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Dyal J, Kofman A, Kollie JZ, Fankhauser J, Orone R, Soka MJ, Glaybo U, Kiawu A, Freeman E, Giah G, Tony HD, Faikai M, Jawara M, Kamara K, Kamara S, Flowers B, Kromah ML, Desamu-Thorpe R, Graziano J, Brown S, Morales-Betoulle ME, Cannon DL, Su K, Linderman SL, Plucinski M, Rogier E, Bradbury RS, Secor WE, Bowden KE, Phillips C, Carrington MN, Park YH, Martin MP, Aguinaga MDP, Mushi R, Haberling DL, Ervin ED, Klena JD, Massaquoi M, Nyenswah T, Nichol ST, Chiriboga DE, Williams DE, Hinrichs SH, Ahmed R, Vonhm BT, Rollin PE, Purpura LJ, Choi MJ. Risk Factors for Ebola Virus Persistence in Semen of Survivors in Liberia. Clin Infect Dis 2023; 76:e849-e856. [PMID: 35639875 PMCID: PMC10169428 DOI: 10.1093/cid/ciac424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/08/2022] [Accepted: 05/24/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Long-term persistence of Ebola virus (EBOV) in immunologically privileged sites has been implicated in recent outbreaks of Ebola virus disease (EVD) in Guinea and the Democratic Republic of Congo. This study was designed to understand how the acute course of EVD, convalescence, and host immune and genetic factors may play a role in prolonged viral persistence in semen. METHODS A cohort of 131 male EVD survivors in Liberia were enrolled in a case-case study. "Early clearers" were defined as those with 2 consecutive negative EBOV semen test results by real-time reverse-transcription polymerase chain reaction (rRT-PCR) ≥2 weeks apart within 1 year after discharge from the Ebola treatment unit or acute EVD. "Late clearers" had detectable EBOV RNA by rRT-PCR >1 year after discharge from the Ebola treatment unit or acute EVD. Retrospective histories of their EVD clinical course were collected by questionnaire, followed by complete physical examinations and blood work. RESULTS Compared with early clearers, late clearers were older (median, 42.5 years; P < .001) and experienced fewer severe clinical symptoms (median 2, P = .006). Late clearers had more lens opacifications (odds ratio, 3.9 [95% confidence interval, 1.1-13.3]; P = .03), after accounting for age, higher total serum immunoglobulin G3 (IgG3) titers (P = .005), and increased expression of the HLA-C*03:04 allele (0.14 [.02-.70]; P = .007). CONCLUSIONS Older age, decreased illness severity, elevated total serum IgG3 and HLA-C*03:04 allele expression may be risk factors for the persistence of EBOV in the semen of EVD survivors. EBOV persistence in semen may also be associated with its persistence in other immunologically protected sites, such as the eye.
