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Marks F, Im J, Park SE, Pak GD, Jeon HJ, Wandji Nana LR, Phoba MF, Mbuyi-Kalonji L, Mogeni OD, Yeshitela B, Panzner U, Cruz Espinoza LM, Beyene T, Owusu-Ansah M, Twumasi-Ankrah S, Yeshambaw M, Alemu A, Adewusi OJ, Adekanmbi O, Higginson E, Adepoju A, Agbi S, Cakpo EG, Ogunleye VO, Tunda GN, Ikhimiukor OO, Mbuyamba J, Toy T, Agyapong FO, Osei I, Amuasi J, Razafindrabe TJL, Raminosoa TM, Nyirenda G, Randriamampionona N, Seo HW, Seo H, Siribie M, Carey ME, Owusu M, Meyer CG, Rakotozandrindrainy N, Sarpong N, Razafindrakalia M, Razafimanantsoa R, Ouedraogo M, Kim YJ, Lee J, Zellweger RM, Kang SSY, Park JY, Crump JA, Hardy L, Jacobs J, Garrett DO, Andrews JR, Poudyal N, Kim DR, Clemens JD, Baker SG, Kim JH, Dougan G, Sugimoto JD, Van Puyvelde S, Kehinde A, Popoola OA, Mogasale V, Breiman RF, MacWright WR, Aseffa A, Tadesse BT, Haselbeck A, Adu-Sarkodie Y, Teferi M, Bassiahi AS, Okeke IN, Lunguya-Metila O, Owusu-Dabo E, Rakotozandrindrainy R. Incidence of typhoid fever in Burkina Faso, Democratic Republic of the Congo, Ethiopia, Ghana, Madagascar, and Nigeria (the Severe Typhoid in Africa programme): a population-based study. Lancet Glob Health 2024; 12:e599-e610. [PMID: 38485427 PMCID: PMC10951957 DOI: 10.1016/s2214-109x(24)00007-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/06/2023] [Accepted: 01/03/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Typhoid Fever remains a major cause of morbidity and mortality in low-income settings. The Severe Typhoid in Africa programme was designed to address regional gaps in typhoid burden data and identify populations eligible for interventions using novel typhoid conjugate vaccines. METHODS A hybrid design, hospital-based prospective surveillance with population-based health-care utilisation surveys, was implemented in six countries in sub-Saharan Africa. Patients presenting with fever (≥37·5°C axillary or ≥38·0°C tympanic) or reporting fever for three consecutive days within the previous 7 days were invited to participate. Typhoid fever was ascertained by culture of blood collected upon enrolment. Disease incidence at the population level was estimated using a Bayesian mixture model. FINDINGS 27 866 (33·8%) of 82 491 participants who met inclusion criteria were recruited. Blood cultures were performed for 27 544 (98·8%) of enrolled participants. Clinically significant organisms were detected in 2136 (7·7%) of these cultures, and 346 (16·2%) Salmonella enterica serovar Typhi were isolated. The overall adjusted incidence per 100 000 person-years of observation was highest in Kavuaya and Nkandu 1, Democratic Republic of the Congo (315, 95% credible interval 254-390). Overall, 46 (16·4%) of 280 tested isolates showed ciprofloxacin non-susceptibility. INTERPRETATION High disease incidence (ie, >100 per 100 000 person-years of observation) recorded in four countries, the prevalence of typhoid hospitalisations and complicated disease, and the threat of resistant typhoid strains strengthen the need for rapid dispatch and implementation of effective typhoid conjugate vaccines along with measures designed to improve clean water, sanitation, and hygiene practices. FUNDING The Bill & Melinda Gates Foundation.
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Affiliation(s)
- Florian Marks
- International Vaccine Institute, Seoul, South Korea; Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany; Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar.
| | - Justin Im
- International Vaccine Institute, Seoul, South Korea
| | - Se Eun Park
- International Vaccine Institute, Seoul, South Korea; Yonsei University Graduate School of Public Health, Seoul, South Korea; Yonsei University Graduate School of Public Health, Seoul, South Korea
| | - Gi Deok Pak
- International Vaccine Institute, Seoul, South Korea
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul, South Korea; Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK; Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | | | - Marie-France Phoba
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Department of Medical Biology, Microbiology Service, University Teaching Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Lisette Mbuyi-Kalonji
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Department of Medical Biology, Microbiology Service, University Teaching Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | | | | | - Tigist Beyene
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Michael Owusu-Ansah
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sampson Twumasi-Ankrah
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Department of Statistics and Actuarial Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Ashenafi Alemu
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Olukemi Adekanmbi
- Department of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Ellen Higginson
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | - Akinlolu Adepoju
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria; Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Sarah Agbi
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Enoch G Cakpo
- Institut Supérieur des Sciences de la Population, Ouagadougou, Burkina Faso
| | - Veronica O Ogunleye
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Gaëlle Nkoji Tunda
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Faculty of Medicine, Congo Protestant University, Kinshasa, Democratic Republic of the Congo
| | - Odion O Ikhimiukor
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Jules Mbuyamba
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Department of Medical Biology, Microbiology Service, University Teaching Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Trevor Toy
- International Vaccine Institute, Seoul, South Korea
| | - Francis Opoku Agyapong
- Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Osei
- Medical Research Council Unit, The Gambia at London School of Hygiene & Tropical Medicine, Banjul, The Gambia; Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - John Amuasi
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Bernhard Nocht Institute of Tropical Medicine, Hamburg, Germany; Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana
| | | | - Tiana Mirana Raminosoa
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | | | | | | | - Hyejin Seo
- International Vaccine Institute, Seoul, South Korea
| | | | - Megan E Carey
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK; International AIDS Vaccine Initiative, Chelsea & Westminster Hospital, London, UK
| | - Michael Owusu
- Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Centre for Health System Strengthening (CfHSS), Kumasi, Ghana; Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana
| | - Christian G Meyer
- Institute of Tropical Medicine, Eberhard-Karls University Tübingen, Tübingen, Germany; Duy Tan University, Da Nang, Viet Nam
| | | | - Nimarko Sarpong
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | | | | | - Jooah Lee
- International Vaccine Institute, Seoul, South Korea; Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | | | | | - Ju Yeon Park
- International Vaccine Institute, Seoul, South Korea; Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Liselotte Hardy
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven Belgium
| | | | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | - John D Clemens
- International Vaccine Institute, Seoul, South Korea; Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Stephen G Baker
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | - Jerome H Kim
- International Vaccine Institute, Seoul, South Korea; Department of Life Sciences, College of Natural Sciences, Seoul National University, Seoul, South Korea
| | - Gordon Dougan
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | - Jonathan D Sugimoto
- International Vaccine Institute, Seoul, South Korea; Epidemiologic Research and Information Center, Cooperative Studies Program, Office of Research and Development, United States Department of Veterans Affairs, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle WA USA
| | - Sandra Van Puyvelde
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK; Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerpen, Belgium
| | - Aderemi Kehinde
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oluwafemi A Popoola
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria; Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Robert F Breiman
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Infectious Diseases and Oncology Research Institute, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Birkneh Tilahun Tadesse
- International Vaccine Institute, Seoul, South Korea; Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden; Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Yaw Adu-Sarkodie
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Octavie Lunguya-Metila
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo; Department of Medical Biology, Microbiology Service, University Teaching Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ellis Owusu-Dabo
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Kim JH, Tack B, Fiorino F, Pettini E, Marchello C, Jacobs J, Crump J, Marks F. Examining geospatial and temporal distribution of invasive non-typhoidal Salmonella disease occurrence in sub-Saharan Africa: a systematic review and modelling study. BMJ Open 2024; 14:e080501. [PMID: 38485477 PMCID: PMC10941155 DOI: 10.1136/bmjopen-2023-080501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Invasive non-typhoidal Salmonella (iNTS) disease is a significant health concern in sub-Saharan Africa. While our knowledge of a larger-scale variation is growing, understanding of the subnational variation in iNTS disease occurrence is lacking, yet crucial for targeted intervention. METHOD We performed a systematic review of reported occurrences of iNTS disease in sub-Saharan Africa, consulting literature from PubMed, Embase and Web of Science published since 2000. Eligibility for inclusion was not limited by study type but required that studies reported original data on human iNTS diseases based on the culture of a normally sterile site, specifying subnational locations and the year, and were available as full-text articles. We excluded studies that diagnosed iNTS disease based on clinical indications, cultures from non-sterile sites or serological testing. We estimated the probability of occurrence of iNTS disease for sub-Saharan Africa on 20 km × 20 km grids by exploring the association with geospatial covariates such as malaria, HIV, childhood growth failure, access to improved water, and sanitation using a boosted regression tree. RESULTS We identified 130 unique references reporting human iNTS disease in 21 countries published from 2000 through 2020. The estimated probability of iNTS occurrence grids showed significant spatial heterogeneity at all levels (20 km × 20 km grids, subnational, country and subregional levels) and temporal heterogeneity by year. For 2020, the probability of occurrence was higher in Middle Africa (0.34, 95% CI: 0.25 to 0.46), followed by Western Africa (0.33, 95% CI: 0.23 to 0.44), Eastern Africa (0.24, 95% CI: 0.17 to 0.33) and Southern Africa (0.08, 95% CI: 0.03 to 0.11). Temporal heterogeneity indicated that the probability of occurrence increased between 2000 and 2020 in countries such as the Republic of the Congo (0.05 to 0.59) and Democratic Republic of the Congo (0.10 to 0.48) whereas it decreased in countries such as Uganda (0.65 to 0.23) or Zimbabwe (0.61 to 0.37). CONCLUSION The iNTS disease occurrence varied greatly across sub-Saharan Africa, with certain regions being disproportionately affected. Exploring regions at high risk for iNTS disease, despite the limitations in our data, may inform focused resource allocation. This targeted approach may enhance efforts to combat iNTS disease in more affected areas.
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Affiliation(s)
- Jong-Hoon Kim
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | - Bieke Tack
- Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Fabio Fiorino
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Department of Medicine and Surgery, LUM University "Giuseppe Degennaro", Bari, Italy
| | - Elena Pettini
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | | | - Jan Jacobs
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - John Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Florian Marks
- Epidemiology Unit, International Vaccine Institute, Seoul, Republic of Korea
- Department of Medicine, University of Cambridge, Cambridge, UK
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Browne AJ, Chipeta MG, Fell FJ, Haines-Woodhouse G, Kashef Hamadani BH, Kumaran EAP, Robles Aguilar G, McManigal B, Andrews JR, Ashley EA, Audi A, Baker S, Banda HC, Basnyat B, Bigogo G, Ngoun C, Chansamouth V, Chunga A, Clemens JD, Davong V, Dougan G, Dunachie SJ, Feasey NA, Garrett DO, Gordon MA, Hasan R, Haselbeck AH, Henry NJ, Heyderman RS, Holm M, Jeon HJ, Karkey A, Khanam F, Luby SP, Malik FR, Marks F, Mayxay M, Meiring JE, Moore CE, Munywoki PK, Musicha P, Newton PN, Pak G, Phommasone K, Pokharel S, Pollard AJ, Qadri F, Qamar FN, Rattanavong S, Reiner B, Roberts T, Saha S, Saha S, Shakoor S, Shakya M, Simpson AJ, Stanaway J, Turner C, Turner P, Verani JR, Vongsouvath M, Day NPJ, Naghavi M, Hay SI, Sartorius B, Dolecek C. Estimating the subnational prevalence of antimicrobial resistant Salmonella enterica serovars Typhi and Paratyphi A infections in 75 endemic countries, 1990-2019: a modelling study. Lancet Glob Health 2024; 12:e406-e418. [PMID: 38365414 PMCID: PMC10882211 DOI: 10.1016/s2214-109x(23)00585-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 11/19/2023] [Accepted: 12/04/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND Enteric fever, a systemic infection caused by Salmonella enterica serovars Typhi and Paratyphi A, remains a major cause of morbidity and mortality in low-income and middle-income countries. Enteric fever is preventable through the provision of clean water and adequate sanitation and can be successfully treated with antibiotics. However, high levels of antimicrobial resistance (AMR) compromise the effectiveness of treatment. We provide estimates of the prevalence of AMR S Typhi and S Paratyphi A in 75 endemic countries, including 30 locations without data. METHODS We used a Bayesian spatiotemporal modelling framework to estimate the percentage of multidrug resistance (MDR), fluoroquinolone non-susceptibility (FQNS), and third-generation cephalosporin resistance in S Typhi and S Paratyphi A infections for 1403 administrative level one districts in 75 endemic countries from 1990 to 2019. We incorporated data from a comprehensive systematic review, public health surveillance networks, and large multicountry studies on enteric fever. Estimates of the prevalence of AMR and the number of AMR infections (based on enteric fever incidence estimates by the Global Burden of Diseases study) were produced at the country, super-region, and total endemic area level for each year of the study. FINDINGS We collated data from 601 sources, comprising 184 225 isolates of S Typhi and S Paratyphi A, covering 45 countries over 30 years. We identified a decline of MDR S Typhi in south Asia and southeast Asia, whereas in sub-Saharan Africa, the overall prevalence increased from 6·0% (95% uncertainty interval 4·3-8·0) in 1990 to 72·7% (67·7-77·3) in 2019. Starting from low levels in 1990, the prevalence of FQNS S Typhi increased rapidly, reaching 95·2% (91·4-97·7) in south Asia in 2019. This corresponded to 2·5 million (1·5-3·8) MDR S Typhi infections and 7·4 million (4·7-11·3) FQNS S Typhi infections in endemic countries in 2019. The prevalence of third-generation cephalosporin-resistant S Typhi remained low across the whole endemic area over the study period, except for Pakistan where prevalence of third-generation cephalosporin resistance in S Typhi reached 61·0% (58·0-63·8) in 2019. For S Paratyphi A, we estimated low prevalence of MDR and third-generation cephalosporin resistance in all endemic countries, but a drastic increase of FQNS, which reached 95·0% (93·7-96·1; 3·5 million [2·2-5·6] infections) in 2019. INTERPRETATION This study provides a comprehensive and detailed analysis of the prevalence of MDR, FQNS, and third-generation cephalosporin resistance in S Typhi and S Paratyphi A infections in endemic countries, spanning the last 30 years. Our analysis highlights the increasing levels of AMR in this preventable infection and serves as a resource to guide urgently needed public health interventions, such as improvements in water, sanitation, and hygiene and typhoid fever vaccination campaigns. FUNDING Fleming Fund, UK Department of Health and Social Care; Wellcome Trust; and Bill and Melinda Gates Foundation.
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Alabi OS, Akintayo I, Odeyemi JS, Oloche JJ, Babalola CM, Nwimo C, Popoola O, Mogeni OD, Marks F, Okeke IN. Suboptimal Bacteriological Quality of Household Water in Municipal Ibadan, Nigeria. Am J Trop Med Hyg 2024; 110:346-355. [PMID: 38167625 PMCID: PMC10859799 DOI: 10.4269/ajtmh.23-0134] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/05/2023] [Indexed: 01/05/2024] Open
Abstract
Access to potable water is difficult for many African residents. This study evaluated the bacteriological quality of household water collected in the dry and wet seasons across five municipal local government areas (LGAs) in Ibadan, a large city in southwest Nigeria. A total of 447 water samples (dry season, n = 250; wet season, n = 197) were aseptically collected from a random sample of mapped households within Ibadan's five municipal LGAs. The pH values and total aerobic and coliform bacterial counts were measured, and samples were screened for Escherichia coli, Salmonella, Shigella, and Yersinia by standard phenotypic techniques and multiplex polymerase chain reaction. The most common source of water was well (53.2%), followed by borehole (34%). None of the households used municipal tap water. Cumulatively, aerobic (P = 0.0002) and coliform (P = 0.0001) counts as well as pH values (P = 0.0002) changed significantly between seasons, with increasing and decreasing counts depending on the LGA. Nonpotable water samples were found to be very common during the dry (86.8%) and wet (74.1%) seasons. Escherichia coli spp., as indicators of recent fecal contamination, were isolated from 115 (25.7%) of the household water sources. Thirty three Salmonella, four enteroaggregative E. coli, and four enterotoxigenic E. coli isolates but no Shigella or Yersinia isolates were identified. This study revealed the absence of treated tap water and the poor quality of alternative sources with detectable pathogens in municipal Ibadan. Addressing the city-wide lack of access to potable water is an essential priority for preventing a high prevalence of feco-orally transmitted infections.
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Affiliation(s)
- Olumuyiwa S. Alabi
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Nigeria
| | - Ifeoluwa Akintayo
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Nigeria
| | - Jesutofunmi S. Odeyemi
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Nigeria
| | - Jeremiah J. Oloche
- Department of Pharmacology and Therapeutics, College of Health Sciences, Benue State University, Makurdi, Nigeria
| | - Chibuzor M. Babalola
- Keck School of Medicine, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California
| | - Chukwuemeka Nwimo
- Department of Community Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Oluwafemi Popoola
- Department of Community Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Ondari D. Mogeni
- Epidemiology, Public Health, Implementation & Clinical Development Unit, International Vaccine Institute, Seoul, South Korea
| | - Florian Marks
- Epidemiology, Public Health, Implementation & Clinical Development Unit, International Vaccine Institute, Seoul, South Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | - Iruka N. Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Nigeria
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Tadesse BT, Cardona RSB, Marks F. Long-term protection conferred by typhoid conjugate vaccines: a step towards typhoid elimination? Lancet 2024; 403:413-415. [PMID: 38281498 DOI: 10.1016/s0140-6736(23)02350-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/17/2023] [Indexed: 01/30/2024]
Affiliation(s)
- Birkneh Tilahun Tadesse
- International Vaccine Institute, SNU Research Park, Seoul 08826, South Korea; Department of Gobal Public Health, Karolinska Institutet, Stockholm, Sweden; Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | | | - Florian Marks
- International Vaccine Institute, SNU Research Park, Seoul 08826, South Korea; Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany; Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
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Sartorius B, Gray AP, Davis Weaver N, Robles Aguilar G, Swetschinski LR, Ikuta KS, Mestrovic T, Chung E, Wool EE, Han C, Gershberg Hayoon A, Araki DT, Abd-Elsalam S, Aboagye RG, Adamu LH, Adepoju AV, Ahmed A, Akalu GT, Akande-Sholabi W, Amuasi JH, Amusa GA, Argaw AM, Aruleba RT, Awoke T, Ayalew MK, Azzam AY, Babin FX, Banerjee I, Basiru A, Bayileyegn NS, Belete MA, Berkley JA, Bielicki JA, Dekker D, Demeke D, Demsie DG, Dessie AM, Dunachie SJ, Ed-Dra A, Ekholuenetale M, Ekundayo TC, El Sayed I, Elhadi M, Elsohaby I, Eyre D, Fagbamigbe AF, Feasey NA, Fekadu G, Fell F, Forrest KM, Gebrehiwot M, Gezae KE, Ghazy RM, Hailegiyorgis TT, Haines-Woodhouse G, Hasaballah AI, Haselbeck AH, Hsia Y, Iradukunda A, Iregbu KC, Iwu CCD, Iwu-Jaja CJ, Iyasu AN, Jaiteh F, Jeon H, Joshua CE, Kassa GG, Katoto PDMC, Krumkamp R, Kumaran EAP, Kyu HH, Manilal A, Marks F, May J, McLaughlin SA, McManigal B, Melese A, Misgina KH, Mohamed NS, Mohammed M, Mohammed S, Mohammed S, Mokdad AH, Moore CE, Mougin V, Mturi N, Mulugeta T, Musaigwa F, Musicha P, Musila LA, Muthupandian S, Naghavi P, Negash H, Nuckchady DC, Obiero CW, Odetokun IA, Ogundijo OA, Okidi L, Okonji OC, Olagunju AT, Olufadewa II, Pak GD, Perovic O, Pollard A, Raad M, Rafaï C, Ramadan H, Redwan EMM, Roca A, Rosenthal VD, Saleh MA, Samy AM, Sharland M, Shittu A, Siddig EE, Sisay EA, Stergachis A, Tesfamariam WB, Tigoi C, Tincho MB, Tiruye TY, Umeokonkwo CD, Walsh T, Walson JL, Yusuf H, Zeru NG, Hay SI, Dolecek C, Murray CJL, Naghavi M. The burden of bacterial antimicrobial resistance in the WHO African region in 2019: a cross-country systematic analysis. Lancet Glob Health 2024; 12:e201-e216. [PMID: 38134946 PMCID: PMC10805005 DOI: 10.1016/s2214-109x(23)00539-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/18/2023] [Accepted: 11/07/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND A critical and persistent challenge to global health and modern health care is the threat of antimicrobial resistance (AMR). Previous studies have reported a disproportionate burden of AMR in low-income and middle-income countries, but there remains an urgent need for more in-depth analyses across Africa. This study presents one of the most comprehensive sets of regional and country-level estimates of bacterial AMR burden in the WHO African region to date. METHODS We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with AMR for 23 bacterial pathogens and 88 pathogen-drug combinations for countries in the WHO African region in 2019. Our methodological approach consisted of five broad components: the number of deaths in which infection had a role, the proportion of infectious deaths attributable to a given infectious syndrome, the proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of a given pathogen resistant to an antimicrobial drug of interest, and the excess risk of mortality (or duration of an infection) associated with this resistance. These components were then used to estimate the disease burden by using two counterfactual scenarios: deaths attributable to AMR (considering an alternative scenario where infections with resistant pathogens are replaced with susceptible ones) and deaths associated with AMR (considering an alternative scenario where drug-resistant infections would not occur at all). We obtained data from research hospitals, surveillance networks, and infection databases maintained by private laboratories and medical technology companies. We generated 95% uncertainty intervals (UIs) for final estimates as the 25th and 975th ordered values across 1000 posterior draws, and models were cross-validated for out-of-sample predictive validity. FINDINGS In the WHO African region in 2019, there were an estimated 1·05 million deaths (95% UI 829 000-1 316 000) associated with bacterial AMR and 250 000 deaths (192 000-325 000) attributable to bacterial AMR. The largest fatal AMR burden was attributed to lower respiratory and thorax infections (119 000 deaths [92 000-151 000], or 48% of all estimated bacterial pathogen AMR deaths), bloodstream infections (56 000 deaths [37 000-82 000], or 22%), intra-abdominal infections (26 000 deaths [17 000-39 000], or 10%), and tuberculosis (18 000 deaths [3850-39 000], or 7%). Seven leading pathogens were collectively responsible for 821 000 deaths (636 000-1 051 000) associated with resistance in this region, with four pathogens exceeding 100 000 deaths each: Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, and Staphylococcus aureus. Third-generation cephalosporin-resistant K pneumoniae and meticillin-resistant S aureus were shown to be the leading pathogen-drug combinations in 25 and 16 countries, respectively (53% and 34% of the whole region, comprising 47 countries) for deaths attributable to AMR. INTERPRETATION This study reveals a high level of AMR burden for several bacterial pathogens and pathogen-drug combinations in the WHO African region. The high mortality rates associated with these pathogens demonstrate an urgent need to address the burden of AMR in Africa. These estimates also show that quality and access to health care and safe water and sanitation are correlated with AMR mortality, with a higher fatal burden found in lower resource settings. Our cross-country analyses within this region can help local governments to leverage domestic and global funding to create stewardship policies that target the leading pathogen-drug combinations. FUNDING Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.
