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Vaughan J, Patel M, Suchard M, Gededzha M, Ranchod H, Howard W, Snyman T, Wiggill T. Derangements of immunological proteins in HIV-associated diffuse large B-cell lymphoma: the frequency and prognostic impact. Front Cell Infect Microbiol 2024; 14:1340096. [PMID: 38633747 PMCID: PMC11021765 DOI: 10.3389/fcimb.2024.1340096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/12/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Diffuse large B-cell lymphoma (DLBCL) is an aggressive malignancy of B-cells frequently encountered among people living with HIV. Immunological abnormalities are common in immunocompetent individuals with DLBCL, and are often associated with poorer outcomes. Currently, data on derangements of immunological proteins, such as cytokines and acute phase reactants, and their impact on outcomes in HIV-associated DLBCL (HIV-DLBCL) is lacking. This study assessed the levels and prognostic relevance of interleukin (IL)-6, IL-10 and Transforming Growth Factor Beta (TGFβ), the acute phase proteins C-reactive protein (CRP) and ferritin; serum free light chains (SFLC) (elevation of which reflects a prolonged pro-inflammatory state); and the activity of the immunosuppressive enzyme Indoleamine 2,3-dioxygenase (IDO)in South African patients with DLBCL. Methods Seventy-six patients with incident DLBCL were enrolled, and peripheral blood IL-6, IL-10, TGFβ, SFLC and IDO-activity measured in selected patients. Additional clinical and laboratory findings (including ferritin and CRP) were recorded from the hospital records. Results Sixty-one (80.3%) of the included patients were people living with HIV (median CD4-count = 148 cells/ul), and survival rates were poor (12-month survival rate 30.0%). The majority of the immunological proteins, except for TGFβ and ferritin, were significantly higher among the people living with HIV. Elevation of IL-6, SFLC and IDO-activity were not associated with survival in HIV-DLBCL, while raised IL-10, CRP, ferritin and TGFβ were. On multivariate analysis, immunological proteins associated with survival independently from the International Prognostic Index (IPI) included TGFβ, ferritin and IL-10. Conclusion Derangements of immunological proteins are common in HIV-DLBCL, and have a differential association with survival compared to that reported elsewhere. Elevation of TGFβ, IL-10 and ferritin were associated with survival independently from the IPI. In view of the poor survival rates in this cohort, investigation of the directed targeting of these cytokines would be of interest in our setting.
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Affiliation(s)
- Jenifer Vaughan
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Services, Johannesburg, South Africa
| | - Moosa Patel
- Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Clinical Haematology Unit, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Melinda Suchard
- Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maemu Gededzha
- National Health Laboratory Services, Johannesburg, South Africa
- Department of Immunology, University of the Witwatersrand, Johannesburg, South Africa
| | - Heena Ranchod
- Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Communicable Diseases, Centre for Vaccines and Immunology, Johannesburg, South Africa
| | - Wayne Howard
- Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Communicable Diseases, Centre for Vaccines and Immunology, Johannesburg, South Africa
| | - Tracy Snyman
- National Health Laboratory Services, Johannesburg, South Africa
| | - Tracey Wiggill
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Services, Johannesburg, South Africa
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2
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Iwu-Jaja C, Ndlovu NL, Rachida S, Yousif M, Taukobong S, Macheke M, Mhlanga L, van Schalkwyk C, Pulliam JRC, Moultrie T, le Roux W, Schaefer L, Pocock G, Coetzee LZ, Mans J, Bux F, Pillay L, de Villiers D, du Toit AP, Jambo D, Gomba A, Groenink S, Madgewick N, van der Walt M, Mutshembele A, Berkowitz N, Suchard M, McCarthy K. The role of wastewater-based epidemiology for SARS-CoV-2 in developing countries: Cumulative evidence from South Africa supports sentinel site surveillance to guide public health decision-making. Sci Total Environ 2023; 903:165817. [PMID: 37506905 DOI: 10.1016/j.scitotenv.2023.165817] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
The uptake of wastewater-based epidemiology (WBE) for SARS-CoV-2 as a complementary tool for monitoring population-level epidemiological features of the COVID-19 pandemic in low-and-middle-income countries (LMICs) is low. We report on the findings from the South African SARS-CoV-2 WBE surveillance network and make recommendations regarding the implementation of WBE in LMICs. Eight laboratories quantified influent wastewater collected from 87 wastewater treatment plants in all nine South African provinces from 01 June 2021 to 31 May 2022 inclusive, during the 3rd and 4th waves of COVID-19. Correlation and regression analyses between wastewater levels of SARS-CoV-2 and district laboratory-confirmed caseloads were conducted. The sensitivity and specificity of novel 'rules' based on WBE data to predict an epidemic wave were determined. Amongst 2158 wastewater samples, 543/648 (85 %) samples taken during a wave tested positive for SARS-CoV-2 compared with 842 positive tests from 1512 (55 %) samples taken during the interwave period. Overall, the regression-co-efficient was 0,66 (95 % confidence interval = 0,6-0,72, R2 = 0.59), ranging from 0.14 to 0.87 by testing laboratory. Early warning of the 4th wave of SARS-CoV-2 in Gauteng Province in November-December 2021 was demonstrated. A 50 % increase in log copies of SARS-CoV-2 compared with a rolling mean over the previous five weeks was the most sensitive predictive rule (58 %) to predict a new wave. Our findings support investment in WBE for SARS-CoV-2 surveillance in LMICs as an early warning tool. Standardising test methodology is necessary due to varying correlation strengths across laboratories and redundancy across testing plants. A sentinel site model can be used for surveillance networks without affecting WBE finding for decision-making. Further research is needed to identify optimal test frequency and the need for normalisation to population size to identify predictive and interpretive rules to support early warning and public health action.
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Affiliation(s)
- Chinwe Iwu-Jaja
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, South Africa.
| | - Nkosenhle Lindo Ndlovu
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, South Africa.
