1
|
Baker J, Aliabadi N, Munjal I, Jiang Q, Feng Y, Brock LG, Cooper D, Anderson AS, Swanson KA, Gruber WC, Gurtman A. Equivalent immunogenicity across three RSVpreF vaccine lots in healthy adults 18-49 years of age: Results of a randomized phase 3 study. Vaccine 2024; 42:3172-3179. [PMID: 38616438 DOI: 10.1016/j.vaccine.2024.03.070] [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: 12/13/2023] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Bivalent RSV prefusion F subunit vaccine (RSVpreF), comprised of equal quantities of stabilized prefusion F antigens from the major circulating subgroups (RSV A, RSV B), is licensed for prevention of RSV-associated lower respiratory tract illness (LRTI) in older adults and for maternal vaccination for prevention of RSV-associated LRTI in infants. To support licensure and large-scale manufacturing, this lot consistency study was conducted to demonstrate equivalence in immunogenicity across 3 RSVpreF lots. METHODS This phase 3, multicenter, parallel-group, placebo-controlled, randomized (1:1:1:1), double-blind study evaluated immunogenicity, safety, and tolerability of RSVpreF in healthy 18-49-year-old adults. Participants received a single 120-µg injection of 1 of 3RSVpreF lots or placebo. Geometric mean ratio (GMR) of RSV serum 50 % neutralizing geometric mean titers obtained 1 month after vaccination were compared between each vaccine lot for RSV A and RSV B, separately. Equivalence between lots was defined using a 1.5-fold criterion (GMR 95 % CIs for every lot pair within the 0.667-1.5 interval). Safety and tolerability were assessed. RESULTS Of 992participants vaccinated, 948 were included in the evaluable immunogenicity population. All 3 RSVpreF lots elicited strong immune responses, meeting the 1.5-fold equivalence criterion for all between-lot comparisons for both RSV A and RSV B. Across the 3 lots, RSV A and RSV B 50 % neutralizing geometric mean titers substantially increased from baseline (RSV A, 1671-1795; RSV B 1358-1429) to 1 month after RSVpreF vaccination (RSV A, 24,131-25,238; RSV B, 19,238-21,702), corresponding to ≥14-fold increases in 50 % neutralizing titers for both RSV A and RSV B from before to 1 month after vaccination. Single doses of RSVpreF were safe and well tolerated, with similar safety profiles across the 3 RSVpreF lots. CONCLUSIONS These findings support the reproducibility of RSVpreF vaccine manufacturing with similar safety and reactogenicity profiles (NCT05096208).
Collapse
Affiliation(s)
- Jeffrey Baker
- Clinical Research Prime, 187 E 13th St, Idaho Falls, ID 83404, USA
| | - Negar Aliabadi
- Vaccine Research and Development, Pfizer Inc, 401 N Middletown Rd, Pearl River, NY 10965, USA
| | - Iona Munjal
- Vaccine Research and Development, Pfizer Inc, 401 N Middletown Rd, Pearl River, NY 10965, USA.
| | - Qin Jiang
- Vaccine Research and Development, Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426, USA
| | - Ye Feng
- Vaccine Research and Development, Pfizer Inc, 401 N Middletown Rd, Pearl River, NY 10965, USA
| | - Linda G Brock
- Vaccine Research and Development, Pfizer Inc, 401 N Middletown Rd, Pearl River, NY 10965, USA
| | - David Cooper
- Vaccine Research and Development, Pfizer Inc, 401 N Middletown Rd, Pearl River, NY 10965, USA
| | - Annaliesa S Anderson
- Vaccine Research and Development, Pfizer Inc, 401 N Middletown Rd, Pearl River, NY 10965, USA
| | - Kena A Swanson
- Vaccine Research and Development, Pfizer Inc, 401 N Middletown Rd, Pearl River, NY 10965, USA
| | - William C Gruber
- Vaccine Research and Development, Pfizer Inc, 401 N Middletown Rd, Pearl River, NY 10965, USA
| | - Alejandra Gurtman
- Vaccine Research and Development, Pfizer Inc, 401 N Middletown Rd, Pearl River, NY 10965, USA
| |
Collapse
|
2
|
Tate JE, Mwenda JM, Keita AM, Tapsoba TW, Ngendahayo E, Kouamé BD, Samateh AL, Aliabadi N, Sissoko S, Traore Y, Bayisenga J, Sounkere-Soro M, Jagne S, Burke RM, Onwuchekwa U, Ouattara M, Bikoroti JB, N'Zue K, Leshem E, Coulibaly O, Ouedraogo I, Uwimana J, Sow S, Parashar UD. Evaluation of Intussusception Following Pentavalent Rotavirus Vaccine (RotaTeq) Administration in 5 African Countries. Clin Infect Dis 2024; 78:210-216. [PMID: 37596934 DOI: 10.1093/cid/ciad492] [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: 06/15/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND A low-level risk of intussusception following rotavirus vaccination has been observed in some settings and may vary by vaccine type. We examined the association between RotaTeq vaccination and intussusception in low-income settings in a pooled analysis from 5 African countries that introduced RotaTeq into their national immunization program. METHODS Active surveillance was conducted at 20 hospitals to identify intussusception cases. A standard case report form was completed for each enrolled child, and vaccination status was determined by review of the child's vaccination card. The pseudo-likelihood adaptation of self-controlled case-series method was used to assess the association between RotaTeq administration and intussusception in the 1-7, 8-21, and 1-21 day periods after each vaccine dose in infants aged 28-245 days. RESULTS Data from 318 infants with confirmed rotavirus vaccination status were analyzed. No clustering of cases occurred in any of the risk windows after any of the vaccine doses. Compared with the background risk of naturally occurring intussusception, no increased risk was observed after dose 1 in the 1-7 day (relative incidence = 2.71; 95% confidence interval [CI] = 0.47-8.03) or the 8-21 day window (relative incidence = 0.77; 95%CI = 0.0-2.69). Similarly, no increased risk of intussusception was observed in any risk window after dose 2 or 3. CONCLUSIONS RotaTeq vaccination was not associated with increased risk of intussusception in this analysis from 5 African countries. This finding mirrors results from similar analyses with other rotavirus vaccines in low-income settings and highlights the need for vaccine-specific and setting-specific risk monitoring.
Collapse
Affiliation(s)
- Jacqueline E Tate
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jason M Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | | | | | | | | | - Negar Aliabadi
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Yacouba Traore
- Centre Hospitalier Universitaire Sourou SANOU de Bobo Dioulasso, Bobo Dioulasso, Burkina Faso
| | | | | | - Sheriffo Jagne
- National Public Health Reference Laboratory, Ministry of Health, Banjul, The Gambia
| | - Rachel M Burke
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Ma Ouattara
- World Health Organization Country Office, Ouagadougou, Burkina Faso
| | | | - Kofi N'Zue
- World Health Organization Country Office, Abidjan, Cote d'Ivoire
| | - Eyal Leshem
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Oumar Coulibaly
- Centre Hospitalier Universitaire Gabriel Touré, Bamako, Mali
| | - Issa Ouedraogo
- Ministry of Health, Expanded Program on Immunizations, Ouagadougou, Burkina Faso
| | | | - Samba Sow
- Center for Vaccine Development, Bamako, Mali
| | - Umesh D Parashar
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
3
|
Britoh Mlan A, Burke RM, Koné H, Boni-Cisse C, N'Guessan R, Zaba F, Aka LN, N'Zue K, Adom SK, Kouadio SK, Bhérat Kouadio A, Meité S, Koffi S, Faye-Kette H, Shaba K, Ntsama B, Biey J, Aliabadi N, Mwenda JM, Parashar UD, Tate JE. Impact of rotavirus vaccine introduction in Abidjan, Côte d'Ivoire. Hum Vaccin Immunother 2023; 19:2156231. [PMID: 36719054 PMCID: PMC9980462 DOI: 10.1080/21645515.2022.2156231] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Côte d'Ivoire introduced rotavirus vaccine in March 2017. Rotavirus surveillance is conducted at Centre Hospitalier Universitaire de Yopougon in Abidjan, the capital city. Children <5 years of age are enrolled in rotavirus surveillance if admitted to the hospital with acute gastroenteritis. We used sentinel surveillance data from 2014 through mid-2019 to compare trends in rotavirus pediatric gastroenteritis hospitalizations before and after rotavirus vaccine introduction. We used Poisson regression to analyze changes in rotavirus prevalence, adjusting for calendar month and accounting for total monthly admissions; January 2014 - December 2016 was considered "pre-vaccine," and January 2017 - June 2019 was considered "post-vaccine." Age distribution and severity were compared between periods using the Mann-Whitney U test. Rotavirus-positive admissions declined 51% (95% CI: 28%-67%), from 31.5% pre-vaccine to 14.9% afterward. The median age of rotavirus-positive children increased from 7 months (interquartile range [IQR]: 5-11) in the pre-vaccine period to 11 months (IQR: 7-18, p = .005) in the post-vaccine period. The median severity score decreased from 11 to 9 (p = .008) among all children, and from 12 pre- to 10.5 post-vaccine (p = .35) among rotavirus-positive children. Our findings suggest that rotavirus vaccine introduction contributed to reduced rotavirus hospitalization in Abidjan and possibly more broadly.
