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Dash P, Hakim A, Akter A, Banna HA, Kaisar MH, Aktar A, Jahan SR, Ferdous J, Basher SR, Kamruzzaman M, Chowdhury F, Akter A, Tauheed I, Weil AA, Charles RC, Calderwood SB, Ryan ET, LaRocque RC, Harris JB, Bhuiyan TR, Qadri F. Cholera toxin and O-specific polysaccharide immune responses after oral cholera vaccination with Dukoral in different age groups of Bangladeshi participants. mSphere 2024; 9:e0056523. [PMID: 38391226 PMCID: PMC10964428 DOI: 10.1128/msphere.00565-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/20/2023] [Indexed: 02/24/2024] Open
Abstract
Vaccination is important to prevent cholera. There are limited data comparing anti-O-specific polysaccharide (OSP) and anti-cholera toxin-specific immune responses following oral whole-cell with cholera toxin B-subunit (WC-rBS) vaccine (Dukoral, Valneva) administration in different age groups. An understanding of the differences is relevant because young children are less well protected by oral cholera vaccines than older children and adults. We compared responses in 50 adults and 49 children (ages 2 to <18) who were administered two doses of WC-rBS at a standard 14-day interval. All age groups had significant IgA and IgG plasma-blast responses to the OSP and cholera toxin B-subunit (CtxB) antigens that peaked 7 days after vaccination. However, in adults and older children (ages 5 to <18), antibody responses directed at the OSP antigen were largely IgA and IgG, with a minimal IgM response, while younger children (ages 2 to <5) mounted significant increases in IgM with minimal increases in IgA and IgG antibody responses 30 days after vaccination. In adults, anti-OSP and CtxB memory B-cell responses were detected after completion of the vaccination series, while children only mounted CtxB-specific IgG memory B-cell responses and no OSP-memory B-cell responses. In summary, children and adults living in a cholera endemic area mounted different responses to the WC-rBS vaccine, which may be a result of more prior exposure to Vibrio cholerae in older participants. The absence of class-switched antibody responses and memory B-cell responses to OSP may explain why protection wanes more rapidly after vaccination in young children compared to older vaccinees.IMPORTANCEVaccination is an important strategy to prevent cholera. Though immune responses targeting the OSP of V. cholerae are believed to mediate protection against cholera, there are limited data on anti-OSP responses after vaccination in different age groups, which is important as young children are not well protected by current oral cholera vaccines. In this study, we found that adults mounted memory B-cell responses to OSP, which were not seen in children. Adults and older children mounted class-switched (IgG and IgA) serum antibody responses to OSP, which were not seen in young children who had only IgM responses to OSP. The lack of class-switched antibody responses and memory B-cell responses to OSP in younger participants may be due to lack of prior exposure to V. cholerae and could explain why protection wanes more rapidly after vaccination in young children.
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Affiliation(s)
- Pinki Dash
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Al Hakim
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Genetic Engineering and Biotechnology, Jagannath University, Dhaka, Bangladesh
| | - Aklima Akter
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Hasan Al Banna
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M. Hasanul Kaisar
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Amena Aktar
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sultana Rownok Jahan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jannatul Ferdous
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Salima Raiyan Basher
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Kamruzzaman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Department of Biochemistry and Molecular Biology, Mawlana Bhashani Science and Technology University, Santosh, Tangail, Bangladesh
| | - Fahima Chowdhury
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Afroza Akter
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Imam Tauheed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ana A. Weil
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Richelle C. Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen B. Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Regina C. LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason B. Harris
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
- Division of Global Health, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Taufiqur Rahman Bhuiyan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Lypaczewski P, Chac D, Dunmire CN, Tandoc KM, Chowdhury F, Khan AI, Bhuiyan T, Harris JB, LaRocque RC, Calderwood SB, Ryan ET, Qadri F, Shapiro BJ, Weil AA. Diversity of Vibrio cholerae O1 through the human gastrointestinal tract during cholera. bioRxiv 2024:2024.02.08.579476. [PMID: 38370713 PMCID: PMC10871328 DOI: 10.1101/2024.02.08.579476] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Vibrio cholerae O1 causes the diarrheal disease cholera, and the small intestine is the site of active infection. During cholera, cholera toxin is secreted from V. cholerae and induces a massive fluid influx into the small intestine, which causes vomiting and diarrhea. Typically, V. cholerae genomes are sequenced from bacteria passed in stool, but rarely from vomit, a fluid that may more closely represents the site of active infection. We hypothesized that the V. cholerae O1 population bottlenecks along the gastrointestinal tract would result in reduced genetic variation in stool compared to vomit. To test this, we sequenced V. cholerae genomes from ten cholera patients with paired vomit and stool samples. Genetic diversity was low in both vomit and stool, consistent with a single infecting population rather than co-infection with divergent V. cholerae O1 lineages. The number of single nucleotide variants decreased between vomit and stool in four patients, increased in two, and remained unchanged in four. The number of genes encoded in the V. cholerae genome decreased between vomit and stool in eight patients and increased in two. Pangenome analysis of assembled short-read sequencing demonstrated that the toxin-coregulated pilus operon more frequently contained deletions in genomes from vomit compared to stool. However, these deletions were not detected by PCR or long-read sequencing, indicating that interpreting gene presence or absence patterns from short-read data alone may be incomplete. Overall, we found that V. cholerae O1 isolated from stool is genetically similar to V. cholerae recovered from the upper intestinal tract.
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Affiliation(s)
- Patrick Lypaczewski
- Department of Microbiology and Immunology, McGill University, Montreal, QC, Canada
| | - Denise Chac
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Fahima Chowdhury
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Ashraful I. Khan
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Taufiqur Bhuiyan
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jason B. Harris
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, US
- Division of Global Health, Massachusetts General Hospital for Children, Boston, MA, USA
| | - Regina C. LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, US
- Harvard Medical School, Boston, MA, USA
| | - Stephen B. Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, US
- Harvard Medical School, Boston, MA, USA
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, US
- Harvard Medical School, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA
| | - Firdausi Qadri
- Infectious Diseases Division, International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - B. Jesse Shapiro
- Department of Microbiology and Immunology, McGill University, Montreal, QC, Canada
| | - Ana A. Weil
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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Matias WR, Guillaume Y, Cene Augustin G, Vissieres K, Ternier R, Slater DM, Harris JB, Franke MF, Ivers LC. Effectiveness of the Euvichol® oral cholera vaccine at 2 years: A case-control and bias-indicator study in Haiti. Int J Infect Dis 2024; 139:153-158. [PMID: 38000510 PMCID: PMC10784151 DOI: 10.1016/j.ijid.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/21/2023] [Accepted: 11/19/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVES The World Health Organization recommends the use of oral cholera vaccine (OCV) in cholera control efforts. Euvichol®, pre-qualified in 2015, is the leading component of the Global OCV stockpile, but data on its field effectiveness are limited. To evaluate Euvichol® vaccine effectiveness (VE), we conducted a case-control study between September 2018 to March 2020 following an OCV campaign in November 2017 in Haiti. METHODS Cases were individuals with acute watery diarrhea. Stool samples were tested by culture and real-time polymerase chain reaction of the Vibrio cholerae ctxA gene. Cases were matched to four community controls without diarrhea by residence, enrollment time, age, and gender, and interviewed for sociodemographics, risk factors, and self-reported vaccination. Cholera cases were analyzed by conditional logistic regression in the VE study. Non-cholera diarrhea cases were analyzed in a bias-indicator study. RESULTS We enrolled 15 cholera cases matched to 60 controls, and 63 non-cholera diarrhea cases matched to 249 controls. In the VE analysis, eight (53%) cases reported vaccination with any number of doses compared to 43 (72%) controls. Adjusted two-dose OCV VE was 69% (95% CI -71 to 94%). CONCLUSIONS Between 10-27 months after vaccination, Euvichol® was effective and similar to Shanchol™, suggesting that it can serve as one component of multi-sectoral comprehensive cholera control.
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Affiliation(s)
- Wilfredo R Matias
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, USA; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, USA; Center for Global Health, Massachusetts General Hospital, Boston, USA.
| | | | | | | | | | - Damien M Slater
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, USA; Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, USA; Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Louise C Ivers
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, USA; Center for Global Health, Massachusetts General Hospital, Boston, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Harvard Global Health Institute, Cambridge, USA
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Matias WR, Fulcher IR, Sauer SM, Nolan CP, Guillaume Y, Zhu J, Molano FJ, Uceta E, Collins S, Slater DM, Sánchez VM, Moheed S, Harris JB, Charles RC, Paxton RM, Gonsalves SF, Franke MF, Ivers LC. Disparities in SARS-CoV-2 Infection by Race, Ethnicity, Language, and Social Vulnerability: Evidence from a Citywide Seroprevalence Study in Massachusetts, USA. J Racial Ethn Health Disparities 2024; 11:110-120. [PMID: 36652163 PMCID: PMC9847437 DOI: 10.1007/s40615-022-01502-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Uncovering and addressing disparities in infectious disease outbreaks require a rapid, methodical understanding of local epidemiology. We conducted a seroprevalence study of SARS-CoV-2 infection in Holyoke, Massachusetts, a majority Hispanic city with high levels of socio-economic disadvantage to estimate seroprevalence and identify disparities in SARS-CoV-2 infection. METHODS We invited 2000 randomly sampled households between 11/5/2020 and 12/31/2020 to complete questionnaires and provide dried blood spots for SARS-CoV-2 antibody testing. We calculated seroprevalence based on the presence of IgG antibodies using a weighted Bayesian procedure that incorporated uncertainty in antibody test sensitivity and specificity and accounted for household clustering. RESULTS Two hundred eighty households including 472 individuals were enrolled. Three hundred twenty-eight individuals underwent antibody testing. Citywide seroprevalence of SARS-CoV-2 IgG was 13.1% (95% CI 6.9-22.3) compared to 9.8% of the population infected based on publicly reported cases. Seroprevalence was 16.1% (95% CI 6.2-31.8) among Hispanic individuals compared to 9.4% (95% CI 4.6-16.4) among non-Hispanic white individuals. Seroprevalence was higher among Spanish-speaking households (21.9%; 95% CI 8.3-43.9) compared to English-speaking households (10.2%; 95% CI 5.2-18.0) and among individuals in high social vulnerability index (SVI) areas based on the CDC SVI (14.4%; 95% CI 7.1-25.5) compared to low SVI areas (8.2%; 95% CI 3.1-16.9). CONCLUSIONS The SARS-CoV-2 IgG seroprevalence in a city with high levels of social vulnerability was 13.1% during the pre-vaccination period of the COVID-19 pandemic. Hispanic individuals and individuals in communities characterized by high SVI were at the highest risk of infection. Public health interventions should be designed to ensure that individuals in high social vulnerability communities have access to the tools to combat COVID-19.
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Affiliation(s)
- Wilfredo R Matias
- Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit St, BUL-130, Boston, MA, 02114, USA.
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA.
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA.
| | - Isabel R Fulcher
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Harvard Data Science Initiative, Cambridge, MA, USA
| | - Sara M Sauer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Cody P Nolan
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Yodeline Guillaume
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Jack Zhu
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Francisco J Molano
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth Uceta
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Shannon Collins
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Damien M Slater
- Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit St, BUL-130, Boston, MA, 02114, USA
| | - Vanessa M Sánchez
- Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit St, BUL-130, Boston, MA, 02114, USA
| | - Serina Moheed
- Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit St, BUL-130, Boston, MA, 02114, USA
| | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit St, BUL-130, Boston, MA, 02114, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Richelle C Charles
- Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit St, BUL-130, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | | | | | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Louise C Ivers
- Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit St, BUL-130, Boston, MA, 02114, USA
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Harvard Global Health Institute, Cambridge, MA, USA
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5
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Roach DJ, Sridhar S, Oliver E, Rao SR, Slater DM, Hwang W, Hutt Vater K, Dinesh A, Qadri F, Chisti MJ, Pierce VM, Turbett SE, Bhattacharyya RP, Worby CJ, Earl AM, LaRocque RC, Harris JB. Clinical and Genomic Characterization of a Cohort of Patients With Klebsiella pneumoniae Bloodstream Infection. Clin Infect Dis 2024; 78:31-39. [PMID: 37633257 PMCID: PMC10810715 DOI: 10.1093/cid/ciad507] [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: 06/14/2023] [Revised: 08/09/2023] [Accepted: 08/22/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The clinical and microbial factors associated with Klebsiella pneumoniae bloodstream infections (BSIs) are not well characterized. Prior studies have focused on highly resistant or hypervirulent isolates, limiting our understanding of K. pneumoniae strains that commonly cause BSI. We performed a record review and whole-genome sequencing to investigate the clinical characteristics, bacterial diversity, determinants of antimicrobial resistance, and risk factors for in-hospital death in a cohort of patients with K. pneumoniae BSI. METHODS We identified 562 patients at Massachusetts General Hospital with K. pneumoniae BSIs between 2016 and 2022. We collected data on comorbid conditions, infection source, clinical outcomes, and antibiotic resistance and performed whole-genome sequencing on 108 sequential BSI isolates from 2021 to 2022. RESULTS Intra-abdominal infection was the most common source of infection accounting for 34% of all BSIs. A respiratory tract source accounted for 6% of BSIs but was associated with a higher in-hospital mortality rate (adjusted odds ratio, 5.4 [95% confidence interval, 2.2-12.8]; P < .001 for comparison with other sources). Resistance to the first antibiotic prescribed was also associated with a higher risk of death (adjusted odds ratio, 5.2 [95% confidence interval, 2.2-12.4]; P < .001). BSI isolates were genetically diverse, and no clusters of epidemiologically and genetically linked cases were observed. Virulence factors associated with invasiveness were observed at a low prevalence, although an unexpected association between O-antigen type and the source of infection was found. CONCLUSIONS These observations demonstrate the versatility of K. pneumoniae as an opportunistic pathogen and highlight the need for new approaches for surveillance and the rapid identification of patients with invasive antimicrobial-resistant K. pneumoniae infection.
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Affiliation(s)
- David J Roach
- The Broad Institute of MIT and Harvard, Boston, Massachusetts, USA
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sushmita Sridhar
- The Broad Institute of MIT and Harvard, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elizabeth Oliver
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sowmya R Rao
- Department of Global Health, Boston University, Boston, Massachusetts, USA
| | - Damien M Slater
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Wontae Hwang
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kian Hutt Vater
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anupama Dinesh
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Firdausi Qadri
- Dhaka Hospital, International Centre for Diarrheal Disease Research, Bangladesh
| | - Mohammod J Chisti
- Dhaka Hospital, International Centre for Diarrheal Disease Research, Bangladesh
| | - Virginia M Pierce
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Sarah E Turbett
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Roby P Bhattacharyya
- The Broad Institute of MIT and Harvard, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Colin J Worby
- The Broad Institute of MIT and Harvard, Boston, Massachusetts, USA
| | - Ashlee M Earl
- The Broad Institute of MIT and Harvard, Boston, Massachusetts, USA
| | - Regina C LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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6
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Akhtar M, Islam MR, Khaton F, Soltana UH, Jafrin SA, Rahman SIA, Tauheed I, Ahmed T, Khan II, Akter A, Khan ZH, Islam MT, Khanam F, Biswas PK, Ahmmed F, Ahmed S, Rashid MM, Hossain MZ, Alam AN, Alamgir ASM, Rahman M, Ryan ET, Harris JB, LaRocque RC, Flora MS, Chowdhury F, Khan AI, Banu S, Shirin T, Bhuiyan TR, Qadri F. Appearance of tolerance-induction and non-inflammatory SARS-CoV-2 spike-specific IgG4 antibodies after COVID-19 booster vaccinations. Front Immunol 2023; 14:1309997. [PMID: 38173725 PMCID: PMC10763240 DOI: 10.3389/fimmu.2023.1309997] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
Background Understanding the characteristics of the humoral immune responses following COVID-19 vaccinations is crucial for refining vaccination strategies and predicting immune responses to emerging SARS-CoV-2 variants. Methods A longitudinal analysis of SARS-CoV-2 spike receptor binding domain (RBD) specific IgG antibody responses, encompassing IgG subclasses IgG1, IgG2, IgG3, and IgG4 was performed. Participants received four mRNA vaccine doses (group 1; n=10) or two ChAdOx1 nCoV-19 and two mRNA booster doses (group 2; n=19) in Bangladesh over two years. Results Findings demonstrate robust IgG responses after primary Covishield or mRNA doses; declining to baseline within six months. First mRNA booster restored and surpassed primary IgG responses but waned after six months. Surprisingly, a second mRNA booster did not increase IgG levels further. Comprehensive IgG subclass analysis showed primary Covishield/mRNA vaccination generated predominantly IgG1 responses with limited IgG2/IgG3, Remarkably, IgG4 responses exhibited a distinct pattern. IgG4 remained undetectable initially but increased extensively six months after the second mRNA dose, eventually replacing IgG1 after the 3rd/4th mRNA doses. Conversely, initial Covishield recipients lack IgG4, surged post-second mRNA booster. Notably, mRNA-vaccinated individuals displayed earlier, robust IgG4 levels post first mRNA booster versus Covishield counterparts. IgG1 to IgG4 ratios decreased with increasing doses, most pronounced with four mRNA doses. This study highlights IgG response kinetics, influenced by vaccine type and doses, impacting immunological tolerance and IgG4 induction, shaping future vaccination strategies. Conclusions This study highlights the dynamics of IgG responses dependent on vaccine type and number of doses, leading to immunological tolerance and IgG4 induction, and shaping future vaccination strategies.