| | - Said Rachida
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, South Africa
| | - Mukhlid Yousif
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, South Africa; School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Setshaba Taukobong
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, South Africa
| | - Mokgaetji Macheke
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, South Africa
| | - Laurette Mhlanga
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Cari van Schalkwyk
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Juliet R C Pulliam
- South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Tom Moultrie
- Centre for Actuarial Research, University of Cape Town, South Africa
| | - Wouter le Roux
- Water Centre, Council for Scientific and Industrial Research, Pretoria, South Africa
| | - Lisa Schaefer
- Water Centre, Council for Scientific and Industrial Research, Pretoria, South Africa
| | | | | | - Janet Mans
- Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | - Faizal Bux
- Institute for Water and Wastewater Technology, Durban University of Technology, Durban, South Africa
| | - Leanne Pillay
- Institute for Water and Wastewater Technology, Durban University of Technology, Durban, South Africa
| | | | - A P du Toit
- Lumegen Laboratories (Pty) Ltd, Potchefstroom, South Africa
| | - Don Jambo
- National Institute for Occupational Health, South Africa
| | | | | | | | | | | | | | - Melinda Suchard
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, South Africa; School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerrigan McCarthy
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, South Africa; School of Pathology, University of the Witwatersrand, Johannesburg, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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3
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Yousif M, Rachida S, Taukobong S, Ndlovu N, Iwu-Jaja C, Howard W, Moonsamy S, Mhlambi N, Gwala S, Levy JI, Andersen KG, Scheepers C, von Gottberg A, Wolter N, Bhiman JN, Amoako DG, Ismail A, Suchard M, McCarthy K. SARS-CoV-2 genomic surveillance in wastewater as a model for monitoring evolution of endemic viruses. Nat Commun 2023; 14:6325. [PMID: 37816740 PMCID: PMC10564906 DOI: 10.1038/s41467-023-41369-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/30/2023] [Indexed: 10/12/2023] Open
Abstract
As global SARS-CoV-2 burden and testing frequency have decreased, wastewater surveillance has emerged as a key tool to support clinical surveillance efforts. The aims of this study were to identify and characterize SARS-CoV-2 variants in wastewater samples collected from urban centers across South Africa. Here we show that wastewater sequencing analyses are temporally concordant with clinical genomic surveillance and reveal the presence of multiple lineages not detected by clinical surveillance. We show that wastewater genomics can support SARS-CoV-2 epidemiological investigations by reliably recovering the prevalence of local circulating variants, even when clinical samples are not available. Further, we find that analysis of mutations observed in wastewater can provide a signal of upcoming lineage transitions. Our study demonstrates the utility of wastewater genomics to monitor evolution and spread of endemic viruses.
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Affiliation(s)
- Mukhlid Yousif
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa.
- Department of Virology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Said Rachida
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Setshaba Taukobong
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Nkosenhle Ndlovu
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Chinwe Iwu-Jaja
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Wayne Howard
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Shelina Moonsamy
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Nompilo Mhlambi
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Sipho Gwala
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Joshua I Levy
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, 92037, USA
| | - Kristian G Andersen
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, 92037, USA
| | - Cathrine Scheepers
- SAMRC Antibody Immunity Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jinal N Bhiman
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Daniel Gyamfi Amoako
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Arshad Ismail
- Sequencing Core Facility, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
- Department of Biochemistry and Microbiology, Faculty of Science, Engineering and Agriculture, University of Venda, Thohoyandou, South Africa
| | - Melinda Suchard
- Department of Chemical Pathology, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerrigan McCarthy
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
- Department of Virology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Yousif M, Hong H, Malfeld S, Smit S, Makhathini L, Motsamai T, Tselana D, Manamela M, Kamupira M, Maseti E, Ranchod H, Otwombe K, McCarthy K, Suchard M. Measles incidence in South Africa: a six-year review, 2015-2020. BMC Public Health 2022; 22:1647. [PMID: 36042453 PMCID: PMC9427172 DOI: 10.1186/s12889-022-14069-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/22/2022] [Indexed: 11/22/2022] Open
Abstract
In 2012 the World Health Organization (WHO) aimed to eliminate measles in five regions by 2020. This retrospective descriptive study reviewed measles surveillance data in South Africa for the period 2015—2020 to document the epidemiology of measles and the progress made towards meeting the 2020 measles elimination goal. A total of 22,578 specimens were tested over the period 2015—2020 yielding 401 (1.8%) confirmed measles cases, 321 (1.4%) compatible and 21,856 (96.8%) discarded cases. The most affected age group was 0–4 year olds. At the provincial level, South Africa achieved adequate surveillance, defined as more than two cases of febrile rash notified annually per 100 000 popoulation, except for KwaZulu-Natal and Limpopo in 2020, probably due to COVID-19 lockdown restrictions. Of confirmed cases, only 26% were vaccinated, 3% were too young to receive vaccines, 5% were not vaccinated, and 65% had unknown vaccination status. Measles vaccine effectiveness amongst 1–4 year olds was 80%. Using the standard case definition, South Africa achieved the measles elimination target of less than one case per one million nationally in years 2015, 2016 and 2020. The years 2017 to 2019 had incidence rates exceeding one per million nationally. Using a narrow case definition, that excluded positive rubella cases, improved the indicators with only the year 2017 having an incidence rate of more than one per million. South Africa displays intermittent measles outbreaks approximately six-yearly interspersed by inter-epidemic periods in which the country meets measles elimination targets. Intense effort is needed to increase the vaccine coverage to avoid periodic outbreaks. Enhanced molecular testing of each case will be required as measles incidence declines regionally.
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Affiliation(s)
- Mukhlid Yousif
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa. .,Department of Virology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Heather Hong
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Susan Malfeld
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Sheilagh Smit
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Lillian Makhathini
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Tshepo Motsamai
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Dipolelo Tselana
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Morubula Manamela
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Mercy Kamupira
- World Health Organization, Pretoria, South Africa.,UNICEF, Pretoria, South Africa
| | - Elizabeth Maseti
- Child, Youth and School Health, National Department of Health, Pretoria, South Africa
| | - Heena Ranchod
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.,Department of Chemical Pathology, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerrigan McCarthy
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Melinda Suchard
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.,Department of Chemical Pathology, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
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5
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Hong H, Malfeld S, Smit S, Makhathini L, Fortuin M, Motsamai T, Tselana D, Manamela MJ, Motaze NV, Ntshoe G, Kamupira M, Khosa-Lesola E, Mokoena S, Buthelezi T, Maseti E, Suchard M. A retrospective 5-year review of rubella in South Africa prior to the introduction of a rubella-containing vaccine. PLoS One 2022; 17:e0265870. [PMID: 35512030 PMCID: PMC9071131 DOI: 10.1371/journal.pone.0265870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/09/2022] [Indexed: 01/13/2023] Open
Abstract
South Africa has yet to introduce a rubella-containing vaccine (RCV) into its Expanded Programme on Immunisation (EPI). Here we evaluated the incidence of laboratory-confirmed rubella and congenital rubella syndrome (CRS) cases over the years 2015 to 2019, to document the epidemiology of rubella and CRS within South Africa prior to a RCV introduction. This retrospective study evaluated the number of laboratory-confirmed rubella cases reported through the national febrile rash surveillance system. A positive test for rubella immunoglobulin M (IgM) antibodies was considered a confirmed rubella case. For CRS cases, we reported laboratory-confirmed CRS cases collected from 28 sentinel-sites from all nine provinces of South Africa. From 2015-2019, 19 773 serum samples were tested for rubella IgM antibodies, 6 643 (33.6%) were confirmed rubella cases. Rubella was seasonal, with peaks in spring (September to November). Case numbers were similar between males (n = 3 239; 50.1%) and females (n = 3 232; 49.9%). The highest burden of cases occurred in 2017 (n = 2 526; 38%). The median age was 5 years (IQR: 3-7 years). Importantly, of females with rubella, 5.0% (161 of 3 232) of the cases were among women of reproductive age (15-44 years). A total of 62 CRS cases were reported, the mortality rate was 12.9% (n = 8), and the most common birth defect was congenital heart disease. In conclusion, rubella is endemic in South Africa. Children below the age of 10 years were the most affected, however, rubella was also reported among women of reproductive age. The baseline data represented here provides insight into the burden of rubella and CRS in South Africa prior to the introduction of a RCV, and can enable planning of RCV introduction into the South African EPI.