Collapse
Affiliation(s)
- Alice Britoh Mlan
- Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Rachel M Burke
- Viral Gastroenteritis Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hamidou Koné
- Direction de Programme Elargi de Vaccination, Abidjan, Côte d'Ivoire
| | | | - Rebecca N'Guessan
- Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Flore Zaba
- Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Lepri Nicaise Aka
- Direction de Programme Elargi de Vaccination, Abidjan, Côte d'Ivoire
| | - Kofi N'Zue
- Country Office for Côte d'Ivoire, World Health Organization, Abidjan, Côte d'Ivoire
| | - San Koffi Adom
- Country Office for Côte d'Ivoire, World Health Organization, Abidjan, Côte d'Ivoire
| | - Sié Kabran Kouadio
- Country Office for Côte d'Ivoire, World Health Organization, Abidjan, Côte d'Ivoire
| | | | - Syndou Meité
- Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire.,Institut Pasteur, Abidjan, Côte d'Ivoire
| | | | | | - Keith Shaba
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Bernard Ntsama
- World Health Organization Regional Office for Africa, Inter-Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Joseph Biey
- World Health Organization Regional Office for Africa, Inter-Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Negar Aliabadi
- Viral Gastroenteritis Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jason M Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Umesh D Parashar
- Viral Gastroenteritis Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jacqueline E Tate
- Viral Gastroenteritis Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
4
|
Lucien MAB, Esona MD, Pierre M, Joseph G, Rivière C, Leshem E, Aliabadi N, Desormeaux AM, Andre-Alboth J, Fitter DL, Grant-Greene Y, Tate J, Boncy J, Patel R, Burnett E, Juin S, Parashar UD, Bowen MD. Diversity of rotavirus strains circulating in Haiti before and after introduction of monovalent vaccine. IJID Regions 2022; 4:146-151. [PMID: 35923644 PMCID: PMC9340491 DOI: 10.1016/j.ijregi.2022.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 11/30/2022]
Abstract
Rotaviruses are the most common cause of acute gastroenteritis among children. In Haiti, the most frequent genotype in the pre-vaccine period was G12P[8]. Equine-like G3P[8] strains dominated most years following vaccine introduction.
Background Haiti introduced a monovalent human group A rotavirus (RVA) vaccine (Rotarix) into its routine infant immunization program in April 2014. The goal of the surveillance program was to characterize RVA strains circulating in Haiti before and after RVA vaccine introduction. Methods Stool samples were collected from children <5 years old presenting with acute gastroenteritis at 16 hospitals in Haiti. RVA antigen enzyme immunoassay (EIA) testing was performed, and G and P genotypes were determined for positive specimens. In this study, genotype data for samples collected from May 2012 through April 2014 (the pre-vaccine introduction era) and May 2014 through July 2019 (post-vaccine introduction era) were analyzed. Results A total of 809 specimens were tested by the Centers for Disease Control and Prevention. During the pre-vaccine introduction era (May 2012 through April 2014), G12P[8] was the predominant genotype, detected in 88–94% of specimens. There was a high prevalence of the equine-like G3P[8] genotype among Haitian children with RVA after vaccine introduction. Conclusions The predominance of equine-like G3P[8] in three of five RVA seasons post-vaccine introduction suggests possible vaccine-specific selection pressure in Haiti. These temporal variations in RVA genotype predominance will require continued monitoring in Haiti as the vaccination program continues.
Collapse
Affiliation(s)
- Mentor Ali Ber Lucien
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
- Corresponding author: Mentor Ali Ber Lucien, Laboratoire National de Santé Publique, Port-au-Prince, Haiti.
| | - Mathew D. Esona
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (NCIRD), CDC, Atlanta, Georgia, USA
| | | | - Gerard Joseph
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | | | - Eyal Leshem
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (NCIRD), CDC, Atlanta, Georgia, USA
| | - Negar Aliabadi
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (NCIRD), CDC, Atlanta, Georgia, USA
| | | | | | | | | | - Jacqueline Tate
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (NCIRD), CDC, Atlanta, Georgia, USA
| | - Jacques Boncy
- Laboratoire National de Santé Publique, Port-au-Prince, Haiti
| | | | - Eleanor Burnett
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (NCIRD), CDC, Atlanta, Georgia, USA
| | | | - Umesh D. Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (NCIRD), CDC, Atlanta, Georgia, USA
| | - Michael D. Bowen
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (NCIRD), CDC, Atlanta, Georgia, USA
| |
Collapse
|
5
|
Toussaint TW, Wandaogo A, Yaméogo W IC, Ouédraogo I, Ouédraogo SMF, Zampou O, Béré B, Aliabadi N, Leshem E, Nikièma M, Ouattara M, Mwenda JM, Bonkoungou I, Bandré E, Parashar UD, Tate JE. Acute intestinal intussusception among children under five years of age admitted in an Ouagadougou hospital, Burkina Faso, 2008-2013: epidemiological, clinical and therapeutic aspects. Pan Afr Med J 2021; 39:5. [PMID: 34548897 PMCID: PMC8437429 DOI: 10.11604/pamj.supp.2021.39.1.25270] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction acute intestinal intussusception is a life-threatening surgical condition. In some settings, rotavirus vaccines have been associated with a low-level increased risk of intussusception. We describe the epidemiology, clinical manifestations and management of intussusception in a tertiary referral hospital in Burkina Faso prior to the introduction of rotavirus vaccine in October 2013. Methods we retrospectively reviewed medical records of all children under 5 years of age treated at the Charles de Gaulle Pediatric Hospital for intussusception meeting the Brighton level 1 diagnostic criteria, from October 31st, 2008 to October 30th, 2013. We report the incidence of intussusception as well as descriptive characteristics of these cases. Results a total of 107 Brighton level 1 intussusception cases were identified, representing a hospital incidence of 21.4 cases / year. There were 69 males and 38 females (sex ratio of 1.8), with a median age of 8 months (range 2 months to 4 years). Sixty-two percent of intussusception cases occurred among infants (n = 67 cases). The average time from symptom onset to seeking medical consultation was 3.8 days +/- 2.7 (range 0 to 14 days). Treatment was mainly surgical (105 patients, 98.1%) with 35 patients (32.7%) undergoing intestinal resection. Thirty-seven patients (35.5%) experienced post-operative complications. The mortality rate was 9.3%. Intestinal resection was a risk factor for death from intussusception. Conclusion in this review of intussusception hospitalizations prior to rotavirus vaccine introduction in Burkina Faso, delays in seeking care were common and were associated with mortality.
