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Galindo-Fraga A, Guerra de Blas PDC, Ortega-Villa AM, Mateja A, Ruiz Quiñones JA, Cervantes PR, Barrientos FL, Ortiz-Hernández AA, Llamosas-Gallardo B, Ramírez-Venegas A, Vázquez RV, Chepitel DN, Moreno-Espinosa S, Powers JH, Lourdes Guerrero M, Ruiz-Palacios GM, Beigel J. DIFFERENT CLINICAL PRESENTATIONS OF HUMAN RHINOVIRUS (HRV) SPECIES INFECTION IN CHILDREN AND ADULTS IN MEXICO. Open Forum Infect Dis 2022; 9:ofac303. [PMID: 35891697 PMCID: PMC9308452 DOI: 10.1093/ofid/ofac303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/15/2022] [Indexed: 11/26/2022] Open
Abstract
Background Human rhinoviruses (HRVs) are a common cause of influenza-like illness, with the ability to infect the upper and lower respiratory tracts. In this study we aim to describe the clinical and molecular features of HRV infection in Mexican children and adults. Methods We performed a hospital-based, 4-year multicenter prospective observational cohort study of patients with influenza-like illness. Participants who tested positive for HRV were included. We described demographic, clinical, and laboratory characteristics and the association between HRV types, illness severity, and clinical outcomes. Results Of the 5662 subjects recruited, 1473 (26%) had HRV; of those, 988 (67.1%) were adults (≥18 years) and 485 (32.9%) were children. One hundred sixty-seven (11.33%) samples were sequenced; 101 (60.5%) were rhinovirus species A (HRV-A), 22 (13.2%) were rhinovirus species B (HRV-B), and 44 (26.3%) were rhinovirus species C (HRV-C). Among children and adults, 30.5% and 23.5%, respectively, were hospitalized (non–intensive care unit [ICU]). The odds of HRV-C are higher than HRV-A for participants in the ICU (compared to outpatient) and when platelets, lymphocytes, white blood cells, and lactate dehydrogenase are increased. The odds of HRV-C are higher than HRV-A and HRV-B with shortness of breath. The odds of HRV-A are higher than HRV-B, and the odds of HRV-B are higher than HRV-C, when mild symptoms like muscle ache and headache occur. Conclusions Rhinoviruses are a common cause of influenza-like illness. It is necessary to improve the surveillance, testing, and species identification for these viruses to understand different clinical presentations and risk factors associated with worse outcomes. Clinical Trials Registration. NCT01418287.
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Affiliation(s)
- Arturo Galindo-Fraga
- Departamento de Epidemiología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , Mexico City , Mexico
| | | | - Ana M Ortega-Villa
- National Institute of Allergy and Infectious Diseases , Bethesda, MD , USA
| | - Allyson Mateja
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research , Frederick, Maryland , United States of America
| | - Jesus Arturo Ruiz Quiñones
- Departamento de Epidemiología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , Mexico City , Mexico
| | - Pilar Ramos Cervantes
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , Mexico City , Mexico
| | - Fernando Ledesma Barrientos
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , Mexico City , Mexico
| | - Ana A Ortiz-Hernández
- División de Desarrollo y Enlace Interinstitucional, Instituto Nacional de Pediatría Mexico City , Mexico
| | - Beatriz Llamosas-Gallardo
- División de Desarrollo y Enlace Interinstitucional, Instituto Nacional de Pediatría Mexico City , Mexico
| | - Alejandra Ramírez-Venegas
- Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas” , Mexico City , Mexico
| | - Rafael Valdéz Vázquez
- Departamento de Infectología, Hospital General “Dr. Manuel Gea González” , Mexico City , Mexico
| | - Daniel Noyola Chepitel
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luís Potosí , San Luis Potosí , Mexico
| | - Sarbelio Moreno-Espinosa
- Departamento de Infectología, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud , Mexico City , Mexico
| | - John H Powers
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick , Maryland , United States of America
| | - M Lourdes Guerrero
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , Mexico City , Mexico
| | - Guillermo M Ruiz-Palacios
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán , Mexico City , Mexico
| | - John Beigel
- National Institute of Allergy and Infectious Diseases , Bethesda, MD , USA
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Halperin SA, Ye L, MacKinnon-Cameron D, Smith B, Cahn PE, Ruiz-Palacios GM, Ikram A, Lanas F, Lourdes Guerrero M, Muñoz Navarro SR, Sued O, Lioznov DA, Dzutseva V, Parveen G, Zhu F, Leppan L, Langley JM, Barreto L, Gou J, Zhu T. Final efficacy analysis, interim safety analysis, and immunogenicity of a single dose of recombinant novel coronavirus vaccine (adenovirus type 5 vector) in adults 18 years and older: an international, multicentre, randomised, double-blinded, placebo-controlled phase 3 trial. Lancet 2022; 399:237-248. [PMID: 34953526 PMCID: PMC8700283 DOI: 10.1016/s0140-6736(21)02753-7] [Citation(s) in RCA: 117] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Ad5-nCoV vaccine is a single-dose adenovirus type 5 (Ad5) vectored vaccine expressing the SARS-CoV-2 spike protein that was well-tolerated and immunogenic in phase 1 and 2 studies. In this study, we report results on the final efficacy and interim safety analyses of the phase 3 trial. METHODS This double-blind, randomised, international, placebo-controlled, endpoint-case driven, phase 3, clinical trial enrolled adults aged 18 years older at study centres in Argentina, Chile, Mexico, Pakistan, and Russia. Participants were eligible for the study if they had no unstable or severe underlying medical or psychiatric conditions; had no history of a laboratory-confirmed SARS-CoV-2 infection; were not pregnant or breastfeeding; and had no previous receipt of an adenovirus-vectored, coronavirus, or SARS-CoV-2 vaccine. After informed consent was obtained, 25 mL of whole blood was withdrawn from all eligible participants who were randomised in a 1:1 ratio to receive a single intramuscular dose of 0·5 mL placebo or a 0·5 mL dose of 5 × 1010 viral particle (vp)/mL Ad5-nCoV vaccine; study staff and participants were blinded to treatment allocation. All participants were contacted weekly by email, telephone, or text message to self-report any symptoms of COVID-19 illness, and laboratory testing for SARS-CoV-2 was done for all participants with any symptoms. The primary efficacy objective evaluated Ad5-nCoV in preventing symptomatic, PCR-confirmed COVID-19 infection occurring at least 28 days after vaccination in all participants who were at least 28 days postvaccination on Jan 15, 2021. The primary safety objective evaluated the incidence of any serious adverse events or medically attended adverse events postvaccination in all participants who received a study injection. This trial is closed for enrolment and is registered with ClinicalTrials.gov (NCT04526990). FINDINGS Study enrolment began on Sept 22, 2020, in Pakistan, Nov 6, 2020, in Mexico, Dec 2, 2020, in Russia and Chile, and Dec 17, 2020, in Argentina; 150 endpoint cases were reached on Jan 15, 2021, triggering the final primary efficacy analysis. One dose of Ad5-nCoV showed a 57·5% (95% CI 39·7-70·0, p=0·0026) efficacy against symptomatic, PCR-confirmed, COVID-19 infection at 28 days or more postvaccination (21 250 participants; 45 days median duration of follow-up [IQR 36-58]). In the primary safety analysis undertaken at the time of the efficacy analysis (36 717 participants), there was no significant difference in the incidence of serious adverse events (14 [0·1%] of 18 363 Ad5-nCoV recipients and 10 [0·1%] of 18 354 placebo recipients, p=0·54) or medically attended adverse events (442 [2·4%] of 18 363 Ad5-nCoV recipients and 411 [2·2%] of 18 354 placebo recipients, p=0·30) between the Ad5-nCoV or placebo groups, or any serious adverse events considered related to the study product (none in both Ad5-nCoV and placebo recipients). In the extended safety cohort, 1004 (63·5%) of 1582 of Ad5-nCoV recipients and 729 (46·4%) of 1572 placebo recipients reported a solicited systemic adverse event (p<0·0001), of which headache was the most common (699 [44%] of Ad5-nCoV recipients and 481 [30·6%] of placebo recipients; p<0·0001). 971 (61·3%) of 1584 Ad5-nCoV recipients and 314 (20·0%) of 1573 placebo recipients reported an injection-site adverse event (p<0·0001), of which pain at the injection site was the most frequent; reported by 939 (59%) Ad5-nCoV recipients and 303 (19%) placebo recipients. INTERPRETATION One dose of Ad5-nCoV is efficacious and safe in healthy adults aged 18 years and older. FUNDING CanSino Biologics and the Beijing Institute of Biotechnology.
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Affiliation(s)
- Scott A Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health, Nova Scotia Health, Halifax, Canada.
| | - Lingyun Ye
- Canadian Center for Vaccinology, Dalhousie University, IWK Health, Nova Scotia Health, Halifax, Canada
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology, Dalhousie University, IWK Health, Nova Scotia Health, Halifax, Canada
| | - Bruce Smith
- Canadian Center for Vaccinology, Dalhousie University, IWK Health, Nova Scotia Health, Halifax, Canada
| | | | | | - Aamer Ikram
- National Institute of Health, Islamabad, Pakistan
| | | | - M Lourdes Guerrero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Omar Sued
- Fundación Huésped, Buenos Aires, Argentina
| | - Dmitry A Lioznov
- Federal State Budgetary Institution, Smorodintsev Research Institute of Influenza, St Petersburg, Russia
| | | | | | - Fengcai Zhu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Laura Leppan
- Canadian Center for Vaccinology, Dalhousie University, IWK Health, Nova Scotia Health, Halifax, Canada
| | - Joanne M Langley
- Canadian Center for Vaccinology, Dalhousie University, IWK Health, Nova Scotia Health, Halifax, Canada
| | | | | | - Tao Zhu
- CanSino Biologics, Tianjin, China
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Gamiño-Arroyo AE, Guerrero ML, McCarthy S, Ramírez-Venegas A, Llamosas-Gallardo B, Galindo-Fraga A, Moreno-Espinosa S, Roldán-Aragón Y, Araujo-Meléndez J, Hunsberger S, Ibarra-González V, Martínez-López J, García-Andrade LA, Kapushoc H, Holley HP, Smolskis MC, Ruiz-Palacios GM, Beigel JH. Efficacy and Safety of Nitazoxanide in Addition to Standard of Care for the Treatment of Severe Acute Respiratory Illness. Clin Infect Dis 2019; 69:1903-1911. [PMID: 30753384 PMCID: PMC6853643 DOI: 10.1093/cid/ciz100] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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: 10/29/2018] [Accepted: 01/30/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Effective therapeutics for respiratory viruses are needed. Early data suggest that nitazoxanide (NTZ) may be beneficial for treating acute respiratory viral illness. METHODS From March 2014 through March 2017, a double-blind, placebo-controlled trial was conducted in 260 participants ≥1 year old hospitalized with influenza-like illness at 6 hospitals in Mexico. Participants were randomized 1:1 to NTZ (age ≥12 years, 600 mg twice daily; age 4-11 years and 1-3 years, 200 or 100 mg twice daily, respectively) or placebo for 5 days in addition to standard of care. The primary endpoint was time from first dose to hospital discharge. Influenza reverse-transcription polymerase chain reaction and Respifinder 22 multiplex test were used for virus detection. RESULTS Of 260 participants enrolled, 257 were randomized and took at least 1 dose of study treatment (intention-to-treat population): 130 in the NTZ group and 127 in the placebo group. The Kaplan-Meier estimate of the median duration of hospitalization was 6.5 (interquartile range [IQR], 4.0-9.0) days in the NTZ group vs 7.0 (IQR, 4.0-9.0) days in the placebo group (P = .56). Duration of hospitalization between the 2 treatments was similar in children (P = .29) and adults (P = .62), influenza A and B (P = .32), and other respiratory viruses. Seven (5.4%) and 6 (4.7%) participants in the NTZ and placebo groups, respectively, reported serious adverse events. CONCLUSIONS Treatment with NTZ did not reduce the duration of hospital stay in severe influenza-like illness. Further analyses based on age and evaluations by virus did not reveal any subgroups that appeared to benefit from NTZ. CLINICAL TRIALS REGISTRATION NCT02057757.