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Affiliation(s)
- Jonathan Dyal
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aaron Kofman
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Romeo Orone
- ELWA Hospital, Samaritan's Purse, Monrovia, Liberia
| | - Moses J Soka
- ELWA Hospital, Samaritan's Purse, Monrovia, Liberia
| | - Uriah Glaybo
- Men's Health Screening Program, Monrovia, Liberia
| | - Armah Kiawu
- Men's Health Screening Program, Monrovia, Liberia
| | - Edna Freeman
- Men's Health Screening Program, Monrovia, Liberia
| | | | - Henry D Tony
- Men's Health Screening Program, Monrovia, Liberia
| | | | - Mary Jawara
- Men's Health Screening Program, Monrovia, Liberia
| | - Kuku Kamara
- Men's Health Screening Program, Monrovia, Liberia
| | | | | | | | - Rodel Desamu-Thorpe
- Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James Graziano
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shelley Brown
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maria E Morales-Betoulle
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Deborah L Cannon
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kaihong Su
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Mateusz Plucinski
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric Rogier
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard S Bradbury
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - W Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine E Bowden
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christi Phillips
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary N Carrington
- Basic Science Program, Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, Maryland, USA.,Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA.,Ragon Institute of MGH, Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA
| | - Yeon-Hwa Park
- Basic Science Program, Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, Maryland, USA
| | - Maureen P Martin
- Basic Science Program, Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, Maryland, USA
| | - Maria Del Pilar Aguinaga
- Department of Internal Medicine, Meharry Sickle Cell Center, Meharry Medical College, Nashville, Tennessee, USA.,Department of Obstetrics and Gynecology, Meharry Sickle Cell Center, Nashville, Tennessee, USA
| | - Robert Mushi
- Department of Internal Medicine, Meharry Sickle Cell Center, Meharry Medical College, Nashville, Tennessee, USA
| | - Dana L Haberling
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth D Ervin
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John D Klena
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Stuart T Nichol
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David E Chiriboga
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Desmond E Williams
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Steven H Hinrichs
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Rafi Ahmed
- Emory Vaccine Center, Emory University, Atlanta, Georgia, USA
| | | | - Pierre E Rollin
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lawrence J Purpura
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary J Choi
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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2
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Rathakrishnan D, Purpura LJ, Salcuni PM, Myers JE, Wahnich A, Daskalakis DC, Edelstein ZR. PrEP Use and Correlates of Use Among a Large, Urban Sample of Men and Transgender Persons Who Have Sex with Men. AIDS Behav 2022; 26:1017-1025. [PMID: 34599419 DOI: 10.1007/s10461-021-03456-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 11/26/2022]
Abstract
We examined recent pre-exposure prophylaxis (PrEP) use (past 6 months) and its correlates among a large sample of men who have sex with men and transgender and gender non-conforming persons participating in a home HIV self-testing program conducted by the New York City Health Department between 11/2016 and 1/2017. Correlates examined included demographic characteristics and HIV-related behaviors in the past 6 months. Associations with recent PrEP use were assessed using log-binomial regression. 400 (22.5%) of 1776 participants reported recent PrEP use. In adjusted models, recent PrEP use was associated with Manhattan residence [adjusted prevalence ratio (aPR) 1.26; 95% confidence interval (CI) (1.04, 1.53)], higher income [aPR 1.29; 95% CI (1.03, 1.62)], and having insurance [aPR 1.89; 95% CI (1.33, 2.69)]. All HIV-related behaviors, except for injection drug use, were individually associated with PrEP use. More research is needed to better understand barriers to PrEP use among patients who are low income and/or uninsured as this may help improve current public health efforts to increase PrEP uptake among disproportionately impacted populations.
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Affiliation(s)
- Dinesh Rathakrishnan
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Lawrence J Purpura
- New York City Department of Health and Mental Hygiene, Queens, NY, USA.
- Division of Infectious Diseases, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th Street, New York, NY, 10032, USA.
- ICAP, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Paul M Salcuni
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Julie E Myers
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
- Division of Infectious Diseases, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th Street, New York, NY, 10032, USA
| | - Amanda Wahnich
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | | | - Zoe R Edelstein
- New York City Department of Health and Mental Hygiene, Queens, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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3
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Purpura LJ, Chang M, Annavajhala MK, Mohri H, Liu L, Shah J, Cantos A, Medrano N, Laracy J, Scully B, Miko BA, Habal M, Pereira MR, suji MT, Ho DD, Uhlemann AC, Yin MT. Prolonged severe acute respiratory syndrome coronavirus 2 persistence, attenuated immunologic response, and viral evolution in a solid organ transplant patient. Am J Transplant 2022; 22:649-653. [PMID: 34510730 PMCID: PMC8813887 DOI: 10.1111/ajt.16837] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/15/2021] [Accepted: 08/29/2021] [Indexed: 02/03/2023]
Abstract
Unlike immunocompetent hosts, the duration of viral persistence after infection with severe acute respiratory syndrome coronavirus 2 can be prolonged in immunosuppressed patients. Here, we present a case of viral persistence for over 19 weeks in a patient with a history of solid organ transplant and explore the clinical, virologic, and immunologic course. Our patient still demonstrated viral persistence at 138 days with low polymerase chain reaction cycle threshold values and evidence of continuing viral sequence evolution indicative of ongoing virus replication. These findings have important implications for infection prevention and control recommendations in immunosuppressed patients. Immune response, including neutralizing antibody titers, T cell activity, and cytokine levels, peaked around days 44-72 after diagnosis. Anti-S trimer antibodies were low at all time points, and T cell response was attenuated by day 119. As immune response waned and viral load increased, increased genetic diversity emerged, suggesting a mechanism for the development of viral variants.