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Kim JH, Choi J, Kim C, Pak GD, Parajulee P, Haselbeck A, Park SE, Mogasale V, Jeon HJ, Browne AJ, Owusu-Dabo E, Rakotozandrindrainy R, Bassiahi AS, Teferi M, Lunguya-Metila O, Dolecek C, Pitzer VE, Crump JA, Hay SI, Marks F. Mapping the incidence rate of typhoid fever in sub-Saharan Africa. PLoS Negl Trop Dis 2024; 18:e0011902. [PMID: 38408128 DOI: 10.1371/journal.pntd.0011902] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 03/26/2024] [Accepted: 01/04/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND With more than 1.2 million illnesses and 29,000 deaths in sub-Saharan Africa in 2017, typhoid fever continues to be a major public health problem. Effective control of the disease would benefit from an understanding of the subnational geospatial distribution of the disease incidence. METHOD We collated records of the incidence rate of typhoid fever confirmed by culture of blood in Africa from 2000 to 2022. We estimated the typhoid incidence rate for sub-Saharan Africa on 20 km × 20 km grids by exploring the association with geospatial covariates representing access to improved water and sanitation, health conditions of the population, and environmental conditions. RESULTS We identified six published articles and one pre-print representing incidence rate estimates in 22 sites in 2000-2022. Estimated incidence rates showed geospatial variation at sub-national, national, and regional levels. The incidence rate was high in Western and Eastern African subregions followed by Southern and Middle African subregions. By age, the incidence rate was highest among 5-14 yo followed by 2-4 yo, > 14 yo, and 0-1 yo. When aggregated across all age classes and grids that comprise each country, predicted incidence rates ranged from 43.7 (95% confidence interval: 0.6 to 591.2) in Zimbabwe to 2,957.8 (95% CI: 20.8 to 4,245.2) in South Sudan per 100,000 person-years. Sub-national heterogeneity was evident with the coefficient of variation at the 20 km × 20 km grid-level ranging from 0.7 to 3.3 and was generally lower in high-incidence countries and widely varying in low-incidence countries. CONCLUSION Our study provides estimates of 20 km × 20 km incidence rate of typhoid fever across sub-Saharan Africa based on data collected from 2000 through 2020. Increased understanding of the subnational geospatial variation of typhoid fever in Africa may inform more effective intervention programs by better targeting resources to heterogeneously disturbed disease risk.
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Affiliation(s)
- Jong-Hoon Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jungsoon Choi
- Department of Mathematics, Hanyang University, Seoul, Republic of Korea
| | - Chaelin Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Gi Deok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | - Se Eun Park
- International Vaccine Institute, Seoul, Republic of Korea
- Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | | | - Hyon Jin Jeon
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | - Annie J Browne
- Malaria Atlas Project, Telethon Kids Institute, Perth, Australia
| | - Ellis Owusu-Dabo
- Malaria Atlas Project, Telethon Kids Institute, Perth, Australia
| | - Raphaël Rakotozandrindrainy
- School of Public Health, Kwame Nkrumah University of Science and Technology, Laing Building Complex J.W. Acheampong CI, Kumasi, Ghana
| | | | - Mekonnen Teferi
- Armauer Hansen Research Institute, ALERT Compound Zenebework, Addis Ababa, Ethiopia
| | - Octavie Lunguya-Metila
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
- Department of Medical Biology, Microbiology Service, University Teaching Hospital, Ave De L'hopital, Kinshasa, Democratic Republic of the Congo
| | - Christiane Dolecek
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, New Haven, Connecticut, United States of America
- Yale Institute for Global Health, New Haven, Connecticut, United States of America
| | - John A Crump
- Centre for International Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Simon I Hay
- Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, Washington, United States of America
- Department of Health Metrics Sciences, University of Washington, Seattle, Washington, United States of America
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
- School of Public Health, Kwame Nkrumah University of Science and Technology, Laing Building Complex J.W. Acheampong CI, Kumasi, Ghana
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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8
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Zida A, Guiguemde T, Sawadogo MP, Tchekounou C, Soulama I, Barry CS, Siribie M, Marks F, Sangaré I, Bamba S. Schistosomiasis in Burkina Faso: review on 60 years' research. Ann Parasitol 2024; 69. [PMID: 38423519 DOI: 10.17420/ap6903/4.514] [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] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Schistosomiasis is a common neglected helminthic disease in the tropics and sub-tropics particularly in sub-Saharan countries including Burkina Faso. It is the second world parasitic endemic disease after malaria. The two prevalent species infecting human in Burkina Faso are are Schistosoma haematobium and Schistosoma mansoni which cause respectively the urogenital schistosomiasis and the intestinal schistosomiasis. This review aimed at providing an historical perspective of research on schistosomiasis from 1960 to 2020 and shedding some light on the gaps in knowledge useful for the disease control and the elimination efforts in Burkina Faso. Formal systematic review was not followed for this review. Published studies on the schistosomiasis in Burkina Faso over the period from 1960 to 2020, were search in Medline, PubMed, Google Scholar, EMBASE and the libraries of main universities in Burkina Faso namely: Joseph KI-ZERBO University and Nazi BONI University. The following key words used were: Schistosomiasis, Bilharzia, Bulinus, Biomphalaria, Upper-Volta and Burkina Faso. Over a period of 60 years, a total of 87 scientific research documents were identified. The original scientific research articles represent the majority of the scientific documents found (65.52%). Urinary schistosomiasis was the most common from the documentation. There has been a gradual decrease in the prevalence, more significantly since the implementation of the National Schistosomiasis Control Program (NSCP). The effectiveness of the NSCP could therefore contribute to the elimination of schistosomiasis in Burkina Faso.
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Affiliation(s)
- Adama Zida
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire Yalgado Ouedraogo, Ouagadougou, Burkina Faso; Ecole Doctorale Sciences et Santé, Université Joseph Ki-Zerbo, Burkina Faso; Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso.
| | - Thierry Guiguemde
- Ecole Doctorale Sciences et Santé, Université Joseph Ki-Zerbo, Burkina Faso; Centre Hospitalier Universitaire Charles De Gaulles, Ouagadougou, Burkina Faso.
| | - Marcel P Sawadogo
- Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire Yalgado Ouedraogo, Ouagadougou, Burkina Faso; Ecole Doctorale Sciences et Santé, Université Joseph Ki-Zerbo, Burkina Faso.
| | - Chanolle Tchekounou
- Institut International des Sciences et Technologie (IISTech), Ouagadougou, Burkina Faso.
| | - Issiaka Soulama
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso; Institut de Recherche en Sciences de la Santé (IRSS/CNRST), Ouagadougou, Burkina Faso.
| | - Cheick S Barry
- Ecole Doctorale Sciences et Santé, Université Joseph Ki-Zerbo, Burkina Faso; Institut International des Sciences et Technologie (IISTech), Ouagadougou, Burkina Faso.
| | | | - Florian Marks
- International Vaccine Institute (IVI), Seoul, Republic of Korea; Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, UK; University of Antananarivo, Antananarivo, Madagascar.
| | - Ibrahim Sangaré
- Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Burkina Faso.
| | - Sanata Bamba
- Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Burkina Faso.
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Im J, Islam MT, Ahmmed F, Kim DR, Tadesse BT, Kang S, Khanam F, Chowdhury F, Ahmed T, Firoj MG, Aziz AB, Hoque M, Jeon HJ, Kanungo S, Dutta S, Zaman K, Khan AI, Marks F, Kim JH, Qadri F, Clemens JD. Do Oral Cholera Vaccine and Water, Sanitation, and Hygiene Combine to Provide Greater Protection Against Cholera? Results From a Cluster-Randomized Trial of Oral Cholera Vaccine in Kolkata, India. Open Forum Infect Dis 2024; 11:ofad701. [PMID: 38274552 PMCID: PMC10810060 DOI: 10.1093/ofid/ofad701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Indexed: 01/27/2024] Open
Abstract
Background Oral cholera vaccine (OCV) and incremental improvements in household water, sanitation, and hygiene (WASH) within cholera-endemic areas can reduce cholera risk. However, we lack empiric evaluation of their combined impact. Methods We evaluated a cluster-randomized, placebo-controlled trial of OCV (Shanchol) in Kolkata, India. The study population included 108 777 individuals, and 106 879 nonpregnant individuals >1 year of age were eligible to receive 2 doses of OCV or placebo. We measured cholera risk in all household members assigned to OCV vs placebo and in all members of households with "Better" vs "Not Better" WASH, where WASH was classified according to validated criteria. Protection was measured by Cox proportional hazard models. Results Residence in an OCV household was associated with protective effectiveness (PE) of 54% (95% CI, 42%-64%; P < .001) and was similar regardless of Better (PE, 57%; 95% CI, 26%-75%; P = .002) or Not Better (PE, 53%; 95% CI, 40%-64%; P < .001) household WASH. Better WASH household residence was associated with PE of 30% (95% CI, 5%-48%; P = .023) and was similar in OCV (PE, 24%; 95% CI, -26% to 54%; P = .293) and placebo (PE, 29%; 95% CI, -3% to 51%; P = .069) households. When assessed conjointly, residence in OCV households with Better WASH was associated with the greatest PE against cholera at 69% (95% CI, 49%-81%; P < .001). Conclusions These findings suggest that the combination of a vaccine policy and improved WASH reduces cholera risk more than either would alone, although the magnitude of either intervention was not affected by the other. Future randomized trials investigating OCV and WASH interventions separately and together are recommended to further understand the interaction between OCV and WASH.
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Affiliation(s)
- Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | - Md Taufiqul Islam
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Faisal Ahmmed
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Deok Ryun Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Sophie Kang
- International Vaccine Institute, Seoul, Republic of Korea
| | - Farhana Khanam
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Fahima Chowdhury
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Tasnuva Ahmed
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Md Golam Firoj
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | | | - Masuma Hoque
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Suman Kanungo
- ICMR–National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Shanta Dutta
- ICMR–National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Khalequ Zaman
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | | | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Firdausi Qadri
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - John D Clemens
- International Vaccine Institute, Seoul, Republic of Korea
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
- Fielding School of Public Health, University of California–Los Angeles, Los Angeles, California, USA
- Vaccine Innovation Center, School of Medicine, Korea University, Seoul, Republic of Korea
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10
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Sujan MJ, Habib ZH, Rahman A, Rizvi SMS, Barua HT, Aboushady AT, Hasnat MA, Rasul SBG, Joh HS, Prifti K, Chi KYK, Kwon SY, Clark A, Gautam S, Holm M, Marks F, Stelling J, Shaw A, Poudyal N. Antimicrobial Resistance Surveillance Methods in Bangladesh: Present and Way Forward. Clin Infect Dis 2023; 77:S549-S559. [PMID: 38118018 PMCID: PMC10732563 DOI: 10.1093/cid/ciad561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
The Institute of Epidemiology, Disease Control and Research (IEDCR) conducts active, case-based national antimicrobial resistance (AMR) surveillance in Bangladesh. The Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia (CAPTURA) project accessed aggregated retrospective data from non-IEDCR study sites and 9 IEDCR sites to understand the pattern and extent of AMR and to use analyzed data to guide ongoing and future national AMR surveillance in both public and private laboratories. Record-keeping practices, data completeness, quality control, and antimicrobial susceptibility test practices were investigated in all laboratories participating in case-based IEDCR surveillance and laboratory-based CAPTURA sites. All 9 IEDCR laboratories recorded detailed case-based data (n = 16 816) in electronic format for a priority subset of processed laboratory samples. In contrast, most CAPTURA sites (n = 18/33 [54.5%]) used handwritten registers to store data. The CAPTURA sites were characterized by fewer recorded variables (such as patient demographics, clinical history, and laboratory findings) with 1 020 197 individual data, less integration of patient records with the laboratory information system, and nonuniform practice of data recording; however, data were collected from all available clinical samples. The analyses conducted on AMR data collected by IEDCR and CAPTURA in Bangladesh provide current data collection status and highlight opportunities to improve ongoing data collection to strengthen current AMR surveillance system initiatives. We recommend a tailored approach to conduct AMR surveillance in high-burden, resource-limited settings.
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Affiliation(s)
| | - Zakir Hossain Habib
- Department of Microbiology, Institute of Epidemiology, Disease Control and Research (IEDCR), Directorate General of Health Services, Ministry of Health and Family Welfare (MoHFW), Bangladesh
| | - Aninda Rahman
- Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - S M Shahriar Rizvi
- Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | | | - Ahmed Taha Aboushady
- International Vaccine Institute, Seoul, Republic of Korea
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Md Abul Hasnat
- International Vaccine Institute, Seoul, Republic of Korea
| | - Saima Binte Golam Rasul
- Department of Microbiology, Institute of Epidemiology, Disease Control and Research (IEDCR), Directorate General of Health Services, Ministry of Health and Family Welfare (MoHFW), Bangladesh
| | - Hea Sun Joh
- International Vaccine Institute, Seoul, Republic of Korea
| | - Kristi Prifti
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Soo Young Kwon
- International Vaccine Institute, Seoul, Republic of Korea
| | - Adam Clark
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sanjay Gautam
- International Vaccine Institute, Seoul, Republic of Korea
- Research & Collaboration, Anka Analytica, Melbourne, Australia
| | - Marianne Holm
- International Vaccine Institute, Seoul, Republic of Korea
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | - John Stelling
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alina Shaw
- Public Health Surveillance Group, LLC, Princeton, New Jersey, USA
| | - Nimesh Poudyal
- International Vaccine Institute, Seoul, Republic of Korea
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11
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Abegaz FA, dos Santos PT, Mogeni OD, Guarnacci T, Poudyal N, Hong J, Kwon SY, Braae R, Prathan R, Tongkum TL, Kamjumpho W, Chuanchuen R, Marks F, Hendriksen RS, Holm M. Evaluating Quality Management and Diagnostics Microbiology Performance Within an International External Quality Assessment (EQA) Program Serving National One Health Sector Reference Laboratories Across Asia: Experience Amid the Coronavirus Disease 2019 (COVID-19) Pandemic. Clin Infect Dis 2023; 77:S588-S596. [PMID: 38118017 PMCID: PMC10732555 DOI: 10.1093/cid/ciad569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Strengthening external quality assessment (EQA) services across the One Health sector supports implementation of effective antimicrobial resistance (AMR) control strategies. Here we describe and compare 2 different approaches for conducting virtual laboratory follow-up assessments within an EQA program to evaluate quality management system (QMS) and procedures for pathogen identification and antimicrobial susceptibility testing (AST). METHODS During the coronavirus disease 2019 (COVID-19) pandemic in 2021 and 2022, 2 laboratory assessment approaches were introduced: virtual-based and survey-based methodologies. The evaluation of 2 underperforming Animal Health laboratories through a virtual-based approach occurred between May and August 2021. This evaluation encompassed the utilization of 3 online meetings and document reviews, performed subsequent to the execution of EQA procedures. Within a distinct group of laboratories, the survey-based assessment was implemented from December 2021 to February 2022, also following EQA procedures. This phase encompassed the dissemination of an online survey to 31 participating laboratories, alongside a sole online consultation meeting involving 4 specific underperforming laboratories. RESULTS The virtual-based assessment post-EQA aimed to identify gaps and areas for improvement in the laboratory's practices for pathogen identification and AST. This approach was, however, time-intensive, and, hence, only 2 laboratories were assessed. In addition, limited interactions in virtual platforms compromised the assessment quality. The survey-based post-EQA assessment enabled evaluation of 31 laboratories. Despite limitations for in-depth analysis of each procedure, gaps in QMS across multiple laboratories were identified and tailored laboratory-specific recommendations were provided. CONCLUSIONS Reliable internet and plans for efficient time management, post-EQA virtual laboratory follow-up assessments are an effective alternative when conducting onsite evaluation is infeasible as observed during the COVID-19 pandemic, although the successful implementation of remediation plans will likely require in person assessments. We advocate application of hybrid approaches (both onsite and virtual) for targeted capacity building of AMR procedures with the ability to implement and oversee the process.
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Affiliation(s)
| | - Patrícia Teixeira dos Santos
- The Technical University of Denmark, National Food Institute, WHO Collaborating Center for Antimicrobial Resistance in Foodborne Pathogens and Genomics and European Union Reference Laboratory for Antimicrobial Resistance, FAO Reference Laboratory for Antimicrobial Resistance, Kgs. Lyngby, Denmark
| | | | | | - Nimesh Poudyal
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jinhui Hong
- International Vaccine Institute, Seoul, Republic of Korea
| | - Soo Young Kwon
- International Vaccine Institute, Seoul, Republic of Korea
| | - Rikke Braae
- The Technical University of Denmark, National Food Institute, WHO Collaborating Center for Antimicrobial Resistance in Foodborne Pathogens and Genomics and European Union Reference Laboratory for Antimicrobial Resistance, FAO Reference Laboratory for Antimicrobial Resistance, Kgs. Lyngby, Denmark
| | - Rangsiya Prathan
- Research Unit for Microbial Food Safety and Antimicrobial Resistance, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Taradon Luang Tongkum
- Research Unit for Microbial Food Safety and Antimicrobial Resistance, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | | | - Rungtip Chuanchuen
- Research Unit for Microbial Food Safety and Antimicrobial Resistance, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | - Rene S Hendriksen
- The Technical University of Denmark, National Food Institute, WHO Collaborating Center for Antimicrobial Resistance in Foodborne Pathogens and Genomics and European Union Reference Laboratory for Antimicrobial Resistance, FAO Reference Laboratory for Antimicrobial Resistance, Kgs. Lyngby, Denmark
| | - Marianne Holm
- International Vaccine Institute, Seoul, Republic of Korea
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12
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Leslie T, Parry C, Ondoa P, Walsh T, Moore C, Poudyal N, Marks F, Gordon NC. The Reality of Antimicrobial Resistance and Antibiotic Usage Data in Asia: The CAPTURA Experience. Clin Infect Dis 2023; 77:S497-S499. [PMID: 38118008 PMCID: PMC10732558 DOI: 10.1093/cid/ciad580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Antimicrobial resistance (AMR), particularly in low- and middle-income countries, is threatening to undermine advances in health and development. Scarce technical and human resources in these countries limit the collection of quality AMR data for evidence-based decision-making. The CAPTURA consortium, funded by the Fleming Fund, was implemented across 7 countries in the South and Southeast Asian region. The program focused on collating historical bacteriological data for qualitative and quantitative analyses. The team gathered standard data on the quality of laboratories and clinics and the quality and quantity of retrospective historical AMR data. In addition, retrospective data on antimicrobial use and consumption were analyzed. While standard protocols guided the project, a tailored approach for stakeholder engagement was implemented to work with countries and secure data-sharing agreements. The program also had to navigate the challenges of the COVID-19 pandemic, making some innovative adaptations to overcome logistical barriers. From 2018 through 2022, a large body of data was collected that was used to base a series of recommended key measures for strengthening the development of standardized national surveillance programs and to support alignment with international efforts.