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Affiliation(s)
- Marjahan Akhtar
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md. Rashedul Islam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fatema Khaton
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Umma Hany Soltana
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Syeda Anoushka Jafrin
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sadia Isfat Ara Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Imam Tauheed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tasnuva Ahmed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ishtiakul Islam Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Afroza Akter
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Zahid Hasan Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md. Taufiqul Islam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farhana Khanam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Prasanta Kumar Biswas
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Faisal Ahmmed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shakeel Ahmed
- Bangladesh Institute of Tropical & Infectious Diseases, Chittagong, Bangladesh
| | - Md. Mamunur Rashid
- Bangladesh Institute of Tropical & Infectious Diseases, Chittagong, Bangladesh
| | - Md. Zakir Hossain
- Bangladesh Institute of Tropical & Infectious Diseases, Chittagong, Bangladesh
| | - Ahmed Nawsher Alam
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - A. S. M. Alamgir
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Mahbubur Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Regina C. LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | | | - Fahima Chowdhury
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashraful Islam Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sayera Banu
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Taufiqur Rahman Bhuiyan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
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Brown DG, Worby CJ, Pender MA, Brintz BJ, Ryan ET, Sridhar S, Oliver E, Harris JB, Turbett SE, Rao SR, Earl AM, LaRocque RC, Leung DT. Development of a prediction model for the acquisition of extended spectrum beta-lactam-resistant organisms in U.S. international travellers. J Travel Med 2023; 30:taad028. [PMID: 36864572 PMCID: PMC10628771 DOI: 10.1093/jtm/taad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Extended spectrum beta-lactamase producing Enterobacterales (ESBL-PE) present a risk to public health by limiting the efficacy of multiple classes of beta-lactam antibiotics against infection. International travellers may acquire these organisms and identifying individuals at high risk of acquisition could help inform clinical treatment or prevention strategies. METHODS We used data collected from a cohort of 528 international travellers enrolled in a multicentre US-based study to derive a clinical prediction rule (CPR) to identify travellers who developed ESBL-PE colonization, defined as those with new ESBL positivity in stool upon return to the United States. To select candidate features, we used data collected from pre-travel and post-travel questionnaires, alongside destination-specific data from external sources. We utilized LASSO regression for feature selection, followed by random forest or logistic regression modelling, to derive a CPR for ESBL acquisition. RESULTS A CPR using machine learning and logistic regression on 10 features has an internally cross-validated area under the receiver operating characteristic curve (cvAUC) of 0.70 (95% confidence interval 0.69-0.71). We also demonstrate that a four-feature model performs similarly to the 10-feature model, with a cvAUC of 0.68 (95% confidence interval 0.67-0.69). This model uses traveller's diarrhoea, and antibiotics as treatment, destination country waste management rankings and destination regional probabilities as predictors. CONCLUSIONS We demonstrate that by integrating traveller characteristics with destination-specific data, we could derive a CPR to identify those at highest risk of acquiring ESBL-PE during international travel.
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Affiliation(s)
- David Garrett Brown
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Colin J Worby
- Infectious Disease and Microbiome Program, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Melissa A Pender
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ben J Brintz
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Edward T Ryan
- Harvard Medical School, Boston, MA, USA
- Travelers’ Advice and Immunization Center, Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sushmita Sridhar
- Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth Oliver
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Sarah E Turbett
- Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Sowmya R Rao
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Ashlee M Earl
- Infectious Disease and Microbiome Program, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Regina C LaRocque
- Harvard Medical School, Boston, MA, USA
- Travelers’ Advice and Immunization Center, Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel T Leung
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, USA
- Division of Microbiology & Immunology, University of Utah School of Medicine, Salt Lake City, UT, USA
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8
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Kaisar MH, Kelly M, Kamruzzaman M, Bhuiyan TR, Chowdhury F, Khan AI, LaRocque RC, Calderwood SB, Harris JB, Charles RC, Čížová A, Mečárová J, Korcová J, Bystrický S, Kováč P, Xu P, Qadri F, Ryan ET. Comparison of O-specific polysaccharide responses in patients following infection with Vibrio cholerae O139 versus vaccination with a bivalent (O1/O139) oral killed cholera vaccine in Bangladesh. mSphere 2023; 8:e0025523. [PMID: 37646517 PMCID: PMC10597347 DOI: 10.1128/msphere.00255-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/05/2023] [Indexed: 09/01/2023] Open
Abstract
Cholera caused by Vibrio cholerae O139 emerged in the early 1990s and spread rapidly to 11 Asian countries before receding for unclear reasons. Protection against cholera is serogroup-specific, which is defined by the O-specific polysaccharide (OSP) component of lipopolysaccharide (LPS). V. cholerae O139 also expresses the OSP-capsule. We, therefore, assessed antibody responses targeting V. cholerae O139 OSP, LPS, capsule, and vibriocidal responses in patients in Bangladesh with cholera caused by V. cholerae O139. We compared these responses to those of age-gender-blood group-matched recipients of the bivalent oral cholera vaccine (OCV O1/O139). We found prominent OSP, LPS, and vibriocidal responses in patients, with a high correlation between these responses. OSP responses primarily targeted the terminal tetrasaccharide of OSP. Vaccinees developed OSP, LPS, and vibriocidal antibody responses, but of significantly lower magnitude and responder frequency (RF) than matched patients. We separately analyzed responses in pediatric vaccinees born after V. cholerae O139 had receded in Bangladesh. We found that OSP responses were boosted in children who had previously received a single dose of bivalent OCV 3 yr previously but not in vaccinated immunologically naïve children. Our results suggest that OSP-specific responses occur during cholera caused by V. cholerae O139 despite the presence of capsules, that vaccination with bivalent OCV is poorly immunogenic in the short term in immunologically naïve individuals, but that OSP-specific immune responses can be primed by previous exposure, although whether such responses can protect against O139 cholera is uncertain. IMPORTANCE Cholera is a severe dehydrating illness in humans caused by Vibrio cholerae serogroups O1 or O139. Protection against cholera is serogroup-specific, which is defined by the O-specific polysaccharide (OSP) of V. cholerae LPS. Yet, little is known about immunity to O139 OSP. In this study, we assessed immune responses targeting OSP in patients from an endemic region with cholera caused by V. cholerae O139. We compared these responses to those of the age-gender-blood group-matched recipients of the bivalent oral cholera vaccine. Our results suggest that OSP-specific responses occur during cholera caused by V. cholerae O139 and that the OSP responses primarily target the terminal tetrasaccharide of OSP. Our results further suggest that vaccination with the bivalent vaccine is poorly immunogenic in the short term for inducing O139-specific OSP responses in immunologically naïve individuals, but OSP-specific immune responses can be primed by previous exposure or vaccination.
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Affiliation(s)
- M. Hasanul Kaisar
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Meagan Kelly
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mohammad Kamruzzaman
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Taufiqur R. Bhuiyan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahima Chowdhury
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashraful Islam Khan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Regina C. LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen B. Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason B. Harris
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Global Health, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | - Richelle C. Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Alžbeta Čížová
- Institute of Chemistry, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Jana Mečárová
- Institute of Chemistry, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Jana Korcová
- Institute of Chemistry, Slovak Academy of Sciences, Bratislava, Slovakia
- Department of Chemical Theory of Drugs, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia
| | - Slavomír Bystrický
- Institute of Chemistry, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Pavol Kováč
- Laboratory of Bioorganic Chemistry (LBC), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, Maryland, USA
| | - Peng Xu
- Laboratory of Bioorganic Chemistry (LBC), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, Maryland, USA
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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9
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Worby CJ, Sridhar S, Turbett SE, Becker MV, Kogut L, Sanchez V, Bronson RA, Rao SR, Oliver E, Walker AT, Walters MS, Kelly P, Leung DT, Knouse MC, Hagmann SHF, Harris JB, Ryan ET, Earl AM, LaRocque RC. Gut microbiome perturbation, antibiotic resistance, and Escherichia coli strain dynamics associated with international travel: a metagenomic analysis. Lancet Microbe 2023; 4:e790-e799. [PMID: 37716364 PMCID: PMC10680401 DOI: 10.1016/s2666-5247(23)00147-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 04/21/2023] [Accepted: 05/09/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Culture-based studies have shown that acquisition of extended-spectrum β-lactamase-producing Enterobacterales is common during international travel; however, little is known about the role of the gut microbiome before and during travel, nor about acquisition of other antimicrobial-resistant organisms. We aimed to identify (1) whether the gut microbiome provided colonisation resistance against antimicrobial-resistant organism acquisition, (2) the effect of travel and travel behaviours on the gut microbiome, and (3) the scale and global heterogeneity of antimicrobial-resistant organism acquisition. METHODS In this metagenomic analysis, participants were recruited at three US travel clinics (Boston, MA; New York, NY; and Salt Lake City, UT) before international travel. Participants had to travel internationally between Dec 8, 2017, and April 30, 2019, and have DNA extractions for stool samples both before and after travel for inclusion. Participants were excluded if they had at least one low coverage sample (<1 million read pairs). Stool samples were collected at home before and after travel, sent to a clinical microbiology laboratory to be screened for three target antimicrobial-resistant organisms (extended-spectrum β-lactamase-producing Enterobacterales, carbapenem-resistant Enterobacterales, and mcr-mediated colistin-resistant Enterobacterales), and underwent DNA extraction and shotgun metagenomic sequencing. We profiled metagenomes for taxonomic composition, antibiotic-resistant gene content, and characterised the Escherichia coli population at the strain level. We analysed pre-travel samples to identify the gut microbiome risk factors associated with acquisition of the three targeted antimicrobial resistant organisms. Pre-travel and post-travel samples were compared to identify microbiome and resistome perturbation and E coli strain acquisition associated with travel. FINDINGS A total of 368 individuals travelled between the required dates, and 296 had DNA extractions available for both before and after travel. 29 travellers were excluded as they had at least one low coverage sample, leaving a final group of 267 participants. We observed a perturbation of the gut microbiota, characterised by a significant depletion of microbial diversity and enrichment of the Enterobacteriaceae family. Metagenomic strain tracking confirmed that 67% of travellers acquired new strains of E coli during travel that were phylogenetically distinct from their pre-travel strains. We observed widespread enrichment of antibiotic-resistant genes in the gut, with a median 15% (95% CI 10-20, p<1 × 10-10) increase in burden (reads per kilobase per million reads). This increase included antibiotic-resistant genes previously classified as threats to public health, which were 56% (95% CI 36-91, p=2 × 10-11) higher in abundance after travel than before. Fluoroquinolone antibiotic-resistant genes were aquired by 97 (54%) of 181 travellers with no detected pre-travel carriage. Although we found that visiting friends or relatives, travel to south Asia, and eating uncooked vegetables were risk factors for acquisition of the three targeted antimicrobial resistant organisms, we did not observe an association between the pre-travel microbiome structure and travel-related antimicrobial-resistant organism acquisition. INTERPRETATION This work highlights a scale of E coli and antimicrobial-resistant organism acquisition by US travellers not apparent from previous culture-based studies, and suggests that strategies to control antimicrobial-resistant organisms addressing international traveller behaviour, rather than modulating the gut microbiome, could be worthwhile. FUNDING US Centers for Disease Control and Prevention and National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Colin J Worby
- Infectious Disease and Microbiome Program, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Sushmita Sridhar
- Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah E Turbett
- Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Margaret V Becker
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Lucyna Kogut
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Vanessa Sanchez
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Ryan A Bronson
- Infectious Disease and Microbiome Program, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Sowmya R Rao
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Elizabeth Oliver
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Allison Taylor Walker
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maroya Spalding Walters
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul Kelly
- Division of Infectious Diseases, Bronx Care Center, Bronx, NY, USA
| | - Daniel T Leung
- Division of Infectious Diseases and Division of Microbiology and Immunology, University of Utah, Salt Lake City, UT, USA
| | - Mark C Knouse
- Department of Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Stefan H F Hagmann
- Division of Pediatric Infectious Diseases, Steven and Alexandra Cohen Children's Medical Center of New York/Northwell Health, New Hyde Park, NY, USA
| | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Division of Pediatric Global Health, Massachusetts General Hospital for Children, Boston, MA, USA
| | - Edward T Ryan
- Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Travellers' Advice and Immunization Center, Massachusetts General Hospital, Boston, MA, USA
| | - Ashlee M Earl
- Infectious Disease and Microbiome Program, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.
| | - Regina C LaRocque
- Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Travellers' Advice and Immunization Center, Massachusetts General Hospital, Boston, MA, USA
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10
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Matias WR, Guillaume Y, Augustin GC, Vissieres K, Ternier R, Charles RC, Harris JB, Franke MF, Ivers LC. Seroprevalence of Vibrio cholerae in Adults, Haiti, 2017. Emerg Infect Dis 2023; 29:1929-1932. [PMID: 37610182 PMCID: PMC10461664 DOI: 10.3201/eid2909.230401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
In Haiti in 2017, the prevalence of serum vibriocidal antibody titers against Vibrio cholerae serogroup O1 among adults was 12.4% in Cerca-la-Source and 9.54% in Mirebalais, suggesting a high recent prevalence of infection. Improved surveillance programs to monitor cholera and guide public health interventions in Haiti are necessary.
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11
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Guillaume Y, Debela M, Slater D, Vissieres K, Ternier R, Franke MF, Harris JB, Ivers LC. Poor Sensitivity of Stool Culture Compared to Polymerase Chain Reaction in Surveillance for Vibrio cholerae in Haiti, 2018-2019. Open Forum Infect Dis 2023; 10:ofad301. [PMID: 37383250 PMCID: PMC10296062 DOI: 10.1093/ofid/ofad301] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/30/2023] [Indexed: 06/30/2023] Open
Abstract
We report on the sensitivity and specificity of stool culture compared to polymerase chain reaction for detecting Vibrio cholerae in Haiti during the waning period of the initial outbreak in 2018-2019. We found that stool culture (with a sensitivity of 33.3% and specificity of 97.4%) may not be sufficiently robust in this context.
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Affiliation(s)
- Yodeline Guillaume
- Correspondence: Yodeline Guillaume, MA, Center for Global Health, Massachusetts General Hospital, 125 Nashua St, Boston, MA 02148 (); Louise Ivers, MD, Center for Global Health, Massachusetts General Hospital, 125 Nashua St, Boston, MA 02148 ()
| | - Meti Debela
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Damien Slater
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kenia Vissieres
- Department of Clinical Programs, Zanmi Lasante, Croix-des-Bouquets, Haiti
| | - Ralph Ternier
- Department of Clinical Programs, Zanmi Lasante, Croix-des-Bouquets, Haiti
| | - Molly F Franke
- Department of Clinical Programs, Zanmi Lasante, Croix-des-Bouquets, Haiti
| | - Jason B Harris
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Louise C Ivers
- Correspondence: Yodeline Guillaume, MA, Center for Global Health, Massachusetts General Hospital, 125 Nashua St, Boston, MA 02148 (); Louise Ivers, MD, Center for Global Health, Massachusetts General Hospital, 125 Nashua St, Boston, MA 02148 ()
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12
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Wiens KE, Iyer AS, Bhuiyan TR, Lu LL, Cizmeci D, Gorman MJ, Yuan D, Becker RL, Ryan ET, Calderwood SB, LaRocque RC, Chowdhury F, Khan AI, Levine MM, Chen WH, Charles RC, Azman AS, Qadri F, Alter G, Harris JB. Predicting Vibrio cholerae infection and symptomatic disease: a systems serology study. Lancet Microbe 2023; 4:e228-e235. [PMID: 36907197 PMCID: PMC10186354 DOI: 10.1016/s2666-5247(22)00391-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/18/2022] [Accepted: 12/09/2022] [Indexed: 03/11/2023]
Abstract
BACKGROUND Vibriocidal antibodies are currently the best characterised correlate of protection against cholera and are used to gauge immunogenicity in vaccine trials. Although other circulating antibody responses have been associated with a decreased risk of infection, the correlates of protection against cholera have not been comprehensively compared. We aimed to analyse antibody-mediated correlates of protection from both V cholerae infection and cholera-related diarrhoea. METHODS We conducted a systems serology study that analysed 58 serum antibody biomarkers as correlates of protection against V cholerae O1 infection or diarrhoea. We used serum samples from two cohorts: household contacts of people with confirmed cholera in Dhaka, Bangladesh, and cholera-naive volunteers who were recruited at three centres in the USA, vaccinated with a single dose of CVD 103-HgR live oral cholera vaccine, and then challenged with V cholerae O1 El Tor Inaba strain N16961. We measured antigen-specific immunoglobulin responses against antigens using a customised Luminex assay and used conditional random forest models to examine which baseline biomarkers were most important for classifying individuals who went on to develop infection versus those who remained uninfected or asymptomatic. V cholerae infection was defined as having a positive stool culture result on days 2-7 or day 30 after enrolment of the household's index cholera case and, in the vaccine challenge cohort, was the development of symptomatic diarrhoea (defined as two or more loose stools of ≥200 mL each, or a single loose stool of ≥300 mL over a 48-h period). FINDINGS In the household contact cohort (261 participants from 180 households), 20 (34%) of the 58 studied biomarkers were associated with protection against V cholerae infection. We identified serum antibody-dependent complement deposition targeting the O1 antigen as the most predictive correlate of protection from infection in the household contacts, whereas vibriocidal antibody titres ranked lower. A five-biomarker model predicted protection from V cholerae infection with a cross-validated area under the curve (cvAUC) of 79% (95% CI 73-85). This model also predicted protection against diarrhoea in unvaccinated volunteers challenged with V cholerae O1 after vaccination (n=67; area under the curve [AUC] 77%, 95% CI 64-90). Although a different five-biomarker model best predicted protection from the development of cholera diarrhoea in the challenged vaccinees (cvAUC 78%, 95% CI 66-91), this model did poorly at predicting protection against infection in the household contacts (AUC 60%, 52-67). INTERPRETATION Several biomarkers predict protection better than vibriocidal titres. A model based on protection against infection among household contacts was predictive of protection against both infection and diarrhoeal illness in challenged vaccinees, suggesting that models based on observed conditions in a cholera-endemic population might be more likely to identify broadly applicable correlates of protection than models trained on single experimental settings. FUNDING National Institute of Allergy and Infectious Diseases and National Institute of Child Health and Human Development, National Institutes of Health.
