1
|
Lee M, Chae SA, Lee YJ, Jeon HJ, Hong SC, Shin M, Jung YH, Yang J. Cell-free supernatant of Lactococcus lactis IDCC 2301 exerts anti-inflammatory effects in LPS-induced macrophages via NF-κB and MAPK signaling pathways. Benef Microbes 2024:1-11. [PMID: 38677715 DOI: 10.1163/18762891-bja00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/27/2024] [Indexed: 04/29/2024]
Abstract
This study investigated the anti-inflammatory effects of cell-free supernatant of Lactococcus lactis IDCC 2301 on lipopolysaccharide (LPS)-induced RAW 264.7 macrophages. Expression of inflammatory mediators and cytokines, and the production of nitric oxide (NO) and prostaglandin E2 (PGE2) were qualitatively analysed. The expression of signal transductors in inflammatory cascades was quantified by western blot. Treatment with cell-free supernatant of L. lactis IDCC 2301 significantly decreased the mRNA expression levels of tumour necrosis factor (TNF-α) and interleukins including IL-1β and IL-6. The levels of inducible nitric oxide synthase (iNOS) and cyclooxygenase (COX-2) were also remarkably reduced in LPS-induced macrophages after the treatment. Furthermore, L. lactis IDCC 2301 reduced the levels of both dephosphorylated and phosphorylated forms of nuclear factor-kappa B (NF-κB), IκB-α, extracellular signal-regulated kinases (ERK), c-Jun amino-terminal kinases (JNK), and p38 in LPS-induced RAW 264.7 cells. Therefore, L. lactis IDCC 2301 shows anti-inflammatory activity by suppressing the NF-κB and mitogen-activated protein kinase (MAPK) signaling pathways.
Collapse
Affiliation(s)
- M Lee
- Ildong Bioscience, Pyeongtaek-si, Gyeonggi-do 17957, Republic of Korea
| | - S A Chae
- Ildong Bioscience, Pyeongtaek-si, Gyeonggi-do 17957, Republic of Korea
| | - Y J Lee
- School of Food Science and Biotechnology, Kyungpook National University, Daegu 41566, Republic of Korea
| | - H J Jeon
- School of Food Science and Biotechnology, Kyungpook National University, Daegu 41566, Republic of Korea
| | - S-C Hong
- Department of Food Science and Biotechnology, Kunsan National University, Gunsan 54150, Republic of Korea
| | - M Shin
- Department of Microbiology, College of Medicine, Inha University, Incheon, 22212, Republic of Korea
| | - Y H Jung
- School of Food Science and Biotechnology, Kyungpook National University, Daegu 41566, Republic of Korea
| | - J Yang
- Department of Microbiology, College of Medicine, Dongguk University, Gyeongju, 38066, Republic of Korea
| |
Collapse
|
2
|
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.
Collapse
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
| | | |
Collapse
|
3
|
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.
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
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.
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Carey ME, MacWright WR, Im J, Meiring JE, Gibani MM, Park SE, Longley A, Jeon HJ, Hemlock C, Yu AT, Soura A, Aiemjoy K, Owusu-Dabo E, Terferi M, Islam S, Lunguya O, Jacobs J, Gordon M, Dolecek C, Baker S, Pitzer VE, Yousafzai MT, Tonks S, Clemens JD, Date K, Qadri F, Heyderman RS, Saha SK, Basnyat B, Okeke IN, Qamar FN, Voysey M, Luby S, Kang G, Andrews J, Pollard AJ, John J, Garrett D, Marks F. The Surveillance for Enteric Fever in Asia Project (SEAP), Severe Typhoid Fever Surveillance in Africa (SETA), Surveillance of Enteric Fever in India (SEFI), and Strategic Typhoid Alliance Across Africa and Asia (STRATAA) Population-based Enteric Fever Studies: A Review of Methodological Similarities and Differences. Clin Infect Dis 2021; 71:S102-S110. [PMID: 32725221 PMCID: PMC7388711 DOI: 10.1093/cid/ciaa367] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Building on previous multicountry surveillance studies of typhoid and others salmonelloses such as the Diseases of the Most Impoverished program and the Typhoid Surveillance in Africa Project, several ongoing blood culture surveillance studies are generating important data about incidence, severity, transmission, and clinical features of invasive Salmonella infections in sub-Saharan Africa and South Asia. These studies are also characterizing drug resistance patterns in their respective study sites. Each study answers a different set of research questions and employs slightly different methodologies, and the geographies under surveillance differ in size, population density, physician practices, access to healthcare facilities, and access to microbiologically safe water and improved sanitation. These differences in part reflect the heterogeneity of the epidemiology of invasive salmonellosis globally, and thus enable generation of data that are useful to policymakers in decision-making for the introduction of typhoid conjugate vaccines (TCVs). Moreover, each study is evaluating the large-scale deployment of TCVs, and may ultimately be used to assess post-introduction vaccine impact. The data generated by these studies will also be used to refine global disease burden estimates. It is important to ensure that lessons learned from these studies not only inform vaccination policy, but also are incorporated into sustainable, low-cost, integrated vaccine-preventable disease surveillance systems.
Collapse
Affiliation(s)
- Megan E Carey
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Justin Im
- International Vaccine Institute, SNU Research Park, Seoul, Republic of Korea
| | - James E Meiring
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Malick M Gibani
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Se Eun Park
- International Vaccine Institute, SNU Research Park, Seoul, Republic of Korea
| | - Ashley Longley
- Global Immunization Division, Centers for Disease Control Foundation, Atlanta, Georgia, USA
| | - Hyon Jin Jeon
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom.,International Vaccine Institute, SNU Research Park, Seoul, Republic of Korea
| | - Caitlin Hemlock
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California, USA
| | - Alexander T Yu
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Abdramane Soura
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Kristen Aiemjoy
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Ellis Owusu-Dabo
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Sahidul Islam
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Octavie Lunguya
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Melita Gordon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,Institute of Infection and Global Health, University of Liverpool, United Kingdom
| | - Christiane Dolecek
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Stephen Baker
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | | | - Susan Tonks
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - John D Clemens
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.,Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Kashmira Date
- Global Immunization Division, Centers for Disease Control Foundation, Atlanta, Georgia, USA
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Robert S Heyderman
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Samir K Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Buddha Basnyat
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Idaban, Nigeria
| | - Farah N Qamar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Merryn Voysey
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Stephen Luby
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | | | - Jason Andrews
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Andrew J Pollard
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Jacob John
- Christian Medical College, Vellore, India
| | - Denise Garrett
- Sabin Vaccine Institute, Washington, District of Columbia, USA
| | - Florian Marks
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom.,International Vaccine Institute, SNU Research Park, Seoul, Republic of Korea
| |
Collapse
|
16
|
Marks F, Liu J, Soura AB, Gasmelseed N, Operario D, Grundy B, Wieser J, Gratz J, Meyer CG, Im J, Lim JK, von Kalckreuth V, Cruz Espinoza LM, Konings F, Jeon HJ, Rakotozandrindrainy R, Zhang J, Panzner U, Houpt E. Pathogens causing acute febrile illness among children and adolescents in Burkina Faso, Madagascar and Sudan. Clin Infect Dis 2021; 73:1338-1345. [PMID: 33822011 PMCID: PMC8528393 DOI: 10.1093/cid/ciab289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/13/2020] [Accepted: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background The etiology and optimal clinical management of acute febrile illness (AFI) is poorly understood. Methods Blood samples taken from study participants with acute fever (≥37.5°C) or a history of fever and recruited into the previous Typhoid Fever Surveillance in Africa (TSAP) study were evaluated using a polymerase chain reaction (PCR)-based TaqMan-Array Card designed to detect a panel of bacterial, viral, and parasitic pathogens. Clinical metadata were also assessed. Results A total of 615 blood samples available for analysis originated from Burkina Faso (n = 53), Madagascar (n = 364), and Sudan (n = 198) and were taken from participants ranging in age from 0–19 years. Through the TaqMan-Array Card, at least 1 pathogen was detected in 62% (33 of 53), 24% (86 of 364), and 60% (118 of 198) of specimens from Burkina Faso, Madagascar, and Sudan, respectively. The leading identified pathogen overall was Plasmodium spp., accounting for 47% (25 of 53), 2.2% (8 of 364), and 45% (90 of 198) of AFI at the respective sites. In Madagascar, dengue virus was the most prevalent pathogen (10.2%). Overall, 69% (357 of 516) of patients with clinical diagnoses of malaria, respiratory infection, or gastrointestinal infection were prescribed a World Health Organization guideline-recommended empiric antibiotic, whereas only 45% (106 of 237) of patients with pathogens detected were treated with an antibiotic exerting likely activity. Conclusions A PCR approach for identifying multiple bacterial, viral, and parasitic pathogens in whole blood unveiled a diversity of previously undetected pathogens in AFI cases and carries implications for the appropriate management of this common syndrome.
Collapse
Affiliation(s)
- 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
| | - Jie Liu
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | | | - Nagla Gasmelseed
- Faculty of Medicine at the University of Gezira, Wad Medani, Sudan
| | - Darwin Operario
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Brian Grundy
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - John Wieser
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Jean Gratz
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Christian G Meyer
- Faculty of Medicine, Duy Tan University, Da Nang, Vietnam.,Institute of Tropical Medicine, Eberhard Karls University, Tübingen, Germany
| | - Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | - Frank Konings
- 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 Biomedical Campus, Cambridge, UK
| | | | - Jixian Zhang
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Ursula Panzner
- International Vaccine Institute, Seoul, Republic of Korea.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Eric Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| |
Collapse
|
17
|
Krumkamp R, Struck NS, Lorenz E, Zimmermann M, Boahen KG, Sarpong N, Owusu-Dabo E, Pak GD, Jeon HJ, Marks F, Jacobs T, May J, Eibach D. Classification of invasive bloodstream infections and Plasmodium falciparum malaria using autoantibodies as biomarkers. Sci Rep 2020; 10:21168. [PMID: 33273605 PMCID: PMC7712777 DOI: 10.1038/s41598-020-78155-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/20/2020] [Indexed: 01/25/2023] Open
Abstract
A better understanding of disease-specific biomarker profiles during acute infections could guide the development of innovative diagnostic methods to differentiate between malaria and alternative causes of fever. We investigated autoantibody (AAb) profiles in febrile children (≤ 5 years) admitted to a hospital in rural Ghana. Serum samples from 30 children with a bacterial bloodstream infection and 35 children with Plasmodium falciparum malaria were analyzed using protein microarrays (Protoplex Immune Response Assay, ThermoFisher). A variable selection algorithm was applied to identify the smallest set of AAbs showing the best performance to classify malaria and bacteremia patients. The selection procedure identified 8 AAbs of which IFNGR2 and FBXW5 were selected in repeated model run. The classification error was 22%, which was mainly due to non-Typhi Salmonella (NTS) diagnoses being misclassified as malaria. Likewise, a cluster analysis grouped patients with NTS and malaria together, but separated malaria from non-NTS infections. Both current and recent malaria are a risk factor for NTS, therefore, a better understanding about the function of AAb in disease-specific immune responses is required in order to support their application for diagnostic purposes.