Collapse
Affiliation(s)
| | - Albert Wandaogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouadougou, Burkina Faso
| | | | - Isso Ouédraogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouadougou, Burkina Faso
| | | | - Olivier Zampou
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouadougou, Burkina Faso
| | - Bernadette Béré
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouadougou, Burkina Faso
| | - Negar Aliabadi
- Centers for Disease Control and Prevention, Atlanta, United States
| | - Eyal Leshem
- Centers for Disease Control and Prevention, Atlanta, United States
| | | | | | - Jason M Mwenda
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | - Emile Bandré
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouadougou, Burkina Faso
| | - Umesh D Parashar
- Centers for Disease Control and Prevention, Atlanta, United States
| | | |
Collapse
|
6
|
Desormeaux AM, Burnett E, Joseph G, Lucien MAB, Aliabadi N, Pierre M, Dély P, Pierre K, Fitter D, Leshem E, Tate JE, Bowen MD, Esona M, Gautier J, Siné F, Katz MA, Grant-Greene Y, Parashar UD, Patel R, Boncy J, Juin S. Impact of Monovalent Rotavirus Vaccine on Rotavirus Hospitalizations among Children Younger Than 5 Years of Age in the Ouest and Artibonite Departments, Haiti, 2013 to 2019. Am J Trop Med Hyg 2021; 105:1309-1316. [PMID: 34398813 DOI: 10.4269/ajtmh.21-0414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/14/2021] [Indexed: 11/07/2022] Open
Abstract
Rotavirus is responsible for 26% of diarrheal deaths in Latin America and the Caribbean. Haiti introduced the monovalent rotavirus vaccine in April 2014. The objective of this analysis is to describe the impact of the rotavirus vaccine on hospitalizations among Haitian children younger than 5 years old during the first 5 years after introduction. This analysis includes all children with diarrhea who were enrolled as part of a sentinel surveillance system at two hospitals from May 2013 to April 2019. We compare the proportion of rotavirus-positive specimens in each post-vaccine introduction year to the pre-vaccine period. To account for the potential dilution of the proportion of rotavirus-positive specimens from a waning cholera outbreak, we also analyzed annual trends in the absolute number of positive stools, fit a two-component finite-mixture model to the negative specimens, and fit a negative binomial time series model to the pre-vaccine rotavirus-positive specimens to predict the number of rotavirus diarrhea hospital admissions in the absence of rotavirus vaccination. The overall percentage of rotavirus-positive specimens declined by 22% the first year after introduction, increased by 17% the second year, and declined by 33% to 50% the subsequent 3 years. All sensitivity analyses confirmed an overall decline. We observed a clear annual rotavirus seasonality before and after vaccine introduction, with the greatest activity in December through April, and a biennial pattern, with high sharp peaks and flatter longer periods of increased rotavirus activity in alternating years, consistent with suboptimal vaccination coverage. Overall, our study shows evidence that the introduction of the rotavirus vaccine reduced the burden of severe rotavirus diarrhea.
Collapse
Affiliation(s)
| | - Eleanor Burnett
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Gérard Joseph
- National Public Health Laboratory, Ministère de la Santé Publique et de la Population/Laboratoire National de Sante Publique, Haiti
| | - Mentor Ali Ber Lucien
- National Public Health Laboratory, Ministère de la Santé Publique et de la Population/Laboratoire National de Sante Publique, Haiti
| | - Negar Aliabadi
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | | | - Patrick Dély
- Directorate of Epidemiology, Laboratory and Research, Ministère de la Santé Publique et de la Population/La Direction d'Epidémiologie, de Laboratoires, de Recherche, Haiti
| | - Katilla Pierre
- Directorate of Epidemiology, Laboratory and Research, Ministère de la Santé Publique et de la Population/La Direction d'Epidémiologie, de Laboratoires, de Recherche, Haiti
| | | | - Eyal Leshem
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Jacqueline E Tate
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Michael D Bowen
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Mathew Esona
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | | | | | | | | | - Umesh D Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | | | - Jacques Boncy
- National Public Health Laboratory, Ministère de la Santé Publique et de la Population/Laboratoire National de Sante Publique, Haiti
| | | |
Collapse
|
7
|
Burnett E, Juin S, Esona MD, Desormeaux AM, Aliabadi N, Pierre M, Andre-Alboth J, Leshem E, Etheart MD, Patel R, Dely P, Fitter D, Jean-Denis G, Kalou M, Katz MA, Bowen MD, Grant-Greene Y, Boncy J, Parashar UD, Joseph GA, Tate JE. Effectiveness of monovalent rotavirus vaccine against hospitalizations due to all rotavirus and equine-like G3P[8] genotypes in Haiti 2014-2019. Vaccine 2021; 39:4458-4462. [PMID: 34187708 PMCID: PMC8474148 DOI: 10.1016/j.vaccine.2021.06.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/16/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Rotavirus vaccines are effective in preventing severe rotavirus. Haiti introduced 2-dose monovalent (G1P[8]) rotavirus vaccine recommended for infants at 6 and 10 weeks of age in 2014. We calculated the effectiveness of rotavirus vaccine against hospitalization for acute gastroenteritis in Haiti. METHODS We enrolled children 6-59 months old admitted May 2014-September 2019 for acute watery diarrhea at any sentinel surveillance hospital. Stool was tested for rotavirus using enzyme immunoassay (EIA) and genotyped with multiplex one-step RT-PCR assay and Sanger sequencing for stratification by genotype. We used a case-negative design where cases were children positive for rotavirus and controls were negative for rotavirus. Only children eligible for vaccination were included and a child was considered vaccinated if vaccine was given ≥ 14 days before enrollment. We used unconditional logistic regression to calculate odds ratios and calculated 2-dose and 1-dose vaccine effectiveness (VE) as (1 - odds ratio) * 100. RESULTS We included 129 (19%) positive cases and 543 (81%) negative controls. Among cases, 77 (60%) were positive for equine-like G3P[8]. Two doses of rotavirus vaccine were 66% (95% CI: 44, 80) effective against hospitalizations due to any strain of rotavirus and 64% (95% CI: 33, 81) effective against hospitalizations due to the equine-like G3P[8] genotype. CONCLUSIONS These findings are comparable to other countries in the Americas region. To the best of our knowledge, this is the first VE estimate both against the equine-like G3P[8] genotype and from a Caribbean country. Overall, these results support rotavirus vaccine use and demonstrate the importance of complete vaccination.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Jocelyn Andre-Alboth
- Ministry of Public Health and Population - Laboratoire National de Sante Publique, Port-au-Prince, Haiti
| | - Eyal Leshem
- Division of Viral Diseases, NCIRD, CDC, USA; Sheba Medical Center and Tel Aviv University, Tel Aviv, Israel
| | | | | | - Patrick Dely
- Ministry of Public Health and Population - Directorate of Epidemiology, Laboratory and Research (DELR), Port-au-Prince, Haiti
| | | | | | | | | | | | | | - Jacques Boncy
- Ministry of Public Health and Population - Laboratoire National de Sante Publique, Port-au-Prince, Haiti
| | | | - Gerard A Joseph
- Ministry of Public Health and Population - Laboratoire National de Sante Publique, Port-au-Prince, Haiti
| | | |
Collapse
|
8
|
Aliabadi N, Bonkoungou IJO, Pindyck T, Nikièma M, Leshem E, Seini E, Kam M, Konaté S, Ouattara M, Ouédraogo B, Gue E, Nezien D, Ouedraogo I, Parashar U, Medah I, Mwenda JM, Tate JE. Cost of pediatric hospitalizations in Burkina Faso: A cross-sectional study of children aged <5 years enrolled through an acute gastroenteritis surveillance program. Vaccine 2020; 38:6517-6523. [PMID: 32868131 DOI: 10.1016/j.vaccine.2020.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/31/2020] [Accepted: 08/12/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Diarrheal illness is a leading cause of hospitalizations among children <5 years. We estimated the costs of inpatient care for rotavirus and all-cause acute gastroenteritis (AGE) in two Burkina Faso hospitals. METHODS We conducted a cross-sectional study among children <5 years from December 2017 to June 2018 in one urban and one rural pediatric hospital. Costs were ascertained through caregiver interview and chart abstraction. Direct medical, non-medical, and indirect costs per child incurred are reported. Costs were stratified by rotavirus results. RESULTS 211 children <5 years were included. AGE hospitalizations cost 161USD (IQR 117-239); 180USD (IQR 121-242) at the urban and 154USD (IQR 116-235) at the rural site. Direct medical costs were higher in the urban compared to the rural site (140USD (IQR 102-182) vs. 90USD (IQR 71-108), respectively). Direct non-medical costs were higher at the rural versus urban site (15USD (IQR 10, 15) vs. 11USD (IQR 5-20), respectively). Indirect costs were higher at the rural versus urban site (35USD (IQR 8-91) vs. 0USD (IQR 0-26), respectively). Rotavirus hospitalizations incurred less direct medical costs as compared to non-rotavirus hospitalizations at the rural site (79USD (IQR 64-103) vs. 95USD (IQR 80-118)). No other differences by rotavirus testing status were observed. The total median cost of a hospitalization incurred by households was 24USD (IQR 12-49) compared to 75USD for government (IQR 59-97). Direct medical costs for households were higher in the urban site (median 49USD (IQR 31-81) versus rural (median 14USD (IQR 8-25)). Households in the lowest wealth quintiles at the urban site expended 149% of their monthly income on the child's hospitalization, compared to 96% at the rural site. CONCLUSIONS AGE hospitalization costs differed between the urban and rural hospitals and were most burdensome to the lowest income households. Rotavirus positivity was not associated with greater household costs.
