764 Neuherberg, Germany
- Department of Business Administration and Economics, Bielefeld University, 33615 Bielefeld, Germany
| | - Abhishek Bakuli
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany
| | - Michael Pritsch
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany
| | - Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany
- German Center for Infection Research (DZIF), Partner site Munich, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany
- German Center for Infection Research (DZIF), Partner site Munich, Germany
| | | | - Volker Fingerle
- German Center for Infection Research (DZIF), Partner site Munich, Germany
- Bavarian Health and Food Safety Authority (LGL), Germany
| | - Ronan Le Gleut
- Institute of Computational Biology, Helmholtz Zentrum München, 85764 Neuherberg, Germany
- Core Facility Statistical Consulting, Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Leonard Gilberg
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany
| | - Isabel Brand
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany
| | - Philine Falk
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany
| | - Alisa Markgraf
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany
| | - Flora Deák
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany
| | - Friedrich Riess
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany
| | - Max Diefenbach
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany
| | - Tabea Eser
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany
| | | | | | | | - Marc Becker
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich Ludwig-Maximilians-University of Munich, Goethestr. 70, 80336 Munich, Germany
- Laboratory Becker and colleagues, Führichstr. 70, 81671 München, Germany
| | - Jürgen Durner
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich Ludwig-Maximilians-University of Munich, Goethestr. 70, 80336 Munich, Germany
- Laboratory Becker and colleagues, Führichstr. 70, 81671 München, Germany
| | - Philipp Girl
- German Center for Infection Research (DZIF), Partner site Munich, Germany
- Bundeswehr Institute of Microbiology, 80937 Munich, Germany
| | - Katharina Müller
- German Center for Infection Research (DZIF), Partner site Munich, Germany
- Bundeswehr Institute of Microbiology, 80937 Munich, Germany
| | - Katja Radon
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336 Munich, Germany
- Center for International Health (CIH), University Hospital, LMU Munich, 80336 Munich, Germany
- Comprehensive Pneumology Center (CPC) Munich, German Center for Lung Research (DZL), 80337 Munich, Germany
| | - Christiane Fuchs
- Institute of Computational Biology, Helmholtz Zentrum München, 85764 Neuherberg, Germany
- Center for Mathematics, Technische Universität München, 85748 Garching, Germany
- Department of Business Administration and Economics, Bielefeld University, 33615 Bielefeld, Germany
- Core Facility Statistical Consulting, Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Roman Wölfel
- German Center for Infection Research (DZIF), Partner site Munich, Germany
- Bundeswehr Institute of Microbiology, 80937 Munich, Germany
| | - Jan Hasenauer
- Institute of Computational Biology, Helmholtz Zentrum München, 85764 Neuherberg, Germany
- Center for Mathematics, Technische Universität München, 85748 Garching, Germany
- Faculty of Mathematics and Natural Sciences, University of Bonn, 53113 Bonn, Germany
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany
- German Center for Infection Research (DZIF), Partner site Munich, Germany
- Center for International Health (CIH), University Hospital, LMU Munich, 80336 Munich, Germany
| | - Andreas Wieser
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany
- German Center for Infection Research (DZIF), Partner site Munich, Germany
| | - on behalf of the KoCo19-Study Group
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany
- German Center for Infection Research (DZIF), Partner site Munich, Germany
- Institute of Radiation Medicine, Helmholtz Zentrum München, 85764 Neuherberg, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, 85764 Neuherberg, Germany
- Center for Mathematics, Technische Universität München, 85748 Garching, Germany
- Department of Business Administration and Economics, Bielefeld University, 33615 Bielefeld, Germany
- Bavarian Health and Food Safety Authority (LGL), Germany
- Core Facility Statistical Consulting, Helmholtz Zentrum München, 85764 Neuherberg, Germany
- BRK-Blutspendedienst, 80336 Munich, Germany
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich Ludwig-Maximilians-University of Munich, Goethestr. 70, 80336 Munich, Germany
- Laboratory Becker and colleagues, Führichstr. 70, 81671 München, Germany
- Bundeswehr Institute of Microbiology, 80937 Munich, Germany
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336 Munich, Germany
- Center for International Health (CIH), University Hospital, LMU Munich, 80336 Munich, Germany
- Comprehensive Pneumology Center (CPC) Munich, German Center for Lung Research (DZL), 80337 Munich, Germany
- Faculty of Mathematics and Natural Sciences, University of Bonn, 53113 Bonn, Germany
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8
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Radon K, Bakuli A, Pütz P, Le Gleut R, Guggenbuehl Noller JM, Olbrich L, Saathoff E, Garí M, Schälte Y, Frahnow T, Wölfel R, Pritsch M, Rothe C, Pletschette M, Rubio-Acero R, Beyerl J, Metaxa D, Forster F, Thiel V, Castelletti N, Rieß F, Diefenbach MN, Fröschl G, Bruger J, Winter S, Frese J, Puchinger K, Brand I, Kroidl I, Wieser A, Hoelscher M, Hasenauer J, Fuchs C. From first to second wave: follow-up of the prospective COVID-19 cohort (KoCo19) in Munich (Germany). BMC Infect Dis 2021; 21:925. [PMID: 34493217 PMCID: PMC8423599 DOI: 10.1186/s12879-021-06589-4] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the 2nd year of the COVID-19 pandemic, knowledge about the dynamics of the infection in the general population is still limited. Such information is essential for health planners, as many of those infected show no or only mild symptoms and thus, escape the surveillance system. We therefore aimed to describe the course of the pandemic in the Munich general population living in private households from April 2020 to January 2021. METHODS The KoCo19 baseline study took place from April to June 2020 including 5313 participants (age 14 years and above). From November 2020 to January 2021, we could again measure SARS-CoV-2 antibody status in 4433 of the baseline participants (response 83%). Participants were offered a self-sampling kit to take a capillary blood sample (dry blood spot; DBS). Blood was analysed using the Elecsys® Anti-SARS-CoV-2 assay (Roche). Questionnaire information on socio-demographics and potential risk factors assessed at baseline was available for all participants. In addition, follow-up information on health-risk taking behaviour and number of personal contacts outside the household (N = 2768) as well as leisure time activities (N = 1263) were collected in summer 2020. RESULTS Weighted and adjusted (for specificity and sensitivity) SARS-CoV-2 sero-prevalence at follow-up was 3.6% (95% CI 2.9-4.3%) as compared to 1.8% (95% CI 1.3-3.4%) at baseline. 91% of those tested positive at baseline were also antibody-positive at follow-up. While sero-prevalence increased from early November 2020 to January 2021, no indication of geospatial clustering across the city of Munich was found, although cases clustered within households. Taking baseline result and time to follow-up into account, men and participants in the age group 20-34 years were at the highest risk of sero-positivity. In the sensitivity analyses, differences in health-risk taking behaviour, number of personal contacts and leisure time activities partly explained these differences. CONCLUSION The number of citizens in Munich with SARS-CoV-2 antibodies was still below 5% during the 2nd wave of the pandemic. Antibodies remained present in the majority of SARS-CoV-2 sero-positive baseline participants. Besides age and sex, potentially confounded by differences in behaviour, no major risk factors could be identified. Non-pharmaceutical public health measures are thus still important.
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Affiliation(s)
- Katja Radon
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336, Munich, Germany.
- Center for International Health (CIH), University Hospital, LMU Munich, 80336, Munich, Germany.
- Comprehensive Pneumology Center (CPC) Munich, German Center for Lung Research (DZL), 89337, Munich, Germany.
| | - Abhishek Bakuli
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Peter Pütz
- Institute of Computational Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Faculty of Business Administration and Economics, Bielefeld University, 33615, Bielefeld, Germany
| | - Ronan Le Gleut
- Institute of Computational Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Core Facility Statistical Consulting, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764, Neuherberg, Germany
| | | | - Laura Olbrich
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
- German Center for Infection Research (DZIF), partner site, Munich, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
- German Center for Infection Research (DZIF), partner site, Munich, Germany
| | - Mercè Garí
- Institute of Computational Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764, Neuherberg, Germany
| | - Yannik Schälte
- Institute of Computational Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Center for Mathematics, Technische Universität München, 85748, Garching, Germany
| | - Turid Frahnow
- Institute of Computational Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Faculty of Business Administration and Economics, Bielefeld University, 33615, Bielefeld, Germany
| | - Roman Wölfel
- German Center for Infection Research (DZIF), partner site, Munich, Germany
- Bundeswehr Institute of Microbiology, 80937, Munich, Germany
| | - Michael Pritsch
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
- German Center for Infection Research (DZIF), partner site, Munich, Germany
| | - Camilla Rothe
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Michel Pletschette
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Raquel Rubio-Acero
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Jessica Beyerl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Dafni Metaxa
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Felix Forster
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336, Munich, Germany
- Comprehensive Pneumology Center (CPC) Munich, German Center for Lung Research (DZL), 89337, Munich, Germany
| | - Verena Thiel
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Noemi Castelletti
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Friedrich Rieß
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
- German Center for Infection Research (DZIF), partner site, Munich, Germany
| | - Maximilian N Diefenbach
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Günter Fröschl
- Center for International Health (CIH), University Hospital, LMU Munich, 80336, Munich, Germany
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Jan Bruger
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Simon Winter
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Jonathan Frese
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Kerstin Puchinger
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Isabel Brand
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
- German Center for Infection Research (DZIF), partner site, Munich, Germany
| | - Andreas Wieser
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
- German Center for Infection Research (DZIF), partner site, Munich, Germany
| | - Michael Hoelscher
- Center for International Health (CIH), University Hospital, LMU Munich, 80336, Munich, Germany
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
- German Center for Infection Research (DZIF), partner site, Munich, Germany
| | - Jan Hasenauer
- Institute of Computational Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Center for Mathematics, Technische Universität München, 85748, Garching, Germany
- Interdisciplinary Research Unit Mathematics and Life Sciences, University of Bonn, 53113, Bonn, Germany
| | - Christiane Fuchs
- Institute of Computational Biology, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Faculty of Business Administration and Economics, Bielefeld University, 33615, Bielefeld, Germany
- Core Facility Statistical Consulting, Helmholtz Zentrum München-German Research Center for Environmental Health, 85764, Neuherberg, Germany
- Center for Mathematics, Technische Universität München, 85748, Garching, Germany
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9
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Froeschl G, Hoelscher M, Maganga LH, Kroidl I, Clowes P, Geis S, Saathoff E, Hoffmann D, Protzer U, Kroidl A. Hepatitis B, C and D virus prevalence in children and adults in Mbeya Region, Tanzania: results from a cohort study 2002 - 2009. Pan Afr Med J 2021; 39:174. [PMID: 34584600 PMCID: PMC8449578 DOI: 10.11604/pamj.2021.39.174.26553] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/08/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION sub-Saharan Africa bears a high prevalence for hepatitis B virus (HBV) infection. This analysis aims at elucidating the exposure to HBV across different age groups in Mbeya Region in Tanzania and determines prevalences of hepatitis C (HCV) and hepatitis delta antigen (HDV) infections. METHODS plasma samples from children and adults with defined HIV status were analysed for HBV, HCV and HDV markers.\. RESULTS hepatitis B (HBs)-antigen positivity was 8.3% (3/36) in the 0 to 5 years age group, 13.3% (8/60) in the 6 to 7 years, 17.2% (10/58) in the 8 to 14 years and 13.3% (8/60) in the 15 to 18 years age groups. In adults 5.0% of samples were HBs-antigen positive. Overall, 17.1% were HIV-1 positive. Adults infected with HIV-1 were significantly more often HBs-antigen positive (7.5%) than HIV-1 negative adults (4.5%; p<0.05). A serological sub-study including 174 adults showed that both total anti-HBs and total anti-HBc positivity increased with age in HBs-antigen negative participants. Across all age groups, HCV antibodies were found in 9 individuals, HDV antibodies in 3 individuals. CONCLUSION children presented a high prevalence of HBs-antigen carriers, with lower levels in the younger children. Among adults, the overall prevalence of HBs-antigen was lower than in children, either corresponding to clearance of HBV over time or due to a die-off effect. HBs-antigen positive adults had higher frequencies of anti-HBc- and anti-HBe-antibodies, indicating better immunological control of HBV infection than children. This supports claims that HBV infections in Africa are mostly acquired in childhood and to a large extent cleared again by adulthood. One in 20 adults remains chronically infected, emphasising the importance of HBV vaccination strategies.
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Affiliation(s)
- Guenter Froeschl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität of Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität of Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Lucas Henze Maganga
- National Institute for Medical Research, Mbeya Medical Research Center, Mbeya, Tanzania
| | - Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität of Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Petra Clowes
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität of Munich, Munich, Germany
- National Institute for Medical Research, Mbeya Medical Research Center, Mbeya, Tanzania
| | - Steffen Geis
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität of Munich, Munich, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität of Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Dieter Hoffmann
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Helmholtz Zentrum München/Technische Universität München, Institute of Virology, Munich, Germany
| | - Ulrike Protzer
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Helmholtz Zentrum München/Technische Universität München, Institute of Virology, Munich, Germany
| | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität of Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
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10
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Pritsch M, Radon K, Bakuli A, Le Gleut R, Olbrich L, Guggenbüehl Noller JM, Saathoff E, Castelletti N, Garí M, Pütz P, Schälte Y, Frahnow T, Wölfel R, Rothe C, Pletschette M, Metaxa D, Forster F, Thiel V, Rieß F, Diefenbach MN, Fröschl G, Bruger J, Winter S, Frese J, Puchinger K, Brand I, Kroidl I, Hasenauer J, Fuchs C, Wieser A, Hoelscher M. Prevalence and Risk Factors of Infection in the Representative COVID-19 Cohort Munich. Int J Environ Res Public Health 2021; 18:ijerph18073572. [PMID: 33808249 PMCID: PMC8038115 DOI: 10.3390/ijerph18073572] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/23/2021] [Accepted: 03/27/2021] [Indexed: 02/07/2023]
Abstract
Given the large number of mild or asymptomatic SARS-CoV-2 cases, only population-based studies can provide reliable estimates of the magnitude of the pandemic. We therefore aimed to assess the sero-prevalence of SARS-CoV-2 in the Munich general population after the first wave of the pandemic. For this purpose, we drew a representative sample of 2994 private households and invited household members 14 years and older to complete questionnaires and to provide blood samples. SARS-CoV-2 seropositivity was defined as Roche N pan-Ig ≥ 0.4218. We adjusted the prevalence for the sampling design, sensitivity, and specificity. We investigated risk factors for SARS-CoV-2 seropositivity and geospatial transmission patterns by generalized linear mixed models and permutation tests. Seropositivity for SARS-CoV-2-specific antibodies was 1.82% (95% confidence interval (CI) 1.28-2.37%) as compared to 0.46% PCR-positive cases officially registered in Munich. Loss of the sense of smell or taste was associated with seropositivity (odds ratio (OR) 47.4; 95% CI 7.2-307.0) and infections clustered within households. By this first population-based study on SARS-CoV-2 prevalence in a large German municipality not affected by a superspreading event, we could show that at least one in four cases in private households was reported and known to the health authorities. These results will help authorities to estimate the true burden of disease in the population and to take evidence-based decisions on public health measures.
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Affiliation(s)
- Michael Pritsch
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (M.P.); (A.B.); (L.O.); (J.M.G.N.); (E.S.); (N.C.); (C.R.); (M.P.); (D.M.); (V.T.); (F.R.); (M.N.D.); (G.F.); (J.B.); (S.W.); (J.F.); (K.P.); (I.B.); (I.K.); (A.W.)
- German Center for Infection Research (DZIF), Partner Site Munich, 80802 Munich, Germany;
| | - Katja Radon
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336 Munich, Germany; (K.R.); (F.F.)