Collapse
Affiliation(s)
- Ralf Krumkamp
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, 20359, Hamburg, Germany.,German Centre for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Nicole Sunaina Struck
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, 20359, Hamburg, Germany. .,German Centre for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany.
| | - Eva Lorenz
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, 20359, Hamburg, Germany.,German Centre for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Marlow Zimmermann
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, 20359, Hamburg, Germany.,German Centre for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Kennedy Gyau Boahen
- Department of Infectious Disease Epidemiology, Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana
| | - Nimako Sarpong
- Department of Infectious Disease Epidemiology, Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana
| | - Ellis Owusu-Dabo
- School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Gi Deok Pak
- Epidemiology Unit, International Vaccine Institute (IVI), Seoul, Republic of Korea
| | - Hyon Jin Jeon
- Epidemiology Unit, International Vaccine Institute (IVI), Seoul, Republic of Korea
| | - Florian Marks
- Epidemiology Unit, International Vaccine Institute (IVI), Seoul, Republic of Korea.,The Department of Medicine, the University of Cambridge, Cambridge, UK
| | - Thomas Jacobs
- Research Group Protozoa Immunology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Jürgen May
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, 20359, Hamburg, Germany.,German Centre for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany.,First Medical Clinic and Polyclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Eibach
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, 20359, Hamburg, Germany.,German Centre for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| |
Collapse
|
18
|
Cruz Espinoza LM, McCreedy E, Holm M, Im J, Mogeni OD, Parajulee P, Panzner U, Park SE, Toy T, Haselbeck A, Seo HJ, Jeon HJ, Kim JH, Kwon SY, Kim JH, Parry CM, Marks F. Occurrence of Typhoid Fever Complications and Their Relation to Duration of Illness Preceding Hospitalization: A Systematic Literature Review and Meta-analysis. Clin Infect Dis 2020; 69:S435-S448. [PMID: 31665781 PMCID: PMC6821330 DOI: 10.1093/cid/ciz477] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Complications from typhoid fever disease have been estimated to occur in 10%-15% of hospitalized patients, with evidence of a higher risk in children and when delaying the implementation of effective antimicrobial treatment. We estimated the prevalence of complications in hospitalized patients with culture-confirmed typhoid fever and the effects of delaying the implementation of effective antimicrobial treatment and age on the prevalence and risk of complications. METHODS A systematic review and meta-analysis were performed using studies in the PubMed database. We rated risk of bias and conducted random-effects meta-analyses. Days of disease at hospitalization (DDA) was used as a surrogate for delaying the implementation of effective antimicrobial treatment. Analyses were stratified by DDA (DDA <10 versus ≥10 mean/median days of disease) and by age (children versus adults). Differences in risk were assessed using odds ratios (ORs) and 95% confidence intervals (CIs). Heterogeneity and publication bias were evaluated with the I2 value and funnel plot analysis, respectively. RESULTS The pooled prevalence of complications estimated among hospitalized typhoid fever patients was 27% (95% CI, 21%-32%; I2 = 90.9%, P < .0001). Patients with a DDA ≥ 10 days presented higher prevalence (36% [95% CI, 29%-43%]) and three times greater risk of severe disease (OR, 3.00 [95% CI, 2.14-4.17]; P < .0001) than patients arriving earlier (16% [95% CI, 13%- 18%]). Difference in prevalence and risk by age groups were not significant. CONCLUSIONS This meta-analysis identified a higher overall prevalence of complications than previously reported and a strong association between duration of symptoms prior to hospitalization and risk of serious complications.
Collapse
Affiliation(s)
| | - Ellen McCreedy
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island
| | - Marianne Holm
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Justin Im
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Ondari D Mogeni
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Prerana Parajulee
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Ursula Panzner
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Se Eun Park
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Trevor Toy
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Andrea Haselbeck
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Hye Jin Seo
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea.,Department of Medicine, University of Cambridge, United Kingdom, United Kingdom
| | - Jong-Hoon Kim
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Soo Young Kwon
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Jerome H Kim
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | | | - Florian Marks
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea.,Department of Medicine, University of Cambridge, United Kingdom, United Kingdom
| |
Collapse
|
19
|
Toy T, Pak GD, Duc TP, Campbell JI, El Tayeb MA, Von Kalckreuth V, Im J, Panzner U, Cruz Espinoza LM, Eibach D, Dekker DM, Park SE, Jeon HJ, Konings F, Mogeni OD, Cosmas L, Bjerregaard-Andersen M, Gasmelseed N, Hertz JT, Jaeger A, Krumkamp R, Ley B, Thriemer K, Kabore LP, Niang A, Raminosoa TM, Sampo E, Sarpong N, Soura A, Owusu-Dabo E, Teferi M, Yeshitela B, Poppert S, May J, Kim JH, Chon Y, Park JK, Aseffa A, Breiman RF, Schütt-Gerowitt H, Aaby P, Adu-Sarkodie Y, Crump JA, Rakotozandrindrainy R, Meyer CG, Sow AG, Clemens JD, Wierzba TF, Baker S, Marks F. Multicountry Distribution and Characterization of Extended-spectrum β-Lactamase-associated Gram-negative Bacteria From Bloodstream Infections in Sub-Saharan Africa. Clin Infect Dis 2020; 69:S449-S458. [PMID: 31665776 PMCID: PMC6821266 DOI: 10.1093/cid/ciz450] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is a major global health concern, yet, there are noticeable gaps in AMR surveillance data in regions such as sub-Saharan Africa. We aimed to measure the prevalence of extended-spectrum β-lactamase (ESBL) producing Gram-negative bacteria in bloodstream infections from 12 sentinel sites in sub-Saharan Africa. Methods Data were generated during the Typhoid Fever Surveillance in Africa Program (TSAP), in which standardized blood cultures were performed on febrile patients attending 12 health facilities in 9 sub-Saharan African countries between 2010 and 2014. Pathogenic bloodstream isolates were identified at the sites and then subsequently confirmed at a central reference laboratory. Antimicrobial susceptibility testing, detection of ESBL production, and conventional multiplex polymerase chain reaction (PCR) testing for genes encoding for β-lactamase were performed on all pathogens. Results Five hundred and five pathogenic Gram-negative bloodstream isolates were isolated during the study period and available for further characterization. This included 423 Enterobacteriaceae. Phenotypically, 61 (12.1%) isolates exhibited ESBL activity, and genotypically, 47 (9.3%) yielded a PCR amplicon for at least one of the screened ESBL genes. Among specific Gram-negative isolates, 40 (45.5%) of 88 Klebsiella spp., 7 (5.7%) of 122 Escherichia coli, 6 (16.2%) of 37 Acinetobacter spp., and 2 (1.3%) of 159 of nontyphoidal Salmonella (NTS) showed phenotypic ESBL activity. Conclusions Our findings confirm the presence of ESBL production among pathogens causing bloodstream infections in sub-Saharan Africa. With few alternatives for managing ESBL-producing pathogens in the African setting, measures to control the development and proliferation of AMR organisms are urgently needed.
Collapse
Affiliation(s)
- Trevor Toy
- International Vaccine Institute, Seoul, South Korea
| | - Gi Deok Pak
- International Vaccine Institute, Seoul, South Korea
| | - Trung Pham Duc
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - James I Campbell
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Justin Im
- International Vaccine Institute, Seoul, South Korea
| | | | | | - Daniel Eibach
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Denise Myriam Dekker
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany
| | - Se Eun Park
- International Vaccine Institute, Seoul, South Korea
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul, South Korea.,Department of Medicine, Cambridge University, United Kingdom
| | | | - Ondari D Mogeni
- International Vaccine Institute, Seoul, South Korea.,Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Nairobi
| | - Leonard Cosmas
- Centers for Disease Control and Prevention, KEMRI Complex, Nairobi, Kenya
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | - Nagla Gasmelseed
- Faculty of Medicine, University of Gezira, Wad Medani, Sudan.,Faculty of Science, University of Hafr Al Batin, Saudi Arabia
| | - Julian T Hertz
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina
| | - Anna Jaeger
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Ralf Krumkamp
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Benedikt Ley
- International Vaccine Institute, Seoul, South Korea.,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia
| | - Kamala Thriemer
- International Vaccine Institute, Seoul, South Korea.,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia
| | | | | | | | - Emmanuel Sampo
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Burkina Faso
| | - Nimako Sarpong
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Ghana
| | - Abdramane Soura
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Burkina Faso
| | - Ellis Owusu-Dabo
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Ghana.,Department of Global and International Health, School of Public Health, KNUST, Kumasi, Ghana
| | | | | | - Sven Poppert
- Infectious Diseases Department, University Hospital Eppendorf, Hamburg, Germany
| | - Jürgen May
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany
| | - Jerome H Kim
- International Vaccine Institute, Seoul, South Korea
| | - Yun Chon
- International Vaccine Institute, Seoul, South Korea
| | | | | | - Robert F Breiman
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Nairobi.,Global Health Institute, Emory University, Atlanta, Georgia
| | - Heidi Schütt-Gerowitt
- International Vaccine Institute, Seoul, South Korea.,Institute of Medical Microbiology, University of Cologne, Germany
| | - Peter Aaby
- Bandim Health Project, Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | - Yaw Adu-Sarkodie
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Ghana.,Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - John A Crump
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina.,Duke Global Health Institute, Duke University, Durham, North Carolina.,Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | - Christian G Meyer
- Institute of Tropical Medicine, Eberhard-Karls University Tübingen, Germany.,Duy Tan University, Da Nang, Vietnam
| | - Amy Gassama Sow
- Institute Pasteur de Dakar, Senegal.,Université Cheikh Anta Diop de Dakar, Senegal
| | - John D Clemens
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.,University of California, Fielding School of Public Health, Los Angeles.,School of Medicine, Korea University, Seoul, South Korea
| | | | - Stephen Baker
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Department of Medicine, Cambridge University, United Kingdom
| | - Florian Marks
- International Vaccine Institute, Seoul, South Korea.,Department of Medicine, Cambridge University, United Kingdom
| |
Collapse
|
20
|
Park SE, Toy T, Cruz Espinoza LM, Panzner U, Mogeni OD, Im J, Poudyal N, Pak GD, Seo H, Chon Y, Schütt-Gerowitt H, Mogasale V, Ramani E, Dey A, Park JY, Kim JH, Seo HJ, Jeon HJ, Haselbeck A, Conway Roy K, MacWright W, Adu-Sarkodie Y, Owusu-Dabo E, Osei I, Owusu M, Rakotozandrindrainy R, Soura AB, Kabore LP, Teferi M, Okeke IN, Kehinde A, Popoola O, Jacobs J, Lunguya Metila O, Meyer CG, Crump JA, Elias S, Maclennan CA, Parry CM, Baker S, Mintz ED, Breiman RF, Clemens JD, Marks F. The Severe Typhoid Fever in Africa Program: Study Design and Methodology to Assess Disease Severity, Host Immunity, and Carriage Associated With Invasive Salmonellosis. Clin Infect Dis 2020; 69:S422-S434. [PMID: 31665779 PMCID: PMC6821161 DOI: 10.1093/cid/ciz715] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Invasive salmonellosis is a common community-acquired bacteremia in persons residing in sub-Saharan Africa. However, there is a paucity of data on severe typhoid fever and its associated acute and chronic host immune response and carriage. The Severe Typhoid Fever in Africa (SETA) program, a multicountry surveillance study, aimed to address these research gaps and contribute to the control and prevention of invasive salmonellosis. METHODS A prospective healthcare facility-based surveillance with active screening of enteric fever and clinically suspected severe typhoid fever with complications was performed using a standardized protocol across the study sites in Burkina Faso, the Democratic Republic of Congo (DRC), Ethiopia, Ghana, Madagascar, and Nigeria. Defined inclusion criteria were used for screening of eligible patients for enrollment into the study. Enrolled patients with confirmed invasive salmonellosis by blood culture or patients with clinically suspected severe typhoid fever with perforation were eligible for clinical follow-up. Asymptomatic neighborhood controls and immediate household contacts of each case were enrolled as a comparison group to assess the level of Salmonella-specific antibodies and shedding patterns. Healthcare utilization surveys were performed to permit adjustment of incidence estimations. Postmortem questionnaires were conducted in medically underserved areas to assess death attributed to invasive Salmonella infections in selected sites. RESULTS Research data generated through SETA aimed to address scientific knowledge gaps concerning the severe typhoid fever and mortality, long-term host immune responses, and bacterial shedding and carriage associated with natural infection by invasive salmonellae. CONCLUSIONS SETA supports public health policy on typhoid immunization strategy in Africa.