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Affiliation(s)
- Toby Leslie
- Fleming Fund Management Agent, Mott MacDonald, London, United Kingdom
| | - Claudia Parry
- Fleming Fund Management Agent, Mott MacDonald, London, United Kingdom
| | - Pascale Ondoa
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
- Department of Global Health, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Timothy Walsh
- Department of Biology, University of Oxford/Ineos Oxford Institute for Antimicrobial Research, Oxford, United Kingdom
| | - Catrin Moore
- Institute of Infection and Immunity at St George's, University of London, London, United Kingdom
| | - Nimesh Poudyal
- International Vaccine Institute, Seoul, Republic of Korea
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
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13
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Maharjan S, Gallagher P, Gautam M, Joh HS, Sujan MJ, Aboushady AT, Kwon SY, Gautam S, Upadhyaya MK, Jha R, Acharya J, MacWright WR, Marks F, Stelling J, Poudyal N. Recording and Reporting of Antimicrobial Resistance (AMR) Priority Variables and Its Implication on Expanding Surveillance Sites in Nepal: A CAPTURA Experience. Clin Infect Dis 2023; 77:S560-S568. [PMID: 38118014 PMCID: PMC10732557 DOI: 10.1093/cid/ciad581] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Data on antimicrobial resistance (AMR) from sites not participating in the National AMR surveillance network, conducted by National Public Health Laboratory (NPHL), remain largely unknown in Nepal. The "Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia" (CAPTURA) assessed AMR data from previously untapped data sources in Nepal. A retrospective cross-sectional data review was carried out for the AMR data recorded between January 2017 and December 2019 to analyze AMR data from 26 hospital-based laboratories and 2 diagnostic laboratories in Nepal. Of the 56 health facilities initially contacted to participate in this project activity, 50.0% (28/56) signed a data-sharing agreement with CAPTURA. Eleven of the 28 hospitals were AMR surveillance sites, whereas the other 17, although not part of the National AMR surveillance network, recorded AMR-related data. Data for 663 602 isolates obtained from 580 038 patients were analyzed. A complete record of the 11 CAPTURA priority variables was obtained from 45.5% (5/11) of government hospitals, 63.6% (7/11) of private hospitals, and 54.6% (6/11) of public-private hospitals networked with NPHL for AMR surveillance. Similarly, 80% (8/10) of clinics and 54.6% (6/11) of laboratories outside the NPHL network recorded complete data for the 10 Global Antimicrobial Resistance and Use Surveillance System (GLASS) priority variables and 11/14 CAPTURA priority variables. Retrospective review of the data identified areas requiring additional resources and interventions to improve the quality of data on AMR in Nepal. Furthermore, we observed no difference in the priority variables reported by sites within or outside the NPHL network, thus suggesting that policies could be made to expand the surveillance system to include these sites without substantially affecting the government's budget.
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Affiliation(s)
- Sanju Maharjan
- Public Health Research, Anweshan Private Limited, Lalitpur, Nepal
| | | | - Manish Gautam
- Public Health Research, Anweshan Private Limited, Lalitpur, Nepal
| | - Hea Sun Joh
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Ahmed Taha Aboushady
- International Vaccine Institute, Seoul, Republic of Korea
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Soo Young Kwon
- International Vaccine Institute, Seoul, Republic of Korea
| | - Sanjay Gautam
- International Vaccine Institute, Seoul, Republic of Korea
- Research & Collaboration, Anka Analytica, Melbourne, Australia
| | | | - Runa Jha
- National Public Health Laboratory, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Jyoti Acharya
- National Public Health Laboratory, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | | | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Madagascar Institute for Vaccine Research, University of Antananarivo, Madagascar
| | - John Stelling
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nimesh Poudyal
- International Vaccine Institute, Seoul, Republic of Korea
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14
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Aboushady AT, Sujan MJ, Pham K, Clark A, Marks F, Holm M, Joh HS, Poudyal N, Stelling J. Key Recommendations for Antimicrobial Resistance Surveillance: Takeaways From the CAPTURA Project. Clin Infect Dis 2023; 77:S581-S587. [PMID: 38118016 PMCID: PMC10732552 DOI: 10.1093/cid/ciad487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Antimicrobial resistance (AMR) is a growing global public health challenge associated with 4.95 million deaths in 2019 and an estimated 10 million deaths per year by 2050 in the absence of coordinated action. A robust AMR surveillance system is therefore required to avert such a scenario. Based on an analysis of country-level AMR data in 8 Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia (CAPTURA) countries, we present a list of key recommendations to strengthen AMR surveillance. We propose 10 primary considerations under 3 broad categories, including recommendations on (1) laboratory and testing practices, (2) data management and analysis, and (3) data use.
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Affiliation(s)
- Ahmed Taha Aboushady
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Kien Pham
- International Vaccine Institute, Seoul, Republic of Korea
| | - Adam Clark
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | - Marianne Holm
- International Vaccine Institute, Seoul, Republic of Korea
| | - Hea Sun Joh
- International Vaccine Institute, Seoul, Republic of Korea
| | - Nimesh Poudyal
- International Vaccine Institute, Seoul, Republic of Korea
| | - John Stelling
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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15
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Holm M, MacWright WR, Poudyal N, Shaw A, Joh HS, Gallagher P, Kim JH, Shaikh A, Seo HJ, Kwon SY, Prifti K, Dolabella B, Taylor BEW, Yeats C, Aanensen DM, Stelling J, Marks F. Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia (CAPTURA). Clin Infect Dis 2023; 77:S500-S506. [PMID: 38118015 PMCID: PMC10732560 DOI: 10.1093/cid/ciad567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND In 2015, the UK government established the Fleming Fund with the aim to address critical gaps in surveillance of antimicrobial resistance (AMR) in low- and middle-income countries in Asia and Africa. Among a large portfolio of grants, the Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia (CAPTURA) project was awarded with the specific objective of expanding the volume of historical data on AMR, consumption (AMC), and use (AMU) in the human healthcare sector across 12 countries in South and Southeast Asia. METHODS Starting in early 2019, the CAPTURA consortium began working with local governments and >100 relevant data-holding facilities across the region to identify, assess for quality, prioritize, and subsequently retrieve data on AMR, AMC, and AMU. Relevant and shared data were collated and analyzed to provide local overviews for national stakeholders as well as regional context, wherever possible. RESULTS From the vast information resource generated on current surveillance capacity and data availability, the project has highlighted gaps and areas for quality improvement and supported comprehensive capacity-building activities to optimize local data-collection and -management practices. CONCLUSIONS The project has paved the way for expansion of surveillance networks to include both the academic and private sector in several countries and has actively engaged in discussions to promote data sharing at the local, national, and regional levels. This paper describes the overarching approach to, and emerging lessons from, the CAPTURA project, and how it contributes to other ongoing efforts to strengthen national AMR surveillance in the region and globally.
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Affiliation(s)
- Marianne Holm
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Nimesh Poudyal
- International Vaccine Institute, Seoul, Republic of Korea
| | - Alina Shaw
- Public Health Surveillance Group LLC, Princeton, New Jersey, USA
| | - Hea Sun Joh
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Jong-Hoon Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Affan Shaikh
- Public Health Surveillance Group LLC, Princeton, New Jersey, USA
| | - Hye Jin Seo
- International Vaccine Institute, Seoul, Republic of Korea
| | - Soo Young Kwon
- International Vaccine Institute, Seoul, Republic of Korea
| | - Kristi Prifti
- International Vaccine Institute, Seoul, Republic of Korea
| | - Brooke Dolabella
- Public Health Surveillance Group LLC, Princeton, New Jersey, USA
| | - Ben E W Taylor
- Centre for Genomic Pathogen Surveillance, Big Data Institute, Oxford University, Oxford, United Kingdom
| | - Corin Yeats
- Centre for Genomic Pathogen Surveillance, Big Data Institute, Oxford University, Oxford, United Kingdom
| | - David M Aanensen
- Centre for Genomic Pathogen Surveillance, Big Data Institute, Oxford University, Oxford, United Kingdom
| | - John Stelling
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
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16
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Poudyal N, Holm M, Joh HS, Gautam S, Sujan MJ, Kwon SY, Sahikh A, Shaw A, Gallagher P, Prifti K, Cho A, Chi KYK, Aboushady AT, MacWright WR, Stelling J, Marks F. Effective Stakeholder Engagement for Collation, Analysis and Expansion of Antimicrobial Resistance (AMR) Data: A CAPTURA Experience. Clin Infect Dis 2023; 77:S519-S527. [PMID: 38118005 PMCID: PMC10732561 DOI: 10.1093/cid/ciad585] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND An effective implementation of antimicrobial resistance (AMR) surveillance projects requires sustainable and multidisciplinary engagement with stakeholders from various backgrounds, interests and aims. The "Capturing Data on Antimicrobial resistance Patterns and Trends in Use in Regions of Asia" (CAPTURA) project, funded by the Fleming Fund, initially targeted 12 countries in South Asia (SA) and Southeast Asia (SEA) to "expand the volume of historical and current data on AMR and antimicrobial usage" and support local agencies through capacity building activities. METHODS In this article, we focus on early stakeholder engagement activities and present overall statistics on AMR data collated from 72 laboratories across seven countries. This included 2.3 million records of antimicrobial susceptibility testing (AST) data, which were curated, analyzed, and shared back to the facilities for informed decision making. RESULTS Approximately 98% of the data collated by CAPTURA originated from laboratories based in SA countries. Furthermore, country-wide data were analyzed to identify commonly reported pathogens in each country, followed by descriptions of AST practices and multidrug-resistant (MDR) pathogens. Overall, we found meager adherence to standard guidelines to perform and record AST results, and a significant number of MDR pathogens were reported. CONCLUSIONS We conclude that close collaboration with the existing national mechanisms for identifying AMR data sources was crucial for the project's success. Although we show a vast retrospective dataset on AMR is available for data sharing in Asia, there remain critical gaps in data generation/management practice and analysis capacity for AMR data at most facilities.
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Affiliation(s)
- Nimesh Poudyal
- International Vaccine Institute, Seoul, Republic of Korea
| | - Marianne Holm
- Research & Collaboration, Anka Analytica, Melbourne, Australia
| | - Hea Sun Joh
- International Vaccine Institute, Seoul, Republic of Korea
| | - Sanjay Gautam
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Soo Young Kwon
- International Vaccine Institute, Seoul, Republic of Korea
| | - Affan Sahikh
- Public Health Surveillance Group LLC, Princeton, USA
| | - Alina Shaw
- Public Health Surveillance Group LLC, Princeton, USA
| | | | - Kristi Prifti
- International Vaccine Institute, Seoul, Republic of Korea
| | - Alyssa Cho
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Ahmed Taha Aboushady
- International Vaccine Institute, Seoul, Republic of Korea
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - John Stelling
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
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17
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Kwon SY, Gautam S, Poudel K, Banneheke H, Ferreira D, Gautam M, Hau'ofa M, Mahmood N, Phommalad B, Sujan MJ, Yangzom P, Joh HS, Shaw A, Dolabella B, Seo HJ, Kim JH, Gallagher P, MacWright WR, Poudyal N, Marks F, Holm M. Utility and Evaluation of Applied Project Management Processes Within a Large Multicountry Health Systems Development Project Conducted During the Coronavirus Disease 2019 (COVID-19) Pandemic. Clin Infect Dis 2023; 77:S543-S548. [PMID: 38118010 PMCID: PMC10732556 DOI: 10.1093/cid/ciad549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Indexed: 12/22/2023] Open
Abstract
The increasing trends in antimicrobial resistance (AMR) continue to pose a significant threat to human health, with grave consequences in low- and middle-income countries. In collaboration with local governments and microbiology laboratories in South Asian and Southeast Asian countries, the Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia (CAPTURA) project worked to identify gaps and expand the volume of existing AMR data to inform decision-makers on how to best strengthen their national AMR surveillance capacity. This article describes overall project management processes and the strategies implemented to address the disruptive impact of the coronavirus disease 2019 (COVID-19) pandemic on the project activities across diverse contexts in different countries. Also, it assesses in-country team's feedback on the conduct of activities and their overall impact on project completion. The strategies employed were tailored to the specific context of each country and included increased communication and collaboration among consortium partners and in-country teams, as well as hiring of additional in-country team members. This paper highlights the importance of local representation and capacities as well as real-time (virtual) engagement with stakeholders, ensuring close monitoring of the local situation and ability to tailor context-specific mitigation strategies to continue project implementation during disruptive external circumstances.
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Affiliation(s)
- Soo Young Kwon
- International Vaccine Institute, Seoul, Republic of Korea
| | - Sanjay Gautam
- International Vaccine Institute, Seoul, Republic of Korea
- Research and Collaboration, Anka Analytica, Melbourne, Australia
| | - Kritika Poudel
- Research and Collaboration, Anka Analytica, Melbourne, Australia
| | - Hasini Banneheke
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Boralesgamuwa, Sri Lanka
| | - Delfim Ferreira
- National Directorate of Pharmacy and Medicines, Ministry of Health, Díli, Timor-Leste
| | - Manish Gautam
- Public Health Research, Anweshan Private Limited, Lalitpur, Nepal
| | | | | | - Bouahome Phommalad
- Food and Drug Department, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | | | - Pema Yangzom
- National Medical Service, Royal Government of Bhutan, Thimpu, Bhutan
| | - Hea Sun Joh
- International Vaccine Institute, Seoul, Republic of Korea
| | - Alina Shaw
- Public Health Surveillance Group, LLC, Princeton, New Jersey, USA
| | - Brooke Dolabella
- Public Health Surveillance Group, LLC, Princeton, New Jersey, USA
| | - Hye Jin Seo
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jong-Hoon Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | - Nimesh Poudyal
- International Vaccine Institute, Seoul, Republic of Korea
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Heidelberg Institute of Global Health, University of Heidelberg, Germany
- Madagascar Institute for Vaccine Research, University of Antananarivo, Madagascar
| | - Marianne Holm
- International Vaccine Institute, Seoul, Republic of Korea
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18
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Tadesse BT, Keddy KH, Rickett NY, Zhusupbekova A, Poudyal N, Lawley T, Osman M, Dougan G, Kim JH, Lee JS, Jeon HJ, Marks F. Vaccination to Reduce Antimicrobial Resistance Burden-Data Gaps and Future Research. Clin Infect Dis 2023; 77:S597-S607. [PMID: 38118013 PMCID: PMC10732565 DOI: 10.1093/cid/ciad562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Antimicrobial resistance (AMR) poses an immediate danger to global health. If unaddressed, the current upsurge in AMR threatens to reverse the achievements in reducing the infectious disease-associated mortality and morbidity associated with antimicrobial treatment. Consequently, there is an urgent need for strategies to prevent or slow the progress of AMR. Vaccines potentially contribute both directly and indirectly to combating AMR. Modeling studies have indicated significant gains from vaccination in reducing AMR burdens for specific pathogens, reducing mortality/morbidity, and economic loss. However, quantifying the real impact of vaccines in these reductions is challenging because many of the study designs used to evaluate the contribution of vaccination programs are affected by significant background confounding, and potential selection and information bias. Here, we discuss challenges in assessing vaccine impact to reduce AMR burdens and suggest potential approaches for vaccine impact evaluation nested in vaccine trials.
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Affiliation(s)
- Birkneh Tilahun Tadesse
- International Vaccine Institute, Seoul, Republic of Korea
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | | | - Nimesh Poudyal
- International Vaccine Institute, Seoul, Republic of Korea
| | - Trevor Lawley
- Wellcome Sanger Institute and Microbiotica, Cambridge, United Kingdom
| | - Majdi Osman
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Gordon Dougan
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
- Seoul National University, College of Natural Sciences, Seoul, Republic of Korea
| | - Jung-Seok Lee
- International Vaccine Institute, Seoul, Republic of Korea
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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19
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Joh HS, Yeats C, Shaw A, Poudyal N, Gallagher P, Kim JH, Shaikh A, Seo HJ, Chi KYK, Prifti K, Cho A, Sujan MJ, Eraly E, Pham KD, Shrestha S, Aboushady AT, Pak G, Jang G, Park EL, Seo HW, Abudahab K, Taylor BEW, Clark A, Dolabella B, Yoon H, Han J, Kwon SY, Marks F, Stelling J, Aanensen DM, MacWright WR, Holm M. Methodological Approach to Identify and Expand the Volume of Antimicrobial Resistance (AMR) Data in the Human Health Sector in Low- and Middle-Income Countries in Asia: Implications for Local and Regional AMR Surveillance Systems Strengthening. Clin Infect Dis 2023; 77:S507-S518. [PMID: 38118007 PMCID: PMC10732564 DOI: 10.1093/cid/ciad634] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Antimicrobial resistance (AMR) is a multifaceted global health problem disproportionately affecting low- and middle-income countries (LMICs). The Capturing data on Antimicrobial resistance Patterns and Trends in Use in Regions of Asia (CAPTURA) project was tasked to expand the volume of AMR and antimicrobial use data in Asia. The CAPTURA project used 2 data-collection streams: facility data and project metadata. Project metadata constituted information collected to map out data sources and assess data quality, while facility data referred to the retrospective data collected from healthcare facilities. A down-selection process, labelled "the funnel approach" by the project, was adopted to use the project metadata in prioritizing and selecting laboratories for retrospective AMR data collection. Moreover, the metadata served as a guide for understanding the AMR data once they were collected. The findings from CAPTURA's metadata add to the current discourse on the limitation of AMR data in LMICs. There is generally a low volume of AMR data generated as there is a lack of microbiology laboratories with sufficient antimicrobial susceptibility testing capacity. Many laboratories in Asia are still capturing data on paper, resulting in scattered or unused data not readily accessible or shareable for analyses. There is also a lack of clinical and epidemiological data captured, impeding interpretation and in-depth understanding of the AMR data. CAPTURA's experience in Asia suggests that there is a wide spectrum of capacity and capability of microbiology laboratories within a country and region. As local AMR surveillance is a crucial instrument to inform context-specific measures to combat AMR, it is important to understand and assess current capacity-building needs while implementing activities to enhance surveillance systems.
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Affiliation(s)
- Hea Sun Joh
- International Vaccine Institute, Seoul, Republic of Korea
| | - Corin Yeats
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, United Kingdom
| | - Alina Shaw
- Public Health Surveillance Group, LLC, Princeton, New Jersey, USA
| | - Nimesh Poudyal
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Jong-Hoon Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Affan Shaikh
- Public Health Surveillance Group, LLC, Princeton, New Jersey, USA
| | - Hye Jin Seo
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Kristi Prifti
- International Vaccine Institute, Seoul, Republic of Korea
| | - Alyssa Cho
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Emmanuel Eraly
- International Vaccine Institute, Seoul, Republic of Korea
| | - Kien Duc Pham
- International Vaccine Institute, Seoul, Republic of Korea
| | - Subha Shrestha
- International Vaccine Institute, Seoul, Republic of Korea
| | - Ahmed Taha Aboushady
- International Vaccine Institute, Seoul, Republic of Korea
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gideok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | - GeunHyeog Jang
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Hyeong-Won Seo
- International Vaccine Institute, Seoul, Republic of Korea
| | - Khalil Abudahab
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, United Kingdom
| | - Ben E W Taylor
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, United Kingdom
| | - Adam Clark
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brooke Dolabella
- Public Health Surveillance Group, LLC, Princeton, New Jersey, USA
| | - Hyein Yoon
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jihyun Han
- International Vaccine Institute, Seoul, Republic of Korea
| | - Soo Young Kwon
- International Vaccine Institute, Seoul, Republic of Korea
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | - John Stelling
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David M Aanensen
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, United Kingdom
| | | | - Marianne Holm
- International Vaccine Institute, Seoul, Republic of Korea
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20
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Prifti K, Chi KYK, Eraly E, Joh HS, Sujan MJ, Poudyal N, Marks F, Holm M. Collecting Multi-country Retrospective Antimicrobial Consumption and Use Data: Challenges and Experience. Clin Infect Dis 2023; 77:S528-S535. [PMID: 38118011 PMCID: PMC10732554 DOI: 10.1093/cid/ciad667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Indexed: 12/22/2023] Open
Abstract
Excessive or inappropriate antimicrobial use contributes to antimicrobial resistance, emphasizing the need to monitor and document the types and quantities of antibiotics used. Thus, data on antimicrobial consumption (AMC) and antimicrobial usage (AMU) are key in informing and promoting judicious use. Our study, conducted during 2019-2023, as part of the CAPTURA project, aimed to understand the state of data availability and quality for AMC and AMU monitoring in Asia. In this article, we describe the challenges and opportunities faced and provide examples of AMU and AMC analysis. World Health Organization (WHO) and country-tailored methodologies and tools were applied to collect retrospective data from 2016 to 2019 in Bangladesh, Bhutan, Laos, Nepal, Pakistan, Papua New Guinea, Sri Lanka, and Timor-Leste. The primary indicator for national AMC was total level of consumption, expressed as total defined daily doses (DDD) per 1000 inhabitants per day for the year or period of data collected. For facility AMC and AMU, the primary indicator was total DDD per admissions per day for the year or period of data collected. Although many countries faced infrastructural challenges in data collection and storage, we managed to collect and analyze AMC data from 6 countries and AMU data from 5. The primary indicators, and additional findings, were visualized to facilitate dissemination and promote the development of action plans. Looking ahead, it is crucial that future initiatives empower each country to establish surveillance infrastructures tailored to their unique contexts, ensuring sustainable progress in the fight against antimicrobial resistance.