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Affiliation(s)
| | - M Lourdes Guerrero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Sean McCarthy
- Social and Scientific Systems, Inc, Silver Spring, Maryland
| | | | | | - Arturo Galindo-Fraga
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | - Sally Hunsberger
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Julia Martínez-López
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Luis A García-Andrade
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - H Preston Holley
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Mary C Smolskis
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Guillermo M Ruiz-Palacios
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Comisión Coordinadora de los Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Secretaría de Salud, Mexico City
| | - John H Beigel
- Leidos Biomedical Research, Inc, Frederick National Laboratory for Cancer Research, Maryland
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Noyola DE, Hunsberger S, Valdés Salgado R, Powers JH, Galindo-Fraga A, Ortiz-Hernández AA, Ramirez-Venegas A, Moreno-Espinosa S, Llamosas-Gallardo B, Guerrero ML, Beigel JH, Ruiz-Palacios G, Perez-Patrigeon S. Comparison of Rates of Hospitalization Between Single and Dual Virus Detection in a Mexican Cohort of Children and Adults With Influenza-Like Illness. Open Forum Infect Dis 2019; 6:ofz424. [PMID: 31696140 PMCID: PMC6824528 DOI: 10.1093/ofid/ofz424] [Citation(s) in RCA: 5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/25/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Molecular detection methods allow for the simultaneous detection of several infectious agents. This study assesses whether co-infection with 2 viruses as compared with 1 is associated with increased hospitalization in those with acute respiratory infections. METHODS We prospectively enrolled a cohort of pediatric and adult participants with influenza-like illness during 2010-2014 in Mexico. Clinical information and respiratory samples were collected at enrollment. Respiratory viruses were detected with multiplex polymerase chain reaction (PCR) and influenza-specific reverse transcription PCR assays. Participants were followed for 14 and 28 days after inclusion. Severity of disease, as measured by hospitalization with acute respiratory infections, was compared between single and dual viral infections. RESULTS Among 5662 participants in the study, either 1 (n = 3285) or 2 (n = 641) viruses were detected in 3926 participants. Rhinovirus (n = 1433), influenza (n = 888), and coronaviruses (n = 703) were the most frequently detected viruses (either alone or in co-infection). Bocavirus, respiratory syncytial virus (RSV), metapneumovirus, and rhinovirus cases were hospitalized more often than other viruses. Bocavirus+rhinovirus cases were hospitalized more often than those with rhinovirus alone (but not bocavirus alone). RSV cases were more likely to be hospitalized than cases with co-infections of RSV and parainfluenza virus or coronavirus. Metapneumovirus cases were hospitalized more often than those co-infected with metapneumovirus+coronavirus. CONCLUSIONS In this study, detection of 2 viruses did not significantly increase hospitalizations compared with single virus infections. Larger studies will allow for distinguishing between sequential and simultaneous infection and for a better understanding of the role of each virus during the evolution of acute respiratory episodes.
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Affiliation(s)
- Daniel E Noyola
- Microbiology Department, Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Sally Hunsberger
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | - John H Powers
- Clinical Research Directorate, FrederickNational Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland, USA
| | - Arturo Galindo-Fraga
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico city, Mexico
| | | | | | | | | | - M Lourdes Guerrero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico city, Mexico
| | - John H Beigel
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Lewnard JA, Lopman BA, Parashar UD, Bennett A, Bar-Zeev N, Cunliffe NA, Samuel P, Guerrero ML, Ruiz-Palacios G, Kang G, Pitzer VE. Heterogeneous susceptibility to rotavirus infection and gastroenteritis in two birth cohort studies: Parameter estimation and epidemiological implications. PLoS Comput Biol 2019; 15:e1007014. [PMID: 31348775 PMCID: PMC6690553 DOI: 10.1371/journal.pcbi.1007014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 08/12/2019] [Accepted: 04/09/2019] [Indexed: 11/19/2022] Open
Abstract
Cohort studies, randomized trials, and post-licensure studies have reported reduced natural and vaccine-derived protection against rotavirus gastroenteritis (RVGE) in low- and middle-income countries. While susceptibility of children to rotavirus is known to vary within and between settings, implications for estimation of immune protection are not well understood. We sought to re-estimate naturally-acquired protection against rotavirus infection and RVGE, and to understand how differences in susceptibility among children impacted estimates. We re-analyzed data from studies conducted in Mexico City, Mexico and Vellore, India. Cumulatively, 573 rotavirus-unvaccinated children experienced 1418 rotavirus infections and 371 episodes of RVGE over 17,636 child-months. We developed a model that characterized susceptibility to rotavirus infection and RVGE among children, accounting for aspects of the natural history of rotavirus and differences in transmission rates between settings. We tested whether model-generated susceptibility measurements were associated with demographic and anthropometric factors, and with the severity of RVGE symptoms. We identified greater variation in susceptibility to rotavirus infection and RVGE in Vellore than in Mexico City. In both cohorts, susceptibility to rotavirus infection and RVGE were associated with male sex, lower birth weight, lower maternal education, and having fewer siblings; within Vellore, susceptibility was also associated with lower socioeconomic status. Children who were more susceptible to rotavirus also experienced higher rates of rotavirus-negative diarrhea, and higher risk of moderate-to-severe symptoms when experiencing RVGE. Simulations suggested that discrepant estimates of naturally-acquired immunity against RVGE can be attributed, in part, to between-setting differences in susceptibility of children, but result primarily from the interaction of transmission rates with age-dependent risk for infections to cause RVGE. We found that more children in Vellore than in Mexico City belong to a high-risk group for rotavirus infection and RVGE, and demonstrate that unmeasured individual- and age-dependent susceptibility may influence estimates of naturally-acquired immune protection against RVGE. Differences in susceptibility can help explain why some individuals, and not others, acquire infection and exhibit symptoms when exposed to infectious disease agents. However, it is difficult to distinguish between differences in susceptibility versus exposure in epidemiological studies. We developed a modeling approach to distinguish transmission intensity and susceptibility in data from cohort studies of rotavirus infection among children in Mexico City, Mexico, and Vellore, India, and evaluated how these factors may have contributed to differences in estimates of naturally-acquired immune protection between the studies. Given the same exposure, more children were at high risk of acquiring rotavirus infection, and of experiencing gastroenteritis when infected, in Vellore than in Mexico City. The probability of belonging to this high-risk stratum was associated with well-known individual factors such as lower socioeconomic status, lower birth weight, and incidence of diarrhea due to other causes. We also found the risk for rotavirus infections to cause symptoms declined with age, independent of acquired immunity. These findings can, in part, account for estimates of lower protective efficacy of acquired immunity against rotavirus gastroenteritis in high-incidence settings, mirroring estimates of reduced effectiveness of live oral rotavirus vaccines in low- and middle-income countries.
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Affiliation(s)
- Joseph A. Lewnard
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
- * E-mail:
| | - Benjamin A. Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Umesh D. Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Aisleen Bennett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
- Center for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, University of Liverpool, Liverpool, United Kingdom
| | - Naor Bar-Zeev
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
- Center for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, University of Liverpool, Liverpool, United Kingdom
- International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Nigel A. Cunliffe
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
- Center for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, University of Liverpool, Liverpool, United Kingdom
| | - Prasanna Samuel
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - M. Lourdes Guerrero
- Instituto Nacional de Ciences Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Gagandeep Kang
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Virginia E. Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
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Lumbard K, Arteaga Cabello FJ, Gouel-Cheron A, Belaunzarán F, Nájera-Cancino G, Caballero-Sosa S, Rincón-León H, Del Carmen Ruis Hernandez E, Cervantes PR, Lourdes Guerrero M, Beigel J, Trujillo-Murillo K, Pedraza G, Sepulveda J, Escobedo-Lopez KM, Mora-Suarez NK, Reyes-Romero M, Ibarra-González V, Marínez-Lopez J, Ruiz-Palacios G, Hunsberger S. 2081. Building a Decision Tree with Serial Serology Measurements Improves Classification in a Flavivirus Co-circulation Region. Open Forum Infect Dis 2018. [PMCID: PMC6254562 DOI: 10.1093/ofid/ofy210.1737] [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: 12/05/2022] Open
Abstract
Background RT-PCR (reverse transcriptase polymerase chain reaction) is often considered the “gold standard” for diagnosis of Zika Virus (ZIKV) infection; however, it has been shown to have low sensitivity. A possible remedy is to study ZIKV-specific IgG (ZsIgG) and IgM (ZsIgM) antibodies. However, the in vitro cross-reactivities of Dengue virus (DENV) and ZIKV-specific antibodies are well known, leading to diagnostic difficulties in an area with co-circulation of the two viruses. Our goal was to use Zika and Dengue serologic assays to build a classification model that improves upon the PPV of commercial kits while maintaining sensitivity. Methods We conducted a prospective longitudinal study in Southern Mexico where DENV and ZIKV co-circulation occurs (NCT02831699). Patients were included in two cohorts: a cohort of subjects presenting with a febrile rash meeting WHO/PAHO Zika case definition and a household cohort. After signed consent, all subjects enrolled were evaluated on study-visit Days 0, 3 and 7 (for fever rash cohort) and 28. We considered a subject “true positive” for ZIKV or DENV if RT-PCR positive at any time point. The healthy household cohort (with no positive RT-PCR) was considered “true negatives.” We fit a statistical decision tree taking as inputs serial serology measurements and outputting a predicted disease category. Funded in part by the NCI Contract No. HHSN261200800001E. Funded in part by the Mexican Ministry of Health. Results As of March 2018, we have 32 subjects in the Zika PCR+ group, 32 in the Dengue PCR+ group, and 68 in the household group. Our decision tree (Figure 1) achieved PPV of at least 90% on all three disease categories, while maintaining sensitivity above 50%. The highest PPV achieved by the kit manufacturer recommended cutoffs while maintaining a sensitivity of at least 10% on Zika PCR+ subjects is 30/114 (26%), and for Dengue PCR+ subjects is 21/30 (70%). Conclusion Using serology data in a statistical decision tree improves the PPV exhibited by the kit manufacturer recommendations while still maintaining respectable sensitivity. Physicians in regions with co-circulating flaviviruses should be aware of the pitfalls of using only RT-PCR or using pre-established commercial cutoffs in the serology kits for diagnosis. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Keith Lumbard
- Clinical Research Directorate/Clinical Monitoring Research Program, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland
| | - Fernando J Arteaga Cabello
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Francisco Belaunzarán
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Sandra Caballero-Sosa
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Tapachula, Mexico
| | | | | | - Pilar Ramos Cervantes
- Molecular Biology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, Mexico
| | - M Lourdes Guerrero
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - John Beigel
- Clinical Research Directorate/Clinical Monitoring Research Program, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland
- NIAID, Bethesda, Maryland
| | | | - Gustavo Pedraza
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jesús Sepulveda
- Hospital Regional de Alta Especialidad Ciudad Salud, Tapachula, Mexico
| | - Kenia Melina Escobedo-Lopez
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Nora K Mora-Suarez
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Monica Reyes-Romero
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Violeta Ibarra-González
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Julia Marínez-Lopez
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Guillermo Ruiz-Palacios
- Comisión Coordinadora de los Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Mexico City, Mexico
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Powers JH, Bacci ED, Leidy NK, Poon JL, Stringer S, Memoli MJ, Han A, Fairchok MP, Coles C, Owens J, Chen WJ, Arnold JC, Danaher PJ, Lalani T, Burgess TH, Millar EV, Ridore M, Hernández A, Rodríguez-Zulueta P, Ortega-Gallegos H, Galindo-Fraga A, Ruiz-Palacios GM, Pett S, Fischer W, Gillor D, Moreno Macias L, DuVal A, Rothman R, Dugas A, Guerrero ML. Performance of the inFLUenza Patient-Reported Outcome (FLU-PRO) diary in patients with influenza-like illness (ILI). PLoS One 2018; 13:e0194180. [PMID: 29566007 PMCID: PMC5863969 DOI: 10.1371/journal.pone.0194180] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 09/01/2017] [Accepted: 02/26/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The inFLUenza Patient Reported Outcome (FLU-PRO) measure is a daily diary assessing signs/symptoms of influenza across six body systems: Nose, Throat, Eyes, Chest/Respiratory, Gastrointestinal, Body/Systemic, developed and tested in adults with influenza. OBJECTIVES This study tested the reliability, validity, and responsiveness of FLU-PRO scores in adults with influenza-like illness (ILI). METHODS Data from the prospective, observational study used to develop and test the FLU-PRO in influenza virus positive patients were analyzed. Adults (≥18 years) presenting with influenza symptoms in outpatient settings in the US, UK, Mexico, and South America were enrolled, tested for influenza virus, and asked to complete the 37-item draft FLU-PRO daily for up to 14-days. Analyses were performed on data from patients testing negative. Reliability of the final, 32-item FLU-PRO was estimated using Cronbach's alpha (α; Day 1) and intraclass correlation coefficients (ICC; 2-day reproducibility). Convergent and known-groups validity were assessed using patient global assessments of influenza severity (PGA). Patient report of return to usual health was used to assess responsiveness (Day 1-7). RESULTS The analytical sample included 220 ILI patients (mean age = 39.3, 64.1% female, 88.6% white). Sixty-one (28%) were hospitalized at some point in their illness. Internal consistency reliability (α) of FLU-PRO Total score was 0.90 and ranged from 0.72-0.86 for domain scores. Reproducibility (Day 1-2) was 0.64 for Total, ranging from 0.46-0.78 for domain scores. Day 1 FLU-PRO scores correlated (≥0.30) with the PGA (except Gastrointestinal) and were significantly different across PGA severity groups (Total: F = 81.7, p<0.001; subscales: F = 6.9-62.2; p<0.01). Mean score improvements Day 1-7 were significantly greater in patients reporting return to usual health compared with those who did not (p<0.05, Total and subscales, except Gastrointestinal and Eyes). CONCLUSIONS Results suggest FLU-PRO scores are reliable, valid, and responsive in adults with influenza-like illness.