Collapse
Affiliation(s)
- Negar Aliabadi
- US Centers for Disease Control and Prevention, Atlanta, USA.
| | | | - Talia Pindyck
- US Centers for Disease Control and Prevention, Atlanta, USA
| | - Moumouni Nikièma
- Ministry of Health, Expanded Program on Immunizations, Ouagadougou, Burkina Faso
| | - Eyal Leshem
- US Centers for Disease Control and Prevention, Atlanta, USA
| | - Emmanuel Seini
- Ministry of Health, Expanded Program on Immunizations, Ouagadougou, Burkina Faso
| | - Madibélé Kam
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | | | - Ma Ouattara
- World Health Organization, Burkina Faso Country Office, Ouagadougou, Burkina Faso
| | - Boureima Ouédraogo
- Ministry of Health, Expanded Program on Immunizations, Ouagadougou, Burkina Faso
| | - Edmond Gue
- Centre Hospitalier Regional de Gaoua, Burkina Faso
| | - Désiré Nezien
- National Public Health Laboratory, Ouagadougou, Burkina Faso
| | - Issa Ouedraogo
- Ministry of Health, Expanded Program on Immunizations, Ouagadougou, Burkina Faso
| | - Umesh Parashar
- US Centers for Disease Control and Prevention, Atlanta, USA
| | - Isaïe Medah
- Ministry of Health, Expanded Program on Immunizations, Ouagadougou, Burkina Faso
| | - Jason M Mwenda
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | | |
Collapse
|
9
|
Aliabadi N, Antoni S, Mwenda JM, Weldegebriel G, Biey JNM, Cheikh D, Fahmy K, Teleb N, Ashmony HA, Ahmed H, Daniels DS, Videbaek D, Wasley A, Singh S, de Oliveira LH, Rey-Benito G, Sanwogou NJ, Wijesinghe PR, Liyanage JBL, Nyambat B, Grabovac V, Heffelfinger JD, Fox K, Paladin FJ, Nakamura T, Agócs M, Murray J, Cherian T, Yen C, Parashar UD, Serhan F, Tate JE, Cohen AL. Global impact of rotavirus vaccine introduction on rotavirus hospitalisations among children under 5 years of age, 2008-16: findings from the Global Rotavirus Surveillance Network. Lancet Glob Health 2020; 7:e893-e903. [PMID: 31200889 PMCID: PMC7336990 DOI: 10.1016/s2214-109x(19)30207-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/19/2018] [Accepted: 04/01/2019] [Indexed: 12/27/2022]
Abstract
Summary Background Rotavirus vaccine use in national immunisation programmes has led to declines in hospital admissions for rotavirus gastroenteritis among children; however, the global impact of rotavirus vaccine introduction has not been described using primary data. We describe the impact of rotavirus vaccine introduction on admissions for acute rotavirus gastroenteritis in primarily low-income and middle-income countries, using 9 years of data from the WHO-coordinated Global Rotavirus Surveillance Network (GRSN). Methods Between Jan 1, 2008, and Dec 31, 2016, children younger than 5 years of age who were admitted to hospital with acute gastroenteritis were prospectively enrolled in GRSN sites. We included sites that enrolled children and collected stool specimens monthly and tested at least 100 specimens annually in the impact analysis, with a separate analysis taking into account site continuity. We compared proportions of acute gastroenteritis cases positive for rotavirus in the pre-vaccine and post-vaccine periods and calculated mean proportion changes for WHO regions, with 95% CIs; these findings were then compared with interrupted time series analyses. We did further sensitivity analyses to account for rotavirus vaccination coverage levels and sites that collected specimens for at least 11 months per year and tested at least 80 specimens per year. We also analysed the age distribution of rotavirus-positive cases before and after vaccine introduction. Findings 403 140 children younger than 5 years of age admitted to hospital with acute gastroenteritis from 349 sites in 82 countries were enrolled over the study period, of whom 132 736 (32.9%) were positive for rotavirus. We included 305 789 children from 198 sites in 69 countries in the impact analysis. In countries that had not introduced rotavirus vaccine in their national immunisation programmes, rotavirus was detected in 38.0% (95% CI 4.8–73.4) of admissions for acute gastroenteritis annually whereas in those that have introduced the vaccine, rotavirus was detected in 23.0% (0.7–57.7) of admissions for acute gastroenteritis, showing a 39.6% (35.4–43.8) relative decline following introduction. Interrupted time series analyses confirmed these findings. Reductions by WHO regions ranged from 26.4% (15.0–37.8) in the Eastern Mediterranean Region to 55.2% (43.0–67.4) in the European Region and were sustained in nine countries (contributing up to 31 sites) for 6–10 years. The age distribution of children with rotavirus gastroenteritis shifted towards older children after rotavirus vaccine introduction. Interpretation A significant and sustained reduction in the proportion of hospital admissions for acute gastroenteritis due to rotavirus was seen among children younger than 5 years in GRSN sites following rotavirus vaccine introduction. These findings highlight the need to incorporate rotavirus vaccines into immunisation programmes in countries that have not yet introduced them and underline the importance of high-quality surveillance.
Collapse
Affiliation(s)
- Negar Aliabadi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Sébastien Antoni
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
| | - Jason M Mwenda
- Regional Office for Africa, World Health Organization, Brazzaville, Congo
| | - Goitom Weldegebriel
- Inter-Country Support Team, Regional Office for Africa, World Health Organization, Harare, Zimbabwe
| | - Joseph N M Biey
- Inter-Country Support Team, Regional Office for Africa, World Health Organization, Ouagadougou, Burkina Faso
| | - Dah Cheikh
- Regional Office for Africa, World Health Organization, Brazzaville, Congo
| | - Kamal Fahmy
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Nadia Teleb
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | | | - Hinda Ahmed
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Danni S Daniels
- Regional Office for Europe, World Health Organization, Copenhagen, Denmark
| | - Dovile Videbaek
- Regional Office for Europe, World Health Organization, Copenhagen, Denmark
| | - Annemarie Wasley
- Regional Office for Europe, World Health Organization, Copenhagen, Denmark
| | - Simarjit Singh
- Regional Office for Europe, World Health Organization, Copenhagen, Denmark
| | | | - Gloria Rey-Benito
- Regional Office for the Americas, World Health Organization, Washington, DC, USA
| | - N Jennifer Sanwogou
- Regional Office for the Americas, World Health Organization, Washington, DC, USA
| | | | | | - Batmunkh Nyambat
- Regional Office for the Western Pacific, World HealthOrganization, Manila, Philippines
| | - Varja Grabovac
- Regional Office for the Western Pacific, World HealthOrganization, Manila, Philippines
| | - James D Heffelfinger
- Regional Office for the Western Pacific, World HealthOrganization, Manila, Philippines
| | - Kimberley Fox
- Regional Office for the Western Pacific, World HealthOrganization, Manila, Philippines
| | - Fem Julia Paladin
- Regional Office for the Western Pacific, World HealthOrganization, Manila, Philippines
| | - Tomoka Nakamura
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
| | - Mary Agócs
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
| | - Jillian Murray
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
| | - Thomas Cherian
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
| | - Catherine Yen
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Umesh D Parashar
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fatima Serhan
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
| | - Jacqueline E Tate
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adam L Cohen
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
| |
Collapse
|
10
|
Burke RM, Tate JE, Dahl RM, Aliabadi N, Parashar UD. Does Rotavirus Vaccination Affect Longer-Term Intussusception Risk in US Infants? J Pediatric Infect Dis Soc 2020; 9:257-260. [PMID: 31197368 PMCID: PMC8112885 DOI: 10.1093/jpids/piz035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 05/03/2019] [Indexed: 11/14/2022]
Abstract
Rotavirus vaccination has been associated with a short-term increased risk of intussusception. Our analysis of insurance claims for 1 858 827 US children with 544 recorded cases of intussusception found a nonsignificant decrease in intussusception (hazard ratio, 0.79 [95% confidence interval, 0.57-1.09]) in fully rotavirus-vaccinated children followed up to the age of 2 years.