- Center for International Health (CIH), University Hospital, LMU Munich, 80336 Munich, Germany
- Comprehensive Pneumology Center (CPC) Munich, German Center for Lung Research (DZL), 89337 Munich, Germany
| | - Abhishek Bakuli
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (M.P.); (A.B.); (L.O.); (J.M.G.N.); (E.S.); (N.C.); (C.R.); (M.P.); (D.M.); (V.T.); (F.R.); (M.N.D.); (G.F.); (J.B.); (S.W.); (J.F.); (K.P.); (I.B.); (I.K.); (A.W.)
| | - Ronan Le Gleut
- Helmholtz Zentrum München—German Research Center for Environmental Health, Institute of Computational Biology, 85764 Neuherberg, Germany; (R.L.G.); (M.G.); (P.P.); (Y.S.); (T.F.); (J.H.); (C.F.)
- Helmholtz Zentrum München—German Research Center for Environmental Health, Core Facility Statistical Consulting, 85764 Neuherberg, Germany
| | - Laura Olbrich
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (M.P.); (A.B.); (L.O.); (J.M.G.N.); (E.S.); (N.C.); (C.R.); (M.P.); (D.M.); (V.T.); (F.R.); (M.N.D.); (G.F.); (J.B.); (S.W.); (J.F.); (K.P.); (I.B.); (I.K.); (A.W.)
- German Center for Infection Research (DZIF), Partner Site Munich, 80802 Munich, Germany;
| | - Jessica Michelle Guggenbüehl Noller
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (M.P.); (A.B.); (L.O.); (J.M.G.N.); (E.S.); (N.C.); (C.R.); (M.P.); (D.M.); (V.T.); (F.R.); (M.N.D.); (G.F.); (J.B.); (S.W.); (J.F.); (K.P.); (I.B.); (I.K.); (A.W.)
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (M.P.); (A.B.); (L.O.); (J.M.G.N.); (E.S.); (N.C.); (C.R.); (M.P.); (D.M.); (V.T.); (F.R.); (M.N.D.); (G.F.); (J.B.); (S.W.); (J.F.); (K.P.); (I.B.); (I.K.); (A.W.)
- German Center for Infection Research (DZIF), Partner Site Munich, 80802 Munich, Germany;
| | - Noemi Castelletti
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (M.P.); (A.B.); (L.O.); (J.M.G.N.); (E.S.); (N.C.); (C.R.); (M.P.); (D.M.); (V.T.); (F.R.); (M.N.D.); (G.F.); (J.B.); (S.W.); (J.F.); (K.P.); (I.B.); (I.K.); (A.W.)
| | - Mercè Garí
- Helmholtz Zentrum München—German Research Center for Environmental Health, Institute of Computational Biology, 85764 Neuherberg, Germany; (R.L.G.); (M.G.); (P.P.); (Y.S.); (T.F.); (J.H.); (C.F.)
| | - Peter Pütz
- Helmholtz Zentrum München—German Research Center for Environmental Health, Institute of Computational Biology, 85764 Neuherberg, Germany; (R.L.G.); (M.G.); (P.P.); (Y.S.); (T.F.); (J.H.); (C.F.)
- Faculty of Business Administration and Economics, Bielefeld University, 33615 Bielefeld, Germany
| | - Yannik Schälte
- Helmholtz Zentrum München—German Research Center for Environmental Health, Institute of Computational Biology, 85764 Neuherberg, Germany; (R.L.G.); (M.G.); (P.P.); (Y.S.); (T.F.); (J.H.); (C.F.)
- Center for Mathematics, Technische Universität München, 85748 Garching, Germany
| | - Turid Frahnow
- Helmholtz Zentrum München—German Research Center for Environmental Health, Institute of Computational Biology, 85764 Neuherberg, Germany; (R.L.G.); (M.G.); (P.P.); (Y.S.); (T.F.); (J.H.); (C.F.)
- Faculty of Business Administration and Economics, Bielefeld University, 33615 Bielefeld, Germany
| | - Roman Wölfel
- German Center for Infection Research (DZIF), Partner Site Munich, 80802 Munich, Germany;
- Bundeswehr Institute of Microbiology, 80937 Munich, Germany
| | - Camilla Rothe
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (M.P.); (A.B.); (L.O.); (J.M.G.N.); (E.S.); (N.C.); (C.R.); (M.P.); (D.M.); (V.T.); (F.R.); (M.N.D.); (G.F.); (J.B.); (S.W.); (J.F.); (K.P.); (I.B.); (I.K.); (A.W.)
| | - Michel Pletschette
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (M.P.); (A.B.); (L.O.); (J.M.G.N.); (E.S.); (N.C.); (C.R.); (M.P.); (D.M.); (V.T.); (F.R.); (M.N.D.); (G.F.); (J.B.); (S.W.); (J.F.); (K.P.); (I.B.); (I.K.); (A.W.)
| | - Dafni Metaxa
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (M.P.); (A.B.); (L.O.); (J.M.G.N.); (E.S.); (N.C.); (C.R.); (M.P.); (D.M.); (V.T.); (F.R.); (M.N.D.); (G.F.); (J.B.); (S.W.); (J.F.); (K.P.); (I.B.); (I.K.); (A.W.)
| | - Felix Forster
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80336 Munich, Germany; (K.R.); (F.F.)
- Comprehensive Pneumology Center (CPC) Munich, German Center for Lung Research (DZL), 89337 Munich, Germany
| | - Verena Thiel
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (M.P.); (A.B.); (L.O.); (J.M.G.N.); (E.S.); (N.C.); (C.R.); (M.P.); (D.M.); (V.T.); (F.R.); (M.N.D.); (G.F.); (J.B.); (S.W.); (J.F.); (K.P.); (I.B.); (I.K.); (A.W.)
| | - Friedrich Rieß
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (M.P.); (A.B.); (L.O.); (J.M.G.N.); (E.S.); (N.C.); (C.R.); (M.P.); (D.M.); (V.T.); (F.R.); (M.N.D.); (G.F.); (J.B.); (S.W.); (J.F.); (K.P.); (I.B.); (I.K.); (A.W.)
- German Center for Infection Research (DZIF), Partner Site Munich, 80802 Munich, Germany;
| | - Maximilian Nikolaus Diefenbach
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (M.P.); (A.B.); (L.O.); (J.M.G.N.); (E.S.); (N.C.); (C.R.); (M.P.); (D.M.); (V.T.); (F.R.); (M.N.D.); (G.F.); (J.B.); (S.W.); (J.F.); (K.P.); (I.B.); (I.K.); (A.W.)
| | - Günter Fröschl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (M.P.); (A.B.); (L.O.); (J.M.G.N.); (E.S.); (N.C.); (C.R.); (M.P.); (D.M.); (V.T.); (F.R.); (M.N.D.); (G.F.); (J.B.); (S.W.); (J.F.); (K.P.); (I.B.); (I.K.); (A.W.)
- Center for International Health (CIH), University Hospital, LMU Munich, 80336 Munich, Germany
| | - Jan Bruger
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (M.P.); (A.B.); (L.O.); (J.M.G.N.); (E.S.); (N.C.); (C.R.); (M.P.); (D.M.); (V.T.); (F.R.); (M.N.D.); (G.F.); (J.B.); (S.W.); (J.F.); (K.P.); (I.B.); (I.K.); (A.W.)
| | - Simon Winter
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (M.P.); (A.B.); (L.O.); (J.M.G.N.); (E.S.); (N.C.); (C.R.); (M.P.); (D.M.); (V.T.); (F.R.); (M.N.D.); (G.F.); (J.B.); (S.W.); (J.F.); (K.P.); (I.B.); (I.K.); (A.W.)
| | - Jonathan Frese
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (M.P.); (A.B.); (L.O.); (J.M.G.N.); (E.S.); (N.C.); (C.R.); (M.P.); (D.M.); (V.T.); (F.R.); (M.N.D.); (G.F.); (J.B.); (S.W.); (J.F.); (K.P.); (I.B.); (I.K.); (A.W.)
| | - Kerstin Puchinger
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (M.P.); (A.B.); (L.O.); (J.M.G.N.); (E.S.); (N.C.); (C.R.); (M.P.); (D.M.); (V.T.); (F.R.); (M.N.D.); (G.F.); (J.B.); (S.W.); (J.F.); (K.P.); (I.B.); (I.K.); (A.W.)
| | - Isabel Brand
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (M.P.); (A.B.); (L.O.); (J.M.G.N.); (E.S.); (N.C.); (C.R.); (M.P.); (D.M.); (V.T.); (F.R.); (M.N.D.); (G.F.); (J.B.); (S.W.); (J.F.); (K.P.); (I.B.); (I.K.); (A.W.)
| | - Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (M.P.); (A.B.); (L.O.); (J.M.G.N.); (E.S.); (N.C.); (C.R.); (M.P.); (D.M.); (V.T.); (F.R.); (M.N.D.); (G.F.); (J.B.); (S.W.); (J.F.); (K.P.); (I.B.); (I.K.); (A.W.)
- German Center for Infection Research (DZIF), Partner Site Munich, 80802 Munich, Germany;
| | - Jan Hasenauer
- Helmholtz Zentrum München—German Research Center for Environmental Health, Institute of Computational Biology, 85764 Neuherberg, Germany; (R.L.G.); (M.G.); (P.P.); (Y.S.); (T.F.); (J.H.); (C.F.)
- Center for Mathematics, Technische Universität München, 85748 Garching, Germany
- Interdisciplinary Research Unit Mathematics and Life Sciences, University of Bonn, 53113 Bonn, Germany
| | - Christiane Fuchs
- Helmholtz Zentrum München—German Research Center for Environmental Health, Institute of Computational Biology, 85764 Neuherberg, Germany; (R.L.G.); (M.G.); (P.P.); (Y.S.); (T.F.); (J.H.); (C.F.)
- Helmholtz Zentrum München—German Research Center for Environmental Health, Core Facility Statistical Consulting, 85764 Neuherberg, Germany
- Faculty of Business Administration and Economics, Bielefeld University, 33615 Bielefeld, Germany
- Center for Mathematics, Technische Universität München, 85748 Garching, Germany
| | - Andreas Wieser
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (M.P.); (A.B.); (L.O.); (J.M.G.N.); (E.S.); (N.C.); (C.R.); (M.P.); (D.M.); (V.T.); (F.R.); (M.N.D.); (G.F.); (J.B.); (S.W.); (J.F.); (K.P.); (I.B.); (I.K.); (A.W.)
- German Center for Infection Research (DZIF), Partner Site Munich, 80802 Munich, Germany;
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802 Munich, Germany; (M.P.); (A.B.); (L.O.); (J.M.G.N.); (E.S.); (N.C.); (C.R.); (M.P.); (D.M.); (V.T.); (F.R.); (M.N.D.); (G.F.); (J.B.); (S.W.); (J.F.); (K.P.); (I.B.); (I.K.); (A.W.)
- German Center for Infection Research (DZIF), Partner Site Munich, 80802 Munich, Germany;
- Center for International Health (CIH), University Hospital, LMU Munich, 80336 Munich, Germany
- Correspondence: ; Tel.: +49-89-44005-9801
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11
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Macicame I, Prista A, Parhofer KG, Cavele N, Manhiça C, Nhachungue S, Saathoff E, Rehfuess E. Social determinants and behaviors associated with overweight and obesity among youth and adults in a peri-urban area of Maputo City, Mozambique. J Glob Health 2021; 11:04021. [PMID: 33868672 PMCID: PMC8038757 DOI: 10.7189/jogh.11.04021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Overweight and obesity are important risk factors for non-communicable diseases (NCDs) such as cardiovascular diseases (CVD), type 2 diabetes and certain cancers. NCDs are responsible for an increased number of deaths worldwide, including in developing countries. We aimed to determine the prevalence of overweight and obesity among youth and adults in a peri-urban area of Maputo city, Mozambique, and to assess their social and behavioral determinants. METHODS A cross-sectional study was conducted in a Health and Demographic Surveillance System (HDSS) area in Maputo city. We measured BMI and interviewed 15-64-year-old inhabitants to assess sociodemographic and behavioral characteristics using the STEPwise Approach methodology. A household wealth index was derived through Principal Component Analysis of various household assets and physical activity (PA) was measured using pedometers and accelerometers. Univariable and multivariable analyses were conducted to determine associations between overweight/obesity and social and behavioral determinants. RESULTS Among a total of 931 participants, the prevalence of overweight (BMI≥25 kg/m2) and obesity (BMI≥30 kg/m2) was 30.9% (95% confidence interval (CI) = 28.0, 33.9) and 12.6% (95% CI = 10.4, 14.7), respectively; one in every 10 youths and adults were underweight. Being female, older and living in a wealthier household were found to be significantly associated with overweight and obesity. Those with higher levels of education were found to have a reduced risk of being obese compared to those with no or lower levels of education. Behavioral risk factors (diet, alcohol and tobacco consumption and physical activity) did not significantly increase the risk of overweight and obesity. CONCLUSIONS Overweight and obesity are highly prevalent in this peri-urban part of the Mozambican capital, where underweight is still present in youth and adults, confirming that the country is facing a double burden of malnutrition. Social determinants of health should be taken into consideration in the design and implementation of NCD prevention programs.
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Affiliation(s)
- Ivalda Macicame
- Instituto Nacional de Saúde, Maputo City, Mozambique
- Center for International Health (CIH), Ludwig-Maximilians-Universität München (LMU) Munich, Germany
| | | | - Klaus G Parhofer
- Medizinische Klinik IV – Grosshadern, Klinikum der Ludwig-Maximilians-Universität München (LMU), Munich, Germany
| | - Nílzio Cavele
- Instituto Nacional de Saúde, Maputo City, Mozambique
| | | | | | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU, Munich, Germany
- German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Eva Rehfuess
- Institute of Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
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Idoko OT, Domingo C, Tapia MD, Sow SO, Geldmacher C, Saathoff E, Kampmann B. Serological Protection 5-6 Years Post Vaccination Against Yellow Fever in African Infants Vaccinated in Routine Programmes. Front Immunol 2020; 11:577751. [PMID: 33133096 PMCID: PMC7578390 DOI: 10.3389/fimmu.2020.577751] [Citation(s) in RCA: 4] [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] [Received: 06/29/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction: Although effective live attenuated yellow fever (YF) vaccines have been available for over 9 decades sporadic outbreaks continue to occur in endemic regions. These may be linked to several factors including epidemiological factors such as vector and intermediate host distribution or vaccine coverage and efficacy. The World Health Organization's research priorities include gathering systematic evidence around the potential need for booster vaccination with YF vaccine whether this follows full or fractional doses in children. Knowledge on the longevity of response to YF vaccine and the implications of this response needs to be consolidated to guide future vaccination policy. Methods: We measured anti-YF IgG by microneutralization assay in a group of 481 African infants who had received YF vaccine as part of routine EPI programmes, to explore serological protection from YF 5-6 years post YF vaccination, as well as the effect of co variates. Findings: Notably, 22.2% of the cohort had undetectable antibody concentrations, with another 7.5% revealing concentrations below the threshold of seropositivity of 0.5 IU/mL. Sex, season, country and time since vaccination did not affect the longevity of antibody concentration or having antibody concentrations above a defined threshold. Conclusion: Roughly 30% of children in this cohort did not demonstrate anti-yellow fever antibody concentrations above the defined threshold of protection, with 20% having no demonstrable antibody. Knowledge on the longevity of response to YF vaccine and the implications needs to be consolidated to guide future vaccination policy.