Collapse
Affiliation(s)
- Se Eun Park
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Trevor Toy
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | | | - Ursula Panzner
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Ondari D Mogeni
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Justin Im
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Nimesh Poudyal
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea.,Department of Microbiology and Infectious Disease, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Gi Deok Pak
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Hyeongwon Seo
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Yun Chon
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Heidi Schütt-Gerowitt
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea.,Institute of Medical Microbiology, University of Cologne, Germany
| | - Vittal Mogasale
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Enusa Ramani
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Ayan Dey
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Ju Yeong Park
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Jong-Hoon Kim
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Hye Jin Seo
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea.,Department of Medicine, Cambridge University, United Kingdom
| | - Andrea Haselbeck
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | | | | | - Yaw Adu-Sarkodie
- School of Public Health, and, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ellis Owusu-Dabo
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea.,Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Osei
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Owusu
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Abdramane Bassiahi Soura
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Mekonnen Teferi
- Armauer Hansen Research Institute, ALERT Campus, Addis Ababa, Ethiopia
| | | | - Aderemi Kehinde
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan.,Department of Medical Microbiology and Parasitology, University College Hospital
| | - Oluwafemi Popoola
- Department of Community Medicine, College of Medicine, University of Ibadan.,Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Jan Jacobs
- Department of Microbiology and Immunology, KU Leuven.,Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Octavie Lunguya Metila
- Institut National de Recherche Biomedicales, Kinshasa.,Service de Microbiologie, Cliniques Universitaires de Kinshasa, Democratic Republic of Congo
| | - Christian G Meyer
- Institute of Tropical Medicine, Eberhard-Karls University of Tübingen, Germany.,Duy Tan University, Da Nang, Vietnam
| | - John A Crump
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Division of Infectious Diseases and International Health, Duke University Medical Center.,Duke Global Health Institute, Duke University, Durham, North Carolina.,Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Sean Elias
- Jenner Institute, University of Oxford, United Kingdom
| | | | | | - Stephen Baker
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Department of Medicine, Cambridge University, United Kingdom.,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Eric D Mintz
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - John D Clemens
- icddr,b, Dhaka, Bangladesh.,Fielding School of Public Health, University of California, Los Angeles
| | - Florian Marks
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea.,Department of Medicine, Cambridge University, United Kingdom
| |
Collapse
|
21
|
Ramani E, Park S, Toy T, Panzner U, Mogeni OD, Im J, Cruz Espinoza LM, Jeon HJ, Pak GD, Seo H, Chon Y, Rakotozandrindrainy R, Owusu-Dabo E, Osei I, Soura AB, Teferi M, Marks F, Mogasale V. A Multicenter Cost-of-Illness and Long-term Socioeconomic Follow-up Study in the Severe Typhoid Fever in Africa Program: Study Protocol. Clin Infect Dis 2020; 69:S459-S465. [PMID: 31665774 PMCID: PMC6821243 DOI: 10.1093/cid/ciz608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background There are limited data on typhoid fever cost of illness (COI) and economic impact from Africa. Health economic data are essential for measuring the cost-effectiveness of vaccination or other disease control interventions. Here, we describe the protocol and methods for conducting the health economic studies under the Severe Typhoid Fever in Africa (SETA) program. Methods The SETA health economic studies will rely on the platform for SETA typhoid surveillance in 4 African countries—Burkina Faso, Ethiopia, Ghana, and Madagascar. A COI and long-term socioeconomic study (LT-SES) will be its components. The COI will be assessed among blood culture–positive typhoid fever cases, blood culture–negative clinically suspected cases (clinical cases), and typhoid fever cases with pathognomonic gastrointestinal perforations (special cases). Repeated surveys using pretested questionnaires will be used to measure out-of-pocket expenses, quality of life, and the long-term socioeconomic impact. The cost of resources consumed for diagnosis and treatment will be collected at health facilities. Results Results from these studies will be published in peer-reviewed journals and presented at scientific conferences to make the data available to the wider health economics and public health research communities. Conclusions The health economic data will be analyzed to estimate the average cost per case, the quality of life at different stages of illness, financial stress due to illness, and the burden on the family due to caregiving during illness. The data generated are expected to be used in economic analysis and policy making on typhoid control interventions in sub-Saharan Africa.
Collapse
Affiliation(s)
- Enusa Ramani
- Policy and Economic Research Department, Development and Delivery Unit, International Vaccine Institute (IVI), Seoul National University (SNU) Research Park, Republic of Korea.,Department of Health Care Management, Faculty of Economics and Management, Berlin University of Technology, Germany
| | - Seeun Park
- Public Health, Access, and Vaccine Epidemiology Unit, IVI, SNU Research Park, Seoul, Republic of Korea.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Trevor Toy
- Public Health, Access, and Vaccine Epidemiology Unit, IVI, SNU Research Park, Seoul, Republic of Korea
| | - Ursula Panzner
- Public Health, Access, and Vaccine Epidemiology Unit, IVI, SNU Research Park, Seoul, Republic of Korea
| | - Ondari D Mogeni
- Public Health, Access, and Vaccine Epidemiology Unit, IVI, SNU Research Park, Seoul, Republic of Korea
| | - Justin Im
- Public Health, Access, and Vaccine Epidemiology Unit, IVI, SNU Research Park, Seoul, Republic of Korea
| | - Ligia Maria Cruz Espinoza
- Public Health, Access, and Vaccine Epidemiology Unit, IVI, SNU Research Park, Seoul, Republic of Korea
| | - Hyon Jin Jeon
- Public Health, Access, and Vaccine Epidemiology Unit, IVI, SNU Research Park, Seoul, Republic of Korea.,Department of Medicine, University of Cambridge, United Kingdom
| | - Gi Deok Pak
- Department of Biostatistics and Data Management, Development and Delivery Unit, IVI, SNU Research Park, Seoul, Republic of Korea
| | - Hyeongwon Seo
- Department of Biostatistics and Data Management, Development and Delivery Unit, IVI, SNU Research Park, Seoul, Republic of Korea
| | - Yun Chon
- Department of Biostatistics and Data Management, Development and Delivery Unit, IVI, SNU Research Park, Seoul, Republic of Korea
| | | | - Ellis Owusu-Dabo
- Public Health, Access, and Vaccine Epidemiology Unit, IVI, SNU Research Park, Seoul, Republic of Korea.,School of Public Health, and, Kumasi, Ghana
| | - Isaac Osei
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Mekonnen Teferi
- Armauer Hansen Research Institute, ALERT Campus, Addis Ababa, Ethiopia
| | - Florian Marks
- Public Health, Access, and Vaccine Epidemiology Unit, IVI, SNU Research Park, Seoul, Republic of Korea.,Department of Medicine, University of Cambridge, United Kingdom
| | - Vittal Mogasale
- Policy and Economic Research Department, Development and Delivery Unit, International Vaccine Institute (IVI), Seoul National University (SNU) Research Park, Republic of Korea
| |
Collapse
|
22
|
Jeon HJ, Im J, Haselbeck A, Holm M, Rakotozandrindrainy R, Bassiahi AS, Panzner U, Mogeni OD, Seo HJ, Lunguya O, Jacobs J, Okeke IN, Terferi M, Owusu-Dabo E, Dougan G, Carey M, Steele AD, Kim JH, Clemens JD, Andrews JR, Park SE, Baker S, Marks F. How Can the Typhoid Fever Surveillance in Africa and the Severe Typhoid Fever in Africa Programs Contribute to the Introduction of Typhoid Conjugate Vaccines? Clin Infect Dis 2020; 69:S417-S421. [PMID: 31665772 PMCID: PMC6821306 DOI: 10.1093/cid/ciz629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The World Health Organization now recommends the use of typhoid conjugate vaccines
(TCVs) in typhoid-endemic countries, and Gavi, the Vaccine Alliance, added TCVs into the
portfolio of subsidized vaccines. Data from the Severe Typhoid Fever in Africa (SETA)
program were used to contribute to TCV introduction decision-making processes,
exemplified for Ghana and Madagascar. Methods Data collected from both countries were evaluated, and barriers to and benefits of
introduction scenarios are discussed. No standardized methodological framework was
applied. Results The Ghanaian healthcare system differs from its Malagasy counterpart: Ghana features a
functioning insurance system, antimicrobials are available nationwide, and several sites
in Ghana deploy blood culture–based typhoid diagnosis. A higher incidence of
antimicrobial-resistant Salmonella Typhi is reported in Ghana, which
has not been identified as an issue in Madagascar. The Malagasy people have a low
expectation of provided healthcare and experience frequent unavailability of medicines,
resulting in limited healthcare-seeking behavior and extended consequences of untreated
disease. Conclusions For Ghana, high typhoid fever incidence coupled with spatiotemporal heterogeneity was
observed. A phased TCV introduction through an initial mass campaign in high-risk areas
followed by inclusion into routine national immunizations prior to expansion to other
areas of the country can be considered. For Madagascar, a national mass campaign
followed by routine introduction would be the introduction scenario of choice as it
would protect the population, reduce transmission, and prevent an often-deadly disease
in a setting characterized by lack of access to healthcare infrastructure. New,
easy-to-use diagnostic tools, potentially including environmental surveillance, should
be explored and improved to facilitate identification of high-risk areas.
Collapse
Affiliation(s)
- Hyon Jin Jeon
- International Vaccine Institute, Seoul, Republic of Korea.,University of Antananarivo, Madagascar
| | - Justin Im
- University of Antananarivo, Madagascar
| | | | | | | | | | | | | | | | - Octavie Lunguya
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp
| | - Jan Jacobs
- Department of Microbiology and Immunology, Katholieke Universiteit Leuven, Leuven, Belgium.,Faculty of Pharmacy, University of Ibadan, Nigeria
| | - Iruka N Okeke
- Armauer Hansen Research Institute, ALERT Campus, Addis Ababa, Ethiopia
| | - Mekonnen Terferi
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Gordon Dougan
- International Vaccine Institute, Seoul, Republic of Korea
| | - Megan Carey
- Bill & Melinda Gates Foundation, Seattle, Washington
| | | | | | - John D Clemens
- icddr,b, Dhaka, Bangladesh.,Fielding School of Public Health, University of California, Los Angeles.,Korea University School of Medicine, Seoul
| | | | - Se Eun Park
- University of Antananarivo, Madagascar.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Stephen Baker
- International Vaccine Institute, Seoul, Republic of Korea.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea.,University of Antananarivo, Madagascar
| |
Collapse
|
23
|
Teferi M, Desta M, Yeshitela B, Beyene T, Cruz Espinoza LM, Im J, Jeon HJ, Kim JH, Konings F, Kwon SY, Pak GD, Park JK, Park SE, Yedenekachew M, Kim J, Baker S, Sir WS, Marks F, Aseffa A, Panzner U. Acute Febrile Illness Among Children in Butajira, South-Central Ethiopia During the Typhoid Fever Surveillance in Africa Program. Clin Infect Dis 2020; 69:S483-S491. [PMID: 31665778 PMCID: PMC6821253 DOI: 10.1093/cid/ciz620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Clearly differentiating causes of fever is challenging where diagnostic capacities are limited, resulting in poor patient management. We investigated acute febrile illness in children aged ≤15 years enrolled at healthcare facilities in Butajira, Ethiopia, during January 2012 to January 2014 for the Typhoid Fever Surveillance in Africa Program. Methods Blood culture, malaria microscopy, and blood analyses followed by microbiological, biochemical, and antimicrobial susceptibility testing of isolates were performed. We applied a retrospectively developed scheme to classify children as malaria or acute respiratory, gastrointestinal or urinary tract infection, or other febrile infections and syndromes. Incidence rates per 100 000 population derived from the classification scheme and multivariate logistic regression to determine fever predictors were performed. Results We rarely observed stunting (4/513, 0.8%), underweight (1/513, 0.2%), wasting (1/513, 0.2%), and hospitalization (21/513, 4.1%) among 513 children with mild transient fever and a mean disease severity score of 12 (95% confidence interval [CI], 11–13). Blood cultures yielded 1.6% (8/513) growth of pathogenic agents; microscopy detected 13.5% (69/513) malaria with 20 611/µL blood (95% CI, 15 352–25 870) mean parasite density. Incidences were generally higher in children aged ≤5 years than >5 to ≤15 years; annual incidences in young children were 301.3 (95% CI, 269.2–337.2) for malaria and 1860.1 (95% CI, 1778.0–1946.0) for acute respiratory and 379.9 (95% CI, 343.6–420.0) for gastrointestinal tract infections. Conclusions We could not detect the etiological agents in all febrile children. Our findings may prompt further investigations and the reconsideration of policies and frameworks for the management of acute febrile illness.