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Affiliation(s)
- Kirsten E Wiens
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA
| | - Anita S Iyer
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Taufiqur R Bhuiyan
- Infectious Diseases Division, International Centre for Diarrheoal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Lenette L Lu
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine and Department of Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Parkland Health and Hospital System, Dallas, TX, USA
| | - Deniz Cizmeci
- Ragon Institute of MGH, Massachusetts Institute of Technology, and Harvard, Cambridge, MA, USA
| | - Matthew J Gorman
- Ragon Institute of MGH, Massachusetts Institute of Technology, and Harvard, Cambridge, MA, USA
| | - Dansu Yuan
- Ragon Institute of MGH, Massachusetts Institute of Technology, and Harvard, Cambridge, MA, USA
| | - Rachel L Becker
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA
| | - Stephen B Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Regina C LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Fahima Chowdhury
- Infectious Diseases Division, International Centre for Diarrheoal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Ashraful I Khan
- Infectious Diseases Division, International Centre for Diarrheoal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Myron M Levine
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Wilbur H Chen
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Richelle C Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrheoal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Galit Alter
- Department of Medicine, Harvard Medical School, Boston, MA, USA; Ragon Institute of MGH, Massachusetts Institute of Technology, and Harvard, Cambridge, MA, USA
| | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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13
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Rubin DHF, Zingl FG, Leitner DR, Ternier R, Compere V, Marseille S, Slater D, Harris JB, Chowdhury F, Qadri F, Boncy J, Ivers LC, Waldor MK. Reemergence of Cholera in Haiti. N Engl J Med 2022; 387:2387-2389. [PMID: 36449726 PMCID: PMC9901182 DOI: 10.1056/nejmc2213908] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Fahima Chowdhury
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Firdausi Qadri
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jacques Boncy
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
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14
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Chowdhury F, Akter A, Bhuiyan TR, Biswas R, Firoj MG, Tauheed I, Harris JB, Larocque RC, Ross AG, McMillan NAJ, Charles RC, Ryan ET, Calderwood SB, Qadri F. Long-term sialidase-specific immune responses after natural infection with cholera: Findings from a longitudinal cohort study in Bangladesh. Front Immunol 2022; 13:1067737. [PMID: 36618409 PMCID: PMC9813220 DOI: 10.3389/fimmu.2022.1067737] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background Immune responses that target sialidase occur following natural cholera and have been associated with protection against cholera. Sialidase is a neuraminidase that facilitates the binding of cholera toxin (CT) to intestinal epithelial cells. Despite this, little is known about age-related sialidase-specific immune responses and the impact of nutritional status and co-infection on sialidase-specific immunity. Methods We enrolled 50 culture-confirmed Vibrio cholerae O1 cholera cases presenting to the icddr,b Dhaka hospital with moderate to severe dehydration. We evaluated antibody responses out to 18 months (day 540) following cholera. We assessed immune responses targeting sialidase, lipopolysaccharide (LPS), cholera toxin B subunit (CtxB), and vibriocidal responses. We also explored the association of sialidase-specific immune responses to nutritional parameters and parasitic co-infection of cases. Results This longitudinal cohort study showed age-dependent differences in anti-sialidase immune response after natural cholera infection. Adult patients developed plasma anti-sialidase IgA and IgG responses after acute infection (P<0.05), which gradually decreased from day 30 on. In children, no significant anti-sialidase IgA, IgM, and IgG response was seen with the exception of a late IgG response at study day 540 (p=0.05 compared to adults). There was a correlation between anti-sialidase IgA with vibriocidal titers, as well as anti-sialidase IgA and IgG with anti-LPS and anti-CtxB antibody responses in adult patients, whereas in children, a significant positive correlation was seen only between anti-sialidase IgA and CtxB IgA responses. Stunted children showed significantly lower anti-sialidase IgA, IgG, and IgM antibody responses and higher LPS IgG and IgM antibody responses than healthy children. The anti-sialidase IgA and IgG responses were significantly higher in cases with concomitant parasitic infection. Conclusion Our data suggest that cholera patients develop age-distinct systemic and mucosal immune responses against sialidase. The stunted children have a lower anti-sialidase antibody response which may be associated with gut enteropathy and the neuraminidase plays an important role in augmented immune response in cholera patients infected with parasites.
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Affiliation(s)
- Fahima Chowdhury
- Infectious Diseases Division, icddr, b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Afroza Akter
- Infectious Diseases Division, icddr, b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Taufiqur Rahman Bhuiyan
- Infectious Diseases Division, icddr, b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Rajib Biswas
- Infectious Diseases Division, icddr, b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
- Department of Biology, Xavier University of Louisiana, New Orleans, AK, United States
| | - Md. Golam Firoj
- Infectious Diseases Division, icddr, b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Imam Tauheed
- Infectious Diseases Division, icddr, b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Jason B. Harris
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
| | - Regina C. Larocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Allen G. Ross
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales, Australia
| | | | - Richelle C. Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, United States
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, United States
| | - Stephen B. Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Department of Microbiology, Harvard Medical School, Boston, MA, United States
| | - Firdausi Qadri
- Infectious Diseases Division, icddr, b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
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15
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Jones FK, Bhuiyan TR, Muise RE, Khan AI, Slater DM, Hutt Vater KR, Chowdhury F, Kelly M, Xu P, Kováč P, Biswas R, Kamruzzaman M, Ryan ET, Calderwood SB, LaRocque RC, Lessler J, Charles RC, Leung DT, Qadri F, Harris JB, Azman AS. Identifying Recent Cholera Infections Using a Multiplex Bead Serological Assay. mBio 2022; 13:e0190022. [PMID: 36286520 PMCID: PMC9765614 DOI: 10.1128/mbio.01900-22] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/31/2022] [Indexed: 11/20/2022] Open
Abstract
Estimates of incidence based on medically attended cholera can be severely biased. Vibrio cholerae O1 leaves a lasting antibody signal and recent advances showed that these can be used to estimate infection incidence rates from cross-sectional serologic data. Current laboratory methods are resource intensive and challenging to standardize across laboratories. A multiplex bead assay (MBA) could efficiently expand the breadth of measured antibody responses and improve seroincidence accuracy. We tested 305 serum samples from confirmed cholera cases (4 to 1083 d postinfection) and uninfected contacts in Bangladesh using an MBA (IgG/IgA/IgM for 7 Vibrio cholerae O1-specific antigens) as well as traditional vibriocidal and enzyme-linked immunosorbent assays (2 antigens, IgG, and IgA). While postinfection vibriocidal responses were larger than other markers, several MBA-measured antibodies demonstrated robust responses with similar half-lives. Random forest models combining all MBA antibody measures allowed for accurate identification of recent cholera infections (e.g., past 200 days) including a cross-validated area under the curve (cvAUC200) of 92%, with simpler 3 IgG antibody models having similar accuracy. Across infection windows between 45 and 300 days, the accuracy of models trained on MBA measurements was non-inferior to models based on traditional assays. Our results illustrated a scalable cholera serosurveillance tool that can be incorporated into multipathogen serosurveillance platforms. IMPORTANCE Reliable estimates of cholera incidence are challenged by poor clinical surveillance and health-seeking behavior biases. We showed that cross-sectional serologic profiles measured with a high-throughput multiplex bead assay can lead to accurate identification of those infected with pandemic Vibrio cholerae O1, thus allowing for estimates of seroincidence. This provides a new avenue for understanding the epidemiology of cholera, identifying priority areas for cholera prevention/control investments, and tracking progress in the global fight against this ancient disease.
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Affiliation(s)
- Forrest K. Jones
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Taufiqur R. Bhuiyan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rachel E. Muise
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ashraful I. Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Damien M. Slater
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kian Robert Hutt Vater
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fahima Chowdhury
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Meagan Kelly
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Peng Xu
- Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Pavol Kováč
- Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Rajib Biswas
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Kamruzzaman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Stephen B. Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Regina C. LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- University of North Carolina Population Center, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Richelle C. Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Daniel T. Leung
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Microbiology and Immunology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew S. Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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16
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Akhtar M, Basher SR, Nizam NN, Kamruzzaman M, Khaton F, Banna HA, Kaisar MH, Karmakar PC, Hakim A, Akter A, Ahmed T, Tauheed I, Islam S, Ahmmed F, Mahamud S, Hasnat MA, Sumon MA, Rashed A, Ghosh S, Calderwood SB, Harris JB, Charles RC, LaRocque RC, Ryan ET, Banu S, Shirin T, Chowdhury F, Bhuiyan TR, Qadri F. Longevity of memory B cells and antibodies, as well as the polarization of effector memory helper T cells, are associated with disease severity in patients with COVID-19 in Bangladesh. Front Immunol 2022; 13:1052374. [PMID: 36578502 PMCID: PMC9791541 DOI: 10.3389/fimmu.2022.1052374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
The longevity of immune responses induced by different degrees of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection provides information important to understanding protection against coronavirus disease 2019 (COVID-19). Here, we report the persistence of SARS-CoV-2 spike receptor-binding domain (RBD) specific antibodies and memory B cells recognizing this antigen in sequential samples from patients in Bangladesh with asymptomatic, mild, moderate and severe COVID-19 out to six months following infection. Since the development of long-lived memory B cells, as well as antibody production, is likely to be dependent on T helper (Th) cells, we also investigated the phenotypic changes of Th cells in COVID-19 patients over time following infection. Our results show that patients with moderate to severe COVID-19 mounted significant levels of IgG antibodies out to six months following infection, while patients with asymptomatic or mild disease had significant levels of IgG antibodies out to 3 months following infection, but these then fell more rapidly at 6 months than in patients with higher disease severity. Patients from all severity groups developed circulating memory B cells (MBCs) specific to SARS-CoV-2 spike RBD by 3 months following infection, and these persisted until the last timepoint measured at 6 months. A T helper cell response with an effector memory phenotype was observed following infection in all symptomatic patients, while patients with asymptomatic infection had no significant increases in effector Th1, Th2 and Th17 effector memory cell responses. Our results suggest that the strength and magnitude of antibody and memory B cells induced following SARS-CoV-2 infection depend on the severity of the disease. Polarization of the Th cell response, with an increase in Th effector memory cells, occurs in symptomatic patients by day 7 following infection, with increases seen in Th1, Th2, Th17 and follicular helper T cell subsets.
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Affiliation(s)
- Marjahan Akhtar
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh
| | - Salima Raiyan Basher
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh
| | - Nuder Nower Nizam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh
| | - Mohammad Kamruzzaman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh
| | - Fatema Khaton
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh
| | - Hasan Al Banna
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh
| | - M Hasanul Kaisar
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh
| | - Polash Chandra Karmakar
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh
| | - Al Hakim
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh
- Department of Genetic Engineering and Biotechnology, Jagannath University, Dhaka, Bangladesh
| | - Afroza Akter
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh
| | - Tasnuva Ahmed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh
| | - Imam Tauheed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh
| | - Shaumik Islam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh
| | - Faisal Ahmmed
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh
| | - Shakil Mahamud
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh
| | - Mohammad Abul Hasnat
- Department of Cardiology, Department of Oncology, Kurmitola General Hospital, Dhaka, Bangladesh
| | - Mostafa Aziz Sumon
- Department of Cardiology, Department of Oncology, Kurmitola General Hospital, Dhaka, Bangladesh
| | - Asif Rashed
- Department of Microbiology, Department of Medicine, Mugda Medical College and Hospital, Dhaka, Bangladesh
| | - Shuvro Ghosh
- Department of Microbiology, Department of Medicine, Mugda Medical College and Hospital, Dhaka, Bangladesh
| | - Stephen B. Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
- Departments of Medicine and Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Richelle C. Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
- Departments of Medicine and Pediatrics, Harvard Medical School, Boston, MA, United States
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Regina C. LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
- Departments of Medicine and Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
- Departments of Medicine and Pediatrics, Harvard Medical School, Boston, MA, United States
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sayera Banu
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Fahima Chowdhury
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh
| | - Taufiqur Rahman Bhuiyan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDRB), Dhaka, Bangladesh
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17
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Aiemjoy K, Rumunu J, Hassen JJ, Wiens KE, Garrett D, Kamenskaya P, Harris JB, Azman AS, Teunis P, Seidman JC, Wamala JF, Andrews JR, Charles RC. Seroincidence of Enteric Fever, Juba, South Sudan. Emerg Infect Dis 2022; 28. [PMID: 36286224 PMCID: PMC9622235 DOI: 10.3201/eid2811.220239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We applied a new serosurveillance tool to estimate typhoidal Salmonella burden using samples collected during 2020 from a population in Juba, South Sudan. By using dried blood spot testing, we found an enteric fever seroincidence rate of 30/100 person-years and cumulative incidence of 74% over a 4-year period.
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18
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Kawser Z, Hossain M, Suliman S, Lockman S, Gitaka J, Bandawe G, Rahmat R, Hasan I, Siddik AB, Afrad MH, Rahman MZ, Miller G, Walt DR, Ivers LC, LaRocque RC, Harris JB, Qadri F. An Assessment of a Rapid SARS-CoV-2 Antigen Test in Bangladesh. Am J Trop Med Hyg 2022; 107:845-849. [PMID: 35970285 DOI: 10.4269/ajtmh.22-0068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/21/2021] [Indexed: 11/07/2022] Open
Abstract
Early detection of SARS-CoV-2 infection is crucial to prevent its spread. This study aimed to document test sensitivity/specificity, correlation with cycle threshold value from polymerase chain reaction (PCR), fitness-for-use in different populations and settings, and user perspectives that could inform large-scale implementation. In this study, we evaluated the performance of a rapid antigen detection test, BD Veritor, and compared this (and another rapid test, Standard Q) against reverse transcription PCR (RT-PCR) in terms of sensitivity and specificity in 130 symptomatic and 130 asymptomatic adults. In addition, we evaluated the suitability and ease of use of the BD Veritor test in a subsample of study participants (n = 42) and implementers (n = 5). At 95% confidence interval, the sensitivity of the BD Veritor and Standard Q test were 70% and 63% in symptomatic and 87% and 73% in asymptomatic individuals, respectively, regarding positive SARS-CoV-2 RT-PCR results. Overall, the BD Veritor test was 78% sensitive and 99.5% specific compared with RT-PCR irrespective of the cycle threshold. This warrants large field evaluation as well as use of the rapid antigen test for quick assessment of SARS-CoV-2 for containment of epidemics in the country.
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Affiliation(s)
- Zannat Kawser
- Institute for Developing Science and Health Initiatives (ideSHi), Dhaka, Bangladesh
| | - Mohabbat Hossain
- Institute for Developing Science and Health Initiatives (ideSHi), Dhaka, Bangladesh
| | - Sara Suliman
- Division of Experimental Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Shahin Lockman
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, Thika, Kenya.,Centre for Malaria Elimination, Mount Kenya University, Thika, Kenya
| | - Gama Bandawe
- Biological Sciences Department, Academy of Medical Sciences, Malawi University of Science and Technology, Thyolo, Malawi
| | - Redwan Rahmat
- Institute for Developing Science and Health Initiatives (ideSHi), Dhaka, Bangladesh
| | - Imrul Hasan
- Institute for Developing Science and Health Initiatives (ideSHi), Dhaka, Bangladesh
| | - Abu Bakar Siddik
- Institute for Developing Science and Health Initiatives (ideSHi), Dhaka, Bangladesh
| | - Mokibul Hassan Afrad
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammed Ziaur Rahman
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Glenn Miller
- Mass General Brigham Center for COVID Innovation, Boston, Massachusetts
| | - David R Walt
- Mass General Brigham Center for COVID Innovation, Boston, Massachusetts.,Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Louise C Ivers
- Department of Global Health and Social Medicine, Harvard Medical School, Boston Massachusetts.,MGH Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
| | - Regina C LaRocque
- MGH Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
| | - Jason B Harris
- MGH Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts
| | - Firdausi Qadri
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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19
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Bhuiyan TR, Akhtar M, Khaton F, Rahman SIA, Ferdous J, Alamgir A, Rahman M, Kawser Z, Hasan I, Calderwood SB, Harris JB, Charles RC, LaRocque RC, Ryan ET, Banu S, Shirin T, Qadri F. Covishield vaccine induces robust immune responses in Bangladeshi adults. IJID Regions 2022; 3:211-217. [PMID: 35720155 PMCID: PMC9050186 DOI: 10.1016/j.ijregi.2022.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/15/2022] [Accepted: 04/22/2022] [Indexed: 11/30/2022]
Abstract
All participants became seropositive 2 months after receipt of the second dose of vaccine. Comparable antibody responses were observed in both males and females. Participants with previous severe acute respiratory syndrome coronavirus-2 infection showed a robust antibody response. Similar antibody responses were observed in participants with and without comorbidities.
Objective To evaluate severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-specific antibody responses after Covishield vaccination for 6 months after vaccination. Design SARS-CoV-2-specific antibody responses were assessed by enzyme-linked immunosorbent assay of the recombinant receptor-binding domain of SARS-CoV-2 in 381 adults given the Covishield vaccine at baseline (n=119), 1 month (n=126) and 2 months (n=75) after the first dose, 1 month after the second dose (n=161), and monthly for 3 additional months. Results Over 51% of participants were seropositive at baseline (before vaccination with Covishield), and almost all participants (159/161) became seropositive 1 month after the second dose. Antibody levels peaked 1 month after receipt of the second dose of vaccine, and decreased by 4 months after the first dose; the lowest responses were found 6 months after the first dose, although antibody responses and responder frequencies remained significantly higher compared with baseline (P<0.0001). Compared with younger participants, older participants had lower antibody responses 6 months after the first dose of vaccine (P<0.05). Participants who had previous SARS-CoV-2 infection showed robust higher antibody responses after vaccination. Conclusions These findings help to elucidate the longevity of vaccine-specific antibody responses following vaccination with Covishield, and provide information relevant to the planning of booster doses after the initial two doses of vaccine.