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Affiliation(s)
- Lawrence J. Purpura
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA,ICAP, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Michelle Chang
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Medini K. Annavajhala
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Hiroshi Mohri
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Lihong Liu
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Jayesh Shah
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Anyelina Cantos
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Nicola Medrano
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Justin Laracy
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Brian Scully
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Benjamin A. Miko
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Marlena Habal
- Advanced Heart Failure and Transplant Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Marcus R. Pereira
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Moriya T suji
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - David D. Ho
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Anne-Catrin Uhlemann
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Michael T Yin
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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4
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Purpura LJ, Alukal J, Chong AM, Liu L, Cantos A, Shah J, Medrano N, Chang JY, Tsuji M, Mohri H, Uhlemann AC, Ho D, Yin MT. SARS-CoV-2 RNA Shedding in Semen and Oligozoospermia of Patient with Severe Coronavirus Disease 11 Weeks after Infection. Emerg Infect Dis 2022; 28:196-200. [PMID: 34647864 PMCID: PMC8714206 DOI: 10.3201/eid2801.211521] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report severe acute respiratory syndrome coronavirus 2 in semen by using quantitative reverse transcription PCR during the late convalescent phase. Virus was associated with adequate humoral and cell-mediated responses, suggesting possible seeding of the immune-privileged testes. We provide longitudinal semen quality data for 6 other men, including 3 who had oligozoospermia.
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5
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Kyzar EJ, Purpura LJ, Shah J, Cantos A, Nordvig AS, Yin MT. Anxiety, depression, insomnia, and trauma-related symptoms following COVID-19 infection at long-term follow-up. Brain Behav Immun Health 2021; 16:100315. [PMID: 34345869 PMCID: PMC8321961 DOI: 10.1016/j.bbih.2021.100315] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/03/2021] [Accepted: 07/28/2021] [Indexed: 12/25/2022] Open
Abstract
A developing finding from the novel coronavirus 2019 (COVID-19) pandemic is the burden of neuropsychiatric symptoms seen in COVID-19 survivors. While studies have shown clinically significant rates of depression, anxiety, insomnia, and trauma-related symptoms such as post-traumatic stress disorder (PTSD) after COVID-19, little is known about how these symptoms evolve over time. Here, we report findings from a cohort study of 52 participants recruited from the greater New York City area following acute COVID-19 infection. Participants completed the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms, the Generalized Anxiety Disorder-7 (GAD-7) for anxiety-related symptoms, the Insomnia Severity Scale (ISS) for sleep-related symptoms, and the PTSD Checklist-Civilian version (PCL-C) for trauma-related symptoms both at baseline and at long-term (24-60 weeks post-infection) follow-up. We found a high degree of correlation between psychiatric symptom scales within participants. More participants met established cutoffs for clinically significant insomnia and post-traumatic stress at follow-up compared to baseline. Symptom scales for depression, insomnia, and PTSD were increased at long-term follow-up, with only increased PCL-C scores surviving correction for multiple comparisons (Z = 2.92, W = 434, p = 0.004). Our results present evidence from a small cohort that neuropsychiatric symptoms, particularly those related to PTSD, may worsen over time in COVID-19 survivors. Future studies should continue to investigate these questions in broader populations, while additionally exploring the potential biological and sociological mechanisms that may contribute to neuropsychiatric pathology after COVID-19 infection.