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Affiliation(s)
- Heather Hong
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
- Department of Virology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Susan Malfeld
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Sheilagh Smit
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Lillian Makhathini
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Mirriam Fortuin
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Tshepo Motsamai
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Dipolelo Tselana
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Morubula Jack Manamela
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Nkengafac Villyen Motaze
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Genevie Ntshoe
- Outbreak Response Unit, Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | | | | | - Thulasizwe Buthelezi
- Child, Youth and School Health, National Department of Health, Pretoria, South Africa
| | - Elizabeth Maseti
- Child, Youth and School Health, National Department of Health, Pretoria, South Africa
| | - Melinda Suchard
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
- Department of Chemical Pathology, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
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Sikhosana ML, Suchard M, Kuonza L, Cutland C, Slogrove A, Otwombe K, Motaze NV. Association between pre-eclampsia and HIV: a case-control study in urban South Africa. AJOG Global Reports 2022; 2:100056. [PMID: 36276804 PMCID: PMC9563819 DOI: 10.1016/j.xagr.2022.100056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Preeclampsia is a considerable cause of maternal and infant morbidity and mortality. Although its etiology is unknown, preeclampsia has been described as a state of exaggerated maternal inflammatory response. Therefore, it has been hypothesized that preeclampsia would occur less commonly in states of immune deficiency. OBJECTIVE This study aimed to compare the prevalence of treated and untreated HIV infections among preeclamptic cases and controls, determine infant outcomes, and evaluate the association between HIV and preeclampsia after adjusting for known predictor variables, including maternal age, gravidity, body mass index, and smoking. STUDY DESIGN This case-control study investigated the association between preeclampsia and HIV infection using secondary data from an unrelated study. We defined preeclamptic cases as pregnant women who were normotensive until 20 weeks of gestation and thereafter had at least 1 high blood pressure measurement either before or at delivery and proteinuria, defined as protein excretion of ≥300 mg within 24 hours or >2 protein on dipstick urinalysis. The prevalence of HIV infection was compared between cases and controls. Multivariate logistic regression analysis was used to assess the association between preeclampsia and potential confounding variables and reported using odds ratios and 95% confidence intervals. RESULTS There were 571 cases with preeclampsia and 596 normotensive controls included in this study. The median age was 27 years for cases and 26 years for controls (P=.008). Most participants (69%) had ≥2 previous pregnancies with no difference between the cases and controls (P=.176). Overall, 43% of the participants were obese, with a mean body mass index of 29 (interquartile range, 24.5–34.2), with higher proportions of women who were overweight and obese in the group with preeclampsia (P=.031). The prevalence of HIV was significantly lower in cases than in controls (24% vs 30%, respectively; P=.014). Compared with 16% of infants born preterm to normotensive controls, 48% of infants were born preterm born to women with preeclampsia (P<.001). Compared with 14% of infants born with low birthweight to normotensive controls, 53% of infants were born with low birthweight to women with preeclampsia (P<.0001). Untreated HIV infection was negatively associated with preeclampsia (unadjusted odds ratio, 0.330; 95% confidence interval, 0.197–0.552; P<.0001), whereas factors associated with preeclampsia were advanced maternal age (odds ratio, 1.673; 95% confidence interval, 1.209–2.316; P=.002) and obesity (odds ratio, 1.611; 95% confidence interval, 1.023–2.537; P=.040). After adjusting for maternal age, gravidity, smoking, and body mass index in the multivariate regression, only obesity remained significantly associated with preeclampsia (adjusted odds ratio, 1.624; 95% confidence interval, 1.024–2.575; P=.039). CONCLUSION Before the large-scale rollout of antiretroviral therapy in a setting with a high burden of HIV and preeclampsia, untreated HIV infection was found to have a protective effect against preeclampsia. The protective effect against preeclampsia was not apparent for HIV infection treated with antiretroviral therapy.
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Affiliation(s)
- Mpho Lerato Sikhosana
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, Johannesburg, Gauteng Province, South Africa (Drs Sikhosana and Kuonza)
- Corresponding author: Mpho Lerato Sikhosana. MBBCh, MPH, FCPath(SA)Viro.
| | - Melinda Suchard
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, Johannesburg, Gauteng Province, South Africa (Drs Suchard and Motaze)
- School of Pathology, University of the Witwatersrand, Johannesburg, Gauteng Province, South Africa (Dr Suchard)
| | - Lazarus Kuonza
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, Johannesburg, Gauteng Province, South Africa (Drs Sikhosana and Kuonza)
| | - Clare Cutland
- Faculty of Health Sciences, African Leadership in Vaccinology Expertise, University of the Witwatersrand, Johannesburg, Gauteng Province, South Africa (Dr Cutland)
| | - Amy Slogrove
- Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Stellenbosch University, Worcester, Western Cape Province, South Africa (Dr Slogrove)
| | - Kennedy Otwombe
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng Province, South Africa (Dr Otwombe)
- Perinatal HIV Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, Gauteng Province, South Africa (Dr Otwombe)
| | - Nkengafac Villyen Motaze
- Medicine Usage in South Africa, School of Pharmacy, Faculty of Health Sciences, North West University, Potchefstroom, North West Province, South Africa (Dr Motaze)
- Faculty of Medicine and Health Sciences, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Johannesburg, Gauteng Province, South Africa (Dr Motaze)
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7
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McCarthy K, Howard W, Yousif M, Moonsamy S, Suchard M. The show is not over - wild-type polio in Malawi is a wake-up call and an opportunity for elimination efforts. Int J Infect Dis 2022; 119:32-33. [PMID: 35257902 DOI: 10.1016/j.ijid.2022.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kerrigan McCarthy
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand.
| | - Wayne Howard
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Mukhlid Yousif
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, Johannesburg, South Africa; Department of Virology, School of Pathology, Faculty of Health Sciences, University of the Witatersrand, Johannesburg, South Africa
| | - Shelina Moonsamy
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Melinda Suchard
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, Johannesburg, South Africa; Department of Chemical Pathology, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
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8
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Prabdial-Sing N, Motaze V, Manamela J, McCarthy K, Suchard M. Establishment of Outbreak Thresholds for Hepatitis A in South Africa Using Laboratory Surveillance, 2017–2020. Viruses 2021; 13:v13122470. [PMID: 34960739 PMCID: PMC8704411 DOI: 10.3390/v13122470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 12/01/2022] Open
Abstract
As South Africa transitions from endemic to intermediate endemicity, hepatitis A surveillance needs strengthening to monitor trends in disease incidence and to identify outbreaks. We used passive laboratory-based surveillance data from the National Health Laboratory Services to calculate national hepatitis A incidence and to establish thresholds for outbreaks. Incidence was calculated by age and geographic location. The static threshold used two or three standard deviations (SDs) above the mean hepatitis A incidence in 2017–2019, and a cumulative summation (CuSum2) threshold used three SDs above the mean of the preceding seven months. These thresholds were applied to hepatitis A data for 2020. From 2017 to 2020, the mean incidence of hepatitis A IgM was 4.06/100,000 and ranged from 4.23 to 4.85/100,000 per year. Hepatitis A incidence was highest in the Western Cape province (WCP) (7.00–10.92/100,000 per year). The highest incidence was in the 1–9-year-olds. The incidence of hepatitis A in 2020 exceeded the static threshold in two districts of the WCP: Cape Winelands in January and Overberg district in August. The provincial incidence did not exceed the static and CuSum2 thresholds. District-level analysis using either threshold was sensitive enough to monitor trends and to alert district health authorities, allowing early outbreak responses.