Collapse
Affiliation(s)
- Rachel M. Burke
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA;,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jacqueline E. Tate
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca M. Dahl
- Maximus Federal, contracting agency to the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Negar Aliabadi
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Umesh D. Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
11
|
Murray J, Soenarto SY, Mulyani NS, Wijesinghe PS, Mpabalwani EM, Simwaka JC, Matapo B, Mwenda JM, Sahakyan G, Grigoryan S, Vanyan A, Khactatryan S, Sanwogou J, Helena de Oliveira L, Rey-Benito G, Kang G, Serhan F, Tate JE, Aliabadi N, Cohen AL. Multicountry Analysis of Spectrum of Clinical Manifestations of Children <5 Years of Age Hospitalized with Diarrhea. Emerg Infect Dis 2020; 25:2253-2256. [PMID: 31742521 PMCID: PMC6874262 DOI: 10.3201/eid2512.180712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
After introduction of rotavirus vaccine, other pathogens might become leading causes of hospitalizations for severe diarrhea among children <5 years of age. Our study in 33 hospitals in 7 countries found acute gastroenteritis accounted for most (84%) reported hospitalizations of children with diarrhea. Bloody and persistent diarrhea each accounted for <1%.
Collapse
|
12
|
Burke RM, Tate JE, Dahl RM, Aliabadi N, Parashar UD. Rotavirus Vaccination Is Associated With Reduced Seizure Hospitalization Risk Among Commercially Insured US Children. Clin Infect Dis 2019; 67:1614-1616. [PMID: 29788180 DOI: 10.1093/cid/ciy424] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/13/2018] [Indexed: 11/13/2022] Open
Abstract
Rotavirus commonly causes diarrhea but can also cause seizures. Analysis of insurance claims for 1773295 US children with 2950 recorded seizures found that, compared to rotavirus-unvaccinated children, seizure hospitalization risk was reduced by 24% (95% confidence interval [CI], 13%-33%) and 14% (95% CI, 0%-26%) among fully and partially rotavirus-vaccinated children, respectively.
Collapse
Affiliation(s)
- Rachel M Burke
- Division of Viral Diseases, Atlanta, Georgia.,Epidemic Intelligence Service, Atlanta, Georgia
| | | | - Rebecca Moritz Dahl
- MAXIMUS Federal, contracting agency to the Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | |
Collapse
|
13
|
Azadi P, Khodabande A, Riazi Esfahani M, Ghassemi F, Aliabadi N. Bilateral choroidal osteoma associated with langerhans cell histiocytosis, a coincidence? J Curr Ophthalmol 2019; 31:109-112. [PMID: 30899858 PMCID: PMC6407095 DOI: 10.1016/j.joco.2018.02.004] [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: 01/03/2018] [Revised: 02/06/2018] [Accepted: 02/20/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose To describe a case of bilateral choroidal osteoma (CO) in a patient with a history of langerhans cell histiocytosis (LCH). Methods A 24-year-old man complaining of gradually decreasing visual acuity in both eyes is presented. He had a history of lymphadenopathy, respiratory symptoms, and pathology-proven diagnosis of LCH. Results Ophthalmic clinical and imaging studies revealed bilateral CO. Conclusion In this patient, we suggest a possible relationship between LCH and CO.
Collapse
Affiliation(s)
- Pejvak Azadi
- Eye Research Center, Emam Khomeini Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khodabande
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammd Riazi Esfahani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA, USA
| | - Fariba Ghassemi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Aliabadi
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
14
|
Aliabadi N, Wikswo ME, Tate JE, Cortese MM, Szilagyi PG, Staat MA, Weinberg GA, Halasa NB, Boom JA, Selvarangan R, Englund JA, Azimi PH, Klein EJ, Moffatt ME, Harrison CJ, Sahni LC, Stewart LS, Bernstein DI, Parashar UD, Payne DC. Factors Associated With Rotavirus Vaccine Coverage. Pediatrics 2019; 143:e20181824. [PMID: 30655333 DOI: 10.1542/peds.2018-1824] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Rotavirus vaccines (RVVs) were included in the US immunization program in 2006 and are coadministered with the diphtheria-tetanus-acellular pertussis (DTaP) vaccine, yet their coverage lags behind DTaP. We assessed timing, initiation, and completion of the RVV series among children enrolled in active gastroenteritis surveillance at 7 US medical institutions during 2014-2016. METHODS We compared coverage and timing of each vaccine series and analyzed characteristics associated with RVV initiation and completion. We report odds ratios (ORs) and 95% confidence intervals (CIs) from multivariable logistic regression models. RESULTS We enrolled 10 603 children. In 2015, ≥1 dose coverage was 91% for RVV and 97% for DTaP. Seven percent of children received their first DTaP vaccine at age ≥15 weeks versus 4% for RVV (P ≤ .001). Recent birth years (2013-2016) were associated with higher odds of RVV initiation (OR = 5.72; 95% CI 4.43-7.39), whereas preterm birth (OR = 0.32; 95% CI 0.24-0.41), older age at DTaP initiation (OR 0.85; 95% CI 0.80-0.91), income between $50 000 and $100 000 (OR = 0.56; 95% CI 0.40-0.78), and higher maternal education (OR = 0.52; 95% CI 0.36-0.74) were associated with lower odds. Once RVV was initiated, recent birth years (2013-2016; OR = 1.57 [95% CI 1.32-1.88]) and higher maternal education (OR = 1.31; 95% CI 1.07-1.60) were associated with higher odds of RVV completion, whereas preterm birth (OR = 0.76; 95% CI 0.62-0.94), African American race (OR = 0.82; 95% CI 0.70-0.97) and public or no insurance (OR = 0.75; 95% CI 0.60-0.93) were associated with lower odds. Regional differences existed. CONCLUSIONS RVV coverage remains lower than that for the DTaP vaccine. Timely DTaP administration may help improve RVV coverage.
Collapse
Affiliation(s)
- Negar Aliabadi
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
| | - Mary E Wikswo
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jacqueline E Tate
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Margaret M Cortese
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Peter G Szilagyi
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
- University of California, Los Angeles, Los Angeles, California
| | | | - Geoffrey A Weinberg
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | | | - Julie A Boom
- Texas Children's Hospital, Houston, Texas
- Baylor College of Medicine, Houston, Texas
| | | | | | - Parvin H Azimi
- University of California, San Francisco Benioff Children's Hospital Oakland, Oakland, California
| | | | | | | | | | | | | | - Umesh D Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel C Payne
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
15
|
Satter SM, Aliabadi N, Gastañaduy PA, Haque W, Mamun A, Flora MS, Zaman K, Rahman M, Heffelfinger JD, Luby SP, Gurley ES, Parashar UD. An update from hospital-based surveillance for rotavirus gastroenteritis among young children in Bangladesh, July 2012 to June 2017. Vaccine 2018; 36:7811-7815. [PMID: 29793894 PMCID: PMC9169511 DOI: 10.1016/j.vaccine.2018.05.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/08/2018] [Accepted: 05/04/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In preparation for the introduction of a rotavirus vaccine into the routine immunization program of Bangladesh in 2018, we report data and highlight evolving genotypes from five years of active hospital-based rotavirus surveillance which began in July 2012. METHODS We enrolled and collected fresh stool from every fourth child < 5 years admitted with acute gastroenteritis (AGE) at 8 participating surveillance hospitals. Rotavirus infections were detected by enzyme immune assay. Twenty-five percent of rotavirus isolates were genotyped using reverse transcription polymerase chain reaction. RESULTS We found that 64% (4832/7562) of children < 5 years of age admitted with AGE had evidence of rotavirus infection. The majority (57%) of patients with rotavirus infection were <12 months of age. The most common strains were G1P[8] (43%), G12P[8] (15%) and G9P[8] (9%); 11% of children had mixed infection.G3P[8], which has not been reported in Bangladesh since 2001, was documented for the first time in our surveillance system. CONCLUSIONS The high burden of rotavirus-associated hospitalizations highlights the potential value of rotavirus vaccination in Bangladesh. Continued surveillance is important for monitoring the impact of vaccination as well as monitoring evolving genotypes.
