1
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Boero E, Carducci M, Keeley AJ, Berlanda Scorza F, Iturriza-Gómara M, Moriel DG, Rossi O. A flow cytometry-based assay to determine the ability of anti-Streptococcus pyogenes antibodies to mediate monocytic phagocytosis in human sera. J Immunol Methods 2024; 528:113652. [PMID: 38458312 DOI: 10.1016/j.jim.2024.113652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
Streptococcus pyogenes, commonly referred to as Group A Streptococcus (Strep A), causes a spectrum of diseases, with the potential to progress into life-threatening illnesses and autoimmune complications. The escalating threat of antimicrobial resistance, stemming from the prevalent reliance on antibiotic therapies to manage Strep A infections, underscores the critical need for the development of disease control strategies centred around vaccination. Phagocytes play a critical role in controlling Strep A infections, and phagocytosis-replicating assays are essential for vaccine development. Traditionally, such assays have employed whole-blood killing or opsonophagocytic methods using HL-60 cells as neutrophil surrogates. However, assays mimicking Fcγ receptors- phagocytosis in clinical contexts are lacking. Therefore, here we introduce a flow cytometry-based method employing undifferentiated THP-1 cells as monocytic/macrophage model to swiftly evaluate the ability of human sera to induce phagocytosis of Strep A. We extensively characterize the assay's precision, linearity, and quantification limit, ensuring robustness. By testing human pooled serum, the assay proved to be suitable for the comparison of human sera's phagocytic capability against Strep A. This method offers a valuable complementary assay for clinical studies, addressing the gap in assessing FcγR-mediated phagocytosis. By facilitating efficient evaluation of Strep A -phagocyte interactions, it may contribute to elucidating the mechanisms required for the prevention of infections and inform the development of future vaccines and therapeutic advancements against Strep A infections.
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Affiliation(s)
- Elena Boero
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy.
| | - Martina Carducci
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy
| | - Alexander J Keeley
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK; Vaccines and Immunity Theme, Medical Research Unit the Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, P. O. Box 273, the Gambia
| | | | - Miren Iturriza-Gómara
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy
| | - Danilo Gomes Moriel
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy
| | - Omar Rossi
- GSK Vaccines Institute for Global Health (GVGH), Via Fiorentina 1, 53100 Siena, Italy
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2
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Stenhouse GE, Keddy KH, Bengtsson RJ, Hall N, Smith AM, Thomas J, Iturriza-Gómara M, Baker KS. The genomic epidemiology of shigellosis in South Africa. Nat Commun 2023; 14:7715. [PMID: 38001075 PMCID: PMC10673971 DOI: 10.1038/s41467-023-43345-5] [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: 05/23/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Shigellosis, a leading cause of diarrhoeal mortality and morbidity globally, predominantly affects children under five years of age living in low- and middle-income countries. While whole genome sequence analysis (WGSA) has been effectively used to further our understanding of shigellosis epidemiology, antimicrobial resistance, and transmission, it has been under-utilised in sub-Saharan Africa. In this study, we applied WGSA to large sub-sample of surveillance isolates from South Africa, collected from 2011 to 2015, focussing on Shigella flexneri 2a and Shigella sonnei. We find each serotype is epidemiologically distinct. The four identified S. flexneri 2a clusters having distinct geographical distributions, and antimicrobial resistance (AMR) and virulence profiles, while the four sub-Clades of S. sonnei varied in virulence plasmid retention. Our results support serotype specific lifestyles as a driver for epidemiological differences, show AMR is not required for epidemiological success in S. flexneri, and that the HIV epidemic may have promoted Shigella population expansion.
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Affiliation(s)
- George E Stenhouse
- Clinical Infection, Microbiology, and Immunology, University of Liverpool, Liverpool, UK.
| | | | - Rebecca J Bengtsson
- Clinical Infection, Microbiology, and Immunology, University of Liverpool, Liverpool, UK
| | - Neil Hall
- Earlham Institute, Norwich Research Park, NR4 7UZ, Norwich, UK
| | - Anthony M Smith
- Centre for Enteric Diseases, National Institute for Communicable Diseases (NICD), Division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Juno Thomas
- Centre for Enteric Diseases, National Institute for Communicable Diseases (NICD), Division of the National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Miren Iturriza-Gómara
- Clinical Infection, Microbiology, and Immunology, University of Liverpool, Liverpool, UK
| | - Kate S Baker
- Clinical Infection, Microbiology, and Immunology, University of Liverpool, Liverpool, UK.
- Department of Genetics, University of Cambridge, CB23EH, Cambridge, UK.
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3
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Cunningham-Oakes E, Bronowski C, Chinyama E, Jere KC, Sindhu KNC, Kang G, Iturriza-Gómara M, Darby AC, Parker EPK. Increased bacterial taxonomic and functional diversity is associated with impaired rotavirus vaccine immunogenicity in infants from India and Malawi. BMC Microbiol 2023; 23:354. [PMID: 37980461 PMCID: PMC10656894 DOI: 10.1186/s12866-023-03098-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/30/2023] [Indexed: 11/20/2023] Open
Abstract
The immunogenicity and effectiveness of oral rotavirus vaccines (ORVs) against severe rotavirus-associated gastroenteritis are impaired in low- and middle-income countries (LMICs) where the burden of disease is highest. Determining risk factors for impaired ORV response may help identify strategies to enhance vaccine effectiveness. In this study, we use metagenomic sequencing to provide a high-resolution taxonomic analysis of stool samples collected at 6 weeks of age (coinciding with the first ORV dose) during a prospective study of ORV immunogenicity in India and Malawi. We then analyse the functional capacity of the developing microbiome in these cohorts. Microbiome composition differed significantly between countries, although functional capacity was more similar than taxonomic composition. Our results confirm previously reported findings that the developing microbiome is more diverse in taxonomic composition in ORV non-seroconverters compared with seroconverters, and we additionally demonstrate a similar pattern in functional capacity. Although taxonomic or functional feature abundances are poor predictors of ORV response, we show that skews in the direction of associations within these microbiome data can be used to identify consistent markers of ORV response across LMIC infant cohorts. We also highlight the systemic under-representation of reference genes from LMICs that limit functional annotation in our study (7% and 13% annotation at pathway and enzyme commission level, respectively). Overall, higher microbiome diversity in early life may act as marker for impaired ORV response in India and Malawi, whilst a holistic perspective of functional capacity may be hidden in the "dark matter" of the microbiome.
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Affiliation(s)
- Edward Cunningham-Oakes
- Department of Infection Biology and Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.
| | - Christina Bronowski
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - End Chinyama
- Virology Research Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, 312225, Malawi
| | - Khuzwayo C Jere
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Virology Research Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, 312225, Malawi
- Department of Medical Laboratory Sciences, School of Life Sciences and Allied Health Professions, Kamuza University of Health Sciences, Blantyre, 312225, Malawi
| | | | - Gagandeep Kang
- Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Miren Iturriza-Gómara
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Centre for Vaccine Innovation and Access, Program for Appropriate Technology in Health (PATH), 1218, Geneva, Switzerland
| | - Alistair C Darby
- Department of Infection Biology and Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Edward P K Parker
- The Vaccine Centre, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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4
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Mandolo J, Parker EPK, Bronowski C, Sindhu KNC, Darby AC, Cunliffe NA, Kang G, Iturriza-Gómara M, Kamng’ona AW, Jere KC. Association Between Maternal Breastmilk Microbiota Composition and Rotavirus Vaccine Response in African, Asian, and European Infants: A Prospective Cohort Study. J Infect Dis 2023; 228:637-645. [PMID: 37364376 PMCID: PMC10469347 DOI: 10.1093/infdis/jiad234] [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: 11/08/2022] [Revised: 03/30/2023] [Accepted: 06/22/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Maternal breastmilk is a source of pre- and pro-biotics that impact neonatal gut microbiota colonization. Because oral rotavirus vaccines (ORVs) are administered at a time when infants are often breastfed, breastmilk microbiota composition may have a direct or indirect influence on vaccine take and immunogenicity. METHODS Using standardized methods across sites, we compared breastmilk microbiota composition in relation to geographic location and ORV response in cohorts prospectively followed from birth to 18 weeks of age in India (n = 307), Malawi (n = 119), and the United Kingdom ([UK] n = 60). RESULTS Breastmilk microbiota diversity was higher in India and Malawi than the UK across 3 longitudinal samples spanning weeks of life 1 to 13. Dominant taxa such as Streptococcus and Staphylococcus were consistent across cohorts; however, significant geographic differences were observed in the prevalence and abundance of common and rare genera throughout follow up. No consistent associations were identified between breastmilk microbiota composition and ORV outcomes including seroconversion, vaccine shedding after dose 1, and postvaccination rotavirus-specific immunoglobulin A level. CONCLUSIONS Our findings suggest that breastmilk microbiota composition may not be a key factor in shaping trends in ORV response within or between countries.
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Affiliation(s)
- Jonathan Mandolo
- Virology Research Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Biomedical Sciences, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Edward P K Parker
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christina Bronowski
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | - Alistair C Darby
- Department of Infection Biology and Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Nigel A Cunliffe
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
- National Institute for Health and Care Research Global Health Research Group on Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
| | - Gagandeep Kang
- Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Miren Iturriza-Gómara
- Centre for Vaccine Innovation and Access, Program for Appropriate Technology in Health (PATH), Geneva, Switzerland
| | - Arox W Kamng’ona
- Virology Research Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Biomedical Sciences, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Khuzwayo C Jere
- Virology Research Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
- Department of Medical Laboratory Sciences, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
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5
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Chen J, Grow S, Iturriza-Gómara M, Hausdorff WP, Fix A, Kirkwood CD. The Challenges and Opportunities of Next-Generation Rotavirus Vaccines: Summary of an Expert Meeting with Vaccine Developers. Viruses 2022; 14:v14112565. [PMID: 36423174 PMCID: PMC9699535 DOI: 10.3390/v14112565] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022] Open
Abstract
The 2nd Next Generation Rotavirus Vaccine Developers Meeting, sponsored by PATH and the Bill and Melinda Gates Foundation, was held in London, UK (7-8 June 2022), and attended by vaccine developers and researchers to discuss advancements in the development of next-generation rotavirus vaccines and to consider issues surrounding vaccine acceptability, introduction, and uptake. Presentations included updates on rotavirus disease burden, the impact of currently licensed oral vaccines, various platforms and approaches for next generation rotavirus vaccines, strategies for combination pediatric vaccines, and the value proposition for novel parenteral rotavirus vaccines. This report summarizes the information shared at the convening and poses various topics worthy of further exploration.
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Affiliation(s)
- Jessie Chen
- Enteric & Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, WA 98109, USA
- Correspondence:
| | - Stephanie Grow
- Enteric & Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, WA 98109, USA
| | | | - William P. Hausdorff
- Faculty of Medicine, Université Libre de Bruxelles, 1050 Brussels, Belgium
- PATH, Washington, DC 20001, USA
| | | | - Carl D. Kirkwood
- Enteric & Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, WA 98109, USA
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6
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Davies R, Iturriza-Gómara M, Glennon-Alty R, Elliot AJ, Vivancos R, Alvarez Nishio A, Cunliffe NA, Hungerford D. Public acceptability of a technology-mediated stool sample collection platform to inform community-based surveillance of infectious intestinal disease: a pilot study. BMC Public Health 2022; 22:958. [PMID: 35562817 PMCID: PMC9099322 DOI: 10.1186/s12889-022-13307-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the UK approximately a quarter of the population experience infectious intestinal disease (IID) each year. However, only 2% present to primary care, preventing a true determination of community burden and pathogen aetiology. The aim of this pilot study was to gauge public acceptability of a technology-mediated platform for reporting episodes of IID and for providing stool samples. METHODS This study employed a cross-sectional online survey design, targeting individuals 16 + years old within Liverpool City Region, UK. Information sought included demographics, comfortability of reporting illness and IID symptoms, willingness to provide stool, and favoured stool-provision method. Univariable logistic regression was used to examine associations between demographic variables and providing a stool sample. Odds ratios (OR) and associated 95% confidence intervals (CIs) were produced. RESULTS A total of 174 eligible participants completed the survey, with 69% female. The sample was skewed towards younger populations, with 2.9% aged 65 + years. Nearly a third (29%) had a household income of less than £30,000 per annum and 70% had attained a degree or higher. The majority identified as White British (81%) and 11% identified as ethnicities typically grouped Black, Asian and minority ethnic (BAME). Three quarters of participants were either 'Comfortable' or 'Very Comfortable' with reporting illness (75%) and with answering symptom-related questions (79%); 78% reported that they would provide a stool sample. Upon univariable analysis, increasing age - being 55 + (OR 6.28, 95% CI 1.15-117.48), and lower income (OR 2.5, 95% CI 1.02-6.60), was associated with willingness to provide a stool sample. Additionally, respondents identifying as BAME ethnicities and men may be less inclined to provide a stool sample. CONCLUSIONS This pilot study assessed the acceptability of technology-mediated platforms for reporting IID and provision of stool samples in the community. Respondents were biased towards younger, technologically inclined, more affluent and educated populations. Acceptability for reporting illness and providing a stool sample through technology-mediated platforms was high. While older populations were under-represented, they were more likely to agree to provide a stool sample. Qualitative research is required to better reach older and more deprived populations, and to understand potential age, gender and ethnic differences in compliance with stool sampling.