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Affiliation(s)
- Nishi Prabdial-Sing
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, Johannesburg 2131, South Africa; (V.M.); (J.M.); (K.M.); (M.S.)
- Faculty of Health Sciences, School of Pathology, University of Witwatersrand, Johannesburg 2000, South Africa
- Correspondence:
| | - Villyen Motaze
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, Johannesburg 2131, South Africa; (V.M.); (J.M.); (K.M.); (M.S.)
- Department of Global Health, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7935, South Africa
| | - Jack Manamela
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, Johannesburg 2131, South Africa; (V.M.); (J.M.); (K.M.); (M.S.)
| | - Kerrigan McCarthy
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, Johannesburg 2131, South Africa; (V.M.); (J.M.); (K.M.); (M.S.)
| | - Melinda Suchard
- Division of the National Health Laboratory Service, National Institute for Communicable Diseases, Johannesburg 2131, South Africa; (V.M.); (J.M.); (K.M.); (M.S.)
- Faculty of Health Sciences, School of Pathology, University of Witwatersrand, Johannesburg 2000, South Africa
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9
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Howard W, Moonsamy S, Seakamela L, Jallow S, Modiko F, du Plessis H, Sibiya R, Kamupira M, Maseti E, Suchard M. Sensitivity of the acute flaccid paralysis surveillance system for poliovirus in South Africa, 2016-2019. J Med Microbiol 2021; 70. [PMID: 34672918 PMCID: PMC8604170 DOI: 10.1099/jmm.0.001441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction Global poliovirus eradication is a public health emergency of international concern. The acute flaccid paralysis (AFP) surveillance programme in South Africa has been instrumental in eliminating polioviruses and keeping the country poliovirus free. Gap statement The sensitivity of surveillance for polioviruses by every African country is of global interest in the effort to ensure global health security from poliovirus re-emergence. Aim To describe the epidemiology of polioviruses from AFP cases and environmental samples in South Africa and to report the performance of the AFP surveillance system for the years 2016–2019 against targets established by the World Health Organization (WHO). Methods Stool specimens from AFP or suspected AFP cases were received and tested as per WHO guidelines. Environmental samples were gathered from sites across the Gauteng province using the grab collection method. Concentration was effected by the two-phase polyethylene glycol method approved by the WHO. Suspected polioviruses were isolated in RD and/or L20B cell cultures through identification of typical cytopathic effects. The presence of polioviruses was confirmed by intratypic differentiation PCR. All polioviruses were sequenced using the Sanger method, and their VP1 gene analysed for mutations. Results Data from 4597 samples (2385 cases) were analysed from the years 2016–2019. Two cases of immunodeficiency-associated vaccine-derived poliovirus (iVDPV) type 3 were detected in 2017 and 2018. A further 24 Sabin type 1 or type 3 polioviruses were detected for the 4 years. The national surveillance programme detected an average of 3.1 cases of AFP/100 000 individuals under 15 years old (2.8/100 000–3.5/100 000). The stool adequacy of the samples received was 53.0 % (47.0–55.0%), well below the WHO target of 80 % adequacy. More than 90 % of results were released from the laboratory within the turnaround time (96.6 %) and non-polio enteroviruses were detected in 11.6 % of all samples. Environmental surveillance detected non-polio enterovirus in 87.5 % of sewage samples and Sabin polioviruses in 12.5 % of samples. Conclusion The AFP surveillance programme in South Africa is sensitive to detect polioviruses in South Africa and provided no evidence of wild poliovirus or VDPV circulation in the country.
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Affiliation(s)
- Wayne Howard
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Services, Johannesburg, South Africa
- *Correspondence: Wayne Howard,
| | - Shelina Moonsamy
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Services, Johannesburg, South Africa
| | - Lerato Seakamela
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Services, Johannesburg, South Africa
| | - Sabelle Jallow
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Services, Johannesburg, South Africa
| | - Faith Modiko
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Services, Johannesburg, South Africa
| | - Heleen du Plessis
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Services, Johannesburg, South Africa
| | - Rosina Sibiya
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Services, Johannesburg, South Africa
| | | | | | - Melinda Suchard
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Services, Johannesburg, South Africa
- Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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10
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Adu-Gyamfi C, Savulescu D, Mikhathani L, Otwombe K, Salazar-Austin N, Chaisson R, Martinson N, George J, Suchard M. Plasma Kynurenine-to-Tryptophan Ratio, a Highly Sensitive Blood-Based Diagnostic Tool for Tuberculosis in Pregnant Women Living With Human Immunodeficiency Virus (HIV). Clin Infect Dis 2021; 73:1027-1036. [PMID: 33718949 PMCID: PMC8442800 DOI: 10.1093/cid/ciab232] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND For pregnant women living with human immunodeficiency virus (HIV), concurrent active tuberculosis (TB) disease increases the risk of maternal mortality and poor pregnancy outcomes. Plasma indoleamine 2,3-dioxygenase (IDO) activity measured by kynurenine-to-tryptophan (K/T) ratio has been proposed as a blood-based TB biomarker. We investigated whether plasma K/T ratio could be used to diagnose active TB among pregnant women with HIV. METHODS Using an enzyme-linked immunosorbent assay (ELISA), we measured K/T ratio in 72 pregnant women with and active TB and compared them to 117 pregnant women with HIB but without TB, matched by age and gestational age. RESULTS Plasma K/T ratio was significantly elevated during pregnancy compared to sampling done after pregnancy (P < .0001). Pregnant women who had received isoniazid preventive therapy (IPT) before enrollment had decreased plasma K/T ratio compared to those who had not received IPT (P = .0174). Plasma K/T ratio was elevated in women with active TB at time of diagnosis compared to those without TB (P < .0001). Using a cutoff of 0.100, plasma K/T ratio gave a diagnostic sensitivity of 94% (95% confidence interval [CI]: 82-95), specificity of 90% (95% CI: 80-91), positive predictive value (PPV) 85% and negative predictive value (NPV) 98%. A receiver operating characteristic curve (ROC) gave an area under the curve of 0.95 (95% CI: .92-.97, P < .0001).In conclusion, plasma K/T ratio is a sensitive blood-based diagnostic test for active TB disease in pregnant women living with HIV. Plasma K/T ratio should be further evaluated as an initial TB diagnostic test to determine its impact on patient care.