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Affiliation(s)
- Olubukola T. Idoko
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
- CIH Center for International Health, Medical Center of the University of Munich (Ludwig-Maximilians-Universität München), Munich, Germany
| | - Cristina Domingo
- Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Milagritos D. Tapia
- Centre pour le Développement des Vaccins, University of Maryland, Bamako, Mali
| | - Samba O. Sow
- Centre pour le Développement des Vaccins, University of Maryland, Bamako, Mali
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität München Munich, Munich, Germany
- German Centre for Infection Research (Deutsches Zentrum für Infektionsforschung), Munich, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität München Munich, Munich, Germany
- German Centre for Infection Research (Deutsches Zentrum für Infektionsforschung), Munich, Germany
| | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
- The Vaccine Centre, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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13
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Mbuya W, Mcharo R, Mhizde J, Mnkai J, Mahenge A, Mwakatima M, Mwalongo W, Chiwerengo N, Hölscher M, Lennemann T, Saathoff E, Rwegoshora F, Torres L, Kroidl A, Geldmacher C, Held K, Chachage M. Depletion and activation of mucosal CD4 T cells in HIV infected women with HPV-associated lesions of the cervix uteri. PLoS One 2020; 15:e0240154. [PMID: 33007050 PMCID: PMC7531815 DOI: 10.1371/journal.pone.0240154] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The burden of HPV-associated premalignant and malignant cervical lesions remains high in HIV+ women even under ART treatment. In order to identify possible underlying pathophysiologic mechanisms, we studied activation and HIV co-receptor expression in cervical T-cell populations in relation to HIV, HPV and cervical lesion status. METHODS Cervical cytobrush (n = 468: 253 HIV- and 215 HIV+; 71% on ART) and blood (in a subset of 39 women) was collected from women in Mbeya, Tanzania. Clinical data on HIV and HPV infection, as well as ART status was collected. T cell populations were characterized using multiparametric flow cytometry-based on their expression of markers for cellular activation (HLA-DR), and memory (CD45RO), as well as HIV co-receptors (CCR5, α4β7). RESULTS Cervical and blood T cells differed significantly, with higher frequencies of T cells expressing CD45RO, as well as the HIV co-receptors CCR5 and α4β7 in the cervical mucosa. The skewed CD4/CD8 T cell ratio in blood of HIV+ women was mirrored in the cervical mucosa and HPV co-infection was linked to lower levels of mucosal CD4 T cells in HIV+ women (%median: 22 vs 32; p = 0.04). In addition, HIV and HPV infection, and especially HPV-associated cervical lesions were linked to significantly higher frequencies of HLA-DR+ CD4 and CD8 T cells (p-values < 0.05). Interestingly, HPV infection did not significantly alter frequencies of CCR5+ or α4β7+ CD4 T cells. CONCLUSION The increased proportion of activated cervical T cells associated with HPV and HIV infection, as well as HPV-associated lesions, together with the HIV-induced depletion of cervical CD4 T cells, may increase the risk for HPV infection, associated premalignant lesions and cancer in HIV+ women. Further, high levels of activated CD4 T cells associated with HPV and HPV-associated lesions could contribute to a higher susceptibility to HIV in HPV infected women.
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Affiliation(s)
- Wilbert Mbuya
- National Institute for Medical Research–Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Ruby Mcharo
- National Institute for Medical Research–Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
- University of Dar es Salaam -Mbeya College of Health and Allied Sciences (UDSM-MCHAS), Mbeya, Tanzania
| | - Jacklina Mhizde
- National Institute for Medical Research–Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Jonathan Mnkai
- National Institute for Medical Research–Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Anifrid Mahenge
- National Institute for Medical Research–Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Maria Mwakatima
- National Institute for Medical Research–Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Wolfram Mwalongo
- National Institute for Medical Research–Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Nhamo Chiwerengo
- National Institute for Medical Research–Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Michael Hölscher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Partner site Munich, Munich, Germany
| | - Tessa Lennemann
- National Institute for Medical Research–Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Partner site Munich, Munich, Germany
| | | | | | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Partner site Munich, Munich, Germany
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Partner site Munich, Munich, Germany
| | - Kathrin Held
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Partner site Munich, Munich, Germany
| | - Mkunde Chachage
- National Institute for Medical Research–Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
- University of Dar es Salaam -Mbeya College of Health and Allied Sciences (UDSM-MCHAS), Mbeya, Tanzania
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
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14
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Radon K, Saathoff E, Pritsch M, Guggenbühl Noller JM, Kroidl I, Olbrich L, Thiel V, Diefenbach M, Riess F, Forster F, Theis F, Wieser A, Hoelscher M. Publisher Correction to: Protocol of a population-based prospective COVID-19 cohort study Munich, Germany (KoCo19). BMC Public Health 2020; 20:1335. [PMID: 32873261 PMCID: PMC7461750 DOI: 10.1186/s12889-020-09394-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Katja Radon
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität (LMU) University Hospital Munich, Ziemssenstr. 1, 80336, Munich, Germany. .,Center for International Health, LMU University Hospital, Munich, Germany.
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Germany, Leopoldstrasse 5, 80802, Munich, Germany.,German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Michael Pritsch
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Germany, Leopoldstrasse 5, 80802, Munich, Germany
| | - Jessica Michelle Guggenbühl Noller
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Germany, Leopoldstrasse 5, 80802, Munich, Germany
| | - Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Germany, Leopoldstrasse 5, 80802, Munich, Germany.,German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Laura Olbrich
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Germany, Leopoldstrasse 5, 80802, Munich, Germany
| | - Verena Thiel
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Germany, Leopoldstrasse 5, 80802, Munich, Germany
| | - Max Diefenbach
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Germany, Leopoldstrasse 5, 80802, Munich, Germany
| | - Friedrich Riess
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Germany, Leopoldstrasse 5, 80802, Munich, Germany
| | - Felix Forster
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität (LMU) University Hospital Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - Fabian Theis
- Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Departments of Mathematics and Life Sciences, Technical University of Munich, Munich, Germany
| | - Andreas Wieser
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Germany, Leopoldstrasse 5, 80802, Munich, Germany.,Max von Pettenkofer Institute, Faculty of Medicine, LMU of Munich, Munich, Germany
| | - Michael Hoelscher
- Center for International Health, LMU University Hospital, Munich, Germany.,Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Germany, Leopoldstrasse 5, 80802, Munich, Germany.,German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
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15
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Radon K, Saathoff E, Pritsch M, Guggenbühl Noller JM, Kroidl I, Olbrich L, Thiel V, Diefenbach M, Riess F, Forster F, Theis F, Wieser A, Hoelscher M. Protocol of a population-based prospective COVID-19 cohort study Munich, Germany (KoCo19). BMC Public Health 2020; 20:1036. [PMID: 32605549 PMCID: PMC7324773 DOI: 10.1186/s12889-020-09164-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to the SARS-CoV-2 pandemic, public health interventions have been introduced globally in order to prevent the spread of the virus and avoid the overload of health care systems, especially for the most severely affected patients. Scientific studies to date have focused primarily on describing the clinical course of patients, identifying treatment options and developing vaccines. In Germany, as in many other regions, current tests for SARS-CoV2 are not conducted on a representative basis and in a longitudinal design. Furthermore, knowledge about the immune status of the population is lacking. Nonetheless, these data are needed to understand the dynamics of the pandemic and hence to appropriately design and evaluate interventions. For this purpose, we recently started a prospective population-based cohort in Munich, Germany, with the aim to develop a better understanding of the state and dynamics of the pandemic. METHODS In 100 out of 755 randomly selected constituencies, 3000 Munich households are identified via random route and offered enrollment into the study. All household members are asked to complete a baseline questionnaire and subjects ≥14 years of age are asked to provide a venous blood sample of ≤3 ml for the determination of SARS-CoV-2 IgG/IgA status. The residual plasma and the blood pellet are preserved for later genetic and molecular biological investigations. For twelve months, each household member is asked to keep a diary of daily symptoms, whereabouts and contacts via WebApp. If symptoms suggestive for COVID-19 are reported, family members, including children < 14 years, are offered a pharyngeal swab taken at the Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, for molecular testing for SARS-CoV-2. In case of severe symptoms, participants will be transferred to a Munich hospital. For one year, the study teams re-visits the households for blood sampling every six weeks. DISCUSSION With the planned study we will establish a reliable epidemiological tool to improve the understanding of the spread of SARS-CoV-2 and to better assess the effectiveness of public health measures as well as their socio-economic effects. This will support policy makers in managing the epidemic based on scientific evidence.
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Affiliation(s)
- Katja Radon
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität (LMU) University Hospital Munich, Ziemssenstr. 1, 80336 Munich, Germany
- Center for International Health, LMU University Hospital, Munich, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Germany, Leopoldstrasse 5, 80802 Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Michael Pritsch
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Germany, Leopoldstrasse 5, 80802 Munich, Germany
| | | | - Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Germany, Leopoldstrasse 5, 80802 Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Laura Olbrich
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Germany, Leopoldstrasse 5, 80802 Munich, Germany
| | - Verena Thiel
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Germany, Leopoldstrasse 5, 80802 Munich, Germany
| | - Max Diefenbach
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Germany, Leopoldstrasse 5, 80802 Munich, Germany
| | - Friedrich Riess
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Germany, Leopoldstrasse 5, 80802 Munich, Germany
| | - Felix Forster
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität (LMU) University Hospital Munich, Ziemssenstr. 1, 80336 Munich, Germany
| | - Fabian Theis
- Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- Departments of Mathematics and Life Sciences, Technical University of Munich, Munich, Germany
| | - Andreas Wieser
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Germany, Leopoldstrasse 5, 80802 Munich, Germany
- Max von Pettenkofer Institute, Faculty of Medicine, LMU of Munich, Munich, Germany
| | - Michael Hoelscher
- Center for International Health, LMU University Hospital, Munich, Germany
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Germany, Leopoldstrasse 5, 80802 Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
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16
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Ivanova O, Khosa C, Bakuli A, Bhatt N, Massango I, Jani I, Saathoff E, Hoelscher M, Rachow A. Lung Function Testing and Prediction Equations in Adult Population from Maputo, Mozambique. Int J Environ Res Public Health 2020; 17:ijerph17124535. [PMID: 32599726 PMCID: PMC7344554 DOI: 10.3390/ijerph17124535] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 12/15/2022]
Abstract
Background: Local spirometric prediction equations are of great importance for interpreting lung function results and deciding on the management strategies for respiratory patients, yet available data from African countries are scarce. The aim of this study was to collect lung function data using spirometry in healthy adults living in Maputo, Mozambique and to derive first spirometric prediction equations for this population. Methods: We applied a cross-sectional study design. Participants, who met the inclusion criteria, underwent a short interview, anthropometric measurements, and lung function testing. Different modelling approaches were followed for generating new, Mozambican, prediction equations and for comparison with the Global Lung Initiative (GLI) and South African equations. The pulmonary function performance of participants was assessed against the different reference standards. Results: A total of 212 males and females were recruited, from whom 155 usable spirometry results were obtained. The mean age of participants was 35.20 years (SD 10.99) and 93 of 155 (59.35%) were females. The predicted values for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and the FEV1/FVC ratio based on the Mozambican equations were lower than the South African—and the GLI-based predictions. Conclusions: This study provides first data on pulmonary function in healthy Mozambican adults and describes how they compare to GLI and South African reference values for spirometry.
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Affiliation(s)
- Olena Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany; (A.B.); (E.S.); (M.H.); (A.R.)
- Correspondence:
| | - Celso Khosa
- Instituto Nacional de Saúde (INS), 3943 Maputo, Mozambique; (C.K.); (N.B.); (I.M.); (I.J.)
- Center for International Health—CIH LMU, 80802 Munich, Germany
| | - Abhishek Bakuli
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany; (A.B.); (E.S.); (M.H.); (A.R.)
| | - Nilesh Bhatt
- Instituto Nacional de Saúde (INS), 3943 Maputo, Mozambique; (C.K.); (N.B.); (I.M.); (I.J.)
| | - Isabel Massango
- Instituto Nacional de Saúde (INS), 3943 Maputo, Mozambique; (C.K.); (N.B.); (I.M.); (I.J.)
| | - Ilesh Jani
- Instituto Nacional de Saúde (INS), 3943 Maputo, Mozambique; (C.K.); (N.B.); (I.M.); (I.J.)
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany; (A.B.); (E.S.); (M.H.); (A.R.)
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany; (A.B.); (E.S.); (M.H.); (A.R.)
- Center for International Health—CIH LMU, 80802 Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site, 80802 Munich, Germany
| | - Andrea Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany; (A.B.); (E.S.); (M.H.); (A.R.)
- Center for International Health—CIH LMU, 80802 Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site, 80802 Munich, Germany
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17
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Khosa C, Bhatt N, Massango I, Azam K, Saathoff E, Bakuli A, Riess F, Ivanova O, Hoelscher M, Rachow A. Development of chronic lung impairment in Mozambican TB patients and associated risks. BMC Pulm Med 2020; 20:127. [PMID: 32381002 PMCID: PMC7203866 DOI: 10.1186/s12890-020-1167-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/27/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Pulmonary tuberculosis (PTB) is frequently associated with chronic respiratory impairment despite microbiological cure. There are only a few clinical research studies that describe the course, type and severity as well as associated risk factors for lung impairment (LI) in TB patients. METHODS A prospective cohort study was conducted at TB Research Clinic of Instituto Nacional de Saúde in Mavalane, Maputo, from June 2014 to June 2016. PTB patients were prospectively enrolled and followed for 52 weeks after TB diagnosis. Lung function was evaluated by spirometry at 8, 26 and 52 weeks after TB treatment initiation, and spirometric values of below the lower limit of normality were considered as LI. Descriptive statistical analysis was performed to summarize the proportion of patients with different lung outcomes at week 52, including type and severity of LI. Risk factors were analysed using multinomial regression analysis. RESULTS A total of 69 PTB patients were enrolled, of which 62 had a valid spirometry result at week 52 after TB treatment start. At week 8, 26 and 52, the proportion of patients with LI was 78, 68.9 and 64.5%, respectively, and 35.5% had moderate or severe LI at week 52. The majority of patients with LI suffered from pulmonary restriction. Female sex, low haemoglobin and heavy smoking were significantly associated with LI. CONCLUSION Moderate or severe LI can be observed in a third of cured TB patients. Further research is urgently needed to gain deeper insight into the characteristics of post TB LI, the causal pathways and potential treatment strategies.