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Affiliation(s)
- Rowan Davies
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.,School of Medicine, University of Liverpool, Liverpool, UK
| | - Miren Iturriza-Gómara
- Centre for Vaccine Innovation and Access, PATH, Geneva, Switzerland.,Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Rebecca Glennon-Alty
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Alex J Elliot
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.,Real-Time Syndromic Surveillance Team, Field Service, Health Protection Operations, UK Health Security Agency, Birmingham, UK.,National Institute for Health and Care Research Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
| | - Roberto Vivancos
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.,Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK.,Field Epidemiology North West, Field Service, Health Protection Operations, UK Health Security Agency, Liverpool, UK.,National Institute for Health and Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | | | - Nigel A Cunliffe
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK.,Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Daniel Hungerford
- National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK. .,Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK. .,Field Epidemiology North West, Field Service, Health Protection Operations, UK Health Security Agency, Liverpool, UK. .,National Institute for Health and Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK.
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7
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Parker EPK, Bronowski C, Sindhu KNC, Babji S, Benny B, Carmona-Vicente N, Chasweka N, Chinyama E, Cunliffe NA, Dube Q, Giri S, Grassly NC, Gunasekaran A, Howarth D, Immanuel S, Jere KC, Kampmann B, Lowe J, Mandolo J, Praharaj I, Rani BS, Silas S, Srinivasan VK, Turner M, Venugopal S, Verghese VP, Darby AC, Kang G, Iturriza-Gómara M. Impact of maternal antibodies and microbiota development on the immunogenicity of oral rotavirus vaccine in African, Indian, and European infants. Nat Commun 2021; 12:7288. [PMID: 34911947 PMCID: PMC8674366 DOI: 10.1038/s41467-021-27074-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Received: 12/03/2020] [Accepted: 11/01/2021] [Indexed: 11/08/2022] Open
Abstract
Identifying risk factors for impaired oral rotavirus vaccine (ORV) efficacy in low-income countries may lead to improvements in vaccine design and delivery. In this prospective cohort study, we measure maternal rotavirus antibodies, environmental enteric dysfunction (EED), and bacterial gut microbiota development among infants receiving two doses of Rotarix in India (n = 307), Malawi (n = 119), and the UK (n = 60), using standardised methods across cohorts. We observe ORV shedding and seroconversion rates to be significantly lower in Malawi and India than the UK. Maternal rotavirus-specific antibodies in serum and breastmilk are negatively correlated with ORV response in India and Malawi, mediated partly by a reduction in ORV shedding. In the UK, ORV shedding is not inhibited despite comparable maternal antibody levels to the other cohorts. In both India and Malawi, increased microbiota diversity is negatively correlated with ORV immunogenicity, suggesting that high early-life microbial exposure may contribute to impaired vaccine efficacy.
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MESH Headings
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- Female
- Gastrointestinal Microbiome
- Humans
- Immunity, Maternally-Acquired
- Immunoglobulin A/blood
- Immunoglobulin A/immunology
- India
- Infant
- Infant, Newborn
- Infant, Newborn, Diseases/blood
- Infant, Newborn, Diseases/microbiology
- Infant, Newborn, Diseases/prevention & control
- Infant, Newborn, Diseases/virology
- Malawi
- Male
- Milk, Human/chemistry
- Milk, Human/immunology
- Pregnancy
- Prospective Studies
- Rotavirus/genetics
- Rotavirus/immunology
- Rotavirus/physiology
- Rotavirus Infections/blood
- Rotavirus Infections/microbiology
- Rotavirus Infections/prevention & control
- Rotavirus Infections/virology
- Rotavirus Vaccines/administration & dosage
- Rotavirus Vaccines/immunology
- United Kingdom
- Vaccine Efficacy
- Vaccines, Attenuated/administration & dosage
- Vaccines, Attenuated/immunology
- Virus Shedding
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Affiliation(s)
- Edward P K Parker
- The Vaccine Centre, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
| | - Christina Bronowski
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
| | | | - Sudhir Babji
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Blossom Benny
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Noelia Carmona-Vicente
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
| | - Nedson Chasweka
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi, Blantyre, PO Box, 30096, Malawi
| | - End Chinyama
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi, Blantyre, PO Box, 30096, Malawi
| | - Nigel A Cunliffe
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Queen Dube
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi, Blantyre, PO Box, 30096, Malawi
| | - Sidhartha Giri
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Nicholas C Grassly
- Department of Infectious Disease Epidemiology, Imperial College London, London, W2 1PG, UK
| | - Annai Gunasekaran
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Deborah Howarth
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
| | - Sushil Immanuel
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Khuzwayo C Jere
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi, Blantyre, PO Box, 30096, Malawi
- Department of Medical Laboratory Sciences, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre, 3, Malawi
| | - Beate Kampmann
- The Vaccine Centre, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Jenna Lowe
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
| | - Jonathan Mandolo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi, Blantyre, PO Box, 30096, Malawi
| | - Ira Praharaj
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | | | - Sophia Silas
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Vivek Kumar Srinivasan
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Mark Turner
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L8 7SS, UK
| | - Srinivasan Venugopal
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Valsan Philip Verghese
- Department of Child Health, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Alistair C Darby
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | - Miren Iturriza-Gómara
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 7BE, UK.
- Centre for Vaccine Innovation and Access, PATH, Geneva, Switzerland.
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8
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Vaselli NM, Setiabudi W, Subramaniam K, Adams ER, Turtle L, Iturriza-Gómara M, Solomon T, Cunliffe NA, French N, Hungerford D. Investigation of SARS-CoV-2 faecal shedding in the community: a prospective household cohort study (COVID-LIV) in the UK. BMC Infect Dis 2021; 21:784. [PMID: 34372788 PMCID: PMC8352155 DOI: 10.1186/s12879-021-06443-7] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/20/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND SARS-CoV-2 is frequently shed in the stool of patients hospitalised with COVID-19. The extent of faecal shedding of SARS-CoV-2 among individuals in the community, and its potential to contribute to spread of disease, is unknown. METHODS In this prospective, observational cohort study among households in Liverpool, UK, participants underwent weekly nasal/throat swabbing to detect SARS-CoV-2 virus, over a 12-week period from enrolment starting July 2020. Participants that tested positive for SARS-CoV-2 were asked to provide a stool sample three and 14 days later. In addition, in October and November 2020, during a period of high community transmission, stool sampling was undertaken to determine the prevalence of SARS-CoV-2 faecal shedding among all study participants. SARS-CoV-2 RNA was detected using Real-Time PCR. RESULTS A total of 434 participants from 176 households were enrolled. Eighteen participants (4.2%: 95% confidence interval [CI] 2.5-6.5%) tested positive for SARS-CoV-2 virus on nasal/throat swabs and of these, 3/17 (18%: 95% CI 4-43%) had SARS-CoV-2 detected in stool. Two of three participants demonstrated ongoing faecal shedding of SARS-CoV-2, without gastrointestinal symptoms, after testing negative for SARS-CoV-2 in respiratory samples. Among 165/434 participants without SARS-CoV-2 infection and who took part in the prevalence study, none had SARS-CoV-2 in stool. There was no demonstrable household transmission of SARS-CoV-2 among households containing a participant with faecal shedding. CONCLUSIONS Faecal shedding of SARS-CoV-2 occurred among community participants with confirmed SARS-CoV-2 infection. However, during a period of high community transmission, faecal shedding of SARS-CoV-2 was not detected among participants without SARS-CoV-2 infection. It is unlikely that the faecal-oral route plays a significant role in household and community transmission of SARS-CoV-2.
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Affiliation(s)
- Natasha Marcella Vaselli
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Wega Setiabudi
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Krishanthi Subramaniam
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Emily R Adams
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections at the University of Liverpool, Liverpool, UK
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lance Turtle
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections at the University of Liverpool, Liverpool, UK
| | - Miren Iturriza-Gómara
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- Current address: Centre for Vaccine Innovation and Access, PATH, Geneva, Switzerland
| | - Tom Solomon
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections at the University of Liverpool, Liverpool, UK
- Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Nigel A Cunliffe
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections at the University of Liverpool, Liverpool, UK
| | - Neil French
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections at the University of Liverpool, Liverpool, UK
| | - Daniel Hungerford
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK.
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections at the University of Liverpool, Liverpool, UK.
- NIHR Health Protection Research Unit in Gastrointestinal Infections at the University of Liverpool, Liverpool, UK.
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9
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Stenhouse GE, Jere KC, Peno C, Bengtsson RJ, Chinyama E, Mandolo J, Cain A, Iturriza-Gómara M, Bar-Zeev N, Cunliffe NA, Cornick J, Baker KS. Whole genome sequence analysis of Shigella from Malawi identifies fluoroquinolone resistance. Microb Genom 2021; 7:000532. [PMID: 33945457 PMCID: PMC8209728 DOI: 10.1099/mgen.0.000532] [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] [Received: 11/26/2020] [Accepted: 01/27/2021] [Indexed: 12/04/2022] Open
Abstract
Increasing antimicrobial resistance and limited alternative treatments have led to fluoroquinolone-resistant Shigella strain inclusion on the WHO global priority pathogens list. In this study we characterized multiple Shigella isolates from Malawi with whole genome sequence analysis, identifying the acquirable fluoroquinolone resistance determinant qnrS1.
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Affiliation(s)
| | - Khuzwayo C. Jere
- University of Liverpool, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Chikondi Peno
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - End Chinyama
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Jonathan Mandolo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Amy Cain
- ARC Centre of Excellence in Synthetic Biology, Department of Molecular Sciences, Macquarie University, North Ryde, Australia
| | - Miren Iturriza-Gómara
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Naor Bar-Zeev
- International Vaccine Access Center Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Nigel A. Cunliffe
- University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Jennifer Cornick
- University of Liverpool, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Kate S. Baker
- University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
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10
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Derrick J, Hollinghurst P, O'Brien S, Elviss N, Allen DJ, Iturriza-Gómara M. Measuring transfer of human norovirus during sandwich production: Simulating the role of food, food handlers and the environment. Int J Food Microbiol 2021; 348:109151. [PMID: 33940535 DOI: 10.1016/j.ijfoodmicro.2021.109151] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
Foodborne outbreaks associated with transmission of norovirus are increasingly becoming a public health concern. Foods can be contaminated with faecal material at the point of production or during food preparation, in both the home and in commercial premises. Transmission of norovirus occurs through the faecal-oral route, either via person-to-person contact or through faecal-contamination of food, water, or environmental surfaces. Understanding the role and pathways of norovirus transmission - either via food handlers' hands, contaminated foods or the environment - remains a key public health priority to reduce the burden of norovirus-associated gastroenteritis. However the proportion of norovirus that is typically transferred remains unknown. Understanding this is necessary to estimate the risk of infection and the burden of gastroenteritis caused by norovirus. In this paper we present a novel method of capture, concentration and molecular detection of norovirus from a wider range of complex food matrices than those demonstrated in existing published methods. We demonstrate that this method can be used as a tool to detect and quantify norovirus from naturally contaminated food, and for monitoring norovirus transfer between food handlers' gloved hands, food or the environment. We measure the effect of introducing contamination at different food production process stages, to the final food product, to determine whether this could cause infection and disease. Between 5.9 and 6.3 Log10 cDNA copies/μl of norovirus GII were inoculated onto food handlers' gloved hands, food or the environment and 1.1-7.4% of norovirus contamination was recovered from all samples tested. When interpreted quantitatively, this percentage equates to levels predicted to be sufficient to cause infection and disease through consumption of the final food product, demonstrating a public health risk. Overall detection and quantification of norovirus from foods, food handlers' gloved hands and the environment, when suspected to be implicated in foodborne transmissions, is paramount for appropriate outbreak investigation.
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Affiliation(s)
- Jade Derrick
- Virus Reference Department, National Infections Service, Public Health England, London, UK.
| | - Philippa Hollinghurst
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah O'Brien
- School of Natural and Environmental Sciences, Newcastle University, Newcastle, UK; NIHR Health Protection Research Unit in Gastrointestinal Infections, UK
| | - Nicola Elviss
- Food, Water and Environmental Microbiology Services, National Infections Service, Public Health England, UK; NIHR Health Protection Research Unit in Gastrointestinal Infections, UK
| | - David J Allen
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; NIHR Health Protection Research Unit in Gastrointestinal Infections, UK
| | - Miren Iturriza-Gómara
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK; NIHR Health Protection Research Unit in Gastrointestinal Infections, UK
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11
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Kelly D, Jere KC, Darby AC, Allen DJ, Iturriza-Gómara M. Complete genome characterization of human noroviruses allows comparison of minor alleles during acute and chronic infections. Access Microbiol 2021; 3:000203. [PMID: 34151158 PMCID: PMC8209700 DOI: 10.1099/acmi.0.000203] [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: 11/23/2020] [Accepted: 01/24/2021] [Indexed: 11/18/2022] Open
Abstract
Human noroviruses (HuNoVs) circulate globally, affect all age groups and place a substantial burden upon health services. High genetic diversity leading to antigenic variation plays a significant role in HuNoV epidemiology, driving periodic global emergence of epidemic variants. Studies have suggested that immunocompromised individuals may be a reservoir for such epidemic variants, but studies investigating the diversity and emergence of HuNoV variants in immunocompetent individuals are underrepresented. To address this, we sequenced the genomes of HuNoVs present in samples collected longitudinally from one immunocompetent (acute infection) and one immunocompromised (chronic infection) patient. A broadly reactive HuNoV capture-based method was used to concentrate the virus present in these specimens prior to massively parallel sequencing to recover near complete viral genomes. Using a novel bioinformatics pipeline, we demonstrated that persistent minor alleles were present in both acute and chronic infections, and that minor allele frequencies represented a larger proportion of the population during chronic infection. In acute infection, minor alleles were more evenly spread across the genome, although present at much lower frequencies, and therefore difficult to discern from error. By contrast, in the chronic infection, more minor alleles were present in the minor structural protein. No non-synonymous minor alleles were detected in the major structural protein over the short sampling period of the HuNoV chronic infection, suggesting where immune pressure is variable or non-existent, epidemic variants could emerge over longer periods of infection by random chance.