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Affiliation(s)
- Evan J. Kyzar
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
| | - Lawrence J. Purpura
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jayesh Shah
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Anyelina Cantos
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Anna S. Nordvig
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Michael T. Yin
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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6
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Zucker J, Gomez-Simmonds A, Purpura LJ, Shoucri S, LaSota E, Morley NE, Sovic BW, Castellon MA, Theodore DA, Bartram LL, Miko BA, Scherer ML, Meyers KA, Turner WC, Kelly M, Pavlicova M, Basaraba CN, Baldwin MR, Brodie D, Burkart KM, Bathon J, Uhlemann AC, Yin MT, Castor D, Sobieszczyk ME. Supervised Machine Learning Approach to Identify Early Predictors of Poor Outcome in Patients with COVID-19 Presenting to a Large Quaternary Care Hospital in New York City. J Clin Med 2021; 10:jcm10163523. [PMID: 34441819 PMCID: PMC8397083 DOI: 10.3390/jcm10163523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/04/2021] [Accepted: 08/08/2021] [Indexed: 12/28/2022] Open
Abstract
Background: The progression of clinical manifestations in patients with coronavirus disease 2019 (COVID-19) highlights the need to account for symptom duration at the time of hospital presentation in decision-making algorithms. Methods: We performed a nested case–control analysis of 4103 adult patients with COVID-19 and at least 28 days of follow-up who presented to a New York City medical center. Multivariable logistic regression and classification and regression tree (CART) analysis were used to identify predictors of poor outcome. Results: Patients presenting to the hospital earlier in their disease course were older, had more comorbidities, and a greater proportion decompensated (<4 days, 41%; 4–8 days, 31%; >8 days, 26%). The first recorded oxygen delivery method was the most important predictor of decompensation overall in CART analysis. In patients with symptoms for <4, 4–8, and >8 days, requiring at least non-rebreather, age ≥ 63 years, and neutrophil/lymphocyte ratio ≥ 5.1; requiring at least non-rebreather, IL-6 ≥ 24.7 pg/mL, and D-dimer ≥ 2.4 µg/mL; and IL-6 ≥ 64.3 pg/mL, requiring non-rebreather, and CRP ≥ 152.5 mg/mL in predictive models were independently associated with poor outcome, respectively. Conclusion: Symptom duration in tandem with initial clinical and laboratory markers can be used to identify patients with COVID-19 at increased risk for poor outcomes.
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Affiliation(s)
- Jason Zucker
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
- Correspondence: ; Tel.: +1-201-723-6637
| | - Angela Gomez-Simmonds
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Lawrence J. Purpura
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Sherif Shoucri
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Elijah LaSota
- Tulane University School of Medicine, Tulane Medical Center, New Orleans, LA 70112, USA;
| | - Nicholas E. Morley
- Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA;
| | - Brit W. Sovic
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Marvin A. Castellon
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Deborah A. Theodore
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Logan L. Bartram
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Benjamin A. Miko
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Matthew L. Scherer
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Kathrine A. Meyers
- Aaron Diamond AIDS Research Center, Vagelos College of Physicians and Surgeons, New York, NY 10032, USA;
| | - William C. Turner
- General Internal Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA; (W.C.T.); (M.K.)
| | - Maureen Kelly
- General Internal Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA; (W.C.T.); (M.K.)
| | - Martina Pavlicova
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.P.); (C.N.B.)
| | - Cale N. Basaraba
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.P.); (C.N.B.)
| | - Matthew R. Baldwin
- Division of Pulmonology, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.R.B.); (D.B.); (K.M.B.)
| | - Daniel Brodie
- Division of Pulmonology, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.R.B.); (D.B.); (K.M.B.)
| | - Kristin M. Burkart
- Division of Pulmonology, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.R.B.); (D.B.); (K.M.B.)