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Affiliation(s)
- John H. Powers
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, MD, United States of America
| | - Elizabeth D. Bacci
- Evidera Evidence, Value & Access by PPD, Seattle, WA, United States of America
| | - Nancy K. Leidy
- Evidera Evidence, Value & Access by PPD, Bethesda, MD, United States of America
| | - Jiat-Ling Poon
- Evidera Evidence, Value & Access by PPD, Bethesda, MD, United States of America
| | - Sonja Stringer
- Evidera Evidence, Value & Access by PPD, Bethesda, MD, United States of America
| | - Matthew J. Memoli
- National Institutes of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States of America
| | - Alison Han
- National Institutes of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States of America
| | - Mary P. Fairchok
- Madigan Army Medical Center, Fort Lewis, WA, United States of America
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States of America
| | - Christian Coles
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States of America
| | - Jackie Owens
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States of America
| | - Wei-Ju Chen
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States of America
| | - John C. Arnold
- Naval Medical Center, San Diego, CA, United States of America
| | - Patrick J. Danaher
- Defense Institute for Medical Operations, San Antonio, TX, United States of America
| | - Tahaniyat Lalani
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States of America
- Naval Medical Center, Portsmouth, VA, United States of America
| | - Timothy H. Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, United States of America
- Walter Reed National Military Medical Center, Bethesda, MD, United States of America
| | - Eugene V. Millar
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, United States of America
| | - Michelande Ridore
- Children’s National Medical Center, Washington, DC, United States of America
| | - Andrés Hernández
- Instituto Nacional de Enfermedades Infecciosas, Mexico City, Mexico
| | | | - Hilda Ortega-Gallegos
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Arturo Galindo-Fraga
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Sarah Pett
- UCL, London, United Kingdom
- INSIGHT Influenza Study Groups, Rochester, MN, United States of America
- Institute of Clinical Trials and Methodology, University College, London, United Kingdom
- Institute for Global Health, University College, London, United Kingdom
- Kirby Institute, University of New South Wales, Kensington, Australia
| | - William Fischer
- INSIGHT Influenza Study Groups, Rochester, MN, United States of America
- University of North Carolina, Chapel Hill, NC, United States of America
| | - Daniel Gillor
- INSIGHT Influenza Study Groups, Rochester, MN, United States of America
- University of Cologne, Cologne, Germany
| | - Laura Moreno Macias
- INSIGHT Influenza Study Groups, Rochester, MN, United States of America
- Hospital General de Agudos JM Ramos Mejia, Buenos Aires, Argentina
| | - Anna DuVal
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Richard Rothman
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Andrea Dugas
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - M. Lourdes Guerrero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Powers JH, Bacci ED, Guerrero ML, Leidy NK, Stringer S, Kim K, Memoli MJ, Han A, Fairchok MP, Chen WJ, Arnold JC, Danaher PJ, Lalani T, Ridoré M, Burgess TH, Millar EV, Hernández A, Rodríguez-Zulueta P, Smolskis MC, Ortega-Gallegos H, Pett S, Fischer W, Gillor D, Macias LM, DuVal A, Rothman R, Dugas A, Ruiz-Palacios GM. Reliability, Validity, and Responsiveness of InFLUenza Patient-Reported Outcome (FLU-PRO©) Scores in Influenza-Positive Patients. Value Health 2018; 21:210-218. [PMID: 29477403 PMCID: PMC5831548 DOI: 10.1016/j.jval.2017.04.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/20/2017] [Accepted: 04/12/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To assess the reliability, validity, and responsiveness of InFLUenza Patient-Reported Outcome (FLU-PRO©) scores for quantifying the presence and severity of influenza symptoms. METHODS An observational prospective cohort study of adults (≥18 years) with influenza-like illness in the United States, the United Kingdom, Mexico, and South America was conducted. Participants completed the 37-item draft FLU-PRO daily for up to 14 days. Item-level and factor analyses were used to remove items and determine factor structure. Reliability of the final tool was estimated using Cronbach α and intraclass correlation coefficients (2-day reliability). Convergent and known-groups validity and responsiveness were assessed using global assessments of influenza severity and return to usual health. RESULTS Of the 536 patients enrolled, 221 influenza-positive subjects comprised the analytical sample. The mean age of the patients was 40.7 years, 60.2% were women, and 59.7% were white. The final 32-item measure has six factors/domains (nose, throat, eyes, chest/respiratory, gastrointestinal, and body/systemic), with a higher order factor representing symptom severity overall (comparative fit index = 0.92; root mean square error of approximation = 0.06). Cronbach α was high (total = 0.92; domain range = 0.71-0.87); test-retest reliability (intraclass correlation coefficient, day 1-day 2) was 0.83 for total scores and 0.57 to 0.79 for domains. Day 1 FLU-PRO domain and total scores were moderately to highly correlated (≥0.30) with Patient Global Rating of Flu Severity (except nose and throat). Consistent with known-groups validity, scores differentiated severity groups on the basis of global rating (total: F = 57.2, P < 0.001; domains: F = 8.9-67.5, P < 0.001). Subjects reporting return to usual health showed significantly greater (P < 0.05) FLU-PRO score improvement by day 7 than did those who did not, suggesting score responsiveness. CONCLUSIONS Results suggest that FLU-PRO scores are reliable, valid, and responsive to change in influenza-positive adults.
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Affiliation(s)
- John H Powers
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., NCI Campus at Frederick, Frederick, MD, USA.
| | | | - M Lourdes Guerrero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | - Matthew J Memoli
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Alison Han
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Mary P Fairchok
- Madigan Army Medical Center, Fort Lewis, WA, USA; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Wei-Ju Chen
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | | | | | - Tahaniyat Lalani
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA; Naval Medical Center, Portsmouth, VA, USA
| | | | - Timothy H Burgess
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Eugene V Millar
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Andrés Hernández
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | | | | | - Hilda Ortega-Gallegos
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Sarah Pett
- University College London, London, UK; Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | - Anna DuVal
- Johns Hopkins University School of Medicine, Baltimore, MD, USA (for the INSIGHT Flu 002 Plus Writing Group, the México Emerging Infectious Diseases Clinical Research Network, and the Infectious Diseases Clinical Research Program)
| | - Richard Rothman
- Johns Hopkins University School of Medicine, Baltimore, MD, USA (for the INSIGHT Flu 002 Plus Writing Group, the México Emerging Infectious Diseases Clinical Research Network, and the Infectious Diseases Clinical Research Program)
| | - Andrea Dugas
- Johns Hopkins University School of Medicine, Baltimore, MD, USA (for the INSIGHT Flu 002 Plus Writing Group, the México Emerging Infectious Diseases Clinical Research Network, and the Infectious Diseases Clinical Research Program)
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Lewnard JA, Lopman BA, Parashar UD, Bar-Zeev N, Samuel P, Guerrero ML, Ruiz-Palacios GM, Kang G, Pitzer VE. Naturally Acquired Immunity Against Rotavirus Infection and Gastroenteritis in Children: Paired Reanalyses of Birth Cohort Studies. J Infect Dis 2017; 216:317-326. [PMID: 28859432 PMCID: PMC5853322 DOI: 10.1093/infdis/jix310] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/29/2017] [Indexed: 01/24/2023] Open
Abstract
Background Observational studies in socioeconomically distinct populations have yielded conflicting conclusions about the strength of naturally acquired immunity against rotavirus gastroenteritis (RVGE), mirroring vaccine underperformance in low-income countries. We revisited birth cohort studies to understand naturally acquired protection against rotavirus infection and RVGE. Methods We reanalyzed data from 200 Mexican and 373 Indian children followed from birth to 2 and 3 years of age, respectively. We reassessed protection against RVGE, decomposing the incidence rate into the rate of rotavirus infection and the risk of RVGE given infection, and tested for serum antibody correlates of protection using regression models. Results Risk for primary, secondary, and subsequent infections to cause RVGE decreased per log-month of age by 28% (95% confidence interval [CI], 12%-41%), 69% (95% CI, 30%-86%), and 64% (95% CI, -186% to 95%), respectively, in Mexico City, and by 10% (95% CI, -1% to 19%), 51% (95% CI, 41%-59%) and 67% (95% CI, 57%-75%), respectively, in Vellore. Elevated serum immunoglobulin A and immunoglobulin G titers were associated with partial protection against rotavirus infection. Associations between older age and reduced risk for RVGE or moderate-to-severe RVGE given infection persisted after controlling for antibody levels. Conclusions Dissimilar estimates of protection against RVGE may be due in part to age-related, antibody-independent risk for rotavirus infections to cause RVGE.
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Affiliation(s)
- Joseph A Lewnard
- Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Umesh D Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Naor Bar-Zeev
- Institute of Infection and Global Health, University of Liverpool, United Kingdom
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre
| | - Prasanna Samuel
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - M Lourdes Guerrero
- Instituto Nacional de Ciences Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Gagandeep Kang
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
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10
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Dingess KA, Valentine CJ, Ollberding NJ, Davidson BS, Woo JG, Summer S, Peng YM, Guerrero ML, Ruiz-Palacios GM, Ran-Ressler RR, McMahon RJ, Brenna JT, Morrow AL. Branched-chain fatty acid composition of human milk and the impact of maternal diet: the Global Exploration of Human Milk (GEHM) Study. Am J Clin Nutr 2017; 105:177-184. [PMID: 27903517 PMCID: PMC5183722 DOI: 10.3945/ajcn.116.132464] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 03/14/2016] [Accepted: 10/12/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND An understudied component of the diet, branched-chain fatty acids (BCFAs) are distinctive saturated fatty acids that may have an important influence on health. Human-milk fatty acid composition is known to differ worldwide, but comparative data are lacking on BCFAs. OBJECTIVE We tested the hypotheses that concentrations of BCFAs in human milk differ between populations and are associated with maternal diet. DESIGN We surveyed the BCFA composition of samples collected as part of a standardized, prospective study of human-milk composition. Mothers were enrolled from 3 urban populations with differing diets: Cincinnati, Ohio; Shanghai, China; and Mexico City, Mexico. Enrollment was limited to healthy mothers of term singleton infants. We undertook a cross-sectional analysis of milk from all women with samples at postpartum week 4 (n = 359; ∼120 women/site). Fatty acids were extracted from milk by using a modified Bligh-Dyer technique and analyzed by gas chromatography. Statistical analysis was performed by ANOVA and Tobit regression. For Cincinnati mothers, 24-h diet recalls were analyzed in relation to the individual BCFA concentrations measured in milk samples. RESULTS Total BCFAs in milk differed by site, with the highest concentration in Cincinnati followed by Mexico City and Shanghai (mean ± SE: 7.90 ± 0.41, 6.10 ± 0.36, and 4.27 ± 0.25 mg/100 mL, respectively; P < 0.001). Site differences persisted after delivery mode, maternal age, and body mass index were controlled for. The individual concentrations of iso-14:0, iso-16:0, iso-18:0, anteiso-15:0, and anteiso-17:0 also differed between sites. Milk concentrations of iso-14:0 and anteiso-15:0 were associated with maternal intake of dairy; iso-16:0 was associated with maternal intakes of dairy and beef. CONCLUSIONS BCFA concentrations in milk at 4 wk postpartum differed between mothers from Cincinnati, Shanghai, and Mexico City. Variations in human-milk BCFAs are influenced by diet. The impact of BCFAs on infant health warrants investigation.
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Affiliation(s)
- Kelly A Dingess
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Christina J Valentine
- The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; .,Mead Johnson Nutrition Inc., Evansville, IN; Divisions of
| | | | - Barbara S Davidson
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | - Suzanne Summer
- Clinical Translational Research Center, Cincinnati Children’s, Cincinnati, OH
| | | | - M Lourdes Guerrero
- National Institute of Medical Sciences and Nutrition, Mexico City, Mexico; and
| | | | | | | | | | - Ardythe L Morrow
- The Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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Ortiz-Brizuela E, Guerrero ML, Ponce-De-León-Garduño A, Ortega-Gallegos H, Ruiz-Palacios G. Etiology of Community-Acquired Pneumonia and Antibiotic Susceptibility in Hospitalized Patients 50 Years Old and above in a Tertiary Care Hospital in Mexico City: 2010–2016. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1521] [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] [Indexed: 11/13/2022] Open
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12
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Guerrero ML, Castro-Corrales MB, Gonzalez-Gamez M, Ortega-Gallegos H, Escobedo-Lopez KM, Mora-Suarez NK, Reyes-Romero M, Sieber-Acuña S, Luna-Lopez M, Gonzalez-Guerrero MC, Galindo-Fraga A, Ponce-De-Leon A, Ruiz-Palacios G. Risk Predictive Markers for Severe Community-Acquired Pneumonia in Hospitalized Elderly Patients. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1537] [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] [Indexed: 11/13/2022] Open
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13
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Gamiño-Arroyo AE, Moreno-Espinosa S, Llamosas-Gallardo B, Ortiz-Hernández AA, Guerrero ML, Galindo-Fraga A, Galán-Herrera JF, Prado-Galbarro FJ, Beigel JH, Ruiz-Palacios GM, Noyola DE. Epidemiology and clinical characteristics of respiratory syncytial virus infections among children and adults in Mexico. Influenza Other Respir Viruses 2016; 11:48-56. [PMID: 27439650 PMCID: PMC5155644 DOI: 10.1111/irv.12414] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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] [Accepted: 07/13/2016] [Indexed: 11/28/2022] Open
Abstract
Background Respiratory syncytial virus (RSV) is a leading etiological agent of acute respiratory tract infections and hospitalizations in children. However, little information is available regarding RSV infections in Latin American countries, particularly among adult patients. Objective To describe the epidemiology of RSV infection and to analyze the factors associated with severe infections in children and adults in Mexico. Methods Patients ≥1 month old, who presented with an influenza‐like illness (ILI) to six hospitals in Mexico, were eligible for participation in the study. Multiplex reverse‐transcriptase polymerase chain reaction identified viral pathogens in nasal swabs from 5629 episodes of ILI. Patients in whom RSV was detected were included in this report. Results Respiratory syncytial virus was detected in 399 children and 171 adults. RSV A was detected in 413 cases and RSV B in 163, including six patients who had coinfection with both subtypes; 414 (72.6%) patients required hospital admission, including 96 (16.8%) patients that required admission to the intensive care unit. Coinfection with one or more respiratory pathogens other than RSV was detected in 159 cases. Young age (in children) and older age (in adults) as well as the presence of some underlying conditions were associated with more severe disease. Conclusions This study confirms that RSV is an important respiratory pathogen in children in Mexico. In addition, a substantial number of cases in adults were also detected highlighting the relevance of this virus in all ages. It is important to identify subjects at high risk of complications who may benefit from current or future preventive interventions.