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Affiliation(s)
| | - Marjahan Akhtar
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Fatema Khaton
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | | | - Jannatul Ferdous
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - A.S.M. Alamgir
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Zannat Kawser
- Institute of Developing Sciences and Health Initiatives, Dhaka, Bangladesh
| | - Imrul Hasan
- Institute of Developing Sciences and Health Initiatives, Dhaka, Bangladesh
| | - Stephen Beaven Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Richelle C. Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Regina C. LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Edward Thomas Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sayera Banu
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
- Corresponding author: Address: Mucosal Immunology and Vaccinology Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh. Tel.: +880 (0)2 2222 77001 10, Ext. 2431.
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20
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Bhuiyan TR, Rahman MA, Trivedi S, Afroz T, Al Banna H, Hoq MR, Pop I, Jensen O, Rashu R, Uddin MI, Hossain M, Khan AI, Chowdhury F, Harris JB, Calderwood SB, Ryan ET, Qadri F, Leung DT. Mucosal-Associated Invariant T (MAIT) cells are highly activated in duodenal tissue of humans with Vibrio cholerae O1 infection: A preliminary report. PLoS Negl Trop Dis 2022; 16:e0010411. [PMID: 35551522 PMCID: PMC9129025 DOI: 10.1371/journal.pntd.0010411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/24/2022] [Accepted: 04/11/2022] [Indexed: 01/13/2023] Open
Abstract
Mucosal-associated invariant T (MAIT) cells are unconventional T lymphocytes with a semi-conserved TCRα, activated by the presentation of vitamin B metabolites by the MHC-I related protein, MR1, and with diverse innate and adaptive effector functions. The role of MAIT cells in acute intestinal infections, especially at the mucosal level, is not well known. Here, we analyzed the presence and phenotype of MAIT cells in duodenal biopsies and paired peripheral blood samples, in patients during and after culture-confirmed Vibrio cholerae O1 infection. Immunohistochemical staining of duodenal biopsies from cholera patients (n = 5, median age 32 years, range 26-44, 1 female) identified MAIT cells in the lamina propria of the crypts, but not the villi. By flow cytometry (n = 10, median age 31 years, range 23-36, 1 female), we showed that duodenal MAIT cells are more activated than peripheral MAIT cells (p < 0.01 across time points), although there were no significant differences between duodenal MAIT cells at day 2 and day 30. We found fecal markers of intestinal permeability and inflammation to be correlated with the loss of duodenal (but not peripheral) MAIT cells, and single-cell sequencing revealed differing T cell receptor usage between the duodenal and peripheral blood MAIT cells. In this preliminary report limited by a small sample size, we show that MAIT cells are present in the lamina propria of the duodenum during V. cholerae infection, and more activated than those in the blood. Future work into the trafficking and tissue-resident function of MAIT cells is warranted.
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Affiliation(s)
- Taufiqur R. Bhuiyan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - M. Arifur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shubhanshi Trivedi
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Taliman Afroz
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Hasan Al Banna
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mohammad Rubel Hoq
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Ioana Pop
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Owen Jensen
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Rasheduzzaman Rashu
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Motaher Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Ashraful I. Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fahima Chowdhury
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts, United States of America
- Division of Pediatric Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Stephen B. Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Daniel T. Leung
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- * E-mail:
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21
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Barrassso K, Chac D, Debela MD, Geigel C, Steenhaut A, Rivera Seda A, Dunmire CN, Harris JB, Larocque RC, Midani FS, Qadri F, Yan J, Weil AA, Ng WL. Impact of a human gut microbe on Vibrio cholerae host colonization through biofilm enhancement. eLife 2022; 11:73010. [PMID: 35343438 PMCID: PMC8993218 DOI: 10.7554/elife.73010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
Recent studies indicate that the human intestinal microbiota could impact the outcome of infection by Vibrio cholerae, the etiological agent of the diarrheal disease cholera. A commensal bacterium, Paracoccus aminovorans, was previously identified in high abundance in stool collected from individuals infected with V. cholerae when compared to stool from uninfected persons. However, if and how P. aminovorans interacts with V. cholerae has not been experimentally determined; moreover, whether any association between this bacterium alters the behaviors of V. cholerae to affect the disease outcome is unclear. Here, we show that P. aminovorans and V. cholerae together form dual-species biofilm structure at the air–liquid interface, with previously uncharacterized novel features. Importantly, the presence of P. aminovorans within the murine small intestine enhances V. cholerae colonization in the same niche that is dependent on the Vibrio exopolysaccharide and other major components of mature V. cholerae biofilm. These studies illustrate that multispecies biofilm formation is a plausible mechanism used by a gut microbe to increase the virulence of the pathogen, and this interaction may alter outcomes in enteric infections.
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Affiliation(s)
- Kelsey Barrassso
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Seattle, United States
| | - Denise Chac
- Department of Medicine, University of Washington, Seattle, United States
| | - Meti D Debela
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, United States
| | - Catherine Geigel
- Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, United States
| | - Anjali Steenhaut
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, United States
| | - Abigail Rivera Seda
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, United States
| | - Chelsea N Dunmire
- Department of Medicine, University of Washington, Seattle, United States
| | - Jason B Harris
- Department of Pediatrics, Massachusetts General Hospital, Boston, United States
| | - Regina C Larocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, United States
| | - Firas S Midani
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, United States
| | | | - Jing Yan
- Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, United States
| | - Ana A Weil
- Department of Medicine, University of Washington, Seattle, United States
| | - Wai-Leung Ng
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, United States
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22
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Bhuiyan TR, Akhtar M, Akter A, Khaton F, Rahman SIA, Ferdous J, Nazneen A, Sumon SA, Banik KC, Bablu AR, Alamgir A, Rahman M, Tony SR, Hossain K, Calderwood SB, Charles RC, Ryan ET, LaRocque RC, Harris JB, Rahman M, Chakraborty N, Rahman M, Arifeen SE, Flora MS, Shirin T, Banu S, Qadri F. Seroprevalence of SARS-CoV-2 antibodies in Bangladesh related to novel coronavirus infection. IJID Regions 2022; 2:198-203. [PMID: 35721426 PMCID: PMC8809641 DOI: 10.1016/j.ijregi.2022.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/20/2022] [Accepted: 01/28/2022] [Indexed: 01/11/2023]
Abstract
30% of the Bangladeshi population were found to be seropositive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) immunoglobulin G antibodies. The highest seroprevalence rate (64%) was found in slum areas in Bangladesh. Thirty-eight percent and 29% of participants from urban and rural areas were SARS-CoV-2 seropositive. The highest seroprevalence rate for coronavirus disease 2019 was observed in August 2020.
Design A cross-sectional study was conducted amongst household members in 32 districts of Bangladesh to build knowledge about disease epidemiology and seroepidemiology of coronavirus disease 2019 (COVID-19). Objective Antibody responses to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) were assessed in people between April and October 2020. Results The national seroprevalence rates of immunoglobulin G (IgG) and IgM were estimated to be 30.4% and 39.7%, respectively. In Dhaka, the seroprevalence of IgG was 35.4% in non-slum areas and 63.5% in slum areas. In areas outside of Dhaka, the seroprevalence of IgG was 37.5% in urban areas and 28.7% in rural areas. Between April and October 2020, the highest seroprevalence rate (57% for IgG and 64% for IgM) was observed in August. IgM antibody was more prevalent in younger participants, while older participants had more frequent IgG seropositivity. Follow-up specimens from patients with COVID-19 and their household members suggested that both IgG and IgM seropositivity increased significantly at day 14 and day 28 compared with day 1 after enrolment. Conclusions: SARS-CoV-2 had spread extensively in Bangladesh by October 2020. This highlights the importance of monitoring seroprevalence data, particularly with the emergence of new SARS-CoV-2 variants over time.
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Affiliation(s)
| | - Marjahan Akhtar
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Aklima Akter
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Fatema Khaton
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Jannatul Ferdous
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Arifa Nazneen
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shariful Amin Sumon
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Kajal C. Banik
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Arifur Rahman Bablu
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - A.S.M. Alamgir
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Selim Reza Tony
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi, Bangladesh
| | - Khaled Hossain
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi, Bangladesh
| | - Stephen B. Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Departments of Medicine and Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Richelle C. Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Departments of Medicine and Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Departments of Medicine and Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Regina C. LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Departments of Medicine and Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Departments of Medicine and Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Mustafizur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Mahmudur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Sayera Banu
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Corresponding author. Mucosal Immunology and Vaccinology Unit, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh. Tel.: +880 (0)2 2222 77001 10, Ext 2431.
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23
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Akter A, Ahmed T, Tauheed I, Akhtar M, Rahman SIA, Khaton F, Ahmmed F, Ferdous J, Afrad MH, Kawser Z, Hossain M, Khondaker R, Hasnat MA, Sumon MA, Rashed A, Ghosh S, Calderwood SB, Charles RC, Ryan ET, Khatri P, Maecker HT, Obermoser G, Pulendran B, Clemens JD, Banu S, Shirin T, LaRocque RC, Harris JB, Bhuiyan TR, Chowdhury F, Qadri F. Disease characteristics and serological responses in patients with differing severity of COVID-19 infection: A longitudinal cohort study in Dhaka, Bangladesh. PLoS Negl Trop Dis 2022; 16:e0010102. [PMID: 34982773 PMCID: PMC8759637 DOI: 10.1371/journal.pntd.0010102] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 06/22/2021] [Revised: 01/14/2022] [Accepted: 12/17/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND COVID-19 caused by SARS-CoV-2 ranges from asymptomatic to severe disease and can cause fatal and devastating outcome in many cases. In this study, we have compared the clinical, biochemical and immunological parameters across the different disease spectrum of COVID-19 in Bangladeshi patients. METHODOLOGY/PRINCIPAL FINDINGS This longitudinal study was conducted in two COVID-19 hospitals and also around the community in Dhaka city in Bangladesh between November 2020 to March 2021. A total of 100 patients with COVID-19 infection were enrolled and classified into asymptomatic, mild, moderate and severe cases (n = 25/group). In addition, thirty age and sex matched healthy participants were enrolled and 21 were analyzed as controls based on exclusion criteria. After enrollment (study day1), follow-up visits were conducted on day 7, 14 and 28 for the cases. Older age, male gender and co-morbid conditions were the risk factors for severe COVID-19 disease. Those with moderate and severe cases of infection had low lymphocyte counts, high neutrophil counts along with a higher neutrophil-lymphocyte ratio (NLR) at enrollment; this decreased to normal range within 42 days after the onset of symptom. At enrollment, D-dimer, CRP and ferritin levels were elevated among moderate and severe cases. The mild, moderate, and severe cases were seropositive for IgG antibody by day 14 after enrollment. Moderate and severe cases showed significantly higher IgM and IgG levels of antibodies to SARS-CoV-2 compared to mild and asymptomatic cases. CONCLUSION/SIGNIFICANCE We report on the clinical, biochemical, and hematological parameters associated with the different severity of COVID-19 infection. We also show different profile of antibody response against SARS-CoV-2 in relation to disease severity, especially in those with moderate and severe disease manifestations compared to the mild and asymptomatic infection.
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Affiliation(s)
- Afroza Akter
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh)
| | - Tasnuva Ahmed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh)
| | - Imam Tauheed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh)
| | - Marjahan Akhtar
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh)
| | - Sadia Isfat Ara Rahman
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh)
| | - Fatema Khaton
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh)
| | - Faisal Ahmmed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh)
| | - Jannatul Ferdous
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh)
| | - Mokibul Hassan Afrad
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh)
| | - Zannat Kawser
- Institute for Developing Science & Health Initiatives (ideSHi), Dhaka, Bangladesh
| | - Mohabbat Hossain
- Institute for Developing Science & Health Initiatives (ideSHi), Dhaka, Bangladesh
| | - Rabeya Khondaker
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh)
| | | | | | - Asif Rashed
- Mugda Medical College & Hospital, Dhaka, Bangladesh
| | - Shuvro Ghosh
- Mugda Medical College & Hospital, Dhaka, Bangladesh
| | - Stephen B. Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Departments of Medicine and Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Richelle C. Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Departments of Medicine and Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Departments of Medicine and Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Purvesh Khatri
- Stanford University, Stanford, California, United States of America
| | | | | | - Bali Pulendran
- Stanford University, Stanford, California, United States of America
| | - John D. Clemens
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh)
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America (JD Clemens MD)
- Korea University School of Medicine, Seoul, South Korea (JD Clemens MD)
| | - Sayera Banu
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh)
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Regina C. LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Departments of Medicine and Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Departments of Medicine and Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Taufiqur Rahman Bhuiyan
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh)
| | - Fahima Chowdhury
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh)
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh)
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24
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Ryan ET, Leung DT, Jensen O, Weil AA, Bhuiyan TR, Khan AI, Chowdhury F, LaRocque RC, Harris JB, Calderwood SB, Qadri F, Charles RC. Systemic, Mucosal, and Memory Immune Responses following Cholera. Trop Med Infect Dis 2021; 6:192. [PMID: 34842841 PMCID: PMC8628923 DOI: 10.3390/tropicalmed6040192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/21/2021] [Accepted: 10/23/2021] [Indexed: 01/13/2023] Open
Abstract
Vibrio cholerae O1, the major causative agent of cholera, remains a significant public health threat. Although there are available vaccines for cholera, the protection provided by killed whole-cell cholera vaccines in young children is poor. An obstacle to the development of improved cholera vaccines is the need for a better understanding of the primary mechanisms of cholera immunity and identification of improved correlates of protection. Considerable progress has been made over the last decade in understanding the adaptive and innate immune responses to cholera disease as well as V. cholerae infection. This review will assess what is currently known about the systemic, mucosal, memory, and innate immune responses to clinical cholera, as well as recent advances in our understanding of the mechanisms and correlates of protection against V. cholerae O1 infection.
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Affiliation(s)
- Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA; (E.T.R.); (R.C.L.); (J.B.H.); (S.B.C.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Daniel T. Leung
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA; (D.T.L.); (O.J.)
| | - Owen Jensen
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA; (D.T.L.); (O.J.)
| | - Ana A. Weil
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA 98109, USA;
| | - Taufiqur Rahman Bhuiyan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (T.R.B.); (A.I.K.); (F.C.); (F.Q.)
| | - Ashraful Islam Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (T.R.B.); (A.I.K.); (F.C.); (F.Q.)
| | - Fahima Chowdhury
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (T.R.B.); (A.I.K.); (F.C.); (F.Q.)
| | - Regina C. LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA; (E.T.R.); (R.C.L.); (J.B.H.); (S.B.C.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA; (E.T.R.); (R.C.L.); (J.B.H.); (S.B.C.)
- Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA 02114, USA
- Mucosal Immunology and Biology Research Center, Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Boston, MA 02115, USA
- Division of Pediatric Global Health, Massachusetts General Hospital, Boston, MA 02115, USA
| | - Stephen B. Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA; (E.T.R.); (R.C.L.); (J.B.H.); (S.B.C.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Microbiology, Harvard Medical School, Boston, MA 02115, USA
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (T.R.B.); (A.I.K.); (F.C.); (F.Q.)
| | - Richelle C. Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA; (E.T.R.); (R.C.L.); (J.B.H.); (S.B.C.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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25
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Abstract
A correlate of protection (CoP) is a measured adaptive immune response to vaccination or infection that is associated with protection against disease. However, the degree to which a CoP can serve as a surrogate end point for vaccine efficacy should depend on the robustness of this association. While cholera toxin is a dominant target of the human antibody response to Vibrio cholerae infection, antitoxin responses are not associated with long-term immunity, and are not effective CoPs for cholera. Instead, protection appears to be mediated by functional antibodies that target the O-polysaccharide coated V. cholerae outer membrane. Vibriocidal antibodies, which are complement-dependent bactericidal antibodies, remain the most accepted CoP for cholera and are used as surrogate end points in some vaccine studies. However, the association between vibriocidal antibody titers and immunity is not absolute, and they are unlikely to reflect a mechanistic correlate of protection against cholera.
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Affiliation(s)
- Anita S Iyer
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
| | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA.,Department of Pediatrics, Harvard Medical School, Boston, MA
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26
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Abstract
PURPOSE OF REVIEW Antimicrobial resistance (AMR) in bacteria poses a major risk to global public health, with many factors contributing to the observed increase in AMR. International travel is one recognized contributor. The purpose of this review is to summarize current knowledge regarding the acquisition, carriage and spread of AMR bacteria by international travelers. RECENT FINDINGS Recent studies have highlighted that travel is an important risk factor for the acquisition of AMR bacteria, with approximately 30% of studied travelers returning with an acquired AMR bacterium. Epidemiological studies have shown there are three major risk factors for acquisition: travel destination, antimicrobial usage and travelers' diarrhea (TD). Analyses have begun to illustrate the AMR genes that are acquired and spread by travelers, risk factors for acquisition and carriage of AMR bacteria, and local transmission of imported AMR organisms. SUMMARY International travel is a contributor to the acquisition and dissemination of AMR organisms globally. Efforts to reduce the burden of AMR organisms should include a focus on international travelers. Routine genomic surveillance would further elucidate the role of international travel in the global spread of AMR bacteria.