Collapse
Affiliation(s)
- Mekonnen Teferi
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | - Mulualem Desta
- International Vaccine Institute, Seoul, South Korea.,Technology and Innovation Institute, Addis Ababa, Ethiopia.,Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Biruk Yeshitela
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | - Tigist Beyene
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | | | - Justin Im
- International Vaccine Institute, Seoul, South Korea
| | | | | | | | | | - Gi Deok Pak
- International Vaccine Institute, Seoul, South Korea
| | | | - Se Eun Park
- International Vaccine Institute, Seoul, South Korea.,Hospital for Tropical Diseases, Welcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Melaku Yedenekachew
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | - Jerome Kim
- International Vaccine Institute, Seoul, South Korea
| | - Stephen Baker
- Hospital for Tropical Diseases, Welcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Department of Medicine, University of Cambridge, United Kingdom
| | - Won Seok Sir
- Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Florian Marks
- International Vaccine Institute, Seoul, South Korea.,Department of Medicine, University of Cambridge, United Kingdom
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | | |
Collapse
|
24
|
Im J, Balasubramanian R, Ouedraogo M, Wandji Nana LR, Mogeni OD, Jeon HJ, van Pomeren T, Haselbeck A, Lim JK, Prifti K, Baker S, Meyer CG, Kim JH, Clemens JD, Marks F, Soura AB. The epidemiology of dengue outbreaks in 2016 and 2017 in Ouagadougou, Burkina Faso. Heliyon 2020; 6:e04389. [PMID: 32695907 PMCID: PMC7364030 DOI: 10.1016/j.heliyon.2020.e04389] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/27/2019] [Accepted: 06/30/2020] [Indexed: 12/22/2022] Open
Abstract
Background Dengue is prevalent in as many as 128 countries with more than 100 million clinical episodes reported annually and four billion people estimated to be at risk. While dengue fever is systematically diagnosed in large parts of Asia and South America, the disease burden in Africa is less well investigated. This report describes two consecutive dengue outbreaks in Ouagadougou, Burkina Faso in 2016 and 2017. Methods Blood samples of febrile patients received at Schiphra laboratory in Ouagadougou, Burkina Faso, were screened for dengue infection using SD Bioline Dengue Duo rapid diagnostic test kits (Standard Diagnostics, Suwon, Republic of Korea). Results A total of 1,397 and 1,882 cases were reported by a single laboratory in 2016 and 2017, respectively. Most cases were at least 15 years of age and the results corroborated reports from WHO indicating the circulation of three dengue virus serotypes in Burkina Faso. Conclusion This study complements data from other, simultaneously conducted surveillance efforts, and indicates that the dengue disease burden might be underestimated in sub-Saharan African nations. Dengue surveillance should be enhanced in African settings to determine the burden more accurately, and accelerated efforts towards a dengue vaccine should be put in place.
Collapse
Affiliation(s)
- Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | - Ruchita Balasubramanian
- International Vaccine Institute, Seoul, Republic of Korea.,Princeton University, Princeton, NJ, USA
| | - Moussa Ouedraogo
- Laboratorie d'Analyses Medicales, Centre Médical avec Antenne chirurgicale Protestant Schiphra, Ouagadougou, Burkina Faso
| | - Lady Rosny Wandji Nana
- Institut Supérieur des Sciences de la Population, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Hyon Jin Jeon
- International Vaccine Institute, Seoul, Republic of Korea.,The Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Tayma van Pomeren
- International Vaccine Institute, Seoul, Republic of Korea.,Institut Supérieur des Sciences de la Population, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | | | | | - Kristi Prifti
- International Vaccine Institute, Seoul, Republic of Korea
| | - Stephen Baker
- The Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Christian G Meyer
- Duy Tan University, Da Nang, Viet Nam.,Institute for Tropical Medicine, Eberhard Karls University, Tübingen, Germany
| | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - John D Clemens
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh.,University of California, Fielding School of Public Health, Los Angeles, USA
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea.,The Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Abdramane Bassiahi Soura
- Institut Supérieur des Sciences de la Population, Université de Ouagadougou, Ouagadougou, Burkina Faso
| |
Collapse
|
25
|
Jeon HJ, Pak GD, Im J, Owusu-Dabo E, Adu-Sarkodie Y, Gassama Sow A, Bassiahi Soura A, Gasmelseed N, Keddy KH, Bjerregaard-Andersen M, Konings F, Aseffa A, Crump JA, Chon Y, Breiman RF, Park SE, Cruz Espinoza LM, Seo HJ, May J, Meyer CG, Andrews JR, Panzner U, von Kalckreuth V, Wierzba TF, Rakotozandrindrainy R, Dougan G, Levine MM, Hombach J, Kim JH, Clemens JD, Baker S, Marks F. Determining the Best Immunization Strategy for Protecting African Children Against Invasive Salmonella Disease. Clin Infect Dis 2019; 67:1824-1830. [PMID: 29746615 PMCID: PMC6260167 DOI: 10.1093/cid/ciy386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/27/2018] [Indexed: 12/26/2022] Open
Abstract
Background The World Health Organization recently prequalified a typhoid conjugate vaccine (TCV), recommending its use in persons ≥6 months to 45 years residing in typhoid fever (TF)-endemic areas. We now need to consider how TCVs can have the greatest impact in the most vulnerable populations. Methods The Typhoid Fever Surveillance in Africa Program (TSAP) was a blood culture-based surveillance of febrile patients from defined populations presenting at healthcare facilities in 10 African countries. TF and invasive non-typhoidal Salmonella (iNTS) disease incidences were estimated for 0-10 year-olds in one-year age increments. Results Salmonella Typhi and iNTS were the most frequently isolated pathogens; 135 and 94 cases were identified, respectively. Analysis from three countries was excluded (incomplete person-years of observation (PYO) data). Thirty-seven of 123 TF cases (30.1%) and 71/90 iNTS disease cases (78.9%) occurred in children aged <5 years. No TF and 8/90 iNTS infections (8.9%) were observed in infants aged <9 months. The TF incidences (/100 000 PYO) for children aged <1 year and 1 to <2 years were 5 and 39, respectively; the highest incidence was 304 per 100 000 PYO in 4 to <5 year-olds. The iNTS disease incidence in the defined age groups ranged between 81 and 233 per 100 000 PYO, highest in 1 to <2 year-olds. TF and iNTS disease incidences were higher in West Africa. Conclusions High burden of TF detected in young children strengthens the need for TCV introduction. Given the concurrent iNTS disease burden, development of a trivalent vaccine against S. Typhi, S. Typhimurium, and S. Enteritidis may be timely in this region.
Collapse
Affiliation(s)
- Hyon Jin Jeon
- International Vaccine Institute, Seoul, Republic of Korea
| | - Gi Deok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | - Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | - Ellis Owusu-Dabo
- Kumasi Center for Collaborative Research in Tropical Medicine, Kumasi, Ghana.,Departments of Global and International Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yaw Adu-Sarkodie
- Departments of Clinical Microbiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Amy Gassama Sow
- Institute Pasteur de Dakar.,Université Cheikh Anta Diop de Dakar, Senegal
| | | | - Nagla Gasmelseed
- Faculty of Medicine, University of Gezira, Wad Medani, Sudan.,Faculty of Science, University of Hafr Al Batin, Saudi Arabia
| | - Karen H Keddy
- National Institute for Communicable Diseases, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | - Frank Konings
- International Vaccine Institute, Seoul, Republic of Korea
| | - Abraham Aseffa
- Armauer Hansen Research Institute, ALERT Campus, Addis Ababa, Ethiopia
| | - John A Crump
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Division of Infectious Diseases and International Health, Duke University Medical Center.,Duke Global Health Institute, Duke University, Durham, North Carolina.,Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Yun Chon
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Se Eun Park
- International Vaccine Institute, Seoul, Republic of Korea.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Hye Jin Seo
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jürgen May
- Bernhard Nocht Institute for Tropical Medicine, Hamburg
| | - Christian G Meyer
- Institute of Tropical Medicine, Eberhard-Karls University Tübingen, Germany.,Duy Tan University, Da Nang, Vietnam
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University, California
| | - Ursula Panzner
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | - Gordon Dougan
- Department of Medicine, University of Cambridge, United Kingdom
| | - Myron M Levine
- Department of Medicine, University of Maryland School of Medicine, Baltimore
| | | | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - John D Clemens
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka.,Fielding School of Public Health, University of California, Los Angeles.,Korea University School of Medicine, Seoul, Republic of Korea
| | - Stephen Baker
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Department of Medicine, University of Cambridge, United Kingdom
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea.,Department of Medicine, University of Cambridge, United Kingdom
| |
Collapse
|
26
|
Owusu M, Acheampong G, Annan A, Marfo KS, Osei I, Amuasi J, Sarpong N, Im J, Mogeni OD, Chiang HY, Kuo CH, Jeon HJ, Panzner U, Park SE, Marks F, Owusu-Dabo E, Adu-Sarkodie Y. Ralstonia mannitolilytica sepsis: a case report. J Med Case Rep 2019; 13:318. [PMID: 31653273 PMCID: PMC6815052 DOI: 10.1186/s13256-019-2235-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 08/16/2019] [Indexed: 11/28/2022] Open
Abstract
Background Ralstonia mannitolilytica is an emerging opportunistic pathogen that is associated with severe disease, including septic shock, meningitis, and renal transplant infections. Reports on this pathogen are limited, however, especially on the African continent. Case presentation A 2-year-old Akan child was presented to a hospital in the northeastern part of Ghana with a 1-week history of fever and chills. We identified Ralstonia mannitolilytica in her blood culture using both conventional and 16S ribosomal deoxyribonucleic acid (rDNA) techniques. The patient’s condition improved clinically upon treatment with cefuroxime. Conclusion Our report highlights the potential of Ralstonia mannitolilytica to cause sepsis and thus emphasizes the need for improved laboratory diagnosis and evidence for use of appropriate antibiotics in rural settings of Africa, where presumptive treatment using antimicrobial agents is rife.