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Affiliation(s)
- Daniel Kelly
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.,Present address: Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Khuzwayo C Jere
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.,Malawi-Liverpool Wellcome Trust - Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Alistair C Darby
- Centre of Genomic Research, Institute of Integrative Biology, University of Liverpool, Liverpool, UK
| | - David J Allen
- Department of Pathogen Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.,Virus Reference Department, National Infections Service, Public Health England, Colindale, London, UK.,NIHR Health Protection Research Unit Gastrointestinal Infections, Liverpool, UK
| | - Miren Iturriza-Gómara
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.,NIHR Health Protection Research Unit Gastrointestinal Infections, Liverpool, UK
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12
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Babji S, Manickavasagam P, Chen YH, Jeyavelu N, Jose NV, Praharaj I, Syed C, Kaliappan SP, John J, Giri S, Venugopal S, Kampmann B, Parker EPK, Iturriza-Gómara M, Kang G, Grassly NC, Uhlig HH. Immune predictors of oral poliovirus vaccine immunogenicity among infants in South India. NPJ Vaccines 2020; 5:27. [PMID: 32218999 PMCID: PMC7089977 DOI: 10.1038/s41541-020-0178-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/03/2020] [Indexed: 11/17/2022] Open
Abstract
Identification of the causes of poor oral vaccine immunogenicity in low-income countries might lead to more effective vaccines. We measured mucosal and systemic immune parameters at the time of vaccination with oral poliovirus vaccine (OPV) in 292 Indian infants aged 6–11 months, including plasma cytokines, leukocyte counts, fecal biomarkers of environmental enteropathy and peripheral blood T-cell phenotype, focused on gut-homing regulatory CD4+ populations. We did not find a distinct immune phenotype associated with OPV immunogenicity, although viral pathogens were more prevalent in stool at the time of immunization among infants who failed to seroconvert (63.9% vs. 45.6%, p = 0.002). Using a machine-learning approach, we could predict seroconversion a priori using immune parameters and infection status with a median 58% accuracy (cross-validation IQR: 50–69%) compared with 50% expected by chance. Better identification of immune predictors of OPV immunogenicity is likely to require sampling of mucosal tissue and improved oral poliovirus infection models.
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Affiliation(s)
- Sudhir Babji
- 1Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | | | - Yin-Huai Chen
- 2Translational Gastroenterology Unit, Nuffield Department of Medicine, and Department of Paediatrics, University of Oxford, Oxford, OX3 9DU UK
| | - Nithya Jeyavelu
- 1Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Nisha Vincy Jose
- 1Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Ira Praharaj
- 1Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Chanduni Syed
- 1Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | | | - Jacob John
- 3Department of Community Health, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Sidhartha Giri
- 1Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Srinivasan Venugopal
- 1Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Beate Kampmann
- 4The Vaccine Centre, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | - Edward P K Parker
- 4The Vaccine Centre, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | - Miren Iturriza-Gómara
- 5Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE UK
| | - Gagandeep Kang
- 1Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Nicholas C Grassly
- 6Department of Infectious Disease Epidemiology, Imperial College London, London, W2 1PG UK
| | - Holm H Uhlig
- 2Translational Gastroenterology Unit, Nuffield Department of Medicine, and Department of Paediatrics, University of Oxford, Oxford, OX3 9DU UK
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13
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Iturriza-Gómara M, Jere KC, Hungerford D, Bar-Zeev N, Shioda K, Kanjerwa O, Houpt ER, Operario DJ, Wachepa R, Pollock L, Bennett A, Pitzer VE, Cunliffe NA. Etiology of Diarrhea Among Hospitalized Children in Blantyre, Malawi, Following Rotavirus Vaccine Introduction: A Case-Control Study. J Infect Dis 2020; 220:213-218. [PMID: 30816414 PMCID: PMC6581894 DOI: 10.1093/infdis/jiz084] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/23/2019] [Indexed: 11/29/2022] Open
Abstract
Despite rotavirus vaccination, diarrhea remains a leading cause of child mortality. We collected stool specimens from 684 children <5 years of age hospitalized with diarrhea (cases) and 527 asymptomatic community controls for 4 years after rotavirus vaccine introduction in Malawi. Specimens were tested for 29 pathogens, using polymerase chain reaction analysis. Three or more pathogens were detected in 71% of cases and 48% of controls. Pathogens significantly associated with diarrhea included rotavirus (in 34.7% of cases and 1.5% of controls), enteric adenovirus (in 29.1% and 2.7%, respectively), Cryptosporidium (in 27.8% and 8.2%, respectively), heat-stable enterotoxin-producing Escherichia coli (in 21.2% and 8.5%, respectively), typical enteropathogenic E. coli (in 18.0% and 8.3%, respectively), and Shigella/enteroinvasive E. coli (in 15.8% and 5.7%, respectively). Additional interventions are required to prevent diarrhea due to rotavirus and other common causal pathogens.
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Affiliation(s)
- Miren Iturriza-Gómara
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, United Kingdom
| | - Khuzwayo C Jere
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, United Kingdom.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre.,Department of Medical Laboratory Sciences, College of Medicine, University of Malawi, Blantyre
| | - Daniel Hungerford
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, United Kingdom
| | - Naor Bar-Zeev
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kayoko Shioda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Oscar Kanjerwa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville
| | - Darwin J Operario
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville
| | - Richard Wachepa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre
| | - Louisa Pollock
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, United Kingdom.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre
| | - Aisleen Bennett
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, United Kingdom.,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Nigel A Cunliffe
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, United Kingdom
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14
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Praharaj I, Parker EPK, Giri S, Allen DJ, Silas S, Revathi R, Kaliappan SP, John J, Prasad JH, Kampmann B, Iturriza-Gómara M, Grassly NC, Kang G. Influence of Nonpolio Enteroviruses and the Bacterial Gut Microbiota on Oral Poliovirus Vaccine Response: A Study from South India. J Infect Dis 2020; 219:1178-1186. [PMID: 30247561 PMCID: PMC6601701 DOI: 10.1093/infdis/jiy568] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/19/2018] [Indexed: 11/26/2022] Open
Abstract
Background Oral poliovirus vaccine (OPV) is less immunogenic in low- or middle-income than in high-income countries. We tested whether bacterial and viral components of the intestinal microbiota are associated with this phenomenon. Methods We assessed the prevalence of enteropathogens using TaqMan array cards 14 days before and at vaccination in 704 Indian infants (aged 6–11 months) receiving monovalent type 3 OPV (CTRI/2014/05/004588). Nonpolio enterovirus (NPEV) serotypes were identified by means of VP1 sequencing. In 120 infants, the prevaccination bacterial microbiota was characterized using 16S ribosomal RNA sequencing. Results We detected 56 NPEV serotypes on the day of vaccination. Concurrent NPEVs were associated with a reduction in OPV seroconversion, consistent across species (odds ratio [95% confidence interval], 0.57 [.36–.90], 0.61 [.43–.86], and 0.69 [.41–1.16] for species A, B, and C, respectively). Recently acquired enterovirus infections, detected at vaccination but not 14 days earlier, had a greater interfering effect on monovalent type 3 OPV seroresponse than did persistent infections, with enterovirus detected at both time points (seroconversion in 44 of 127 infants [35%] vs 63 of 129 [49%]; P = .02). The abundance of specific bacterial taxa did not differ significantly according to OPV response, although the microbiota was more diverse in nonresponders at the time of vaccination. Conclusion Enteric viruses have a greater impact on OPV response than the bacterial microbiota, with recent enterovirus infections having a greater inhibitory effect than persistent infections.
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Affiliation(s)
- Ira Praharaj
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Edward P K Parker
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Sidhartha Giri
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - David J Allen
- Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Enteric Virus Unit, Virus Reference Department, Microbiology Services, Public Health England, London, United Kingdom
| | - Sophia Silas
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - R Revathi
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Jacob John
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jasmine Helan Prasad
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - Beate Kampmann
- Department of Paediatrics, St Mary's Campus, Imperial College London, London, United Kingdom
| | - Miren Iturriza-Gómara
- Centre for Global Vaccine Research, Institute of Infection and Global Health, and National Institute for Health Research Health Protection Research Unit in Gastrointestinal Infection, University of Liverpool, United Kingdom
| | - Nicholas C Grassly
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
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15
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Hungerford D, Jere KC, Bar-Zeev N, Harris JP, Cunliffe NA, Iturriza-Gómara M. Epidemiology and genotype diversity of norovirus infections among children aged <5 years following rotavirus vaccine introduction in Blantyre, Malawi. J Clin Virol 2019; 123:104248. [PMID: 31881509 DOI: 10.1016/j.jcv.2019.104248] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/04/2019] [Accepted: 12/17/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Following rotavirus vaccine introduction, norovirus has emerged as a significant pathogen associated with acute gastroenteritis among children in some high- and middle-income countries. In a case-control study following rotavirus vaccination in Malawi, we used PCR to test for multiple enteric pathogens in fecal samples from children aged <5 years hospitalized with diarrhea, and from asymptomatic community controls (Iturriza-Gómara et al. 2019). OBJECTIVES To describe the epidemiology and genotype diversity of norovirus infections among infants and young children in Blantyre, Malawi, following rotavirus vaccine introduction in 2012. STUDY DESIGN We analysed data from the case-control study to assess annual and agespecific norovirus prevalence and the presence of co-infection. Norovirus-containing specimens were amplified by PCR and sequenced to determined genotype. RESULTS Norovirus prevalence in cases was similar for each complete year of study (11.4% in 2013, 9.3% in 2014 and 11.2% in 2015). Prevalence of norovirus among children aged <6 months, 6-11 months, 12-23 months and 24+ months was 15.3% (11/72), 13.3% (44/331), 11.0% (24/219) and 6.6% (4/61) respectively in cases and 6.7% (2/30), 13.1% (30/229), 4.2% (8/192) and 7.1 (5/70) in controls. Co-pathogens were commonly detected in norovirus positive cases (77/83) and controls (44/45). Norovirus GII.4 was the most commonly identified genotype, comprising 48% and 41% of genotyped strains among cases and controls, respectively. CONCLUSIONS Norovirus disease prevalence was unchanged during the study period, and was greatest amongst infants. Frequent co-infection and asymptomatic shedding suggests intense community transmission of norovirus and other enteric pathogens in this low-income, African setting.
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Affiliation(s)
- Daniel Hungerford
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Members of Liverpool Health Partners, Ronald Ross Building, 8 West Derby Street, Liverpool, L69 7BE, UK; NIHR, Health Protection Research Unit in Gastrointestinal Infections at University of Liverpool, L69 3GL, Liverpool, United Kingdom.
| | - Khuzwayo C Jere
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Members of Liverpool Health Partners, Ronald Ross Building, 8 West Derby Street, Liverpool, L69 7BE, UK; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; Department of Medical Laboratory Sciences, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Naor Bar-Zeev
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - John P Harris
- NIHR, Health Protection Research Unit in Gastrointestinal Infections at University of Liverpool, L69 3GL, Liverpool, United Kingdom
| | - Nigel A Cunliffe
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Members of Liverpool Health Partners, Ronald Ross Building, 8 West Derby Street, Liverpool, L69 7BE, UK
| | - Miren Iturriza-Gómara
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Members of Liverpool Health Partners, Ronald Ross Building, 8 West Derby Street, Liverpool, L69 7BE, UK; NIHR, Health Protection Research Unit in Gastrointestinal Infections at University of Liverpool, L69 3GL, Liverpool, United Kingdom
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16
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Hungerford DJ, French N, Iturriza-Gómara M, Read JM, Cunliffe NA, Vivancos R. Reduction in hospitalisations for acute gastroenteritis-associated childhood seizures since introduction of rotavirus vaccination: a time-series and change-point analysis of hospital admissions in England. J Epidemiol Community Health 2019; 73:1020-1025. [PMID: 31511311 PMCID: PMC6877709 DOI: 10.1136/jech-2019-213055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 01/17/2023]
Abstract
Introduction The incidence of severe childhood diarrhoea has fallen substantially following the introduction of rotavirus vaccine in the UK in July 2013. Since children with rotavirus infection may experience febrile and afebrile seizures, we evaluated the impact of rotavirus vaccination on seizure hospitalisations in children in England. Methods Using data from Hospital Episode Statistics, we employed interrupted time-series analyses to assess changes in monthly hospital admissions for seizures among children aged <5 years from July 2000 to June 2017. Outcome measures comprised all seizures and febrile seizures, with and without a co-diagnosis of acute gastroenteritis (AGE). Models were adjusted for pneumococcal conjugate vaccine (PCV) introduction. Change-point analysis was used to independently identify step-changes in the time-series. Results Among hospitalised children aged <5 years, the incidence of any seizures and febrile seizures with AGE decreased post-vaccine introduction by 23% (95% CI: 11% to 33%) and 31% (95% CI: 19% to 41%), respectively. For febrile seizures with AGE, a single change-point was identified in July 2013 (95% CI: June 2013 to December 2013). Reductions in seizure incidence were higher during the rotavirus season (49%, 95% CI: 37% to 58%) compared with out-of-season (13%, 95% CI: −4 to 28%) and showed no relation to PCV introduction. There were small reductions in any seizures with any co-diagnosis (4%, 95% CI: 0% to 8%) and in febrile seizures with any co-diagnosis (10%, 95% CI: 2% to 16%). Conclusion Rotavirus vaccination has reduced hospitalisations for seizures associated with AGE in England, providing additional evidence of population-level impact of rotavirus vaccination on seizure incidence in high-income countries.