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Affiliation(s)
- Clement Adu-Gyamfi
- Center for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
- Department of Chemical Pathology, School of Pathology, Faculty of Health Sciences, University of The Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Dana Savulescu
- Center for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Lillian Mikhathani
- Center for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal Health Research Unit (PHRU), Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa
| | - Nicole Salazar-Austin
- Johns Hopkins University Centre for TB Research, Baltimore, MarylandUSA
- Johns Hopkins School of Medicine, Baltimore, MarylandUSA
| | - Richard Chaisson
- Johns Hopkins University Centre for TB Research, Baltimore, MarylandUSA
| | - Neil Martinson
- Perinatal Health Research Unit (PHRU), Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, Faculty of Health Sciences, University of The Witwatersrand, Johannesburg, South Africa
- Johns Hopkins University Centre for TB Research, Baltimore, MarylandUSA
| | - Jaya George
- Department of Chemical Pathology, School of Pathology, Faculty of Health Sciences, University of The Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Melinda Suchard
- Center for Vaccines and Immunology, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
- Department of Chemical Pathology, School of Pathology, Faculty of Health Sciences, University of The Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
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11
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Tushabe P, Howard W, Bwogi J, Birungi M, Eliku JP, Kakooza P, Bukenya H, Namuwulya P, Gaizi J, Tibanagwa M, Kabaliisa T, Mulindwa J, Muhanguzi D, Suchard M, Gumede N, Bakamutumaho B. Molecular characterization of non-polio enteroviruses isolated from acute flaccid paralysis patients in Uganda. J Med Virol 2021; 93:4720-4728. [PMID: 33458840 PMCID: PMC9787851 DOI: 10.1002/jmv.26804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/18/2020] [Accepted: 01/14/2021] [Indexed: 12/31/2022]
Abstract
Enteroviruses (EVs) are RNA viruses that can cause many clinical syndromes including acute flaccid paralysis (AFP). Within the global polio laboratory network, EVs are categorized either as polioviruses or non-polio enteroviruses (NPEVs). Specific NPEVs have been described in polio-like residual paralytic events in AFP patients. Retrospective analysis of 112 NPEV isolates from AFP patients was performed and thirty one NPEV types were identified of which 91% were Enterovirus B and 9% were Enterovirus A species. The NPEVs were distributed across the country with most patients in the eastern region (41/89; 46.1%). The highest proportion of patients were children less than 5 years (77/89; 86.5%) and male patients were more common (54/89; 60.7%). Echovirus 11 (11/89; 12.4%) was frequently observed and phylogenetic analysis of these sequences revealed high diversity. Coxsackievirus B5 (CV-B5), CV-B6, E21, and EV-B69 were only seen in patients with residual paralysis. Analyses of the EV-A71 sequence indicated a unique genogroup.
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Affiliation(s)
| | - Wayne Howard
- National Institute for Communicable DiseasesJohannesburgSouth Africa
| | | | - Molly Birungi
- EPI LaboratoryUganda Virus Research InstituteEntebbeUganda
| | - James P. Eliku
- EPI LaboratoryUganda Virus Research InstituteEntebbeUganda
| | | | - Henry Bukenya
- EPI LaboratoryUganda Virus Research InstituteEntebbeUganda
| | | | - Joseph Gaizi
- EPI LaboratoryUganda Virus Research InstituteEntebbeUganda
| | - Mayi Tibanagwa
- EPI LaboratoryUganda Virus Research InstituteEntebbeUganda
| | | | - Julius Mulindwa
- Department of Biochemistry and Sports Sciences, College of Natural SciencesSchool of Biological Sciences, Makerere UniversityKampalaUganda
| | - Dennis Muhanguzi
- Department of Biomolecular Resources and Biolaboratory SciencesCollege of Veterinary Medicine, Animal Resources and Biosecurity, Makerere UniversityKampalaUganda
| | - Melinda Suchard
- National Institute for Communicable DiseasesJohannesburgSouth Africa,University of WitwatersrandJohannesburgSouth Africa
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12
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Jallow S, Wilmshurst JM, Howard W, Copelyn J, Seakamela L, Chan KW, Sebunya R, Sibiya R, Du Plessis H, Jacobs C, Berkowitz N, Blumberg L, McCarthy K, Maseti E, Kamupira M, Dlamini N, Gumede N, Diop OM, Lau YL, Moonsamy S, Eley B, Suchard M. Accelerated Immunodeficiency-associated Vaccine-derived Poliovirus Serotype 3 Sequence Evolution Rate in an 11-week-old Boy With X-linked Agammaglobulinemia and Perinatal Human Immunodeficiency Virus Exposure. Clin Infect Dis 2021; 70:132-135. [PMID: 31086993 PMCID: PMC6912151 DOI: 10.1093/cid/ciz361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/29/2019] [Indexed: 01/10/2023] Open
Abstract
Primary B-cell immunodeficiencies are risk factors for the generation of vaccine-derived polioviruses. We report immunodeficiency-associated vaccine-derived poliovirus serotype 3 in an 11-week-old boy with X-linked agammaglobulinemia. Unique characteristics of this case include early age of presentation, high viral evolutionary rate, and the child's perinatal exposure to human immunodeficiency virus.