Collapse
Affiliation(s)
- Michael Owusu
- Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Godfred Acheampong
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Augustina Annan
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwadwo Sarfo Marfo
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Osei
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - John Amuasi
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Department of Global Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Nimako Sarpong
- Agogo Presbyterian Hospital, Agogo, Ashanti Region, Ghana
| | - Justin Im
- Department of Epidemiology, International Vaccine Institute, Seoul, Republic of Korea
| | - Ondari D Mogeni
- Department of Epidemiology, International Vaccine Institute, Seoul, Republic of Korea
| | - Hsin-Ying Chiang
- Institute of Plant and Microbial Biology, Academia Sinica, Taipei, Taiwan
| | - Chih-Horng Kuo
- Institute of Plant and Microbial Biology, Academia Sinica, Taipei, Taiwan
| | - Hyon Jin Jeon
- Department of Epidemiology, International Vaccine Institute, Seoul, Republic of Korea
| | - Ursula Panzner
- Department of Epidemiology, International Vaccine Institute, Seoul, Republic of Korea
| | - Se Eun Park
- Department of Epidemiology, International Vaccine Institute, Seoul, Republic of Korea
| | - Florian Marks
- Department of Epidemiology, International Vaccine Institute, Seoul, Republic of Korea
| | - Ellis Owusu-Dabo
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. .,Department of Global Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Yaw Adu-Sarkodie
- Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| |
Collapse
|
27
|
Frickmann H, Wiemer DF, Wassill L, Hinz R, Rojak S, Wille A, Loderstädt U, Schwarz NG, von Kalckreuth V, Im J, Jin Jeon H, Marks F, Owusu-Dabo E, Sarpong N, May J, Eibach D, Dekker D. Loop-mediated isothermal amplification-based detection of typhoid fever on an automated Genie II Mk2 system - A case-control-based approach. Acta Trop 2019; 190:293-295. [PMID: 30528158 DOI: 10.1016/j.actatropica.2018.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 12/02/2018] [Accepted: 12/03/2018] [Indexed: 12/20/2022]
Abstract
Typhoid fever, caused by the bacterium Salmonella enterica subsp. enterica serovar Typhi, is an important cause of blood stream infections in the tropics, for which easy-to-apply molecular diagnostic approaches are desirable. The diagnostic performance of a newly introduced and a previously described loop-mediated isothermal amplification (LAMP) approach using different primer sets on a Genie II Mk2 device for the identification of Salmonella enterica ssp. enterica ser. Typhi was evaluated with well-characterized residual materials from the tropics in a case control-based approach. After in-vitro confirmation of binding characteristics of both LAMP primer sets with culture isolates (n = 112), sensitivity and specificity were 100% for the newly designed new LAMP primer set 1 with incubated blood culture materials, while specificity was reduced to 97.1% for primer set 2. For 170 EDTA blood samples, sensitivity and specificity were 10% and 98.3% for primer set 1 as well as 38.0% and 83.3% for primer set 2, respectively; qPCR from EDTA blood did not score much better with 10% sensitivity and 100% specificity. LAMP using a Genie II Mk2 device is suitable for the identification of Salmonella enterica spp. enterica ser. Typhi from incubated blood culture materials. Sensitivity and specificity were insufficient for diagnosis directly from EDTA blood samples but LAMP showed similar sensitivity as qPCR.
Collapse
|
28
|
Pak GD, Haselbeck AH, Seo HW, Osei I, Amuasi J, Breiman RF, Cruz Espinosa LM, Holm M, Im J, Jang GH, Jeon HJ, Luby SP, Lunguya-Metila O, MacWright W, Mogeni OD, Okeke IN, Owusu-Dabo E, Park JK, Park SE, Popoola O, Seo HJ, Soura AB, Teferi M, Toy T, Chon Y, Rafindrakalia M, Rakotozandrindrainy R, Meyer CG, Marks F, Panzner U. The HPAfrica protocol: Assessment of health behaviour and population-based socioeconomic, hygiene behavioural factors - a standardised repeated cross-sectional study in multiple cohorts in sub-Saharan Africa. BMJ Open 2018; 8:e021438. [PMID: 30573477 PMCID: PMC6303690 DOI: 10.1136/bmjopen-2017-021438] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 08/31/2018] [Accepted: 10/11/2018] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION The objective of the Health Population Africa (HPAfrica) study is to determine health behaviour and population-based factors, including socioeconomic, ethnographic, hygiene and sanitation factors, at sites of the Severe Typhoid Fever in Africa (SETA) programme. SETA aims to investigate healthcare facility-based fever surveillance in Burkina Faso, the Democratic Republic of the Congo, Ethiopia, Ghana, Madagascar and Nigeria. Meaningful disease burden estimates require adjustment for health behaviour patterns, which are assumed to vary among a study population. METHODS AND ANALYSIS For the minimum sample size of household interviews required, the assumptions of an infinite population, a design effect and age-stratification and sex-stratification are considered. In the absence of a population sampling frame or household list, a spatial approach will be used to generate geographic random points with an Aeronautical Reconnaissance Coverage Geographic Information System tool. Printouts of Google Earth Pro satellite imagery visualise these points. Data of interest will be assessed in different seasons by applying population-weighted stratified sampling. An Android-based application and a web service will be developed for electronic data capturing and synchronisation with the database server in real time. Sampling weights will be computed to adjust for possible differences in selection probabilities. Descriptive data analyses will be performed in order to assess baseline information of each study population and age-stratified and sex-stratified health behaviour. This will allow adjusting disease burden estimates. In addition, multivariate analyses will be applied to look into associations between health behaviour, population-based factors and the disease burden as determined in the SETA study. ETHICS AND DISSEMINATION Ethic approvals for this protocol were obtained by the Institutional Review Board of the International Vaccine Institute (No. 2016-0003) and by all collaborating institutions of participating countries. It is anticipated to disseminate findings from this study through publication on a peer-reviewed journal.
Collapse
Affiliation(s)
- Gi Deok Pak
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | | | - Hyeong Won Seo
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | - Isaac Osei
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Ghana, Africa
| | - John Amuasi
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Ghana, Africa
- School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Robert F Breiman
- Global Health Institute, Emory University, Atlanta, Georgia, USA
| | | | - Marianne Holm
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | - Justin Im
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | - Geun Hyeog Jang
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | - Hyon Jin Jeon
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | - Stephen P Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Octavie Lunguya-Metila
- Service de Microbiologie, Cliniques Universitaires de Kinshasa, Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicales, Kinshasa, Democratic Republic of the Congo
| | | | | | - Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Ellis Owusu-Dabo
- School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Jin Kyung Park
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | - Se Eun Park
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | - Oluwafemi Popoola
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Hye Jin Seo
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | - Abdramane Bassiahi Soura
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | | | - Trevor Toy
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | - Yun Chon
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
| | | | | | - Christian G Meyer
- Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
- Institute of Tropical Medicine, Eberhard Karls University, Tübingen, Germany
| | - Florian Marks
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
- The Department of Medicine, The University of Cambridge, Cambridge, UK
| | - Ursula Panzner
- International Vaccine Institute, Gwanak-gu, Seoul, Republic of Korea
- Swiss Tropical and Public HealthInstitute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
29
|
Balasubramanian R, Im J, Lee JS, Jeon HJ, Mogeni OD, Kim JH, Rakotozandrindrainy R, Baker S, Marks F. The global burden and epidemiology of invasive non-typhoidal Salmonella infections. Hum Vaccin Immunother 2018; 15:1421-1426. [PMID: 30081708 PMCID: PMC6663144 DOI: 10.1080/21645515.2018.1504717] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [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] [Indexed: 11/18/2022] Open
Abstract
Invasive non-typhoidal Salmonella (iNTS) disease has emerged as a major public health concern. Yet, understanding of the global burden is incomplete, limited particularly by the breadth of blood culture-based surveillance systems that are able to accurately diagnose the etiology of bacteremia. The accessibility of whole genome sequencing has allowed for genetic characterization of pathogens, shedding light on its evolutionary history and sounding alerts for its future progression. iNTS disease is observed to be a particular threat in sub-Saharan Africa, with a case fatality rate greatly exceeding that of typhoid fever, and commonly affecting infants, young children and immunocompromised adults. While iNTS disease might also be a threat in Asia and Latin America, its burden is not well characterized, primarily owing to the lack of comprehensive reporting in these regions. Drug-resistant Salmonella enterica (S. enterica) serovars (e.g. Typhimurium sequence type 313 (ST313)) have emerged as a potential consequence of sustained antibiotic pressure. Genetic analyses have identified distinguished iNTS disease-causing strains that are particularly virulent in certain human host populations. Effective treatment strategies, including vaccination, are necessary; iNTS vaccines targeting the most common S. enterica serovars, Typhimurium, Enteritidis and Dublin, are currently in early developmental stages. Funding and political support is needed to promote vaccine development and implementation programs to ultimately reduce the threat of iNTS disease in high risk areas.
Collapse
Affiliation(s)
| | - Justin Im
- b International Vaccine Institute , Seoul , Republic of Korea
| | - Jung-Seok Lee
- b International Vaccine Institute , Seoul , Republic of Korea
| | - Hyon Jin Jeon
- b International Vaccine Institute , Seoul , Republic of Korea
| | - Ondari D Mogeni
- b International Vaccine Institute , Seoul , Republic of Korea
| | - Jerome H Kim
- b International Vaccine Institute , Seoul , Republic of Korea
| | | | - Stephen Baker
- d The Department of Medicine , University of Cambridge , Cambridge , United Kingdom.,e Oxford University Clinical Research Unit , Ho Chi Minh City , Vietnam
| | - Florian Marks
- b International Vaccine Institute , Seoul , Republic of Korea.,d The Department of Medicine , University of Cambridge , Cambridge , United Kingdom
| |
Collapse
|
30
|
Jeon HJ, Fang T, Lee JG, Jang JY, Kim K, Choi S, Yan JJ, Ryu JH, Koo TY, Ahn C, Yang J. VDJ Gene Usage of B Cell Receptors in Peripheral Blood of ABO-incompatible Kidney Transplantation Patients. Transplant Proc 2018; 50:1056-1062. [PMID: 29731065 DOI: 10.1016/j.transproceed.2018.01.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 01/22/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION B cell subtypes and immunoglobulin variable (V), diversity (D), joining (J) gene segment usage of B cell receptors in ABO-incompatible (ABOi) kidney transplantation (KT) in comparison to ABO-compatible KT have not been studied. The aims of this study were to analyze the VDJ gene segment usages of B cell receptors in peripheral blood of ABOi KT recipients. METHODS Eighteen ABOi KT patients with accommodation (ABOiA), 10 ABO-compatible stable KT patients (ABOcS), and 10 ABOi KT patients with biopsy-proven acute antibody-mediated rejection (ABOiR) at day 10 after transplantation were selected. Complete transcriptomes of their peripheral blood samples were sequenced and analyzed through RNA sequencing. RESULTS By family, immunoglobulin heavy chain variable 3 (IGHV3), immunoglobulin light kappa chain variable 1 (IGKV1), immunoglobulin light lambda chain variable 2 (IGLV2), and immunoglobulin light lambda chain joining 3 (IGLJ3) gene segments were most frequently used in all groups, and their usage was not statistically different among the three groups except for IGHV3 and IGKV1. IGKV1 was more frequently used in the ABOiA group than in the ABOcS group. According to individual gene segments, IGHV3-7, IGHV3-15, IGHV4-59, IGKV3-11, IGLV1-44, IGLV2-14, IGLV4-69, and IGLV7-46 were more frequently used in the ABOcS group than other groups, and IGKV3-7 was more frequently used in the ABOiR group than other groups. IGLV5-52 and IGLV7-43 were more frequently used in the ABOiA group than in ABOcS group. CONCLUSIONS Our findings suggest that RNA sequencing transcriptomic analyses of peripheral blood can provide information on the VDJ gene usage of B cell receptors and the mechanisms of accommodation and immune reaction in ABOi KT.