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Affiliation(s)
- Daniel James Hungerford
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK .,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom.,Field Service, National Infection Service, Public Health England, Liverpool, UK
| | - Neil French
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Tropical and Infectious Disease Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, members of Liverpool Health Partners, Liverpool, United Kingdom
| | - Miren Iturriza-Gómara
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
| | - Jonathan M Read
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom.,Centre for Health Informatics, Computing and Statistics, Lancaster University, Faculty of Health and Medicine, Lancaster, UK
| | - Nigel A Cunliffe
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,Department of Microbiology, Alder Hey Children's NHS Foundation Trust, members of Liverpool Health Partners, Liverpool, United Kingdom
| | - Roberto Vivancos
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom.,Field Service, National Infection Service, Public Health England, Liverpool, UK
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17
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Hungerford D, Allen DJ, Nawaz S, Collins S, Ladhani S, Vivancos R, Iturriza-Gómara M. Impact of rotavirus vaccination on rotavirus genotype distribution and diversity in England, September 2006 to August 2016. Euro Surveill 2019; 24:1700774. [PMID: 30755297 PMCID: PMC6373066 DOI: 10.2807/1560-7917.es.2019.24.6.1700774] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IntroductionRotavirus vaccination with the live-attenuated monovalent (a G1P[8] human rotavirus strain) two-dose Rotarix vaccine was introduced in England in July 2013. Since then, there have been significant reductions in rotavirus gastroenteritis incidence.AimWe assessed the vaccine's impact on rotavirus genotype distribution and diversity 3 years post-vaccine introduction.MethodsEpidemiological and microbiological data on genotyped rotavirus-positive samples between September 2006 and August 2016 were supplied by EuroRotaNet and Public Health England. Multinomial multivariable logistic regression adjusting for year, season and age was used to quantify changes in genotype prevalence in the vaccine period. Genotype diversity was measured using the Shannon's index (H') and Simpson's index of diversity (D).ResultsWe analysed genotypes from 8,044 faecal samples. In the pre-vaccine era, G1P[8] was most prevalent, ranging from 39% (411/1,057) to 74% (527/709) per year. In the vaccine era, G1P[8] prevalence declined each season (35%, 231/654; 12%, 154/1,257; 5%, 34/726) and genotype diversity increased significantly in 6-59 months old children (H' p < 0.001: D p < 0.001). In multinomial analysis, G2P[4] (adjusted multinomial odds ratio (aMOR): 9.51; 95% confidence interval (CI): 7.02-12.90), G3P[8] (aMOR: 2.83; 95% CI: 2.17-3.81), G12P[8] (aMOR: 2.46; 95% CI: 1.62-3.73) and G4P[8] (aMOR: 1.42; 95% CI: 1.02-1.96) significantly increased relative to G1P[8].ConclusionsIn the context of reduced rotavirus disease incidence, genotype diversity has increased, with a relative change in the dominant genotype from G1P[8] to G2P[4] after vaccine introduction. These changes will need continued surveillance as the number and age of vaccinated birth cohorts increase in the future.
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Affiliation(s)
- Daniel Hungerford
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom,Field Epidemiology Services, National Infection Service, Public Health England, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
| | - David J Allen
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom,Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sameena Nawaz
- Virus Reference Department, National Infection Service, Public Health England, London, United Kingdom
| | - Sarah Collins
- Immunisation Department, National Infection Service, Public Health England, London, United Kingdom
| | - Shamez Ladhani
- Immunisation Department, National Infection Service, Public Health England, London, United Kingdom,NIHR Health Protection Research Unit in Immunisation, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roberto Vivancos
- Field Epidemiology Services, National Infection Service, Public Health England, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
| | - Miren Iturriza-Gómara
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, United Kingdom,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
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18
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Hungerford D, Vivancos R, Read JM, Bonnett LJ, Bar-Zeev N, Iturriza-Gómara M, Cunliffe NA, French N. Mitigating bias in observational vaccine effectiveness studies using simulated comparator populations: Application to rotavirus vaccination in the UK. Vaccine 2018; 36:6674-6682. [PMID: 30293764 DOI: 10.1016/j.vaccine.2018.09.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/18/2018] [Accepted: 09/21/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Measuring vaccine effectiveness (VE) relies on the use of observational study designs. However, achieving robust estimates of direct and indirect VE is frequently compromised by bias, particularly when using syndromic diagnoses of low-specificity. METHODS In order to mitigate confounding between the measured outcome and vaccine uptake, we developed a method to balance comparator populations using individual-level propensity scoring derived from the vaccine-exposed population, and applied it to the unexposed comparator population. Indirect VE was estimated by comparing the unvaccinated vaccine-exposed group with a propensity score-simulated unvaccinated, unexposed group. Direct VE was derived by removing indirect VE from the overall VE. We applied this method to an evaluation of the effectiveness of infant rotavirus vaccination in the UK. Using a general practice cohort of 45,259 live births between May 2010 and December 2015, we calculated indirect and direct VE against consultations for acute gastroenteritis using conventional and vaccination-propensity adjustment comparator populations. RESULTS The overall VE during the rotavirus-season (January-May) calculated using mixed-effects Cox regression was 30% [95% confidence intervals (95% CI: 25,35%)]. Use of conventional comparator populations resulted in implausible VE estimates -14% (95% CI: -41,7%) for direct and 29% (95% CI: 14,42%) for indirect effects. Applying our alternative method, direct VE was 26% (95% CI: 1,45%) and indirect VE was 8% (95% CI: -19,29%). CONCLUSIONS Estimating VE using propensity score simulated comparator populations, particularly for studies using routine health data with syndromic, low-specificity endpoints will aid accurate measurement of the broader public health impact of a vaccine programme.
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Affiliation(s)
- Daniel Hungerford
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK; Field Epidemiology Services, National Infection Service, Public Health England, Suite 3b, Third Floor, The Cunard Building, Water Street, Liverpool L3 1DS, UK; NIHR Health Protection Research Unit in Gastrointestinal Infections, The Farr Institute@HeRC, University of Liverpool, 2nd Floor, Block F, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool L69 3GL, UK; NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK.
| | - Roberto Vivancos
- Field Epidemiology Services, National Infection Service, Public Health England, Suite 3b, Third Floor, The Cunard Building, Water Street, Liverpool L3 1DS, UK; NIHR Health Protection Research Unit in Gastrointestinal Infections, The Farr Institute@HeRC, University of Liverpool, 2nd Floor, Block F, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool L69 3GL, UK; NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK.
| | - Jonathan M Read
- NIHR Health Protection Research Unit in Gastrointestinal Infections, The Farr Institute@HeRC, University of Liverpool, 2nd Floor, Block F, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool L69 3GL, UK; NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK; Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK.
| | - Laura J Bonnett
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Block F, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool L69 3GL, UK.
| | - Naor Bar-Zeev
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK; International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street 5th Floor, Baltimore, MD 21231, USA
| | - Miren Iturriza-Gómara
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK; NIHR Health Protection Research Unit in Gastrointestinal Infections, The Farr Institute@HeRC, University of Liverpool, 2nd Floor, Block F, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool L69 3GL, UK; NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK.
| | - Nigel A Cunliffe
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK.
| | - Neil French
- The Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK.
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19
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Parker EPK, Ramani S, Lopman BA, Church JA, Iturriza-Gómara M, Prendergast AJ, Grassly NC. Causes of impaired oral vaccine efficacy in developing countries. Future Microbiol 2018; 13:97-118. [PMID: 29218997 PMCID: PMC7026772 DOI: 10.2217/fmb-2017-0128] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/13/2017] [Indexed: 12/12/2022] Open
Abstract
Oral vaccines are less immunogenic when given to infants in low-income compared with high-income countries, limiting their potential public health impact. Here, we review factors that might contribute to this phenomenon, including transplacental antibodies, breastfeeding, histo blood group antigens, enteric pathogens, malnutrition, microbiota dysbiosis and environmental enteropathy. We highlight several clear risk factors for vaccine failure, such as the inhibitory effect of enteroviruses on oral poliovirus vaccine. We also highlight the ambiguous and at times contradictory nature of the available evidence, which undoubtedly reflects the complex and interconnected nature of the factors involved. Mechanisms responsible for diminished immunogenicity may be specific to each oral vaccine. Interventions aiming to improve vaccine performance may need to reflect the diversity of these mechanisms.
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Affiliation(s)
- Edward PK Parker
- Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, W2 1PG, UK
| | | | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - James A Church
- Centre for Paediatrics, Blizard Institute, Queen Mary University of London, London, E1 2AT, UK
| | - Miren Iturriza-Gómara
- Centre for Global Vaccine Research, Institute of Infection & Global Health, University of Liverpool, Liverpool, L69 7BE, UK
| | - Andrew J Prendergast
- Centre for Paediatrics, Blizard Institute, Queen Mary University of London, London, E1 2AT, UK
| | - Nicholas C Grassly
- Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, W2 1PG, UK
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20
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Parker EPK, Praharaj I, Zekavati A, Lazarus RP, Giri S, Operario DJ, Liu J, Houpt E, Iturriza-Gómara M, Kampmann B, John J, Kang G, Grassly NC. Influence of the intestinal microbiota on the immunogenicity of oral rotavirus vaccine given to infants in south India. Vaccine 2017; 36:264-272. [PMID: 29217369 PMCID: PMC5755003 DOI: 10.1016/j.vaccine.2017.11.031] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [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: 03/29/2017] [Revised: 10/19/2017] [Accepted: 11/13/2017] [Indexed: 11/27/2022]
Abstract
Oral rotavirus vaccines have consistently proven to be less immunogenic among infants in developing countries. Discrepancies in the intestinal microbiota, including a greater burden of enteropathogens and an altered commensal community composition, may contribute to this trend by inhibiting the replication of vaccine viruses. To test this possibility, we performed a nested case–control study in Vellore, India, in which we compared the intestinal microbiota of infants who responded serologically or not after two doses of Rotarix delivered at 6 and 10 weeks of age as part of a clinical trial (CTRI/2012/05/002677). The prevalence of 40 bacterial, viral, and eukaryotic pathogen targets was assessed in pre-vaccination stool samples from 325 infants using singleplex real-time PCR on a Taqman array card (TAC). In a subset of 170 infants, we assessed bacterial microbiota composition by sequencing the 16S rRNA gene V4 region. Contrary to expectations, responders were more likely than non-responders to harbor ≥1 bacterial enteropathogen at dose 1 (26% [40/156] vs 13% [21/157] of infants with TAC results who completed the study per protocol; χ2, P = .006), although this was not apparent at dose 2 (24% [38/158] vs 23% [36/158]; P = .790). Rotavirus shedding after dose 1 was negatively correlated with the replication of co-administered oral poliovirus vaccine (OPV). We observed no consistent differences in composition or diversity of the 16S bacterial microbiota according to serological response, although rotavirus shedding was associated with slightly more bacterial taxa pre-vaccination. Overall, our findings demonstrate an inhibitory effect of co-administered OPV on the first dose of Rotarix, consistent with previous studies, but in the context of OPV co-administration we did not find a strong association between other components of the intestinal microbiota at the time of vaccination and Rotarix immunogenicity.
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Affiliation(s)
- Edward P K Parker
- Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, UK.
| | - Ira Praharaj
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Anna Zekavati
- Imperial BRC Genomics Facility, Commonwealth Building, Hammersmith Hospital, London, UK
| | - Robin P Lazarus
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Sidhartha Giri
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Darwin J Operario
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Jie Liu
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Eric Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Miren Iturriza-Gómara
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK; NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Beate Kampmann
- Department of Paediatrics, St Mary's Campus, Imperial College London, London, UK; MRC Unit The Gambia, Fajara, Gambia
| | - Jacob John
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Nicholas C Grassly
- Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, UK
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21
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Hungerford D, Smith K, Tucker A, Iturriza-Gómara M, Vivancos R, McLeonard C, A Cunliffe N, French N. Population effectiveness of the pentavalent and monovalent rotavirus vaccines: a systematic review and meta-analysis of observational studies. BMC Infect Dis 2017; 17:569. [PMID: 28810833 PMCID: PMC5556361 DOI: 10.1186/s12879-017-2613-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 07/18/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Rotavirus was the leading cause of acute gastroenteritis (AGE) in infants and young children prior to the introduction of routine vaccination. Since 2006 there have been two licensed vaccines available; with successful clinical trials leading the World Health Organization to recommend rotavirus vaccination for all children worldwide. In order to inform immunisation policy we have conducted a systematic review and meta-analysis of observation studies to assess population effectiveness against acute gastroenteritis. METHODS We systematically searched PubMed, Medline, Web of Science, Cinhal and Academic Search Premier and grey literature sources for studies published between January 2006 and April 2014. Studies were eligible for inclusion if they were observational measuring population effectiveness of rotavirus vaccination against health care attendances for rotavirus gastroenteritis or AGE. To evaluate study quality we use used the Newcastle-Ottawa Scale for non-randomised studies, categorising studies by risk of bias. Publication bias was assessed using funnel plots. If two or more studies reported a measure of vaccine effectiveness (VE), we conducted a random effects meta-analysis. We stratified analyses by World Bank country income level and used study quality in sensitivity analyses. RESULTS We identified 30 studies, 19 were from high-income countries and 11 from middle-income countries. Vaccine effectiveness against hospitalization for laboratory confirmed rotavirus gastroenteritis was highest in high-income countries (89% VE; 95% CI 84-92%) compared to middle-income countries (74% VE; 95% CI 67-80%). Vaccine effectiveness was higher for those receiving the complete vaccine schedule (81% VE; 95% CI 75-86%) compared to partial schedule (62% VE; 95% CI 55-69%). Two studies from high-income countries measured VE against community consultations for AGE with a pooled estimate of 40% (95% CI 13-58%; 2 studies). CONCLUSIONS We found strong evidence to further support the continued use of rotavirus vaccines. Vaccine effectiveness was similar to that reported in clinical trials for both high and middle-income countries. There is limited data from Low income settings at present. There was lower effectiveness against milder disease. Further studies, should continue to report effectiveness against AGE and less-severe rotavirus disease because as evidenced by pre-vaccine introduction studies this is likely to contribute the greatest burden on healthcare resources, particularly in high-income countries.