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Affiliation(s)
- Sabelle Jallow
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg
| | - Jo M Wilmshurst
- Department of Paediatric Neurology, Neuroscience Institute, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | - Wayne Howard
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg
| | - Julie Copelyn
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.,Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Lerato Seakamela
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg
| | - Koon-Wing Chan
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, China
| | - Robert Sebunya
- Department of Paediatric Neurology, Neuroscience Institute, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | - Rosinah Sibiya
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg
| | - Heleen Du Plessis
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg
| | - Charlene Jacobs
- Division of Public Health, Surveillance and Response, Department of Health, Provincial Government of the Western Cape, Cape Town
| | | | | | - Kerrigan McCarthy
- Outbreak Response Unit, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg
| | - Elizabeth Maseti
- Child, Youth and School Health, National Department of Health, Pretoria, South Africa
| | - Mercy Kamupira
- World Health Organization (WHO) Country Office, Pretoria, South Africa
| | - Nonhlanhla Dlamini
- Child, Youth and School Health, National Department of Health, Pretoria, South Africa
| | - Nicksy Gumede
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | - Ousmane M Diop
- Polio Department, WHO Strategic Initiatives Cluster, Geneva, Switzerland
| | - Yu Lung Lau
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, China
| | - Shelina Moonsamy
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg
| | - Brian Eley
- Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.,Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Melinda Suchard
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg.,Chemical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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13
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Motaze NV, Manamela J, Smit S, Rabie H, Harper K, duPlessis N, Reubenson G, Coetzee M, Ballot D, Moore D, Nuttall J, Linley L, Tooke L, Kriel J, Hallbauer U, Sutton C, Moodley P, Hardie D, Mazanderani AH, Goosen F, Kyaw T, Leroux D, Hussain A, Singh R, Kelly C, Ducasse G, Muller M, Blaauw M, Hamese M, Leeuw T, Mekgoe O, Rakgole P, Dungwa N, Maphosa T, Sanyane K, Preiser W, Cohen C, Suchard M. Congenital Rubella Syndrome Surveillance in South Africa Using a Sentinel Site Approach: A Cross-sectional Study. Clin Infect Dis 2020; 68:1658-1664. [PMID: 30203002 PMCID: PMC6495013 DOI: 10.1093/cid/ciy758] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 08/31/2018] [Indexed: 11/12/2022] Open
Abstract
Background Congenital rubella syndrome (CRS) includes disorders associated with intrauterine rubella infection. Incidence of CRS is higher in countries with no rubella-containing vaccines (RCV) in their immunization schedules. In the World Health Organization African region, RCVs are being introduced as part of the 2012–2020 global measles and rubella strategic plan. This study aimed to describe the epidemiology of confirmed CRS in South Africa prior to introduction of RCVs in the immunization schedule. Methods This was a descriptive study with 28 sentinel sites reporting laboratory-confirmed CRS cases in all 9 provinces of South Africa. In the retrospective phase (2010 to 2014), CRS cases were retrieved from medical records, and in the prospective phase (2015 to 2017) clinicians at study sites reported CRS cases monthly. Results There were 42 confirmed CRS cases in the retrospective phase and 53 confirmed CRS cases in the prospective phase. Most frequently reported birth defects were congenital heart disease and cataracts. The median age of mothers of CRS cases was 21 years in the retrospective phase (range: 11 to 38 years) and 22 years in the prospective phase (range: 15 to 38 years). Conclusion Baseline data on laboratory-confirmed CRS will enable planning and monitoring of RCV implementation in the South African Expanded Programme on Immunization program. Ninety-eight percent of mothers of infants with CRS were young women 14–30 years old, indicating a potential immunity gap in this age group for consideration during introduction of RCV.
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Affiliation(s)
- Nkengafac Villyen Motaze
- National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa.,Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Jack Manamela
- National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Sheilagh Smit
- National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Helena Rabie
- Department of Pediatrics, Tygerberg Hospital, Stellenbosch University, South Africa
| | - Kim Harper
- Department of Pediatrics, Frere Hospital, East London, South Africa
| | - Nicolette duPlessis
- Department of Pediatrics, Kalafong Hospital, University of Pretoria, South Africa
| | - Gary Reubenson
- Department of Pediatrics and Child Health, Empilweni Service and Research Unit, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Melantha Coetzee
- Department of Paediatrics and Child Health, Steve Biko Academic Hospital, University of Pretoria, South Africa
| | - Daynia Ballot
- Department of Pediatrics and Child Health, Charlotte Maxeke Academic Hospital, Johannesburg
| | - David Moore
- Department of Pediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - James Nuttall
- Department of Pediatrics, Red Cross War Memorial Children's Hospital, South Africa
| | - Lucy Linley
- Department of Pediatrics, Mowbray Maternity Hospital, South Africa
| | - Lloyd Tooke
- Department of Pediatrics, Groote Schuur Hospital, University of Cape Town, South Africa
| | - Jeannette Kriel
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Ute Hallbauer
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Christopher Sutton
- Department of Pediatrics and Child Health, Polokwane Hospital, University of Limpopo, South Africa
| | - Pravi Moodley
- Department of Virology, Inkosi Albert Luthuli Central Hospital, University of Kwazulu-Natal, South Africa
| | - Diana Hardie
- Division of Medical Virology, Groote Schuur Hospital, University of Cape Town, South Africa
| | - Ahmad Haeri Mazanderani
- National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Felicity Goosen
- Department of Pediatrics, Cecilia Makiwane Hospital, East London, South Africa
| | - Thanda Kyaw
- Department of Virological Pathology, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Dave Leroux
- Department of Pediatrics, New Somerset Hospital, University of Cape Town, South Africa
| | - Akhtar Hussain
- Department of Pediatrics, Prince Mshiyeni Memorial Hospital, Durban
| | - Radhika Singh
- Department of Pediatrics, King Edward VIII Hospital, Durban
| | | | - Graham Ducasse
- Department of Pediatrics, Grey's Hospital, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | | | - Magdaleen Blaauw
- Department of Pediatrics and Neonatology, Dr Harry Surtie Hospital, Upington, South Africa
| | - Mohlabi Hamese
- Department of Pediatrics and Child Health, Mankweng Hospital, University of Limpopo, South Africa
| | - Tumelo Leeuw
- Department of Pediatrics, Mafikeng Provincial Hospital, South Africa
| | - Omphile Mekgoe
- Department of Pediatrics, Klerksdorp Hospital, South Africa
| | - Philemon Rakgole
- Department of Pediatrics, Job Shimankana Tabane Hospital, Rustenburg, South Africa
| | - Norman Dungwa
- Department of Pediatrics, Witbank Hospital, South Africa
| | - Thulisile Maphosa
- Department of Pediatrics, Rob Fereirra Hospital, Nelspruit, South Africa
| | - Kgomotso Sanyane
- Department of Pediatrics, Dr George Mukhari Hospital, Sefako Makgatho University, Pretoria, South Africa
| | - Wolfgang Preiser
- Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service Tygerberg, South Africa
| | - Cheryl Cohen
- National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa.,Division of Epidemiology and Biostatistics, School of Public Health, Johannesburg, South Africa
| | - Melinda Suchard
- National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa.,Chemical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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14
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Savulescu DM, Groome M, Malfeld SCK, Madhi S, Koen A, Jones S, Duxbury V, Scheuermaier K, De Assis Rosa D, Suchard M. HLA antibody repertoire in infants suggests selectivity in transplacental crossing. Am J Reprod Immunol 2020; 84:e13264. [PMID: 32395838 PMCID: PMC7507134 DOI: 10.1111/aji.13264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 12/24/2022] Open
Abstract
Problem Late in pregnancy, women produce and transfer high amounts of antibodies to the foetus. During gestation, women produce antibodies against human leukocyte antigens (HLA), including antibodies directed at foetal HLA. There is paucity of data on transplacental crossing, specificity and role of HLA antibodies in pregnancy and new‐borns. Method of study Using highly sensitive Luminex technology, we measured prevalence of IgG HLA antibodies in 30 mother‐infant pairs six weeks post‐partum. Additionally, in six pregnant women, we measured HLA antibodies longitudinally and HLA‐typed infant DNA to assess whether maternal HLA antibodies were directed at infant specificities. Results Overall, 68% of mothers and 44% of infants expressed HLA‐I antibodies and 56% of mothers and 52% of infants expressed HLA‐II antibodies. Infants shared up to 78% of antibodies with their mothers, suggesting that the remaining antibodies were self‐made. Less than 25% of maternal HLA antibodies were detected in infants, possibly due to selection in transplacental crossing. We detected complement‐fixing HLA antibodies in mothers and at low levels in infants. In a third of our pregnant subjects, we detected infant‐directed HLA antibodies. Conclusion Our findings raise the possibility of selection in transplacental crossing of HLA antibodies. As HLA antibodies may act as autoantibodies in the neonate, the mechanism of a selective transfer may give important insights into immune tolerance. Findings also suggest that infants start producing their own HLA antibodies in the first weeks of life, which, together with maternally derived antibodies may impact the infant's immune reaction to HLA proteins.