Collapse
Affiliation(s)
- H J Jeon
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Republic of Korea
| | - T Fang
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - J-G Lee
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - J Y Jang
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - K Kim
- Division of Clinical Bioinformatics, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - S Choi
- Division of Clinical Bioinformatics, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - J-J Yan
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - J H Ryu
- Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - T Y Koo
- Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - C Ahn
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - J Yang
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea; Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
| |
Collapse
|
31
|
Im J, Balasubramanian R, Yastini NW, Suwarba IGN, Andayani AR, Bura V, Jeon HJ, Clemens JD, Marks F. Protecting children against Japanese encephalitis in Bali, Indonesia. Lancet 2018; 391:2500-2501. [PMID: 29976465 DOI: 10.1016/s0140-6736(18)31191-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/17/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Justin Im
- International Vaccine Institute, Seoul 08826, South Korea
| | - Ruchita Balasubramanian
- International Vaccine Institute, Seoul 08826, South Korea; Princeton University, Princeton, NJ, USA
| | | | - I Gusti Ngurah Suwarba
- Paediatric Department, Medical Faculty, Udayana University and Sanglah General Hospital, Denpasar, Indonesia
| | | | - Vinod Bura
- WHO, Indonesia Country Office, Jakarta, Indonesia
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul 08826, South Korea
| | - John D Clemens
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh; University of California, Fielding School of Public Health, Los Angeles, CA, USA; School of Medicine, Korea University, Seoul, South Korea
| | - Florian Marks
- International Vaccine Institute, Seoul 08826, South Korea; Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK.
| |
Collapse
|
32
|
Marks F, von Kalckreuth V, Aaby P, Adu-Sarkodie Y, El Tayeb MA, Ali M, Aseffa A, Baker S, Biggs HM, Bjerregaard-Andersen M, Breiman RF, Campbell JI, Cosmas L, Crump JA, Espinoza LMC, Deerin JF, Dekker DM, Fields BS, Gasmelseed N, Hertz JT, Van Minh Hoang N, Im J, Jaeger A, Jeon HJ, Kabore LP, Keddy KH, Konings F, Krumkamp R, Ley B, Løfberg SV, May J, Meyer CG, Mintz ED, Montgomery JM, Niang AA, Nichols C, Olack B, Pak GD, Panzner U, Park JK, Park SE, Rabezanahary H, Rakotozandrindrainy R, Raminosoa TM, Razafindrabe TJL, Sampo E, Schütt-Gerowitt H, Sow AG, Sarpong N, Seo HJ, Sooka A, Soura AB, Tall A, Teferi M, Thriemer K, Warren MR, Yeshitela B, Clemens JD, Wierzba TF. Incidence of invasive salmonella disease in sub-Saharan Africa: a multicentre population-based surveillance study. Lancet Glob Health 2017; 5:e310-e323. [PMID: 28193398 PMCID: PMC5316558 DOI: 10.1016/s2214-109x(17)30022-0] [Citation(s) in RCA: 175] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/17/2016] [Accepted: 11/23/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Available incidence data for invasive salmonella disease in sub-Saharan Africa are scarce. Standardised, multicountry data are required to better understand the nature and burden of disease in Africa. We aimed to measure the adjusted incidence estimates of typhoid fever and invasive non-typhoidal salmonella (iNTS) disease in sub-Saharan Africa, and the antimicrobial susceptibility profiles of the causative agents. METHODS We established a systematic, standardised surveillance of blood culture-based febrile illness in 13 African sentinel sites with previous reports of typhoid fever: Burkina Faso (two sites), Ethiopia, Ghana, Guinea-Bissau, Kenya, Madagascar (two sites), Senegal, South Africa, Sudan, and Tanzania (two sites). We used census data and health-care records to define study catchment areas and populations. Eligible participants were either inpatients or outpatients who resided within the catchment area and presented with tympanic (≥38·0°C) or axillary temperature (≥37·5°C). Inpatients with a reported history of fever for 72 h or longer were excluded. We also implemented a health-care utilisation survey in a sample of households randomly selected from each study area to investigate health-seeking behaviour in cases of self-reported fever lasting less than 3 days. Typhoid fever and iNTS disease incidences were corrected for health-care-seeking behaviour and recruitment. FINDINGS Between March 1, 2010, and Jan 31, 2014, 135 Salmonella enterica serotype Typhi (S Typhi) and 94 iNTS isolates were cultured from the blood of 13 431 febrile patients. Salmonella spp accounted for 33% or more of all bacterial pathogens at nine sites. The adjusted incidence rate (AIR) of S Typhi per 100 000 person-years of observation ranged from 0 (95% CI 0-0) in Sudan to 383 (274-535) at one site in Burkina Faso; the AIR of iNTS ranged from 0 in Sudan, Ethiopia, Madagascar (Isotry site), and South Africa to 237 (178-316) at the second site in Burkina Faso. The AIR of iNTS and typhoid fever in individuals younger than 15 years old was typically higher than in those aged 15 years or older. Multidrug-resistant S Typhi was isolated in Ghana, Kenya, and Tanzania (both sites combined), and multidrug-resistant iNTS was isolated in Burkina Faso (both sites combined), Ghana, Kenya, and Guinea-Bissau. INTERPRETATION Typhoid fever and iNTS disease are major causes of invasive bacterial febrile illness in the sampled locations, most commonly affecting children in both low and high population density settings. The development of iNTS vaccines and the introduction of S Typhi conjugate vaccines should be considered for high-incidence settings, such as those identified in this study. FUNDING Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Florian Marks
- International Vaccine Institute, SNU Research Park, Seoul, South Korea.
| | | | - Peter Aaby
- Bandim Health Project, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | - Yaw Adu-Sarkodie
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Mohammad Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Stephen Baker
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Holly M Biggs
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | - Robert F Breiman
- Centers for Disease Control and Prevention, Nairobi, Kenya; Global Health Institute, Emory University, Atlanta, GA, USA
| | - James I Campbell
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Leonard Cosmas
- Centers for Disease Control and Prevention, Nairobi, Kenya; WHO-Kenya Country Office, Nairobi, Kenya
| | - John A Crump
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA; Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | | | - Denise Myriam Dekker
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany
| | - Barry S Fields
- Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Nagla Gasmelseed
- Faculty of Medicine, University of Gezira, Wad Medani, Sudan; Faculty of Science, University of Hafr Al Batin, Hafr Al Batin, Saudi Arabia
| | - Julian T Hertz
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | | | - Justin Im
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Anna Jaeger
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Hyon Jin Jeon
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | | | - Karen H Keddy
- National Institute for Communicable Diseases, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frank Konings
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Ralf Krumkamp
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany
| | - Benedikt Ley
- International Vaccine Institute, SNU Research Park, Seoul, South Korea; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia
| | - Sandra Valborg Løfberg
- Bandim Health Project, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | - Jürgen May
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany
| | - Christian G Meyer
- Institute of Tropical Medicine, Eberhard-Karls University Tübingen, Tübingen, Germany; Duy Tan University, Da Nang, Vietnam
| | - Eric D Mintz
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Chelsea Nichols
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Beatrice Olack
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Gi Deok Pak
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Ursula Panzner
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Jin Kyung Park
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Se Eun Park
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | | | | | | | | | | | - Heidi Schütt-Gerowitt
- International Vaccine Institute, SNU Research Park, Seoul, South Korea; Institute of Medical Microbiology, University of Cologne, Cologne, Germany
| | - Amy Gassama Sow
- Institute Pasteur de Dakar, Dakar, Senegal; University Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Nimako Sarpong
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany
| | - Hye Jin Seo
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Arvinda Sooka
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Abdramane Bassiahi Soura
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Adama Tall
- Institute Pasteur de Dakar, Dakar, Senegal
| | | | - Kamala Thriemer
- International Vaccine Institute, SNU Research Park, Seoul, South Korea; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia
| | - Michelle R Warren
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | | | - John D Clemens
- International Vaccine Institute, SNU Research Park, Seoul, South Korea; International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh; University of California Fielding School of Public Health, Los Angeles, CA, USA
| | - Thomas F Wierzba
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| |
Collapse
|
33
|
Abstract
Background Adrenal myelolipoma is a rare benign tumor composed of adipose tissue and hematopoetic elements resembling bone marrow. The majority of myelolipoma do not produce adrenal hormones and are only found as a result of evaluation for another disorder. With the widespread use of non-invasive abdominal imaging for various reason, its incidental detection has become more common. There are a few cases of breast cancer with concomitant adrenal myelolipoma in the literature. Case A 43-year-old woman presented to endocrine clinic due to presurgical assessment of adrenal mass prior breast cancer surgery. Abdominal CT showed a 9 x 8 cm sized, lobulated contour heterogeneous fatty density mass with peripheral calcification in right adrenal gland. Hormonal studies for adrenal incidentaloma revealed: Aldosterone/Renin ratio, 0.70 ([normal range < 30]; normal DHEA-S, 85.0 µg/dL ([normal range, 80 -560 µg/dL]), ACTH 25 pg/mL ([normal range, 10 - 60 pg/mL]), morning serum cortisol 8.9 µg/dL ([normal range, 5 - 12 µg/dL]). In 24-hour urine, there revealed free cortisol 21.6 µg/day ([normal range, 10 - 50 µg/day); metanephrine 0.19 mg/day ([normal range < 0.8 mg/day]); 17-ketosteroid 14.06 mg/day ([normal range, 7 - 20 mg/day]). The hormonal results of adrenal mass revealed as nonfunctioning. The adrenal mass was surgically resected in order to rule out malignancy. Pathology report showed myelolipoma. Conclusion We reported a case of adrenal myelolipoma coexisting with breast cancer where the diagnosis was made incidentally based on radiological features, treated with surgical resection.
Collapse
Affiliation(s)
- H J Jeon
- Chunbguk National University, Dept. of Internal Medicine, Cheong-Ju, Republic of Korea
| | - S Y Lee
- Hankook General Hospital, Dept. of Internal Medicine, Cheong-Ju, Republic of Korea
| |
Collapse
|
34
|
Kim SC, Lee KH, Choi HY, Noble J, Lee K, Jeon HJ. On-scene factors that predict severe injury of patients involved in frontal crashes of passenger cars. Eur J Trauma Emerg Surg 2016; 43:663-670. [PMID: 27469515 DOI: 10.1007/s00068-016-0714-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 07/19/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE We sought to determine on-scene factors that predict severe injury to the occupants of passenger cars involved in frontal crashes. METHODS From January 2011 to December 2014, we collected data from patients who were taken to two emergency centres following a frontal motor vehicle crash. Binomial logistic regression was used to model the effects of occupant characteristics (sex, age, body mass index), vehicle damage (according to the collision deformation classification code), and safety devices on severe injuries (injury severity score >15). RESULTS Of 344 subjects, 75 (21.8 %) had severe injuries. Sex, seat belt status, extent of vertical crash, intrusion, and deformation extent (DE) were significantly different between severe and non-severe injuries. After adjusting for confounders, non-use of seat belt tripled the odds of severe injury [odds ratio (OR) 2.7, 95 % confidence interval (CI) 1.461-5.105]. DE ≥4 and intrusion increased the risk of severe injury (OR 2.4, 95 % CI 1.120-5.204 and OR 5.2, 95 % CI 2.525-10.780, respectively). A combination model to predict severe injury using intrusion, seat belt use, and DE ≥4 demonstrated 56.0 % sensitivity, 88.9 % specificity, and 58.4 % positive predictive value (AUC = 0.781, 95 % CI 0.734-0.824). CONCLUSIONS For passenger cars involved in a frontal crash, intrusion, unbelted status, and DE ≥4 are good predictors of severe injury. Sequential criteria using vehicle DE, seat belt use, and intrusion can be used by first responders to triage patients involved in a frontal collision.
Collapse
Affiliation(s)
- S C Kim
- Department of Emergency Medicine, Konkuk University School of Medicine Chungju Hospital, 82 Gukwon-daero, Chungju, South Korea
| | - K H Lee
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, South Korea.
| | - H Y Choi
- Department of Mechanical System Design, Hongik University College of Engineering, 94 Wausan-ro, Mapo-gu, Seoul, South Korea
| | - J Noble
- Department of Pediatric Emergency Medicine, Children's Hospital of Michigan, 3901 Beaubien St, Detroit, MI, USA
| | - K Lee
- Department of Preventive Medicine, Dongguk University Kyeongju Hospital, 1090-1 Seokjang-dong, Gyeongju, South Korea
| | - H J Jeon
- Department of Emergency Medicine, Konkuk University School of Medicine Chungju Hospital, 82 Gukwon-daero, Chungju, South Korea
| |
Collapse
|
35
|
Jeon HJ, Kim BM, Kim DJ, Park KY, Kim JW, Kim DI. Combination of Multicatheter Plus Stent or Balloon for Treatment of Complex Aneurysms. AJNR Am J Neuroradiol 2015; 37:311-6. [PMID: 26381558 DOI: 10.3174/ajnr.a4526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/10/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Coiling of complex aneurysms is still difficult even with current adjuvant techniques. This study sought to evaluate the safety and effectiveness of a combination of multicatheter plus stent or balloon for the treatment of complex aneurysms. MATERIALS AND METHODS All complex aneurysms that underwent coiling with the combination technique were identified from prospectively maintained neurointerventional data bases. "Complex aneurysm" was defined as a wide-neck aneurysm with branch incorporation into or a deep lobulation of the sac. The clinical and angiographic outcomes were retrospectively analyzed. RESULTS Sixty-two complex aneurysms (12 ruptured, 50 unruptured) in 62 patients (mean age, 57 years; male/female ratio, 12:50) were treated with a combination technique by using a multicatheter plus stent (n = 42, 3 ruptured) or balloon (n = 20, 9 ruptured). Treatment-related morbidity (grade 3 hemiparesis) occurred in 1 patient (1.6%). Except for 1 patient who had treatment-related morbidity, none of the other patients with unruptured aneurysms developed new neurologic symptoms at discharge. Nine of the 12 patients with ruptured aneurysms had good outcomes (Glasgow Outcome Score, 4 or 5) at the latest follow-up (mean, 32 months; range, 6-72 months), and 1 patient died from an initial SAH. Posttreatment control angiograms revealed complete occlusion in 27, neck remnant in 34, and incomplete occlusion in 1 aneurysm. At least 1 follow-up catheter or MR angiogram was available in 80.6% (n = 50) (mean, 21 months; range, 6-65 months). There were 4 minor and 3 major recurrences (14.0%). CONCLUSIONS In this case series, the combination technique by using multicatheter plus stent or balloon seemed safe and effective for the treatment of complex aneurysms.