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Affiliation(s)
- Daniel Hungerford
- Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK. .,Field Epidemiology Service, National Infection Service, Public Health England, Liverpool, L1 1JF, UK. .,The Centre for Global Vaccine Research, University of Liverpool, Liverpool, L69 7BE, UK.
| | - Katie Smith
- Health Education North West, Liverpool, L3 4BL, UK
| | | | - Miren Iturriza-Gómara
- Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK.,The Centre for Global Vaccine Research, University of Liverpool, Liverpool, L69 7BE, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK
| | - Roberto Vivancos
- Field Epidemiology Service, National Infection Service, Public Health England, Liverpool, L1 1JF, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.,NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK
| | - Catherine McLeonard
- Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK
| | - Nigel A Cunliffe
- Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK.,The Centre for Global Vaccine Research, University of Liverpool, Liverpool, L69 7BE, UK.,Department of Medical Microbiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Neil French
- Institute of Infection and Global Health, University of Liverpool, Liverpool, L69 7BE, UK.,The Centre for Global Vaccine Research, University of Liverpool, Liverpool, L69 7BE, UK.,Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
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22
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Sindhu KNC, Cunliffe N, Peak M, Turner M, Darby A, Grassly N, Gordon M, Dube Q, Babji S, Praharaj I, Verghese V, Iturriza-Gómara M, Kang G. Impact of maternal antibodies and infant gut microbiota on the immunogenicity of rotavirus vaccines in African, Indian and European infants: protocol for a prospective cohort study. BMJ Open 2017; 7:e016577. [PMID: 28360258 PMCID: PMC5372070 DOI: 10.1136/bmjopen-2017-016577] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Gastroenteritis is the leading cause of morbidity and mortality among young children living in resource-poor settings, majority of which is attributed to rotavirus. Rotavirus vaccination can therefore have a significant impact on infant mortality. However, rotavirus vaccine efficacy in Sub-Saharan Africa and Southeast Asia is significantly lower than in high-income countries. Maternally derived antibodies, infant gut microbiota and concomitant oral polio vaccination have been proposed as potential reasons for poor vaccine performance in low-income settings. The overall aim of this study is to compare the role of maternally derived antibodies and infant gut microbiota in determining immune response to rotavirus vaccine in high-income and low-income settings, using the same vaccine and a similar study protocol. METHODS AND ANALYSIS The study is an observational cohort in three countries-Malawi, India and UK. Mothers will be enrolled in third trimester of pregnancy and followed up, along with infants after delivery, until the infant completes two doses of oral rotavirus vaccine (along with routine immunisation). The levels of prevaccination maternally derived rotavirus-specific antibodies (IgG) will be correlated with infant seroconversion and antibody titres, 4 weeks after the second dose of rotavirus vaccine. Both within-country and between-country comparisons of gut microbiome will be carried out between children who seroconvert and those who do not. The impact of oral polio vaccine coadministration on rotavirus vaccine response will be studied in Indian infants. ETHICS AND DISSEMINATION Ethical approvals have been obtained from Integrated Research Application System (IRAS, NHS ethics) in UK, College of Medicine Research and Ethics Committee (COMREC) in Malawi and Institutional Review Board (IRB), Christian Medical College, Vellore in India. Participant recruitment and follow-up is ongoing at all three sites. Analysis of data, followed by publication of the results, is expected in 2018.
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Affiliation(s)
| | | | - Matthew Peak
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | | | | | | | | | - Sudhir Babji
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ira Praharaj
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Valsan Verghese
- Department of Child Health, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
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23
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Iturriza-Gómara M, Cunliffe NA. The Gut Microbiome as Possible Key to Understanding and Improving Rotavirus Vaccine Performance in High–Disease Burden Settings. J Infect Dis 2016; 215:8-10. [DOI: 10.1093/infdis/jiw521] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023] Open
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24
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Arana A, Montes M, Jere KC, Alkorta M, Iturriza-Gómara M, Cilla G. Emergence and spread of G3P[8] rotaviruses possessing an equine-like VP7 and a DS-1-like genetic backbone in the Basque Country (North of Spain), 2015. Infect Genet Evol 2016; 44:137-144. [PMID: 27370571 DOI: 10.1016/j.meegid.2016.06.048] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/07/2016] [Accepted: 06/25/2016] [Indexed: 11/30/2022]
Abstract
In March 2015, an atypical G3P[8] rotavirus with an equine-like VP7 gene was detected in Gipuzkoa (Basque Country, Spain) and spread contributing significantly to the seasonal epidemic. The strain was identified in fecal samples collected from 68 patients, mainly children from rural and urban settings with acute gastroenteritis, representing 14.9% of the 455 rotavirus strains genotyped between July 2014 and June 2015. Seven patients (10.3%) were hospitalized. Full genome analysis of six of these strains revealed a DS-1-like genotype constellation, G3-P[8]-I2-R2-C2-M2-A2-N2-T2-E2-H2, and showed that most genome segments shared the highest nucleotide sequence identity with strains isolated in Japan, Thailand, Australia and the Philippines. The strains of Gipuzkoa were similar to novel G3P[8] reassortant rotaviruses with an equine-like VP7 gene and a DS-1-like genetic backbone that emerged in the Asia-Pacific Region in 2013. The study highlights the circulation of these atypical rotaviruses outside the Asia-Pacific Region of origin, and their emergence in a European Region. Due to their unusual genotype constellation, these strains pose a challenge for the rotavirus strain surveillance, since G-/P-typing, the most commonly used classification system, cannot identify this type of intergenogroup reassortants.
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Affiliation(s)
- Ainara Arana
- Microbiology Department, Donostia University Hospital - Biodonostia Health Research Institute, San Sebastián, Spain
| | - Milagrosa Montes
- Microbiology Department, Donostia University Hospital - Biodonostia Health Research Institute, San Sebastián, Spain; Biomedical Research Centre Network for Respiratory Diseases (CIBERES), San Sebastián, Spain
| | - Khuzwayo C Jere
- Institute of Infection & Global Health, University of Liverpool, Ronald Ross Building, Liverpool, UK; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Miriam Alkorta
- Microbiology Department, Donostia University Hospital - Biodonostia Health Research Institute, San Sebastián, Spain
| | - Miren Iturriza-Gómara
- Institute of Infection & Global Health, University of Liverpool, Ronald Ross Building, Liverpool, UK; NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Gustavo Cilla
- Microbiology Department, Donostia University Hospital - Biodonostia Health Research Institute, San Sebastián, Spain; Biomedical Research Centre Network for Respiratory Diseases (CIBERES), San Sebastián, Spain.
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Hungerford D, Vivancos R, Read JM, Pitzer VE, Cunliffe N, French N, Iturriza-Gómara M. In-season and out-of-season variation of rotavirus genotype distribution and age of infection across 12 European countries before the introduction of routine vaccination, 2007/08 to 2012/13. ACTA ACUST UNITED AC 2016; 21:30106. [PMID: 26794258 DOI: 10.2807/1560-7917.es.2016.21.2.30106] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 04/15/2015] [Accepted: 09/14/2015] [Indexed: 12/21/2022]
Abstract
The EuroRotaNet surveillance network has conducted rotavirus genotype surveillance since 2007 in 16 European countries. Using epidemiological and microbiological data from 39,786 genotyped rotavirus-positive specimens collected between September 2007 and August 2013, we assessed genotype distribution and age distribution of rotavirus gastroenteritis (RVGE) cases in and out of peak season in 12 countries which were yet to implement routine rotavirus vaccination. In multinomial multivariate logistic regression, adjusting for year, country and age, the odds of infection caused by genotype-constellation 2 DS-1-like stains (adjusted multinomial odds ratio (aM-OR) = 1.25; 95% confidence interval (CI): 1.13-1.37; p < 0.001), mixed or untypable genotypes (aM-OR = 1.55; 95% CI: 1.40-1.72; p < 0.001) and less common genotypes (aM-OR = 2.11; 95% CI:1.78-2.51; p < 0.001) increased out of season relative to G1P[8]. Age varied significantly between seasons; the proportion of RVGE cases younger than 12 months in the United Kingdom increased from 34% in season to 39% out of season (aM-OR = 1.66; 95% CI: 1.20-2.30), and the proportion five years and older increased from 9% in season to 17% out of season (aM-OR = 2.53; 95% CI: 1.67-3.82). This study provides further understanding of the rotavirus ecology before vaccine introduction, which will help interpret epidemiological changes in countries introducing or expanding rotavirus vaccination programmes.
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Affiliation(s)
- Daniel Hungerford
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
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26
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Carmona-Vicente N, Allen DJ, Rodríguez-Díaz J, Iturriza-Gómara M, Buesa J. Antibodies against Lewis antigens inhibit the binding of human norovirus GII.4 virus-like particles to saliva but not to intestinal Caco-2 cells. Virol J 2016; 13:82. [PMID: 27206610 PMCID: PMC4875664 DOI: 10.1186/s12985-016-0538-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/12/2016] [Indexed: 12/01/2022] Open
Abstract
Background Human noroviruses (NoVs) are the main cause of gastroenteritis worldwide. The most commonly detected NoV strains belong to the genetically diverse GII.4 genotype, with new pandemic variants emerging periodically. Despite extensive efforts, NoV investigation has been hampered by the lack of an effective in vitro cell culture system. However, NoV-derived recombinant virus-like particles (VLPs) resembling empty capsids are good surrogates for analysing NoV antigenicity and virus-ligand interactions. NoV VLPs have been reported to bind to histo-blood group antigens (HBGAs). We have analysed the ability of NoV VLPs derived from GI.1 genotype and from three GII.4 genotype variants, GII.4-1999, GII.4-2004 and GII.4-2006b, to bind to porcine gastric mucin (PGM), human saliva and differentiated human intestinal Caco-2 cells (D-Caco-2 cells). Results Distinct patterns of saliva binding with the NoV GII.4 variant VLPs were observed, although they bound to D-Caco-2 cells independently of the expression of HBGAs. Monoclonal antibodies against Lewis antigens were able to block the binding of NoV VLPs to saliva, but not to D-Caco-2 cells. Blocking HBGAs on the surface of D-Caco-2 cells with specific monoclonal antibodies did not affect NoV VLP binding to cellular membranes. Co-localisation of Lewis y (Ley) and H-type 2 antigens with NoV VLPs was not observed by immunofluorescence assays. Conclusion Although the binding of NoV VLPs of GII.4 genotype variants to human saliva samples occur with distinct HBGA binding patterns and can be blocked by antibodies against Lewis antigens, their attachment to D-Caco-2 cells can be mediated by other receptors, which still need further investigation.
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Affiliation(s)
- Noelia Carmona-Vicente
- Department of Microbiology, School of Medicine, University of Valencia, Avda. Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - David J Allen
- Virus Reference Department, Public Health England, London, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Jesús Rodríguez-Díaz
- Department of Microbiology, School of Medicine, University of Valencia, Avda. Blasco Ibáñez, 17, 46010, Valencia, Spain
| | - Miren Iturriza-Gómara
- CIMI, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Javier Buesa
- Department of Microbiology, School of Medicine, University of Valencia, Avda. Blasco Ibáñez, 17, 46010, Valencia, Spain.