Collapse
Affiliation(s)
| | - Negar Aliabadi
- Centers for Disease Control and Prevention(CDC), Atlanta, USA
| | | | | | | | - Meerjady S Flora
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | | | | | - Stephen P Luby
- Center for Innovation in Global Health, Stanford University, USA
| | | | | |
Collapse
|
16
|
Chernyshova LI, Radionova NM, Demchyshyna IV, Kotlik LS, Sadkova OB, Samoilovich EO, Semeiko GV, Daniels DS, Cohen AL, Aliabadi N. Observations on the epidemiology of rotavirus infection among hospitalized children younger than 5 years in 2 Ukrainian hospitals, 2007-2015. Vaccine 2018; 36:7798-7804. [PMID: 29198918 DOI: 10.1016/j.vaccine.2017.11.044] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/08/2017] [Accepted: 11/15/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Acute gastroenteritis remains a burden among children under 5 years of age. Ukraine joined the World Health Organization's Global Rotavirus Surveillance Network in 2006, with a goal of providing accurate rotavirus burden data to aid policy makers in planning for rotavirus vaccine introduction. This analysis describes rotavirus epidemiology among Ukrainian children enrolled in Kyiv and Odesa, two large Ukrainian cities. METHODS Children 0-59 months of age hospitalized for acute gastroenteritis at 2 sentinel sites in Kyiv and Odesa were enrolled into the active, prospective surveillance program. In Odesa, the surveillance period was during 2007-2015 and in Kyiv, it was during 2011-2015. Acute gastroenteritis was defined as 3 or more episodes of diarrhea per day during a 24 h period, with symptom duration before hospitalization not exceeding 7 days. Guardians of enrolled children completed a questionnaire including demographic, clinical and treatment information. Each child provided a stool specimen within 2 days of hospitalization. Stools were tested for rotavirus using ProSpecT™ Rotavirus Kit (Oxoid Ltd., Great Britain), and positive specimens were genotyped. Descriptive data are reported, as well as comparison of demographic, clinical and treatment data among rotavirus positive and negative children. RESULTS During July 2007-June 2015, 12,350 children were enrolled in the surveillance programs and had stool specimens collected and tested for rotavirus. Overall, rotavirus infection was diagnosed in 5412/12350 (44%) of children, 929/1734 (54%) of those in Kyiv and 4483/10616 (42%) in Odesa. Rotavirus infections peaked during the winter months. Children with rotavirus acute gastroenteritis displayed more severe clinical symptoms than those without rotavirus. Predominant genotypes identified included G1P[8], G2P[4], G3 P[8], G4 P[8] and G9 P[8]. CONCLUSION Active surveillance of acute gastroenteritis in hospitalized children younger 5 years in two large Ukrainian cities reveals a significant burden of rotavirus infection. These data provide scientific justification for incorporating rotavirus vaccines into the Ukrainian national immunization schedule.
Collapse
Affiliation(s)
| | | | - Iryna V Demchyshyna
- State Institution "Ukrainian Center for Disease Control and Monitoring, Ministry of Health", Kyiv, Ukraine
| | - Liudmyla S Kotlik
- State Institution "Odesa Oblast Laboratory Center, Ministry of Health", Odesa, Ukraine
| | - Oleksandra B Sadkova
- State Institution "Odesa Oblast Laboratory Center, Ministry of Health", Odesa, Ukraine
| | - Elena O Samoilovich
- Republican Research and Practical Center for Epidemiology and Microbiology, Ministry of Health, Minsk, Belarus
| | - Galina V Semeiko
- Republican Research and Practical Center for Epidemiology and Microbiology, Ministry of Health, Minsk, Belarus
| | - Danni S Daniels
- Vaccine-preventable Diseases and Immunization, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Adam L Cohen
- Expanded Programme on Immunization, World Health Organization, Geneva, Switzerland
| | - Negar Aliabadi
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
| |
Collapse
|
17
|
Mursalova N, Shugayev N, Suleymanova J, Daniels DS, Wasley A, Cohen AL, Aliabadi N. Rotavirus gastroenteritis surveillance in Azerbaijan, 2011-2016. Vaccine 2018; 36:7790-7793. [PMID: 29784471 PMCID: PMC9169510 DOI: 10.1016/j.vaccine.2018.02.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/19/2018] [Accepted: 02/09/2018] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Rotavirus is a leading cause of acute gastroenteritis and mortality among children worldwide but data describing rotavirus disease in Azerbaijan are lacking. This analysis describes the rotavirus disease burden in Baku, the largest city in Azerbaijan. METHODS We conducted active, prospective, sentinel hospital surveillance with laboratory confirmation for rotavirus among children under 5 years of age hospitalized at a large pediatric hospital in Baku during 2011-2016. Children with bloody diarrhea, or prior use of antibiotics or intravenous fluids were excluded. The guardians of enrolled children completed a questionnaire documenting clinical and demographic information. A stool specimen was collected from each enrolled child. We report the number and proportion of rotavirus positive hospitalizations during the surveillance period and a clinical description of rotavirus-positive and rotavirus-negative children. RESULTS From July 2011 through June 2016, 3139 children <5 years of age were enrolled into the surveillance system. Of these, 523 (17%) were positive for rotavirus, varying from 13% to 21% by surveillance year, with a median of 16% over the surveillance period. Increase in rotavirus detections occurred during December-May. Most rotavirus infections (303/523; 58%) occurred in children aged 6-23 months. CONCLUSION Rotavirus is responsible for approximately 16% of annual hospital admissions for acute gastroenteritis in children <5 years of age in Baku. This is lower than regional estimates. Exclusion of children with a history of antibiotic use or intravenous fluids may be accounting for this lower prevalence, and expansion of surveillance to include these groups could provide a more comprehensive picture of acute rotavirus gastroenteritis in Baku.
Collapse
Affiliation(s)
- Nazifa Mursalova
- Ministry of Health of Azerbaijan, National Program, Baku, Azerbaijan
| | - Nazim Shugayev
- Immunological Laboratory of the Republican Anti-plague Station, National Laboratory for the Diagnosis of Rotavirus Enteritis, Baku, Azerbaijan
| | | | - Danni S Daniels
- Vaccine-preventable Diseases and Immunization, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Annemarie Wasley
- Vaccine-preventable Diseases and Immunization, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Adam L Cohen
- Expanded Programme on Immunization, World Health Organization, Geneva, Switzerland
| | - Negar Aliabadi
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| |
Collapse
|
18
|
Tsolenyanu E, Djadou KE, Fiawoo M, Akolly DAE, Mwenda JM, Leshem E, Tate JE, Aliabadi N, Koudema W, Guedenon KM, Godonou M, Dagnra A, Gbadoe AD, Boko A, Landoh D, Atakouma Y, Parashar UD. Evidence of the impact of monovalent rotavirus vaccine on childhood acute gastroenteritis hospitalization in Togo. Vaccine 2018; 36:7185-7191. [PMID: 29397224 DOI: 10.1016/j.vaccine.2018.01.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 06/15/2017] [Revised: 11/23/2017] [Accepted: 01/22/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Monovalent rotavirus vaccine (RV1) was introduced in the immunization schedule of Togo in June 2014. We evaluated the impact of rotavirus vaccines on acute gastroenteritis (AGE) and rotavirus-associated hospitalizations in Togolese children. METHODS Sentinel surveillance for AGE (defined as ≥3 liquid or semi-liquid stools/24 h lasting <7 days) hospitalizations among children <5 years of age was conducted in two sites in the capital city, Lome. ELISA was used for diagnosis of rotavirus infection in children with AGE. Additionally, review of hospitalization registers was performed at five hospitals to assess trends in AGE hospitalizations among children aged <5 years. For the vaccine impact assessment, pre-rotavirus vaccine introduction (July 2010-June 2014) and post-rotavirus vaccine introduction (July 2014-June 2016) periods were compared for annual changes in proportions of hospitalizations associated with AGE and rotavirus. RESULTS During the pre-vaccine period, sentinel surveillance showed that 1017 patients were enrolled and 57% (range, 53-62%) tested positive for rotavirus, declining to 42% (23% reduction) in the first post-vaccine year and to 26% (53% reduction) in the second post-vaccine year; declines were most marked among infants. The patient register review showed that, compared with pre-vaccine rotavirus seasons, declines in hospitalizations due to all-cause AGE during post-vaccine rotavirus seasons were 48% among <1 year age-group in both first and second years following vaccine introduction. Among 1-4 year olds no reduction was noted in the first year and a 19% decline occurred in the second year. CONCLUSIONS We report rapid and marked reduction in the number of AGE hospitalizations and the proportion of AGE hospitalizations attributable to rotavirus in the first two years post- RV1 implementation in Togo. It is necessary to monitor long-term vaccine impact on rotavirus disease burden through continued surveillance.