Collapse
Affiliation(s)
- H J Jeon
- From the Department of Neurosurgery (H.J.J.), Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - B M Kim
- Departments of Radiology (B.M.K., D.J.K., J.W.K., D.I.K.) bmoon21@hanmail
| | - D J Kim
- Departments of Radiology (B.M.K., D.J.K., J.W.K., D.I.K.)
| | - K Y Park
- Neurosurgery (K.Y.P.), Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J W Kim
- Departments of Radiology (B.M.K., D.J.K., J.W.K., D.I.K.)
| | - D I Kim
- Departments of Radiology (B.M.K., D.J.K., J.W.K., D.I.K.)
| |
Collapse
|
36
|
Cho ES, Lee KT, Choi JW, Jeon HJ, Lee SW, Cho YM, Kim TH. Novel SNPs in the growth arrest and DNA damage-inducible protein 45 alpha gene (GADD45A) associated with meat quality traits in Berkshire pigs. Genet Mol Res 2015; 14:8581-8. [PMID: 26345789 DOI: 10.4238/2015.july.31.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study was conducted to evaluate the porcine gene GADD45A (growth arrest and DNA-damage-inducible protein 45 alpha) as a positional candidate controlling quantitative trait loci (QTL) for meat quality traits on chromosome 6 (SSC6). Four exons of the porcine GADD45A gene were defined from cDNA and BAC clone sequences. A total of 4 single nucleotide polymorphisms (SNPs) were identified in porcine GADD45A. The association of these SNPs (g.196A>G, g.392C>A, g.955T>C and g.3247A>T) with meat quality traits was evaluated in 678 Berkshire pigs. The genotype distribution of only one SNP (g.3247A>T) conformed to Hardy Weinberg equilibrium in the pig population analyzed in this study, and the other SNPs were not in Hardy-Weinberg equilibrium. All four SNPs were significantly associated with meat quality traits. Three SNPS (g.196A>G, g.392C>A, and g.955T>C) showed similar significant association patterns for drip loss, cooking loss, meat color (lightness; MC_L and yellowness; MC_B), shear force and water-holding capacity traits. By contrast, g.3247A>T had a different association pattern with other traits such as intramuscular fat content (IMF) and backfat thickness (BF), drip loss, MC_L, and moisture. These findings will provide useful information for genetic characterization or association studies in other pig populations. Additionally, these markers can potentially be applied in pig breeding programs to improve meat quality traits, including IMF and BF.
Collapse
Affiliation(s)
- E S Cho
- Animal Genomics and Bioinformatics Division, National Institute of Animal Science, Rural Development Administration, Suwon, Korea
| | - K T Lee
- Animal Genomics and Bioinformatics Division, National Institute of Animal Science, Rural Development Administration, Suwon, Korea
| | - J W Choi
- Animal Genomics and Bioinformatics Division, National Institute of Animal Science, Rural Development Administration, Suwon, Korea
| | - H J Jeon
- Animal Genomics and Bioinformatics Division, National Institute of Animal Science, Rural Development Administration, Suwon, Korea
| | - S W Lee
- Animal Genomics and Bioinformatics Division, National Institute of Animal Science, Rural Development Administration, Suwon, Korea
| | - Y M Cho
- Animal Genomics and Bioinformatics Division, National Institute of Animal Science, Rural Development Administration, Suwon, Korea
| | - T H Kim
- Animal Genomics and Bioinformatics Division, National Institute of Animal Science, Rural Development Administration, Suwon, Korea
| |
Collapse
|
37
|
Kim HJ, Hong JP, Woo JM, Jeon HJ. Importance Of Remission In Patients With Major Depressive Disorder In Korea For Improving Health-Related Quality Of Life And Economic Burden. Value Health 2014; 17:A770. [PMID: 27202833 DOI: 10.1016/j.jval.2014.08.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- H J Kim
- Pfizer Pharmaceuticals Korea Limited, Seoul, South Korea
| | - J P Hong
- Asan Medical Center, Seoul, South Korea
| | - J M Woo
- Seoul Paik Hospital, Seoul, Seoul, South Korea
| | - H J Jeon
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| |
Collapse
|
38
|
Jeon HJ, Han M, Jeong JC, Kim YJ, Kwon HY, Koo TY, Ahn C, Yang J. Impact of vitamin D, bisphosphonate, and combination therapy on bone mineral density in kidney transplant patients. Transplant Proc 2014; 45:2963-7. [PMID: 24157013 DOI: 10.1016/j.transproceed.2013.08.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Osteoporosis can develop and become aggravated in kidney transplant patients; however, the best preventive options for post-transplantation osteoporosis remain controversial. METHODS We retrospectively analyzed cohort of 182 renal transplant recipients of mean age 46.7 ± 12.1 years including 47.3% women. Seventy-three patients received neither vitamin D nor bisphosphonate after transplantation (group 1). The other patients were classified into the following 3 groups: calcium plus vitamin D (group 2; n = 40); bisphosphonate (group 3; n = 18); and both regimens (group 4; n = 51). Bone mineral density (BMD) was evaluated by dual-energy X-ray absorptiometry at baseline and at 1 year after transplantation. RESULTS At 1 year after transplantation, T-scores of the femoral neck and entire femur were significantly decreased in group 1 (-0.23 ± 0.65 [P = .004] and -0.21 ± 0.74 [P = .018], respectively), whereas the lumbar spine was significantly increased in group 4 (0.27 ± 0.79; P = .020). Post hoc analysis demonstrated that the delta T-score was significantly lower in group 1 than in group 4 (P = .009, 0.035, and 0.031 for lumbar spine, femoral neck, and entire femur, respectively). In a multivariate analysis adjusted by age, sex, body mass index, dialysis duration, diabetes, calcineurin inhibitors, estimated glomerular filtration rate, and persistent hyperparathyroidism, both group 2 and group 4 showed protective effects on BMD reduction (odds ratio [OR], 0.165; 95% confidence interval [CI] 0.032-0.845 [P = .031]; and OR, 0.169; 95% CI, 0.045-0.626 [P = .008]; respectively). However, group 3 did not show a protective effect (OR, 0.777; 95% CI, 0.198-3.054; P = .718), because their incidence of persistent hyperparathyroidism after transplantation was significantly higher (50.0%) than the other groups (P < .001). The incidence of bone fractures did not differ among the groups. CONCLUSIONS Combination therapy with vitamin D and bisphosphonate was the most effective regimen to improve BMD among kidney recipients.
Collapse
Affiliation(s)
- H J Jeon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Seo HJ, Lee BC, Seok JH, Jeon HJ, Paik JW, Kim W, Kwak KP, Han C, Lee KU, Pae CU. An open-label, rater-blinded, 8-week trial of bupropion hydrochloride extended-release in patients with major depressive disorder with atypical features. Pharmacopsychiatry 2013; 46:221-6. [PMID: 23963965 DOI: 10.1055/s-0033-1353171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The present study aimed at investigating the effectiveness and tolerability of -bupropion hydrochloride extended release (XL) in major depressive disorder (MDD) patients with atypical features (AF).51 patients were prescribed bupropion XL for 8 weeks (6 visits: screening, baseline, weeks 1, 2, 4 and 8). The primary efficacy measure was a change of the Structured Interview Guide for the Hamilton Depression Rating Scale-Seasonal Affective Disorder Version (SIGH-SAD) from baseline to endpoint. Secondary efficacy measures included the SIGH-SAD atypical symptoms subscale, Clinical Global Impression-Severity (CGI-S), Sheehan Disability Scale (SDS) and Epworth Sleepiness Questionnaire (ESQ). Response or remission was defined as ≥50% reduction or ≤7 in SIGH-SAD total scores, respectively, at end of treatment.The HAM-D-29 total score reduced by 55.3% from baseline (27.3±6.5) to end of treatment (12.2±6.3) (p<0.001). Atypical symptom subscale scores also reduced by 54.5% from baseline (9.2±3.0) to end of treatment (4.2±2.8) (p<0.001). At the end of treatment, 24.4% (n=10) and 51.2% (n=21) subjects were classified as remitters and responders, respectively. The most frequently reported AEs were headache (13.7%), dry mouth (11.8%), dizziness (9.8%), and dyspepsia (9.8%).Our preliminary study indicates that bupropion XL may be beneficial in the treatment of MDD with atypical features. Adequately powered, randomized, double-blind, placebo-controlled trials are necessary to determine our results.
Collapse
Affiliation(s)
- H-J Seo
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
An HS, Park HS, Kim YJ, Jung SI, Jeon HJ. Focal nodular hyperplasia: characterisation at gadoxetic acid-enhanced MRI and diffusion-weighted MRI. Br J Radiol 2013; 86:20130299. [PMID: 23873903 DOI: 10.1259/bjr.20130299] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The aim of this study was to assess the enhancement patterns of hepatic focal nodular hyperplasia (FNH) on gadoxetic acid-enhanced MRI and diffusion-weighted (DW) MRI. METHODS This retrospective study had institutional review board approval. Gadoxetic acid-enhanced and DW MR images were evaluated in 23 patients with 30 FNHs (26 histologically proven and 4 radiologically diagnosed). The lesion enhancement patterns of the hepatobiliary phase images were classified as heterogeneous or homogeneous signal intensity (SI), and as dominantly high/iso or low SI compared with those of adjacent liver parenchyma. Heterogeneous (any) SI lesions and homogeneous low SI lesions were categorised into the fibrosis group, whereas homogeneous high/iso SI lesions were categorised into the non-fibrosis group. Additionally, lesion SI on T2 weighted images, DW images and apparent diffusion coefficient (ADC) values were compared between the two groups. RESULTS The lesions showed heterogeneous high/iso SI (n=16), heterogeneous low SI (n=5), homogeneous high/iso SI (n=7) or homogeneous low SI (n=2) at the hepatobiliary phase MR images. The fibrosis group lesions were more likely to show high SI on DW images and T2 weighted images compared with those in the non-fibrosis group (p<0.05). ADC values tended to be lower in the fibrosis group than those in the non-fibrosis group without significance. CONCLUSION FNH showed variable enhancement patterns on hepatobiliary phase images during gadoxetic acid-enhanced MRI. SI on DW and T2 weighted images differed according to the fibrosis component contained in the lesion. ADVANCES IN KNOWLEDGE FNH shows a wide spectrum of imaging findings on gadoxetic acid-enhanced MRI and DW MRI.