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Grassly NC, Praharaj I, Babji S, Kaliappan SP, Giri S, Venugopal S, Parker EPK, Abraham A, Muliyil J, Doss S, Raman U, Liu J, Peter JV, Paranjape M, Jeyapaul S, Balakumar S, Ravikumar J, Srinivasan R, Bahl S, Iturriza-Gómara M, Uhlig HH, Houpt ER, John J, Kang G. The effect of azithromycin on the immunogenicity of oral poliovirus vaccine: a double-blind randomised placebo-controlled trial in seronegative Indian infants. Lancet Infect Dis 2016; 16:905-14. [PMID: 27156189 DOI: 10.1016/s1473-3099(16)30023-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/20/2016] [Accepted: 03/29/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Oral poliovirus vaccine is less immunogenic and effective in low-income countries than in high-income countries, similarly to other oral vaccines. The high prevalence of intestinal pathogens and associated environmental enteropathy has been proposed to explain this problem. Because administration of an antibiotic has the potential to resolve environmental enteropathy and clear bacterial pathogens, we aimed to assess whether antibiotics would improve oral poliovirus vaccine immunogenicity. METHODS We did a double-blind, randomised, placebo-controlled trial of the effect of azithromycin on the immunogenicity of serotype-3 monovalent oral poliovirus vaccine given to healthy infants living in 14 blocks of Vellore district, India. Infants were eligible to participate if they were 6-11 months old, available for the study duration, and lacked serum neutralising antibodies to serotype-3 poliovirus. Infants were randomly assigned (1:1) at enrolment to receive oral 10 mg/kg azithromycin or placebo once daily for 3 days, followed by serotype-3 monovalent oral poliovirus vaccine on day 14. The primary outcome was detection of serum neutralising antibodies to serotype-3 poliovirus at a dilution of one in eight or more on day 35 and was assessed in the per-protocol population (ie, all those who received azithromycin or placebo, oral poliovirus vaccine, and provided a blood sample according to the study protocol). Safety outcomes were assessed in all infants enrolled in the study. The trial is registered with the Clinical Trials Registry India, number CTRI/2014/05/004588. FINDINGS Between Aug 5, 2014, and March 21, 2015, 754 infants were randomly assigned: 376 to receive azithromycin and 378 to placebo. Of these, 348 (93%) of 376 in the azithromycin group and 357 (94%) of 378 infants in the placebo group completed the study per protocol. In the azithromycin group, 175 (50%) seroconverted to serotype-3 poliovirus compared with 192 (54%) in the placebo group (risk ratio 0·94, 95% CI 0·81-1·08; p=0·366). Azithromycin reduced faecal biomarkers of environmental enteropathy (calprotectin, myeloperoxidase, α1-antitrypsin) and the prevalence of bacterial but not viral or eukaryotic pathogens. Viral pathogens were associated with lower seroconversion. Three serious adverse events were reported (two in the azithromycin group and one in the placebo group), but none was considered related to the study interventions. INTERPRETATION Azithromycin did not improve the immunogenicity of oral poliovirus vaccine despite reducing biomarkers of environmental enteropathy and the prevalence of pathogenic intestinal bacteria. Viral interference and innate antiviral immune mechanisms might be more important determinants of the immunogenicity of live-virus oral vaccines. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Nicholas C Grassly
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK; Christian Medical College, Vellore, Tamil Nadu, India.
| | - Ira Praharaj
- Christian Medical College, Vellore, Tamil Nadu, India
| | - Sudhir Babji
- Christian Medical College, Vellore, Tamil Nadu, India
| | | | | | | | - Edward P K Parker
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Asha Abraham
- Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Sridhar Doss
- Christian Medical College, Vellore, Tamil Nadu, India
| | - Uma Raman
- Christian Medical College, Vellore, Tamil Nadu, India
| | - Jie Liu
- Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | | | | | | | | | | | - Sunil Bahl
- WHO Regional Office for South-East Asia, New Delhi, India
| | - Miren Iturriza-Gómara
- Institute of Infection and Global Health, and NIHR Health Protection Research Unit in Gastrointestinal Infection, University of Liverpool, Liverpool, UK
| | - Holm H Uhlig
- Translational Gastroenterology Unit, Nuffield Department of Medicine, and Department of Paediatrics, University of Oxford, Oxford, UK
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Jacob John
- Christian Medical College, Vellore, Tamil Nadu, India
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28
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Trainor E, Iturriza-Gómara M, Ngwira B, Cunliffe N. Detection of enterotoxigenic E. coli in hospitalised children with and without diarrhoea in Blantyre, Malawi. Paediatr Int Child Health 2016; 36:102-5. [PMID: 25940596 DOI: 10.1179/2046905515y.0000000014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Enterotoxigenic E. coli (ETEC) is an important cause of diarrhoea among children in developing countries. The burden of ETEC infection was investigated for the first time in children in Malawi. METHODS Faecal samples obtained from children < 5 years of age hospitalised with diarrhoea in Blantyre, Malawi over a 10-year period (1997-2007) before introduction of the rotavirus vaccine were examined by PCR for ETEC heat-labile (LT) and heat-stable (STh and STp) enterotoxins. Children hospitalised without diarrhoea were enrolled over a 2-year period as a comparison group. RESULTS ETEC was detected in 205 (10.6%) of 1941 children with diarrhoea. The most prevalent toxin type was STh (6·6%), followed by LT (2·1%) and STp (0·9%). ETEC infection was most prevalent in infants aged 6-11 months. Co-infection with rotavirus was common. ETEC was detected in 37 (7·3%) of 507 children without diarrhoea. CONCLUSION The burden of ETEC infection in young Malawian children is substantial and should become a focus of diarrhoea prevention efforts in the post-rotavirus vaccine era.
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Affiliation(s)
- Eamonn Trainor
- a Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health , University of Liverpool , UK
| | - Miren Iturriza-Gómara
- a Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health , University of Liverpool , UK
| | - Bagrey Ngwira
- b Department of Community Health, College of Medicine , University of Malawi, Blantyre , Malawi
| | - Nigel Cunliffe
- a Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health , University of Liverpool , UK
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29
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Allen DJ, Trainor E, Callaghan A, O’Brien SJ, Cunliffe NA, Iturriza-Gómara M. Early Detection of Epidemic GII-4 Norovirus Strains in UK and Malawi: Role of Surveillance of Sporadic Acute Gastroenteritis in Anticipating Global Epidemics. PLoS One 2016; 11:e0146972. [PMID: 27115152 PMCID: PMC4846118 DOI: 10.1371/journal.pone.0146972] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 09/21/2015] [Accepted: 12/22/2015] [Indexed: 12/30/2022] Open
Abstract
Noroviruses are endemic in the human population, and are recognised as a leading cause of acute gastroenteritis worldwide. Although they are a highly diverse group of viruses, genogroup-II genotype-4 (GII-4) noroviruses are the most frequently identified strains worldwide. The predominance of GII-4 norovirus strains is driven by the periodic emergence of antigenic variants capable of evading herd protection. The global molecular epidemiology of emerging GII-4 strains is largely based on data from outbreak surveillance programmes, but the epidemiology of GII-4 strains among sporadic or community cases is far less well studied. To understand the distribution of GII-4 norovirus strains associated with gastroenteritis in the wider population, we characterised the GII-4 norovirus strains detected during studies of sporadic cases of infectious gastroenteritis collected in the UK and Malawi between 1993 and 2009. Our data shows that GII-4 norovirus strains that have emerged as strains of global epidemic importance have circulated in the community up to 18 years before their recognition as pandemic strains associated with increases in outbreaks. These data may suggest that more comprehensive surveillance programmes that incorporate strains associated with sporadic cases may provide a way for early detection of emerging strains with pandemic potential. This may be of particular relevance as vaccines become available.
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Affiliation(s)
- David J. Allen
- Virus Reference Department, Public Health England, London, United Kingdom
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, United Kingdom
| | - Eamonn Trainor
- Department of Clinical Infection, Microbiology & Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- St Helens and Knowsley Teaching Hospitals NHS Trust, Liverpool, United Kingdom
| | - Anna Callaghan
- Virus Reference Department, Public Health England, London, United Kingdom
- Pathogen Molecular Biology Unit, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah J. O’Brien
- Department of Epidemiology & Public Health, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, United Kingdom
| | - Nigel A. Cunliffe
- Department of Clinical Infection, Microbiology & Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Miren Iturriza-Gómara
- Department of Clinical Infection, Microbiology & Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, United Kingdom
- * E-mail:
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30
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Hungerford D, Read JM, Cooke RPD, Vivancos R, Iturriza-Gómara M, Allen DJ, French N, Cunliffe N. Early impact of rotavirus vaccination in a large paediatric hospital in the UK. J Hosp Infect 2015; 93:117-20. [PMID: 26876744 DOI: 10.1016/j.jhin.2015.12.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 10/26/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
The impact of routine rotavirus vaccination on community-acquired (CA) and healthcare-associated (HA) rotavirus gastroenteritis (RVGE) at a large paediatric hospital, UK, was investigated over a 13-year period. A total of 1644 hospitalized children aged 0-15 years tested positive for rotavirus between July 2002 and June 2015. Interrupted time-series analysis demonstrated that, post vaccine introduction (July 2013 to June 2015), CA- and HA-RVGE hospitalizations were 83% [95% confidence interval (CI): 72-90%) and 83% (95% CI: 66-92%] lower than expected, respectively. Rotavirus vaccination has rapidly reduced the hospital rotavirus disease burden among both CA- and HA-RVGE cases.
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Affiliation(s)
- D Hungerford
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK; Field Epidemiology Services, Public Health England, Liverpool, UK.
| | - J M Read
- CHICAS Group, Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - R P D Cooke
- Department of Microbiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - R Vivancos
- Field Epidemiology Services, Public Health England, Liverpool, UK
| | - M Iturriza-Gómara
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - D J Allen
- Virus Reference Department, Public Health England, Colindale, London, UK
| | - N French
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - N Cunliffe
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK; Department of Microbiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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31
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Tokuhara D, Álvarez B, Mejima M, Hiroiwa T, Takahashi Y, Kurokawa S, Kuroda M, Oyama M, Kozuka-Hata H, Nochi T, Sagara H, Aladin F, Marcotte H, Frenken LGJ, Iturriza-Gómara M, Kiyono H, Hammarström L, Yuki Y. Rice-based oral antibody fragment prophylaxis and therapy against rotavirus infection. J Clin Invest 2013; 123:3829-38. [PMID: 23925294 DOI: 10.1172/jci70266] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 06/13/2013] [Indexed: 12/30/2022] Open
Abstract
Rotavirus-induced diarrhea is a life-threatening disease in immunocompromised individuals and in children in developing countries. We have developed a system for prophylaxis and therapy against rotavirus disease using transgenic rice expressing the neutralizing variable domain of a rotavirus-specific llama heavy-chain antibody fragment (MucoRice-ARP1). MucoRice-ARP1 was produced at high levels in rice seeds using an overexpression system and RNAi technology to suppress the production of major rice endogenous storage proteins. Orally administered MucoRice-ARP1 markedly decreased the viral load in immunocompetent and immunodeficient mice. The antibody retained in vitro neutralizing activity after long-term storage (>1 yr) and boiling and conferred protection in mice even after heat treatment at 94°C for 30 minutes. High-yield, water-soluble, and purification-free MucoRice-ARP1 thus forms the basis for orally administered prophylaxis and therapy against rotavirus infections.
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Affiliation(s)
- Daisuke Tokuhara
- Division of Mucosal Immunology, Department of Microbiology and Immunology, The Institute of Medical Science, University of Tokyo, Tokyo, Japan
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32
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Halstead FD, Lee AV, Couto-Parada X, Polley SD, Ling C, Jenkins C, Chalmers RM, Elwin K, Gray JJ, Iturriza-Gómara M, Wain J, Clark DA, Bolton FJ, Manuel RJ, The Olympics Gi Group. Universal extraction method for gastrointestinal pathogens. J Med Microbiol 2013; 62:1535-1539. [PMID: 23831766 DOI: 10.1099/jmm.0.058743-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A universal stool extraction method for recovery of nucleic acids (NAs) from gastrointestinal pathogens was developed to support rapid diagnostics for the London 2012 Olympics. The method involved mechanical disruption (bead beating) of the stools, followed by automated extraction and detection using real-time PCR. This method had been used extensively in the Second Infectious Intestinal Disease Study (IID2) for the isolation of NA from bacteria and parasites (and was effective for the robust recovery of Cryptosporidium spp.) but had not been used for enteric viruses. To ensure this method was universally suitable, panels of samples known to contain target bacteria, viruses or parasites were processed in triplicate using the pre-treatment method routinely used for each target and the new extraction method (bead beating). The extracts were tested using real-time PCR and the cycle threshold values were compared. The results from this study showed that bead beating improved yields for the bacterial and parasitic targets and was suitable for the viral targets. The implementation of this universal method should confer cost- and time-saving benefits and streamline the processes required for the characterization of an array of pathogens from faecal samples.