Collapse
Affiliation(s)
| | | | | | | | - Jason M Mwenda
- The World Health Organization, Regional Office for Africa, Brazzaville, Congo.
| | - Eyal Leshem
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Jacqueline E Tate
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Negar Aliabadi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | | | | | | | | | | | | | | | - Yawo Atakouma
- Department of Paediatrics, Medical School of Lome, Togo
| | - Umesh D Parashar
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| |
Collapse
|
19
|
Aliabadi N, Messacar K, Pastula DM, Robinson CC, Leshem E, Sejvar JJ, Nix WA, Oberste MS, Feikin DR, Dominguez SR. Enterovirus D68 Infection in Children with Acute Flaccid Myelitis, Colorado, USA, 2014. Emerg Infect Dis 2018; 22:1387-94. [PMID: 27434186 PMCID: PMC4982171 DOI: 10.3201/eid2208.151949] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Odds of this viral infection in the nasopharynx were 10 times greater for children with this condition than for controls. During August 8, 2014–October 14, 2014, a total of 11 children with acute flaccid myelitis and distinctive neuroimaging changes were identified near Denver, Colorado, USA. A respiratory prodrome was experienced by 10, and nasopharyngeal specimens were positive for enterovirus D68 (EV-D68) for 4. To determine whether an association exists between EV-D68 infection and acute flaccid myelitis, we conducted a retrospective case–control study comparing these patients with 2 groups of outpatient control children (1 group tested for acute respiratory illness and 1 for Bordetella pertussis infection). Adjusted analyses indicated that, for children with acute flaccid myelitis, the odds of having EV-D68 infection were 10.3 times greater than for those tested for acute respiratory infection and 4.5 times greater than for those tested for B. pertussis infection. No statistical association was seen between acute flaccid myelitis and non–EV-D68 enterovirus or rhinovirus infection. These findings support an association between EV-D68 infection and acute flaccid myelitis.
Collapse
|
20
|
Bonkoungou IJO, Aliabadi N, Leshem E, Kam M, Nezien D, Drabo MK, Nikiema M, Ouedraogo B, Medah I, Konaté S, Ouédraogo-Traoré R, Sangaré L, Kam L, Yé D, Ouattara M, Biey JN, Mwenda JM, Tate JE, Parashar UD. Impact and effectiveness of pentavalent rotavirus vaccine in children <5 years of age in Burkina Faso. Vaccine 2017; 36:7170-7178. [PMID: 29290478 DOI: 10.1016/j.vaccine.2017.12.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/06/2017] [Accepted: 12/18/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Burkina Faso was one of the first African nations to introduce pentavalent rotavirus vaccine (RV5, RotaTeq) into its national immunization program in October 2013. We describe the impact and effectiveness of rotavirus vaccine on acute gastroenteritis (AGE) hospitalizations among Burkinabe children. METHODS Sentinel hospital-based surveillance for AGE was conducted at four hospitals during December 2013 - February 2017. Demographic, clinical, and vaccination information was collected and stool specimens were tested by EIA. Trends in rotavirus AGE hospitalizations and changes in the proportion of AGE hospitalizations due to rotavirus were examined at two sentinel sites from January 2014 - December 2016. Unconditional logistic regression models using data from all 4 surveillance sites were used to calculate vaccine effectiveness (VE, defined as 1-odds ratio) by comparing the odds of vaccination among rotavirus AGE (cases) and non-rotavirus AGE (controls) patients, controlling for age, season, hospital site and socioeconomic factors. RESULTS The proportion of AGE hospitalizations that tested positive for rotavirus declined significantly among children <5 years of age, from 36% (154/422) in 2014 to 22% (71/323, 40% reduction, p < .01) in 2015 and 20% (61/298, 44% reduction, p < .01) in 2016. Among infants, the percentage of AGE admissions due to rotavirus fell significantly from 38% (94/250) in 2014 to 21% (32/153, 44% reduction, p < .01) in 2015 and 17% (26/149, 54% reduction, p < .01) in 2016. The adjusted VE for full 3-dose series of RV5 against rotavirus hospitalization was 58% (95% [CI], 10%, 81%) in children 6-11 months of age and 19% (-78%, 63%) in children ≥12 months. CONCLUSION Rotavirus hospitalizations declined after introduction of pentavalent rotavirus vaccine in children, particularly among infants. RV5 significantly protected against severe rotavirus gastroenteritis in infants, but effectiveness decreased in older children.
Collapse
Affiliation(s)
- Isidore Juste O Bonkoungou
- University Ouaga 1 Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso; National Public Health Laboratory, Ouagadougou, Burkina Faso.
| | - Negar Aliabadi
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eyal Leshem
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Internal Medicine C, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Madibèlè Kam
- Charles de Gaulle Pediatric University Hospital, Ouagadougou, Burkina Faso
| | - Désiré Nezien
- University Ouaga 1 Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Maxime K Drabo
- University Ouaga 1 Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Moumouni Nikiema
- National Immunization Program, Minister of Health, Ouagadougou, Burkina Faso
| | - Boureima Ouedraogo
- National Immunization Program, Minister of Health, Ouagadougou, Burkina Faso
| | - Isaïe Medah
- National Immunization Program, Minister of Health, Ouagadougou, Burkina Faso
| | | | - Rasmata Ouédraogo-Traoré
- University Ouaga 1 Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso; Charles de Gaulle Pediatric University Hospital, Ouagadougou, Burkina Faso
| | - Lassana Sangaré
- University Ouaga 1 Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso; Yalgado Ouédraogo University Hospital, Ouagadougou, Burkina Faso
| | - Ludovic Kam
- University Ouaga 1 Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso; Yalgado Ouédraogo University Hospital, Ouagadougou, Burkina Faso
| | - Diarra Yé
- University Ouaga 1 Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso; Charles de Gaulle Pediatric University Hospital, Ouagadougou, Burkina Faso
| | - Ma Ouattara
- World Health Organization, Burkina Faso Office, Ouagadougou, Burkina Faso
| | - Joseph N Biey
- World Health Organization, IST/WA, Ouagadougou, Burkina Faso
| | - Jason M Mwenda
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Jacqueline E Tate
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Umesh D Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
21
|
Diop A, Thiongane A, Mwenda JM, Aliabadi N, Sonko MA, Diallo A, Ndoye B, Faye PM, Ba ID, Parashar UD, Tate JE, Ndiaye O, Cissé MF, Ba M. Impact of rotavirus vaccine on acute gastroenteritis in children under 5 years in Senegal: Experience of sentinel site of the Albert Royer Children's Hospital in Dakar. Vaccine 2017; 36:7192-7197. [PMID: 29162319 DOI: 10.1016/j.vaccine.2017.10.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/30/2017] [Accepted: 10/17/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Acute gastroenteritis (AGE) is a leading cause of morbidity and mortality among children <5 years of age in developing countries, with rotavirus being the most common infectious etiology. In November 2014, monovalent rotavirus vaccine was introduced in Senegal. We determined the impact of rotavirus vaccine on hospitalizations for all-cause and rotavirus related AGE in children <60 months of age. METHODS We examined two data sources from the national referral hospital. Using sentinel surveillance data from March 2011 to February 2017, we examined the proportion of AGE hospitalizations among children <60 months of age attributable to rotavirus, stratified by age groups (0-11, 12-23 and 24-59 months). Using pediatric logbook data from March 2010 to February 2017, we examined the proportion of all childhood hospitalizations attributable to AGE, among the same age groups. RESULTS In sentinel surveillance, 673 patients <60 months were hospitalized for AGE, with 30% (203/673) due to rotavirus. In pre-vaccine years, the median proportion of rotavirus-positive hospitalizations was 42%; this proportion declined by 76% to 10% rotavirus positive in 2015-2016 (p < .001) and by 59% to 17% in 2016-2017 (p < .001). From the logbook data, among all children <60 months, a median of 11% of all hospitalizations in the pre-vaccine period were due to AGE, with 2015-2016 seeing a 16% decline (p < .001), to 9% of all hospitalizations, and 2016-2017 seeing a 39% decline (p < .001), to 7% of all hospitalizations. Declines in both rotavirus-associated and all-cause AGE hospitalizations were most marked among infants, with a suggestion of herd effect among older children seen in the surveillance data. CONCLUSION Rotavirus vaccine demonstrated a significant impact on rotavirus-associated hospitalizations and all-cause AGE hospitalizations in the first two seasons after vaccine introduction in Senegal. Our data support the continued use of this vaccine in national immunization program.