| | - Joan Bathon
- Division of Rheumatology, Columbia University Irving Medical Center, New York, NY 10032, USA;
| | - Anne-Catrin Uhlemann
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Michael T. Yin
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Delivette Castor
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Magdalena E. Sobieszczyk
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
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7
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Mehta M, Purpura LJ, McConville TH, Neidell MJ, Anderson MR, Bernstein EJ, Dietz DE, Laracy J, Gunaratne SH, Miller EH, Cheng J, Zucker J, Shah SS, Chaudhuri S, Gordillo CA, Patel SR, Guo TW, Karaaslan LE, Reshef R, Miko BA, Bathon JM, Pereira MR, Uhlemann AC, Yin MT, Sobieszczyk ME. What about tocilizumab? A retrospective study from a NYC Hospital during the COVID-19 outbreak. PLoS One 2021; 16:e0249349. [PMID: 33831046 PMCID: PMC8031323 DOI: 10.1371/journal.pone.0249349] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/16/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Tocilizumab, an interleukin-6 receptor blocker, has been used in the inflammatory phase of COVID-19, but its impact independent of corticosteroids remains unclear in patients with severe disease. METHODS In this retrospective analysis of patients with COVID-19 admitted between March 2 and April 14, 2020 to a large academic medical center in New York City, we describe outcomes associated with tocilizumab 400 mg (without methylprednisolone) compared to a propensity-matched control. The primary endpoints were change in a 7-point ordinal scale of oxygenation and ventilator free survival, both at days 14 and 28. Secondary endpoints include incidence of bacterial superinfections and gastrointestinal perforation. Primary outcomes were evaluated using t-test. RESULTS We identified 33 patients who received tocilizumab and matched 74 controls based on demographics and health measures upon admission. After adjusting for illness severity and baseline ordinal scale, we failed to find evidence of an improvement in hypoxemia based on an ordinal scale at hospital day 14 in the tocilizumab group (OR 2.2; 95% CI, 0.7-6.5; p = 0.157) or day 28 (OR 1.1; 95% CI, 0.4-3.6; p = 0.82). There also was no evidence of an improvement in ventilator-free survival at day 14 (OR 0.8; 95% CI, 0.18-3.5; p = 0.75) or day 28 (OR 1.1; 95% CI, 0.1-1.8; p = 0.23). There was no increase in secondary bacterial infection rates in the tocilizumab group compared to controls (OR 0.37; 95% CI, 0.09-1.53; p = 0.168). CONCLUSIONS There was no evidence to support an improvement in hypoxemia or ventilator-free survival with use of tocilizumab 400 mg in the absence of corticosteroids. No increase in secondary bacterial infections was observed in the group receiving tocilizumab.
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Affiliation(s)
- Monica Mehta
- Department of Pharmacy, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, United States of America
- * E-mail:
| | - Lawrence J. Purpura
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Thomas H. McConville
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Matthew J. Neidell
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Michaela R. Anderson
- Division of Pulmonary Critical Care, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Elana J. Bernstein
- Division of Rheumatology, Department of Medicine, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Donald E. Dietz
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Justin Laracy
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Shauna H. Gunaratne
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Emily Happy Miller
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Jennifer Cheng
- Department of Pharmacy, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Jason Zucker
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Shivang S. Shah
- Division of Infectious Diseases, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Shaoli Chaudhuri
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Christian A. Gordillo
- Blood and Marrow Transplantation Program, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Shreena R. Patel
- Division of Pulmonary Critical Care, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Tai Wei Guo
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Lara E. Karaaslan
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Ran Reshef
- Blood and Marrow Transplantation Program, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Benjamin A. Miko
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Joan M. Bathon
- Division of Rheumatology, Department of Medicine, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Marcus R. Pereira
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Anne-Catrin Uhlemann
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Michael T. Yin
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Magdalena E. Sobieszczyk
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
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8
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Wang P, Liu L, Nair MS, Yin MT, Luo Y, Wang Q, Yuan T, Mori K, Solis AG, Yamashita M, Garg A, Purpura LJ, Laracy JC, Yu J, Joshua-Tor L, Sodroski J, Huang Y, Ho DD. SARS-CoV-2 neutralizing antibody responses are more robust in patients with severe disease. Emerg Microbes Infect 2020; 9:2091-2093. [PMID: 32930052 PMCID: PMC7534308 DOI: 10.1080/22221751.2020.1823890] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We studied plasma antibody responses of 35 patients about 1 month after SARS-CoV-2 infection. Titers of antibodies binding to the viral nucleocapsid and spike proteins were significantly higher in patients with severe disease. Likewise, mean antibody neutralization titers against SARS-CoV-2 pseudovirus and live virus were higher in the sicker patients, by ∼5-fold and ∼7-fold, respectively. These findings have important implications for those pursuing plasma therapy, isolation of neutralizing monoclonal antibodies, and determinants of immunity.