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Affiliation(s)
- Celso Khosa
- Instituto Nacional de Saúde (INS), Maputo, Mozambique. .,Center for International Health - CIHLMU, Munich, Germany.
| | - Nilesh Bhatt
- Instituto Nacional de Saúde (INS), Maputo, Mozambique
| | | | - Khalide Azam
- Instituto Nacional de Saúde (INS), Maputo, Mozambique.,Center for International Health - CIHLMU, Munich, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,German Centre for Infection Research (DZIF), partner site, Munich, Germany
| | - Abhishek Bakuli
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Friedrich Riess
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Olena Ivanova
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Michael Hoelscher
- Center for International Health - CIHLMU, Munich, Germany.,Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,German Centre for Infection Research (DZIF), partner site, Munich, Germany
| | - Andrea Rachow
- Center for International Health - CIHLMU, Munich, Germany.,Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,German Centre for Infection Research (DZIF), partner site, Munich, Germany
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18
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Sabi I, Mahiga H, Mgaya J, Geisenberger O, Kastner S, Olomi W, Saathoff E, Njovu L, Lueer C, France J, Maboko L, Ntinginya NE, Hoelscher M, Kroidl A. Accuracy and Operational Characteristics of Xpert Human Immunodeficiency Virus Point-of-Care Testing at Birth and Until Week 6 in Human Immunodeficiency Virus-exposed Neonates in Tanzania. Clin Infect Dis 2020; 68:615-622. [PMID: 29961841 PMCID: PMC6355822 DOI: 10.1093/cid/ciy538] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 03/23/2018] [Accepted: 06/28/2018] [Indexed: 01/24/2023] Open
Abstract
Background Point-of-care (PoC) systems for early infant diagnosis (EID) may improve timely infant human immunodeficiency virus (HIV) management. Experiences within African public health settings are limited. Methods We evaluated the accuracy and operational feasibility of the Xpert HIV-1 Qual for PoC-EID testing, using fresh blood and dried blood spots (DBS) samples at obstetric health facilities in Tanzania at birth and at postpartum weeks 1, 2, 3, and 6 in HIV-exposed infants. Test results were confirmed using TaqMan DBS HIV-deoxyribonucleic acid and/or plasma HIV-ribonucleic acid (RNA) testing. Results At week 6, 15 (2.5%) out of 614 infants were diagnosed with HIV; 10 (66.7%) of them at birth (median HIV-RNA 4570 copies/mL). At birth, the Xpert-PoC and Xpert-DBS were 100% sensitive (95% confidence intervals: PoC, 69.2–100%; DBS, 66.4–100%) and 100% specific (PoC, 92.1–100%; DBS, 88.4–100%). By week 3, 5 infants with intra/postpartum HIV-infection (median HIV-RNA 1 160 000 copies/mL) were all correctly diagnosed by Xpert. In 2 cases, Xpert-PoC testing correctly identified HIV-infection when DBS tests (Xpert and TaqMan) were negative, suggesting a greater sensitivity. In 2 infants with confirmed HIV at birth, all tests were negative at week 6, possibly because of viral suppression under nevirapine prophylaxis. Problems were reported in 183/2736 (6.7%) of Xpert-PoC tests, mostly related to power cuts (57.9%). Conclusions We demonstrated excellent Xpert HIV-1 Qual performance and good operational feasibility for PoC-EID testing at obstetric health facilities. Week 6 sensitivity issues were possibly related to nevirapine prophylaxis, supporting additional birth PoC-EID testing to avoid underdiagnosis. Clinical Trials Registration NCT02545296
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Affiliation(s)
- Issa Sabi
- National Institute for Medical Research, Mbeya Medical Research Center, Tanzania
| | - Hellen Mahiga
- National Institute for Medical Research, Mbeya Medical Research Center, Tanzania
| | - Jimson Mgaya
- National Institute for Medical Research, Mbeya Medical Research Center, Tanzania
| | - Otto Geisenberger
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich.,German Center for Infection Research (DZIF), Munich, Germany
| | - Sabine Kastner
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich.,German Center for Infection Research (DZIF), Munich, Germany
| | - Willyhelmina Olomi
- National Institute for Medical Research, Mbeya Medical Research Center, Tanzania
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich.,German Center for Infection Research (DZIF), Munich, Germany
| | - Lilian Njovu
- National Institute for Medical Research, Mbeya Medical Research Center, Tanzania
| | - Cornelia Lueer
- National Institute for Medical Research, Mbeya Medical Research Center, Tanzania.,Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich
| | - John France
- Department of Obstetrics and Gynaecology, Mbeya Zonal Referral Hospital, Tanzania
| | - Leonard Maboko
- National Institute for Medical Research, Mbeya Medical Research Center, Tanzania
| | | | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich.,German Center for Infection Research (DZIF), Munich, Germany
| | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich.,German Center for Infection Research (DZIF), Munich, Germany
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19
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Kroidl I, Chachage M, Mnkai J, Nsojo A, Berninghoff M, Verweij JJ, Maganga L, Ntinginya NE, Maboko L, Clowes P, Hoelscher M, Saathoff E, Geldmacher C. Wuchereria bancrofti infection is linked to systemic activation of CD4 and CD8 T cells. PLoS Negl Trop Dis 2019; 13:e0007623. [PMID: 31425508 PMCID: PMC6736309 DOI: 10.1371/journal.pntd.0007623] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/30/2019] [Revised: 09/10/2019] [Accepted: 07/10/2019] [Indexed: 11/29/2022] Open
Abstract
Background Susceptibility to HIV has been linked to systemic CD4+ T cell activation in cohorts of seronegative individuals with high HIV-exposure risk. We recently described an increased risk of HIV transmission in individuals infected with Wuchereria bancrofti, the causative agent for lymphatic filariasis, in a prospective cohort study. However, the reason for this phenomenon needs further investigation. Methodology/Principal findings Two-hundred and thirty-five HIV negative adults were tested using Trop Bio ELISA for detection of W. bancrofti infection and Kato Katz urine filtration and stool based RT-PCR for detection of soil transmitted helminths and schistosomiasis. FACS analysis of the fresh peripheral whole blood was used to measure T cell activation markers (HLA-DR, CD38), differentiation markers (CD45, CD27), markers for regulatory T cells (FoxP3, CD25) and the HIV entry receptor CCR5. Frequencies of activated HLA-DRpos CD4 T cells were significantly increased in subjects with W. bancrofti infection (n = 33 median: 10.71%) compared to subjects without any helminth infection (n = 42, median 6.97%, p = 0.011) or those with other helminths (Schistosoma haematobium, S. mansoni, Trichuris trichiura, Ascaris lumbricoides, hookworm) (n = 151, median 7.38%, p = 0.009). Similarly, a significant increase in HLA-DRposCD38pos CD4 T cells and effector memory cells CD4 T cells (CD45ROposCD27neg) was observed in filarial infected participants. Multivariable analyses further confirmed a link between W. bancrofti infection and systemic activation of CD4 T cells independent of age, fever, gender or other helminth infections. Conclusions/Significance W. bancrofti infection is linked to systemic CD4 T cell activation, which may contribute to the increased susceptibility of W. bancrofti infected individuals to HIV infection. The importance of CD4 T cell activation for HIV susceptibility has been emphasized in several studies focusing on HIV transmission and prevention. Particularly, activated HLA-DR+ CD4 T cells may play a major role in HIV susceptibility. In this analysis we describe systemic activation of CD4 T cells in individuals infected with W. bancrofti the causative agent of lymphatic filariasis. This helminth disease leads to debilitating pathology in some of the individuals; however, the majority of infected persons remain asymptomatic. We recently described an increased HIV incidence in subjects infected with W. bancrofti compared to uninfected individuals from the same area. To decipher underlying reasons for this phenomenon, we measured immune activation parameters in CD4 and CD8 T cells. The increased percentage of HLADR positive and HLADR/CD38 positive CD4 T cells and also effector memory CD4 T cells that we describe here could be a possible mechanism to explain our previous findings of increased HIV incidence in individuals infected with this filarial nematode.
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Affiliation(s)
- Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich Germany
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
- German Center for Infection Research (DZIF), partner site Munich, Germany
- * E-mail:
| | - Mkunde Chachage
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich Germany
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Jonathan Mnkai
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Anthony Nsojo
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Myrna Berninghoff
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich Germany
| | - Jaco J. Verweij
- Laboratory for Medical Microbiology and Immunology, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Lucas Maganga
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Nyanda E. Ntinginya
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Leonard Maboko
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Petra Clowes
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich Germany
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich Germany
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
- German Center for Infection Research (DZIF), partner site Munich, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich Germany
- German Center for Infection Research (DZIF), partner site Munich, Germany
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich Germany
- German Center for Infection Research (DZIF), partner site Munich, Germany
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20
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Idoko OT, Mohammed N, Ansah P, Hodgson A, Tapia MD, Sow SO, Chowdhury PR, Niedrig M, Saathoff E, Kampmann B. Antibody responses to yellow fever vaccine in 9 to 11-month-old Malian and Ghanaian children. Expert Rev Vaccines 2019; 18:867-875. [PMID: 31269829 DOI: 10.1080/14760584.2019.1640118] [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] [Indexed: 10/26/2022]
Abstract
Background: The World Health Organization recommends use of a single yellow fever (YF) vaccine dose for life and fractional doses in outbreaks when there are limited vaccine stocks. In endemic regions, this vaccine is given as part of routine infant immunization programs around 9 months of age. There is a need to better understand immune responses when vaccinating infants particularly in contexts where the child may be malnourished. Methods: Data from 393 Malian and Ghanaian infants who concomitantly received measles and YF vaccines at 9 to 11 months of age were retrospectively analyzed. Response to YF vaccine was examined for association with nutritional status at time of vaccination, sex, age, pre-vaccination titers and season of vaccination. Results: Neutralizing antibodies following vaccination were unaffected by season of vaccination, sex, pre-vaccination titers or nutritional status, though there was a trend to higher titers in males and children with higher height for age z-scores. Seroconversion rates differed significantly between countries (63.5 in Ghana vs. 91.0% in Mali). Conclusion: Longitudinal, prospective studies are needed to optimize the use of YF vaccine in infants in endemic settings. There may be a need for booster vaccinations and to compare various vaccine preparations to optimize the use of available vaccines.
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Affiliation(s)
- Olubukola T Idoko
- a The Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine , Fajara , The Gambia.,b CIHLMU Center for International Health, Medical Center of the University of Munich (LMU) , Munich , Germany
| | - Nuredin Mohammed
- a The Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine , Fajara , The Gambia
| | - Patrick Ansah
- c Navrongo Health Research Centre, Ghana Health Service , Navrongo , Ghana
| | - Abraham Hodgson
- c Navrongo Health Research Centre, Ghana Health Service , Navrongo , Ghana
| | - Milagritos D Tapia
- d Centre pour le Developement des Vaccins, University of Maryland , Bamako , Mali
| | - Samba O Sow
- d Centre pour le Developement des Vaccins, University of Maryland , Bamako , Mali
| | - Paanchali R Chowdhury
- e Centre for Biologic Threats and Special Pathogens, Robert Koch Institute , Berlin , Germany
| | - Matthias Niedrig
- e Centre for Biologic Threats and Special Pathogens, Robert Koch Institute , Berlin , Germany
| | - Elmar Saathoff
- f Division of Infectious Diseases and Tropical Medicine, University Hospital , LMU Munich , Germany.,g German Centre for Infection Research (DZIF), partner site Munich , Germany
| | - Beate Kampmann
- a The Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine , Fajara , The Gambia.,h The Vaccine Centre, London School of Hygiene and Tropical Medicine , London , England
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Sabi I, Rachow A, Mapamba D, Clowes P, Ntinginya NE, Sasamalo M, Kamwela L, Haraka F, Hoelscher M, Paris D, Saathoff E, Reither K. OC 8215 DIAGNOSTIC ACCURACY OF XPERT MTB/RIF ULTRA FOR PULMONARY TUBERCULOSIS IN CHILDREN: A MULTICENTRE COMPARATIVE STUDY. BMJ Glob Health 2019. [DOI: 10.1136/bmjgh-2019-edc.3] [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] [Indexed: 11/04/2022] Open
Abstract
BackgroundXpert® MTB/RIF (Xpert) has suboptimal sensitivity for the diagnosis of pulmonary tuberculosis in children. The next-generation Xpert MTB/RIF Ultra assay (Xpert Ultra) is substantially more sensitive than Xpert and may allow improved detection of paediatric tuberculosis. We evaluated the diagnostic accuracy of Xpert Ultra versus Xpert in the detection of pulmonary tuberculosis in children.MethodsFrom May 2011 to September 2012, children with presumptive pulmonary tuberculosis were enrolled at two Tanzanian research sites in the EDCTP-funded TB CHILD project. Sputum samples were collected and examined for tuberculosis using sputum smear, Xpert and culture. Xpert Ultra analysis was performed between January and June 2017 at both sites using decontaminated sputum pellets which had been stored at −80°C. The diagnostic accuracy of Xpert and Xpert Ultra was determined using well-defined case definitions as reference standard.ResultsIn total, 215 children were included in the analysis. The median age was 5.4 years (IQR, 1.5 to 9.9), the HIV prevalence was 52%, and 28 children (13%) had culture-confirmed pulmonary tuberculosis. When only the first available sample of each patient was considered, the sensitivity of Xpert Ultra was 64.3% (95% CI: 44.1 to 81.4) while that of Xpert was 53.6% (95% CI: 33.9 to 72.5). The specificity of Xpert Ultra based on the analysis of all available samples was 98.1% (95% CI: 93.4 to 99.7), whereas that of Xpert was 100%.ConclusionIn settings with a high burden of tuberculosis and HIV, Xpert Ultra had a better sensitivity than Xpert in children. However, the specificity was slightly lower than that of Xpert. Thus, Xpert Ultra has the potential to increase the reliability and the speed of tuberculosis diagnosis in children.
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Ahmed MIM, Ntinginya NE, Kibiki G, Mtafya BA, Semvua H, Mpagama S, Mtabho C, Saathoff E, Held K, Loose R, Kroidl I, Chachage M, von Both U, Haule A, Mekota AM, Boeree MJ, Gillespie SH, Hoelscher M, Heinrich N, Geldmacher C. Phenotypic Changes on Mycobacterium Tuberculosis-Specific CD4 T Cells as Surrogate Markers for Tuberculosis Treatment Efficacy. Front Immunol 2018; 9:2247. [PMID: 30323818 PMCID: PMC6172348 DOI: 10.3389/fimmu.2018.02247] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 04/17/2018] [Accepted: 09/10/2018] [Indexed: 12/12/2022] Open
Abstract
Background: The analysis of phenotypic characteristics on Mycobacterium tuberculosis (MTB)-specific T cells is a promising approach for the diagnosis of active tuberculosis (aTB) and for monitoring treatment success. We therefore studied phenotypic changes on MTB-specific CD4 T cells upon anti-tuberculosis treatment initiation in relation to the treatment response as determined by sputum culture. Methods: Peripheral blood mononuclear cells from subjects with latent MTB infection (n = 16) and aTB (n = 39) at baseline, weeks 9, 12, and 26 (end of treatment) were analyzed after intracellular interferon gamma staining and overnight stimulation with tuberculin. Liquid sputum cultures were performed weekly until week 12 and during 4 visits until week 26. Results: T cell activation marker expression on MTB-specific CD4 T cells differed significantly between subjects with aTB and latent MTB infection with no overlap for the frequencies of CD38pos and Ki67pos cells (both p < 0.0001). At 9 weeks after anti-TB treatment initiation the frequencies of activation marker (CD38, HLA-DR, Ki67) positive MTB-specific, but not total CD4 T cells, were significantly reduced (p < 0.0001). Treatment induced phenotypic changes from baseline until week 9 and until week 12 differed substantially between individual aTB patients and correlated with an individual's time to stable sputum culture conversion for expression of CD38 and HLA-DR (both p < 0.05). In contrast, the frequencies of maturation marker CD27 positive MTB-specific CD4 T cells remained largely unchanged until week 26 and significantly differed between subjects with treated TB disease and latent MTB infection (p = 0.0003). Discussion: Phenotypic changes of MTB-specific T cells are potential surrogate markers for tuberculosis treatment efficacy and can help to discriminate between aTB (profile: CD38pos, CD27low), treated TB (CD38neg, CD27low), and latent MTB infection (CD38neg, CD27high).