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Affiliation(s)
- Dana M Savulescu
- Centre for Vaccines and Immunology (CVI), National Institute for Communicable Diseases (NICD), A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| | - Michelle Groome
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Susan C K Malfeld
- Centre for Vaccines and Immunology (CVI), National Institute for Communicable Diseases (NICD), A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| | - Shabir Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Anthonet Koen
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Stephanie Jones
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Vania Duxbury
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Karine Scheuermaier
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Debbie De Assis Rosa
- School of Molecular and Cell Biology, Faculty of Science, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Melinda Suchard
- Centre for Vaccines and Immunology (CVI), National Institute for Communicable Diseases (NICD), A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa.,Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
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15
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Suchard M, Tomori O, Blumberg L. Extra time and penalties in the polio endgame. Int J Infect Dis 2020; 91:252-254. [PMID: 31918002 DOI: 10.1016/j.ijid.2019.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/06/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- Melinda Suchard
- National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, South Africa; Chemical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, South Africa.
| | - Oyewale Tomori
- College of Natural Sciences, and African Center of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Nigeria
| | - Lucille Blumberg
- National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, South Africa
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16
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Keating P, Carrion Martin AI, Blake A, Lechevalier P, Uzzeni F, Gignoux E, Okonta C, Langendorf C, Smit S, Ahuka S, Suchard M, Pukuta E, Degail MA, Hansen L, Kibanza-Kyungu J, Ciglenecki I, Cohuet S. Measles seroprevalence after reactive vaccination campaigns during the 2015 measles outbreak in four health zones of the former Katanga Province, Democratic Republic of Congo. BMC Public Health 2019; 19:1153. [PMID: 31438898 PMCID: PMC6704676 DOI: 10.1186/s12889-019-7500-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 08/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Measles continues to circulate in the Democratic Republic of Congo, and the country suffered from several important outbreaks over the last 5 years. Despite a large outbreak starting in the former province of Katanga in 2010 and the resulting immunization activities, another outbreak occurred in 2015 in this same region. We conducted measles seroprevalence surveys in four health zones (HZ) in the former Katanga Province in order to assess the immunity against measles in children 6 months to 14 years after the 2015 outbreak. METHODS We conducted multi-stage cluster surveys stratified by age group in four HZs, Kayamba, Malemba-Nkulu, Fungurume, and Manono. The age groups were 6-11 months, 12-59 months, and 5-14 years in Kayamba and Malemba-Nkulu, 6-59 months and 5-14 years in Manono and Fungurume. The serological status was measured on dried capillary blood spots collected systematically along with vaccination status (including routine Extended Program of Immunization (EPI), and supplementary immunization activities (SIAs)) and previous self-reported history of suspected measles. RESULTS Overall seroprevalence against measles was 82.7% in Kayamba, 97.6% in Malemba-Nkulu, 83.2% in Manono, and 74.4% in Fungurume, and it increased with age in all HZs. It was 70.7 and 93.8% in children 12-59 months in Kayamba and Malemba-Nkulu, and 49.8 and 64.7% in children 6-59 months in Fungurume and Manono. The EPI coverage was low but varied across HZ. The accumulation of any type of vaccination against measles resulted in an overall vaccine coverage (VC) of at least 85% in children 12-59 months in Kayamba and Malemba-Nkulu, 86.1 and 74.8% in children 6-59 months in Fungurume and Manono. Previous measles infection in 2015-early 2016 was more frequently reported in children aged 12-59 months or 6-59 months (depending on the HZ). CONCLUSION The measured seroprevalence was consistent with the events that occurred in these HZs over the past few years. Measles seroprevalence might prove a valuable source of information to help adjust the timing of future SIAs and prioritizing support to the EPI in this region as long as the VC does not reach a level high enough to efficiently prevent epidemic flare-ups.
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Affiliation(s)
- Patrick Keating
- European Programme for Intervention Epidemiology Training, Stockholm, Sweden
- Epicentre, Paris, France
| | | | | | | | - Florent Uzzeni
- Médecins Sans Frontières – Operational Center Geneva, Geneva, Switzerland
| | | | - Chibuzo Okonta
- Médecins Sans Frontières – Operational Center Paris, Paris, France
| | | | - Sheilagh Smit
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Steve Ahuka
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Melinda Suchard
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Elizabeth Pukuta
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | | | - Lisa Hansen
- European Programme for Intervention Epidemiology Training, Stockholm, Sweden
| | - Jerry Kibanza-Kyungu
- Division Provinciale Sanitaire du Tanganyika, Kalémie, Democratic Republic of Congo
| | - Iza Ciglenecki
- Médecins Sans Frontières – Operational Center Geneva, Geneva, Switzerland
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17
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Haeri Mazanderani A, Motaze NV, McCarthy K, Suchard M, du Plessis NM. Hepatitis A virus seroprevalence in South Africa - Estimates using routine laboratory data, 2005-2015. PLoS One 2019; 14:e0216033. [PMID: 31242191 PMCID: PMC6594585 DOI: 10.1371/journal.pone.0216033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/14/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction South Africa is considered highly endemic for hepatitis A virus (HAV) although few seroprevalence studies have been conducted over the past two decades. The World Health Organization recommends integrating HAV vaccination into national childhood immunization schedules where there is transition from high to intermediate endemicity. As a means of gauging age-specific rates of infection, we report HAV seroprevalence rates among specimens tested for HAV serology within South Africa’s public health sector from 2005–2015. Materials and methods Hepatitis A serology results (Anti-HAV IgM, IgG and total antibody) from 2005–2015 were extracted from South Africa’s National Health Laboratory Service’s Corporate Data Warehouse (NHLS CDW), the central data repository of all laboratory test-sets within the public health sector. Results were extracted according to test-set, result, date of testing, health facility, name, surname, age, and sex. Anti-HAV IgG results were merged with total antibody results to reflect anti-HAV seroprevalence. Testing volume, positivity rates and age-specific anti-HAV seroprevalence rates by year and geographic distribution are described. Results and discussion A total of 501 083 HAV IgM results were retrieved, of which 16 423 (3.3%) were positive, 484 259 (96.6%) negative and 401 (0.1%) equivocal; and 34 710 HAV total antibody/IgG tests of which 30 675 (88.4%) were positive, 4 020 (11.6%) negative and 15 equivocal. Whereas IgM positivity was highest among the 1–4 year age group (33.5%) and lowest among patients >45 years (<0.5%), total antibody positivity ranged from its lowest level of 52.7% in the 1–4 year age group increasing to levels of >90% only after 25 years of age. Conclusion Anti-HAV total antibody testing within the South African public health sector demonstrates seroprevalence rates reach levels >90% only in adulthood, suggesting South Africa could be in transition from high to intermediate endemicity. Prospective studies with geographically representative sampling are required to confirm these findings and evaluate provincial and urban/rural heterogeneity.