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Affiliation(s)
- Pengfei Wang
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Lihong Liu
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Manoj S Nair
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Michael T Yin
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Yang Luo
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Qian Wang
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Department of Microbiology, Harvard Medical School, Boston, MA, USA
| | - Ting Yuan
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Kanako Mori
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Axel Guzman Solis
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Masahiro Yamashita
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Ankur Garg
- W. M. Keck Structural Biology Laboratory, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - Lawrence J Purpura
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Justin C Laracy
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Jian Yu
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Leemor Joshua-Tor
- W. M. Keck Structural Biology Laboratory, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - Joseph Sodroski
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Department of Microbiology, Harvard Medical School, Boston, MA, USA
| | - Yaoxing Huang
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - David D Ho
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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9
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Kofman A, Linderman S, Su K, Purpura LJ, Ervin E, Brown S, Morales-Betoulle M, Graziano J, Cannon DL, Klena JD, Desamu-Thorpe R, Fankhauser J, Orone R, Soka M, Glaybo U, Massaquoi M, Nysenswah T, Nichol ST, Kollie J, Kiawu A, Freeman E, Giah G, Tony H, Faikai M, Jawara M, Kamara K, Kamara S, Flowers B, Mohammed K, Chiriboga D, Williams DE, Hinrichs SH, Ahmed R, Vonhm B, Rollin PE, Choi MJ. Characteristics of Ebola Virus Disease Survivor Blood and Semen in Liberia: Serology and RT-PCR. Clin Infect Dis 2020; 73:e3641-e3646. [PMID: 32894277 DOI: 10.1093/cid/ciaa1331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Ebola virus (EBOV), species Zaire ebolavirus, may persist in the semen of male survivors of Ebola Virus Disease (EVD). We conducted a study of male survivors of the 2014-2016 EVD outbreak in Liberia and evaluated their immune responses to EBOV. We report here findings from the serologic testing of blood for EBOV-specific antibodies, molecular testing for EBOV in blood and semen, and serologic testing of peripheral blood mononuclear cells (PBMCs) in a subset of study participants. METHODS We tested for EBOV RNA in blood by qRT-PCR, and for anti-EBOV-specific IgM and IgG antibodies by enzyme-linked immunosorbent assay (ELISA) for 126 study participants. We performed peripheral blood mononuclear cell (PBMC) analysis on a subgroup of 26 IgG-negative participants. RESULTS All 126 participants tested negative for EBOV RNA in blood by qRT-PCR. The blood of 26 participants tested negative for EBOV-specific IgG antibodies by ELISA. PBMCs were collected from 23/26 EBOV IgG-negative participants. Of these, 1/23 participants had PBMCs which produced anti-EBOV-specific IgG antibodies upon stimulation with EBOV-specific GP and NP antigens. DISCUSSION The blood of EVD survivors, collected when they did not have symptoms meeting the case definition for acute or relapsed EVD, is unlikely to pose a risk for EBOV transmission. We identified one IgM/IgG negative participant who had PBMCs which produced anti-EBOV-specific antibodies upon stimulation. Immunogenicity following acute EBOV infection may exist along a spectrum and absence of antibody response should not be exclusionary in determining an individual's status as a survivor of EVD.