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Affiliation(s)
- Mohamed I M Ahmed
- Division of Infectious Diseases and Tropical Medicine, Klinikum of the University of Munich (LMU), Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany.,CIH LMU Center for International Health, Klinikum of the University of Munich, Munich, Germany
| | - Nyanda E Ntinginya
- National Institute for Medical Research-Mbeya Medical Research Center, Mbeya, Tanzania
| | - Gibson Kibiki
- Kilimanjaro Christian Medical Centre, Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Bariki A Mtafya
- National Institute for Medical Research-Mbeya Medical Research Center, Mbeya, Tanzania
| | - Hadija Semvua
- Kilimanjaro Christian Medical Centre, Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Stellah Mpagama
- Kilimanjaro Christian Medical Centre, Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Charles Mtabho
- Kilimanjaro Christian Medical Centre, Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, Klinikum of the University of Munich (LMU), Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Kathrin Held
- Division of Infectious Diseases and Tropical Medicine, Klinikum of the University of Munich (LMU), Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Rebecca Loose
- Division of Infectious Diseases and Tropical Medicine, Klinikum of the University of Munich (LMU), Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, Klinikum of the University of Munich (LMU), Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Mkunde Chachage
- Division of Infectious Diseases and Tropical Medicine, Klinikum of the University of Munich (LMU), Munich, Germany.,National Institute for Medical Research-Mbeya Medical Research Center, Mbeya, Tanzania
| | - Ulrich von Both
- Division of Infectious Diseases and Tropical Medicine, Klinikum of the University of Munich (LMU), Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany.,Dr. von Hauner Children's Hospital, Division of Paediatric Infectious Diseases, Klinikum of the University of Munich (LMU), Munich, Germany
| | - Antelmo Haule
- National Institute for Medical Research-Mbeya Medical Research Center, Mbeya, Tanzania
| | - Anna-Maria Mekota
- Division of Infectious Diseases and Tropical Medicine, Klinikum of the University of Munich (LMU), Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Martin J Boeree
- Department of Lung Diseases, Radboud University Medical Centre Nijmegen, Nijmegen, Netherlands
| | - Stephen H Gillespie
- Infection and Global Health Research Division, University of St Andrews, St Andrews, United Kingdom
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Klinikum of the University of Munich (LMU), Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Norbert Heinrich
- Division of Infectious Diseases and Tropical Medicine, Klinikum of the University of Munich (LMU), Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, Klinikum of the University of Munich (LMU), Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
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23
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Sabi I, Rachow A, Mapamba D, Clowes P, Ntinginya NE, Sasamalo M, Kamwela L, Haraka F, Hoelscher M, Paris DH, Saathoff E, Reither K. Xpert MTB/RIF Ultra assay for the diagnosis of pulmonary tuberculosis in children: a multicentre comparative accuracy study. J Infect 2018; 77:321-327. [PMID: 30036606 DOI: 10.1016/j.jinf.2018.07.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 04/10/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVES We evaluated the diagnostic performance of the novel next-generation Xpert MTB/RIF Ultra (Xpert Ultra) in comparison to Xpert MTB/RIF (Xpert) assay for the detection of paediatric pulmonary tuberculosis in high burden settings. METHODS From May 2011 to September 2012, children with suspected pulmonary tuberculosis were enrolled at two Tanzanian sites and sputum samples were examined using sputum smear, Xpert and culture. Xpert Ultra was tested between January and June 2017 using sputum pellets, which had been stored at -80°C. The diagnostic accuracy of Ultra versus Xpert was determined using well-defined case definitions as reference standard. RESULTS In total, 215 children were included. The median age was 5.4 years, the HIV prevalence was 52% and 13% had culture-confirmed pulmonary tuberculosis. When only the first available sample of each patient was analysed, the sensitivity of Xpert Ultra was 64.3 % (95% CI: 44.1 to 81.4) while that of Xpert was 53.6% (95%CI: 33.9 to 72.5). The specificity of Xpert Ultra based on analysis of all available samples was 98.1% (95%CI: 93.4 to 99.7), that of Xpert was 100%. CONCLUSIONS Xpert Ultra was found to have a higher sensitivity, but slightly reduced specificity compared to Xpert in detecting pulmonary tuberculosis in children.
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Affiliation(s)
- Issa Sabi
- NIMR-Mbeya Medical Research Center, Mbeya, United Republic of Tanzania
| | - Andrea Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Daniel Mapamba
- NIMR-Mbeya Medical Research Center, Mbeya, United Republic of Tanzania
| | - Petra Clowes
- NIMR-Mbeya Medical Research Center, Mbeya, United Republic of Tanzania
| | | | | | - Lujeko Kamwela
- Ifakara Health Institute, Bagamoyo, United Republic of Tanzania
| | - Frederick Haraka
- Ifakara Health Institute, Bagamoyo, United Republic of Tanzania; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Daniel H Paris
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Klaus Reither
- Ifakara Health Institute, Bagamoyo, United Republic of Tanzania; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
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Froeschl G, Saathoff E, Kroidl I, Berens-Riha N, Clowes P, Maboko L, Assisya W, Mwalongo W, Gerhardt M, Ntinginya EN, Hoelscher M. Reduction of malaria prevalence after introduction of artemisinin-combination-therapy in Mbeya Region, Tanzania: results from a cohort study with 6773 participants. Malar J 2018; 17:245. [PMID: 29940968 PMCID: PMC6019526 DOI: 10.1186/s12936-018-2389-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 03/21/2018] [Accepted: 06/13/2018] [Indexed: 11/10/2022] Open
Abstract
Background A marked decline in malaria morbidity and mortality has been reported after the introduction of artemisinin-based combination therapy (ACT) in high malaria prevalence countries in Africa. Data on the impact of ACT and on the prevalence of malaria has so far been scarce for Southwest Tanzania. Methods Between 2005 and 2011, a large general population cohort in the Mbeya Region in the south-west of Tanzania has been surveyed within the EMINI-study (Evaluation and Monitoring of the Impact of New Interventions). Participants were examined once per year, including rapid diagnostic testing for malaria. ACT was introduced in the region according to national guidelines in the time period 2006/2007, replacing sulfadoxine/pyrimethamine as first-line therapy. In four study sites, 6773 individuals who participated in the first two of three consecutive survey visits in the period from 2006 to 2009 were included in this analysis. The prevalence of Plasmodium infection prior to and after the introduction of ACT was compared by logistic regression, with consideration of climatic variability, age, sex, socio-economic status and bed net use as potential confounders. Results A significant reduction over time in the prevalence of Plasmodium falciparum infection from 2.5 to 0.3% was shown across the four study sites. The decline was not explained by other factors included in the analysis, therefore, the decline over time most likely reflects the impact of introduction of ACT in the study area. Conclusions The longitudinal study showed a significant and relevant decline in the prevalence of P. falciparum infection after introduction of ACT, which could not be explained by potential confounders. The data suggests that artemisinin-based combinations are not only an effective instrument for reduction of immediate morbidity and mortality, but also for reduction of transmission rates.
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Affiliation(s)
- Guenter Froeschl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Leopoldstr. 5, 80802, Munich, Germany. .,German Center for Infection Research (DZIF), Partner Site Munich, Leopoldstr. 5, 80802, Munich, Germany.
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Leopoldstr. 5, 80802, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Leopoldstr. 5, 80802, Munich, Germany
| | - Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Leopoldstr. 5, 80802, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Leopoldstr. 5, 80802, Munich, Germany
| | - Nicole Berens-Riha
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Leopoldstr. 5, 80802, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Leopoldstr. 5, 80802, Munich, Germany
| | - Petra Clowes
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Leopoldstr. 5, 80802, Munich, Germany.,National Institute of Medical Research-Mbeya Medical Research Centre, P.O. Box 2410, Hospital Hill Road, Mbeya, Tanzania
| | - Leonard Maboko
- National Institute of Medical Research-Mbeya Medical Research Centre, P.O. Box 2410, Hospital Hill Road, Mbeya, Tanzania
| | - Weston Assisya
- National Institute of Medical Research-Mbeya Medical Research Centre, P.O. Box 2410, Hospital Hill Road, Mbeya, Tanzania
| | - Wolfram Mwalongo
- National Institute of Medical Research-Mbeya Medical Research Centre, P.O. Box 2410, Hospital Hill Road, Mbeya, Tanzania
| | - Martina Gerhardt
- National Institute of Medical Research-Mbeya Medical Research Centre, P.O. Box 2410, Hospital Hill Road, Mbeya, Tanzania
| | - Elias Nyanda Ntinginya
- National Institute of Medical Research-Mbeya Medical Research Centre, P.O. Box 2410, Hospital Hill Road, Mbeya, Tanzania
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Leopoldstr. 5, 80802, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, Leopoldstr. 5, 80802, Munich, Germany
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Rachow A, Saathoff E, Mtafya B, Mapamba D, Mangu C, Rojas-Ponce G, Ntinginya NE, Boeree M, Heinrich N, Gillespie SH, Hoelscher M. The impact of repeated NALC/NaOH- decontamination on the performance of Xpert MTB/RIF assay. Tuberculosis (Edinb) 2018; 110:56-58. [PMID: 29779774 DOI: 10.1016/j.tube.2018.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 03/27/2018] [Accepted: 04/03/2018] [Indexed: 11/30/2022]
Abstract
The Xpert MTB/RIF assay detects Mycobacterium tuberculosis in unprocessed or NALC/NaOH- decontaminated sputum. The effect of repeated NALC/NaOH-decontamination on several Xpert performance parameters was assessed in this study. A second NALC/NaOH-decontamination had no effect on the binary Xpert-outcome but increased the value for the quantitative readout (CTmin). Repeated decontamination was not associated with PCR-inhibition or invalid results. The CTmin of M.tb positive samples was higher in inhibited Xpert runs. Our data indicate that NALC/NaOH-decontamination has an effect on the performance of the Xpert assay, and that CTmin readouts of decontaminated sputum samples should be interpreted with caution.
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Affiliation(s)
- Andrea Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Germany.
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Germany
| | - Bariki Mtafya
- National Institute of Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Daniel Mapamba
- National Institute of Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Chacha Mangu
- National Institute of Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Gabriel Rojas-Ponce
- National Institute of Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Nyanda E Ntinginya
- National Institute of Medical Research - Mbeya Medical Research Centre (NIMR-MMRC), Mbeya, Tanzania
| | - Martin Boeree
- Radboud UMC /UCCZ Dekkerswald, Nijmegen, The Netherlands
| | - Norbert Heinrich
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
| | - Stephen H Gillespie
- University of St Andrews School of Medicine, North Haugh, St Andrews, Scotland, UK.
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany; German Centre for Infection Research (DZIF), Partner Site Munich, Germany
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Manz KM, Clowes P, Kroidl I, Kowuor DO, Geldmacher C, Ntinginya NE, Maboko L, Hoelscher M, Saathoff E. Trichuris trichiura infection and its relation to environmental factors in Mbeya region, Tanzania: A cross-sectional, population-based study. PLoS One 2017; 12:e0175137. [PMID: 28384306 PMCID: PMC5383155 DOI: 10.1371/journal.pone.0175137] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 12/11/2016] [Accepted: 03/21/2017] [Indexed: 01/19/2023] Open
Abstract
Background The intestinal nematode Trichuris trichiura is among the most common causes of human infectious disease worldwide. As for other soil-transmitted nematodes, its reproductive success and thus prevalence and intensity of infection in a given area strongly depend on environmental conditions. Characterization of the influence of environmental factors can therefore aid to identify infection hot spots for targeted mass treatment. Methodology We analyzed data from a cross-sectional survey including 6234 participants from nine distinct study sites in Mbeya region, Tanzania. A geographic information system was used to combine remotely sensed and individual data, which were analyzed using uni- and multivariable Poisson regression. Household clustering was accounted for and when necessary, fractional polynomials were used to capture non-linear relationships between T. trichiura infection prevalence and environmental variables. Principal findings T. trichiura infection was restricted to the Kyela site, close to Lake Nyasa with only very few cases in the other eight sites. The prevalence of T. trichiura infection in Kyela was 26.6% (95% confidence interval (CI) 23.9 to 29.6%). Multivariable models revealed a positive association of infection with denser vegetation (prevalence ratio (PR) per 0.1 EVI units = 2.12, CI 1.28 to 3.50) and inverse associations with rainfall (PR per 100 mm = 0.54, CI 0.44 to 0.67) and elevation (PR per meter = 0.89, CI 0.86 to 0.93) while adjusting for age and previous worm treatment. Slope of the terrain was modelled non-linearly and also showed a positive association with T. trichiura infection (p-value p<0.001). Conclusion/Significance Higher prevalences of T. trichiura infection were only found in Kyela, a study site characterized by denser vegetation, high rainfall, low elevation and flat terrain. But even within this site, we found significant influences of vegetation density, rainfall, elevation and slope on T. trichiura infection. The inverse association of rainfall with infection in Kyela is likely due to the fact, that rainfall in this site is beyond the optimum conditions for egg development. Our findings demonstrate that use of remotely sensed environmental data can aid to predict high-risk areas for targeted helminth control.
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Affiliation(s)
- Kirsi M. Manz
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- * E-mail:
| | - Petra Clowes
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- NIMR-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- NIMR-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | | | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | | | - Leonard Maboko
- NIMR-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- NIMR-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
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Kroidl I, Saathoff E, Maganga L, Makunde WH, Hoerauf A, Geldmacher C, Clowes P, Maboko L, Hoelscher M. Effect of Wuchereria bancrofti infection on HIV incidence in southwest Tanzania: a prospective cohort study. Lancet 2016; 388:1912-1920. [PMID: 27495354 DOI: 10.1016/s0140-6736(16)31252-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/08/2016] [Accepted: 07/13/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND The past decades have seen an ongoing controversial debate about whether the immune activation induced by helminths has an effect on the susceptibility of individuals to HIV. In view of this, we assessed the effect of lymphatic filariasis, a chronic helminth disease elicited by Wuchereria bancrofti, on HIV incidence in southwest Tanzania. METHODS In this population-based cohort study, we enrolled a geographically stratified randomly chosen sample of about 10% of the households in nine distinct sites in southwest Tanzania. All household members present were followed up and tested for HIV and circulating filarial antigen, an indicator of W bancrofti adult worm burden. Our main outcome of interest was HIV incidence in participants with or without lymphatic filariasis. FINDINGS Between May 29, 2006, and June 16, 2011, we enrolled 4283 households with roughly 18 000 participants. Of these, 2699 individuals from Kyela district participated in at least one round of the EMINI study. In the 1055 initially HIV-negative adolescents and adults with clearly defined lymphatic filariasis status, 32 new HIV infections were observed in 2626 person-years. HIV incidence in lymphatic filariasis-positive participants (1·91 cases per 100 person-years) was significantly higher than the incidence in lymphatic filariasis-negative participants (0·80 cases per 100 person-years). The age-adjusted and sex-adjusted incidence rate ratio was 2·17 (95% CI 1·08-4·37, p=0·0300). Lymphatic filariasis status remained an independent and significantly relevant risk factor for HIV infection when controlled for other known risk factors such as sexual behaviour and socioeconomic factors. INTERPRETATION To our knowledge, this is the first prospective study demonstrating a significantly increased risk of acquiring HIV for lymphatic filariasis-infected individuals. Immunological studies and interventional treatment studies that eliminate the adult worms and not only the microfilariae are needed to follow up on the results presented. FUNDING European Union as part of EuropAid; German Federal Ministry of Education and Research; German Center for Infection Research.
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Affiliation(s)
- Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany; National Institute of Medical Research, Mbeya Medical Research Centre, Mbeya, Tanzania; German Center for Infection Research (DZIF), partner site Munich, Munich, Germany.
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany; German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Lucas Maganga
- National Institute of Medical Research, Mbeya Medical Research Centre, Mbeya, Tanzania
| | | | - Achim Hoerauf
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital of Bonn, Bonn, Germany; German Center for Infection Research (DZIF), partner site Bonn-Cologne, Bonn-Cologne, Germany
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany; German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Petra Clowes
- National Institute of Medical Research, Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Leonard Maboko
- National Institute of Medical Research, Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany; National Institute of Medical Research, Mbeya Medical Research Centre, Mbeya, Tanzania; German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
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Kroidl I, Saathoff E, Maganga L, Clowes P, Maboko L, Hoerauf A, Makunde WH, Haule A, Mviombo P, Pitter B, Mgeni N, Mabuye J, Kowuor D, Mwingira U, Malecela MN, Löscher T, Hoelscher M. Correction: Prevalence of Lymphatic Filariasis and Treatment Effectiveness of Albendazole/ Ivermectin in Individuals with HIV Co-infection in Southwest-Tanzania. PLoS Negl Trop Dis 2016; 10:e0004967. [PMID: 27564060 PMCID: PMC5001645 DOI: 10.1371/journal.pntd.0004967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Nicoli F, Chachage M, Clowes P, Bauer A, Kowour D, Ensoli B, Cafaro A, Maboko L, Hoelscher M, Gavioli R, Saathoff E, Geldmacher C. Association between different anti-Tat antibody isotypes and HIV disease progression: data from an African cohort. BMC Infect Dis 2016; 16:344. [PMID: 27450538 PMCID: PMC4957276 DOI: 10.1186/s12879-016-1647-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 06/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The presence of IgG and IgM against Tat, an HIV protein important for viral replication and immune dysfunction, is associated with slow disease progression in clade B HIV-infected individuals. However, although Tat activities strictly depend on the viral clade, our knowledge about the importance of anti-Tat antibodies in non-clade B HIV infection is poor. The objective of this study was to investigate the association of different anti-Tat antibody isotypes with disease progression in non-clade B HIV-infected subjects and to study the relationship between anti-Tat humoral responses and immunological abnormalities. METHODS Anti-clade B and -clade C Tat IgG, IgM and IgA titers were assessed in serum samples from 96 cART-naïve subjects with chronic HIV infection from Mbeya, Tanzania, and associated with CD4(+) T cell count, plasma viremia and CD4(+) and CD8(+) T cell phenotypes. RESULTS Anti-Tat IgM were preferentially detected in chronic HIV-infected subjects with low T cell activation (p-value = 0.03) and correlated with higher CD4(+) T cell counts and lower viral loads irrespective of the duration of infection (p-value = 0.019 and p-value = 0.037 respectively). Conversely, anti-Tat IgA were preferentially detected in individuals with low CD4(+) T cell counts and high viral load (p-value = 0.02 and p-value < 0.001 respectively). The simultaneous presence of anti-Tat IgG and IgM protected from fast CD4(+) T cell decline (p-value < 0.01) and accumulation of CD38(+)HLADR(+)CD8(+) T cells (p- value = 0.029). CONCLUSIONS Anti-Tat IgG alone are not protective in non-clade B infected subjects, unless concomitant with IgM, suggesting a protective role of persistent anti-Tat IgM irrespective of the infecting clade.