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Affiliation(s)
- Kristi Prifti
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Emmanuel Eraly
- International Vaccine Institute, Seoul, Republic of Korea
| | - Hea Sun Joh
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Nimesh Poudyal
- International Vaccine Institute, Seoul, Republic of Korea
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | - Marianne Holm
- International Vaccine Institute, Seoul, Republic of Korea
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Joh HS, Dolabella B, Early E, Stelling J, Ak G, Upadhyaya MK, Rahman A, Chuki P, MacWright WR, Ondoa P, Sarkar S, Moore C, Holm M, Leslie T, Zellweger RM, Paing G, Kwon SY, Marks F, Poudyal N. CAPTURA Regional Workshop Proceedings (28-30 June 2022, Virtual). Clin Infect Dis 2023; 77:S536-S542. [PMID: 38118006 PMCID: PMC10732551 DOI: 10.1093/cid/ciad568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
In response to the global threat of antimicrobial resistance (AMR), the Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia (CAPTURA) project worked with microbiology laboratories, pharmacies, and local governments in South Asia and Southeast Asia to expand the volume of historical and current data available on AMR and antimicrobial use and to identify gaps in data and areas for quality improvement. When the CAPTURA project completed its country-level engagement in the first half of 2022, the consortium brought together local, regional, and global AMR stakeholders for a virtual regional workshop to review data outputs from the project and share strategies to inform national and regional efforts to combat AMR. This paper summarizes the main topics presented in the workshop held from 28 to 30 June 2022. As such, it highlights lessons learned from the project and strategies to fight AMR. Although CAPTURA has been invaluable to countries and information from the project is already being used, barriers concerning data quality and sharing remain. Regional-level initiatives should continue to build on the momentum gained from the CAPTURA project in supporting national-level surveillance and data quality improvements to inform critical decisions around planning, policies, and clinical care. Project findings have highlighted that issues with antimicrobial resistance and use are wide ranging across countries. Going forward, building on the current foundations and tailoring approaches to meet local needs and capacities will be fundamental in combatting AMR.
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Affiliation(s)
- Hea Sun Joh
- International Vaccine Institute, Seoul, Republic of Korea
| | - Brooke Dolabella
- Public Health Surveillance Group, LLC, Princeton, New Jersey, USA
| | - Emmanuel Early
- International Vaccine Institute, Seoul, Republic of Korea
| | - John Stelling
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gabriella Ak
- Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | | | - Aninda Rahman
- Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Pem Chuki
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | | | - Pascale Ondoa
- African Society for Laboratory Medicine, Addis Ababa, Ethiopia
- Department of Global Health, Amsterdam Institute for Global health and Development, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Catrin Moore
- Institute of Infection and Immunity at St George’s, University of London, London, United Kingdom
| | - Marianne Holm
- International Vaccine Institute, Seoul, Republic of Korea
| | - Toby Leslie
- Fleming Fund Management Agent, Mott MacDonald, London, United Kingdom
| | | | - Giyoung Paing
- International Vaccine Institute, Seoul, Republic of Korea
| | - Soo Young Kwon
- International Vaccine Institute, Seoul, Republic of Korea
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | - Nimesh Poudyal
- International Vaccine Institute, Seoul, Republic of Korea
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Tadesse BT, Khanam F, Ahmmed F, Liu X, Islam MT, Kim DR, Kang SS, Im J, Chowdhury F, Ahmed T, Aziz AB, Hoque M, Park J, Pak G, Jeon HJ, Zaman K, Khan AI, Kim JH, Marks F, Qadri F, Clemens JD. Association Among Household Water, Sanitation, and Hygiene (WASH) Status and Typhoid Risk in Urban Slums: Prospective Cohort Study in Bangladesh. JMIR Public Health Surveill 2023; 9:e41207. [PMID: 37983081 PMCID: PMC10696503 DOI: 10.2196/41207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/30/2023] [Accepted: 10/05/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Typhoid fever, or enteric fever, is a highly fatal infectious disease that affects over 9 million people worldwide each year, resulting in more than 110,000 deaths. Reduction in the burden of typhoid in low-income countries is crucial for public health and requires the implementation of feasible water, sanitation, and hygiene (WASH) interventions, especially in densely populated urban slums. OBJECTIVE In this study, conducted in Mirpur, Bangladesh, we aimed to assess the association between household WASH status and typhoid risk in a training subpopulation of a large prospective cohort (n=98,087), and to evaluate the performance of a machine learning algorithm in creating a composite WASH variable. Further, we investigated the protection associated with living in households with improved WASH facilities and in clusters with increasing prevalence of such facilities during a 2-year follow-up period. METHODS We used a machine learning algorithm to create a dichotomous composite variable ("Better" and "Not Better") based on 3 WASH variables: private toilet facility, safe drinking water source, and presence of water filter. The algorithm was trained using data from the training subpopulation and then validated in a distinct subpopulation (n=65,286) to assess its sensitivity and specificity. Cox regression models were used to evaluate the protective effect of living in "Better" WASH households and in clusters with increasing levels of "Better" WASH prevalence. RESULTS We found that residence in households with improved WASH facilities was associated with a 38% reduction in typhoid risk (adjusted hazard ratio=0.62, 95% CI 0.49-0.78; P<.001). This reduction was particularly pronounced in individuals younger than 10 years at the first census participation, with an adjusted hazard ratio of 0.49 (95% CI 0.36-0.66; P<.001). Furthermore, we observed an inverse relationship between the prevalence of "Better" WASH facilities in clusters and the incidence of typhoid, although this association was not statistically significant in the multivariable model. Specifically, the adjusted hazard of typhoid decreased by 0.996 (95% CI 0.986-1.006) for each percent increase in the prevalence of "Better" WASH in the cluster (P=.39). CONCLUSIONS Our findings demonstrate that existing variations in household WASH are associated with differences in the risk of typhoid in densely populated urban slums. This suggests that attainable improvements in WASH facilities can contribute to enhanced typhoid control, especially in settings where major infrastructural improvements are challenging. These findings underscore the importance of implementing and promoting comprehensive WASH interventions in low-income countries as a means to reduce the burden of typhoid and improve public health outcomes in vulnerable populations.
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Affiliation(s)
- Birkneh Tilahun Tadesse
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Farhana Khanam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Faisal Ahmmed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Xinxue Liu
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford, Oxford, United Kingdom
| | - Md Taufiqul Islam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Deok Ryun Kim
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Sophie Sy Kang
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Justin Im
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Fahima Chowdhury
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Tasnuva Ahmed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Asma Binte Aziz
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Masuma Hoque
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Juyeon Park
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Gideok Pak
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Hyon Jin Jeon
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Khalequ Zaman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ashraful Islam Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Jerome H Kim
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Florian Marks
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - John D Clemens
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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23
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Islam MT, Im J, Ahmmed F, Kim DR, Tadesse BT, Kang S, Khanam F, Chowdhury F, Ahmed T, Firoj MG, Aziz AB, Hoque M, Park J, Jeon HJ, Kanungo S, Dutta S, Zaman K, Khan AI, Marks F, Kim JH, Qadri F, Clemens JD. Better Existing Water, Sanitation, and Hygiene Can Reduce the Risk of Cholera in an Endemic Setting: Results From a Prospective Cohort Study From Kolkata, India. Open Forum Infect Dis 2023; 10:ofad535. [PMID: 38023545 PMCID: PMC10662546 DOI: 10.1093/ofid/ofad535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Global cholera control efforts rely heavily on effective water, sanitation, and hygiene (WASH) interventions in cholera-endemic settings. Methods Using data from a large, randomized controlled trial of oral cholera vaccine conducted in Kolkata, India, we evaluated whether natural variations in WASH in an urban slum setting were predictive of cholera risk. From the control population (n = 55 086), baseline WASH data from a randomly selected "training subpopulation" (n = 27 634) were analyzed with recursive partitioning to develop a dichotomous ("better" vs "not better") composite household WASH variable from several WASH features collected at baseline, and this composite variable was then evaluated in a mutually exclusive "validation population" (n = 27 452). We then evaluated whether residents of better WASH households in the entire population (n = 55 086) experienced lower cholera risk using Cox regression models. Better WASH was defined by a combination of 4 dichotomized WASH characteristics including safe source of water for daily use, safe source of drinking water, private or shared flush toilet use, and always handwashing with soap after defecation. Results Residence in better WASH households was associated with a 30% reduction in risk of cholera over a 5-year period (adjusted hazard ratio, 0.70 [95% confidence interval, .49-.99]; P = .048). We also found that the impact of better WASH households on reducing cholera risk was greatest in young children (0-4 years) and this effect progressively declined with age. Conclusions The evidence suggests that modest improvements in WASH facilities and behaviors significantly modify cholera risk and may be an important component of cholera prevention and elimination strategies in endemic settings. Clinical Trials Registration. NCT00289224.
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Affiliation(s)
- Md Taufiqul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Justin Im
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Faisal Ahmmed
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Deok Ryun Kim
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Birkneh Tilahun Tadesse
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Sophie Kang
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Farhana Khanam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fahima Chowdhury
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tasnuva Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md Golam Firoj
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Asma Binte Aziz
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Masuma Hoque
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Juyeon Park
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Hyon Jin Jeon
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Suman Kanungo
- National Institute of Cholera and Enteric Diseases, Indian Council of Medical Research, Kolkata, West Bengal, India
| | - Shanta Dutta
- National Institute of Cholera and Enteric Diseases, Indian Council of Medical Research, Kolkata, West Bengal, India
| | - Khalequ Zaman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Ashraful Islam Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Florian Marks
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Jerome H Kim
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - John D Clemens
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Epidemiology, Public Health, Impact Unit, International Vaccine Institute, Seoul, Republic of Korea
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
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24
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Van Puyvelde S, de Block T, Sridhar S, Bawn M, Kingsley RA, Ingelbeen B, Beale MA, Barbé B, Jeon HJ, Mbuyi-Kalonji L, Phoba MF, Falay D, Martiny D, Vandenberg O, Affolabi D, Rutanga JP, Ceyssens PJ, Mattheus W, Cuypers WL, van der Sande MAB, Park SE, Kariuki S, Otieno K, Lusingu JPA, Mbwana JR, Adjei S, Sarfo A, Agyei SO, Asante KP, Otieno W, Otieno L, Tahita MC, Lompo P, Hoffman IF, Mvalo T, Msefula C, Hassan-Hanga F, Obaro S, Mackenzie G, Deborggraeve S, Feasey N, Marks F, MacLennan CA, Thomson NR, Jacobs J, Dougan G, Kariuki S, Lunguya O. A genomic appraisal of invasive Salmonella Typhimurium and associated antibiotic resistance in sub-Saharan Africa. Nat Commun 2023; 14:6392. [PMID: 37872141 PMCID: PMC10593746 DOI: 10.1038/s41467-023-41152-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/23/2023] [Indexed: 10/25/2023] Open
Abstract
Invasive non-typhoidal Salmonella (iNTS) disease manifesting as bloodstream infection with high mortality is responsible for a huge public health burden in sub-Saharan Africa. Salmonella enterica serovar Typhimurium (S. Typhimurium) is the main cause of iNTS disease in Africa. By analysing whole genome sequence data from 1303 S. Typhimurium isolates originating from 19 African countries and isolated between 1979 and 2017, here we show a thorough scaled appraisal of the population structure of iNTS disease caused by S. Typhimurium across many of Africa's most impacted countries. At least six invasive S. Typhimurium clades have already emerged, with ST313 lineage 2 or ST313-L2 driving the current pandemic. ST313-L2 likely emerged in the Democratic Republic of Congo around 1980 and further spread in the mid 1990s. We observed plasmid-borne as well as chromosomally encoded fluoroquinolone resistance underlying emergences of extensive-drug and pan-drug resistance. Our work provides an overview of the evolution of invasive S. Typhimurium disease, and can be exploited to target control measures.
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Affiliation(s)
- Sandra Van Puyvelde
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 0AW, UK.
- Parasites and Microbes Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK.
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
| | | | - Sushmita Sridhar
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 0AW, UK
- Parasites and Microbes Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
- Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Matt Bawn
- Quadram Institute Bioscience, Norwich, UK
- Earlham Institute, Norwich, UK
- Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Robert A Kingsley
- Quadram Institute Bioscience, Norwich, UK
- School of Biological Science, University of East Anglia, Norwich, UK
| | - Brecht Ingelbeen
- Institute of Tropical Medicine, Antwerp, Belgium
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Mathew A Beale
- Parasites and Microbes Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | | | - Hyon Jin Jeon
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 0AW, UK
- International Vaccine Institute, 1 Gwanak-ro, Seoul, 08826, Republic of Korea
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | - Lisette Mbuyi-Kalonji
- Department of Medical Biology, University Teaching Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Marie-France Phoba
- Department of Medical Biology, University Teaching Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Dadi Falay
- Department of Pediatrics, University Hospital of Kisangani, Kisangani, Democratic Republic of the Congo
| | - Delphine Martiny
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles-Universitair Laboratorium Brussel (LHUB-ULB), Université Libre de Bruxelles (ULB), 1000, Brussels, Belgium
- Faculty of Medicine and Pharmacy, University of Mons (UMONS), 7000, Mons, Belgium
| | - Olivier Vandenberg
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles-Universitair Laboratorium Brussel (LHUB-ULB), Université Libre de Bruxelles (ULB), 1000, Brussels, Belgium
- Division of Infection and Immunity, Faculty of Medical Sciences, University College London, London, UK
| | - Dissou Affolabi
- Centre National Hospitalier Universitaire Hubert Koutoukou Maga, Cotonou, Benin
| | - Jean Pierre Rutanga
- Institute of Tropical Medicine, Antwerp, Belgium
- College of Science and Technology, University of Rwanda, Kigali, Rwanda
| | - Pieter-Jan Ceyssens
- National Reference Center for Salmonella, Unit of Human Bacterial Diseases, Sciensano, J. Wytsmanstraat 14, B-1050, Brussels, Belgium
| | - Wesley Mattheus
- National Reference Center for Salmonella, Unit of Human Bacterial Diseases, Sciensano, J. Wytsmanstraat 14, B-1050, Brussels, Belgium
| | - Wim L Cuypers
- Institute of Tropical Medicine, Antwerp, Belgium
- Department of Computer Science, University of Antwerp, Antwerp, Belgium
| | - Marianne A B van der Sande
- Institute of Tropical Medicine, Antwerp, Belgium
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Se Eun Park
- International Vaccine Institute, 1 Gwanak-ro, Seoul, 08826, Republic of Korea
- Yonsei University Graduate School of Public Health, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Simon Kariuki
- Kenya Medical Research Institute/Centre for Global Health Research, Kisumu, Kenya
| | - Kephas Otieno
- Kenya Medical Research Institute/Centre for Global Health Research, Kisumu, Kenya
| | - John P A Lusingu
- National Institute for Medical Research, Tanga, Tanzania
- Center for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, København, Denmark
| | - Joyce R Mbwana
- National Institute for Medical Research, Tanga, Tanzania
| | - Samuel Adjei
- University of Health & Allied Sciences, Ho, Volta Region, Ghana
| | - Anima Sarfo
- University of Health & Allied Sciences, Ho, Volta Region, Ghana
| | - Seth O Agyei
- University of Health & Allied Sciences, Ho, Volta Region, Ghana
| | - Kwaku P Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Ho, Volta Region, Ghana
| | | | | | - Marc C Tahita
- Institut de Recherche en Science de la Santé, Direction Régionale du Centre-Ouest/ClinicalResearch Unit of Nanoro, Nanoro, Burkina Faso
| | - Palpouguini Lompo
- Institut de Recherche en Science de la Santé, Direction Régionale du Centre-Ouest/ClinicalResearch Unit of Nanoro, Nanoro, Burkina Faso
| | | | - Tisungane Mvalo
- University of North Carolina Project, Lilongwe, Malawi
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chisomo Msefula
- Malawi Liverpool Wellcome Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Fatimah Hassan-Hanga
- Department of Paediatrics, Bayero University, Kano, Nigeria
- Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Stephen Obaro
- University of Nebraska Medical Center, Omaha, NE, USA
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - Grant Mackenzie
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | | | - Nicholas Feasey
- University of North Carolina Project, Lilongwe, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Florian Marks
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 0AW, UK
- International Vaccine Institute, 1 Gwanak-ro, Seoul, 08826, Republic of Korea
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Calman A MacLennan
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Nicholas R Thomson
- Parasites and Microbes Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Jan Jacobs
- Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Gordon Dougan
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 0AW, UK
| | - Samuel Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Octavie Lunguya
- Department of Medical Biology, University Teaching Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
- National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo
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25
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Kim CL, Agampodi S, Marks F, Kim JH, Excler JL. Mitigating the effects of climate change on human health with vaccines and vaccinations. Front Public Health 2023; 11:1252910. [PMID: 37900033 PMCID: PMC10602790 DOI: 10.3389/fpubh.2023.1252910] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/04/2023] [Indexed: 10/31/2023] Open
Abstract
Climate change represents an unprecedented threat to humanity and will be the ultimate challenge of the 21st century. As a public health consequence, the World Health Organization estimates an additional 250,000 deaths annually by 2030, with resource-poor countries being predominantly affected. Although climate change's direct and indirect consequences on human health are manifold and far from fully explored, a growing body of evidence demonstrates its potential to exacerbate the frequency and spread of transmissible infectious diseases. Effective, high-impact mitigation measures are critical in combating this global crisis. While vaccines and vaccination are among the most cost-effective public health interventions, they have yet to be established as a major strategy in climate change-related health effect mitigation. In this narrative review, we synthesize the available evidence on the effect of climate change on vaccine-preventable diseases. This review examines the direct effect of climate change on water-related diseases such as cholera and other enteropathogens, helminthic infections and leptospirosis. It also explores the effects of rising temperatures on vector-borne diseases like dengue, chikungunya, and malaria, as well as the impact of temperature and humidity on airborne diseases like influenza and respiratory syncytial virus infection. Recent advances in global vaccine development facilitate the use of vaccines and vaccination as a mitigation strategy in the agenda against climate change consequences. A focused evaluation of vaccine research and development, funding, and distribution related to climate change is required.
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Affiliation(s)
- Cara Lynn Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Suneth Agampodi
- International Vaccine Institute, Seoul, Republic of Korea
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Jerome H. Kim
- International Vaccine Institute, Seoul, Republic of Korea
- College of Natural Sciences, Seoul National University, Seoul, Republic of Korea
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Yao L, Chemaitelly H, Goldman E, Gudina EK, Khalil A, Ahmed R, James AB, Roca A, Fallah MP, Macnab A, Cho WC, Eikelboom J, Qamar FN, Kremsner P, Oliu-Barton M, Sisa I, Tadesse BT, Marks F, Wang L, Kim JH, Meng X, Wang Y, Fly AD, Wang CY, Day SW, Howard SC, Graff JC, Maida M, Ray K, Franco-Paredes C, Mashe T, Ngongo N, Kaseya J, Ndembi N, Hu Y, Bottazzi ME, Hotez PJ, Ishii KJ, Wang G, Sun D, Aleya L, Gu W. Time to establish an international vaccine candidate pool for potential highly infectious respiratory disease: a community's view. EClinicalMedicine 2023; 64:102222. [PMID: 37811488 PMCID: PMC10550631 DOI: 10.1016/j.eclinm.2023.102222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/26/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
In counteracting highly infectious and disruptive respiratory diseases such as COVID-19, vaccination remains the primary and safest way to prevent disease, reduce the severity of illness, and save lives. Unfortunately, vaccination is often not the first intervention deployed for a new pandemic, as it takes time to develop and test vaccines, and confirmation of safety requires a period of observation after vaccination to detect potential late-onset vaccine-associated adverse events. In the meantime, nonpharmacologic public health interventions such as mask-wearing and social distancing can provide some degree of protection. As climate change, with its environmental impacts on pathogen evolution and international mobility continue to rise, highly infectious respiratory diseases will likely emerge more frequently and their impact is expected to be substantial. How quickly a safe and efficacious vaccine can be deployed against rising infectious respiratory diseases may be the most important challenge that humanity will face in the near future. While some organizations are engaged in addressing the World Health Organization's "blueprint for priority diseases", the lack of worldwide preparedness, and the uncertainty around universal vaccine availability, remain major concerns. We therefore propose the establishment of an international candidate vaccine pool repository for potential respiratory diseases, supported by multiple stakeholders and countries that contribute facilities, technologies, and other medical and financial resources. The types and categories of candidate vaccines can be determined based on information from previous pandemics and epidemics. Each participant country or region can focus on developing one or a few vaccine types or categories, together covering most if not all possible potential infectious diseases. The safety of these vaccines can be tested using animal models. Information for effective candidates that can be potentially applied to humans will then be shared across all participants. When a new pandemic arises, these pre-selected and tested vaccines can be quickly tested in RCTs for human populations.