Collapse
Affiliation(s)
- H S An
- Department of Radiology, Konkuk University School of Medicine, Gwangjin-gu, Seoul, Republic of Korea
| | | | | | | | | |
Collapse
|
41
|
Kim YJ, Kim MG, Jeon HJ, Ro H, Park HC, Jeong JC, Oh KH, Ha J, Yang J, Ahn C. Clinical manifestations of hypercalcemia and hypophosphatemia after kidney transplantation. Transplant Proc 2012; 44:651-6. [PMID: 22483461 DOI: 10.1016/j.transproceed.2011.12.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Abnormalities of calcium and phosphorus metabolism in end-stage renal disease patients can persist after transplantation. We investigated their natural courses after transplantation, their risk factors for posttransplantation hypercalcemia and hypophosphatemia, and their impacts on allograft outcomes. METHODS We retrospectively analyzed a total of 490 adult patients who underwent kidney transplantations between 2000 and 2009. RESULTS The serum calcium continued to increase, and reaching a plateau at around 3 months after transplantation. Thereafter it decreased, reaching a stable level by 2 years. Forty-four patients (9.0%) displayed hypercalcemia within 1 year; it persisted longer than that in 23 subjects (4.7%). Both longer dialysis duration (odds ratio [OR] 1.423; 95% confidence interval [CI], 1.192-1.699) and high intact serum parathyroid hormone (iPTH) level before transplantation (OR 1.002; 95% CI, 1.000-1.003) increased the risk for posttransplantation hypercalcemia. After a significant decrease during the first week, the serum phosphorus level increased, becoming stable between 1 and 6 months after transplantation. Hypophsphatemia occurred in 379 patients (77.3%) with 336 patients displaying hypophosphatemia without hypercalcemia. However, neither hypercalcemia nor hypophosphatemia influenced graft outcomes. Eight patients underwent pretransplantation parathyroidectomy, whereas 4 patients underwent posttransplantation parathyroidectomy. Neither group of patients experienced posttransplantation hypercalcemia. CONCLUSIONS Both hypercalcemia and hypophosphatemia are common after renal transplantation, especially among patients with a long history of dialysis before transplantation. Strict control of hyperparathyroidism including parathyroidectomy before transplantation may be the appropriate approach to these abnormalities.
Collapse
Affiliation(s)
- Y J Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Jeon HJ, Yoon JS, Cho SS, Kang KO. Indigo carmine-induced hypotension in patients undergoing general anaesthesia. Singapore Med J 2012; 53:e57-e59. [PMID: 22434307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Indigo carmine is a blue dye that is widely applied to localise ureteral orifices. It is generally believed to be a safe, biologically inert substance, and hypotensive reactions are extremely rare. However, we experienced three cases of indigo carmine-induced hypotension within a period of two weeks.
Collapse
Affiliation(s)
- H J Jeon
- Department of Anaesthesiology and Pain Medicine, Seoul Veterans Hospital, Dunchon 1-dong, Gangdong-gu, Seoul 134-060, Korea.
| | | | | | | |
Collapse
|
43
|
Jeon HJ, Han JH, Park S, Youn S, Chae H, Yoon S. Endoscopic sphincterotomy-related perforation in the common bile duct successfully treated by placement of a covered metal stent. Endoscopy 2012; 43 Suppl 2 UCTN:E295-6. [PMID: 21915834 DOI: 10.1055/s-0030-1256464] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- H J Jeon
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea
| | | | | | | | | | | |
Collapse
|
44
|
Chang DJ, Chang CH, Lee JS, Jeon HJ, Han DW. Propofol-remifentanil and the ankle clonus test in scoliosis patients. Anaesthesia 2010; 65:749-50. [PMID: 20642525 DOI: 10.1111/j.1365-2044.2010.06391.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
45
|
Lee MW, Kim YJ, Park SW, Hwang JH, Jung SI, Jeon HJ, Kwon WK. Percutaneous radiofrequency ablation of small hepatocellular carcinoma invisible on both ultrasonography and unenhanced CT: a preliminary study of combined treatment with transarterial chemoembolisation. Br J Radiol 2009; 82:908-15. [PMID: 19433482 DOI: 10.1259/bjr/55877882] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The purpose of this study was to assess the feasibility and efficacy of percutaneous radiofrequency ablation combined with transarterial chemoembolisation (TACE) for the treatment of hepatocellular carcinoma that are invisible on both ultrasound and unenhanced CT. 73 patients with a total of 101 nodular hepatocellular carcinomas were referred for possible radiofrequency (RF) ablation. Of these, 14 lesions (14%) in 14 patients were invisible on both ultrasound and unenhanced CT. The invisible nodules averaged 1.2 cm in diameter (range, 0.8-2.0 cm; median, 1.1 cm). After segmental TACE, percutaneous RF ablation was performed if the index tumour was visible on fluoroscopy, ultrasound or CT. All cases of combined treatment were evaluated for size of ablative zone, complications, rate of technical effectiveness at 1-month follow-up CT and local tumour progression. After TACE, percutaneous RF ablation was technically feasible in 10 (71%) of the 14 nodules. RF ablation was performed with the guidance of fluoroscopy (n = 6, 42%), ultrasound (n = 2, 14%) or CT (n = 2, 14%). The mean diameter of the ablative zone by percutaneous RF ablation combined with TACE was 4.8+/-0.7 cm and 3.4+/-0.6 cm in the long and short axis, respectively. No major complications were documented. The primary technical effectiveness rate for nodules treated by combined treatment was 100% (10/10) at 1-month follow-up CT. No local tumour progression was found during the follow-up period (median 15 months; range 4-20 months). Percutaneous RF ablation combined with TACE is a feasible and effective technique for treating small hepatocellular carcinomas that are not visible on ultrasound or unenhanced CT.
Collapse
Affiliation(s)
- M W Lee
- Department of Radiology, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul 143-729
| | | | | | | | | | | | | |
Collapse
|
46
|
Lee MW, Kim YJ, Park SW, Jeon HJ, Yi JG, Choe WH, Kwon SY, Lee CH. Percutaneous radiofrequency ablation of liver dome hepatocellular carcinoma invisible on ultrasonography: a new targeting strategy. Br J Radiol 2008; 81:e130-4. [PMID: 18440934 DOI: 10.1259/bjr/16397365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Targeting of index tumours is prerequisite to their radiofrequency ablation. However, small hepatocellular carcinomas (HCCs) in the liver dome are often invisible on ultrasonography, thus causing difficulty in their targeting. In cases with multinodular HCCs, adjacent HCC lesions with compact iodized oil retention can be used as anatomic landmarks to guide radiofrequency (RF) ablation of such nodules under fluoroscopy. We present two cases in which nodules that were difficult to target with conventional methods were successfully treated by RF ablation using this targeting strategy.
Collapse
Affiliation(s)
- M W Lee
- Department of Radiology, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, South Korea
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Hahm BJ, Shin YW, Shim EJ, Jeon HJ, Seo JM, Chung H, Yu HG. Depression and the vision-related quality of life in patients with retinitis pigmentosa. Br J Ophthalmol 2008; 92:650-4. [DOI: 10.1136/bjo.2007.127092] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
48
|
Park SW, Choe WH, Lee CH, Lee MW, Kim YJ, Kwon SY, Jeon HJ. Transcatheter embolization of a pseudoaneurysm of the inferior epigastric artery with N-butyl cyanoacrylate. Br J Radiol 2008; 81:e64-7. [PMID: 18270285 DOI: 10.1259/bjr/86813899] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 41-year-old man presented with alcoholic liver cirrhosis with ascites and clotting abnormality. After therapeutic paracentesis, haemoperitoneum ensued without colour Doppler ultrasound or CT evidence of pseudoaneurysm or haematoma at the site of paracentesis. However, an angiogram of the inferior epigastric artery revealed an obvious small pseudoaneurysm arising from its small muscular branch, and this pseudoaneurysm was successfully treated by transcatheter embolization with N-butyl cyanoacrylate. Transcatheter embolization with N-butyl cyanoacrylate is useful treatment for pseudoaneurysms arising from the small muscular branch of the inferior epigastric artery, which cannot be catheterized superselectively close to the pseudoaneurysm.
Collapse
Affiliation(s)
- S W Park
- Department of Radiology, Konkuk University Hospital, 4-12 Hwayang-dong, Gwangjin-gu, 143-729 Seoul, Republic of Korea
| | | | | | | | | | | | | |
Collapse
|
49
|
Park SW, Lee SH, Kim CH, Jeon GS, Hong SJ, Yi JG, Jeon HJ. Inhibition of pseudointimal hyperplasia in swine TIPS models: the efficacy of local delivery of paclitaxel using a perforated balloon catheter. Br J Radiol 2007; 80:702-7. [PMID: 17928498 DOI: 10.1259/bjr/18259234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The aim of this study was to investigate the efficacy and feasibility of local delivery of paclitaxel to inhibit pseudointimal hyperplasia/intimal hyperplasia in swine transjugular intrahepatic portosystemic shunt (TIPS) models TIPS were created in seven healthy domestic swine (15-20 kg). Before TIPS stent insertion, we performed a short-term infusion of paclitaxel (treatment group: n = 4) and saline (control group: n = 3) into the TIPS tract using a balloon catheter in which two 0.010 inch holes were created on opposite sides of the balloon. Paclitaxel or saline was given to all animals via the hepatic parenchymal and venous outflow tract. The animals were followed for up to two weeks and then killed. Gross and histological evaluations of the shunts were performed, and the maximum pseudointimal/intimal hyperplasia thicknesses were calculated for each animal The average infusion time of paclitaxel or saline was 7.6 min (6-9 min). At gross and histological evaluation, considerable pseudointimal hyperplasia had formed in the control group and statistically significant differences were found upon microscopic evaluation in the maximum pseudointimal hyperplasia thickness between the control (2.41 mm, range 1.7-3.16 mm) and animals receiving paclitaxel (0.63 mm, range 0.42-0.98 mm, p<0.05) Local delivery of paclitaxel at the time of TIPS creation may have been effective in reducing pseudointimal/intimal hyperplasia in swine TIPS models.
Collapse
Affiliation(s)
- S W Park
- Department of Radiology, Konkuk University Hospital, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
50
|
Kim SC, Chang IH, Jeon HJ. Preference for oral sildenafil or intracavernosal injection in patients with erectile dysfunction already using intracavernosal injection for > 1 year. BJU Int 2003; 92:277-80. [PMID: 12887483 DOI: 10.1046/j.1464-410x.2003.04324.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED Authors from Seoul describe their experience with patients already on triple therapy by intracavernosal injection who changed to oral sildenafil. Rather surprisingly, they found that patients had had a greater preference than expected for triple therapy, feeling that they had a better quality of erection on intracavernosal injection. The subject of the effect of renal transplantation on sperm quality and sex hormone levels is discussed by authors from Teheran. They found that sperm morphology and density remained unchanged, but there were significant improvements in sperm mobility. There was also an improvement in hormone levels and sexual function. OBJECTIVE To investigate the efficacy and preference for oral sildenafil or intracavernosal injection (ICI) therapy in patients with erectile dysfunction (ED) already using ICI. PATIENTS AND METHODS In all, 69 patients with ED (mean age 55.1 years, sd 12.3) on ICI therapy with triple solution (papaverine/phentolamine/prostaglandin-E1) for > 1 year were recruited for the study. Their erection quality, adverse reactions and selection rate of oral sildenafil or ICI as treatment, after using sildenafil for 3 months, and the reasons for their preferences, were compared between the regimens, RESULTS Overall, 52 men (75%) responded to sildenafil; of these men, the erection quality with ICI was better than that with sildenafil in 46 (89%) and 16 (31%) preferred ICI as their treatment. Eighteen patients (35%) used each treatment alternately and 18 (35%) used sildenafil exclusively. The main reason given by patients for choosing ICI was a better quality of erection (74%). CONCLUSION More patients with ED and using ICI preferred it as their main treatment than was expected, even though they had a good response to oral sildenafil. A better quality of erection with ICI was the reason why experienced patients chose this method, differing from the choice of patients starting treatment for ED.
Collapse
Affiliation(s)
- S C Kim
- Department of Urology, College of Medicine, Chung-Ang University, Seoul, Korea.
| | | | | |
Collapse
|