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Affiliation(s)
- Francesco Nicoli
- Center for International Health, Ludwig-Maximilians-Universität München, Leopoldstraße 7, 80802, Munich, Germany. .,Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy. .,Current address: CIMI INSERM U1135, 91 bd del'Hopital, 75013, Paris, France.
| | - Mkunde Chachage
- Center for International Health, Ludwig-Maximilians-Universität München, Leopoldstraße 7, 80802, Munich, Germany.,National Institute for Medical Research (NIMR)-Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Petra Clowes
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Centre, Mbeya, Tanzania.,Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Asli Bauer
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Centre, Mbeya, Tanzania.,Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Dickens Kowour
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Barbara Ensoli
- National AIDS Center, Istituto Superiore di Sanità, Rome, Italy
| | - Aurelio Cafaro
- National AIDS Center, Istituto Superiore di Sanità, Rome, Italy
| | - Leonard Maboko
- National Institute for Medical Research (NIMR)-Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany.,German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Riccardo Gavioli
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany.,German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany.,German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
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Kroidl I, Clowes P, Reither K, Mtafya B, Rojas-Ponce G, Ntinginya EN, Kalomo M, Minja LT, Kowuor D, Saathoff E, Kroidl A, Heinrich N, Maboko L, Bates M, O'Grady J, Zumla A, Hoelscher M, Rachow A. Performance of urine lipoarabinomannan assays for paediatric tuberculosis in Tanzania. Eur Respir J 2015; 46:761-70. [PMID: 26113682 DOI: 10.1183/09031936.00003315] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/09/2015] [Indexed: 12/15/2022]
Abstract
We evaluated the diagnostic performance of two tests based on the release of lipoarabinomannan (LAM) into the urine, the MTB-LAM-ELISA assay and the Determine TB-LAM-strip assay, in children with suspected tuberculosis (TB) in a high TB/HIV-prevalence setting.In a prospective study, 132 children with suspected active TB were assigned to diagnostic subgroups. Urine samples were subjected to testing by both assays to ascertain sensitivity and specificity. Host factors associated with positive LAM results were investigated and LAM excretion monitored after antituberculous treatment initiation.18 (13.6%) children had culture-confirmed pulmonary TB. The assays' sensitivity was higher in HIV-positive versus HIV-negative children: 70% (95% confidence interval 35-93%) versus 13% (0-53%) for MTB-LAM-ELISA and 50% (19-81%) versus 0% (0-37%) for Determine TB-LAM. In 35 (27%) children with excluded active TB, both assays showed a specificity of 97.1% (85-100%). Proteinuria and low body mass index were independently associated with LAM positivity. In most patients, LAM excretion declined to zero during or at conclusion of antituberculous treatment.HIV/TB co-infected children might benefit from LAM-based tests to aid early TB diagnosis and subsequent positive impact on morbidity and mortality. Using LAM as a rule-in and treatment-monitoring tool may also show further potential.
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Affiliation(s)
- Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Germany National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania Both authors contributed equally
| | - Petra Clowes
- National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania Both authors contributed equally
| | - Klaus Reither
- Medical Services and Diagnostic, Swiss Tropical and Public Health Institute, Basel, Switzerland Medical Services and Diagnostic (Swiss TPH), University of Basel, Basel, Switzerland
| | - Bariki Mtafya
- National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Gabriel Rojas-Ponce
- National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Elias N Ntinginya
- National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Mariam Kalomo
- Dept for Paediatrics and Child Health, Mbeya Referral Hospital, Mbeya, Tanzania
| | - Lilian T Minja
- National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania Medical Services and Diagnostic, Swiss Tropical and Public Health Institute, Basel, Switzerland Medical Services and Diagnostic (Swiss TPH), University of Basel, Basel, Switzerland Ifakara Health Institute, Bagamoyo, Tanzania
| | - Dickens Kowuor
- National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Germany German Centre for Infection Research (DZIF), partner site Munich, Germany
| | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Germany German Centre for Infection Research (DZIF), partner site Munich, Germany National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Norbert Heinrich
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Germany German Centre for Infection Research (DZIF), partner site Munich, Germany
| | - Leonard Maboko
- National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Matthew Bates
- University of Zambia-University College London Medical School Research and Training Project, University Teaching Hospital, Lusaka, Zambia Division of Infection and Immunity, University College London, London, UK NIHR Biomedical Research Centre, University College London Hospitals, London, UK
| | - Justin O'Grady
- University of Zambia-University College London Medical School Research and Training Project, University Teaching Hospital, Lusaka, Zambia Division of Infection and Immunity, University College London, London, UK NIHR Biomedical Research Centre, University College London Hospitals, London, UK
| | - Alimuddin Zumla
- University of Zambia-University College London Medical School Research and Training Project, University Teaching Hospital, Lusaka, Zambia Division of Infection and Immunity, University College London, London, UK NIHR Biomedical Research Centre, University College London Hospitals, London, UK
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Germany German Centre for Infection Research (DZIF), partner site Munich, Germany National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Andrea Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Germany German Centre for Infection Research (DZIF), partner site Munich, Germany National Institute for Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania
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Portevin D, Moukambi F, Mpina M, Bauer A, Haraka F, Chachage M, Metzger P, Saathoff E, Clowes P, Ntinginya NE, Rachow A, Hoelscher M, Reither K, Daubenberger CA, Geldmacher C. Maturation and Mip-1β Production of Cytomegalovirus-Specific T Cell Responses in Tanzanian Children, Adolescents and Adults: Impact by HIV and Mycobacterium tuberculosis Co-Infections. PLoS One 2015; 10:e0126716. [PMID: 25974183 PMCID: PMC4431818 DOI: 10.1371/journal.pone.0126716] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 04/07/2015] [Indexed: 12/18/2022] Open
Abstract
It is well accepted that aging and HIV infection are associated with quantitative and functional changes of CMV-specific T cell responses. We studied here the expression of Mip-1β and the T cell maturation marker CD27 within CMVpp65-specific CD4(+) and CD8(+) T cells in relation to age, HIV and active Tuberculosis (TB) co-infection in a cohort of Tanzanian volunteers (≤ 16 years of age, n = 108 and ≥ 18 years, n = 79). Independent of HIV co-infection, IFNγ(+) CMVpp65-specific CD4(+) T cell frequencies increased with age. In adults, HIV co-infection further increased the frequencies of these cells. A high capacity for Mip-1β production together with a CD27(low) phenotype was characteristic for these cells in children and adults. Interestingly, in addition to HIV co-infection active TB disease was linked to further down regulation of CD27 and increased capacity of Mip-1β production in CMVpp65-specific CD4+ T cells. These phenotypic and functional changes of CMVpp65-specific CD4 T cells observed during HIV infection and active TB could be associated with increased CMV reactivation rates.
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Affiliation(s)
- Damien Portevin
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Félicien Moukambi
- NIMR-Mbeya Medical Research Centre, Mbeya, Tanzania
- Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | | | - Asli Bauer
- NIMR-Mbeya Medical Research Centre, Mbeya, Tanzania
- Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | | | | | - Philipp Metzger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Elmar Saathoff
- Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
- German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Petra Clowes
- NIMR-Mbeya Medical Research Centre, Mbeya, Tanzania
- Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
| | | | - Andrea Rachow
- Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
- German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Michael Hoelscher
- Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
- German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Klaus Reither
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Ifakara Health Institute, Bagamoyo, Tanzania
| | - Claudia A. Daubenberger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Christof Geldmacher
- Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich, Munich, Germany
- German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
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Kyeyune R, Saathoff E, Ezeamama A, Fawzi W, Loescher T, Guwatudde D. Hematological Profiles of HIV-infected Adults Initiating Highly Active Antiretroviral Therapy (HAART) in Uganda. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5468.abstract] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rachel Kyeyune
- Infectious Diseases Institute, Research, Kampala, Uganda
| | - Elmar Saathoff
- Medical Center of the University of Munich, Division of Infectious Diseases and Tropical Medicine, Munich, Germany
| | - Amara Ezeamama
- University of Georgia, Epidemiology and Biostatistics, Athens, GA, United States
| | - Wafaie Fawzi
- Harvard School of Public Health, Nutrition, Boston, MA, United States
| | - Thomas Loescher
- Medical Center of the University of Munich, Division of Infectious Diseases and Tropical Medicine, Munich, Germany
| | - David Guwatudde
- Makerere University College of Health Sciences, School of Public Health, Epidemiology and Biostatistics, Kampala, Uganda
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Kyeyune R, Saathoff E, Ezeamama AE, Löscher T, Fawzi W, Guwatudde D. Prevalence and correlates of cytopenias in HIV-infected adults initiating highly active antiretroviral therapy in Uganda. BMC Infect Dis 2014; 14:496. [PMID: 25209550 PMCID: PMC4165997 DOI: 10.1186/1471-2334-14-496] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 09/03/2014] [Indexed: 11/12/2022] Open
Abstract
Background Cytopenias are the most common HIV-associated hematological abnormality. Cytopenias have been associated with several factors including sex, race/ethnicity, geographical location and comorbidities such as tuberculosis, hepatitis B infection, fever and oral candidiasis. Cytopenias become more prevalent as HIV progresses and are often fatal. Data from resource-limited settings about the prevalence and correlates of cytopenia are limited. Therefore we conducted this cross-sectional study to assess the prevalence and correlates of cytopenia among adult AIDS patients at initiation of HAART in Uganda. Methods 400 HIV-infected subjects who were HAART-naïve or on HAART for ≤ 6 months were enrolled into the Multivitamins, HAART and HIV/AIDS Trial. Anemia was defined according to WHO guidelines as any hemoglobin concentration < 12 g/dl for non-pregnant females and < 13 g/dl for males. Leucopenia and thrombocytopenia were defined using study site laboratory reference ranges for lack of generally accepted definitions for these 2 cell lines as leucopenia if white blood cell count < 2.75 × 109 cells/litre and thrombocytopenia if platelets < 125 × 109 cells/litre for females and < 156 × 109 cells/litre for males. Univariate and bivariate analyses were done to describe the patient population and log-binomial regression was used to quantify the correlates of cytopenia. Results Sixty five percent of the 400 subjects had at least one form of cytopenia. Anemia occurred in 47.8%, leucopenia in 24.3%, thrombocytopenia in 8.3%, bicytopenia in 21.9% and only 2 had a pancytopenia. Cytopenia was more prevalent in females (prevalence ratio [PR]:1.33, 95% confidence interval [CI]:1.12-1.59); CD4 count category 50 to <200 (PR: 0.75, 95% CI: 0.64 -0.88) and CD4 count category 200 to <350 (PR: 0.74, 95% CI: 0.59 - 0.92) compared to CD4 count category <50; normal BMI (PR: 0.82, 95% CI:0.68-1.00) and overweight BMI (PR: 0.64, 95% CI:0.50- 0.82) compared to underweight BMI and those with a history or presence of oral candidiasis. Conclusions Cytopenias are a frequent complication in HIV-infected adults at initiation of HAART in Uganda. The presence of any cytopenia was associated with female sex, decreasing CD4 count and decreasing body mass index. Prospective studies in resource-limited settings on the trend in HIV-related cytopenias are needed.
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Affiliation(s)
- Rachel Kyeyune
- Infectious Diseases Institute, Makerere College of Health Sciences, P,O Box 22418, Kampala, Uganda.
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Portevin D, Moukambi F, Clowes P, Bauer A, Chachage M, Ntinginya NE, Mfinanga E, Said K, Haraka F, Rachow A, Saathoff E, Mpina M, Jugheli L, Lwilla F, Marais BJ, Hoelscher M, Daubenberger C, Reither K, Geldmacher C. Assessment of the novel T-cell activation marker-tuberculosis assay for diagnosis of active tuberculosis in children: a prospective proof-of-concept study. Lancet Infect Dis 2014; 14:931-8. [PMID: 25185458 DOI: 10.1016/s1473-3099(14)70884-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The diagnosis of paediatric tuberculosis is complicated by non-specific symptoms, difficult specimen collection, and the paucibacillary nature of the disease. We assessed the accuracy of a novel immunodiagnostic T-cell activation marker-tuberculosis (TAM-TB) assay in a proof-of-concept study to identify children with active tuberculosis. METHODS Children with symptoms that suggested tuberculosis were prospectively recruited at the NIMR-Mbeya Medical Research Center in Mbeya, and the Ifakara Health Institute in Bagamoyo, Tanzania, between May 10, 2011, and Sept 4, 2012. Sputum and peripheral blood mononuclear cells were obtained for Mycobacterium tuberculosis culture and performance assessment of the TAM-TB assay. The children were assigned to standardised clinical case classifications based on microbiological and clinical findings. FINDINGS Among 290 children screened, we selected a subgroup of 130 to ensure testing of at least 20 with culture-confirmed tuberculosis. 17 of 130 children were excluded because of inconclusive TAM-TB assay results. The TAM-TB assay enabled detection of 15 of 18 culture-confirmed cases (sensitivity 83·3%, 95% CI 58·6-96·4). Specificity was 96·8% (95% CI 89·0-99·6) in the cases that were classified as not tuberculosis (n=63), with little effect from latent tuberculosis infection. The TAM-TB assay identified five additional patients with highly probable or probable tuberculosis, in whom M tuberculosis was not isolated. The median time to diagnosis was 19·5 days (IQR 14-45) for culture. INTERPRETATION The sputum-independent TAM-TB assay is a rapid and accurate blood test that has the potential to improve the diagnosis of active tuberculosis in children. FUNDING European and Developing Countries Clinical Trials Partnership, German Federal Ministry of Education and Research, and Swiss National Science Foundation.
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Affiliation(s)
- Damien Portevin
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Felicien Moukambi
- NIMR-Mbeya Medical Research Center, Mbeya, Tanzania; Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Germany
| | - Petra Clowes
- NIMR-Mbeya Medical Research Center, Mbeya, Tanzania; Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Germany
| | - Asli Bauer
- NIMR-Mbeya Medical Research Center, Mbeya, Tanzania; Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Germany
| | | | | | | | | | | | - Andrea Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Germany; German Centre for Infection Research, Partner Site Munich, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Germany; German Centre for Infection Research, Partner Site Munich, Germany
| | | | - Levan Jugheli
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Ifakara Health Institute, Bagamoyo, Tanzania
| | - Fred Lwilla
- Ifakara Health Institute, Bagamoyo, Tanzania
| | - Ben J Marais
- Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Germany; German Centre for Infection Research, Partner Site Munich, Germany
| | - Claudia Daubenberger
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Klaus Reither
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Ifakara Health Institute, Bagamoyo, Tanzania.
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Germany; German Centre for Infection Research, Partner Site Munich, Germany.