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Affiliation(s)
- Sushmita Sridhar
- Division of Infectious Diseases, Massachusetts General Hospital
- Department of Medicine, Harvard Medical School
| | - Sarah E. Turbett
- Division of Infectious Diseases, Massachusetts General Hospital
- Department of Medicine, Harvard Medical School
- Department of Pathology
| | - Jason B. Harris
- Division of Pediatric Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Regina C. LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital
- Department of Medicine, Harvard Medical School
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27
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Kamruzzaman M, Kelly M, Charles RC, Harris JB, Calderwood SB, Akter A, Biswas R, Kaisar MH, Bhuiyan TR, Ivers LC, Ternier R, Jerome JG, Pfister HB, Lu X, Soliman SE, Ruttens B, Saksena R, Mečárová J, Čížová A, Qadri F, Bystrický S, Kováč P, Xu P, Ryan ET. Defining Polysaccharide-Specific Antibody Targets against Vibrio cholerae O139 in Humans following O139 Cholera and following Vaccination with a Commercial Bivalent Oral Cholera Vaccine, and Evaluation of Conjugate Vaccines Targeting O139. mSphere 2021; 6:e0011421. [PMID: 34232076 PMCID: PMC8386440 DOI: 10.1128/msphere.00114-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/02/2021] [Indexed: 11/20/2022] Open
Abstract
Cholera caused by Vibrio cholerae O139 could reemerge, and proactive development of an effective O139 vaccine would be prudent. To define immunoreactive and potentially immunogenic carbohydrate targets of Vibrio cholerae O139, we assessed immunoreactivities of various O-specific polysaccharide (OSP)-related saccharides with plasma from humans hospitalized with cholera caused by O139, comparing responses to those induced in recipients of a commercial oral whole-cell killed bivalent (O1 and O139) cholera vaccine (WC-O1/O139). We also assessed conjugate vaccines containing selected subsets of these saccharides for their ability to induce protective immunity using a mouse model of cholera. We found that patients with wild-type O139 cholera develop IgM, IgA, and IgG immune responses against O139 OSP and many of its fragments, but we were able to detect only a moderate IgM response to purified O139 OSP-core, and none to its fragments, in immunologically naive recipients of WC-O1/O139. We found that immunoreactivity of O139-specific polysaccharides with antibodies elicited by wild-type infection markedly increase when saccharides contain colitose and phosphate residues, that a synthetic terminal tetrasaccharide fragment of OSP is more immunoreactive and protectively immunogenic than complete OSP, that native OSP-core is a better protective immunogen than the synthetic OSP lacking core, and that functional vibriocidal activity of antibodies predicts in vivo protection in our model but depends on capsule thickness. Our results suggest that O139 OSP-specific responses are not prominent following vaccination with a currently available oral cholera vaccine in immunologically naive humans and that vaccines targeting V. cholerae O139 should be based on native OSP-core or terminal tetrasaccharide. IMPORTANCE Cholera is a severe dehydrating illness of humans caused by Vibrio cholerae serogroup O1 or O139. Protection against cholera is serogroup specific, and serogroup specificity is defined by O-specific polysaccharide (OSP). Little is known about immunity to O139 OSP. In this study, we used synthetic fragments of the O139 OSP to define immune responses to OSP in humans recovering from cholera caused by V. cholerae O139, compared these responses to those induced by the available O139 vaccine, and evaluated O139 fragments in next-generation conjugate vaccines. We found that the terminal tetrasaccharide of O139 is a primary immune target but that the currently available bivalent cholera vaccine poorly induces an anti-O139 OSP response in immunologically naive individuals.
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Affiliation(s)
- Mohammad Kamruzzaman
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Meagan Kelly
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Richelle C. Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Global Health, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | - Stephen B. Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Aklima Akter
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Rajib Biswas
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - M. Hasanul Kaisar
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Taufiqur R. Bhuiyan
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Louise C. Ivers
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - Xiaowei Lu
- NIDDK, LBC, National Institutes of Health, Bethesda, Maryland, USA
| | - Sameh E. Soliman
- NIDDK, LBC, National Institutes of Health, Bethesda, Maryland, USA
| | - Bart Ruttens
- NIDDK, LBC, National Institutes of Health, Bethesda, Maryland, USA
| | - Rina Saksena
- NIDDK, LBC, National Institutes of Health, Bethesda, Maryland, USA
| | - Jana Mečárová
- Institute of Chemistry, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Alžbeta Čížová
- Institute of Chemistry, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Slavomír Bystrický
- Institute of Chemistry, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Pavol Kováč
- NIDDK, LBC, National Institutes of Health, Bethesda, Maryland, USA
| | - Peng Xu
- NIDDK, LBC, National Institutes of Health, Bethesda, Maryland, USA
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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28
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Aktar A, Rahman MA, Afrin S, Akter A, Uddin T, Yasmin T, Sami MIN, Dash P, Jahan SR, Chowdhury F, Khan AI, LaRocque RC, Charles RC, Bhuiyan TR, Mandlik A, Kelly M, Kováč P, Xu P, Calderwood SB, Harris JB, Qadri F, Ryan ET. Correction: Plasma and memory B cell responses targeting O-specific polysaccharide (OSP) are associated with protection against Vibrio cholerae O1 infection among household contacts of cholera patients in Bangladesh. PLoS Negl Trop Dis 2021; 15:e0009616. [PMID: 34280200 PMCID: PMC8289001 DOI: 10.1371/journal.pntd.0009616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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29
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Chisti MJ, Harris JB, Carroll RW, Shahunja KM, Shahid ASMSB, Moschovis PP, Schenkel SR, Hasibur Rahman ASMM, Shahrin L, Faruk T, Kabir F, Ahmed D, Ahmed T. Antibiotic-Resistant Bacteremia in Young Children Hospitalized With Pneumonia in Bangladesh Is Associated With a High Mortality Rate. Open Forum Infect Dis 2021; 8:ofab260. [PMID: 34277885 PMCID: PMC8280371 DOI: 10.1093/ofid/ofab260] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/20/2021] [Indexed: 12/29/2022] Open
Abstract
Background Pneumonia is a leading cause of sepsis and mortality in children under 5 years. However, our understanding of the causes of bacteremia in children with pneumonia is limited. Methods We characterized risk factors for bacteremia and death in a cohort of children admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) between 2014 and 2017 with radiographically confirmed pneumonia. Results A total of 4007 young children were hospitalized with pneumonia over the study period. A total of 1814 (45%) had blood cultures obtained. Of those, 108 (6%) were positive. Gram-negative pathogens predominated, accounting for 83 (77%) of positive cultures. These included Pseudomonas (N = 22), Escherichia coli (N = 17), Salmonella enterica (N = 14, including 11 Salmonella Typhi), and Klebsiella pneumoniae (N = 11). Gram-positive pathogens included Pneumococcus (N = 7) and Staphylococcus aureus (N = 6). Resistance to all routinely used empiric antibiotics (ampicillin, gentamicin, ciprofloxacin, and ceftriaxone) for children with pneumonia at the icddr,b was observed in 20 of the 108 isolates. Thirty-one of 108 (29%) children with bacteremia died, compared to 124 of 1706 (7%) who underwent culture without bacteremia (odds ratio [OR], 5.1; 95% confidence interval [CI], 3.3–8.1; P < .001). Children infected with bacteria resistant to all routinely used empiric antibiotics were at greater risk of death compared to children without bacteremia (OR, 17.3; 95% CI, 7.0–43.1; P < .001). Conclusions Antibiotic-resistant Gram-negative bacteremia in young children with pneumonia in Dhaka, Bangladesh was associated with a high mortality rate. The pandemic of antibiotic resistance is shortening the lives of young children in Bangladesh, and new approaches to prevent and treat these infections are desperately needed.
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Affiliation(s)
- Mohammod Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.,Division of Pediatric Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Ryan W Carroll
- Division of Pediatric Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Division of Pediatric Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - K M Shahunja
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu S M S B Shahid
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Peter P Moschovis
- Division of Pediatric Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Division of Pediatric Pulmonology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sara R Schenkel
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Lubaba Shahrin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tanveer Faruk
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farhad Kabir
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dilruba Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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30
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Wiens KE, Mawien PN, Rumunu J, Slater D, Jones FK, Moheed S, Caflisch A, Bior BK, Jacob IA, Lako RL, Guyo AG, Olu OO, Maleghemi S, Baguma A, Hassen JJ, Baya SK, Deng L, Lessler J, Demby MN, Sanchez V, Mills R, Fraser C, Charles RC, Harris JB, Azman AS, Wamala JF. Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 IgG in Juba, South Sudan, 2020 1. Emerg Infect Dis 2021; 27:1598-1606. [PMID: 34013872 PMCID: PMC8153877 DOI: 10.3201/eid2706.210568] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Relatively few coronavirus disease cases and deaths have been reported from sub-Saharan Africa, although the extent of its spread remains unclear. During August 10-September 11, 2020, we recruited 2,214 participants for a representative household-based cross-sectional serosurvey in Juba, South Sudan. We found 22.3% of participants had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) receptor binding domain IgG titers above prepandemic levels. After accounting for waning antibody levels, age, and sex, we estimated that 38.3% (95% credible interval 31.8%-46.5%) of the population had been infected with SARS-CoV-2. At this rate, for each PCR-confirmed SARS-CoV-2 infection reported by the Ministry of Health, 103 (95% credible interval 86-126) infections would have been unreported, meaning SARS-CoV-2 has likely spread extensively within Juba. We also found differences in background reactivity in Juba compared with Boston, Massachusetts, USA, where the immunoassay was validated. Our findings underscore the need to validate serologic tests in sub-Saharan Africa populations.
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Affiliation(s)
- Kirsten E. Wiens
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Pinyi Nyimol Mawien
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - John Rumunu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Damien Slater
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Forrest K. Jones
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Serina Moheed
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Andrea Caflisch
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Bior K. Bior
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Iboyi Amanya Jacob
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Richard Lino Lako
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Argata Guracha Guyo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Olushayo Oluseun Olu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Sylvester Maleghemi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Andrew Baguma
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Juma John Hassen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Sheila K. Baya
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Lul Deng
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Justin Lessler
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Maya N. Demby
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Vanessa Sanchez
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Rachel Mills
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
| | - Clare Fraser
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (K.E. Wiens, F.K. Jones, J. Lessler, M.N. Demby, A.S. Azman)
- Republic of South Sudan Ministry of Health, Juba, South Sudan (P.N. Mawien, J. Rumunu, B.K. Bior, I.A. Jacob, R.L. Lako, L. Deng)
- Massachusetts General Hospital, Boston, Massachusetts, USA (D. Slater, S. Moheed, V. Sanchez, R. Mills, C. Fraser, R.C. Charles, J.B. Harris)
- International Organization for Migration, Juba (A. Caflisch)
- World Health Organization, Juba (A.G. Guyo, O.O. Olu, S. Maleghemi, A. Baguma, J.J. Hassen, S.K. Baya, J.F. Wamala)
- Kabale University School of Medicine, Kabale, Uganda (A. Baguma)
- Harvard Medical School, Boston (R.C. Charles, J.B. Harris)
- Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman)
- Institute of Global Health, Geneva (A.S. Azman)
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31
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Anahtar MN, Shaw BM, Slater D, Byrne EH, Botti-Lodovico Y, Adams G, Schaffner SF, Eversley J, McGrath GEG, Gogakos T, Lennerz J, Marble HD, Ritterhouse LL, Batten JM, Georgantas NZ, Pellerin R, Signorelli S, Thierauf J, Kemball M, Happi C, Grant DS, Ndiaye D, Siddle KJ, Mehta SB, Harris JB, Ryan ET, Pierce VM, LaRocque RC, Lemieux JE, Sabeti PC, Rosenberg ES, Branda JA, Turbett SE. Development of a qualitative real-time RT-PCR assay for the detection of SARS-CoV-2: a guide and case study in setting up an emergency-use, laboratory-developed molecular microbiological assay. J Clin Pathol 2021; 74:496-503. [PMID: 34049977 PMCID: PMC8311084 DOI: 10.1136/jclinpath-2020-207128] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/20/2021] [Accepted: 01/30/2021] [Indexed: 12/31/2022]
Abstract
Developing and deploying new diagnostic tests are difficult, but the need to do so in response to a rapidly emerging pandemic such as COVID-19 is crucially important. During a pandemic, laboratories play a key role in helping healthcare providers and public health authorities detect active infection, a task most commonly achieved using nucleic acid-based assays. While the landscape of diagnostics is rapidly evolving, PCR remains the gold-standard of nucleic acid-based diagnostic assays, in part due to its reliability, flexibility and wide deployment. To address a critical local shortage of testing capacity persisting during the COVID-19 outbreak, our hospital set up a molecular-based laboratory developed test (LDT) to accurately and safely diagnose SARS-CoV-2. We describe here the process of developing an emergency-use LDT, in the hope that our experience will be useful to other laboratories in future outbreaks and will help to lower barriers to establishing fast and accurate diagnostic testing in crisis conditions.
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Affiliation(s)
- Melis N Anahtar
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bennett M Shaw
- Infectious Disease and Microbiome Program, Eli and Edythe L. Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA.,Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Damien Slater
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elizabeth H Byrne
- Infectious Disease and Microbiome Program, Eli and Edythe L. Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Yolanda Botti-Lodovico
- Infectious Disease and Microbiome Program, Eli and Edythe L. Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Gordon Adams
- Infectious Disease and Microbiome Program, Eli and Edythe L. Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA.,Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stephen F Schaffner
- Infectious Disease and Microbiome Program, Eli and Edythe L. Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA.,Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Jacqueline Eversley
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Graham E G McGrath
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tasos Gogakos
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jochen Lennerz
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hetal Desai Marble
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lauren L Ritterhouse
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Julie M Batten
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - N Zeke Georgantas
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rebecca Pellerin
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sylvia Signorelli
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Julia Thierauf
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Otorhinolaryngology, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Molly Kemball
- Infectious Disease and Microbiome Program, Eli and Edythe L. Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA.,Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Christian Happi
- Department of Biological Sciences, Redeemer's University, Ede, Osun, Nigeria.,African Center of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun, Nigeria
| | - Donald S Grant
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.,College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Daouda Ndiaye
- African Center of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun, Nigeria.,Department of Mycology and Pharmacology, Universite Cheikh Anta Diop, Dakar, Senegal
| | - Katherine J Siddle
- Infectious Disease and Microbiome Program, Eli and Edythe L. Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA.,Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Samar B Mehta
- Infectious Disease and Microbiome Program, Eli and Edythe L. Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA.,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jason B Harris
- Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| | - Edward T Ryan
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Virginia M Pierce
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| | - Regina C LaRocque
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jacob E Lemieux
- Infectious Disease and Microbiome Program, Eli and Edythe L. Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA .,Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pardis C Sabeti
- Infectious Disease and Microbiome Program, Eli and Edythe L. Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA .,Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA.,Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Howard Hughes Medical Institute, Chevy Chase, Maryland, USA
| | - Eric S Rosenberg
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John A Branda
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah E Turbett
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA .,Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
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32
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Uddin MI, Hossain M, Islam S, Akter A, Nishat NS, Nila TA, Rafique TA, Leung DT, Calderwood SB, Ryan ET, Harris JB, LaRocque RC, Bhuiyan TR, Qadri F. An assessment of potential biomarkers of environment enteropathy and its association with age and microbial infections among children in Bangladesh. PLoS One 2021; 16:e0250446. [PMID: 33886672 PMCID: PMC8061931 DOI: 10.1371/journal.pone.0250446] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 04/06/2021] [Indexed: 01/13/2023] Open
Abstract
Interventional studies targeting environment enteropathy (EE) are impeded by the lack of appropriate, validated, non-invasive biomarkers of EE. Thus, we aimed to validate the association of potential biomarkers for EE with enteric infections and nutritional status in a longitudinal birth cohort study. We measured endotoxin core antibody (EndoCab) and soluble CD14 (sCD14) in serum, and myeloperoxidase (MPO) in feces using commercially available enzyme-linked immunosorbent assay (ELISA) kits. We found that levels of serum EndoCab and sCD14 increase with the cumulative incidence of enteric infections. We observed a significant correlation between the fecal MPO level in the children at 24 months of age with the total number of bacterial and viral infections, the total number of parasitic infections, and the total number of diarrheal episodes and diarrheal duration. We observed that the levels of serum EndoCab, sCD14, and fecal MPO at 3 months of age were significantly associated with whether children were malnourished at 18 months of age or not. Biomarkers such as fecal MPO, serum EndoCab and sCD14 in children at an early age may be useful as a measure of cumulative burden of preceding enteric infections, which are predictive of subsequent malnutrition status and may be useful non-invasive biomarkers for EE.
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Affiliation(s)
| | | | - Shahidul Islam
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Aklima Akter
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | | | | | | | - Daniel T. Leung
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Stephen B. Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Regina C. LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Firdausi Qadri
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
- * E-mail: (FQ); (TRB)
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33
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Akter A, Kelly M, Charles RC, Harris JB, Calderwood SB, Bhuiyan TR, Biswas R, Xu P, Kováč P, Qadri F, Ryan ET. Parenteral Vaccination with a Cholera Conjugate Vaccine Boosts Vibriocidal and Anti-OSP Responses in Mice Previously Immunized with an Oral Cholera Vaccine. Am J Trop Med Hyg 2021; 104:2024-2030. [PMID: 33872211 PMCID: PMC8176512 DOI: 10.4269/ajtmh.20-1511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/26/2020] [Accepted: 02/15/2021] [Indexed: 11/20/2022] Open
Abstract
Oral cholera vaccination protects against cholera; however, responses in young children are low and of short duration. The best current correlates of protection against cholera target Vibrio cholerae O-specific polysaccharide (anti-OSP), including vibriocidal responses. A cholera conjugate vaccine has been developed that induces anti-OSP immune responses, including memory B-cell responses. To address whether cholera conjugate vaccine would boost immune responses following oral cholera vaccination, we immunized mice with oral cholera vaccine Inaba CVD 103-HgR or buffer only (placebo) on day 0, followed by parenteral boosting immunizations on days 14, 42, and 70 with cholera conjugate vaccine Inaba OSP: recombinant tetanus toxoid heavy chain fragment or phosphate buffered saline (PBS)/placebo. Compared with responses in mice immunized with oral vaccine alone or intramuscular cholera conjugate vaccine alone, mice receiving combination vaccination developed significantly higher vibriocidal, IgM OSP-specific serum responses and OSP-specific IgM memory B-cell responses. A combined vaccination approach, which includes oral cholera vaccination followed by parenteral cholera conjugate vaccine boosting, results in increased immune responses that have been associated with protection against cholera. These results suggest that such an approach should be evaluated in humans.