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Affiliation(s)
- Aaron Kofman
- Epidemic Intelligence Service, CDC.,Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | | | - Kaihong Su
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Lawrence J Purpura
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | - Elizabeth Ervin
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | - Shelley Brown
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | - Maria Morales-Betoulle
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | | | - Deborah L Cannon
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | - John D Klena
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | - Rodel Desamu-Thorpe
- Office of, Public Health Preparedness and Response, Center for Preparedness and Response, CDC
| | - John Fankhauser
- ELWA Hospital, Samaritan's Purse.,Ventura County Medical Center, Ventura, CA', CA
| | | | - Moses Soka
- Ministry of Health Liberia, Men's, Health Screening Program, Liberia
| | | | - Moses Massaquoi
- Ministry of Health Liberia, Men's, Health Screening Program, Liberia
| | | | - Stuart T Nichol
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | - Jomah Kollie
- Ministry of Health Liberia, Men's, Health Screening Program, Liberia
| | - Armah Kiawu
- University of Massachusetts Medical School, Worcester, MA
| | - Edna Freeman
- University of Massachusetts Medical School, Worcester, MA
| | - Giovanni Giah
- University of Massachusetts Medical School, Worcester, MA
| | - Henry Tony
- University of Massachusetts Medical School, Worcester, MA
| | - Mylene Faikai
- University of Massachusetts Medical School, Worcester, MA
| | - Mary Jawara
- University of Massachusetts Medical School, Worcester, MA
| | - Kuku Kamara
- University of Massachusetts Medical School, Worcester, MA
| | - Samuel Kamara
- Ministry of Health Liberia, Men's, Health Screening Program, Liberia
| | - Benjamin Flowers
- Ministry of Health Liberia, Men's, Health Screening Program, Liberia
| | - Kromah Mohammed
- Ministry of Health Liberia, Men's, Health Screening Program, Liberia
| | | | | | - Steven H Hinrichs
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE
| | - Rafi Ahmed
- Emory Vaccine Center, Emory University, Atlanta, GA
| | | | - Pierre E Rollin
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
| | - Mary J Choi
- Division of High-Consequence Pathogens and Pathology, National Center, for Emerging and Zoonotic Infectious Diseases, CDC
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10
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Purpura LJ, Rogers E, Baller A, White S, Soka M, Choi MJ, Mahmoud N, Wasunna C, Massaquoi M, Kollie J, Dweh S, Bemah P, Ladele V, Kpaka J, Jawara M, Mugisha M, Subah O, Faikai M, Bailey JA, Rollin P, Marston B, Nyenswah T, Gasasira A, Knust B, Nichol S, Williams D. Ebola Virus RNA in Semen from an HIV-Positive Survivor of Ebola. Emerg Infect Dis 2017; 23:714-715. [PMID: 28287374 PMCID: PMC5367423 DOI: 10.3201/eid2304.161743] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Ebola virus is known to persist in semen of male survivors of Ebola virus disease (EVD). However, maximum duration of, or risk factors for, virus persistence are unknown. We report an EVD survivor with preexisting HIV infection, whose semen was positive for Ebola virus RNA 565 days after recovery from EVD.