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Affiliation(s)
| | | | | | | | - M Lourdes Guerrero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Arturo Galindo-Fraga
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan F Galán-Herrera
- Mexico Emerging Infectious Diseases Clinical Research Network Coordinating Center, Mexico City, Mexico
| | | | - John H Beigel
- Leidos Biomedical, Frederick, MD, in support of the National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | - Daniel E Noyola
- Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
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14
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Powers JH, Guerrero ML, Leidy NK, Fairchok MP, Rosenberg A, Hernández A, Stringer S, Schofield C, Rodríguez-Zulueta P, Kim K, Danaher PJ, Ortega-Gallegos H, Bacci ED, Stepp N, Galindo-Fraga A, St Clair K, Rajnik M, McDonough EA, Ridoré M, Arnold JC, Millar EV, Ruiz-Palacios GM. Development of the Flu-PRO: a patient-reported outcome (PRO) instrument to evaluate symptoms of influenza. BMC Infect Dis 2016; 16:1. [PMID: 26729246 PMCID: PMC4700740 DOI: 10.1186/s12879-015-1330-0] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 12/21/2015] [Indexed: 11/16/2022] Open
Abstract
Background To develop content validity of a comprehensive patient-reported outcome (PRO) measure following current best scientific methodology to standardize assessment of influenza (flu) symptoms in clinical research. Methods Stage I (Concept Elicitation): 1:1 telephone interviews with influenza-positive adults (≥18 years) in the US and Mexico within 7 days of diagnosis. Participants described symptom type, character, severity, and duration. Content analysis identified themes and developed the draft Flu-PRO instrument. Stage II (Cognitive Interviewing): The Flu-PRO was administered to a unique set of influenza-positive adults within 14 days of diagnosis; telephone interviews addressed completeness, respondent interpretation of items and ease of use. Results Samples: Stage I: N = 46 adults (16 US, 30 Mexico); mean (SD) age: 38 (19), 39 (14) years; % female: 56 %, 73 %; race: 69 % White, 97 % Mestizo. Stage II: N = 34 adults (12 US, 22 Mexico); age: 37 (14), 39 (11) years; % female: 50 %, 50 %; race: 58 % White, 100 % Mestizo. Symptoms: Symptoms identified by >50 %: coughing, weak or tired, throat symptoms, congestion, headache, weakness, sweating, chills, general discomfort, runny nose, chest (trouble breathing), difficulty sleeping, and body aches or pains. No new content was uncovered during Stage II; participants easily understood the instrument. Conclusions Results show the 37-item Flu-PRO is a content valid measure of influenza symptoms in adults with a confirmed diagnosis of influenza. Research is underway to evaluate the suitability of the instrument for children and adolescents. This work can form the basis for future quantitative tests of reliability, validity, and responsiveness to evaluate the measurement properties of Flu-PRO for use in clinical trials and epidemiology studies.
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Affiliation(s)
- John H Powers
- Clinical Monitoring and Research Program, Clinical Research Directorate, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, 21702 in support of the Collaborative Clinical Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA. .,, 5601 Fishers Lane, Room 4D50, Rockville, MD, 20852, USA.
| | - M Lourdes Guerrero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | | | - Mary P Fairchok
- Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, MD, USA. .,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA. .,Madigan Army Medical Center, Tacoma, WA, USA.
| | - Alice Rosenberg
- Clinical Monitoring and Research Program, Clinical Research Directorate, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, 21702 in support of the Collaborative Clinical Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.
| | - Andrés Hernández
- Instituto Nacional de Enfermedades Infecciosas, Mexico City, Mexico.
| | | | | | | | | | | | - Hilda Ortega-Gallegos
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | | | | | - Arturo Galindo-Fraga
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | | | - Michael Rajnik
- Walter Reed National Military Medical Center, Bethesda, MD, USA.
| | | | - Michelande Ridoré
- Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, MD, USA. .,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
| | | | - Eugene V Millar
- Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, MD, USA. .,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
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Tanimoto MA, Guerrero ML, Morita Y, Aguirre-Valadez J, Gomez E, Moctezuma-Velazquez C, Estradas-Trujillo JA, Valdovinos MA, Uscanga LF, Fujita R. Impact of formal training in endoscopic submucosal dissection for early gastrointestinal cancer: A systematic review and a meta-analysis. World J Gastrointest Endosc 2015; 7:417-428. [PMID: 25901222 PMCID: PMC4400632 DOI: 10.4253/wjge.v7.i4.417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 02/09/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To summarize the clinical impact of a formal training for the effectiveness and safety of endoscopic submucosal dissection for gastrointestinal cancer.
METHODS: We searched databases including PubMed, EMBASE and the Cochrane Library and Science citation Index updated to August 2014 to include eligible articles. In the Meta-analysis, the main outcome measurements were en bloc resection rate, local recurrence rate (R0) and the incidence of procedure-related complications (perforation, bleeding).
RESULTS: En bloc resection was high for both, dissecting stomach tumors with an overall percentage of 93.2% (95%CI: 90.5-95.8) and dissecting colorectal tumors with an overall percentage of 89.4% (95%CI: 85.1-93.7). Although the number of studies reporting R0 resection (the dissected specimen was revealed free of tumor in both vertical and lateral margins) was small, the overall estimates for R0 resection were 81.4% (95%CI: 72-90.8) for stomach and 85.9% (95%CI: 77.5-95.5) for colorectal tumors, respectively. The analysis showed that the percentage of immediate perforation and bleeding were very low; 4.96 (95%CI: 3.6-6.3) and 1.4% (95%CI: 0.8-1.9) for colorectal tumors and 3.1% (95%CI: 2.0-4.1) and 4.8% (95%CI: 2.8-6.7) for stomach tumors, respectively.
CONCLUSION: In order to obtain the same rate of success of the analyzed studies it is a necessity to create training centers in the western countries during the “several years” of gastroenterology residence first only to teach EGC diagnose and second only to train endoscopic submucosal dissection.
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Dingess K, Valentine C, Davidson B, Peng Y, Guerrero ML, Ruiz‐Palacios G, Ollberding N, Summer S, Ward D, Newburg D, Brenna JT, McMahon R, Morrow A. Branch Chain Fatty Acids of Human Milk: Influenced by Maternal Diet? FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.582.10] [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] [Indexed: 11/11/2022]
Affiliation(s)
- K Dingess
- Perinatal Cincinnati Children's HospitalUnited States
| | - C Valentine
- Perinatal Cincinnati Children's HospitalUnited States
- NutritionMead JohnsonUnited States
| | - B Davidson
- Perinatal Cincinnati Children's HospitalUnited States
| | - Y Peng
- PediatricsShanghai Children's HospitalChina
| | - M L Guerrero
- NutritionNational Institute of Medical Sciences & NutritionMexico
| | - G Ruiz‐Palacios
- NutritionNational Institute of Medical Sciences & NutritionMexico
| | - N Ollberding
- Perinatal Cincinnati Children's HospitalUnited States
| | - S Summer
- Perinatal Cincinnati Children's HospitalUnited States
| | - D Ward
- BioinformaticsBroad InstituteUnited States
| | | | - J T Brenna
- NutritionCornell UniversityUnited States
| | | | - A Morrow
- Perinatal Cincinnati Children's HospitalUnited States
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Follmann D, Qin J, Lourdes Guerrero M, Gabrielle Breugelmans J, Rosales Pedraza G, Gessner BD, Ruiz-Palacios GM. Estimating the burden of pertussis in Mexican adolescents from paired serological data by using a bivariate mixture model. J R Stat Soc Ser C Appl Stat 2014. [DOI: 10.1111/rssc.12051] [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] [Indexed: 11/26/2022]
Affiliation(s)
- Dean Follmann
- National Institute of Allergy and Infectious Diseases; Bethesda USA
| | - Jing Qin
- National Institute of Allergy and Infectious Diseases; Bethesda USA
| | - M. Lourdes Guerrero
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran; Mexico City Mexico
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Galindo-Fraga A, Ortiz-Hernández AA, Ramírez-Venegas A, Vázquez RV, Moreno-Espinosa S, Llamosas-Gallardo B, Pérez-Patrigeon S, Salinger M, Freimanis L, Huang CY, Gu W, Guerrero ML, Beigel J, Ruiz-Palacios GM. Clinical characteristics and outcomes of influenza and other influenza-like illnesses in Mexico City. Int J Infect Dis 2013; 17:e510-7. [PMID: 23416208 PMCID: PMC3655081 DOI: 10.1016/j.ijid.2013.01.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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: 09/19/2012] [Revised: 12/28/2012] [Accepted: 01/06/2013] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Influenza-like illnesses (ILI) are estimated to cause millions of deaths annually. Despite this disease burden, the etiologic causes of ILI are poorly described for many geographical regions. METHODS Beginning in April 2010, we conducted an observational cohort study at five hospitals in Mexico City, enrolling subjects who met the criteria for ILI. Evaluations were conducted at enrollment and on day 28, with the collection of clinical data and a nasopharyngeal swab (or nasal aspirate in children). Swabs were tested by multiplex PCR for 15 viral pathogens and real-time PCR for influenza. RESULTS During the first year, 1065 subjects were enrolled in this study, 55% of whom were hospitalized; 24% of all subjects were children. One or more pathogens were detected by PCR in 64% of subjects, most commonly rhinovirus (25% of all isolates) and influenza (24% of isolates). Six percent of subjects died, and of those, 54% had no pathogen identified. Rhinovirus was the most common pathogen among those who died, although it did not have the highest case fatality rate. CONCLUSIONS Multiple respiratory viruses beyond influenza are associated with significant morbidity and mortality among adults and children in Mexico City. Detection of these agents could be useful for the adjustment of antibiotic treatment in severe cases.
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Affiliation(s)
- Arturo Galindo-Fraga
- Instituto Nacional de Ciencias de Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Col. Sección XVI, Mexico City, DF 14000, Mexico.
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19
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Woo JG, Guerrero ML, Ruiz-Palacios GM, Peng YM, Herbers PM, Yao W, Ortega H, Davidson BS, McMahon RJ, Morrow AL. Specific infant feeding practices do not consistently explain variation in anthropometry at age 1 year in urban United States, Mexico, and China cohorts. J Nutr 2013; 143:166-74. [PMID: 23236024 PMCID: PMC3542908 DOI: 10.3945/jn.112.163857] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Infant feeding practices generally influence infant growth, but it is unclear how introduction of specific foods affects growth across global populations. We studied 3 urban populations in the Global Exploration of Human Milk study to determine the association between infant feeding and anthropometry at 1 y of age. Three hundred sixty-five breastfeeding mother-infant pairs (120 US, 120 China, and 125 Mexico) were recruited soon after the infant's birth. Enrollment required agreement to breastfeed ≥75% for at least 3 mo. Weekly, 24-h, food frequency data were conducted on infants for 1 y and exclusive breastfeeding (EBF) duration and timing of specific complementary food introduction were calculated. Weight and length were measured at age 1 y and anthropometry Z-scores calculated using WHO standards. Cohorts in the 3 urban populations (Shanghai, China; Cincinnati, USA; and Mexico City, Mexico) differed by median EBF duration (5, 14, and 7 wk, respectively; P < 0.001), timing of introduction of meat/eggs/legumes (4.8, 9.3, and 7.0 mo, respectively; P < 0.0001), and other feeding practices. By age 1 y, infants in Shanghai were heavier and longer than Cincinnati and Mexico City infants (P < 0.001). Adjusting for nonfeeding covariates, the only feeding variable associated with anthropometry was EBF duration, which was modestly inversely associated with weight-for-age but not length-for-age or BMI Z-scores at 1 y. Although feeding variables differed by cohort, their impact on anthropometry differences was not consistent among cohorts. Overall, across these urban, international, breast-fed cohorts, differences in specific feeding practices did not explain the significant variation in anthropometry.