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Weller N, Clowes P, Dobler G, Saathoff E, Kroidl I, Ntinginya NE, Maboko L, Löscher T, Hoelscher M, Heinrich N. Seroprevalence of alphavirus antibodies in a cross-sectional study in southwestern Tanzania suggests endemic circulation of chikungunya. PLoS Negl Trop Dis 2014; 8:e2979. [PMID: 25079964 PMCID: PMC4117434 DOI: 10.1371/journal.pntd.0002979] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 05/13/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND To date, Alphavirus infections and their most prominent member, chikungunya fever, a viral disease which first became apparent in Tanzania in 1953, have been very little investigated in regions without epidemic occurrence. Few data exist on burden of disease and socio-economic and environmental covariates disposing to infection. METHODS A cross-sectional seroprevalence study was undertaken in 1,215 persons from Mbeya region, South-Western Tanzania, to determine the seroprevalence of anti-Alphavirus IgG antibodies, and to investigate associated risk factors. RESULTS 18% of 1,215 samples were positive for Alphavirus IgG. Seropositivity was associated with participant age, low to intermediate elevation, flat terrain and with IgG positivity for Rift Valley fever, Flaviviridae, and rickettsiae of the spotted fever group. When comparing the geographical distribution of Alphavirus seropositivity to that of Rift Valley fever, it was obvious that Alphaviruses had spread more widely throughout the study area, while Rift Valley fever was concentrated along the shore of Lake Malawi. CONCLUSION Alphavirus infections may contribute significantly to the febrile disease burden in the study area, and are associated with several arthropod-borne infections. Their spread seems only limited by factors affecting mosquitoes, and seems less restricted than that of Rift Valley fever.
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Affiliation(s)
- Nina Weller
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
| | - Petra Clowes
- National Institute for Medical Research -Mbeya Medical Research Center, Mbeya, Tanzania
| | - Gerhard Dobler
- Bundeswehr Institute of Microbiology, Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- National Institute for Medical Research -Mbeya Medical Research Center, Mbeya, Tanzania
| | | | - Leonard Maboko
- National Institute for Medical Research -Mbeya Medical Research Center, Mbeya, Tanzania
| | - Thomas Löscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- National Institute for Medical Research -Mbeya Medical Research Center, Mbeya, Tanzania
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Norbert Heinrich
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
- * E-mail:
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Schüle SA, Clowes P, Kroidl I, Kowuor DO, Nsojo A, Mangu C, Riess H, Geldmacher C, Laubender RP, Mhina S, Maboko L, Löscher T, Hoelscher M, Saathoff E. Ascaris lumbricoides infection and its relation to environmental factors in the Mbeya region of Tanzania, a cross-sectional, population-based study. PLoS One 2014; 9:e92032. [PMID: 24643023 PMCID: PMC3958400 DOI: 10.1371/journal.pone.0092032] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 02/17/2014] [Indexed: 11/29/2022] Open
Abstract
Background With one quarter of the world population infected, the intestinal nematode Ascaris lumbricoides is one of the most common infectious agents, especially in the tropics and sub-tropics. Infection is caused by oral intake of eggs and can cause respiratory and gastrointestinal problems. To identify high risk areas for intervention, it is necessary to understand the effects of climatic, environmental and socio-demographic conditions on A. lumbricoides infection. Methodology Cross-sectional survey data of 6,366 study participants in the Mbeya region of South-Western Tanzania were used to analyze associations between remotely sensed environmental data and A. lumbricoides infection. Non-linear associations were accounted for by using fractional polynomial regression, and socio-demographic and sanitary data were included as potential confounders. Principal Findings The overall prevalence of A. lumbricoides infection was 6.8%. Our final multivariable model revealed a significant non-linear association between rainfall and A. lumbricoides infection with peak prevalences at 1740 mm of mean annual rainfall. Mean annual land surface temperature during the day was linearly modeled and negatively associated with A. lumbricoides infection (odds ratio (OR) = 0.87, 95% confidence interval (CI) = 0.78–0.97). Furthermore, age, which also showed a significant non-linear association (infection maximum at 7.7 years), socio-economic status (OR = 0.82, CI = 0.68–0.97), and latrine coverage around the house (OR = 0.80, CI = 0.67–0.96) remained in the final model. Conclusions A. lumbricoides infection was associated with environmental, socio-demographic and sanitary factors both in uni- and multivariable analysis. Non-linear analysis with fractional polynomials can improve model fit, resulting in a better understanding of the relationship between environmental conditions and helminth infection, and more precise predictions of high prevalence areas. However, socio-demographic determinants and sanitary conditions should also be considered, especially when planning public health interventions on a smaller scale, such as the community level.
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Affiliation(s)
- Steffen Andreas Schüle
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- Institute for Medical Bioinformatics, Biometry, and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
- Department of Social Epidemiology, Institute for Public Health and Nursing Research, University of Bremen, Bremen, Germany
- * E-mail:
| | - Petra Clowes
- NIMR-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- NIMR-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | | | - Anthony Nsojo
- NIMR-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Chacha Mangu
- NIMR-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Helene Riess
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- Institute for Medical Bioinformatics, Biometry, and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Rüdiger Paul Laubender
- Institute for Medical Bioinformatics, Biometry, and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Seif Mhina
- Mbeya Regional Medical Office, Mbeya, Tanzania
| | - Leonard Maboko
- NIMR-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Thomas Löscher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- NIMR-Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
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Kroidl I, Clowes P, Mwakyelu J, Maboko L, Kiangi A, Rachow A, Reither K, Jung J, Nsojo A, Saathoff E, Hoelscher M. Reasons for false-positive lipoarabinomannan ELISA results in a Tanzanian population. ACTA ACUST UNITED AC 2013; 46:144-8. [DOI: 10.3109/00365548.2013.853133] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Riess H, Clowes P, Kroidl I, Kowuor DO, Nsojo A, Mangu C, Schüle SA, Mansmann U, Geldmacher C, Mhina S, Maboko L, Hoelscher M, Saathoff E. Hookworm infection and environmental factors in mbeya region, Tanzania: a cross-sectional, population-based study. PLoS Negl Trop Dis 2013; 7:e2408. [PMID: 24040430 PMCID: PMC3764225 DOI: 10.1371/journal.pntd.0002408] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 07/24/2013] [Indexed: 12/21/2022] Open
Abstract
Background Hookworm disease is one of the most common infections and cause of a high disease burden in the tropics and subtropics. Remotely sensed ecological data and model-based geostatistics have been used recently to identify areas in need for hookworm control. Methodology Cross-sectional interview data and stool samples from 6,375 participants from nine different sites in Mbeya region, south-western Tanzania, were collected as part of a cohort study. Hookworm infection was assessed by microscopy of duplicate Kato-Katz thick smears from one stool sample from each participant. A geographic information system was used to obtain remotely sensed environmental data such as land surface temperature (LST), vegetation cover, rainfall, and elevation, and combine them with hookworm infection data and with socio-demographic and behavioral data. Uni- and multivariable logistic regression was performed on sites separately and on the pooled dataset. Principal Findings Univariable analyses yielded significant associations for all ecological variables. Five ecological variables stayed significant in the final multivariable model: population density (odds ratio (OR) = 0.68; 95% confidence interval (CI) = 0.63–0.73), mean annual vegetation density (OR = 0.11; 95% CI = 0.06–0.18), mean annual LST during the day (OR = 0.81; 95% CI = 0.75–0.88), mean annual LST during the night (OR = 1.54; 95% CI = 1.44–1.64), and latrine coverage in household surroundings (OR = 1.02; 95% CI = 1.01–1.04). Interaction terms revealed substantial differences in associations of hookworm infection with population density, mean annual enhanced vegetation index, and latrine coverage between the two sites with the highest prevalence of infection. Conclusion/Significance This study supports previous findings that remotely sensed data such as vegetation indices, LST, and elevation are strongly associated with hookworm prevalence. However, the results indicate that the influence of environmental conditions can differ substantially within a relatively small geographic area. The use of large-scale associations as a predictive tool on smaller scales is therefore problematic and should be handled with care. Hookworm disease, caused by the nematodes Ancylostoma duodenale and Necator americanus, is an important cause of maternal and child morbidity in the developing countries of the tropics and subtropics. In children, hookworm disease has been shown to potentially result in growth retardation as well as intellectual and cognitive impairments. In a cross-sectional survey in Mbeya region, Tanzania, we assessed the effects of possible risk factors for hookworm infection with a focus on remotely sensed ecological factors such as elevation, vegetation density, land surface temperature, and rainfall. We found that several ecological variables were significantly associated with hookworm infection. However, differing effects for these factors were estimated when performing the analyses separately for the two sites with the highest hookworm prevalence. Our study shows that effects are scale-dependent and that prediction at smaller scales using large-scale data and vice versa should be handled with caution, because regional variation can substantially influence the presence of hookworm infection.
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Affiliation(s)
- Helene Riess
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
- Institute for Medical Bioinformatics, Biometry, and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Petra Clowes
- NIMR-Mbeya Medical Research Center, Mbeya, Tanzania
| | - Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
- NIMR-Mbeya Medical Research Center, Mbeya, Tanzania
| | | | | | - Chacha Mangu
- NIMR-Mbeya Medical Research Center, Mbeya, Tanzania
| | - Steffen A. Schüle
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
- Institute for Medical Bioinformatics, Biometry, and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Ulrich Mansmann
- Institute for Medical Bioinformatics, Biometry, and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Christof Geldmacher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Seif Mhina
- Mbeya Regional Medical Office, Mbeya, Tanzania
| | | | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
- NIMR-Mbeya Medical Research Center, Mbeya, Tanzania
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
- German Centre for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- * E-mail:
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Koehler RN, Alter G, Tovanabutra S, Saathoff E, Arroyo MA, Walsh AM, Sanders-Buell EE, Maboko L, Hoelscher M, Robb ML, Michael NL, McCutchan FE, Kim JH, Kijak GH. Natural killer cell-mediated innate sieve effect on HIV-1: the impact of KIR/HLA polymorphism on HIV-1 subtype-specific acquisition in east Africa. J Infect Dis 2013; 208:1250-4. [PMID: 23922366 DOI: 10.1093/infdis/jit349] [Citation(s) in RCA: 11] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Here we explore the association between killer cell immunoglobulin-like receptor (KIR)/HLA and human immunodeficiency virus type 1 (HIV-1) acquisition with different viral subtypes circulating in East Africa. In the prospective Cohort Development (CODE) cohort (Mbeya, Tanzania), carriers of KIR3DS1 and its putative ligand (HLA-A or HLA-B Bw4-80Ile alleles) showed increased HIV-1 acquisition risk (odds ratio [OR] = 3.46; 95% confidence interval [CI], 1.12-10.63; P = .04) and a trend for enrichment for subtype A and A-containing recombinants (78% vs. 46%; OR = 4.05; 95% CI, .91-28.30; P = .09) at the expense of subtype C (11% vs. 43%; OR = 0.17; 95% CI, .01-.97; P = .08). In vitro, only natural killer cells from KIR3DS1(+)/HLA-Bw4-80Ile(+) healthy donors showed a 2-fold increased capacity to inhibit replication of subtype C vs subtype A viruses (P = .01). These findings suggest the presence of an innate sieve effect and may inform HIV-1 vaccine development.
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Dill T, Dobler G, Saathoff E, Clowes P, Kroidl I, Ntinginya E, Machibya H, Maboko L, Löscher T, Hoelscher M, Heinrich N. High seroprevalence for typhus group rickettsiae, southwestern Tanzania. Emerg Infect Dis 2013; 19:317-20. [PMID: 23347529 PMCID: PMC3559041 DOI: 10.3201/eid1902.120601] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Rickettsioses caused by typhus group rickettsiae have been reported in various African regions. We conducted a cross-sectional survey of 1,227 participants from 9 different sites in the Mbeya region, Tanzania; overall seroprevalence of typhus group rickettsiae was 9.3%. Risk factors identified in multivariable analysis included low vegetation density and highway proximity.
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Affiliation(s)
- Tatjana Dill
- Medical Centre of the University of Munich, Munich, Germany
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Friedrich SO, Rachow A, Saathoff E, Singh K, Mangu CD, Dawson R, Phillips PP, Venter A, Bateson A, Boehme CC, Heinrich N, Hunt RD, Boeree MJ, Zumla A, McHugh TD, Gillespie SH, Diacon AH, Hoelscher M. Assessment of the sensitivity and specificity of Xpert MTB/RIF assay as an early sputum biomarker of response to tuberculosis treatment. Lancet Respir Med 2013; 1:462-70. [PMID: 24429244 DOI: 10.1016/s2213-2600(13)70119-x] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND An accurate biomarker is urgently needed to monitor the response to treatment in patients with pulmonary tuberculosis. The Xpert MTB/RIF assay is a commercially available real-time PCR that can be used to detect Mycobacterium-tuberculosis-specific DNA sequences in sputum samples. We therefore evaluated this assay with serial sputum samples obtained over 26 weeks from patients undergoing treatment for tuberculosis. METHODS We analysed sputum samples from 221 patients with smear-positive tuberculosis enrolled at two sites (Cape Town, South Africa, and Mbeya, Tanzania) of a multicentre randomised clinical trial REMoxTB of antituberculosis treatment on a weekly basis (weeks 0 to 8), then at weeks 12, 17, 22, and 26 after treatment initiation. The Xpert MTB/RIF results over time were compared with the results of standard smear microscopy and culture methods. FINDINGS We obtained and analysed 2741 sputum samples from 221 patients. The reduction in positivity rates with Xpert MTB/RIF were slower than those with the standard methods. At week 8, positive results were obtained for 62 (29%) of 212 sputum samples with smear microscopy, 46 (26%) of 175 with solid culture (Löwenstein-Jensen medium), 77 (42%) of 183 with liquid culture (Bactec MGIT960 system), and 174 (84%) of 207 with Xpert MTB/RIF; at 26 weeks, positive results were obtained for ten (5%) of 199, four (3%) of 157, seven (4%) of 169, and 22 (27%) of 83 sputum samples, respectively. The reduction in detection of quantitative M tuberculosis DNA with Xpert MTB/RIF correlated with smear grades (ρ=-0·74; p<0·0001), solid culture grades (ρ=-0·73; p<0·0001), and time to liquid culture positivity (ρ=0·73; p<0·0001). Compared with the combined binary smear and culture results as a reference standard, the Xpert MTB/RIF assay had high sensitivity (97·0%, 95% CI 95·8-97·9), but poor specificity (48·6%, 45·0-52·2). INTERPRETATION The poor specificity precludes the use of the Xpert MTB/RIF assay as a biomarker for monitoring tuberculosis treatment, and should not replace standard smear microscopy and culture. FUNDING Global Alliance for TB Drug Development, Bill & Melinda Gates Foundation, UK Medical Research Council, German Ministry of Science and Technology.
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Affiliation(s)
- Sven O Friedrich
- Division of Medical Physiology, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andrea Rachow
- National Institute of Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania; Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany; DZIF German Centre for Infection Research, Munich, Germany
| | - Elmar Saathoff
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
| | - Kasha Singh
- Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK
| | - Chacha D Mangu
- National Institute of Medical Research-Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Rodney Dawson
- Division of Pulmonology, Department of Medicine, University of Cape Town Lung Institute, Groote Schuur Hospital, Cape Town, South Africa
| | | | - Amour Venter
- MRC Centre for Molecular and Cellular Biology, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anna Bateson
- Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK
| | | | - Norbert Heinrich
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
| | - Robert D Hunt
- Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK
| | - Martin J Boeree
- Radboud University Nijmegen Medical Centre/UCCZ Dekkerswald, Nijmegen
| | - Alimuddin Zumla
- Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK
| | - Timothy D McHugh
- Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK
| | - Stephen H Gillespie
- University of St Andrews School of Medicine, North Haugh, St Andrews, Scotland, UK.
| | - Andreas H Diacon
- Division of Medical Physiology, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany; DZIF German Centre for Infection Research, Munich, Germany
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Ntinginya EN, Squire SB, Millington KA, Mtafya B, Saathoff E, Heinrich N, Rojas-Ponce G, Kowuor D, Maboko L, Reither K, Clowes P, Hoelscher M, Rachow A. Performance of the Xpert® MTB/RIF assay in an active case-finding strategy: a pilot study from Tanzania. Int J Tuberc Lung Dis 2012; 16:1468-70. [PMID: 22964006 DOI: 10.5588/ijtld.12.0127] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In this pilot study, we evaluated the Xpert® MTB/RIF assay in an active case-finding strategy, using two spot sputum samples collected within a 1-hour interval from household contacts of smear-positive TB index cases. Tuberculosis (TB) confirmed by culture served as the reference standard. Among 219 enrolled contacts, the yield of active TB was 2.3%. While the sensitivity of smear microscopy was 60% (95%CI 14.7-94.7), Xpert MTB/RIF achieved a sensitivity of 100% (95%CI 47.81-100.0). All culture-confirmed cases tested positive by Xpert MTB/RIF on the first submitted sample, suggesting that the evaluation of only one sample could be sufficient for TB diagnosis in this context.