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Affiliation(s)
- Lan Yao
- Department of Nutrition and Health Science, College of Health, Ball State University, Muncie, IN 47306, USA
- Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Centre, Memphis, TN 38163, USA
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Emanuel Goldman
- Department of Microbiology, Biochemistry and Molecular Genetics, New Jersey Medical School, Rutgers University, Newark, NJ 07103, USA
| | - Esayas Kebede Gudina
- Department of Internal Medicine, Jimma University Institute of Health, Jimma, Ethiopia
| | - Asma Khalil
- Fetal Medicine Unit, St George’s Hospital, St George’s University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | - Rahaman Ahmed
- Cell Biology and Genetics Department, University of Lagos, Lagos 101017, Nigeria
- Centre for Human Virology and Genomics, Microbiology Department, Nigerian Institute of Medical Research, Lagos 100001, Nigeria
| | - Ayorinde Babatunde James
- Department of Biochemistry and Nutrition, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
| | - Anna Roca
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | - Mosoka Papa Fallah
- Refuge Place International, Monrovia, Liberia
- Centre for Emerging Infectious Diseases Policy and Research, Boston University, Boston, MA, USA
- Africa Centre for Disease Control, Addis Ababa, Ethiopia
| | - Andrew Macnab
- The Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, South Africa
| | - William C. Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong, China
| | - John Eikelboom
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Karachi, Sindh 74800, Pakistan
| | - Peter Kremsner
- Institut für Tropenmedizin, Universität Tübingen, Germany
- Centre de Recherches Medicales de Lambarene, Gabon
| | - Miquel Oliu-Barton
- Université Paris Dauphine – PSL, Pl. du Maréchal de Lattre de Tassigny, Paris 75016, France
- Bruegel, Rue de la Charité 33, Brussels 1210, Belgium
| | - Ivan Sisa
- College of Health Sciences, Universidad San Francisco de Quito, Quito 170901, Ecuador
| | | | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
| | - Lishi Wang
- Department of Basic Medicine, Inner Mongolia Medical University, Jinshan Development Zone, Huhhot, China
| | - Jerome H. Kim
- International Vaccine Institute, Seoul, Republic of Korea
- Seoul National University, College of Natural Sciences, Seoul, Republic of Korea
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Alyce D. Fly
- Department of Nutrition and Health Science, College of Health, Ball State University, Muncie, IN 47306, USA
| | - Cong-Yi Wang
- NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, The Centre for Biomedical Research, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Sara W. Day
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Scott C. Howard
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - J. Carolyn Graff
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta 93100, Italy
| | - Kunal Ray
- School of Biological Science, Ramkrishna Mission Vivekananda Education & Research Institute, Narendrapur 700103, West Bengal, India
| | - Carlos Franco-Paredes
- Hospital Infantil de Mexico, Federico Gomez, Mexico
- Department of Microbiology, Immunology, and Pathology, Colorado State University, USA
| | - Tapfumanei Mashe
- One Health Office, Ministry of Health and Child Care, Harare, Zimbabwe
- World Health Organization, Harare, Zimbabwe
| | | | | | | | - Yu Hu
- Institute of Haematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
- Hubei Clinical and Research Centre of Thrombosis and Hemostasis, Wuhan, China
| | - Maria Elena Bottazzi
- Department of Pediatrics, Texas Children's Hospital Centre for Vaccine Development, Baylor College of Medicine, Houston, TX, USA
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
- Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Peter J. Hotez
- Department of Pediatrics, Texas Children's Hospital Centre for Vaccine Development, Baylor College of Medicine, Houston, TX, USA
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
- Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Ken J. Ishii
- Division of Vaccine Science, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- International Vaccine Design Centre, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Centre for Vaccine Adjuvant Research, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Gang Wang
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dianjun Sun
- Centre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University; Key Laboratory of Etiologic Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health 23618104, 157 Baojian Road, Harbin, Heilongjiang 150081, China
| | - Lotfi Aleya
- Chrono-Environnement Laboratory, UMR CNRS 6249, Bourgogne Franche-Comté University, Besançon Cedex F-25030, France
| | - Weikuan Gu
- Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Centre, Memphis, TN 38163, USA
- Research Service, Memphis VA Medical Centre, 1030 Jefferson Avenue, Memphis, TN 38104, USA
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Chae C, Kim RK, Jang EJ, Shim JA, Park E, Lee KH, Hong SL, Aziz AB, Tadesse BT, Marks F, Tak S, Lee S, Kwon D. Comparing the effectiveness of bivalent and monovalent COVID-19 vaccines against COVID-19 infection during the winter season of 2022-2023: A real-world retrospective observational matched cohort study in the Republic of Korea. Int J Infect Dis 2023; 135:95-100. [PMID: 37572956 DOI: 10.1016/j.ijid.2023.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/14/2023] Open
Abstract
OBJECTIVES To compare the effectiveness of bivalent and monovalent COVID-19 vaccines throughout the 2022-2023 winter season based on real-world data. METHODS This retrospective observational matched cohort study used the national vaccination program and a surveillance dataset from the Republic of Korea, and included adults aged >18 years who received bivalent or monovalent COVID-19 vaccines between October 11, 2022, and December 17, 2022. Cox proportional hazard models were used to estimate the hazard ratio for COVID-19 infection between the groups. RESULTS We included 29,245 matched individuals in the bivalent and monovalent vaccine groups, respectively. The bivalent vaccine recipients showed 12.2% (95% confidence interval [CI] 6.5-17.7%) additional protection against COVID-19 infection compared with the monovalent vaccine recipients. The additional protection provided by bivalent vaccines was significantly higher among residents of long-term care facilities (39.4%, 95% CI 21.6-53.1%). Maximum additional protection was observed 3 to 4 months after completing the vaccination (17.6%, 95% CI 6.6-27.3%). CONCLUSION Bivalent COVID-19 vaccines showed significantly better protection against infection than monovalent vaccines among adults during the 2022-2023 winter season. Our results highlight that immunization programs with bivalent vaccines comprising recent variants can be an effective measure to prepare for seasonal COVID-19 circulation.
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Affiliation(s)
- Chungman Chae
- Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea.
| | - Ryu Kyung Kim
- Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Eun Jung Jang
- Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Ji Ae Shim
- Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Eunkyung Park
- Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Kil Hun Lee
- Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Sye Lim Hong
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea; Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany; Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | - Sangwoo Tak
- Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Sangwon Lee
- Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Donghyok Kwon
- Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
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28
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Birkhold M, Datta S, Pak GD, Im J, Ogundoyin OO, Olulana DI, Lawal TA, Afuwape OO, Kehinde A, Phoba MF, Nkoji G, Aseffa A, Teferi M, Yeshitela B, Popoola O, Owusu M, Nana LRW, Cakpo EG, Ouedraogo M, Ouangre E, Ouedraogo I, Heroes AS, Jacobs J, Mogeni OD, Haselbeck A, Sukri L, Neuzil KM, Metila OL, Owusu-Dabo E, Adu-Sarkodie Y, Bassiahi AS, Rakotozandrindrainy R, Okeke IN, Zellweger RM, Marks F. Characterization of Typhoid Intestinal Perforation in Africa: Results From the Severe Typhoid Fever Surveillance in Africa Program. Open Forum Infect Dis 2023; 10:S67-S73. [PMID: 37274524 PMCID: PMC10236516 DOI: 10.1093/ofid/ofad138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Background Typhoid intestinal perforation (TIP) remains the most serious complication of typhoid fever. In many countries, the diagnosis of TIP relies on intraoperative identification, as blood culture and pathology capacity remain limited. As a result, many cases of TIP may not be reported as typhoid. This study demonstrates the burden of TIP in sites in Burkina Faso, Democratic Republic of Congo (DRC), Ethiopia, Ghana, Madagascar, and Nigeria. Methods Patients with clinical suspicion of nontraumatic intestinal perforation were enrolled and demographic details, clinical findings, surgical records, blood cultures, tissue biopsies, and peritoneal fluid were collected. Participants were then classified as having confirmed TIP, probable TIP, possible TIP, or clinical intestinal perforation based on surgical descriptions and cultures. Results A total of 608 participants were investigated for nontraumatic intestinal perforation; 214 (35%) participants had surgically-confirmed TIP and 33 participants (5%) had culture-confirmed typhoid. The overall proportion of blood or surgical site Salmonella enterica subspecies enterica serovar Typhi positivity in surgically verified TIP cases was 10.3%. TIP was high in children aged 5-14 years in DRC, Ghana, and Nigeria. We provide evidence for correlation between monthly case counts of S. Typhi and the occurrence of intestinal perforation. Conclusions Low S. Typhi culture positivity rates, as well as a lack of blood and tissue culture capability in many regions where typhoid remains endemic, significantly underestimate the true burden of typhoid fever. The occurrence of TIP may indicate underlying typhoid burden, particularly in countries with limited culture capability.
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Affiliation(s)
- Megan Birkhold
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Shrimati Datta
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Gi Deok Pak
- Epidemiology, Public Health, and Impact Unit (EPIC), International Vaccine Institute, Seoul, Republic of Korea
| | - Justin Im
- Epidemiology, Public Health, and Impact Unit (EPIC), International Vaccine Institute, Seoul, Republic of Korea
| | - Olakayode O Ogundoyin
- Division of Pediatric Surgery, University College Hospital and Department of Surgery, University of Ibadan, Ibadan, Nigeria
| | - Dare I Olulana
- Division of Pediatric Surgery, University College Hospital and Department of Surgery, University of Ibadan, Ibadan, Nigeria
| | - Taiwo A Lawal
- Division of Pediatric Surgery, University College Hospital and Department of Surgery, University of Ibadan, Ibadan, Nigeria
| | - Oludolapo O Afuwape
- Division of Gastrointestinal Surgery, University College Hospital and Department of Surgery, University of Ibadan, Ibadan, Nigeria
| | - Aderemi Kehinde
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Marie-France Phoba
- Department of Microbiology, Institut National de Recherche Biomedicales, Kinshasa, Democratic Republic of Congo
| | - Gaëlle Nkoji
- Department of Microbiology, Institut National de Recherche Biomedicales, Kinshasa, Democratic Republic of Congo
| | - Abraham Aseffa
- Armauer Hansen Research Institute, ALERT Campus, Addis Ababa, Ethiopia
| | - Mekonnen Teferi
- Armauer Hansen Research Institute, ALERT Campus, Addis Ababa, Ethiopia
| | - Biruk Yeshitela
- Armauer Hansen Research Institute, ALERT Campus, Addis Ababa, Ethiopia
| | - Oluwafemi Popoola
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Michael Owusu
- Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lady Rosny Wandji Nana
- Institut Supérieur des Sciences de la Population, Université Joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | - Enoch G Cakpo
- Institut Supérieur des Sciences de la Population, Université Joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | - Moussa Ouedraogo
- Laboratorie d'Analyses Medicales, Hopital Protestant Schiphra, Ouagadougou, Burkina Faso
| | - Edgar Ouangre
- Service de Chirurgie Viscérale, Hopital Yalgado, Ouagadougou, Burkina Faso
| | - Isso Ouedraogo
- Pediatric Department, Hopital Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Anne-Sophie Heroes
- Department of Tropical Bacteriology, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Jan Jacobs
- Department of Tropical Bacteriology, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Ondari D Mogeni
- Epidemiology, Public Health, and Impact Unit (EPIC), International Vaccine Institute, Seoul, Republic of Korea
| | - Andrea Haselbeck
- Epidemiology, Public Health, and Impact Unit (EPIC), International Vaccine Institute, Seoul, Republic of Korea
| | - Leah Sukri
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Octavie Lunguya Metila
- Department of Microbiology, Institut National de Recherche Biomedicales, Kinshasa, Democratic Republic of Congo
- Service de Microbiologie, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Ellis Owusu-Dabo
- Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yaw Adu-Sarkodie
- Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abdramane Soura Bassiahi
- Institut Supérieur des Sciences de la Population, Université Joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | | | - Iruka N Okeke
- Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Raphaël M Zellweger
- Epidemiology, Public Health, and Impact Unit (EPIC), International Vaccine Institute, Seoul, Republic of Korea
| | - Florian Marks
- Epidemiology, Public Health, and Impact Unit (EPIC), International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
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Chowdhury F, Aziz AB, Ahmmed F, Ahmed T, Kang SS, Im J, Park J, Tadesse BT, Islam MT, Kim DR, Hoque M, Pak G, Khanam F, McMillan NAJ, Liu X, Zaman K, Khan AI, Kim JH, Marks F, Qadri F, Clemens JD. The interplay between WASH practices and vaccination with oral cholera vaccines in protecting against cholera in urban Bangladesh: Reanalysis of a cluster-randomized trial. Vaccine 2023; 41:2368-2375. [PMID: 36898931 PMCID: PMC10102718 DOI: 10.1016/j.vaccine.2023.02.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 02/06/2023] [Accepted: 02/16/2023] [Indexed: 03/11/2023]
Abstract
The current global initiative to end Cholera by 2030 emphasizes the use of oral cholera vaccine (OCV) combined with feasible household Water-Sanitation-Hygiene (WASH) interventions. However, little is known about how improved WASH practices and behaviors and OCV interact to reduce the risk of cholera. We reanalyzed two arms of a cluster-randomized trial in urban Bangladesh, to evaluate the effectiveness of OCV given as a 2-dose regimen. One arm (30 clusters, n = 94,675) was randomized to vaccination of persons aged one year and older with OCV, and the other arm (30 clusters, n = 80,056) to no intervention. We evaluated the prevention of cholera by household WASH, classified at baseline using a previously validated rule, and OCV over 2 years of follow-up. When analyzed by assignment to OCV clusters rather than receipt of OCV, in comparison to persons living in "Not Better WASH" households in the control clusters, reduction of severe cholera (the primary outcome) was similar for persons in "Not Better WASH" households in vaccine clusters (46%, 95% CI:24,62), for persons in "Better WASH" households in the control clusters (48%, 95% CI:25,64), and for persons in "Better WASH" households in the vaccine clusters (48%, 95% CI:16,67). In contrast, when analyzed by actual receipt of a complete OCV regimen, , in comparison to persons in "Not Better WASH" households in the control clusters, protection against severe cholera increased steadily from 39% (95% CI:13,58) in residents of "Better WASH" households in the control clusters to 57% (95% CI:35,72) in vaccinated persons in "Not Better WASH" households to 63% (95% CI:21,83) in vaccinated persons in "Better WASH" households. This analysis suggests that improved household WASH and OCV received may interact to provide greater protection against cholera. However, the divergence between findings related to intent to vaccinate versus those pertaining to actual receipt of OCV underscores the need for further research on this topic.
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Affiliation(s)
- Fahima Chowdhury
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh; Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
| | | | - Faisal Ahmmed
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tasnuva Ahmed
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sophie Sy Kang
- International Vaccine Institute, Seoul, Republic of Korea
| | - Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | - Juyeon Park
- International Vaccine Institute, Seoul, Republic of Korea; Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Md Taufiqul Islam
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Deok Ryun Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Masuma Hoque
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Gideok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | - Farhana Khanam
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nigel A J McMillan
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Xinxue Liu
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Khalequ Zaman
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Ashraful Islam Khan
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea; Department of Medicine, University of Cambridge, Cambridge, United Kingdom; University of Antananarivo, Antananarivo, Madagascar
| | - Firdausi Qadri
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - John D Clemens
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh; International Vaccine Institute, Seoul, Republic of Korea; UCLA Fielding School of Public Health, Los Angeles, CA 90095-1772, USA
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30
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Tack B, Vita D, Nketo J, Wasolua N, Ndengila N, Herssens N, Ntangu E, Kasidiko G, Nkoji-Tunda G, Phoba MF, Im J, Jeon HJ, Marks F, Toelen J, Lunguya O, Jacobs J. Health itinerary-related survival of children under-five with severe malaria or bloodstream infection, DR Congo. PLoS Negl Trop Dis 2023; 17:e0011156. [PMID: 36877726 PMCID: PMC10019685 DOI: 10.1371/journal.pntd.0011156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/16/2023] [Accepted: 02/09/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Prompt appropriate treatment reduces mortality of severe febrile illness in sub-Saharan Africa. We studied the health itinerary of children under-five admitted to the hospital with severe febrile illness in a setting endemic for Plasmodium falciparum (Pf) malaria and invasive non-typhoidal Salmonella infections, identified delaying factors and assessed their associations with in-hospital death. METHODOLOGY Health itinerary data of this cohort study were collected during 6 months by interviewing caretakers of children (>28 days - <5 years) admitted with suspected bloodstream infection to Kisantu district hospital, DR Congo. The cohort was followed until discharge to assess in-hospital death. PRINCIPAL FINDINGS From 784 enrolled children, 36.1% were admitted >3 days after fever onset. This long health itinerary was more frequent in children with bacterial bloodstream infection (52.9% (63/119)) than in children with severe Pf malaria (31.0% (97/313)). Long health itinerary was associated with in-hospital death (OR = 2.1, p = 0.007) and two thirds of deaths occurred during the first 3 days of admission. Case fatality was higher in bloodstream infection (22.8% (26/114)) compared to severe Pf malaria (2.6%, 8/309). Bloodstream infections were mainly (74.8% (89/119)) caused by non-typhoidal Salmonella. Bloodstream infections occurred in 20/43 children who died in-hospital before possible enrolment and non-typhoidal Salmonella caused 16 out of these 20 bloodstream infections. Delaying factors associated with in-hospital death were consulting traditional, private and/or multiple providers, rural residence, prehospital intravenous therapy, and prehospital overnight stays. Use of antibiotics reserved for hospital use, intravenous therapy and prehospital overnight stays were most frequent in the private sector. CONCLUSIONS Long health itineraries delayed appropriate treatment of bloodstream infections in children under-five and were associated with increased in-hospital mortality. Non-typhoidal Salmonella were the main cause of bloodstream infection and had high case fatality. TRIAL REGISTRATION NCT04289688.
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Affiliation(s)
- Bieke Tack
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Pediatrics, University Hospitals UZ Leuven, Leuven, Belgium
- * E-mail:
| | - Daniel Vita
- Hôpital Général de Référence Saint Luc de Kisantu, Kisantu, Democratic Republic of the Congo
| | - José Nketo
- Zone de Santé Kisantu, Kisantu, Democratic Republic of the Congo
| | - Naomie Wasolua
- Hôpital Général de Référence Saint Luc de Kisantu, Kisantu, Democratic Republic of the Congo
| | - Nathalie Ndengila
- Hôpital Général de Référence Saint Luc de Kisantu, Kisantu, Democratic Republic of the Congo
| | - Natacha Herssens
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Emmanuel Ntangu
- Hôpital Général de Référence Saint Luc de Kisantu, Kisantu, Democratic Republic of the Congo
| | - Grace Kasidiko
- Hôpital Général de Référence Saint Luc de Kisantu, Kisantu, Democratic Republic of the Congo
| | - Gaëlle Nkoji-Tunda
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Department of Medical Biology, University Teaching Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Marie-France Phoba
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Department of Medical Biology, University Teaching Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | - Jaan Toelen
- Department of Pediatrics, University Hospitals UZ Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Octavie Lunguya
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Department of Medical Biology, University Teaching Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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Sarker AR, Khan AI, Islam MT, Chowdhury F, Khanam F, Kang S, Ahmmed F, Im J, Kim DR, Tadesse BT, Ahmed T, Aziz AB, Hoque M, Park J, Liu X, Pak G, Zaman K, Marks F, Kim JH, Clemens JD, Qadri F. Cost of oral cholera vaccine delivery in a mass immunization program for children in urban Bangladesh. Vaccine X 2022; 12:100247. [PMID: 36545347 PMCID: PMC9761845 DOI: 10.1016/j.jvacx.2022.100247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Cholera poses a substantial health burden in the developing world due to both epidemic and endemic diseases. The World Health Organization recommends oral cholera vaccines for mass vaccination campaigns in addition to traditional prevention practices and treatments in resource-poor settings. In many developing countries like Bangladesh, the major challenge behind implementing mass vaccination campaigns concerns the affordability of the oral cholera vaccine (OCV). Vaccination of children with OCV is not only an impactful approach for controlling cholera at the population level and reducing childhood morbidity but is also considered more cost-effective than vaccinating all ages. The aim of the study was to estimate the cost of an OCV campaign for children from a societal perspective using empirical study. A total of 66,311 children aged 1 to 14 years old were fully vaccinated with two doses of the OCV Shanchol while 9,035 individuals received one dose of this vaccine. The estimated societal cost per individual for full vaccination was US$ 6.11, which includes the cost of vaccine delivery estimated at US$ 1.95. The cost per single dose was estimated at US$ 2.86. The total provider cost for full vaccination was estimated at US$ 6.01 and the recipient cost at US$ 0.10. Our estimation of OCV delivery costs for children was relatively higher than what was found in a similar mass OCV campaign for all age groups, indicating that there may be additional cost factors to consider in targeted vaccine campaigns. This analysis provides useful benchmarks for the possible costs related to delivery of OCV to children and future OCV cost-effectiveness models should factor in these possible cost disparities. Attempts to reduce the cost per dose are likely to have a greater impact on the cost of similar vaccination campaigns in many resource-poor settings.