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Affiliation(s)
- Jessica G. Woo
- Division of Biostatistics and Epidemiology, and,To whom correspondence should be addressed. E-mail:
| | | | | | - Yong-mei Peng
- Children’s Hospital of Fudan University, Shanghai, China; and
| | | | - Wen Yao
- Children’s Hospital of Fudan University, Shanghai, China; and
| | - Hilda Ortega
- National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
| | - Barbara S. Davidson
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | - Ardythe L. Morrow
- Division of Biostatistics and Epidemiology, and,Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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20
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Ruiz-Palacios GM, Guerrero ML, Hernández-Delgado L, Lavalle-Villalobos A, Casas-Muñoz A, Cervantes-Apolinar Y, Moreira M, Schuerman L. Immunogenicity, reactogenicity and safety of the 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in Mexican infants. Hum Vaccin 2011; 7:1137-45. [PMID: 22048109 DOI: 10.4161/hv.7.11.17984] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The immunogenicity and safety of the 10-valent pneumococcal conjugate vaccine, PHiD-CV, have been documented in European and Asian studies. In this open study conducted in Mexico (NCT00489554), 230 healthy infants received three doses of PHiD-CV and DTPa-HBV-IPV/Hib vaccines at 2, 4 and 6 months of age and two doses of oral human rotavirus vaccine at 2 and 4 months. Serotype-specific pneumococcal responses and opsonophagocytic activity (OPA) were measured one month post-dose 3. PHiD-CV's primary vaccination course was highly immunogenic against each of the 10 pneumococcal vaccine serotypes and carrier protein D. Antibody responses against pneumococcal serotypes and protein D were generally higher in Mexican infants compared with European antibody responses, and functional OPA responses were also higher or in the same range. The most frequent solicited local symptom was pain, with high but similar incidences of grade 3 pain reported at both injection sites (up to 15% of all doses). PHiD-CV was well tolerated, with no serious adverse events considered as causally related to vaccination. Most solicited symptoms were mild and there was no increase in incidence of solicited symptoms with successive vaccine doses.
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Woo JG, Guerrero ML, Altaye M, Ruiz-Palacios GM, Martin LJ, Dubert-Ferrandon A, Newburg DS, Morrow AL. Human milk adiponectin is associated with infant growth in two independent cohorts. Breastfeed Med 2009; 4:101-9. [PMID: 19500050 PMCID: PMC2779028 DOI: 10.1089/bfm.2008.0137] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Adiponectin, a circulating adipocyte protein, is associated with lower obesity. We have previously shown that adiponectin is present in human milk. This study determined whether higher milk adiponectin is associated with infant growth and investigated milk adiponectin's oligomeric form. DESIGN AND METHODS This is a study of two parallel longitudinal cohorts of breastfed infants born between 1998 and 2005. Forty-five mother-infant pairs from Cincinnati, OH and 277 mother-infant pairs from Mexico City, Mexico were analyzed. All participants were healthy, term infants breastfed at least 1 month who completed 6 months of follow-up. Monthly milk samples (n = 1,379) up to 6 months were assayed for adiponectin by radioimmunoassay. Infant weight-for-age, length-for-age, and weight-for-length Z-scores up to 6 months of age were calculated using World Health Organization standards. Repeated-measures analysis was conducted. The structural form of human milk adiponectin was assessed by western blot. RESULTS In the population studies, initial milk adiponectin was 24.0 +/- 8.6 microg/L and did not differ by cohort. Over the first 6 months, higher milk adiponectin was associated with lower infant weight-for-age Z-score (-0.20 +/- 0.04, p < 0.0001) and weight-for-length Z-score (-0.29 +/- 0.08, p = 0.0002) but not length-for-age Z-score, adjusted for covariates, with no difference by cohort. By western blot, human milk adiponectin was predominantly in the biologically active high-molecular-weight form. CONCLUSIONS Our data suggest milk adiponectin may play a role in the early growth and development of breastfed infants.
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Affiliation(s)
- Jessica G. Woo
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Mekibib Altaye
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Lisa J. Martin
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alix Dubert-Ferrandon
- Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - David S. Newburg
- Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Ardythe L. Morrow
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
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Vargas-Infante YA, Guerrero ML, Ruiz-Palacios GM, Soto-Ramírez LE, Del Río C, Carranza J, Domínguez-Cherit G, Sierra-Madero JG. Improving outcome of human immunodeficiency virus-infected patients in a Mexican intensive care unit. Arch Med Res 2007; 38:827-33. [PMID: 17923262 DOI: 10.1016/j.arcmed.2007.05.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 05/07/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND In Latin America, insufficient data are available to improve local admission policies for human immunodeficiency virus (HIV) patients in the intensive care units (ICU). We undertook this study to evaluate the outcome and survival determinants of HIV patients in a Mexican ICU during three time periods. METHODS From December 1985 through January 2006, a clinical chart-based, retrospective study of all HIV patients admitted to the ICU was conducted. Demographic, clinical and laboratory data; disease severity score (APACHE II) and mortality were evaluated. A comprehensive database was created and data were analyzed using survival and regression models. RESULTS Ninety HIV patients were admitted to the ICU during the study: 16 (18%) in 1985-1992 (non-antiretroviral [ARV]-period), 21 (23%) in 1993-1996 (ARV-period), and 53 (58%) in 1996-2006 (highly active antiretroviral treatment [HAART] period). Leading reasons for admission were the need for mechanical ventilatory support (MVS, 85.5%), septic shock (23%), and non-HIV/AIDS complications (15.5%). Survival in the ICU increased from 12.5% (non-ARV period) to 57% (HAART period). Mortality during ICU stay was associated with MVS (HR: 3.2; 95% CI 1.0-10.2) and APACHE II > or =13 points (HR: 2.2; 95% CI 1.3-4.0). Use of steroids (HR: 0.4; 95% CI 0.2-0.8) and HAART (HR: 0.25; 95% CI 0.1-0.5) were associated with a lower risk of death. In multivariate analysis, septic shock was the main predictor of death in the ICU (HR: 2.4; 95% CI 1.1-5.2) and after discharge. HAART remained as a significant protective factor. CONCLUSIONS Overall survival in Mexican HIV patients admitted to an ICU has substantially increased in recent years. These data should encourage policies that consider HIV patients as good candidates for receiving intensive care.
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Affiliation(s)
- Yetlanezi A Vargas-Infante
- Department of Infectious Diseases, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico, DF, Mexico
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Perez-Schael I, Salinas B, Tomat M, Linhares AC, Guerrero ML, Ruiz-Palacios GM, Bouckenooghe A, Yarzabal JP. Efficacy of the Human Rotavirus Vaccine RIX4414 in Malnourished Children. J Infect Dis 2007; 196:537-40. [PMID: 17624838 DOI: 10.1086/519687] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Accepted: 02/16/2007] [Indexed: 11/03/2022] Open
Abstract
UNLABELLED The effect of nutritional status on protective efficacy of a live attenuated human rotavirus vaccine (RIX4414) was studied. Vaccine protection was evaluated through a secondary analysis of data from an efficacy study conducted in Brazil, Mexico, and Venezuela. Vaccine efficacy against rotavirus gastroenteritis (RVGE) was similar in well-nourished and malnourished infants: 74.1% (95% confidence interval [CI], 52.2%-86.2%) and 73% (95% CI, 11.2%-92.3%) for severe RVGE and 60.9% (95% CI, 37.4%-75.4%) and 61.2% (95% CI, 10.4%-83.1%) for RVGE of any severity, respectively. RIX4414 significantly decreased the rate of RVGE regardless of nutritional status, which suggests that this patient group can also benefit from rotavirus vaccination. CLINICAL TRIALS REGISTRY e-Track 444563-006, NCT00385320 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Irene Perez-Schael
- Instituto de Biomedicina-Fuvesin, Universidad Central de Venezuela, Ministerio de Salud, Caracas, Venezuela.
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24
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Ruiz-Palacios GM, Guerrero ML, Bautista-Márquez A, Ortega-Gallegos H, Tuz-Dzib F, Reyes-González L, Rosales-Pedraza G, Martínez-López J, Castañón-Acosta E, Cervantes Y, Costa-Clemens S, DeVos B. Dose response and efficacy of a live, attenuated human rotavirus vaccine in Mexican infants. Pediatrics 2007; 120:e253-61. [PMID: 17606534 DOI: 10.1542/peds.2006-2630] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Immunization against rotavirus has been proposed as the most cost-effective intervention to reduce the disease burden associated with this infection worldwide. The objective of this study was to determine the dose response, immunogenicity, and efficacy of 2 doses of an oral, attenuated monovalent G1[P8] human rotavirus vaccine in children from the same setting in Mexico, where the natural protection against rotavirus infection was studied. METHODS From June 2001 through May 2003, 405 healthy infants were randomly assigned to 1 of 3 vaccine groups (virus concentrations 10(4.7), 10(5.2), and 10(5.8) infectious units) and to a placebo group and were monitored to the age of 2 years. The vaccine/placebo was administered concurrently with diphtheria-tetanus toxoid-pertussis/hepatitis B/Haemophilus influenzae type b vaccine at 2 and 4 months of age. After the administration of the first vaccine/placebo dose, weekly home visits to collect information regarding infant health were conducted. Stool samples were collected during each gastroenteritis episode and tested for rotavirus antigen and serotype. RESULTS The vaccine was well tolerated and induced a greater rate of seroconversion than observed in infants who received placebo. For the pooled vaccine groups, efficacy after 2 oral doses was 80% and 95% against any and severe rotavirus gastroenteritis, respectively. Efficacy was 100% against severe rotavirus gastroenteritis and 70% against severe gastroenteritis of any cause with the vaccine at the highest virus concentration (10(5.8) infectious units). The predominant infecting rotavirus serotype in this cohort was wild-type G1 (85%). Adverse events, including fever, irritability, loss of appetite, cough, diarrhea, and vomiting, were similar among vaccinees and placebo recipients. CONCLUSION This new oral, live, attenuated human rotavirus vaccine was safe, immunogenic, and highly efficacious in preventing any and, more importantly, severe rotavirus gastroenteritis in healthy infants. This vaccine produced comparable protection to natural infection.
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Affiliation(s)
- Guillermo M Ruiz-Palacios
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico.
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Linhares AC, Ruiz-Palacios GM, Guerrero ML, Salinas B, Perez-Schael I, Clemens SAC, Innis B, Yarzabal JP, Vespa G, Cervantes Y, Hardt K, De Vos B. A short report on highlights of world-wide development of RIX4414: A Latin American experience. Vaccine 2006; 24:3784-5. [PMID: 16098636 DOI: 10.1016/j.vaccine.2005.07.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
An oral, human-derived monovalent (G1P1A) rotavirus vaccine, strain RIX4414, has been developed by GlaxoSmithKline, Rixensart, Belgium. The safety, immunogenicity and efficacy of this vaccine were evaluated in a randomized, double-blind, placebo-controlled, phase IIb trial conducted in Brazil, Mexico and Venezuela. Healthy infants were given two doses of vaccine (104.7, 105.2 or 105.8 ffu) or placebo at age 2 and 4 months, with routine DTPw-HBV and Hib vaccines. OPV was given separately, at least 2 weeks before or after administration of the study vaccine. A total of 2155 infants were enrolled, of whom 1618 received one of the three vaccine viral concentrations and 537 were given placebo. Analysis of efficacy included diarrheal episodes occurring from 2 weeks after second dose until one year of age. Efficacy rates against any rotavirus gastroenteritis, severe rotavirus gastroenteritis and hospitalizations for rotavirus disease were as high as 70% (46-84%; 95%CI), 86% (63-96%; 95%CI), and 93% (54-100%; 95%CI), respectively. For non-G1 (mainly G9) serotypes, RIX4414 vaccine conferred protection as high as 83% (40-97%; 95%CI) against severe gastroenteritis. A decrease was noted in the incidence of severe rotavirus-related gastroenteritis after first dose. It is demonstrated that two doses of RIX4414 are highly efficacious against severe rotavirus gastroenteritis and hospitalization, including disease caused by non-G1 strains, namely G9 serotypes.
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Affiliation(s)
- A C Linhares
- Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, MS, Av. Almirante Barroso, 492, Marco CEP 66.090-000, Belém, Pará, Brazil.