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Affiliation(s)
- E N Ntinginya
- National Institute for Medical Research, Mbeya Medical Research Programme, Mbeya, Tanzania.
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Kroidl I, Clowes P, Mwalongo W, Maganga L, Maboko L, Kroidl AL, Geldmacher C, Machibya H, Hoelscher M, Saathoff E. Low specificity of determine HIV1/2 RDT using whole blood in south west Tanzania. PLoS One 2012; 7:e39529. [PMID: 22768086 PMCID: PMC3387183 DOI: 10.1371/journal.pone.0039529] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 05/23/2012] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate the diagnostic performance of two rapid detection tests (RDTs) for HIV 1/2 in plasma and in whole blood samples. Methods More than 15,000 study subjects above the age of two years participated in two rounds of a cohort study to determine the prevalence of HIV. HIV testing was performed using the Determine HIV 1/2 test (Abbott) in the first (2006/2007) and the HIV 1/2 STAT-PAK Dipstick Assay (Chembio) in the second round (2007/2008) of the survey. Positive results were classified into faint and strong bands depending on the visual appearance of the test strip and confirmed by ELISA and Western blot. Results The sensitivity and specificity of the Determine RDT were 100% (95% confidence interval = 86.8 to 100%) and 96.8% (95.9 to 97.6%) in whole blood and 100% (99.7 to 100%) and 97.9% (97.6 to 98.1%) in plasma respectively. Specificity was highly dependent on the tested sample type: when using whole blood, 67.1% of positive results were false positive, as opposed to 17.4% in plasma. Test strips with only faint positive bands were more often false positive than strips showing strong bands and were more common in whole blood than in plasma. Evaluation of the STAT-PAK RDT in plasma during the second year resulted in a sensitivity of 99.7% (99.1 to 99.9%) and a specificity of 99.3% (99.1 to 99.4%) with 6.9% of the positive results being false. Conclusions Our study shows that the Determine HIV 1/2 strip test with its high sensitivity is an excellent tool to screen for HIV infection, but that – at least in our setting – it can not be recommended as a confirmatory test in VCT campaigns where whole blood is used.
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Affiliation(s)
- Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany.
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Kawai K, Villamor E, Mugusi FM, Saathoff E, Urassa W, Bosch RJ, Spiegelman D, Fawzi WW. Predictors of change in nutritional and hemoglobin status among adults treated for tuberculosis in Tanzania. Int J Tuberc Lung Dis 2012; 15:1380-9. [PMID: 22283899 DOI: 10.5588/ijtld.10.0784] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with tuberculosis (TB) often suffer from profound malnutrition. OBJECTIVE To examine the patterns and predictors of change in nutritional and hemoglobin status during and after TB treatment. METHODS A total of 471 human immunodeficiency virus (HIV) positive and 416 HIV-negative adults with pulmonary TB were prospectively followed in Dar es Salaam, Tanzania. All patients received 8 months' TB treatment following enrollment. RESULTS About 40% of HIV-positive and 47% of HIV-negative TB patients had body mass index (BMI) < 18.5 kg/m 2 at baseline, while about 94% of HIV-positive and 84% of HIV-negative participants were anemic at baseline. Both HIV-positive and HIV-negative patients experienced increases in BMI and hemoglobin concentrations over the course of TB treatment. Among HIV- positive patients, older age, low CD4 cell counts, and high viral load were independently associated with a smaller increase in BMI from baseline to 8 months. Fe- male sex, older age, low CD4 cell counts, previous TB infection and less money spent on food were independently associated with a smaller improvement in hemoglobin levels among HIV-positive patients during treatment. CONCLUSION HIV-positive TB patients, especially those with low CD4 cell counts, showed poor nutritional recovery during TB treatment. Adequate nutritional support should be considered during TB treatment.
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Affiliation(s)
- K Kawai
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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Rachow A, Clowes P, Saathoff E, Mtafya B, Michael E, Ntinginya EN, Kowour D, Rojas-Ponce G, Kroidl A, Maboko L, Heinrich N, Reither K, Hoelscher M. Increased and expedited case detection by Xpert MTB/RIF assay in childhood tuberculosis: a prospective cohort study. Clin Infect Dis 2012; 54:1388-96. [PMID: 22474220 DOI: 10.1093/cid/cis190] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Diagnosis and timely treatment of tuberculosis in children is hampered by the absence of fast and reliable tests, especially in the era of human immunodeficiency virus (HIV). The aim of this study was to evaluate the diagnostic performance of the Xpert MTB/RIF assay (Xpert) in children with suspected tuberculosis in a high tuberculosis/HIV-burden setting. METHODS In a prospective study with a minimum follow-up of 12 months, 164 children with suspected tuberculosis were assigned to predefined diagnostic subgroups, based on microbiological and clinical findings. Results of smear microscopy and culture were compared against diagnostic performance of Xpert. RESULTS Twenty-eight of 164 children (17.1%) had confirmed tuberculosis. Xpert detected 100% (95% confidence interval [CI], 59.0%-100%) of smear-positive cases and 66.6% (95% CI, 43.0%-85.4%) of culture-positive but smear-negative cases. In the per-sample analysis, Xpert displayed a similar sensitivity (54.7% [95% CI, 42.7%-66.2%]) compared with culture methods. Xpert detected 3-fold more confirmed tuberculosis cases than smear microscopy but with equal rapidity. Four additional cases (8.5%) with clinical tuberculosis but negative culture were diagnosed by Xpert. Testing second and third samples increased sensitivity by 20% and an additional 16%, respectively. When tuberculosis was reliably excluded, Xpert's specificity was 100%. HIV infection did not affect diagnostic accuracy of Xpert. CONCLUSIONS Xpert was easy to perform and displayed similar diagnostic accuracy as culture methods in children with suspected tuberculosis. Rapid turnaround times should reduce treatment delay and improve patient outcome, although sensitivity remains suboptimal and access is dependent on local laboratory infrastructure.
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Affiliation(s)
- Andrea Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany.
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Heinrich N, Saathoff E, Weller N, Clowes P, Kroidl I, Ntinginya E, Machibya H, Maboko L, Löscher T, Dobler G, Hoelscher M. High seroprevalence of Rift Valley FEVER AND EVIDENCE FOR ENDEMIC circulation in Mbeya region, Tanzania, in a cross-sectional study. PLoS Negl Trop Dis 2012; 6:e1557. [PMID: 22479657 PMCID: PMC3313937 DOI: 10.1371/journal.pntd.0001557] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 01/19/2012] [Indexed: 11/25/2022] Open
Abstract
Background The Rift Valley fever virus (RVFV) is an arthropod-borne phlebovirus. RVFV mostly causes outbreaks among domestic ruminants with a major economic impact. Human infections are associated with these events, with a fatality rate of 0.5–2%. Since the virus is able to use many mosquito species of temperate climates as vectors, it has a high potential to spread to outside Africa. Methodology/Principal Findings We conducted a stratified, cross-sectional sero-prevalence survey in 1228 participants from Mbeya region, southwestern Tanzania. Samples were selected from 17,872 persons who took part in a cohort study in 2007 and 2008. RVFV IgG status was determined by indirect immunofluorescence. Possible risk factors were analyzed using uni- and multi-variable Poisson regression models. We found a unique local maximum of RVFV IgG prevalence of 29.3% in a study site close to Lake Malawi (N = 150). The overall seroprevalence was 5.2%. Seropositivity was significantly associated with higher age, lower socio-economic status, ownership of cattle and decreased with distance to Lake Malawi. A high vegetation density, higher minimum and lower maximum temperatures were found to be associated with RVFV IgG positivity. Altitude of residence, especially on a small scale in the high-prevalence area was strongly correlated (PR 0.87 per meter, 95% CI = 0.80–0.94). Abundant surface water collections are present in the lower areas of the high-prevalence site. RVF has not been diagnosed clinically, nor an outbreak detected in the high-prevalence area. Conclusions RVFV is probably circulating endemically in the region. The presence of cattle, dense vegetation and temperate conditions favour mosquito propagation and virus replication in the vector and seem to play major roles in virus transmission and circulation. The environmental risk-factors that we identified could serve to more exactly determine areas at risk for RVFV endemicity. We describe a high seropositivity rate for Rift Valley fever virus, in up to 29.3% of tested individuals from the shore of Lake Malawi in southwestern Tanzania, and much lower rates from areas distant to the lake. Rift Valley fever disease or outbreaks have not been observed there in the past, which suggests that the virus is circulating under locally favorable conditions and is either a non-pathogenic strain, or that occasional occurrence of disease is missed. We were able to identify a low socio-economic status and cattle ownership as possible socio-economic risk factors for an individual to be seropositive. Environmental risk factors associated with seropositivity include dense vegetation, and ambient land surface temperatures which may be important for breeding success of the mosquitoes which transmit Rift Valley fever, and for efficient multiplication of the virus in the mosquito. Low elevation of the home, and proximity to Lake Malawi probably lead to abundant surface water collections, which serve as breeding places for mosquitoes. These findings will inform patient care in the areas close to Lake Malawi, and may help to design models which predict low-level virus circulation.
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Affiliation(s)
- Norbert Heinrich
- Division of Infectious Diseases, Medical Center of the University of Munich, Munich, Germany.
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Saathoff E, Villamor E, Mugusi F, Bosch RJ, Urassa W, Fawzi WW. Anemia in adults with tuberculosis is associated with HIV and anthropometric status in Dar es Salaam, Tanzania. Int J Tuberc Lung Dis 2011; 15:925-32. [PMID: 21682966 DOI: 10.5588/ijtld.10.0477] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Tuberculosis (TB) infected adults attending out-patient TB clinics in Dar es Salaam, Tanzania. OBJECTIVE To examine the association of anemia with human immunodeficiency virus (HIV) co-infection, indicators of socio-economic status (SES) and anthropometric status in TB-infected adults. DESIGN Cross-sectional data collection during screening for a clinical trial. RESULTS Overall, 750 females and 1693 males participated in this study, of whom respectively 49% and 24% were co-infected with HIV-1. Hemoglobin levels were significantly lower in females than in males and in HIV-positive than in HIV-negative participants. HIV co-infection in this antiretroviral-naïve population was also associated with severe anemia (hemoglobin < 85 g/l) in both women (prevalence ratio [PR] = 2.07, 95%CI 1.65-2.59) and men (PR 3.45, 95%CI 2.66-4.47). Although severe anemia was negatively associated with indicators of SES, especially in males, adjustment for SES indicators only marginally changed its association with HIV co-infection. In both sexes, anemia was inversely associated with anthropometric status, independently of HIV infection and SES. CONCLUSION Among TB-infected adults, anemia is strongly associated with HIV co-infection and anthropometric status, independently of SES indicators. As anemia is a risk factor for morbidity and mortality in both infections, the management of anemia in TB-HIV co-infected patients warrants special attention.
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Affiliation(s)
- E Saathoff
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA.
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Geldmacher C, Ngwenyama N, Schuetz A, Petrovas C, Reither K, Heeregrave EJ, Casazza JP, Ambrozak DR, Louder M, Ampofo W, Pollakis G, Hill B, Sanga E, Saathoff E, Maboko L, Roederer M, Paxton WA, Hoelscher M, Koup RA. Preferential infection and depletion of Mycobacterium tuberculosis-specific CD4 T cells after HIV-1 infection. ACTA ACUST UNITED AC 2010; 207:2869-81. [PMID: 21115690 PMCID: PMC3005236 DOI: 10.1084/jem.20100090] [Citation(s) in RCA: 193] [Impact Index Per Article: 13.8] [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: 11/05/2022]
Abstract
HIV-1 preferentially infects M. tuberculosis-specific CD4+ T cells due to their increased production of IL-2. HIV-1 infection results in the progressive loss of CD4 T cells. In this study, we address how different pathogen-specific CD4 T cells are affected by HIV infection and the cellular parameters involved. We found striking differences in the depletion rates between CD4 T cells to two common opportunistic pathogens, cytomegalovirus (CMV) and Mycobacterium tuberculosis (MTB). CMV-specific CD4 T cells persisted after HIV infection, whereas MTB-specific CD4 T cells were depleted rapidly. CMV-specific CD4 T cells expressed a mature phenotype and produced very little IL-2, but large amounts of MIP-1β. In contrast, MTB-specific CD4 T cells were less mature, and most produced IL-2 but not MIP-1β. Staphylococcal enterotoxin B–stimulated IL-2–producing cells were more susceptible to HIV infection in vitro than MIP-1β–producing cells. Moreover, IL-2 production was associated with expression of CD25, and neutralization of IL-2 completely abrogated productive HIV infection in vitro. HIV DNA was found to be most abundant in IL-2–producing cells, and least abundant in MIP-1β–producing MTB-specific CD4 T cells from HIV-infected subjects with active tuberculosis. These data support the hypothesis that differences in function affect the susceptibility of pathogen-specific CD4 T cells to HIV infection and depletion in vivo, providing a potential mechanism to explain the rapid loss of MTB-specific CD4 T cells after HIV infection.
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Affiliation(s)
- Christof Geldmacher
- Immunology Laboratory, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
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Koehler RN, Walsh AM, Saathoff E, Tovanabutra S, Arroyo MA, Currier JR, Maboko L, Hoelscher M, Hoelsher M, Robb ML, Michael NL, McCutchan FE, Kim JH, Kijak GH. Class I HLA-A*7401 is associated with protection from HIV-1 acquisition and disease progression in Mbeya, Tanzania. J Infect Dis 2010; 202:1562-6. [PMID: 20923372 DOI: 10.1086/656913] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Here we explore associations between HLA variation and human immunodeficiency virus type 1 (HIV-1) acquisition and disease progression in a community cohort in Mbeya, Tanzania, a region that, despite harboring high rates of HIV-1 infection, remains understudied. African-specific allele HLA-A*74:01 was associated with decreased risk of infection (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.14-0.80; P = .011) and with protection from CD4(+) cell counts <200 cells/uL in women (OR, 0.31; 95% CI, 0.07-0.91; P = .032) and men (OR, 0.15; 95% CI, 0.01-0.78; P = .020). These associations remained significant after adjustment for linkage disequilibrium with HLA-B and HLA-C alleles. This observation calls for additional investigation of mechanisms by which HLA-A*74:01 may influence HIV-1 acquisition and control of the infection.
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Affiliation(s)
- Rebecca N Koehler
- US Military HIV Research Program, Henry M Jackson Foundation, Rockville, Maryland 20850, USA
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Reither K, Saathoff E, Jung J, Minja LT, Machibya H, Maboko L, Perkins MD, Hoelscher M, Boehme CC. Evaluation of Diagnos TB AG, a flow-through immunoassay for rapid detection of pulmonary tuberculosis. Int J Tuberc Lung Dis 2010; 14:238-240. [PMID: 20074417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
We evaluated the diagnostic performance of the Diagnos TB AG immunoassay in 171 Tanzanians with suspected pulmonary tuberculosis (TB). The sensitivity and specificity, and positive and negative predictive values of the rapid test for the detection of pulmonary TB in this population were respectively 60.0%, 33.3%, 40.3% and 52.6%. In its current configuration, this test will not help overcome difficulties in the rapid diagnosis of TB.
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Affiliation(s)
- K Reither
- Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany.
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