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Affiliation(s)
- Abdur Razzaque Sarker
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Bangladesh,Health Economics Unit, University of Birmingham, Birmingham, United Kingdom
| | - Ashraful Islam Khan
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh,Corresponding author at: International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Md. Taufiqul Islam
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahima Chowdhury
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farhana Khanam
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sophie Kang
- International Vaccine Institute, Seoul, Republic of Korea
| | - Faisal Ahmmed
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | - Deok Ryun Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Birkneh Tilahun Tadesse
- International Vaccine Institute, Seoul, Republic of Korea,Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, 14186 Stockholm, Sweden,Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia
| | - Tasnuva Ahmed
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Masuma Hoque
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Juyeon Park
- International Vaccine Institute, Seoul, Republic of Korea,Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge CB2 0AW, United Kingdom
| | - Xinxue Liu
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Gideok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | - Khalequ Zaman
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea,Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge CB2 0AW, United Kingdom,University of Antananarivo, Antananarivo, Madagascar,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Jerome H. Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - John D. Clemens
- International Vaccine Institute, Seoul, Republic of Korea,UCLA Fielding School of Public Health, Los Angeles, CA 90095-1772, USA
| | - Firdausi Qadri
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Tadesse BT, Bravo L, Marks F, Aziz AB, You YA, Sugimoto J, Li P, Garcia J, Rockhold F, Clemens R, Roa C, Borja-Tabora C, Carlos J, Montellano MEB, de Los Reyes MRA, Alberto ER, Salvani-Bautista M, Kim DR, Kang SSY, Njau I. Impact of vaccination with SCB-2019 COVID-19 vaccine on transmission of SARS-CoV-2 infection: a household contact study in the Philippines. Clin Infect Dis 2022; 76:1180-1187. [PMID: 36433685 PMCID: PMC10069839 DOI: 10.1093/cid/ciac914] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/11/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT
Background
An exploratory household transmission study was nested in SPECTRA, the phase 2/3 efficacy study of the adjuvanted recombinant protein-based COVID-19 vaccine SCB-2019. We compared occurrence of confirmed COVID-19 infections between households and household contacts of infected SPECTRA placebo or SCB-2019 recipients.
Methods
SPECTRA participants at eight study sites in the Philippines who developed rRT-PCR-confirmed COVID-19 were contacted by a study team blinded to assignment of index cases to vaccine or placebo groups to enroll in this household transmission study. Enrolled households and household contacts were monitored for three weeks using rRT-PCR and anti-SARS-CoV-2 N-antigen IgG/IgM testing to detect new COVID-19 infections.
Results
154 eligible COVID-19 index cases (51 vaccinees, 103 placebo) were included. The secondary attack rate per household for symptomatic COVID-19 infection was 0.76% (90% CI: 0.15–3.90) if the index case was a SCB-2019 vaccinee compared with 5.88% (90% CI: 3.20–10.8) for placebo index cases, a relative risk reduction (RRR) of 79% (90% CI: -28–97). The RRR of symptomatic COVID-19 per household member was similar: 84% (90% CI: 28–97). Impact on attack rates in household members if index cases were symptomatic (n = 130; RRR = 80%; 90% CI: 7–96) or asymptomatic (n = 24; RRR = 100%; 90% CI: -76–100) was measurable but the low numbers undermine the clinical significance.
Conclusions
In this prospective household contact study vaccination with SCB-2019 reduced SARS-CoV-2 transmission compared with placebo in households and in household members independently of whether index cases were symptomatic or not.
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Affiliation(s)
- Birkneh Tilahun Tadesse
- International Vaccine Institute , Seoul , Republic of Korea
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute , Stockholm , Sweden
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University , Addis Ababa , Ethiopia
| | - Lulu Bravo
- University of the Philippines Manila , Ermita, Manila , The Philippines
| | - Florian Marks
- International Vaccine Institute , Seoul , Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine , Cambridge , UK
- Heidelberg Institute of Global Health, University of Heidelberg , Heidelberg , Germany
- University of Antananarivo , Antananarivo , Madagascar
| | | | - Young Ae You
- International Vaccine Institute , Seoul , Republic of Korea
| | - Jonathan Sugimoto
- Seattle Epidemiologic Research and Information Center, Cooperative Studies Program, Office of Research and Development, Department of Veterans Affairs , Seattle, WA , USA
- Department of Epidemiology, University of Washington , Seattle, WA
- Vaccine and Infectious Diseases Division, Fred Hutchinson Research Institute , Seattle, WA , USA
| | - Ping Li
- Clover Biopharmaceuticals , Cambridge, MA , USA
| | | | - Frank Rockhold
- Duke Clinical Research Institute, Duke University Medical Center , Durham, NC , USA
| | - Ralf Clemens
- International Vaccine Institute , Seoul , Republic of Korea
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33
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Kang S, Chowdhury F, Park J, Ahmed T, Tadesse BT, Islam MT, Kim DR, Im J, Aziz AB, Hoque M, Pak G, Khanam F, Ahmmed F, Liu X, Zaman K, Khan AI, Kim JH, Marks F, Qadri F, Clemens JD. Are better existing WASH practices in urban slums associated with a lower long-term risk of severe cholera? A prospective cohort study with 4 years of follow-up in Mirpur, Bangladesh. BMJ Open 2022; 12:e060858. [PMID: 36130764 PMCID: PMC9494564 DOI: 10.1136/bmjopen-2022-060858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To investigate the association between existing household water quality, sanitation and hygiene (WASH) practices and severe cholera risk in a dense urban slum where cholera is highly endemic. DESIGN, SETTING AND PARTICIPANTS We assembled a large prospective cohort within a cluster randomised trial evaluating the effectiveness of oral cholera vaccine. Our dynamic cohort population (n=193 576) comprised individuals living in the 'non-intervention' clusters of the trial, and were followed over 4 years. This study was conducted in a dense urban slum community of Dhaka, Bangladesh and cholera surveillance was undertaken in 12 hospitals serving the study area. PRIMARY OUTCOME MEASURE First severe cholera episode detected during follow-up period. METHODS We applied a machine learning algorithm on a training subpopulation (n=96 943) to develop a binary ('better', 'not better') composite WASH variable predictive of severe cholera. The WASH rule was evaluated for performance in a separate validation subpopulation (n=96 633). Afterwards, we used Cox regression models to evaluate the association between 'better' WASH households and severe cholera risk over 4 years in the entire study population. RESULTS The 'better' WASH rule found that water quality and access were the most significant factors associated with severe cholera risk. Members of 'better' WASH households, constituting one-third of the population, had a 47% reduced risk of severe cholera (95% CI: 29 to 69; p<0.001), after adjusting for covariates. The protective association between living in a 'better' WASH household and severe cholera persisted in all age groups. CONCLUSIONS Salutary existing household WASH practices were associated with a significantly reduced long-term risk of severe cholera in an urban slum of Dhaka. These findings suggest that WASH adaptations already practised in the community may be important for developing and implementing effective and sustainable cholera control programmes in similar settings. TRIAL REGISTRATION NUMBER This article is a re-analysis of data from a cluster randomized trial; can be found on ClinicalTrials.gov NCT01339845.
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Affiliation(s)
- Sophie Kang
- Epidemiology, Public Health, and Impact Unit, International Vaccine Institute, Gwanak-gu, The Republic of Korea
| | - Fahima Chowdhury
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- Griffith University Menzies Health Institute Queensland, Nathan, Queensland, Australia
| | - Juyeon Park
- Epidemiology, Public Health, and Impact Unit, International Vaccine Institute, Gwanak-gu, The Republic of Korea
| | - Tasnuva Ahmed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Birkneh Tilahun Tadesse
- Epidemiology, Public Health, and Impact Unit, International Vaccine Institute, Gwanak-gu, The Republic of Korea
| | - Md Taufiqul Islam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Deok Ryun Kim
- Epidemiology, Public Health, and Impact Unit, International Vaccine Institute, Gwanak-gu, The Republic of Korea
| | - Justin Im
- Epidemiology, Public Health, and Impact Unit, International Vaccine Institute, Gwanak-gu, The Republic of Korea
| | - Asma Binte Aziz
- Epidemiology, Public Health, and Impact Unit, International Vaccine Institute, Gwanak-gu, The Republic of Korea
| | - Masuma Hoque
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Gideok Pak
- Epidemiology, Public Health, and Impact Unit, International Vaccine Institute, Gwanak-gu, The Republic of Korea
| | - Farhana Khanam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Faisal Ahmmed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Xinxue Liu
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - K Zaman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ashraful Islam Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Jerome H Kim
- International Vaccine Institute, Gwanak-gu, The Republic of Korea
| | - Florian Marks
- Epidemiology, Public Health, and Impact Unit, International Vaccine Institute, Gwanak-gu, The Republic of Korea
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - John D Clemens
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
- International Vaccine Institute, Gwanak-gu, The Republic of Korea
- Fielding School of Public Health, University of California, Los Angeles, California, USA
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Hahesy E, Cruz-Espinoza LM, Nyirenda G, Tadesse BT, Kim JH, Marks F, Rakotozandrindrainy R, Wetzker W, Haselbeck A. Madagascar's EPI vaccine programs: A systematic review uncovering the role of a child's sex and other barriers to vaccination. Front Public Health 2022; 10:995788. [PMID: 36187658 PMCID: PMC9523513 DOI: 10.3389/fpubh.2022.995788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/29/2022] [Indexed: 01/26/2023] Open
Abstract
Background Immunizations are one of the most effective tools a community can use to increase overall health and decrease the burden of vaccine-preventable diseases. Nevertheless, socioeconomic status, geographical location, education, and a child's sex have been identified as contributing to inequities in vaccine uptake in low- and middle-income countries (LMICs). Madagascar follows the World Health Organization's Extended Programme on Immunization (EPI) schedule, yet vaccine distribution remains highly inequitable throughout the country. This systematic review sought to understand the differences in EPI vaccine uptake between boys and girls in Madagascar. Methods A systematic literature search was conducted in August 2021 through MEDLINE, the Cochrane Library, Global Index Medicus, and Google Scholar to identify articles reporting sex-disaggregated vaccination rates in Malagasy children. Gray literature was also searched for relevant data. All peer-reviewed articles reporting sex-disaggregated data on childhood immunizations in Madagascar were eligible for inclusion. Risk of bias was assessed using a tool designed for use in systematic reviews. Data extraction was conducted with a pre-defined data extraction tool. Sex-disaggregated data were synthesized to understand the impact of a child's sex on vaccination status. Findings The systematic search identified 585 articles of which a total of three studies were included in the final data synthesis. One additional publication was included from the gray literature search. Data from included articles were heterogeneous and, overall, indicated similar vaccination rates in boys and girls. Three of the four articles reported slightly higher vaccination rates in girls than in boys. A meta-analysis was not conducted due to the heterogeneity of included data. Six additional barriers to immunization were identified: socioeconomic status, mother's education, geographic location, supply chain issues, father's education, number of children in the household, and media access. Interpretation The systematic review revealed the scarcity of available sex-stratified immunization data for Malagasy children. The evidence available was limited and heterogeneous, preventing researchers from conclusively confirming or denying differences in vaccine uptake based on sex. The low vaccination rates and additional barriers identified here indicate a need for increased focus on addressing the specific obstacles to vaccination in Madagascar. A more comprehensive assessment of sex-disaggregated vaccination status of Malagasy children and its relationship with such additional obstacles is recommended. Further investigation of potential differences in vaccination status will allow for the effective implementation of strategies to expand vaccine coverage in Madagascar equitably. Funding and registration AH, BT, FM, GN, and RR are supported by a grant from the Bill and Melinda Gates Foundation (grant number: OPP1205877). The review protocol is registered in the Prospective Register of Systematic Reviews (PROSPERO ID: CRD42021265000).
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Affiliation(s)
- Emma Hahesy
- Bowdoin College, Brunswick, ME, United States
| | | | | | | | | | - Florian Marks
- International Vaccine Institute, Seoul, South Korea
- University of Antananarivo, Antananarivo, Madagascar
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
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Elias Chitio JJ, Baltazar CS, Langa JP, Baloi LD, Mboane RBJ, Manuel JA, Assane S, Omar A, Manso M, Capitine I, Van Rensburg C, Luiz N, Mogasale V, Marks F, Park SE, Beck NS. Pre-emptive oral cholera vaccine (OCV) mass vaccination campaign in Cuamba District, Niassa Province, Mozambique: feasibility, vaccination coverage and delivery costs using CholTool. BMJ Open 2022; 12:e053585. [PMID: 36547726 PMCID: PMC9454037 DOI: 10.1136/bmjopen-2021-053585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Mozambique suffers from regular floods along its principal river basins and periodic cyclones that resulted in several cholera epidemics during the last decades. Cholera outbreaks in the recent 5 years affected particularly the northern provinces of the country including Nampula and Niassa provinces. A pre-emptive oral cholera vaccine (OCV) mass vaccination campaign was conducted in Cuamba District, Niassa Province, and the feasibility, costs, and vaccination coverage assessed. METHODS WHO prequalified OCV (Euvichol-Plus), a killed whole-cell bivalent vaccine containing Vibrio cholerae O1 (classical and El Tor) and O139, was administered in two doses with a 15-day interval during 7-31 August 2018, targeting around 180 000 people aged above 1 year in Cuamba District. Microplanning, community sensitisation, and training of local public health professionals and field enumerators were conducted. Feasibility and costs of vaccination were assessed using CholTool. Vaccination coverage and barriers were assessed through community surveys. RESULTS The administrative coverage of the first and second rounds of the campaign were 98.9% (194 581) and 98.8% (194 325), respectively, based on the available population data that estimated total 196 652 inhabitants in the target area. The vaccination coverage survey exhibited 75.9% (±2.2%) and 68.5% (±3.3%) coverage for the first and second rounds, respectively. Overall, 60.4% (±3.4%) of the target population received full two doses of OCV. Barriers to vaccination included incompatibility between working hours and campaign time. No severe adverse events were notified. The total financial cost per dose delivered was US$0.60 without vaccine cost and US$1.98 including vaccine costs. CONCLUSION The pre-emptive OCV mass vaccination campaign in remote setting in Mozambique was feasible with reasonable full-dose vaccination coverage to confer sufficient herd immunity for at least the next 3 to 5 years. The delivery cost estimate indicates that the OCV campaign is affordable as it is comparable with Gavi's operational support for vaccination campaigns.
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Affiliation(s)
- Jucunú J Elias Chitio
- National Department for Surveillance and Surveys in Health, National Institute of Health, Maputo, Mozambique
| | - Cynthia S Baltazar
- National Department for Surveillance and Surveys in Health, National Institute of Health, Maputo, Mozambique
| | - José Paulo Langa
- National Department for Surveillance and Surveys in Health, National Institute of Health, Maputo, Mozambique
| | - Liliana Dengo Baloi
- National Department for Surveillance and Surveys in Health, National Institute of Health, Maputo, Mozambique
| | | | | | - Sadate Assane
- Provincial Directorate of Health, Lichinga City, Mozambique
| | - Alide Omar
- District Health Directorate, Cuamba District, Mozambique
| | - Mariana Manso
- District Health Directorate, Cuamba District, Mozambique
| | - Igor Capitine
- National Department for Surveillance and Surveys in Health, National Institute of Health, Maputo, Mozambique
| | - Craig Van Rensburg
- Policy and Economic Research Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Naira Luiz
- National Department for Surveillance and Surveys in Health, National Institute of Health, Maputo, Mozambique
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Vittal Mogasale
- Policy and Economic Research Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Florian Marks
- Epidemology, Public Health, Impact (EPIC) Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Se Eun Park
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
- Yonsei University Graduate School of Public Health, Seoul, Republic of Korea
| | - Namseon S Beck
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
- Medair Headquarters, Ecublens, VD, Switzerland
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36
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Ogunleye VO, Oluwalusi OP, Popoola O, Kehinde A, Agbi S, Akintayo I, Udofia I, Bamidele F, Alonge T, Mogeni OD, Adekanmbi O, Ajiboye JJ, Marks F, Okeke IN. Restoring non-COVID-19 clinical research and surveillance in Oyo state, Nigeria during the SARS-CoV-2pandemic. J Public Health Afr 2022; 13:1720. [PMID: 36393921 PMCID: PMC9664379 DOI: 10.4081/jphia.2022.1720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 09/21/2021] [Indexed: 11/06/2022] Open
Abstract
Background Many sub-Saharan African patients receive clinical care from extramurally-supported research and surveillance. Dur- ing the COVID-19 pandemic, pausing these activities reduces pa- tient care, surveillance, and research staff employment, increasing pandemic losses. In Oyo State, Nigeria, we paused a multi-country invasive salmonellosis surveillance initiative and a rural clinical bac- teriology project. Objective Working with research partners raises health facility con- cerns about SARS-CoV-2 transmission risks and incurs infection pre- vention costs, so we developed and implemented re-opening plans to protect staff and patients and help health facilities deliver care. Methods Our reopening plan included appointing safety and per- sonal protective equipment (PPE) managers from existing project staff cadres, writing new standard operating procedures, implement- ing extensive assessed training, COVID-19 testing for staff, procuring and managing PPE, and providing secondary bacteraemia blood culture support for COVID-19 patients in State isolation facilities. Results Surveillance data showed that the pandemic reduced care access and negatively affected patient unsupervised antibacterial use. The re-opening plan repurposed human and material resources from national and international extramurally-supported programs to mitigate these effects on public health. Conclusions A structured reopening plan restarted care, surveil- lance, and infection prevention and control.
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Affiliation(s)
- Veronica O. Ogunleye
- Severe Typhoid in Africa Project, College of Medicine, Univ. of Ibadan, Nigeria
- Univ. College Hospital, Ibadan, Nigeria
| | | | - Oluwafemi Popoola
- Severe Typhoid in Africa Project, College of Medicine, Univ. of Ibadan, Nigeria
- Univ. College Hospital, Ibadan, Nigeria
- Dept. of Community Medicine, Clinical Sciences, College of Medicine, Univ. of Ibadan, Nigeria
| | - Aderemi Kehinde
- Severe Typhoid in Africa Project, College of Medicine, Univ. of Ibadan, Nigeria
- Univ. College Hospital, Ibadan, Nigeria
| | - Sarah Agbi
- Severe Typhoid in Africa Project, College of Medicine, Univ. of Ibadan, Nigeria
| | - Ifeoluwa Akintayo
- Dept. of Pharmaceutical Microbiology, Pharmacy, Univ. of Ibadan, Nigeria
| | - Ifiok Udofia
- Severe Typhoid in Africa Project, College of Medicine, Univ. of Ibadan, Nigeria
| | - Folasade Bamidele
- Univ. College Hospital, Ibadan, Nigeria
- Infectious Disease Hospital, Ibadan, Nigeria
| | - Temitope Alonge
- Univ. College Hospital, Ibadan, Nigeria
- Oyo State Government, COVID-19 Task Force, Ibadan, Nigeria
- Dept. of Surgery, College of Medicine, Univ. of Ibadan, Nigeria
| | | | - Olukemi Adekanmbi
- Univ. College Hospital, Ibadan, Nigeria
- Dept. of Medicine, College of Medicine, Univ. of Ibadan, Nigeria
| | - Jolaade J. Ajiboye
- Dept. of Pharmaceutical Microbiology, Pharmacy, Univ. of Ibadan, Nigeria
| | - Florian Marks
- International Vaccine Institute Seoul, Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Univ. of Cambridge School of Med., UK
- Madagascr Institute for Vaccine Research, University of Antananarivo, Madagascar
- Institute of Global Health, Univ. of Heidelberg, Germany
| | - Iruka N. Okeke
- Severe Typhoid in Africa Project, College of Medicine, Univ. of Ibadan, Nigeria
- Dept. of Pharmaceutical Microbiology, Pharmacy, Univ. of Ibadan, Nigeria
- Corresponding Author: Iruka N. Okeke, Department of Pharmaceutical Microbiology, Fac-ulty of Pharmacy, University of Ibadan, Nigeria. .