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Meinzen-Derr JK, Guerrero ML, Altaye M, Ortega-Gallegos H, Ruiz-Palacios GM, Morrow AL. Risk of infant anemia is associated with exclusive breast-feeding and maternal anemia in a Mexican cohort. J Nutr 2006; 136:452-8. [PMID: 16424127 DOI: 10.1093/jn/136.2.452] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The WHO recommends exclusive breast-feeding (EBF) for the first 6 mo of life to decrease the burden of infectious disease. However, some are concerned about the effect of EBF >6 mo on iron status of children in developing countries in which anemia is prevalent. This study examines the risk of anemia in relation to the duration of EBF and maternal anemia in a birth cohort studied between March 1998 and April 2003. All infant birth weights were >or=2.2 kg. All mothers received home-based peer counseling to promote EBF. Infant feeding data were collected weekly. Nurses measured hemoglobin (Hb) values every 3 mo. Hb was measured in 183 infants at 9 mo of age. Anemia at 9 mo was defined as a Hb value <100 g/L. EBF was defined by WHO criteria and ranged in duration from 0 to 31 wk. At 9 mo, Hb (mean +/- SEM) was 114 +/- 0.9 g/L; 23 children (12.5%) had Hb levels <100 g/L. EBF >6 mo, but not EBF 4-6 mo, was associated with increased risk of infant anemia compared with EBF <4 mo (odds ratio=18.4, 95% CI=1.9, 174.0). Maternal anemia was independently (P=0.03) associated with a 3-fold increased risk of infant anemia. These associations were not explained by confounding with other maternal or infant factors. By linear regression, a lower infant Hb at 9 mo was associated with increased EBF duration among mothers who had a history of anemia (beta=-0.07, P=0.003), but not among mothers with no history of anemia. Infants who are exclusively breast-fed for >6 mo in developing countries may be at increased risk of anemia, especially among mothers with a poor iron status; greater attention to this issue is warranted.
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Affiliation(s)
- Jareen K Meinzen-Derr
- Departament of Pediatrics, University of Cincinnati College Of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Ruiz-Palacios GM, Pérez-Schael I, Velázquez FR, Abate H, Breuer T, Clemens SC, Cheuvart B, Espinoza F, Gillard P, Innis BL, Cervantes Y, Linhares AC, López P, Macías-Parra M, Ortega-Barría E, Richardson V, Rivera-Medina DM, Rivera L, Salinas B, Pavía-Ruz N, Salmerón J, Rüttimann R, Tinoco JC, Rubio P, Nuñez E, Guerrero ML, Yarzábal JP, Damaso S, Tornieporth N, Sáez-Llorens X, Vergara RF, Vesikari T, Bouckenooghe A, Clemens R, De Vos B, O'Ryan M. Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. N Engl J Med 2006; 354:11-22. [PMID: 16394298 DOI: 10.1056/nejmoa052434] [Citation(s) in RCA: 1267] [Impact Index Per Article: 70.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The safety and efficacy of an attenuated G1P[8] human rotavirus (HRV) vaccine were tested in a randomized, double-blind, phase 3 trial. METHODS We studied 63,225 healthy infants from 11 Latin American countries and Finland who received two oral doses of either the HRV vaccine (31,673 infants) or placebo (31,552 infants) at approximately two months and four months of age. Severe gastroenteritis episodes were identified by active surveillance. The severity of disease was graded with the use of the 20-point Vesikari scale. Vaccine efficacy was evaluated in a subgroup of 20,169 infants (10,159 vaccinees and 10,010 placebo recipients). RESULTS The efficacy of the vaccine against severe rotavirus gastroenteritis and against rotavirus-associated hospitalization was 85 percent (P<0.001 for the comparison with placebo) and reached 100 percent against more severe rotavirus gastroenteritis. Hospitalization for diarrhea of any cause was reduced by 42 percent (95 percent confidence interval, 29 to 53 percent; P<0.001). During the 31-day window after each dose, six vaccine recipients and seven placebo recipients had definite intussusception (difference in risk, -0.32 per 10,000 infants; 95 percent confidence interval, -2.91 to 2.18; P=0.78). CONCLUSIONS Two oral doses of the live attenuated G1P[8] HRV vaccine were highly efficacious in protecting infants against severe rotavirus gastroenteritis, significantly reduced the rate of severe gastroenteritis from any cause, and were not associated with an increased risk of intussusception. (ClinicalTrials.gov numbers, NCT00139347 and NCT00263666.)
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Salinas B, Pérez Schael I, Linhares AC, Ruiz Palacios GM, Guerrero ML, Yarzábal JP, Cervantes Y, Costa Clemens S, Damaso S, Hardt K, De Vos B. Evaluation of safety, immunogenicity and efficacy of an attenuated rotavirus vaccine, RIX4414: A randomized, placebo-controlled trial in Latin American infants. Pediatr Infect Dis J 2005; 24:807-16. [PMID: 16148848 DOI: 10.1097/01.inf.0000178294.13954.a1] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A live attenuated monovalent rotavirus vaccine RIX4414 was developed with a human strain of G1P1A P[8] specificity to reduce the rotavirus burden in children. METHODS A double blind, randomized, placebo-controlled study evaluated the efficacy, immunogenicity, safety and reactogenicity of 2 oral doses of RIX4414 (10(4.7), 10(5.2) or 10(5.8) focus-forming units) at 2 and 4 months coadministered with routine vaccinations and oral poliovirus vaccine given for study purposes at least 14 days apart. The 2155 infants (1618 vaccine/537 placebo) enrolled in Brazil, Mexico and Venezuela were followed until 1 year of age. RESULTS Antirotavirus IgA seroconversion rates 2 months after dose 2 ranged between 61% (10(4.7) ffu group) and 65% (10(5.8) ffu group), and most of the infants had seroprotective levels of antibodies to coadministered routine vaccinations. The reactogenicity profile of RIX4414 was similar to that of the placebo, and no vaccination-related serious adverse events were reported. Protective efficacy against severe and any rotavirus gastroenteritis from 15 days post-dose 2 was highest in the 10(5.8) ffu group [86%; 95% confidence interval (95% CI), 63-96% and 70% (95% CI 46-84%), P < 0.001, 2-sided Fisher's exact test]. The efficacy against hospitalization was 79% (95% CI 48-92%) for pooled vaccine groups. Multiple rotavirus serotypes [G1 (50%), G9 (40%), G2, G3 and G4] were identified from gastroenteritis stools (enzyme-linked immunosorbent assay and reverse transcription-polymerase chain reaction) during the study period. For severe gastroenteritis caused by G9 serotypes, the protection reached 77% (95% CI 18-96%) in the 10(5.8) ffu group, providing proof of concept that the monovalent G1P1A P[8] human rotavirus vaccine elicits cross-protection against the G9 strain. A reduction in any and severe rotavirus gastroenteritis was already observed at post-dose 1 (period: day of dose 1 to 14 days post-dose 2) in vaccinees compared with placebo recipients. CONCLUSIONS Two doses of RIX4414 are highly efficacious, providing cross-protection (G1 and G9 strains, prevalent during this study) and early protection against any and severe rotavirus gastroenteritis and hospitalization to infants in Latin America.
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Morrow AL, Ruiz-Palacios GM, Altaye M, Jiang X, Guerrero ML, Meinzen-Derr JK, Farkas T, Chaturvedi P, Pickering LK, Newburg DS. Human milk oligosaccharides are associated with protection against diarrhea in breast-fed infants. J Pediatr 2004; 145:297-303. [PMID: 15343178 DOI: 10.1016/j.jpeds.2004.04.054] [Citation(s) in RCA: 302] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the association between maternal milk levels of 2-linked fucosylated oligosaccharide and prevention of diarrhea as a result of Campylobacter, caliciviruses, and diarrhea of all causes in breast-fed infants. STUDY DESIGN Data and banked samples were analyzed from 93 breast-feeding mother-infant pairs who were prospectively studied during 1988-1991 from birth to 2 years with infant feeding and diarrhea data collected weekly; diarrhea was diagnosed by a study physician. Milk samples obtained 1 to 5 weeks postpartum were analyzed for oligosaccharide content. Data were analyzed by Poisson regression. RESULTS Total 2-linked fucosyloligosaccharide in maternal milk ranged from 0.8 to 20.8 mmol/L (50%-92% of milk oligosaccharide). Moderate-to-severe diarrhea of all causes (n=77 cases) occurred less often (P=.001) in infants whose milk contained high levels of total 2-linked fucosyloligosaccharide as a percent of milk oligosaccharide. Campylobacter diarrhea (n=31 cases) occurred less often (P=.004) in infants whose mother's milk contained high levels of 2'-FL, a specific 2-linked fucosyloligosaccharide, and calicivirus diarrhea (n=16 cases) occurred less often (P=.012) in infants whose mother's milk contained high levels of lacto-N-difucohexaose (LDFH-I), another 2-linked fucosyloligosaccharide. CONCLUSION This study provides novel evidence suggesting that human milk oligosaccharides are clinically relevant to protection against infant diarrhea.
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Affiliation(s)
- Ardythe L Morrow
- Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
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Morrow AL, Ruiz-Palacios GM, Altaye M, Jiang X, Guerrero ML, Meinzen-Derr JK, Farkas T, Chaturvedi P, Pickering LK, Newburg DS. Human Milk Oligosaccharide Blood Group Epitopes and Innate Immune Protection against Campylobacter and Calicivirus Diarrhea in Breastfed Infants. Advances in Experimental Medicine and Biology 2004; 554:443-6. [PMID: 15384621 DOI: 10.1007/978-1-4757-4242-8_61] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- A L Morrow
- Center for Epidemiology & Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
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Meinzen-Derr JK, Guerrero ML, Altaye M, Ruiz-Palacios GM, Morrow AL. Duration of exclusive breastfeeding and risk of anemia in a cohort of Mexican infants. Adv Exp Med Biol 2004; 554:395-8. [PMID: 15384609 DOI: 10.1007/978-1-4757-4242-8_49] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Newburg DS, Ruiz-Palacios GM, Altaye M, Chaturvedi P, Guerrero ML, Meinzen-Derr JK, Morrow AL. Human Milk α1,2-Linked Fucosylated Oligosaccharides Decrease Risk of Diarrhea Due to Stable Toxin of E. Coli in Breastfed Infants. Advances in Experimental Medicine and Biology 2004; 554:457-61. [PMID: 15384624 DOI: 10.1007/978-1-4757-4242-8_64] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- David S Newburg
- Shriver Center of the University of Massachusetts Medical School, Waltham, MA 02452, USA.
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Pérez-Escamilla R, Guerrero ML. Epidemiology of breastfeeding: advances and multidisciplinary applications. Adv Exp Med Biol 2004; 554:45-59. [PMID: 15384566] [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] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Advancing understanding of the importance of breastfeeding (BF) has required advances in application of epidemiologic methods to BF research. This chapter considers, in the context of BF epidemiology, how different research designs complement each other to establish firmer causal inferences, the need for multidisciplinary collaborations, and the application of powerful analytical methods to strengthen epidemiologic studies. A recent global meta-analysis of 47 studies documenting the inverse association between lifetime BF duration and breast cancer risk illustrates the value of longitudinal (cohort) studies to establish the temporal sequence of events and to rule out differential recall biases that can threaten the internal validity of case-control studies. The discovery of the transmission of human immunodeficiency virus (HIV) via human milk has led epidemiologists to provide important hypotheses to be tested at the molecular and cellular level and in turn test hypotheses generated in laboratory studies. Application of powerful statistical methods to BF epidemiology has helped strengthen causal inferences. A retrospective analysis of the 1976--1977 Malaysian Family Life Survey found interactive multivariate statistical models to better understand how different socioeconomic and cultural contexts modify the influence of BF on child health. Further, a study conducted in Cebu City, Philippines, demonstrated how structural equation models can be used to test the pathways through which proximate (e.g., BF) and distal (e.g., socioeconomic status) determinants affect child health after adjusting for reverse causality (i.e., child health influencing maternal BF choice). For ethical reasons, BF randomized controlled trials (RCTs) have seldom been conducted. Recent RCTs examining the link between BF peer counseling and BF outcomes in diverse settings provides a unique opportunity to firmly establish the causal inferences regarding BF and the prevention of diarrheal diseases. The value of rapid assessment anthropologic methods to guide development of peer counseling interventions subsequently tested through RCTs is presented. This chapter also illustrates how Cox regression and logistic regression can be applied to BF research.
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Guerrero ML, Moreno-Espinosa S, Tuz-Dzib F, Solís-Albino J, Ortega-Gallegos H, Ruiz-Palacios GM. Breastfeeding and Natural Colonization with Lactobacillus SPP as Protection against Rotavirus-Associated Diarrhea. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2004; 554:451-5. [PMID: 15384623 DOI: 10.1007/978-1-4757-4242-8_63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- M L Guerrero
- Departamento de Infectologia, Instituto Nacional de Ciencias Médicas y Nutrición--Salvador Zubirán, Vasco de Quiroga No 15, Delegacion Tlalpan, México DF V 14000, México.