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Affiliation(s)
- Fenella D Halstead
- PHE Microbiology Services, Colindale, London, UK.,Royal Free London NHS Trust, London, UK
| | - Adele V Lee
- Burnet Institute, Melbourne, Australia.,PHE Public Health Laboratory London, Barts Health NHS Trust, London, UK
| | - Xose Couto-Parada
- PHE Public Health Laboratory London, Barts Health NHS Trust, London, UK
| | | | - Clare Ling
- PHE Public Health Laboratory London, Barts Health NHS Trust, London, UK
| | | | - Rachel M Chalmers
- Cryptosporidium Reference Laboratory, Public Health Wales Microbiology, Swansea, UK
| | - Kristin Elwin
- Cryptosporidium Reference Laboratory, Public Health Wales Microbiology, Swansea, UK
| | - Jim J Gray
- Norfolk and Norwich University Hospitals NHS Trust, UK.,PHE Microbiology Services, Colindale, London, UK
| | | | - John Wain
- PHE Microbiology Services, Colindale, London, UK
| | - Duncan A Clark
- PHE Public Health Laboratory London, Barts Health NHS Trust, London, UK
| | | | - Rohini J Manuel
- PHE Public Health Laboratory London, Barts Health NHS Trust, London, UK
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34
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Nakagomi T, Doan YH, Dove W, Ngwira B, Iturriza-Gómara M, Nakagomi O, Cunliffe NA. G8 rotaviruses with conserved genotype constellations detected in Malawi over 10 years (1997-2007) display frequent gene reassortment among strains co-circulating in humans. J Gen Virol 2013; 94:1273-1295. [PMID: 23407423 PMCID: PMC3945219 DOI: 10.1099/vir.0.050625-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [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
Rotavirus A, the most common cause of severe diarrhoea in children worldwide, occurs in five major VP7 (G) and VP4 (P) genotype combinations, comprising G1P[8], G2P[4], G3P[8], G4P[8] and G9P[8]. However, G8, a common bovine rotavirus genotype, has been reported frequently among children in African countries. Surveillance of rotavirus gastroenteritis conducted in a sentinel hospital in Blantyre, Malawi between 1997 and 2007 provided a rare opportunity to examine the whole genotype constellation of G8 strains and their evolution over time. A sample of 27 (9.0 %) of 299 G8 strains was selected to represent each surveillance year and a range of P genotypes, which shifted in predominance from P[6] to P[4] and P[8] during the study period. Following cell culture adaptation, whole genome sequencing demonstrated that the genetic background of 26 strains possessed the DS-1 genotype constellation. A single G8P[6] strain was a reassortant in which both NSP2 and NSP5 genes from strains with the Wa genotype constellation had been inserted into a strain with the DS-1 genotype background. Phylogenetic analysis suggested frequent reassortment among co-circulating strains with the DS-1 genotype constellation. Little evidence was identified to suggest the introduction of contemporary bovine rotavirus genes into any of the 27 G8 strains examined. In conclusion, Malawian G8 strains are closely related to other human strains with the DS-1 genotype constellation. They have evolved over the last decade through genetic reassortment with other human rotaviruses, changing their VP4 genotypes while maintaining a conserved genotype constellation for the remaining structural and non-structural proteins.
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Affiliation(s)
- Toyoko Nakagomi
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Department of Molecular Microbiology and Immunology, Graduate School of Biomedical Sciences, and the Global Centre of Excellence, Nagasaki University, Nagasaki, Japan
| | - Yen Hai Doan
- Department of Molecular Microbiology and Immunology, Graduate School of Biomedical Sciences, and the Global Centre of Excellence, Nagasaki University, Nagasaki, Japan
| | - Winifred Dove
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Bagrey Ngwira
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Miren Iturriza-Gómara
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Osamu Nakagomi
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Department of Molecular Microbiology and Immunology, Graduate School of Biomedical Sciences, and the Global Centre of Excellence, Nagasaki University, Nagasaki, Japan
| | - Nigel A Cunliffe
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
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35
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Rodrigues F, Iturriza-Gómara M, Marlow R, Gray J, Nawaz S, Januário L, Finn A. The evolving epidemiology of rotavirus gastroenteritis in central Portugal with modest vaccine coverage. J Clin Virol 2012; 56:129-34. [PMID: 23238239 DOI: 10.1016/j.jcv.2012.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 09/22/2012] [Accepted: 10/30/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rotavirus (RV) vaccines have been available on the private market in Portugal since 2006, with an estimated coverage rising from 16 to 42% between 2007 and 2010. OBJECTIVES To assess trends, surveillance of children presenting with acute gastroenteritis (AG) to a large paediatric emergency service (ES) in the central region of Portugal was conducted yearly during the winter-spring seasons. STUDY DESIGN Stool samples, collected throughout five epidemic seasons (January-June, 2006 to 2010) from children ≤ 36 months of age attending the ES with AG, were tested for RV by immunochromatographic rapid test and positive samples were genotyped. RESULTS A total of 6145 AG cases were identified: 1956 (32%) provided a stool sample (range: 28% in 2008-37% in 2009). The proportion of AG subjects who tested positive for RV fluctuated over the five surveillance seasons (49%, 39%, 25%, 26% and 39%, respectively) as did the distribution of co-circulating RV genotypes. There were no consistent changes in seasonality or age distribution and the proportion of admitted AG subjects who tested RV-positive did not show progressive trends over time. CONCLUSIONS Our results demonstrate fluctuations in RVAG incidence with no clear progressive trends or seasonal RV shifts among our surveillance subjects over five years, in the context of limited rotavirus vaccine coverage. Significant annual changes in genotype distributions were detected. Higher vaccine coverage may be necessary than at present for consistent impact on disease.
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Affiliation(s)
- Fernanda Rodrigues
- Emergency Service and Infectious Diseases Unit, Hospital Pediátrico de Coimbra, Centro Hospitalar e Universitário de Coimbra, Av. Afonso Romão, Alto da Baleia, 3000-602 Coimbra, Portugal.
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Abstract
Noroviruses are a frequent cause of both acute gastroenteritis and outbreaks of gastroenteritis. Infection is usually self-limiting although it has been associated with mortality in children in the developing world and in vulnerable groups such as immunodeficient or immunosuppressed and elderly patients elsewhere. Diagnostic tests may be useful in preventing or limiting the spread and duration of outbreaks, and are needed to define norovirus-associated morbidity and mortality. However, the interpretation of test results should take account of the limitations of the different tests currently available. Therefore, the clinical, immunological and molecular tests available for norovirus detection have been reviewed. Early recognition of cases (clinical diagnoses) together with confirmation by sensitive and specific laboratory tests may contribute to reducing the spread of norovirus within hospitals. Syndromic testing that includes multiple or multiplex assays for the detection of viral, bacterial and parasitic pathogens with the inclusion of control groups are likely to better define norovirus-associated morbidity and mortality in low- and middle-income countries.
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Affiliation(s)
- Andrew Kirby
- Department of Clinical Infection, Microbiology & Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
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Mladenova Z, Papp H, Lengyel G, Kisfali P, Steyer A, Steyer AF, Esona MD, Iturriza-Gómara M, Bányai K. Detection of rare reassortant G5P[6] rotavirus, Bulgaria. Infect Genet Evol 2012; 12:1676-84. [PMID: 22850117 DOI: 10.1016/j.meegid.2012.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 07/10/2012] [Accepted: 07/11/2012] [Indexed: 11/30/2022]
Abstract
During the ongoing rotavirus strain surveillance program conducted in Bulgaria, an unusual human rotavirus A (RVA) strain, RVA/Human/BG/BG620/2008/G5P[6], was identified among 2200 genotyped Bulgarian RVAs. This strain showed the following genomic configuration: G5-P[6]-I1-R1-C1-M1-A8-N1-T1-E1-H1. Phylogenetic analysis of the genes encoding the neutralization proteins and backbone genes identified a probable mixture of RVA genes of human and porcine origin. The VP1, VP6 and NSP2 genes were more closely related to typical human rotavirus strains. The remaining eight genes were either closely related to typical porcine and unusual human-porcine reassortant rotavirus strains or were equally distant from reference human and porcine strains. This study is the first to report an unusual rotavirus isolate with G5P[6] genotype in Europe which has most likely emerged from zoonotic transmission. The absence of porcine rotavirus sequence data from this area did not permit to assess if the suspected ancestral zoonotic porcine strain already had human rotavirus genes in its genome when transmitted from pig to human, or, the transmission was coupled or followed by gene reassortment event(s). Because our strain shared no neutralization antigens with rotavirus vaccines used for routine immunization in children, attention is needed to monitor if this G-P combination will be able to emerge in human populations. A better understanding of the ecology of rotavirus zoonoses requires simultaneous monitoring of rotavirus strains in humans and animals.
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Abstract
BACKGROUND Human Noroviruses (NoV) are the major cause of acute nonbacterial gastroenteritis and the leading cause of outbreaks of gastroenteritis worldwide. Genotype II-4 (GII-4) NoV has been shown to spread rapidly and is the most commonly detected strain worldwide, particularly in association with outbreaks. Previously, we have shown that circulating GII-4 NoV strains exist as populations of selectively neutral variants, and that the emergence of epidemic GII-4 NoV strains correlated with mutations in at least two key sites (Sites A and B) within the P2 domain of the surface exposed major capsid protein (VP1). METHODOLOGY We developed a rapid pyrosequencing method for screening of the two Sites A and B and a homology based modelling system was used to predict the effects of amino acid substitutions at these sites on the antigenic properties of the virus (defined as surface motif types). PRINCIPLE FINDING/CONCLUSION Here, we describe the characterisation of amino acid diversity at Sites A and B for 1062 GII-4 NoV strains from clinical specimen associated with outbreak of gastroenteritis (2000-2011) and 250 GII-4 NoV sequences from Genbank. Our data identified a high diversity of different Site A and B site combinations at amino acid level and amino acid diversity was higher at Site B than Site A. Site A motifs could be grouped into 3 clusters based on similar surface motif types. We predict that Site A is a major epitope on the virus surface, responsible for defining the antigenic profile, and a more subtle role for Site B, maintaining minor antigenic variation within the virus population.
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Affiliation(s)
- Katherina Zakikhany
- Virus Reference Department, Health Protection Agency Microbiology Services, London, United Kingdom
- The European Programme for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - David J. Allen
- Virus Reference Department, Health Protection Agency Microbiology Services, London, United Kingdom
- * E-mail:
| | - David Brown
- Virus Reference Department, Health Protection Agency Microbiology Services, London, United Kingdom
| | - Miren Iturriza-Gómara
- Virus Reference Department, Health Protection Agency Microbiology Services, London, United Kingdom
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39
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Nawaz S, Allen DJ, Aladin F, Gallimore C, Iturriza-Gómara M. Human bocaviruses are not significantly associated with gastroenteritis: results of retesting archive DNA from a case control study in the UK. PLoS One 2012; 7:e41346. [PMID: 22848470 PMCID: PMC3404102 DOI: 10.1371/journal.pone.0041346] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [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: 03/20/2012] [Accepted: 06/20/2012] [Indexed: 11/18/2022] Open
Abstract
Gastroenteritis is a common illness causing considerable morbidity and mortality worldwide. Despite improvements in detection methods, a significant diagnostic gap still remains. Human bocavirus (HBoV)s, which are associated with respiratory infections, have also frequently been detected in stool samples in cases of gastroenteritis, and a tentative association between HBoVs, and in particular type-2 HBoVs, and gastroenteritis has previously been made. The aim of this study was to determine the role of HBoVs in gastroenteritis, using archived DNA samples from the case-control Infectious Intestinal Disease Study (IID). DNA extracted from stool samples from 2,256 cases and 2,124 controls were tested for the presence of HBoV DNA. All samples were screened in a real time PCR pan-HBoV assay, and positive samples were then tested in genotype 1 to 3-specific assays. HBoV was detected in 7.4% but no significantly different prevalence was observed between cases and controls. In the genotype-specific assays 106 of the 324 HBoV-positive samples were genotyped, with HBoV-1 predominantly found in controls whilst HBoV-2 was more frequently associated with cases of gastroenteritis (p<0.01). A significant proportion of HBoV positives could not be typed using the type specific assays, 67% of the total positives, and this was most likely due to low viral loads being present in the samples. However, the distribution of the untyped HBoV strains was no different between cases and controls. In conclusion, HBoVs, including HBoV-2 do not appear to be a significant cause of gastroenteritis in the UK population.
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Affiliation(s)
- Sameena Nawaz
- Virus Reference Department, Health Protection Agency, London, United Kingdom
| | - David J. Allen
- Virus Reference Department, Health Protection Agency, London, United Kingdom
| | - Farah Aladin
- Virus Reference Department, Health Protection Agency, London, United Kingdom
| | | | - Miren Iturriza-Gómara
- Virus Reference Department, Health Protection Agency, London, United Kingdom
- * E-mail:
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40
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Elwin K, Robinson G, Hadfield SJ, Fairclough HV, Iturriza-Gómara M, Chalmers RM. A comparison of two approaches to extracting Cryptosporidium DNA from human stools as measured by a real-time PCR assay. J Microbiol Methods 2012; 89:38-40. [PMID: 22366300 DOI: 10.1016/j.mimet.2012.02.006] [Citation(s) in RCA: 30] [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] [Received: 01/09/2012] [Revised: 02/07/2012] [Accepted: 02/10/2012] [Indexed: 10/28/2022]
Abstract
Direct extraction of Cryptosporidium DNA from 46 stools by bead-beating, guanidine thiocyanate and silica purification provided slightly lower PCR positivity (93.5% vs. 100%) and higher threshold cycle values (mean 34.93 vs. 28.03; P=0.00) than spin-column extraction from boiled, semi-purified oocyst suspensions. However, direct extraction is cheaper, and amenable to automation.