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Affiliation(s)
- Aklima Akter
- 1Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,2icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Meagan Kelly
- 1Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - Richelle C Charles
- 1Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,3Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jason B Harris
- 1Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,4Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,5Division of Global Health, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Stephen B Calderwood
- 1Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,3Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Taufiqur R Bhuiyan
- 2icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Rajib Biswas
- 1Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,2icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Peng Xu
- 6NIDDK, LBC, National Institutes of Health, Bethesda, Maryland
| | - Pavol Kováč
- 6NIDDK, LBC, National Institutes of Health, Bethesda, Maryland
| | - Firdausi Qadri
- 2icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Edward T Ryan
- 1Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,3Department of Medicine, Harvard Medical School, Boston, Massachusetts.,7Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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34
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Wiens KE, Mawien PN, Rumunu J, Slater D, Jones FK, Moheed S, Caflish A, Bior BK, Jacob IA, Lako RLL, Guyo AG, Olu OO, Maleghemi S, Baguma A, Hassen JJ, Baya SK, Deng L, Lessler J, Demby MN, Sanchez V, Mills R, Fraser C, Charles RC, Harris JB, Azman AS, Wamala JF. Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Juba, South Sudan: a population-based study. medRxiv 2021:2021.03.08.21253009. [PMID: 33758900 PMCID: PMC7987059 DOI: 10.1101/2021.03.08.21253009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Relatively few COVID-19 cases and deaths have been reported through much of sub-Saharan Africa, including South Sudan, although the extent of SARS-CoV-2 spread remains unclear due to weak surveillance systems and few population-representative serosurveys. METHODS We conducted a representative household-based cross-sectional serosurvey in Juba, South Sudan. We quantified IgG antibody responses to SARS-CoV-2 spike protein receptor-binding domain and estimated seroprevalence using a Bayesian regression model accounting for test performance. RESULTS We recruited 2,214 participants from August 10 to September 11, 2020 and 22.3% had anti-SARS-CoV-2 IgG titers above levels in pre-pandemic samples. After accounting for waning antibody levels, age, and sex, we estimated that 38.5% (32.1 - 46.8) of the population had been infected with SARS-CoV-2. For each RT-PCR confirmed COVID-19 case, 104 (87-126) infections were unreported. Background antibody reactivity was higher in pre-pandemic samples from Juba compared to Boston, where the serological test was validated. The estimated proportion of the population infected ranged from 30.1% to 60.6% depending on assumptions about test performance and prevalence of clinically severe infections. CONCLUSIONS SARS-CoV-2 has spread extensively within Juba. Validation of serological tests in sub-Saharan African populations is critical to improve our ability to use serosurveillance to understand and mitigate transmission.
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Affiliation(s)
- Kirsten E. Wiens
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - John Rumunu
- Republic of South Sudan Ministry of Health, Juba, South Sudan
| | - Damien Slater
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Forrest K. Jones
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Serina Moheed
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Andrea Caflish
- Displacement Tracking Matrix, International Organization for Migration, Juba, South Sudan
| | - Bior K. Bior
- Republic of South Sudan Ministry of Health, Juba, South Sudan
| | | | | | | | | | | | - Andrew Baguma
- World Health Organization, Juba, South Sudan
- Kabale University School of Medicine, Department of Microbiology and Immunology
| | | | | | - Lul Deng
- Republic of South Sudan Ministry of Health, Juba, South Sudan
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maya N. Demby
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vanessa Sanchez
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Rachel Mills
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Clare Fraser
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Richelle C. Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Andrew S. Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Médecins Sans Frontières, Geneva, Switzerland
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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35
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Lemieux JE, Siddle KJ, Shaw BM, Loreth C, Schaffner SF, Gladden-Young A, Adams G, Fink T, Tomkins-Tinch CH, Krasilnikova LA, DeRuff KC, Rudy M, Bauer MR, Lagerborg KA, Normandin E, Chapman SB, Reilly SK, Anahtar MN, Lin AE, Carter A, Myhrvold C, Kemball ME, Chaluvadi S, Cusick C, Flowers K, Neumann A, Cerrato F, Farhat M, Slater D, Harris JB, Branda JA, Hooper D, Gaeta JM, Baggett TP, O'Connell J, Gnirke A, Lieberman TD, Philippakis A, Burns M, Brown CM, Luban J, Ryan ET, Turbett SE, LaRocque RC, Hanage WP, Gallagher GR, Madoff LC, Smole S, Pierce VM, Rosenberg E, Sabeti PC, Park DJ, MacInnis BL. Phylogenetic analysis of SARS-CoV-2 in Boston highlights the impact of superspreading events. Science 2021; 371:eabe3261. [PMID: 33303686 PMCID: PMC7857412 DOI: 10.1126/science.abe3261] [Citation(s) in RCA: 165] [Impact Index Per Article: 55.0] [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: 08/19/2020] [Accepted: 12/07/2020] [Indexed: 12/20/2022]
Abstract
Analysis of 772 complete severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomes from early in the Boston-area epidemic revealed numerous introductions of the virus, a small number of which led to most cases. The data revealed two superspreading events. One, in a skilled nursing facility, led to rapid transmission and significant mortality in this vulnerable population but little broader spread, whereas other introductions into the facility had little effect. The second, at an international business conference, produced sustained community transmission and was exported, resulting in extensive regional, national, and international spread. The two events also differed substantially in the genetic variation they generated, suggesting varying transmission dynamics in superspreading events. Our results show how genomic epidemiology can help to understand the link between individual clusters and wider community spread.
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Affiliation(s)
- Jacob E Lemieux
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA.
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Katherine J Siddle
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Bennett M Shaw
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Christine Loreth
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
| | - Stephen F Schaffner
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Gordon Adams
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
| | - Timelia Fink
- Massachusetts Department of Public Health, Boston, MA, USA
| | - Christopher H Tomkins-Tinch
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Lydia A Krasilnikova
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Katherine C DeRuff
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
| | - Melissa Rudy
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
| | - Matthew R Bauer
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
- Harvard Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, MA 02115, USA
| | - Kim A Lagerborg
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
- Harvard Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, MA 02115, USA
| | - Erica Normandin
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
- Department of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - Sinéad B Chapman
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
| | - Steven K Reilly
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Melis N Anahtar
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Aaron E Lin
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Amber Carter
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
| | - Cameron Myhrvold
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Molly E Kemball
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
- Department of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - Sushma Chaluvadi
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
| | - Caroline Cusick
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
| | - Katelyn Flowers
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
| | - Anna Neumann
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
| | - Felecia Cerrato
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
| | - Maha Farhat
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Damien Slater
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - John A Branda
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - David Hooper
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Jessie M Gaeta
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, MA, USA
- Section of General Internal Medicine, Boston University Medical Center, Boston, MA, USA
| | - Travis P Baggett
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - James O'Connell
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Andreas Gnirke
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
| | - Tami D Lieberman
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
- Institute for Medical Engineering and Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Anthony Philippakis
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
| | - Meagan Burns
- Massachusetts Department of Public Health, Boston, MA, USA
| | | | - Jeremy Luban
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
- Massachusetts Consortium on Pathogen Readiness, Boston, MA 02115, USA
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Sarah E Turbett
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Regina C LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - William P Hanage
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | | | - Lawrence C Madoff
- Massachusetts Department of Public Health, Boston, MA, USA
- University of Massachusetts Medical School, Infectious Diseases and Immunology, Worcester, MA 01655, USA
| | - Sandra Smole
- Massachusetts Department of Public Health, Boston, MA, USA
| | - Virginia M Pierce
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
- Pediatric Infectious Disease Unit, Massachusetts General Hospital for Children, Boston, MA, USA
- Department of Pathology, Harvard Medical School, Boston, MA, USA
| | - Eric Rosenberg
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Pardis C Sabeti
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA.
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Massachusetts Consortium on Pathogen Readiness, Boston, MA 02115, USA
- Howard Hughes Medical Institute, 4000 Jones Bridge Rd, Chevy Chase, MD 20815, USA
| | - Daniel J Park
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA
| | - Bronwyn L MacInnis
- Broad Institute of Harvard and MIT, 415 Main Street, Cambridge, MA 02142, USA.
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Massachusetts Consortium on Pathogen Readiness, Boston, MA 02115, USA
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Azman AS, Lauer SA, Bhuiyan TR, Luquero FJ, Leung DT, Hegde ST, Harris JB, Paul KK, Khaton F, Ferdous J, Lessler J, Salje H, Qadri F, Gurley ES. Vibrio cholerae O1 transmission in Bangladesh: insights from a nationally representative serosurvey. Lancet Microbe 2020; 1:e336-e343. [PMID: 33345203 PMCID: PMC7738617 DOI: 10.1016/s2666-5247(20)30141-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pandemic Vibrio cholerae from cholera-endemic countries around the Bay of Bengal regularly seed epidemics globally. Without reducing cholera in these countries, including Bangladesh, global cholera control might never be achieved. Little is known about the geographical distribution and magnitude of V cholerae O1 transmission nationally. We aimed to describe infection risk across Bangladesh, making use of advances in cholera seroepidemiology, therefore overcoming many of the limitations of current clinic-based surveillance. METHODS We tested serum samples from a nationally representative serosurvey in Bangladesh with eight V cholerae-specific assays. Using these data with a machine-learning model previously validated within a cohort of confirmed cholera cases and their household contacts, we estimated the proportion of the population with evidence of infection by V cholerae O1 in the previous year (annual seroincidence) and used Bayesian geostatistical models to create high-resolution national maps of infection risk. FINDINGS Between Oct 16, 2015, and Jan 24, 2016, we obtained and tested serum samples from 2930 participants (707 households) in 70 communities across Bangladesh. We estimated national annual seroincidence of V cholerae O1 infection of 17·3% (95% CI 10·5-24·1). Our high-resolution maps showed large heterogeneity of infection risk, with community-level annual infection risk within the sampled population ranging from 4·3% to 62·9%. Across Bangladesh, we estimated that 28·1 (95% CI 17·1-39·2) million infections occurred in the year before the survey. Despite having an annual seroincidence of V cholerae O1 infection lower than much of Bangladesh, Dhaka (the capital of Bangladesh and largest city in the country) had 2·0 (95% CI 0·6-3·9) million infections during the same year, primarily because of its large population. INTERPRETATION Serosurveillance provides an avenue for identifying areas with high V cholerae O1 transmission and investigating key risk factors for infection across geographical scales. Serosurveillance could serve as an important method for countries to plan and monitor progress towards 2030 cholera elimination goals. FUNDING The Bill & Melinda Gates Foundation, National Institutes of Health, and US Centers for Disease Control and Prevention.
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Affiliation(s)
- Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephen A Lauer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Francisco J Luquero
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Epicentre, Paris, France
| | - Daniel T Leung
- Division of Infectious Diseases and Division of Microbiology and Immunology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sonia T Hegde
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jason B Harris
- Division of Infectious Diseases and Division of Global Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard School of Medicine, Boston, MA, USA
| | | | | | | | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Henrik Salje
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France
| | | | - Emily S Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- icddr,b, Dhaka, Bangladesh
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37
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Bhuiyan MS, Kalsy A, Arifuzzaman M, Charles RC, Harris JB, Calderwood SB, Qadri F, Ryan ET. Transcutaneous Vaccination with Conjugate Typhoid Vaccine Vi-DT Induces Systemic, Mucosal, and Memory Anti-Polysaccharide Responses. Am J Trop Med Hyg 2020; 103:1032-1038. [PMID: 32720632 PMCID: PMC7470581 DOI: 10.4269/ajtmh.19-0798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Transcutaneous vaccination can induce both mucosal and systemic immune responses. However, there are few data on anti-polysaccharide responses following transcutaneous vaccination of polysaccharides, despite the role that anti-polysaccharide responses play in protecting against intestinal mucosal and respiratory pathogens. Whether transcutaneous vaccination with a conjugate polysaccharide vaccine would be able to induce memory responses is also unknown. To address this, we transcutaneously vaccinated mice with virulence antigen (Vi) polysaccharide of Salmonella enterica serovar Typhi (the cause of typhoid fever), either in unconjugated or conjugated form (the latter as a Vi-DT conjugate). We also assessed the ability of the immunoadjuvant cholera toxin to impact responses following vaccination. We found that presenting Vi in a conjugate versus nonconjugate form transcutaneously resulted in comparable serum IgG responses but higher serum and lamina propria lymphocyte IgA anti-Vi responses, as well as increased IgG memory responses. The addition of immunoadjuvant did not further increase these responses; however, it boosted fecal IgA and serum IgG anti-Vi responses. Our results suggest that transcutaneous vaccination of a conjugate vaccine can induce systemic as well as enhanced mucosal and memory B-cell anti-polysaccharide responses.
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Affiliation(s)
- Md Saruar Bhuiyan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Anuj Kalsy
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - Mohammad Arifuzzaman
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Richelle C Charles
- Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - Jason B Harris
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - Stephen B Calderwood
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - Firdausi Qadri
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Department of Immunology and Infectious Disease, Harvard School of Public Health, Boston, Massachusetts
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38
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Harris JB, Larocque RC. Hiding in Plain View: Cholera in Bangladesh. Clin Infect Dis 2020; 71:1643-1644. [DOI: 10.1093/cid/ciz1079] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/25/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Regina C Larocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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39
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Iyer AS, Jones FK, Nodoushani A, Kelly M, Becker M, Slater D, Mills R, Teng E, Kamruzzaman M, Garcia-Beltran WF, Astudillo M, Yang D, Miller TE, Oliver E, Fischinger S, Atyeo C, Iafrate AJ, Calderwood SB, Lauer SA, Yu J, Li Z, Feldman J, Hauser BM, Caradonna TM, Branda JA, Turbett SE, LaRocque RC, Mellon G, Barouch DH, Schmidt AG, Azman AS, Alter G, Ryan ET, Harris JB, Charles RC. Persistence and decay of human antibody responses to the receptor binding domain of SARS-CoV-2 spike protein in COVID-19 patients. Sci Immunol 2020; 5:eabe0367. [PMID: 33033172 PMCID: PMC7857394 DOI: 10.1126/sciimmunol.abe0367] [Citation(s) in RCA: 435] [Impact Index Per Article: 108.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/05/2020] [Indexed: 12/11/2022]
Abstract
We measured plasma and/or serum antibody responses to the receptor-binding domain (RBD) of the spike (S) protein of SARS-CoV-2 in 343 North American patients infected with SARS-CoV-2 (of which 93% required hospitalization) up to 122 days after symptom onset and compared them to responses in 1548 individuals whose blood samples were obtained prior to the pandemic. After setting seropositivity thresholds for perfect specificity (100%), we estimated sensitivities of 95% for IgG, 90% for IgA, and 81% for IgM for detecting infected individuals between 15 and 28 days after symptom onset. While the median time to seroconversion was nearly 12 days across all three isotypes tested, IgA and IgM antibodies against RBD were short-lived with median times to seroreversion of 71 and 49 days after symptom onset. In contrast, anti-RBD IgG responses decayed slowly through 90 days with only 3 seropositive individuals seroreverting within this time period. IgG antibodies to SARS-CoV-2 RBD were strongly correlated with anti-S neutralizing antibody titers, which demonstrated little to no decrease over 75 days since symptom onset. We observed no cross-reactivity of the SARS-CoV-2 RBD-targeted antibodies with other widely circulating coronaviruses (HKU1, 229 E, OC43, NL63). These data suggest that RBD-targeted antibodies are excellent markers of previous and recent infection, that differential isotype measurements can help distinguish between recent and older infections, and that IgG responses persist over the first few months after infection and are highly correlated with neutralizing antibodies.
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Affiliation(s)
- Anita S Iyer
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Forrest K Jones
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ariana Nodoushani
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Meagan Kelly
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Margaret Becker
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Damien Slater
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Rachel Mills
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Erica Teng
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Mohammad Kamruzzaman
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | | | - Michael Astudillo
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Diane Yang
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Tyler E Miller
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth Oliver
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | | | - Caroline Atyeo
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - A John Iafrate
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen B Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Microbiology, Harvard Medical School, Boston, MA, USA
| | - Stephen A Lauer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jingyou Yu
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Zhenfeng Li
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jared Feldman
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Blake M Hauser
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | | | - John A Branda
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah E Turbett
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Regina C LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Guillaume Mellon
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Dan H Barouch
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Aaron G Schmidt
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
- Department of Microbiology, Harvard Medical School, Boston, MA, USA
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Richelle C Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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40
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Shirin T, Bhuiyan TR, Charles RC, Amin S, Bhuiyan I, Kawser Z, Rahat A, Alam AN, Sultana S, Aleem MA, Khan MH, Khan SR, LaRocque RC, Calderwood SB, Ryan ET, Slater DM, Banu S, Clemens J, Harris JB, Flora MS, Qadri F. Antibody responses after COVID-19 infection in patients who are mildly symptomatic or asymptomatic in Bangladesh. Int J Infect Dis 2020; 101:220-225. [PMID: 33031941 PMCID: PMC7534791 DOI: 10.1016/j.ijid.2020.09.1484] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Studies on serological responses following coronavirus disease-2019 (COVID-19) have been published primarily in individuals who are moderately or severely symptomatic, but there are few data from individuals who are mildly symptomatic or asymptomatic. METHODS We measured IgG, IgM, and IgA to the receptor-binding domain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by using enzyme-linked immunosorbent assay in mildly symptomatic (n = 108) and asymptomatic (n = 63) on days 1, 7, 14, and 30 following RT-PCR confirmation in Bangladesh and when compared with pre-pandemic samples, including healthy controls (n = 73) and individuals infected with other viruses (n = 79). RESULTS Mildly symptomatic individuals developed IgM and IgA responses by day 14 in 72% and 83% of individuals, respectively, while 95% of individuals developed IgG response, and rose to 100% by day 30. In contrast, individuals infected with SARS-CoV-2 but who remained asymptomatic developed antibody responses significantly less frequently, with only 20% positive for IgA and 22% positive for IgM by day 14, and 45% positive for IgG by day 30 after infection. CONCLUSIONS These results confirm immune responses are generated following COVID-19 who develop mildly symptomatic illness. However, those with asymptomatic infection do not respond or have lower antibody levels. These results will impact modeling needed for determining herd immunity generated by natural infection or vaccination.