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Laird AR, Ibarra V, Ruiz-Palacios G, Guerrero ML, Glass RI, Gentsch JR. Unexpected detection of animal VP7 genes among common rotavirus strains isolated from children in Mexico. J Clin Microbiol 2003; 41:4400-3. [PMID: 12958276 PMCID: PMC193830 DOI: 10.1128/jcm.41.9.4400-4403.2003] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
In the course of characterizing 103 rotaviruses from children in Mexico, we found that the majority of strains were globally common types (55.4% of total), while uncommon types represented 5.7%, mixed infections with common types represented 14.8%, and partially or fully nontypeable isolates represented about 24%. Serotype G9 was detected for the first time in Mexico. We sequenced a subset of strains that were G nontypeable by reverse transcriptase PCR and found surprisingly that two strains having common human rotavirus P genotypes (8 and 6) had serotype G3 and G4 VP7 gene sequences that shared closer homology with canine and porcine strains, respectively, than with human strains, suggesting that these isolates represented reassortants between human and animal rotaviruses.
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Affiliation(s)
- A R Laird
- Viral Gastroenteritis Section, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, Georgia 30333, USA
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Noguera-Obenza M, Ochoa TJ, Gomez HF, Guerrero ML, Herrera-Insua I, Morrow AL, Ruiz-Palacios G, Pickering LK, Guzman CA, Cleary TG. Human milk secretory antibodies against attaching and effacing Escherichia coli antigens. Emerg Infect Dis 2003; 9:545-51. [PMID: 12737737 PMCID: PMC2972756 DOI: 10.3201/eid0905.020441] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Secretory immunoglobulin A (sIgA) is a primary factor responsible for preventing attachment of enteropathogens to gut epithelium in breastfeeding infants. We compared the frequency of sIgA to major surface antigens of enterohemorrhagic Escherichia coli (EHEC) in milk of 123 women from the United States and Mexico to determine whether regional differences existed in the frequency of antibodies to these surface antigens. In both groups of women, milk commonly has sIgA against various EHEC lipopolysaccharides, EspA, EspB, intimin, and less frequently against Shiga toxin. The study suggests that persons living in the United States are exposed to attaching/effacing enteropathogens more frequently than is generally assumed. The low frequency of antibodies to Stx1 (in 12% of Mexican and in 22% of U.S. samples) suggests that the rare appearance of hemolytic uremic syndrome in adults is not due to neutralization of toxin at the gut level. Only anti-EspA is found in most milk samples from both populations of women. EspA may represent a useful target for an immunization strategy to prevent EHEC disease in humans.
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Affiliation(s)
| | | | - Henry F. Gomez
- University of Texas-Houston Medical School, Houston, Texas, USA
| | - M. Lourdes Guerrero
- Instituto Nacional de la Nutricion “Salvador Zubiran,” México City, México, D. F
| | | | | | | | | | - Carlos A. Guzman
- GBF-German National Research Centre for Biotechnology, Braunschweig, Germany
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Abstract
UNLABELLED Despite known health benefits, exclusive breast-feeding for at least 4 months is uncommon in many countries. In Mexico, most mothers initiate breast-feeding but few breast-feed exclusively. OBJECTIVE The objective was to examine the effectiveness of home visits by lay peer counselors to increase exclusive breast-feeding among mothers in a periurban area of Mexico. METHODS An ethnographic assessment conducted in 1994 that identified key maternal beliefs, practices, and needs was used to guide educational strategies. Lay counselors were recruited from the same community and trained by La Leche League. From March 1995 through September 1996, pregnant women were identified by community census and invited to participate. Women were enrolled into a randomized, controlled study of 3 groups: no intervention (control), 3 visits, and 6 visits during pregnancy and early postpartum. Data collection was performed by a social worker apart from the counselors. Exclusive breast-feeding was defined by WHO criteria. RESULTS The study enrolled 130 women; 52 were in the 3-visit group, 44 in the 6-visit group, and 34 in the control group. Study groups did not differ in the maternal characteristics or initiation of breast-feeding (96%). At 3 months postpartum, exclusive breast-feeding was practiced by only 12% of controls vs. 52% in the 3-visit group and 67% in the 6-visit group (P < 0.001, log rank test). In the first 3 months, significantly (P = 0.037) fewer intervention than control infants had an episode of diarrhea (11% vs. 26%, respectively). Intervention effectiveness was independent of maternal factors or birth hospital. CONCLUSIONS This unique experimental study demonstrated a dramatic increase in exclusive breast-feeding and a significant reduction in infant illness in an urban community through well-designed maternal support including early intervention and repeated contact.
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Affiliation(s)
- A L Morrow
- Center for Pediatric Research, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk 23510, USA
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Vázquez EG, de Górgolas M, Guerrero ML. [Relation between erythrocyte sedimentation rate, clinical and immune status and virus load in non-hospitalized HIV-infected patients]. Rev Esp Quimioter 2001; 14:264-8. [PMID: 11753447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The objective of this study was to analyze the clinical, immunitary and virological implications of an elevated erythrocyte sedimentation rate (ESR) in HIV-positive patients. A retrospective crossover study of 350 HIV-positive patients undergoing periodic evaluations (942 follow-ups) at the outpatient service of the Division of Infectious Diseases of the Fundación Jiménez Díaz in Madrid was carried out from January 1993 to July 1998. The relationship between the ESR (cut-off point: 20 mm/h), the clinical status (symptomatic or asymptomatic), the immune status (CD4, cut-off point: 200 cells/microl), and viral status (viral load, cut-off point: 3 log) of the patients was analyzed. Information on other possible confounding factors was also collected. It was found that in 667 cases (71%), the ESR was normal and in 275 (29%) it was >20 mm/h. In the univariate analysis, a statistically significant relation was found between the ESR and the clinical, immune and viral status of the patients: a normal ESR was associated with a CD4 >200 cells/ml, viral load <3 log, and an asymptomatic clinical status (p <0.05). A significant inverse relation was found between ESR and hematocrit (p <0.05, CI 95%: 3.87-5.1) and between ESR and gammaglobulin (p <0.05). The multivariate analysis did not show a significant relation between ESR and clinical status (OR: 1.98, IC95%: 1-3.9), nor between ESR and the CD4 level (in the case of hematocrit 42-43%, OR: 0.755, p >0.005). However, in patients with low hematocrit the risk of having CD4 < or = 200 cells/microl when the ESR was >20 mm/h was significant (OR: 9.34, IC95%: 4.56-11.35). When adjusting for clinical factors such as age, sex, gammaglobulin, hematocrit and co-infection with hepatitis C or B virus, we did not find a relation between the ESR and the clinical, immune or viral status of the seropositive patients. We believe that it is not necessary to determine the ESR when monitoring HIV-positive patients, since it does not appear to be a good marker for a deterioration in clinical, immune or viral status.
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Affiliation(s)
- E G Vázquez
- División de Enfermedades Infecciosas, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid
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Walter JE, Mitchell DK, Guerrero ML, Berke T, Matson DO, Monroe SS, Pickering LK, Ruiz-Palacios G. Molecular epidemiology of human astrovirus diarrhea among children from a periurban community of Mexico City. J Infect Dis 2001; 183:681-6. [PMID: 11181143 DOI: 10.1086/318825] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2000] [Revised: 11/13/2000] [Indexed: 11/03/2022] Open
Abstract
Human astroviruses (HAstVs) were detected in 23 stool samples from 365 diarrhea episodes among 214 children (<18 months old) prospectively monitored for diarrhea in Mexico City. Stool samples were tested by EIA and reverse transcriptase-polymerase chain reaction (RT-PCR) analysis. EIA was less sensitive (74%) and equally specific, compared with RT-PCR analysis using type-common primers for HAstV detection. Of 31 HAstV isolates, EIA typed 18 (69%) of 26 EIA-positive samples, and RT-PCR analysis typed 26 (84%) of 31 RT-PCR-positive samples. Phylogenetic analysis of the 3' end of the capsid region (363 nucleotides) confirmed the type assignment by EIA and RT-PCR analysis and determined the type for 5 previously untyped samples. Six HAstV antigenic types cocirculated in the community: HAstV-2 (42%), HAstV-4 (23%), HAstV-3 (13%), HAstV-1 (10%), HAstV-5 (6%), and HAstV-7 (6%). RT-PCR and sequence analysis provided more detailed epidemiology of HAstV in the community than did antigenic detection methods.
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Affiliation(s)
- J E Walter
- Center for Pediatric Research, 855 West Brambleton Ave., Norfolk, VA 23510-1001, USA.
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Walter JE, Briggs J, Guerrero ML, Matson DO, Pickering LK, Ruiz-Palacios G, Berke T, Mitchell DK. Molecular characterization of a novel recombinant strain of human astrovirus associated with gastroenteritis in children. Arch Virol 2001; 146:2357-67. [PMID: 11811685 PMCID: PMC7087139 DOI: 10.1007/s007050170008] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report a naturally occurring human astrovirus (HAstV) strain detected in two different geographic locations. We identified two isolates of this strain in a diarrhea outbreak at a child care center in Houston, Texas; and two isolates in diarrhea stool samples from two children in Mexico City. All four isolates were detected in stool samples by enzyme immunoassay (EIA). One of the Mexican isolates was typed by EIA and all four isolates were HAstV-5 by typing RT-PCR. The four isolates were >97% nucleotide-identical in two different genomic regions: ORF1a (246 nt), and the 3' end of the genome (471 nt). One isolate from each geographic location was further sequenced in the transition region from ORF1b to ORF2 (1255 nt) and this region of the two isolates showed > or = 99% nt identity. Phylogenetic analyses of sequences of eight HAstV antigenic types and the novel strain in the transition region demonstrated the new strain being closely related to HAstV-3 in ORF1b, but closest to HAstV-5 in ORF2. These results and high sequence identity among all HAstV antigenic types in the transition region and RNA structural predictions supported a potential recombination site at the ORF1b/ORF2 junction. This is the first evidence that recombination occurs among human astroviruses.
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Affiliation(s)
- J E Walter
- Center for Pediatric Research, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk 23510-1001, USA
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Velázquez FR, Matson DO, Guerrero ML, Shults J, Calva JJ, Morrow AL, Glass RI, Pickering LK, Ruiz-Palacios GM. Serum antibody as a marker of protection against natural rotavirus infection and disease. J Infect Dis 2000; 182:1602-9. [PMID: 11069230 DOI: 10.1086/317619] [Citation(s) in RCA: 133] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2000] [Revised: 07/31/2000] [Indexed: 11/03/2022] Open
Abstract
To determine whether naturally acquired serum IgA and IgG antibodies were associated with protection against rotavirus infection and illness, a cohort of 200 Mexican infants was monitored weekly for rotavirus excretion and diarrhea from birth to age 2 years. Serum samples collected during the first week after birth and every 4 months were tested for anti-rotavirus IgA and IgG. Children with an IgA titer >1:800 had a lower risk of rotavirus infection (adjusted relative risk [aRR], 0.21; P<.001) and diarrhea (aRR, 0. 16; P=.01) and were protected completely against moderate-to-severe diarrhea. However, children with an IgG titer >1:6400 were protected against rotavirus infection (aRR, 0.51; P<.001) but not against rotavirus diarrhea. Protective antibody titers were achieved after 2 consecutive symptomatic or asymptomatic rotavirus infections. These findings indicate that serum anti-rotavirus antibody, especially IgA, was a marker of protection against rotavirus infection and moderate-to-severe diarrhea.
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Affiliation(s)
- F R Velázquez
- Department of Infectious Diseases, Instituto Nacional de la Nutrición, Mexico City, Mexico
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Farkas T, Jiang X, Guerrero ML, Zhong W, Wilton N, Berke T, Matson DO, Pickering LK, Ruiz-Palacios G. Prevalence and genetic diversity of human caliciviruses (HuCVs) in Mexican children. J Med Virol 2000; 62:217-23. [PMID: 11002251] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Human caliciviruses (HuCVs) contain two genera: "Norwalk-like viruses" (NLVs) and "Sapporo-like viruses" (SLVs). The importance of the two genera as a cause of acute gastroenteritis of infants and children remains unknown. Beginning in 1989, a birth cohort of children in Mexico was enrolled and monitored for acute gastroenteritis. A subset of 115 diarrhea stool specimens from 76 children and 66 non-diarrhea stool specimens from 64 children was examined for HuCVs by RT-PCR by using a primer pair (p289/290) that detects both NLVs and SLVs. Twenty-two (19%) of the 115 diarrhea stool specimens and 5 (7%) of 66 non-diarrhea stool specimens produced RT-PCR products of expected size (319 bp for NLVs and 331 bp for SLVs). Twenty of the twenty-seven strains were cloned and sequenced. Pairwise sequence analysis showed that 9 (60%) and 6 (40%) of the 15 strains from the diarrhea stools were NLVs and SLVs, respectively. The same proportions of NLVs (60%) and SLVs (40%) were observed in the non-diarrhea stools. Strains in the NLV genus could be further divided into four clusters: Lordsdale, MxV, and HV and one potentially new cluster. Strains in the SLV genus could be divided into three clusters: Sapporo/82, Lon/92, and a potentially new cluster. Strains from the Lordsdale cluster were the most common among these children. The findings of both genera and multiple clusters of HuCVs co-circulating and the identification of new strains of HuCVs in the population justify the need for future studies of HuCVs in infants and children.