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11
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Soka MJ, Choi MJ, Purpura LJ, Ströher U, Knust B, Rollin P. Screening of genital fluid for Ebola virus – Authors' reply. The Lancet Global Health 2017; 5:e33. [DOI: 10.1016/s2214-109x(16)30290-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022] Open
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12
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Purpura LJ, Soka M, Baller A, White S, Rogers E, Choi MJ, Mahmoud N, Wasunna C, Massaquoi M, Vanderende K, Kollie J, Dweh S, Bemah P, Christie A, Ladele V, Subah O, Pillai S, Mugisha M, Kpaka J, Nichol S, Ströher U, Abad N, Mettee-Zarecki S, Bailey JA, Rollin P, Marston B, Nyenswah T, Gasasira A, Knust B, Williams D. Implementation of a National Semen Testing and Counseling Program for Male Ebola Survivors — Liberia, 2015–2016. MMWR Morb Mortal Wkly Rep 2016; 65:963-6. [DOI: 10.15585/mmwr.mm6536a5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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13
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Soka MJ, Choi MJ, Baller A, White S, Rogers E, Purpura LJ, Mahmoud N, Wasunna C, Massaquoi M, Abad N, Kollie J, Dweh S, Bemah PK, Christie A, Ladele V, Subah OC, Pillai S, Mugisha M, Kpaka J, Kowalewski S, German E, Stenger M, Nichol S, Ströher U, Vanderende KE, Zarecki SM, Green HHW, Bailey JA, Rollin P, Marston B, Nyenswah TG, Gasasira A, Knust B, Williams D. Prevention of sexual transmission of Ebola in Liberia through a national semen testing and counselling programme for survivors: an analysis of Ebola virus RNA results and behavioural data. Lancet Glob Health 2016; 4:e736-43. [PMID: 27596037 DOI: 10.1016/s2214-109x(16)30175-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 06/29/2016] [Accepted: 07/15/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Ebola virus has been detected in semen of Ebola virus disease survivors after recovery. Liberia's Men's Health Screening Program (MHSP) offers Ebola virus disease survivors semen testing for Ebola virus. We present preliminary results and behavioural outcomes from the first national semen testing programme for Ebola virus. METHODS The MHSP operates out of three locations in Liberia: Redemption Hospital in Montserrado County, Phebe Hospital in Bong County, and Tellewoyan Hospital in Lofa County. Men aged 15 years and older who had an Ebola treatment unit discharge certificate are eligible for inclusion. Participants' semen samples were tested for Ebola virus RNA by real-time RT-PCR and participants received counselling on safe sexual practices. Participants graduated after receiving two consecutive negative semen tests. Counsellors collected information on sociodemographics and sexual behaviours using questionnaires administered at enrolment, follow up, and graduation visits. Because the programme is ongoing, data analysis was restricted to data obtained from July 7, 2015, to May 6, 2016. FINDINGS As of May 6, 2016, 466 Ebola virus disease survivors had enrolled in the programme; real-time RT-PCR results were available from 429 participants. 38 participants (9%) produced at least one semen specimen that tested positive for Ebola virus RNA. Of these, 24 (63%) provided semen specimens that tested positive 12 months or longer after Ebola virus disease recovery. The longest interval between discharge from an Ebola treatment unit and collection of a positive semen sample was 565 days. Among participants who enrolled and provided specimens more than 90 days since their Ebola treatment unit discharge, men older than 40 years were more likely to have a semen sample test positive than were men aged 40 years or younger (p=0·0004). 84 (74%) of 113 participants who reported not using a condom at enrolment reported using condoms at their first follow-up visit (p<0·0001). 176 (46%) of 385 participants who reported being sexually active at enrolment reported abstinence at their follow-up visit (p<0·0001). INTERPRETATION Duration of detection of Ebola virus RNA by real-time RT-PCR varies by individual and might be associated with age. By combining behavioural counselling and laboratory testing, the Men's Health Screening Program helps male Ebola virus disease survivors understand their individual risk and take appropriate measures to protect their sexual partners. FUNDING World Health Organization and the US Centers for Disease Control and Prevention.
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Affiliation(s)
| | - Mary J Choi
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | | | | | | | | | | | | | - Neetu Abad
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | | | | | - Satish Pillai
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Emilio German
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark Stenger
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stuart Nichol
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ute Ströher
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Jeffrey A Bailey
- Academic Consortium Combating Ebola in Liberia, University of Massachusetts Medical School, MA, USA
| | - Pierre Rollin
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Barbara Marston
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Barbara Knust
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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