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Affiliation(s)
- Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | | | - Richelle C Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Departments of Medicine and Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Shaheena Amin
- Infectious Diseases Division, icddr,b, Mohakhali, Dhaka, Bangladesh
| | - Imran Bhuiyan
- Institute for Developing Science & Health Initiatives (ideSHi), Dhaka, Bangladesh
| | - Zannat Kawser
- Institute for Developing Science & Health Initiatives (ideSHi), Dhaka, Bangladesh
| | - Asifuzaman Rahat
- Institute for Developing Science & Health Initiatives (ideSHi), Dhaka, Bangladesh
| | - Ahmed Nawsher Alam
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Sharmin Sultana
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Md Abdul Aleem
- Infectious Diseases Division, icddr,b, Mohakhali, Dhaka, Bangladesh
| | | | | | - Regina C LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Departments of Medicine and Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Stephen B Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Departments of Medicine and Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Departments of Medicine and Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Damien M Slater
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Sayera Banu
- Infectious Diseases Division, icddr,b, Mohakhali, Dhaka, Bangladesh
| | - John Clemens
- Infectious Diseases Division, icddr,b, Mohakhali, Dhaka, Bangladesh
| | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA; Departments of Medicine and Pediatrics, Harvard Medical School, Boston, MA, USA
| | | | - Firdausi Qadri
- Infectious Diseases Division, icddr,b, Mohakhali, Dhaka, Bangladesh.
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41
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Miller TE, Garcia Beltran WF, Bard AZ, Gogakos T, Anahtar MN, Astudillo MG, Yang D, Thierauf J, Fisch AS, Mahowald GK, Fitzpatrick MJ, Nardi V, Feldman J, Hauser BM, Caradonna TM, Marble HD, Ritterhouse LL, Turbett SE, Batten J, Georgantas NZ, Alter G, Schmidt AG, Harris JB, Gelfand JA, Poznansky MC, Bernstein BE, Louis DN, Dighe A, Charles RC, Ryan ET, Branda JA, Pierce VM, Murali MR, Iafrate AJ, Rosenberg ES, Lennerz JK. Clinical sensitivity and interpretation of PCR and serological COVID-19 diagnostics for patients presenting to the hospital. FASEB J 2020; 34:13877-13884. [PMID: 32856766 PMCID: PMC7461169 DOI: 10.1096/fj.202001700rr] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 12/15/2022]
Abstract
The diagnosis of COVID-19 requires integration of clinical and laboratory data. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostic assays play a central role in diagnosis and have fixed technical performance metrics. Interpretation becomes challenging because the clinical sensitivity changes as the virus clears and the immune response emerges. Our goal was to examine the clinical sensitivity of two most common SARS-CoV-2 diagnostic test modalities, polymerase chain reaction (PCR) and serology, over the disease course to provide insight into their clinical interpretation in patients presenting to the hospital. We conducted a single-center, retrospective study. To derive clinical sensitivity of PCR, we identified 209 PCR-positive SARS-CoV-2 patients with multiple PCR test results (624 total PCR tests) and calculated daily sensitivity from date of symptom onset or first positive test. Clinical sensitivity of PCR decreased with days post symptom onset with >90% clinical sensitivity during the first 5 days after symptom onset, 70%-71% from Days 9 to 11, and 30% at Day 21. To calculate daily clinical sensitivity by serology, we utilized 157 PCR-positive patients with a total of 197 specimens tested by enzyme-linked immunosorbent assay for IgM, IgG, and IgA anti-SARS-CoV-2 antibodies. In contrast to PCR, serological sensitivity increased with days post symptom onset with >50% of patients seropositive by at least one antibody isotype after Day 7, >80% after Day 12, and 100% by Day 21. Taken together, PCR and serology are complimentary modalities that require time-dependent interpretation. Superimposition of sensitivities over time indicate that serology can function as a reliable diagnostic aid indicating recent or prior infection.
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Affiliation(s)
- Tyler E. Miller
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | | | - Adam Z. Bard
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Tasos Gogakos
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Melis N. Anahtar
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | | | - Diane Yang
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Julia Thierauf
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Adam S. Fisch
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Grace K. Mahowald
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Megan J. Fitzpatrick
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Valentina Nardi
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Jared Feldman
- Ragon Institute of MGH, MIT, and HarvardCambridgeMAUSA
| | | | | | - Hetal D. Marble
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Lauren L. Ritterhouse
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Sara E. Turbett
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Julie Batten
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | | | - Galit Alter
- Ragon Institute of MGH, MIT, and HarvardCambridgeMAUSA
| | | | - Jason B. Harris
- Division of Infectious DiseasesDepartment of PediatricsMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Jeffrey A. Gelfand
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Mark C. Poznansky
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Bradley E. Bernstein
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - David N. Louis
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Anand Dighe
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Richelle C. Charles
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Edward T. Ryan
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - John A. Branda
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Virginia M. Pierce
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
- Division of Infectious DiseasesDepartment of PediatricsMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Mandakolathur R. Murali
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
- Division of Allergy and ImmunologyDepartment of MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - A. John Iafrate
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Eric S. Rosenberg
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Jochen K. Lennerz
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
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42
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Lemieux JE, Siddle KJ, Shaw BM, Loreth C, Schaffner SF, Gladden-Young A, Adams G, Fink T, Tomkins-Tinch CH, Krasilnikova LA, DeRuff KC, Rudy M, Bauer MR, Lagerborg KA, Normandin E, Chapman SB, Reilly SK, Anahtar MN, Lin AE, Carter A, Myhrvold C, Kemball ME, Chaluvadi S, Cusick C, Flowers K, Neumann A, Cerrato F, Farhat M, Slater D, Harris JB, Branda J, Hooper D, Gaeta JM, Baggett TP, O'Connell J, Gnirke A, Lieberman TD, Philippakis A, Burns M, Brown CM, Luban J, Ryan ET, Turbett SE, LaRocque RC, Hanage WP, Gallagher GR, Madoff LC, Smole S, Pierce VM, Rosenberg E, Sabeti PC, Park DJ, Maclnnis BL. Phylogenetic analysis of SARS-CoV-2 in the Boston area highlights the role of recurrent importation and superspreading events. medRxiv 2020:2020.08.23.20178236. [PMID: 32869040 PMCID: PMC7457619 DOI: 10.1101/2020.08.23.20178236] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
SARS-CoV-2 has caused a severe, ongoing outbreak of COVID-19 in Massachusetts with 111,070 confirmed cases and 8,433 deaths as of August 1, 2020. To investigate the introduction, spread, and epidemiology of COVID-19 in the Boston area, we sequenced and analyzed 772 complete SARS-CoV-2 genomes from the region, including nearly all confirmed cases within the first week of the epidemic and hundreds of cases from major outbreaks at a conference, a nursing facility, and among homeless shelter guests and staff. The data reveal over 80 introductions into the Boston area, predominantly from elsewhere in the United States and Europe. We studied two superspreading events covered by the data, events that led to very different outcomes because of the timing and populations involved. One produced rapid spread in a vulnerable population but little onward transmission, while the other was a major contributor to sustained community transmission, including outbreaks in homeless populations, and was exported to several other domestic and international sites. The same two events differed significantly in the number of new mutations seen, raising the possibility that SARS-CoV-2 superspreading might encompass disparate transmission dynamics. Our results highlight the failure of measures to prevent importation into MA early in the outbreak, underscore the role of superspreading in amplifying an outbreak in a major urban area, and lay a foundation for contact tracing informed by genetic data.
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Affiliation(s)
- Jacob E Lemieux
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Katherine J Siddle
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Bennett M Shaw
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Christine Loreth
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Stephen F Schaffner
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Gordon Adams
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Timelia Fink
- Massachusetts Department of Public Health, Boston, MA, USA
| | - Christopher H Tomkins-Tinch
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Lydia A Krasilnikova
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Katherine C DeRuff
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Melissa Rudy
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Matthew R Bauer
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
- Harvard Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, MA 02115, USA
| | - Kim A Lagerborg
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
- Harvard Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, MA 02115, USA
| | - Erica Normandin
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
- Department of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - Sinead B Chapman
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Steven K Reilly
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Melis N Anahtar
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Aaron E Lin
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Amber Carter
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Cameron Myhrvold
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Molly E Kemball
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
- Department of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - Sushma Chaluvadi
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Caroline Cusick
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Katelyn Flowers
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Anna Neumann
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Felecia Cerrato
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Maha Farhat
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Damien Slater
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - John Branda
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - David Hooper
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Jessie M Gaeta
- lnstitute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, MA, USA
- Section of General Internal Medicine, Boston University Medical Center, Boston
| | - Travis P Baggett
- lnstitute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - James O'Connell
- lnstitute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Andreas Gnirke
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Tami D Lieberman
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
- lnstitute for Medical Engineering and Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Anthony Philippakis
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Meagan Burns
- Massachusetts Department of Public Health, Boston, MA, USA
| | | | - Jeremy Luban
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
- Massachusetts Consortium on Pathogen Readiness, Boston, MA, 02115, USA
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Sarah E Turbett
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Regina C LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - William P Hanage
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | | | - Lawrence C Madoff
- Massachusetts Department of Public Health, Boston, MA, USA
- University of Massachusetts Medical School, Infectious Diseases and Immunology, Worcester, MA 01655
| | - Sandra Smole
- Massachusetts Department of Public Health, Boston, MA, USA
| | - Virginia M Pierce
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
- Pediatric Infectious Disease Unit, MassGeneral Hospital for Children, Boston, MA, USA
- Department of Pathology, Harvard Medical School, Boston, MA, USA
| | - Eric Rosenberg
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Pardis C Sabeti
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Massachusetts Consortium on Pathogen Readiness, Boston, MA, 02115, USA
- Howard Hughes Medical Institute, 4000 Jones Bridge Rd, Chevy Chase, MD 20815
| | - Daniel J Park
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Bronwyn L Maclnnis
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Massachusetts Consortium on Pathogen Readiness, Boston, MA, 02115, USA
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43
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Lemieux JE, Siddle KJ, Shaw BM, Loreth C, Schaffner SF, Gladden-Young A, Adams G, Fink T, Tomkins-Tinch CH, Krasilnikova LA, DeRuff KC, Rudy M, Bauer MR, Lagerborg KA, Normandin E, Chapman SB, Reilly SK, Anahtar MN, Lin AE, Carter A, Myhrvold C, Kemball ME, Chaluvadi S, Cusick C, Flowers K, Neumann A, Cerrato F, Farhat M, Slater D, Harris JB, Branda J, Hooper D, Gaeta JM, Baggett TP, O'Connell J, Gnirke A, Lieberman TD, Philippakis A, Burns M, Brown CM, Luban J, Ryan ET, Turbett SE, LaRocque RC, Hanage WP, Gallagher GR, Madoff LC, Smole S, Pierce VM, Rosenberg E, Sabeti PC, Park DJ, Maclnnis BL. Phylogenetic analysis of SARS-CoV-2 in the Boston area highlights the role of recurrent importation and superspreading events. medRxiv 2020. [PMID: 32869040 DOI: 10.1101/2020.04.12.20059618v1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
SARS-CoV-2 has caused a severe, ongoing outbreak of COVID-19 in Massachusetts with 111,070 confirmed cases and 8,433 deaths as of August 1, 2020. To investigate the introduction, spread, and epidemiology of COVID-19 in the Boston area, we sequenced and analyzed 772 complete SARS-CoV-2 genomes from the region, including nearly all confirmed cases within the first week of the epidemic and hundreds of cases from major outbreaks at a conference, a nursing facility, and among homeless shelter guests and staff. The data reveal over 80 introductions into the Boston area, predominantly from elsewhere in the United States and Europe. We studied two superspreading events covered by the data, events that led to very different outcomes because of the timing and populations involved. One produced rapid spread in a vulnerable population but little onward transmission, while the other was a major contributor to sustained community transmission, including outbreaks in homeless populations, and was exported to several other domestic and international sites. The same two events differed significantly in the number of new mutations seen, raising the possibility that SARS-CoV-2 superspreading might encompass disparate transmission dynamics. Our results highlight the failure of measures to prevent importation into MA early in the outbreak, underscore the role of superspreading in amplifying an outbreak in a major urban area, and lay a foundation for contact tracing informed by genetic data.
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Affiliation(s)
- Jacob E Lemieux
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Katherine J Siddle
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA.,Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Bennett M Shaw
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Christine Loreth
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Stephen F Schaffner
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA.,Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Gordon Adams
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Timelia Fink
- Massachusetts Department of Public Health, Boston, MA, USA
| | - Christopher H Tomkins-Tinch
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA.,Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Lydia A Krasilnikova
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA.,Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Katherine C DeRuff
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Melissa Rudy
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Matthew R Bauer
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA.,Harvard Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, MA 02115, USA
| | - Kim A Lagerborg
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA.,Harvard Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, MA 02115, USA
| | - Erica Normandin
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA.,Department of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - Sinead B Chapman
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Steven K Reilly
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA.,Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Melis N Anahtar
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Aaron E Lin
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA.,Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Amber Carter
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Cameron Myhrvold
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA.,Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Molly E Kemball
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA.,Department of Systems Biology, Harvard Medical School, Boston, MA, USA
| | - Sushma Chaluvadi
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Caroline Cusick
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Katelyn Flowers
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Anna Neumann
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Felecia Cerrato
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Maha Farhat
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.,Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Damien Slater
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - John Branda
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - David Hooper
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Jessie M Gaeta
- lnstitute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, MA, USA.,Section of General Internal Medicine, Boston University Medical Center, Boston
| | - Travis P Baggett
- lnstitute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - James O'Connell
- lnstitute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, MA, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Andreas Gnirke
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Tami D Lieberman
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA.,lnstitute for Medical Engineering and Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Anthony Philippakis
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Meagan Burns
- Massachusetts Department of Public Health, Boston, MA, USA
| | | | - Jeremy Luban
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA.,Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA.,Massachusetts Consortium on Pathogen Readiness, Boston, MA, 02115, USA
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Sarah E Turbett
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Regina C LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - William P Hanage
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | | | - Lawrence C Madoff
- Massachusetts Department of Public Health, Boston, MA, USA.,University of Massachusetts Medical School, Infectious Diseases and Immunology, Worcester, MA 01655
| | - Sandra Smole
- Massachusetts Department of Public Health, Boston, MA, USA
| | - Virginia M Pierce
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.,Pediatric Infectious Disease Unit, MassGeneral Hospital for Children, Boston, MA, USA.,Department of Pathology, Harvard Medical School, Boston, MA, USA
| | - Eric Rosenberg
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Pardis C Sabeti
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA.,Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.,Massachusetts Consortium on Pathogen Readiness, Boston, MA, 02115, USA.,Howard Hughes Medical Institute, 4000 Jones Bridge Rd, Chevy Chase, MD 20815
| | - Daniel J Park
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA
| | - Bronwyn L Maclnnis
- Broad Institute of Harvard and MIT, 75 Ames Street, Cambridge, MA 02142, USA.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.,Massachusetts Consortium on Pathogen Readiness, Boston, MA, 02115, USA
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44
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Iyer AS, Jones FK, Nodoushani A, Kelly M, Becker M, Slater D, Mills R, Teng E, Kamruzzaman M, Garcia-Beltran WF, Astudillo M, Yang D, Miller TE, Oliver E, Fischinger S, Atyeo C, Iafrate AJ, Calderwood SB, Lauer SA, Yu J, Li Z, Feldman J, Hauser BM, Caradonna TM, Branda JA, Turbett SE, LaRocque RC, Mellon G, Barouch DH, Schmidt AG, Azman AS, Alter G, Ryan ET, Harris JB, Charles RC. Dynamics and significance of the antibody response to SARS-CoV-2 infection. medRxiv 2020:2020.07.18.20155374. [PMID: 32743600 PMCID: PMC7386524 DOI: 10.1101/2020.07.18.20155374] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Characterizing the humoral immune response to SARS-CoV-2 and developing accurate serologic assays are needed for diagnostic purposes and estimating population-level seroprevalence. METHODS We measured the kinetics of early antibody responses to the receptor-binding domain (RBD) of the spike (S) protein of SARS-CoV-2 in a cohort of 259 symptomatic North American patients infected with SARS-CoV-2 (up to 75 days after symptom onset) compared to antibody levels in 1548 individuals whose blood samples were obtained prior to the pandemic. RESULTS Between 14-28 days from onset of symptoms, IgG, IgA, or IgM antibody responses to RBD were all accurate in identifying recently infected individuals, with 100% specificity and a sensitivity of 97%, 91%, and 81% respectively. Although the estimated median time to becoming seropositive was similar across isotypes, IgA and IgM antibodies against RBD were short-lived with most individuals estimated to become seronegative again by 51 and 47 days after symptom onset, respectively. IgG antibodies against RBD lasted longer and persisted through 75 days post-symptoms. IgG antibodies to SARS-CoV-2 RBD were highly correlated with neutralizing antibodies targeting the S protein. No cross-reactivity of the SARS-CoV-2 RBD-targeted antibodies was observed with several known circulating coronaviruses, HKU1, OC 229 E, OC43, and NL63. CONCLUSIONS Among symptomatic SARS-CoV-2 cases, RBD-targeted antibodies can be indicative of previous and recent infection. IgG antibodies are correlated with neutralizing antibodies and are possibly a correlate of protective immunity.