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Aiemjoy K, Seidman JC, Saha S, Munira SJ, Islam Sajib MS, Sium SMA, Sarkar A, Alam N, Zahan FN, Kabir MS, Tamrakar D, Vaidya K, Shrestha R, Shakya J, Katuwal N, Shrestha S, Yousafzai MT, Iqbal J, Dehraj IF, Ladak Y, Maria N, Adnan M, Pervaiz S, Carter AS, Longley AT, Fraser C, Ryan ET, Nodoushani A, Fasano A, Leonard MM, Kenyon V, Bogoch II, Jeon HJ, Haselbeck A, Park SE, Zellweger RM, Marks F, Owusu-Dabo E, Adu-Sarkodie Y, Owusu M, Teunis P, Luby SP, Garrett DO, Qamar FN, Saha SK, Charles RC, Andrews JR. Estimating typhoid incidence from community-based serosurveys: a multicohort study. Lancet Microbe 2022; 3:e578-e587. [PMID: 35750069 PMCID: PMC9329131 DOI: 10.1016/s2666-5247(22)00114-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The incidence of enteric fever, an invasive bacterial infection caused by typhoidal Salmonellae (Salmonella enterica serovars Typhi and Paratyphi), is largely unknown in regions without blood culture surveillance. The aim of this study was to evaluate whether new diagnostic serological markers for typhoidal Salmonella can reliably estimate population-level incidence. METHODS We collected longitudinal blood samples from patients with blood culture-confirmed enteric fever enrolled from surveillance studies in Bangladesh, Nepal, Pakistan, and Ghana between 2016 and 2021 and conducted cross-sectional serosurveys in the catchment areas of each surveillance site. We used ELISAs to measure quantitative IgA and IgG antibody responses to hemolysin E and S Typhi lipopolysaccharide. We used Bayesian hierarchical models to fit two-phase power-function decay models to the longitudinal antibody responses among enteric fever cases and used the joint distributions of the peak antibody titres and decay rate to estimate population-level incidence rates from cross-sectional serosurveys. FINDINGS The longitudinal antibody kinetics for all antigen-isotypes were similar across countries and did not vary by clinical severity. The seroincidence of typhoidal Salmonella infection among children younger than 5 years ranged between 58·5 per 100 person-years (95% CI 42·1-81·4) in Dhaka, Bangladesh, to 6·6 per 100 person-years (4·3-9·9) in Kavrepalanchok, Nepal, and followed the same rank order as clinical incidence estimates. INTERPRETATION The approach described here has the potential to expand the geographical scope of typhoidal Salmonella surveillance and generate incidence estimates that are comparable across geographical regions and time. FUNDING Bill & Melinda Gates Foundation. TRANSLATIONS For the Nepali, Bengali and Urdu translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Kristen Aiemjoy
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA; Division of Epidemiology, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA.
| | | | - Senjuti Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | - Syed Muktadir Al Sium
- Child Health Research Foundation, Dhaka, Bangladesh; Bangladesh Council of Scientific and Industrial Research, Dhaka, Bangladesh
| | - Anik Sarkar
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Nusrat Alam
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | - Dipesh Tamrakar
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Krista Vaidya
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Rajeev Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Jivan Shakya
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Nishan Katuwal
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Sony Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | | | - Junaid Iqbal
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Irum Fatima Dehraj
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Yasmin Ladak
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Noshi Maria
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Mehreen Adnan
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sadaf Pervaiz
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Ashley T Longley
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Clare Fraser
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ariana Nodoushani
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Alessio Fasano
- Center for Celiac Research and Treatment, MassGeneral Hospital for Children, Boston, MA, USA; Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Maureen M Leonard
- Center for Celiac Research and Treatment, MassGeneral Hospital for Children, Boston, MA, USA; Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Victoria Kenyon
- Center for Celiac Research and Treatment, MassGeneral Hospital for Children, Boston, MA, USA
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul, South Korea; Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | | | - Se Eun Park
- International Vaccine Institute, Seoul, South Korea
| | | | - Florian Marks
- International Vaccine Institute, Seoul, South Korea; Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK; Department of Microbiology and Parasitology, University of Antananarivo, Antananarivo, Madagascar; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Ellis Owusu-Dabo
- School of Medical Sciences, Kwame Nkrumah University for Science and Technology, Kumasi, Ghana
| | - Yaw Adu-Sarkodie
- School of Medical Sciences, Kwame Nkrumah University for Science and Technology, Kumasi, Ghana
| | - Michael Owusu
- School of Medical Sciences, Kwame Nkrumah University for Science and Technology, Kumasi, Ghana
| | - Peter Teunis
- Center for Global Safe Water, Sanitation and Hygiene, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Farah Naz Qamar
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Richelle C Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Garrett DO, Longley AT, Aiemjoy K, Yousafzai MT, Hemlock C, Yu AT, Vaidya K, Tamrakar D, Saha S, Bogoch II, Date K, Saha S, Islam MS, Sayeed KMI, Bern C, Shakoor S, Dehraj IF, Mehmood J, Sajib MSI, Islam M, Thobani RS, Hotwani A, Rahman N, Irfan S, Naga SR, Memon AM, Pradhan S, Iqbal K, Shrestha R, Rahman H, Hasan MM, Qazi SH, Kazi AM, Saddal NS, Jamal R, Hunzai MJ, Hossain T, Marks F, Carter AS, Seidman JC, Qamar FN, Saha SK, Andrews JR, Luby SP. Incidence of typhoid and paratyphoid fever in Bangladesh, Nepal, and Pakistan: results of the Surveillance for Enteric Fever in Asia Project. Lancet Glob Health 2022; 10:e978-e988. [PMID: 35714648 PMCID: PMC9210262 DOI: 10.1016/s2214-109x(22)00119-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 02/28/2022] [Accepted: 03/11/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Precise enteric fever disease burden data are needed to inform prevention and control measures, including the use of newly available typhoid vaccines. We established the Surveillance for Enteric Fever in Asia Project (SEAP) to inform these strategies. METHODS From September, 2016, to September, 2019, we conducted prospective clinical surveillance for Salmonella enterica serotype Typhi (S Typhi) and Paratyphi (S Paratyphi) A, B, and C at health facilities in predetermined catchment areas in Dhaka, Bangladesh; Kathmandu and Kavrepalanchok, Nepal; and Karachi, Pakistan. Patients eligible for inclusion were outpatients with 3 or more consecutive days of fever in the last 7 days; inpatients with suspected or confirmed enteric fever; patients with blood culture-confirmed enteric fever from the hospital laboratories not captured by inpatient or outpatient enrolment and cases from the laboratory network; and patients with non-traumatic ileal perforation under surgical care. We used a hybrid surveillance model, pairing facility-based blood culture surveillance with community surveys of health-care use. Blood cultures were performed for enrolled patients. We calculated overall and age-specific typhoid and paratyphoid incidence estimates for each study site. Adjusted estimates accounted for the sensitivity of blood culture, the proportion of eligible individuals who consented and provided blood, the probability of care-seeking at a study facility, and the influence of wealth and education on care-seeking. We additionally calculated incidence of hospitalisation due to typhoid and paratyphoid. FINDINGS A total of 34 747 patients were enrolled across 23 facilitates (six tertiary hospitals, surgical wards of two additional hospitals, and 15 laboratory network sites) during the study period. Of the 34 303 blood cultures performed on enrolled patients, 8705 (26%) were positive for typhoidal Salmonella. Adjusted incidence rates of enteric fever considered patients in the six tertiary hospitals. Adjusted incidence of S Typhi, expressed per 100 000 person-years, was 913 (95% CI 765-1095) in Dhaka. In Nepal, the adjusted typhoid incidence rates were 330 (230-480) in Kathmandu and 268 (202-362) in Kavrepalanchok. In Pakistan, the adjusted incidence rates per hospital site were 176 (144-216) and 103 (85-126). The adjusted incidence rates of paratyphoid (of which all included cases were due to S Paratyphi A) were 128 (107-154) in Bangladesh, 46 (34-62) and 81 (56-118) in the Nepal sites, and 23 (19-29) and 1 (1-1) in the Pakistan sites. Adjusted incidence of hospitalisation was high across sites, and overall, 2804 (32%) of 8705 patients with blood culture-confirmed enteric fever were hospitalised. INTERPRETATION Across diverse communities in three south Asian countries, adjusted incidence exceeded the threshold for "high burden" of enteric fever (100 per 100 000 person-years). Incidence was highest among children, although age patterns differed across sites. The substantial disease burden identified highlights the need for control measures, including improvements to water and sanitation infrastructure and the implementation of typhoid vaccines. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Denise O Garrett
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA.
| | - Ashley T Longley
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, GA, USA; Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristen Aiemjoy
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Mohammad T Yousafzai
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Caitlin Hemlock
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | - Alexander T Yu
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Krista Vaidya
- Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchok, Nepal
| | - Dipesh Tamrakar
- Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchok, Nepal
| | - Shampa Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kashmira Date
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Senjuti Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Sadia Shakoor
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan; Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Irum F Dehraj
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Junaid Mehmood
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Rozina S Thobani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Najeeb Rahman
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Seema Irfan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Shiva R Naga
- Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchok, Nepal
| | | | - Sailesh Pradhan
- Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
| | | | - Rajeev Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Kavrepalanchok, Nepal
| | | | | | - Saqib H Qazi
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Abdul M Kazi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Raza Jamal
- National Institute of Child Health, Karachi, Pakistan
| | - Mohammed J Hunzai
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Tanvir Hossain
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Florian Marks
- International Vaccine Institute, Seoul, South Korea; Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, UK; University of Antananarivo, Antananarivo, Madagascar; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Alice S Carter
- Applied Epidemiology, Sabin Vaccine Institute, Washington, DC, USA
| | | | - Farah N Qamar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh; Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA
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Hsiao A, Ramani E, Seo HJ, Pak G, Vuntade D, M'bang'ombe M, Ngwira B, Quentin W, Marks F, Mogasale V. Economic impact of cholera in households in rural southern Malawi: a prospective study. BMJ Open 2022; 12:e052337. [PMID: 35649608 PMCID: PMC9161053 DOI: 10.1136/bmjopen-2021-052337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 03/08/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Cholera remains a significant contributor to diarrhoeal illness, especially in sub-Saharan Africa. Few studies have estimated the cost of illness (COI) of cholera in Malawi, a cholera-endemic country. The present study estimated the COI of cholera in Nsanje, southern Malawi, as part of the Cholera Surveillance in Malawi (CSIMA) programme following a mass cholera vaccination campaign in 2015. METHODS Patients ≥12 months of age who were recruited as part of CSIMA were invited to participate in the COI survey. The COI tool captured household components of economic burden, including direct medical and non-medical costs, and indirect lost productivity costs. RESULTS Between April 2016 and March 2020, 40 cholera cases were enrolled in the study, all of whom participated in the COI survey. Only two patients had any direct medical costs and five patients reported lost wages due to illness. The COI per patient was US$14.34 (in 2020), more than half of which was from direct non-medical costs from food, water, and transportation to the health centre. CONCLUSION For the majority of Malawians who struggle to subsist on less than US$2 a day, the COI of cholera represents a significant cost burden to families. While cholera treatment is provided for free in government-run health centres, additional investments in cholera control and prevention at the community level and financial support beyond direct medical costs may be necessary to alleviate the economic burden of cholera on households in southern Malawi.
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Affiliation(s)
- Amber Hsiao
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Enusa Ramani
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
- Policy and Economic Research, International Vaccine Institute, Seoul, The Republic of Korea
| | - Hye-Jin Seo
- Epidemiology, Public Health, Impact, International Vaccine Institute, Seoul, The Republic of Korea
| | - GiDeok Pak
- Biostatistics & Data Management, International Vaccine Institute, Seoul, The Republic of Korea
| | - Dan Vuntade
- Department of Environmental Health, University of Malawi the Polytechnic, Blantyre, Malawi
| | | | - Bagrey Ngwira
- Department of Environmental Health, University of Malawi the Polytechnic, Blantyre, Malawi
| | - Wilm Quentin
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Florian Marks
- Epidemiology, Public Health, Impact, International Vaccine Institute, Gwanak-gu, The Republic of Korea
- Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge Institute of Therapeutic Immunology and Infectious Disease, Cambridge, UK
| | - Vittal Mogasale
- Policy and Economic Research, International Vaccine Institute, Seoul, The Republic of Korea
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Marchello CS, Birkhold M, Crump JA, Martin LB, Ansah MO, Breghi G, Canals R, Fiorino F, Gordon MA, Kim JH, Hamaluba M, Hanumunthadu B, Jacobs J, Kariuki S, Malvolti S, Mantel C, Marks F, Medaglini D, Mogasale V, Msefula CL, Muthumbi E, Niyrenda TS, Onsare R, Owusu-Dabo E, Pettini E, Ramasamy MN, Soura BA, Spadafina T, Tack B. Complications and mortality of non-typhoidal salmonella invasive disease: a global systematic review and meta-analysis. The Lancet Infectious Diseases 2022; 22:692-705. [PMID: 35114140 PMCID: PMC9021030 DOI: 10.1016/s1473-3099(21)00615-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/03/2021] [Accepted: 09/06/2021] [Indexed: 01/07/2023]
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Im J, Khanam F, Ahmmed F, Kim DR, Kang S, Tadesse BT, Chowdhury F, Ahmed T, Aziz AB, Hoque M, Islam MT, Park J, Liu X, Sur D, Pak G, Jeon HJ, Zaman K, Khan AI, Qadri F, Marks F, Kim JH, Clemens JD. Prevention of Typhoid Fever by Existing Improvements in Household Water, Sanitation, and Hygiene, and the Use of the Vi Polysaccharide Typhoid Vaccine in Poor Urban Slums: Results from a Cluster-Randomized Trial. Am J Trop Med Hyg 2022; 106:1149-1155. [PMID: 35385827 PMCID: PMC8991341 DOI: 10.4269/ajtmh.21-1034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/27/2021] [Accepted: 12/12/2021] [Indexed: 11/07/2022] Open
Abstract
Modest improvements in household water, sanitation, and hygiene (WASH) and typhoid vaccination can reduce typhoid risk in endemic settings. However, empiric evaluation of their combined impact is lacking. A total of 62,756 persons residing in 80 clusters in a Kolkata slum were allocated randomly 1:1 to either the typhoid Vi polysaccharide (ViPS) vaccine or hepatitis A (Hep A) vaccine. Surveillance was conducted for 2 years before and 2 years after vaccination. We classified households as having "better" or "not better" WASH, and calculated the prevalence of better WASH households in clusters using previously validated criteria. We evaluated the protection by better household WASH, better household WASH prevalence, and ViPS vaccination against typhoid in all cluster members present at baseline using Cox proportional hazard models. Overall, ViPS vaccination was associated with a 55% (P < 0.001; 95% CI, 35-69) reduction of typhoid risk and was similar regardless of better WASH in the residence. Living in a better WASH household was associated with a typhoid risk reduction of 31% (P = 0.16; 95% CI, -16 to 59) overall. The reduction was 48% (P = 0.05; 95% CI, -1 to 73) in Hep A clusters, 6% (P = 0.85; 95% CI, -82 to 51) in ViPS clusters, and 57% (P < 0.05; 95% CI, 15-78) in the population during the 2 years preceding the trial. These findings demonstrate a preventive association of better household WASH in the non-ViPS population, but, unexpectedly, an absence of additional protection from ViPS by better WASH in the ViPS population. This analysis highlights the importance of assessing the combination of WASH in conjunction with typhoid vaccines, and has implications for the evaluation of new-generation typhoid conjugate vaccines.
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Affiliation(s)
- Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Faisal Ahmmed
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Deok Ryun Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Sophie Kang
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Fahima Chowdhury
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tasnuva Ahmed
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Masuma Hoque
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md. Taufiqul Islam
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Juyeon Park
- International Vaccine Institute, Seoul, Republic of Korea
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Xinxue Liu
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Dipika Sur
- National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Gideok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul, Republic of Korea
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Khalequ Zaman
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Ashraful Islam Khan
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Firdausi Qadri
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- University of Antananarivo, Antananarivo, Madagascar
| | - Jerome H. Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - John D. Clemens
- International Vaccine Institute, Seoul, Republic of Korea
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
- University of California Los Angeles Fielding School of Public Health, Los Angeles, California
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Kim CL, Cruz Espinoza LM, Vannice KS, Tadesse BT, Owusu-Dabo E, Rakotozandrindrainy R, Jani IV, Teferi M, Bassiahi Soura A, Lunguya O, Steele AD, Marks F. The Burden of Typhoid Fever in Sub-Saharan Africa: A Perspective. Res Rep Trop Med 2022; 13:1-9. [PMID: 35308424 PMCID: PMC8932916 DOI: 10.2147/rrtm.s282461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/12/2022] [Indexed: 11/23/2022] Open
Abstract
While typhoid fever has largely been eliminated in high-income regions which have developed modern water, sanitation, and hygiene facilities, it remains a significant public health burden resulting in morbidity and mortality among millions of individuals in resource-constrained settings. Prevention and control efforts are needed that integrate several high-impact interventions targeting facilities and infrastructure, including those addressing improvements in sanitation, access to safe water, and planned urbanization, together with parallel efforts directed at effective strategies for use of typhoid conjugate vaccines (TCV). The use of TCVs is a critical tool with the potential of having a rapid impact on typhoid fever disease burden; their introduction will also serve as an important strategy to combat evolving antimicrobial resistance to currently available typhoid fever treatments. Well-designed epidemiological surveillance studies play a critical role in establishing the need for, and monitoring the impact of, typhoid fever control and prevention strategies implemented by public health authorities. Here, we present a perspective based on a narrative review of the impact of typhoid fever on morbidity and mortality in sub-Saharan Africa and discuss ongoing surveillance activities and the role of vaccination in prevention and control efforts.
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Affiliation(s)
- Cara Lynn Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Kirsten S Vannice
- Enteric and Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Birkneh Tilahun Tadesse
- International Vaccine Institute, Seoul, Republic of Korea
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ellis Owusu-Dabo
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Ilesh V Jani
- Instituto Nacional de Saúde (INS), Maputo Province, Mozambique
| | | | - Abdramane Bassiahi Soura
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo de Ouagadougou, Ouagadougou, Burkina Faso
| | - Octavie Lunguya
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Department of Medical Biology, University Teaching Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - A Duncan Steele
- Enteric and Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- University of Antananarivo, Antananarivo, Madagascar
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Correspondence: Florian Marks, Tel +82-2-881-1133, Email
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Holm M, Zellweger RM, Poudyal N, Smith KHT, Joh HS, Marks F. Measuring the Link Between Vaccines and Antimicrobial Resistance in Low Resource Settings – Limitations and Opportunities in Direct and Indirect Assessments and Implications for Impact Studies. Front Trop Dis 2022. [DOI: 10.3389/fitd.2022.805833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The importance of vaccines in combatting antimicrobial resistance (AMR) is commonly accepted. Although scientific reasoning supports the putative connection between vaccines and reduction of AMR, reliably measuring the magnitude and effect of vaccines on antimicrobial resistance is inherently challenging, especially in low resource settings. We review the intrinsic challenges in estimating the effect of vaccines on AMR and discuss the limitations and opportunities in current methods from the host, pathogen, and environment perspectives. We highlight advantages and pitfalls in different epidemiological study designs with a specific focus on impact studies in low resource settings and suggest how these perspectives could be considered in future research.