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Affiliation(s)
- K Elwin
- UK Cryptosporidium Reference Unit, Public Health Wales Microbiology, Singleton Hospital, Swansea, SA2 8QA, United Kingdom
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41
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Matthijnssens J, Ciarlet M, McDonald SM, Attoui H, Bányai K, Brister JR, Buesa J, Esona MD, Estes MK, Gentsch JR, Iturriza-Gómara M, Johne R, Kirkwood CD, Martella V, Mertens PPC, Nakagomi O, Parreño V, Rahman M, Ruggeri FM, Saif LJ, Santos N, Steyer A, Taniguchi K, Patton JT, Desselberger U, Van Ranst M. Uniformity of rotavirus strain nomenclature proposed by the Rotavirus Classification Working Group (RCWG). Arch Virol 2011; 156:1397-413. [PMID: 21597953 DOI: 10.1007/s00705-011-1006-z] [Citation(s) in RCA: 731] [Impact Index Per Article: 56.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 04/19/2011] [Indexed: 12/31/2022]
Abstract
In April 2008, a nucleotide-sequence-based, complete genome classification system was developed for group A rotaviruses (RVs). This system assigns a specific genotype to each of the 11 genome segments of a particular RV strain according to established nucleotide percent cutoff values. Using this approach, the genome of individual RV strains are given the complete descriptor of Gx-P[x]-Ix-Rx-Cx-Mx-Ax-Nx-Tx-Ex-Hx. The Rotavirus Classification Working Group (RCWG) was formed by scientists in the field to maintain, evaluate and develop the RV genotype classification system, in particular to aid in the designation of new genotypes. Since its conception, the group has ratified 51 new genotypes: as of April 2011, new genotypes for VP7 (G20-G27), VP4 (P[28]-P[35]), VP6 (I12-I16), VP1 (R5-R9), VP2 (C6-C9), VP3 (M7-M8), NSP1 (A15-A16), NSP2 (N6-N9), NSP3 (T8-T12), NSP4 (E12-E14) and NSP5/6 (H7-H11) have been defined for RV strains recovered from humans, cows, pigs, horses, mice, South American camelids (guanaco), chickens, turkeys, pheasants, bats and a sugar glider. With increasing numbers of complete RV genome sequences becoming available, a standardized RV strain nomenclature system is needed, and the RCWG proposes that individual RV strains are named as follows: RV group/species of origin/country of identification/common name/year of identification/G- and P-type. In collaboration with the National Center for Biotechnology Information (NCBI), the RCWG is also working on developing a RV-specific resource for the deposition of nucleotide sequences. This resource will provide useful information regarding RV strains, including, but not limited to, the individual gene genotypes and epidemiological and clinical information. Together, the proposed nomenclature system and the NCBI RV resource will offer highly useful tools for investigators to search for, retrieve, and analyze the ever-growing volume of RV genomic data.
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Affiliation(s)
- Jelle Matthijnssens
- Laboratory of Clinical & Epidemiological Virology, Department of Microbiology & Immunology, Rega Institute for Medical Research, University of Leuven, Minderbroedersstraat 10, 3000, Leuven, Belgium.
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42
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Morter S, Bennet G, Fish J, Richards J, Allen D, Nawaz S, Iturriza-Gómara M, Brolly S, Gray J. Norovirus in the hospital setting: virus introduction and spread within the hospital environment. J Hosp Infect 2011; 77:106-12. [DOI: 10.1016/j.jhin.2010.09.035] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 09/24/2010] [Indexed: 10/18/2022]
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43
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Steyer A, Bajželj M, Iturriza-Gómara M, Mladenova Z, Korsun N, Poljšak-Prijatelj M. Molecular analysis of human group A rotavirus G10P[14] genotype in Slovenia. J Clin Virol 2010; 49:121-5. [DOI: 10.1016/j.jcv.2010.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 06/24/2010] [Accepted: 07/06/2010] [Indexed: 11/28/2022]
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Aladin F, Nawaz S, Iturriza-Gómara M, Gray J. Identification of G8 rotavirus strains determined as G12 by rotavirus genotyping PCR: updating the current genotyping methods. J Clin Virol 2010; 47:340-4. [PMID: 20138804 DOI: 10.1016/j.jcv.2010.01.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 12/31/2009] [Accepted: 01/09/2010] [Indexed: 01/20/2023]
Abstract
BACKGROUND Rotaviruses are classified into G- and P-types, which are determined by the reactivity with antibodies to the outer viral proteins, VP7 and VP4, respectively, or sequence variation in the genes encoding these proteins. There are presently a number of different rotavirus strains co-circulating within the UK, with the common human strains G1P[8], G2P[4] and G9P[8] being the most prevalent. As part of strain surveillance for the European Rotavirus Network (EuroRotaNet) a cluster (n=29) of G8 strains was detected in the UK between February and May 2009. OBJECTIVES G8 strains were initially mistyped as G12 through multiplex RT-PCR, therefore further investigation was performed to ascertain the reasons behind this mistyping. STUDY DESIGN The genes encoding the VP7 of these G8 strains were sequenced and aligned with the existing G8- and G12-specific oligonucleotide primers. RESULTS Multiple alignment of sequences derived from these strains and the G8- and G12-specific oligonucleotide primers revealed a series of point mutations which resulted in mismatches at the 3' end of the G8-specific primer binding site that prevented amplification with the G8-specific primer, whilst a close homology with the G12-specific primer allowed mis-priming. Both the G8 and G12 primers were redesigned and their ability to correctly identify G8 and G12 strains was evaluated and confirmed. CONCLUSION These findings highlight the importance of monitoring the specificity and sensitivity of the genotyping methods in order to detect changes in the genotype distribution and changes associated with genetic drift of common or uncommon genotypes.
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Affiliation(s)
- Farah Aladin
- Health Protection Agency, Centre for Infections, 61 Colindale Avenue, London, NW9 5HT, United Kingdom
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45
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Abstract
Rotaviruses can be detected easily, and methods have been developed to visualise their characteristic morphology, to detect rotavirus proteins through immunological methods or the virus genome, either directly by polyacrylamide gel electrophoresis or after reverse transcription of the viral RNA and amplification by PCR. The abundance of virus particles found in clinical samples during an acute infection makes the detection of rotavirus proteins, mainly VP6, the method of choice for virus detection. Molecular methods are generally reserved for the characterisation of a diverse population of viruses circulating in many mammalian species. Characterisation methods have been developed to determine diversity within genes encoding viral structural proteins, VP4, VP7, and VP6 and the non-structural protein and viral enterotoxin, NSP4. The combined use of the detection and characterisation methods described in this chapter allows novel rotavirus strains resulting from genetic reassortment among common strains, reassortment among animal and human strains and zoonotic strains to be identified. Also, strains in which diversity is generated through the accumulation of point mutations during virus replication are identified. The development of safe and effective rotavirus vaccines necessitates the detection and characterisation of rotaviruses of genomic and antigenic diversity circulating in both the human and animal populations.
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Affiliation(s)
- Jim Gray
- Enteric Virus Unit, Virus Reference Department, Centre for Infections, Health Protection Agency, London, UK
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46
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Iturriza-Gómara M, Dallman T, Bányai K, Böttiger B, Buesa J, Diedrich S, Fiore L, Johansen K, Korsun N, Kroneman A, Lappalainen M, László B, Maunula L, Matthinjnssens J, Midgley S, Mladenova Z, Poljsak-Prijatelj M, Pothier P, Ruggeri FM, Sanchez-Fauquier A, Schreier E, Steyer A, Sidaraviciute I, Tran AN, Usonis V, Van Ranst M, de Rougemont A, Gray J. Rotavirus Surveillance in Europe, 2005–2008: Web‐Enabled Reporting and Real‐Time Analysis of Genotyping and Epidemiological Data. J Infect Dis 2009; 200 Suppl 1:S215-21. [PMID: 19821712 DOI: 10.1086/605049] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- M Iturriza-Gómara
- Enteric Virus Unit, Virus Reference Department, London, United Kingdom.
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47
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Allen DJ, Noad R, Samuel D, Gray JJ, Roy P, Iturriza-Gómara M. Characterisation of a GII-4 norovirus variant-specific surface-exposed site involved in antibody binding. Virol J 2009; 6:150. [PMID: 19781066 PMCID: PMC2762976 DOI: 10.1186/1743-422x-6-150] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [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: 08/25/2009] [Accepted: 09/25/2009] [Indexed: 12/16/2022] Open
Abstract
Background The human noroviruses are a highly diverse group of viruses with a single-stranded RNA genome encoding a single major structural protein (VP1), which has a hypervariable domain (P2 domain) as the most exposed part of the virion. The noroviruses are classified on the basis of nucleotide sequence diversity in the VP1-encoding ORF2 gene, which divides the majority of human noroviruses into two genogroups (GI and GII). GII-4 noroviruses are the major aetiological agent of outbreaks of gastroenteritis around the world. During a winter season the diversity among the GII-4 noroviruses has been shown to fluctuate, driving the appearance of new virus variants in the population. We have previously shown that sequence data and in silico modelling experiments suggest there are two surface-exposed sites (site A and site B) in the hypervariable P2 domain. We predict these sites may form a functional variant-specific epitope that evolves under selective pressure from the host immune response and gives rise to antibody escape mutants. Results In this paper, we describe the construction of recombinant baculoviruses to express VLPs representing one pre-epidemic and one epidemic variant of GII-4 noroviruses, and the production of monoclonal antibodies against them. We use these novel reagents to provide evidence that site A and site B form a conformational, variant-specific, surface-exposed site on the GII-4 norovirus capsid that is involved in antibody binding. Conclusion As predicted by our earlier study, significant amino acid changes at site A and site B give rise to GII-4 norovirus epidemic variants that are antibody escape mutants.
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Affiliation(s)
- David J Allen
- Enteric Virus Unit, Virus Reference Department, Centre for Infections, Health Protection Agency, London, UK.
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48
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Xerry J, Gallimore CI, Iturriza-Gómara M, Gray JJ. Tracking the transmission routes of genogroup II noroviruses in suspected food-borne or environmental outbreaks of gastroenteritis through sequence analysis of the P2 domain. J Med Virol 2009; 81:1298-304. [DOI: 10.1002/jmv.21517] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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49
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Braham S, Iturriza-Gómara M, Gray J. Detection of TT virus by single-primer sequence-independent amplification in multiple samples collected from an outbreak of gastroenteritis. Arch Virol 2009; 154:981-5. [PMID: 19407928 DOI: 10.1007/s00705-009-0387-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 04/20/2009] [Indexed: 11/26/2022]
Abstract
A panel of gastroenteritis outbreak samples was subjected to a virus purification and concentration algorithm followed by a sequence-independent amplification method devised to detect viral enteric pathogens. The application of these methods allowed the identification of torque teno virus (TTV) in one outbreak. The complete genome sequence of 3,260 nt was obtained through "genome walking", and four open reading frames were deduced from the genomic sequence. Phylogenetic analysis grouped this virus in TTV genetic group 3, clustering with genotype 27, with 85% similarity at the nt level with strain SAa-01.
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Affiliation(s)
- S Braham
- Enteric Virus Unit, Virus Reference Department, Centre for Infections, Health Protection Agency, Colindale, London, NW9 5HT, UK
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50
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Bányai K, Bogdán Á, Szücs G, Arista S, De Grazia S, Kang G, Banerjee I, Iturriza-Gómara M, Buonavoglia C, Martella V. Assignment of the group A rotavirus NSP4 gene into genotypes using a hemi-nested multiplex PCR assay: a rapid and reproducible assay for strain surveillance studies. J Med Microbiol 2009; 58:303-311. [PMID: 19208878 DOI: 10.1099/jmm.0.005124-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The rotavirus non-structural protein NSP4 has been implicated in a number of biological functions during the rotavirus cellular cycle and pathogenesis, and has been addressed as a target for vaccine development. The NSP4 gene has been classified into six genotypes (A-F). A semi-nested triplex PCR was developed for genotyping the major human NSP4 genotypes (A-C), which are common in human rotavirus strains but are also shared among most mammalian rotavirus strains. A total of 192 previously characterized human strains representing numerous G and P type specificities (such as G1P[8], G1P[4], G2P[4], G3P[3], G3P[8], G3P[9], G4P[6], G4P[8], G6P[4], G6P[9], G6P[14], G8P[10], G8P[14], G9P[8], G9P[11], G10P[11], G12P[6] and G12P[8]) were tested for NSP4 specificity by the collaborating laboratories. An additional 35 animal strains, including the reference laboratory strains SA11 (simian, G3P[2]), NCDV (bovine, G6P[1]), K9 and CU-1 (canine, G3P[3]), together with 31 field isolates (canine, G3P[3]; feline, G3P[9]; porcine, G2P[23], G3P[6], G4P[6], G5P[6], G5P[7], G5P[26], G5P[27], G9P[6] and G9P[7]) were also successfully NSP4-typed. Four human G3P[9] strains and one feline G3P[9] strain were found to possess an NSP4 A genotype, instead of NSP4 C, suggesting a reassortment event between heterologous strains. Routine NSP4 genotyping may help to determine the genomic constellation of rotaviruses of man and livestock, and identify interspecies transmission of heterologous strains.
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Affiliation(s)
- Krisztián Bányai
- Veterinary Medical Research Institute, Hungarian Academy of Sciences, Budapest, Hungary.,Regional Laboratory of Virology, Baranya County Institute of State Public Health Service, Pécs, Hungary
| | - Ágnes Bogdán
- Regional Laboratory of Virology, Baranya County Institute of State Public Health Service, Pécs, Hungary
| | - György Szücs
- Regional Laboratory of Virology, Baranya County Institute of State Public Health Service, Pécs, Hungary
| | - Serenella Arista
- Department of Hygiene and Microbiology, University of Palermo, Palermo, Italy
| | - Simona De Grazia
- Department of Hygiene and Microbiology, University of Palermo, Palermo, Italy
| | - Gagandeep Kang
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore, India
| | - Indrani Banerjee
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore, India
| | - Miren Iturriza-Gómara
- Enteric Virus Unit, Enteric, Respiratory and Neurological Virus Laboratory, Health Protection Agency, London, UK
| | - Canio Buonavoglia
- Department of Public Health and Zootecnic, Faculty of Veterinary Medicine, University of Bari, Bari, Italy
| | - Vito Martella
- Department of Public Health and Zootecnic, Faculty of Veterinary Medicine, University of Bari, Bari, Italy
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