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Affiliation(s)
- Ahmad Haeri Mazanderani
- Centre for HIV & STIs, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
- Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- * E-mail:
| | - Nkengafac Villyen Motaze
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Kerrigan McCarthy
- Outbreak Response Unit, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Melinda Suchard
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
- Chemical Pathology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicolette Marie du Plessis
- Department of Paediatrics, Kalafong Provincial Tertiary Hospital, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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18
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Prabdial-Sing N, Chirwa T, Thaver J, Smuts H, Vermeulen M, Suchard M, Puren AJ. Hepatitis C genotype distribution in patient and blood donor samples in South Africa for the period 2008-2012. J Viral Hepat 2016; 23:881-888. [PMID: 27545625 DOI: 10.1111/jvh.12571] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 07/07/2016] [Indexed: 12/18/2022]
Abstract
There are limited molecular epidemiological studies of hepatitis C at a national level in South Africa. The introduction of newer treatment modalities for hepatitis C requires knowledge of the genotypes as these may have different prognostic and therapeutic implications. This retrospective study describes genotype distributions of patients attending specialist clinics and a blood donor group studied during the period 2008-2012 in South Africa. Residual samples from diagnostic viral load testing from specialist clinics in South Africa (n=941) and from the South African National Blood Service (n=294) were analysed quantitatively by real-time PCR and genotyped using the Versant line probe assay or sequencing. Genotype 1 was predominant in blood donors (34%), whilst genotype 5a was prevalent in patients (36%). In the blood donor group, genotype 4 was detected for the first time. Genotype 2 was rare in the patient group and not detected in blood donors. Genotype 1 was the predominant genotype in the younger age groups (less than 30 years), whereas genotype 5a was found at higher proportions in the older age groups for both the patient and blood donor groups, comprising more than 60% of genotypes in those older than 50 years. Genotypes 1 and 5 were at highest proportions across all provinces compared to other genotypes. In blood donors, genotype 1 was predominant among Caucasians (43%) and genotype 5a among Blacks (54%). Such information is required for planning the impact on the health sector with regard to newly emerging therapies for hepatitis C and burden of disease.
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Affiliation(s)
- N Prabdial-Sing
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases (NICD), Johannesburg, South Africa. .,Faculty of Health Sciences, Division of Virology and Communicable Diseases Surveillance, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.
| | - T Chirwa
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - J Thaver
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases (NICD), Johannesburg, South Africa
| | - H Smuts
- Division of Medical Virology, University of Cape Town and National Health Laboratory Services, Cape Town, South Africa
| | - M Vermeulen
- Donation Testing, South African National Blood Service, Roodepoort, South Africa
| | - M Suchard
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases (NICD), Johannesburg, South Africa.,Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - A J Puren
- Faculty of Health Sciences, Division of Virology and Communicable Diseases Surveillance, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.,Centre for HIV and STI, National Institute for Communicable Diseases (NICD), Johannesburg, South Africa
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19
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Moonsamy S, Suchard M. Seroprevalence of polio antibodies in adult laboratory staff in South Africa, 2009 to 2013. S Afr J Infect Dis 2016. [DOI: 10.4102/sajid.v31i2.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The global eradication of polio has been a World Health Organization goal since May 1988 with the current target for global eradication set at 2018. A keystone of the eradication initiative is achieving and maintaining high immunisation coverage, producing high population immunity. Assessing infant vaccination coverage does not give a reliable indication of adult immunity levels as antibody titres decline with age. A requirement of the occupational health programme at the National Institute for Communicable Diseases is to test newly appointed personnel for immunity to polio. During the period 2009 to 2013, 352 sera were collected and tested by means of antibody neutralisation assays to determine immunity to all three polio serotypes. The objective of this study was to assess immunity to polio in personnel employed at the National Institute for Communicable Diseases as a proxy for the general adult South African population. The seroprevalence to polio serotypes 1, 2 and 3 were 85.5, 90.0 and 74.0%, respectively. Of the 352 samples tested, 2.3% were sero-negative for all three serotypes and 36.0% were sero-negative to at least one of the serotypes. The seroprevalence to polio serotype 3 falls below the target of 80.0%, and could pose a potential risk following importation or development of vaccine derived poliovirus type 3.
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20
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Moonsamy S, Suchard M. Seroprevalence of polio antibodies in adult laboratory staff in South Africa, 2009 to 2013. S Afr J Infect Dis 2016. [DOI: 10.1080/23120053.2016.1128149] [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: 10/22/2022] Open
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21
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Suchard M. Measles in Africa: onwards and upwards. S Afr J Infect Dis 2015. [DOI: 10.1080/23120053.2015.1103951] [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: 10/23/2022] Open
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22
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Paraskevis D, Lemey P, Salemi M, Suchard M, Van De Peer Y, Vandamme AM. Analysis of the evolutionary relationships of HIV-1 and SIVcpz sequences using bayesian inference: implications for the origin of HIV-1. Mol Biol Evol 2003; 20:1986-96. [PMID: 12949143 DOI: 10.1093/molbev/msg207] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The most plausible origin of HIV-1 group M is an SIV lineage currently represented by SIVcpz isolated from the chimpanzee subspecies Pan troglodytes troglodytes. The origin of HIV-1 group O is less clear. Putative recombination between any of the HIV-1 and SIVcpz sequences was tested using bootscanning and Bayesian-scanning plots, as well as a new method using a Bayesian multiple change-point (BMCP) model to infer parental sequences and crossing-over points. We found that in the case of highly divergent sequences, such as HIV-1/SIVcpz, Bayesian scanning and BMCP methods are more appropriate than bootscanning analysis to investigate spatial phylogenetic variation, including estimating the boundaries of the regions with discordant evolutionary relationships and the levels of support of the phylogenetic clusters under study. According to the Bayesian scanning plots and BMCP method, there was strong evidence for discordant phylogenetic clustering throughout the genome: (1) HIV-1 group O clustered with SIVcpzANT/TAN in middle pol, and partial vif/env; (2) SIVcpzGab1 clustered with SIVcpzANT/TAN in 3'pol/vif, and middle env; (3) HIV-1 group O grouped with SIVcpzCamUS and SIVcpzGab1 in p17/p24; (4) HIV-1 group M was more closely related to SIVcpzCamUS in 3'gag/pol and in middle pol, whereas in partial gp120 group M clustered with group O. Conditionally independent phylogenetic analysis inferred by maximum likelihood (ML) and Bayesian methods further confirmed these findings. The discordant phylogenetic relationships between the HIV-1/SIVcpz sequences may have been caused by ancient recombination events, but they are also due, at least in part, to altered rates of evolution between parental SIVcpz lineages.
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Affiliation(s)
- D Paraskevis
- Rega Institute for Medical Research, Katholieke Universiteit Leuven, Belgium
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