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Affiliation(s)
- Anita S. Iyer
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Forrest K. Jones
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ariana Nodoushani
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Meagan Kelly
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Margaret Becker
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Damien Slater
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Rachel Mills
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Erica Teng
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Mohammad Kamruzzaman
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | | | - Michael Astudillo
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Diane Yang
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Tyler E. Miller
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth Oliver
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | | | - Caroline Atyeo
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - A. John Iafrate
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen B. Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Microbiology, Harvard Medical School, Boston, MA, USA
| | - Stephen A. Lauer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jingyou Yu
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Zhenfeng Li
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jared Feldman
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Blake M. Hauser
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | | | - John A. Branda
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah E. Turbett
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Regina C. LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Guillaume Mellon
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Dan H. Barouch
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Aaron G. Schmidt
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
- Department of Microbiology, Harvard Medical School, Boston, MA, USA
| | - Andrew S. Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Richelle C. Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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45
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Levade I, Saber MM, Midani FS, Chowdhury F, Khan AI, Begum YA, Ryan ET, David LA, Calderwood SB, Harris JB, LaRocque RC, Qadri F, Shapiro BJ, Weil AA. Predicting Vibrio cholerae Infection and Disease Severity Using Metagenomics in a Prospective Cohort Study. J Infect Dis 2020; 223:342-351. [PMID: 32610345 PMCID: PMC7857355 DOI: 10.1093/infdis/jiaa358] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Susceptibility to Vibrio cholerae infection is affected by blood group, age, and preexisting immunity, but these factors only partially explain who becomes infected. A recent study used 16S ribosomal RNA amplicon sequencing to quantify the composition of the gut microbiome and identify predictive biomarkers of infection with limited taxonomic resolution. METHODS To achieve increased resolution of gut microbial factors associated with V. cholerae susceptibility and identify predictors of symptomatic disease, we applied deep shotgun metagenomic sequencing to a cohort of household contacts of patients with cholera. RESULTS Using machine learning, we resolved species, strains, gene families, and cellular pathways in the microbiome at the time of exposure to V. cholerae to identify markers that predict infection and symptoms. Use of metagenomic features improved the precision and accuracy of prediction relative to 16S sequencing. We also predicted disease severity, although with greater uncertainty than our infection prediction. Species within the genera Prevotella and Bifidobacterium predicted protection from infection, and genes involved in iron metabolism were also correlated with protection. CONCLUSION Our results highlight the power of metagenomics to predict disease outcomes and suggest specific species and genes for experimental testing to investigate mechanisms of microbiome-related protection from cholera.
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Affiliation(s)
- Inès Levade
- Department of Biological Sciences, University of Montreal, Montreal, Quebec, Canada
| | - Morteza M Saber
- Department of Biological Sciences, University of Montreal, Montreal, Quebec, Canada
| | - Firas S Midani
- Program in Computational Biology and Bioinformatics, Duke University, Durham, North Carolina, USA,Center for Genomic and Computational Biology, Duke University, Durham, North Carolina, USA,Department of Molecular Genetics and Microbiology, Duke University, Durham, North Carolina, USA
| | - Fahima Chowdhury
- Center for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ashraful I Khan
- Center for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Yasmin A Begum
- Center for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lawrence A David
- Program in Computational Biology and Bioinformatics, Duke University, Durham, North Carolina, USA,Center for Genomic and Computational Biology, Duke University, Durham, North Carolina, USA,Department of Molecular Genetics and Microbiology, Duke University, Durham, North Carolina, USA,Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Stephen B Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA,Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Regina C LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Firdausi Qadri
- Center for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - B Jesse Shapiro
- Department of Biological Sciences, University of Montreal, Montreal, Quebec, Canada,Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada,McGill Genome Centre, Montreal, Quebec, Canada,Correspondence: B. Jesse Shapiro, McGill University, Montreal, Quebec, Canada ()
| | - Ana A Weil
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
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46
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Azman AS, Lessler J, Luquero FJ, Bhuiyan TR, Khan AI, Chowdhury F, Kabir A, Gurwith M, Weil AA, Harris JB, Calderwood SB, Ryan ET, Qadri F, Leung DT. Estimating cholera incidence with cross-sectional serology. Sci Transl Med 2020; 11:11/480/eaau6242. [PMID: 30787170 PMCID: PMC6430585 DOI: 10.1126/scitranslmed.aau6242] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [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: 06/29/2018] [Revised: 11/09/2018] [Accepted: 01/30/2019] [Indexed: 12/02/2022]
Abstract
The development of new approaches to cholera control relies on an accurate understanding of cholera epidemiology. However, most information on cholera incidence lacks laboratory confirmation and instead relies on surveillance systems reporting medically attended acute watery diarrhea. If recent infections could be identified using serological markers, cross-sectional serosurveys would offer an alternative approach to measuring incidence. Here, we used 1569 serologic samples from a cohort of cholera cases and their uninfected contacts in Bangladesh to train machine learning models to identify recent Vibrio cholerae O1 infections. We found that an individual’s antibody profile contains information on the timing of V. cholerae O1 infections in the previous year. Our models using six serological markers accurately identified individuals in the Bangladesh cohort infected within the last year [cross-validated area under the curve (AUC), 93.4%; 95% confidence interval (CI), 92.1 to 94.7%], with a marginal performance decrease using models based on two markers (cross-validated AUC, 91.0%; 95% CI, 89.2 to 92.7%). We validated the performance of the two-marker model on data from a cohort of North American volunteers challenged with V. cholerae O1 (AUC range, 88.4 to 98.4%). In simulated serosurveys, our models accurately estimated annual incidence in both endemic and epidemic settings, even with sample sizes as small as 500 and annual incidence as low as two infections per 1000 individuals. Crosssectional serosurveys may be a viable approach to estimating cholera incidence.
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Affiliation(s)
- Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Francisco J Luquero
- Epicentre, Paris 75012, France.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Taufiqur Rahman Bhuiyan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Ashraful Islam Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Fahima Chowdhury
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Alamgir Kabir
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | | | - Ana A Weil
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA .,Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA .,Division of Global Health, Massachusetts General Hospital, Boston, MA 02114, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Stephen B Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA .,Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA .,Department of Medicine, Harvard Medical School, Boston, MA 02115, USA.,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Daniel T Leung
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.,Division of Microbiology and Immunology, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
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47
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Hossain M, Islam K, Kelly M, Mayo Smith LM, Charles RC, Weil AA, Bhuiyan TR, Kováč P, Xu P, Calderwood SB, Simon JK, Chen WH, Lock M, Lyon CE, Kirkpatrick BD, Cohen M, Levine MM, Gurwith M, Leung DT, Azman AS, Harris JB, Qadri F, Ryan ET. Immune responses to O-specific polysaccharide (OSP) in North American adults infected with Vibrio cholerae O1 Inaba. PLoS Negl Trop Dis 2019; 13:e0007874. [PMID: 31743334 PMCID: PMC6863522 DOI: 10.1371/journal.pntd.0007874] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/25/2019] [Indexed: 01/01/2023] Open
Abstract
Background Antibodies targeting O-specific polysaccharide (OSP) of Vibrio cholerae may protect against cholera; however, little is known about this immune response in infected immunologically naïve humans. Methodology We measured serum anti-OSP antibodies in adult North American volunteers experimentally infected with V. cholerae O1 Inaba El Tor N16961. We also measured vibriocidal and anti-cholera toxin B subunit (CtxB) antibodies and compared responses to those in matched cholera patients in Dhaka, Bangladesh, an area endemic for cholera. Principal findings We found prominent anti-OSP antibody responses following initial cholera infection: these responses were largely IgM and IgA, and highest to infecting serotype with significant cross-serotype reactivity. The anti-OSP responses peaked 10 days after infection and remained elevated over baseline for ≥ 6 months, correlated with vibriocidal responses, and may have been blunted in blood group O individuals (IgA anti-OSP). We found significant differences in immune responses between naïve and endemic zone cohorts, presumably reflecting previous exposure in the latter. Conclusions Our results define immune responses to O-specific polysaccharide in immunologically naive humans with cholera, find that they are largely IgM and IgA, may be blunted in blood group O individuals, and differ in a number of significant ways from responses in previously humans. These differences may explain in part varying degrees of protective efficacy afforded by cholera vaccination between these two populations. Trial registration number ClinicalTrials.gov NCT01895855. Cholera is an acute, secretory diarrheal disease caused by Vibrio cholerae O1. There is a growing body of evidence that immune responses targetting the O-specific polysaccharide (OSP) of V. cholerae are associated with protecton against cholera. Despite this, little is known about immune responses targeting OSP in immunologically naive individals. Cholera affects populations in severely resource-limited areas. To address this, we assessed anti-OSP immune responses in North American volunteers experimentally infected with wild type V. cholerae O1 El Tor Inaba strain N16961. We found that antibody responses were largely IgM and IgA, cross-reacted to both Inaba and Ogawa serotypes, and correlated with vibriocidal responses. We found no association of responses to severity of disease, but did find that blood group O individuals mounted lower IgA fold-changes to OSP than did non-blood group O individuals. Individuals with blood group O are at particular risk for severe cholera, and are less well protected against cholera following oral vaccination. We also compared anti-OSP responses in previously unexposed individuals to responses in matched endemic zone patients, and found a number of significant differences. Such differences may explain in part the varying degrees of protective efficacy afforded by cholera vaccination between these two populations.
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Affiliation(s)
- Motaher Hossain
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- * E-mail:
| | - Kamrul Islam
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Meagan Kelly
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Leslie M. Mayo Smith
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Richelle C. Charles
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ana A. Weil
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Taufiqur Rahman Bhuiyan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Pavol Kováč
- National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), Laboratory of Bioorganic Chemistry (LBC), National Institutes of Health, Bethesda, Maryland, United States of America
| | - Peng Xu
- National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), Laboratory of Bioorganic Chemistry (LBC), National Institutes of Health, Bethesda, Maryland, United States of America
| | - Stephen B. Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jakub K. Simon
- Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | - Wilbur H. Chen
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Michael Lock
- PaxVax, Inc., Redwood City, California, United States of America
| | - Caroline E. Lyon
- Vaccine Testing Center, Departments of Medicine and Microbiology and Molecular Genetics, University of Vermont College of Medicine, Burlington, Vermont, United States of America
| | - Beth D. Kirkpatrick
- Vaccine Testing Center, Departments of Medicine and Microbiology and Molecular Genetics, University of Vermont College of Medicine, Burlington, Vermont, United States of America
| | - Mitchell Cohen
- Cincinnati Children’s Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Myron M. Levine
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Marc Gurwith
- PaxVax, Inc., Redwood City, California, United States of America
| | - Daniel T. Leung
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Andrew S. Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Jason B. Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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48
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Abstract
Vibrio cholerae is a prototypical noninvasive mucosal pathogen, yet infection generates long-lasting protection against subsequent disease. Vibriocidal antibody responses are an imperfect but established correlate of protection against cholera following both infection and vaccination. However, vibriocidal antibody responses are likely a surrogate marker for longer-lasting functional immune responses that target the O-polysaccharide antigen at the mucosal surface. While the current bivalent inactivated oral whole cell vaccine is being increasingly used to prevent cholera in areas where the disease is a threat, the most significant limitation of this vaccine is it offers relatively limited direct protection in young children. Future strategies for cholera vaccination include the development of cholera conjugate vaccines and the further development of live attenuated vaccines. Ultimately, the goal of a multivalent vaccine for cholera and other childhood enteric infections that can be incorporated into a standard immunization schedule should be realized.
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Affiliation(s)
- Jason B Harris
- Division of Pediatric Global Health, Massachusetts General Hospital, Boston, Massachusetts.,Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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49
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Midani FS, Weil AA, Chowdhury F, Begum YA, Khan AI, Debela MD, Durand HK, Reese AT, Nimmagadda SN, Silverman JD, Ellis CN, Ryan ET, Calderwood SB, Harris JB, Qadri F, David LA, LaRocque RC. Human Gut Microbiota Predicts Susceptibility to Vibrio cholerae Infection. J Infect Dis 2019; 218:645-653. [PMID: 29659916 DOI: 10.1093/infdis/jiy192] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 04/10/2018] [Indexed: 12/20/2022] Open
Abstract
Background Cholera is a public health problem worldwide, and the risk factors for infection are only partially understood. Methods We prospectively studied household contacts of patients with cholera to compare those who were infected to those who were not. We constructed predictive machine learning models of susceptibility, using baseline gut microbiota data. We identified bacterial taxa associated with susceptibility to Vibrio cholerae infection and tested these taxa for interactions with V. cholerae in vitro. Results We found that machine learning models based on gut microbiota, as well as models based on known clinical and epidemiological risk factors, predicted V. cholerae infection. A predictive gut microbiota of roughly 100 bacterial taxa discriminated between contacts who developed infection and those who did not. Susceptibility to cholera was associated with depleted levels of microbes from the phylum Bacteroidetes. By contrast, a microbe associated with cholera by our modeling framework, Paracoccus aminovorans, promoted the in vitro growth of V. cholerae. Gut microbiota structure, clinical outcome, and age were also linked. Conclusion These findings support the hypothesis that abnormal gut microbial communities are a host factor related to V. cholerae susceptibility.
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Affiliation(s)
- Firas S Midani
- Program in Computational Biology and Bioinformatics, Duke University, Durham, North Carolina.,Center for Genomic and Computational Biology, Duke University, Durham, North Carolina.,Department of Molecular Genetics and Microbiology, Duke University, Durham, North Carolina
| | - Ana A Weil
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Fahima Chowdhury
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | - Yasmin A Begum
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | - Ashraful I Khan
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | - Meti D Debela
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
| | - Heather K Durand
- Department of Molecular Genetics and Microbiology, Duke University, Durham, North Carolina
| | - Aspen T Reese
- Department of Molecular Genetics and Microbiology, Duke University, Durham, North Carolina.,Department of Biology, Duke University, Durham, North Carolina
| | - Sai N Nimmagadda
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Justin D Silverman
- Program in Computational Biology and Bioinformatics, Duke University, Durham, North Carolina.,Center for Genomic and Computational Biology, Duke University, Durham, North Carolina.,Department of Molecular Genetics and Microbiology, Duke University, Durham, North Carolina.,Medical Scientist Training Program, Duke University, Durham, North Carolina
| | - Crystal N Ellis
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Massachusetts College of Pharmacy and Health Sciences University, Boston
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
| | - Stephen B Calderwood
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts
| | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Firdausi Qadri
- Mucosal Immunology and Vaccinology Laboratory, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | - Lawrence A David
- Program in Computational Biology and Bioinformatics, Duke University, Durham, North Carolina.,Center for Genomic and Computational Biology, Duke University, Durham, North Carolina.,Department of Molecular Genetics and Microbiology, Duke University, Durham, North Carolina.,Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Regina C LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
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50
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Weil AA, Ellis CN, Debela MD, Bhuiyan TR, Rashu R, Bourque DL, Khan AI, Chowdhury F, LaRocque RC, Charles RC, Ryan ET, Calderwood SB, Qadri F, Harris JB. Posttranslational Regulation of IL-23 Production Distinguishes the Innate Immune Responses to Live Toxigenic versus Heat-Inactivated Vibrio cholerae. mSphere 2019; 4:e00206-19. [PMID: 31434744 PMCID: PMC6706466 DOI: 10.1128/msphere.00206-19] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/06/2019] [Indexed: 12/25/2022] Open
Abstract
Vibrio cholerae infection provides long-lasting protective immunity, while oral, inactivated cholera vaccines (OCV) result in more-limited protection. To identify characteristics of the innate immune response that may distinguish natural V. cholerae infection from OCV, we stimulated differentiated, macrophage-like THP-1 cells with live versus heat-inactivated V. cholerae with and without endogenous or exogenous cholera holotoxin (CT). Interleukin 23A gene (IL23A) expression was higher in cells exposed to live V. cholerae than in cells exposed to inactivated organisms (mean change, 38-fold; 95% confidence interval [95% CI], 4.0 to 42; P < 0.01). IL-23 secretion was also higher in cells exposed to live V. cholerae than in cells exposed to inactivated V. cholerae (mean change, 5.6-fold; 95% CI, 4.4 to 11; P < 0.001). This increase in IL-23 secretion was more marked than for other key innate immune cytokines (e.g., IL-1β and IL-6) and dependent on exposure to the combination of both live V. cholerae and CT. While IL-23 secretion was reduced following stimulation with either heat-inactivated wild-type V. cholerae or a live isogenic ctxAB mutant of V. cholerae, the addition of exogenous CT restored IL-23 secretion in combination with the live isogenic ctxAB mutant V. cholerae, but not when it was paired with stimulation by heat-inactivated V. cholerae The posttranslational regulation of IL-23 under these conditions was dependent on the activity of the cysteine protease cathepsin B. In humans, IL-23 promotes the differentiation of Th17 cells to T follicular helper cells, which maintain and support long-term memory B cell generation after infection. Based on these findings, the stimulation of IL-23 production may be a determinant of protective immunity following V. cholerae infection.IMPORTANCE An episode of cholera provides better protection against reinfection than oral cholera vaccines, and the reasons for this are still under study. To better understand this, we compared the immune responses of human cells exposed to live Vibrio cholerae with those of cells exposed to heat-killed V. cholerae (similar to the contents of oral cholera vaccines). We also compared the effects of active cholera toxin and the inactive cholera toxin B subunit (which is included in some cholera vaccines). One key immune signaling molecule, IL-23, was uniquely produced in response to the combination of live bacteria and active cholera holotoxin. Stimulation with V. cholerae that did not produce the active toxin or was killed did not produce an IL-23 response. The stimulation of IL-23 production by cholera toxin-producing V. cholerae may be important in conferring long-term immunity after cholera.
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Affiliation(s)
- Ana A Weil
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Crystal N Ellis
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meti D Debela
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Taufiqur R Bhuiyan
- Infectious Diseases Division, International Center for Diarrheal Disease and Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rasheduzzaman Rashu
- Infectious Diseases Division, International Center for Diarrheal Disease and Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Daniel L Bourque
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ashraful I Khan
- Infectious Diseases Division, International Center for Diarrheal Disease and Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahima Chowdhury
- Infectious Diseases Division, International Center for Diarrheal Disease and Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Regina C LaRocque
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Richelle C Charles
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Edward T Ryan
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Stephen B Calderwood
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Microbiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Firdausi Qadri
- Infectious Diseases Division, International Center for Diarrheal Disease and Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jason B Harris
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Global Health, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
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