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Affiliation(s)
- T Farkas
- Center for Pediatric Research, Eastern Virginia Medical School and Children's Hospital of The King's Daughters, Norfolk, Virginia, USA
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Farkas T, Jiang X, Guerrero ML, Zhong W, Wilton N, Berke T, Matson DO, Pickering LK, Ruiz-Palacios G. Prevalence and genetic diversity of human caliciviruses (HuCVs) in Mexican children. J Med Virol 2000. [DOI: 10.1002/1096-9071(200010)62:2<217::aid-jmv13>3.0.co;2-f] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Morrow AL, Guerrero ML, Shults J, Calva JJ, Lutter C, Bravo J, Ruiz-Palacios G, Morrow RC, Butterfoss FD. Efficacy of home-based peer counselling to promote exclusive breastfeeding: a randomised controlled trial. Lancet 1999; 353:1226-31. [PMID: 10217083 DOI: 10.1016/s0140-6736(98)08037-4] [Citation(s) in RCA: 281] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Exclusive breastfeeding is recommended worldwide but not commonly practised. We undertook a randomised controlled study of the efficacy of home-based peer counselling to increase the proportion of exclusive breastfeeding among mothers and infants residing in periurban Mexico City. METHODS Two intervention groups with different counselling frequencies, six visits (44) and three visits (52), were compared with a control group (34) that had no intervention. From March, 1995, to September, 1996, 170 pregnant women were identified by census and invited to participate in the study. Home visits were made during pregnancy and early post partum by peer counsellors recruited from the same community and trained by La Leche League. Data were collected by independent interview. Exclusive breastfeeding was defined by WHO criteria. FINDINGS 130 women participated in the study. Only 12 women refused participation. Study groups did not differ in baseline factors. At 3 months post partum, exclusive breastfeeding was practised by 67% of six-visit, 50% of three-visit, and 12% of control mothers (intervention groups vs controls, p<0.001; six-visit vs three-visit, p=0.02). Duration of breastfeeding was significantly (p=0.02) longer in intervention groups than in controls, and fewer intervention than control infants had an episode of diarrhoea (12% vs 26%, p=0.03). INTERPRETATION This is the first reported community-based randomised trial of breastfeeding promotion. Early and repeated contact with peer counsellors was associated with a significant increase in breastfeeding exclusivity and duration. The two-fold decrease in diarrhoea demonstrates the importance of breastfeeding promotion to infant health.
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Affiliation(s)
- A L Morrow
- Centre for Pediatric Research, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk 23510-1001, USA.
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Guerrero ML, Morrow RC, Calva JJ, Ortega-Gallegos H, Weller SC, Ruiz-Palacios GM, Morrow AL. Rapid ethnographic assessment of breastfeeding practices in periurban Mexico City. Bull World Health Organ 1999; 77:323-30. [PMID: 10327711 PMCID: PMC2557643] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Before carrying out a breastfeeding promotion programme in a periurban area of Mexico City, we conducted a rapid ethnographic study to determine the factors associated with absence of exclusive breastfeeding. The responses to pilot interviews were used to develop a standardized questionnaire regarding reasons for infant feeding choice, sources of advice, and barriers to breastfeeding. We interviewed a random sample of 150 mothers with a child < 5 years of age; 136 (91%) of them had initiated breastfeeding; but only 2% exclusively breastfed up to 4 months. The mothers consistently stated that the child's nutrition, health, growth, and hygiene were the main reasons for the type of feeding selected; cost, comfort, and the husband's opinion were less important. Physicians were ranked as the most important source of advice. Reduction or cessation of breastfeeding occurred on the doctor's advice (68%); or when the mothers encountered local folk illnesses such as "coraje" (52%) or "susto" (54%), which are associated with anger or fright; or had "not enough milk" (62%) or "bad milk" (56%); or because of illness of the mother (56%) or child (43%). During childhood illnesses and conditions, breastfeeding was reduced and the use of supplementary foods was increased. This study emphasizes the importance of cultural values in infant feeding choices, defines specific barriers to breastfeeding, and provides a basis for interventions to promote exclusive breastfeeding in the study population.
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Affiliation(s)
- M L Guerrero
- Department of Infectious Diseases, Instituto Nacional de la Nutrición, Mexico City, Mexico
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Sifuentes-Osornio J, Gonzalez R, Ponce-de-Leon A, Guerrero ML. Epidemiology and prognosis of Pseudomonas aeruginosa bacteremia in a tertiary care center. Rev Invest Clin 1998; 50:383-8. [PMID: 9949667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To describe the epidemiology and prognosis of P. aeruginosa bloodstream infections in a tertiary-care center. DESIGN Retrospective analysis. SETTING Tertiary-care teaching hospital in Mexico City. PATIENTS All cases of P. aeruginosa bacteremia diagnosed from 1981 to 1994. DATA Relevant demographic, clinical and therapeutic variables were analyzed. RESULTS A total of 153 bacteremias were found between 1981 and 1994, with a mean prevalence of 4.1 episodes per 1000 hospital discharges. Twenty-five percent of the infections derived from the biliary tract, and the most frequent underlying diseases were hematologic malignancies. The overall crude mortality was 46% (70/153) whereas mortality in the nosocomially-acquired episodes was 47% (58/124). Mortality within the first 72 h was 24% (37/153). A multivariate analysis showed six risk factors associated with a fatal outcome: age > or = 40 years, shock, mechanical ventilation, prior use of antibiotics, splenectomy and inappropriate selection of antibiotics. CONCLUSION The identification of risk factors, and therefore a prompt instauration of specific antibiotic therapy, improved the prognosis of these severely ill patients.
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Affiliation(s)
- J Sifuentes-Osornio
- Department of Infectious Diseases, Laboratory of Clinical Microbiology Vasco de Quiroga 15, Tlalpan México, D.F.
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Guerrero ML, Noel JS, Mitchell DK, Calva JJ, Morrow AL, Martínez J, Rosales G, Velázquez FR, Monroe SS, Glass RI, Pickering LK, Ruiz-Palacios GM. A prospective study of astrovirus diarrhea of infancy in Mexico City. Pediatr Infect Dis J 1998; 17:723-7. [PMID: 9726348 DOI: 10.1097/00006454-199808000-00012] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To describe the epidemiologic and clinical characteristics of astrovirus-associated diarrhea in a cohort of young children from a periurban community in Mexico City. METHODS From November, 1988, through December, 1991, a total of 214 children were enrolled in a longitudinal study of diarrhea and monitored from birth to 18 months of age. A stool specimen was collected during each episode of diarrhea. Specimens from a total of 510 diarrhea episodes were tested for astrovirus by enzyme immunoassay and examined for other enteric pathogens. The antigenic types of astrovirus were determined by a typing enzyme immunoassay. RESULTS Astrovirus was detected in 26 (5%) of 510 diarrhea episodes, with an incidence rate of 0.1 episode/child year; the highest rate was in children 13 to 18 months of age. Astrovirus-associated diarrhea was characterized by a median of 4 stools (range, 2 to 10) during the first 24 h, a median duration of 3 days (range, 1 to 21), vomiting (20%), and fever (7%). No cases of dehydration or repeat symptomatic infections were observed. Coinfection with another pathogen was detected in 11 of the 26 episodes (42%). Serotype 2 (35%) was most common, followed by serotypes 4 (15%), 3 (11%), and 1 and 5 (4% each); 31% were nontypable. Astrovirus-associated diarrhea was less severe, as measured by the number of stools (4.3 +/- 1.9), than diarrhea caused by rotavirus (7.1 +/- 2.8) or when coinfections occurred (5.5 +/- 1.6; P = 0.008). CONCLUSIONS Astrovirus was associated with 5% of the episodes of diarrhea in this cohort of young Mexican children and presented as a mild secretory diarrhea. Five predominant antigenic types were detected with type 2 being the most common.
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Affiliation(s)
- M L Guerrero
- Department of Infectious Disease, National Institute of Nutrition, Mexico City, Mexico
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Padilla-Noriega L, Méndez-Toss M, Menchaca G, Contreras JF, Romero-Guido P, Puerto FI, Guiscafré H, Mota F, Herrera I, Cedillo R, Muñoz O, Calva J, Guerrero ML, Coulson BS, Greenberg HB, López S, Arias CF. Antigenic and genomic diversity of human rotavirus VP4 in two consecutive epidemic seasons in Mexico. J Clin Microbiol 1998; 36:1688-92. [PMID: 9620401 PMCID: PMC104901 DOI: 10.1128/jcm.36.6.1688-1692.1998] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/1997] [Accepted: 03/11/1998] [Indexed: 02/07/2023] Open
Abstract
In the present investigation we characterized the antigenic diversity of the VP4 and VP7 proteins in 309 and 261 human rotavirus strains isolated during two consecutive epidemic seasons, respectively, in three different regions of Mexico. G3 was found to be the prevalent VP7 serotype during the first year, being superseded by serotype G1 strains during the second season. To antigenically characterize the VP4 protein of the strains isolated, we used five neutralizing monoclonal antibodies (MAbs) which showed specificity for VP4 serotypes P1A, P1B, and P2 in earlier studies. Eight different patterns of reactivity with these MAbs were found, and the prevalence of three of these patterns varied from one season to the next. The P genotype of a subset of 52 samples was determined by PCR. Among the strains characterized as genotype P[4] and P[8] there were three and five different VP4 MAb reactivity patterns, respectively, indicating that the diversity of neutralization epitopes in VP4 is greater than that previously appreciated by the genomic typing methods.
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Affiliation(s)
- L Padilla-Noriega
- Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Morelos
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Newburg DS, Peterson JA, Ruiz-Palacios GM, Matson DO, Morrow AL, Shults J, Guerrero ML, Chaturvedi P, Newburg SO, Scallan CD, Taylor MR, Ceriani RL, Pickering LK. Role of human-milk lactadherin in protection against symptomatic rotavirus infection. Lancet 1998; 351:1160-4. [PMID: 9643686 DOI: 10.1016/s0140-6736(97)10322-1] [Citation(s) in RCA: 209] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Human milk contains a 46 kDa mucin-associated glycoprotein, lactadherin, which binds specifically to rotavirus and inhibits its replication. This study tested the hypothesis that lactadherin protects against symptoms of rotavirus infection. METHODS 200 infants in Mexico City were recruited at birth and monitored by regular stool EIA for rotavirus, serology, and recording of feeding and stool patterns. Milk samples were obtained from the mothers weekly until 4 weeks post partum then monthly. The sample taken immediately before an infant's episode of rotavirus infection was assayed for lactadherin, butyrophilin, mucin, and secretory IgA. An infection was defined as symptomatic if diarrhoea occurred in the 5 days before or after detection of the virus. FINDINGS 31 infants developed rotavirus infection; 15 were symptomatic and 16 had no symptoms. The median concentration of lactadherin in the milk samples (obtained 4-41 days [median 13] before the infection) was 48.4 (range 5.6-180) microg/mL in the asymptomatic group and 29-2 (6.2-103-4) microg/mL in the symptomatic group. Although these medians did not differ significantly, in logistic regression analysis adjusted for age at infection and secretory IgA concentration there was a significant difference between the groups (p=0O01). No association between symptom status and concentrations of butyrophilin, mucin, or secretory IgA was found. INTERPRETATION Protection against rotavirus by human milk is associated with the glycoprotein lactadherin. This association is independent of products of the secretory immune system.
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Affiliation(s)
- D S Newburg
- Shriver Center for Mental Retardation, Waltham, MA 02254, USA.
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Guerrero ML, Beron J, Spindler B, Groscurth P, Wallimann T, Verrey F. Metabolic support of Na+ pump in apically permeabilized A6 kidney cell epithelia: role of creatine kinase. Am J Physiol 1997; 272:C697-706. [PMID: 9124314 DOI: 10.1152/ajpcell.1997.272.2.c697] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The contribution of ATP-generating systems to Na+ pump (Na+-K+-ATPase) function was studied in Xenopus laevis A6 kidney epithelia apically permeabilized with digitonin. The ouabain-inhibitable Na+ pump current (I(P)) was measured in the presence of otherwise impermeant inhibitors and/or substrates at Na+ and K+ concentrations that allowed near-maximal pump function. Confocal fluorescence microscopy after apical addition of sulfosuccinimidobiotin (molecular weight of 443) showed that all cells were permeabilized. Less than 15% of the endogenous lactate dehydrogenase and creatine kinase (CK) were released into the apical medium. The I(P) was approximately 5 microA/cm2 in the presence of D-glucose. Blocking glycolysis with 2-deoxy-D-glucose or oxidative phosphorylation with antimycin A decreased it by > or = 50%. Exogenously added ATP prevented these decreases fully or partially, respectively. Two CK isoforms were detected, one likely being mitochondrial and the other corresponding to mammalian B isoform of CK. Phosphocreatine partially restored Na+ pump activity during inhibition of either ATP synthesis pathway. In conclusion, the ATP used by Na+ pumps of apically digitonin-permeabilized A6 epithelia is generated to a similar extent by glycolysis and oxidative phosphorylation. The CK system can partially support the ATP supply to the Na+ pumps.
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Affiliation(s)
- M L Guerrero
- Institute for Cell Biology, Swiss Federal Institute of Technology, Zurich
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