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Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, Han C, Bisignano C, Rao P, Wool E, Johnson SC, Browne AJ, Chipeta MG, Fell F, Hackett S, Haines-Woodhouse G, Kashef Hamadani BH, Kumaran EAP, McManigal B, Achalapong S, Agarwal R, Akech S, Albertson S, Amuasi J, Andrews J, Aravkin A, Ashley E, Babin FX, Bailey F, Baker S, Basnyat B, Bekker A, Bender R, Berkley JA, Bethou A, Bielicki J, Boonkasidecha S, Bukosia J, Carvalheiro C, Castañeda-Orjuela C, Chansamouth V, Chaurasia S, Chiurchiù S, Chowdhury F, Clotaire Donatien R, Cook AJ, Cooper B, Cressey TR, Criollo-Mora E, Cunningham M, Darboe S, Day NPJ, De Luca M, Dokova K, Dramowski A, Dunachie SJ, Duong Bich T, Eckmanns T, Eibach D, Emami A, Feasey N, Fisher-Pearson N, Forrest K, Garcia C, Garrett D, Gastmeier P, Giref AZ, Greer RC, Gupta V, Haller S, Haselbeck A, Hay SI, Holm M, Hopkins S, Hsia Y, Iregbu KC, Jacobs J, Jarovsky D, Javanmardi F, Jenney AWJ, Khorana M, Khusuwan S, Kissoon N, Kobeissi E, Kostyanev T, Krapp F, Krumkamp R, Kumar A, Kyu HH, Lim C, Lim K, Limmathurotsakul D, Loftus MJ, Lunn M, Ma J, Manoharan A, Marks F, May J, Mayxay M, Mturi N, Munera-Huertas T, Musicha P, Musila LA, Mussi-Pinhata MM, Naidu RN, Nakamura T, Nanavati R, Nangia S, Newton P, Ngoun C, Novotney A, Nwakanma D, Obiero CW, Ochoa TJ, Olivas-Martinez A, Olliaro P, Ooko E, Ortiz-Brizuela E, Ounchanum P, Pak GD, Paredes JL, Peleg AY, Perrone C, Phe T, Phommasone K, Plakkal N, Ponce-de-Leon A, Raad M, Ramdin T, Rattanavong S, Riddell A, Roberts T, Robotham JV, Roca A, Rosenthal VD, Rudd KE, Russell N, Sader HS, Saengchan W, Schnall J, Scott JAG, Seekaew S, Sharland M, Shivamallappa M, Sifuentes-Osornio J, Simpson AJ, Steenkeste N, Stewardson AJ, Stoeva T, Tasak N, Thaiprakong A, Thwaites G, Tigoi C, Turner C, Turner P, van Doorn HR, Velaphi S, Vongpradith A, Vongsouvath M, Vu H, Walsh T, Walson JL, Waner S, Wangrangsimakul T, Wannapinij P, Wozniak T, Young Sharma TEMW, Yu KC, Zheng P, Sartorius B, Lopez AD, Stergachis A, Moore C, Dolecek C, Naghavi M. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 2022; 399:629-655. [PMID: 35065702 PMCID: PMC8841637 DOI: 10.1016/s0140-6736(21)02724-0] [Citation(s) in RCA: 3855] [Impact Index Per Article: 1927.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/18/2021] [Accepted: 11/24/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Antimicrobial resistance (AMR) poses a major threat to human health around the world. Previous publications have estimated the effect of AMR on incidence, deaths, hospital length of stay, and health-care costs for specific pathogen-drug combinations in select locations. To our knowledge, this study presents the most comprehensive estimates of AMR burden to date. METHODS We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 23 pathogens and 88 pathogen-drug combinations in 204 countries and territories in 2019. We obtained data from systematic literature reviews, hospital systems, surveillance systems, and other sources, covering 471 million individual records or isolates and 7585 study-location-years. We used predictive statistical modelling to produce estimates of AMR burden for all locations, including for locations with no data. Our approach can be divided into five broad components: number of deaths where infection played a role, proportion of infectious deaths attributable to a given infectious syndrome, proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of a given pathogen resistant to an antibiotic of interest, and the excess risk of death or duration of an infection associated with this resistance. Using these components, we estimated disease burden based on two counterfactuals: deaths attributable to AMR (based on an alternative scenario in which all drug-resistant infections were replaced by drug-susceptible infections), and deaths associated with AMR (based on an alternative scenario in which all drug-resistant infections were replaced by no infection). We generated 95% uncertainty intervals (UIs) for final estimates as the 25th and 975th ordered values across 1000 posterior draws, and models were cross-validated for out-of-sample predictive validity. We present final estimates aggregated to the global and regional level. FINDINGS On the basis of our predictive statistical models, there were an estimated 4·95 million (3·62-6·57) deaths associated with bacterial AMR in 2019, including 1·27 million (95% UI 0·911-1·71) deaths attributable to bacterial AMR. At the regional level, we estimated the all-age death rate attributable to resistance to be highest in western sub-Saharan Africa, at 27·3 deaths per 100 000 (20·9-35·3), and lowest in Australasia, at 6·5 deaths (4·3-9·4) per 100 000. Lower respiratory infections accounted for more than 1·5 million deaths associated with resistance in 2019, making it the most burdensome infectious syndrome. The six leading pathogens for deaths associated with resistance (Escherichia coli, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa) were responsible for 929 000 (660 000-1 270 000) deaths attributable to AMR and 3·57 million (2·62-4·78) deaths associated with AMR in 2019. One pathogen-drug combination, meticillin-resistant S aureus, caused more than 100 000 deaths attributable to AMR in 2019, while six more each caused 50 000-100 000 deaths: multidrug-resistant excluding extensively drug-resistant tuberculosis, third-generation cephalosporin-resistant E coli, carbapenem-resistant A baumannii, fluoroquinolone-resistant E coli, carbapenem-resistant K pneumoniae, and third-generation cephalosporin-resistant K pneumoniae. INTERPRETATION To our knowledge, this study provides the first comprehensive assessment of the global burden of AMR, as well as an evaluation of the availability of data. AMR is a leading cause of death around the world, with the highest burdens in low-resource settings. Understanding the burden of AMR and the leading pathogen-drug combinations contributing to it is crucial to making informed and location-specific policy decisions, particularly about infection prevention and control programmes, access to essential antibiotics, and research and development of new vaccines and antibiotics. There are serious data gaps in many low-income settings, emphasising the need to expand microbiology laboratory capacity and data collection systems to improve our understanding of this important human health threat. FUNDING Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.
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Clemens J, Aziz AB, Tadesse BT, Kang S, Marks F, Kim J. Evaluation of protection by COVID-19 vaccines after deployment in low and lower-middle income countries. EClinicalMedicine 2022; 43:101253. [PMID: 34977517 PMCID: PMC8703050 DOI: 10.1016/j.eclinm.2021.101253] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/02/2021] [Accepted: 12/10/2021] [Indexed: 12/20/2022] Open
Abstract
The availability and use of vaccines for the coronavirus disease 2019 (COVID-19) in low and middle-income countries (L/MICs) lags far behind more affluent countries, and vaccines currently used in L/MICs are predominantly of lower efficacy. As vaccines continue to be rolled out in L/MICs, successful control of COVID-19 by vaccines requires monitoring both of vaccine protection of vaccinees (effectiveness) and of the entire targeted populations, including vaccine herd protection of non-vaccinees (impact). To be of greatest relevance to L/MICs, there is the need to address the distinctive medical and demographic features of populations, health systems, and demography that may greatly affect vaccine performance in these settings. We identified 58 published studies that included 85 evaluations of the effectiveness of different COVID-19 vaccines globally. Only three were done in L/MICs, and no impact studies were identified in these settings. Post-deployment studies of the protection by COVID-19 vaccines rolled out in L/MICs constitute an important but currently neglected global priority.
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Affiliation(s)
- John Clemens
- International Vaccine Institute, Seoul, South Korea
- UCLA Fielding School of Public Health, Los Angeles, United States
| | - Asma Binte Aziz
- International Vaccine Institute, Seoul, South Korea
- Institute of Clinical Medicine, University of Oslo, Norway
| | | | - Sophie Kang
- International Vaccine Institute, Seoul, South Korea
| | - Florian Marks
- International Vaccine Institute, Seoul, South Korea
- University of Cambridge, United Kingdom
- University of Antananarivo, Antananarivo, Madagascar
| | - Jerome Kim
- International Vaccine Institute, Seoul, South Korea
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46
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Jeon HJ, Marks F, Sugimoto J, Im J, Kang SS, Haselbeck A, Rakotozandrindrainy R. Surge of Typhoid Intestinal Perforations as Possible Result of COVID-19-Associated Delays in Seeking Care, Madagascar. Emerg Infect Dis 2021; 27:3163-3165. [PMID: 34808080 PMCID: PMC8632171 DOI: 10.3201/eid2712.210516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
During the coronavirus disease pandemic, we observed a 6.4-fold increase in typhoid intestinal perforation incidence in Antananarivo, Madagascar. Thirteen perforations occurred within 6 months (February 2020–July 2020), compared with 13 perforations during the previous 41 months (August 2016–January 2020). The increase may be attributable to delayed healthcare seeking during the pandemic.
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47
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Grundy B, Panzner U, Liu J, Jeon HJ, Im J, von Kalckreuth V, Konings F, Pak GD, Cruz Espinoza LM, Bassiahi AS, Gasmelseed N, Rakotozandrindrainy RL, Stroup S, Houpt E, Marks F. Detection of Pathogens of Acute Febrile Illness Using Polymerase Chain Reaction from Dried Blood Spots. Am J Trop Med Hyg 2021; 106:454-456. [PMID: 34749309 PMCID: PMC8832910 DOI: 10.4269/ajtmh.21-0814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/08/2021] [Indexed: 11/24/2022] Open
Abstract
Quantitative polymerase chain reaction (qPCR) of dried blood spots (DBS) for pathogen detection is a potentially convenient method for infectious disease diagnosis. This study tested 115 DBS samples paired with whole blood specimens of children and adolescent from Burkina Faso, Sudan, and Madagascar by qPCR for a wide range of pathogens, including protozoans, helminths, fungi, bacteria, and viruses. Plasmodium spp. was consistently detected from DBS but yielded a mean cycle threshold (Ct) 5.7 ± 1.6 higher than that from whole blood samples. A DBS qPCR Ct cutoff of 27 yielded 94.1% sensitivity and 95.1% specificity against the whole blood qPCR cutoff of 21 that has been previously suggested for malaria diagnosis. For other pathogens investigated, DBS testing yielded a sensitivity of only 8.5% but a specificity of 98.6% compared with whole blood qPCR. In sum, direct PCR of DBS had reasonable performance for Plasmodium but requires further investigation for the other pathogens assessed in this study.
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Affiliation(s)
- Brian Grundy
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Ursula Panzner
- International Vaccine Institute, Seoul, Republic of Korea.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Jie Liu
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul, Republic of Korea.,Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Frank Konings
- International Vaccine Institute, Seoul, Republic of Korea
| | - Gi Deok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | | | - Suzanne Stroup
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Eric Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea.,Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom.,University of Antananarivo, Antananarivo, Madagascar
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48
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Kim MS, Jung SY, Ahn JG, Park SJ, Shoenfeld Y, Kronbichler A, Koyanagi A, Dragioti E, Tizaoui K, Hong SH, Jacob L, Salem JE, Yon DK, Lee SW, Ogino S, Kim H, Kim JH, Excler JL, Marks F, Clemens JD, Eisenhut M, Barnett Y, Butler L, Ilie CP, Shin EC, Il Shin J, Smith L. Comparative safety of mRNA COVID-19 vaccines to influenza vaccines: A pharmacovigilance analysis using WHO international database. J Med Virol 2021; 94:1085-1095. [PMID: 34709664 PMCID: PMC8662238 DOI: 10.1002/jmv.27424] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 09/17/2021] [Accepted: 10/26/2021] [Indexed: 12/19/2022]
Abstract
Two messenger RNA (mRNA) vaccines developed by Pfizer‐BioNTech and Moderna are being rolled out. Despite the high volume of emerging evidence regarding adverse events (AEs) associated with the COVID‐19 mRNA vaccines, previous studies have thus far been largely based on the comparison between vaccinated and unvaccinated control, possibly highlighting the AE risks with COVID‐19 mRNA vaccination. Comparing the safety profile of mRNA vaccinated individuals with otherwise vaccinated individuals would enable a more relevant assessment for the safety of mRNA vaccination. We designed a comparative safety study between 18 755 and 27 895 individuals who reported to VigiBase for adverse events following immunization (AEFI) with mRNA COVID‐19 and influenza vaccines, respectively, from January 1, 2020, to January 17, 2021. We employed disproportionality analysis to rapidly detect relevant safety signals and compared comparative risks of a diverse span of AEFIs for the vaccines. The safety profile of novel mRNA vaccines was divergent from that of influenza vaccines. The overall pattern suggested that systematic reactions like chill, myalgia, fatigue were more noticeable with the mRNA COVID‐19 vaccine, while injection site reactogenicity events were more prevalent with the influenza vaccine. Compared to the influenza vaccine, mRNA COVID‐19 vaccines demonstrated a significantly higher risk for a few manageable cardiovascular complications, such as hypertensive crisis (adjusted reporting odds ratio [ROR], 12.72; 95% confidence interval [CI], 2.47–65.54), and supraventricular tachycardia (adjusted ROR, 7.94; 95% CI, 2.62–24.00), but lower risk of neurological complications such as syncope, neuralgia, loss of consciousness, Guillain‐Barre syndrome, gait disturbance, visual impairment, and dyskinesia. This study has not identified significant safety concerns regarding mRNA vaccination in real‐world settings. The overall safety profile patterned a lower risk of serious AEFI following mRNA vaccines compared to influenza vaccines.
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Affiliation(s)
- Min Seo Kim
- College of Medicine, Korea University, Seoul, Republic of Korea.,Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
| | - Se Yong Jung
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Gyun Ahn
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, South Korea
| | - Se Jin Park
- Department of Pediatrics, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Yehuda Shoenfeld
- Laboratory of the Mosaics of Autoimmunity, Saint Petersburg State University, Saint-Petersburg, Russian Federation.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Affiliated to Tel-Aviv University School of Medicine, Tel-Hashomer, Israel
| | - Andreas Kronbichler
- Department of Internal Medicine IV, Medical University Innsbruck, Innsbruck, Austria
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, Barcelona, Spain.,ICREA, Pg. Lluis Companys 23, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Kalthoum Tizaoui
- Laboratory of Microorganismes and Active Biomolecules, Sciences Faculty of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Sung Hwi Hong
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, Barcelona, Spain.,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Joe-Elie Salem
- Sorbonne Université, INSERM, CIC-1901 Paris-Est, CLIP² Galilée, UNICO-GRECO Cardio-oncology Program, and Department of Pharmacology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dong Keon Yon
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Republic of Korea
| | - Shuji Ogino
- Cancer Immunology and Cancer Epidemiology Programs, Dana-Farber Harvard Cancer Center, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.,Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts, USA
| | - Hanna Kim
- College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea.,Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, UK.,University of Antananarivo, Antananarivo, Madagascar
| | - John D Clemens
- International Vaccine Institute, Seoul, Republic of Korea.,International Centre for Diarrheal Diseases Research, Dhaka, Dhaka, Bangladesh.,UCLA Fielding School of Public Health, Los Angeles, California, USA
| | | | - Yvonne Barnett
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Laurie Butler
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | | | - Eui-Cheol Shin
- Laboratory of Immunology and Infectious Diseases, Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.,The Center for Epidemic Preparedness, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
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Panzner U, Excler JL, Kim JH, Marks F, Carter D, Siddiqui AA. Recent Advances and Methodological Considerations on Vaccine Candidates for Human Schistosomiasis. Front Trop Dis 2021. [DOI: 10.3389/fitd.2021.719369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Schistosomiasis remains a neglected tropical disease of major public health concern with high levels of morbidity in various parts of the world. Although considerable efforts in implementing mass drug administration programs utilizing praziquantel have been deployed, schistosomiasis is still not contained. A vaccine may therefore be an essential part of multifaceted prevention control efforts. In the 1990s, a joint United Nations committee promoting parasite vaccines shortlisted promising candidates including for schistosomiasis discussed below. After examining the complexity of immune responses in human hosts infected with schistosomes, we review and discuss the antigen design and preclinical and clinical development of the four leading vaccine candidates: Sm-TSP-2 in Phase 1b/2b, Sm14 in Phase 2a/2b, Sm-p80 in Phase 1 preparation, and Sh28GST in Phase 3. Our assessment of currently leading vaccine candidates revealed some methodological issues that preclude a fair comparison between candidates and the rationale to advance in clinical development. These include (1) variability in animal models - in particular non-human primate studies - and predictive values of each for protection in humans; (2) lack of consensus on the assessment of parasitological and immunological parameters; (3) absence of reliable surrogate markers of protection; (4) lack of well-designed parasitological and immunological natural history studies in the context of mass drug administration with praziquantel. The controlled human infection model - while promising and unique - requires validation against efficacy outcomes in endemic settings. Further research is also needed on the impact of advanced adjuvants targeting specific parts of the innate immune system that may induce potent, protective and durable immune responses with the ultimate goal of achieving meaningful worm reduction.
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50
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Park SE, Pham DT, Pak GD, Panzner U, Maria Cruz Espinoza L, von Kalckreuth V, Im J, Mogeni OD, Schütt-Gerowitt H, Crump JA, Breiman RF, Adu-Sarkodie Y, Owusu-Dabo E, Rakotozandrindrainy R, Bassiahi Soura A, Aseffa A, Gasmelseed N, Sooka A, Keddy KH, May J, Aaby P, Biggs HM, Hertz JT, Montgomery JM, Cosmas L, Olack B, Fields B, Sarpong N, Razafindrabe TJL, Raminosoa TM, Kabore LP, Sampo E, Teferi M, Yeshitela B, El Tayeb MA, Krumkamp R, Dekker DM, Jaeger A, Tall A, Gassama A, Niang A, Bjerregaard-Andersen M, Løfberg SV, Deerin JF, Park JK, Konings F, Carey ME, Van Puyvelde S, Ali M, Clemens J, Dougan G, Baker S, Marks F. The genomic epidemiology of multi-drug resistant invasive non-typhoidal Salmonella in selected sub-Saharan African countries. BMJ Glob Health 2021; 6:bmjgh-2021-005659. [PMID: 34341020 PMCID: PMC8330565 DOI: 10.1136/bmjgh-2021-005659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/06/2021] [Indexed: 01/23/2023] Open
Abstract
Background Invasive non-typhoidal Salmonella (iNTS) is one of the leading causes of bacteraemia in sub-Saharan Africa. We aimed to provide a better understanding of the genetic characteristics and transmission patterns associated with multi-drug resistant (MDR) iNTS serovars across the continent. Methods A total of 166 iNTS isolates collected from a multi-centre surveillance in 10 African countries (2010–2014) and a fever study in Ghana (2007–2009) were genome sequenced to investigate the geographical distribution, antimicrobial genetic determinants and population structure of iNTS serotypes–genotypes. Phylogenetic analyses were conducted in the context of the existing genomic frameworks for various iNTS serovars. Population-based incidence of MDR-iNTS disease was estimated in each study site. Results Salmonella Typhimurium sequence-type (ST) 313 and Salmonella Enteritidis ST11 were predominant, and both exhibited high frequencies of MDR; Salmonella Dublin ST10 was identified in West Africa only. Mutations in the gyrA gene (fluoroquinolone resistance) were identified in S. Enteritidis and S. Typhimurium in Ghana; an ST313 isolate carrying blaCTX-M-15 was found in Kenya. International transmission of MDR ST313 (lineage II) and MDR ST11 (West African clade) was observed between Ghana and neighbouring West African countries. The incidence of MDR-iNTS disease exceeded 100/100 000 person-years-of-observation in children aged <5 years in several West African countries. Conclusions We identified the circulation of multiple MDR iNTS serovar STs in the sampled sub-Saharan African countries. Investment in the development and deployment of iNTS vaccines coupled with intensified antimicrobial resistance surveillance are essential to limit the impact of these pathogens in Africa.
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Affiliation(s)
- Se Eun Park
- International Vaccine Institute, Seoul, Republic of Korea.,Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Duy Thanh Pham
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Gi Deok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | - Ursula Panzner
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | - Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Heidi Schütt-Gerowitt
- International Vaccine Institute, Seoul, Republic of Korea.,Institute of Medical Microbiology, University of Cologne, Cologne, Germany
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand.,Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Robert F Breiman
- Centers for Disease Control and Prevention, KEMRI Complex, Nairobi, Kenya.,Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Yaw Adu-Sarkodie
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Ellis Owusu-Dabo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | | | - Abdramane Bassiahi Soura
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Nagla Gasmelseed
- Faculty of Medicine, University of Gezira, Wad Medani, Sudan.,Faculty of Science, University of Hafr Al Batin, Hafr Albatin, Saudi Arabia
| | - Arvinda Sooka
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Karen H Keddy
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jürgen May
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research, Braunschweig, Germany
| | - Peter Aaby
- Bandim Health Project, Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Holly M Biggs
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Julian T Hertz
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Joel M Montgomery
- Centers for Disease Control and Prevention, KEMRI Complex, Nairobi, Kenya
| | - Leonard Cosmas
- Centers for Disease Control and Prevention, KEMRI Complex, Nairobi, Kenya
| | | | - Barry Fields
- Centers for Disease Control and Prevention, KEMRI Complex, Nairobi, Kenya
| | - Nimako Sarpong
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,German Center for Infection Research, Braunschweig, Germany
| | | | | | | | | | | | | | | | - Ralf Krumkamp
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research, Braunschweig, Germany
| | - Denise Myriam Dekker
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research, Braunschweig, Germany
| | - Anna Jaeger
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research, Braunschweig, Germany
| | - Adama Tall
- Institute Pasteur de Dakar, Dakar, Senegal
| | - Amy Gassama
- Institute Pasteur de Dakar, Dakar, Senegal.,Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | | | - Morten Bjerregaard-Andersen
- Bandim Health Project, Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Sandra Valborg Løfberg
- Bandim Health Project, Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | | | - Jin Kyung Park
- International Vaccine Institute, Seoul, Republic of Korea
| | - Frank Konings
- International Vaccine Institute, Seoul, Republic of Korea
| | - Megan E Carey
- Department of Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Sandra Van Puyvelde
- Medicine, Cambridge University, Cambridge, UK.,Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Mohammad Ali
- International Vaccine Institute, Seoul, Republic of Korea.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John Clemens
- International Vaccine Institute, Seoul, Republic of Korea.,International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.,University of California, Fielding School of Public Health, Los Angeles, California, USA
| | - Gordon Dougan
- Department of Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Stephen Baker
- Department of Medicine, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
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