Collapse
Affiliation(s)
- Amadou Diop
- Bacteriology and Virology Laboratory, Albert Royer Teaching Hospital, Dakar, Senegal.
| | - Aliou Thiongane
- Paediatric Unit, Albert Royer Teaching Hospital, Dakar, Senegal
| | - Jason M Mwenda
- World Health Organization, Regional Office for Africa, Brazzaville, People's Republic of Congo
| | - Negar Aliabadi
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA, USA
| | - Mouhamadou A Sonko
- Bacteriology and Virology Laboratory, Albert Royer Teaching Hospital, Dakar, Senegal
| | - Aliou Diallo
- Expanded Programme on Immunization Focal Point, World Health Organization Country Office, Dakar, Senegal
| | - Babacar Ndoye
- Expanded Programme on Immunization, Ministry of Health, Dakar, Senegal
| | - Papa M Faye
- Paediatric Unit, Albert Royer Teaching Hospital, Dakar, Senegal
| | - Idrissa D Ba
- Paediatric Unit, Albert Royer Teaching Hospital, Dakar, Senegal
| | - Umesh D Parashar
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA, USA
| | - Jacqueline E Tate
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA, USA
| | - Ousmane Ndiaye
- Paediatric Unit, Albert Royer Teaching Hospital, Dakar, Senegal
| | - Moussa F Cissé
- Bacteriology and Virology Laboratory, Albert Royer Teaching Hospital, Dakar, Senegal
| | - Mamadou Ba
- Paediatric Unit, Albert Royer Teaching Hospital, Dakar, Senegal
| |
Collapse
|
22
|
Mwenda JM, Burke RM, Shaba K, Mihigo R, Tevi-Benissan MC, Mumba M, Biey JNM, Cheikh D, Poy, MSc A, Zawaira FR, Aliabadi N, Tate JE, Hyde T, Cohen AL, Parashar UD. Implementation of Rotavirus Surveillance and Vaccine Introduction - World Health Organization African Region, 2007-2016. MMWR Morb Mortal Wkly Rep 2017; 66:1192-1196. [PMID: 29095805 PMCID: PMC5689217 DOI: 10.15585/mmwr.mm6643a7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
23
|
Abstract
Abstract
Background
Before implementation of rotavirus vaccination in 2006, rotavirus caused 55,000-70,000 hospitalizations and 410,000 clinic visits annually in US children. This report examines the long-term impact of vaccine introduction on rotavirus detection and seasonality through comparison of pre (2000–2006) and post (2007–2016) vaccine seasons through the National Respiratory and Enteric Virus Surveillance System (NREVSS).
Methods
NREVSS is a passive laboratory system collecting results of weekly total and rotavirus-positive stool specimens. Seasons are defined as July through June. To characterize changes in rotavirus detection, total and positive specimens for each post vaccine season from 11 continuously reporting (≥26 weeks per season) laboratories were compared with median values for 2000–2006. Data from 20 participating laboratories were used to determine changes in season characteristics. ArcGIS software was used to document the annual geographic trend across the United States between 2000 and 2015. For season 2015–2016, data are available through April and are not included in the ArcGIS analysis.
Results
Nationally, there was a 53–93% reduction in rotavirus positivity in the post vaccine period as compared with the median in 2000–2006. Trends in rotavirus positivity declined steeply after vaccine introduction in 2006, and have remained low compared with the pre-vaccine period, with alternating years of lower and greater activity (figure). All regions had similar reductions in positive tests. ArcGIS data indicate that peak seasonal activity was largely restricted to January-April for each pre-vaccine year. In the 2006–2007 season, peak activity occurred during January-April, for 2007–2008, this shifted to March-April, for 2008–2009, the peak activity nationwide occurred at all months of the year from the reporting laboratories. This diffuse activity occurred for all subsequent years, save 2009–2010 and 2012–2013, where peak seasonal activity was again confined to January-April.
Conclusion
Rotavirus vaccine substantially and sustainably reduced the burden and changed the epidemiology of rotavirus in US children. The biennial pattern observed may be explained by accumulating unvaccinated children over two successive seasons resulting in stronger rotavirus seasons every alternate year.
Disclosures
All authors: No reported disclosures.
Collapse
Affiliation(s)
- Negar Aliabadi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amber Haynes
- IHRC Inc., contracting agency to Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jacqueline Tate
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Umesh D Parashar
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Aaron T Curns
- Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
24
|
Satter SM, Aliabadi N, Yen C, Gastañaduy PA, Ahmed M, Mamun A, Islam K, Flora MS, Rahman M, Zaman K, Rahman M, Heffelfinger JD, Luby SP, Gurley ES, Parashar UD. Epidemiology of childhood intussusception in Bangladesh: Findings from an active national hospital based surveillance system, 2012-2016. Vaccine 2017; 36:7805-7810. [PMID: 28941622 PMCID: PMC5864564 DOI: 10.1016/j.vaccine.2017.08.092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/06/2017] [Accepted: 08/09/2017] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Rotavirus vaccines have significantly decreased the burden of diarrheal diseases in countries that have introduced them into their immunization programs. In some studies, there has been a small association between rotavirus vaccines and intussusception in post-marketing surveillance, highlighting the importance of tracking incidence before and after vaccine introduction. The objective of this study was to describe the epidemiology of intussusception among Bangladeshi children pre-vaccine introduction. METHODS We conducted active, hospital-based surveillance for intussusception at 7 tertiary care hospitals with pediatric surgical facilities during July 2012 to September 2016. Hospitalized children under 2years of age were identified according to Brighton Collaboration level 1 criteria for intussusception. The frequency and proportion of intussusception among overall surgical admissions, as well as the demographic and clinical information of the cases is described. RESULTS Overall 153 cases of intussusception among children <2years-old were identified at participating sites over the enrolment period, confirmed by Level 1 Brighton criteria. These cases represented 2% of all surgical admissions under 2years of age. One hundred twelve cases (73%) were male; the median age was 7months; and the median duration of hospitalization was 7days. One hundred forty-six (95%) children with intussusception required surgery, and 11 (7%) died. CONCLUSIONS Confirmed cases of intussusception represented nearly 2% of pediatric surgical admissions at tertiary referral centers in Bangladesh during the study period and 7% of children with intussusception died. Given the high burden of rotavirus disease in Bangladesh, vaccine introduction is warranted, however, further studies after introduction of rotavirus vaccine are necessary to determine any association between vaccine and intussusception in this setting.
Collapse
Affiliation(s)
| | - Negar Aliabadi
- Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Catherine Yen
- Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | | | - Makhdum Ahmed
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Khaleda Islam
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Meerjady S Flora
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | | | | | - Stephen P Luby
- Center for Innovation in Global Health, Stanford University, USA
| | | | | |
Collapse
|
25
|
Yousafzai MT, Thobani R, Qazi SH, Saddal N, Yen C, Aliabadi N, Ali SA. Intussusception among children less than 2years of age: Findings from pre-vaccine introduction surveillance in Pakistan. Vaccine 2017; 36:7775-7779. [PMID: 28709556 DOI: 10.1016/j.vaccine.2017.06.073] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/23/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Rotavirus vaccination introduction in routine immunization is under consideration in Pakistan. Data on the baseline epidemiology of intussusception will inform surveillance strategies for intussusception after rotavirus vaccine introduction in Pakistan. We describe the epidemiology of intussusception-associated hospitalizations among children <2years of age in Karachi, Pakistan. METHODS We conducted a retrospective chart review for July 01, 2012 through June 30, 2015 at the National Institute of Child Health (NICH) and Aga Khan University Hospital (AKUH) Karachi. At AKUH, the International Classification of Disease, ninth revision, code 560.0 for intussusception was used to retrieve intussusception case records. At NICH, daily Operation Theater, Emergency Room, and surgical daycare log sheets and surgical ward census sheets were used to identify cases. Records of children who fulfilled eligibility criteria and the Brighton Collaboration level one case definition of intussusception were selected for data analysis. We used structured case report forms to extract data for the descriptive analysis. RESULTS We identified 158 cases of confirmed intussusception; 30 cases (19%) were from AKUH. More than half (53%) of the cases occurred in children aged 6-12months, followed by 35% among those aged <6months. Two-thirds (106/158) of the cases were male. The most common presenting complaints were vomiting and bloody stool. At NICH, almost all (93%) were managed surgically, while at AKUH, ∼57% of the cases were managed with enemas. Three deaths occurred, all from NICH. Cases occurred without any seasonality. At NICH, 4% (128/3618) of surgical admissions among children aged <2years were attributed to intussusception, while that for AKUH was 2% (30/1702). CONCLUSION In this chart review, intussusception predominantly affected children 0-6months of age and occurred more commonly in males. This information on the baseline epidemiology of intussusception will inform post-vaccine introduction adverse event monitoring related to intussusception in Pakistan.
Collapse
Affiliation(s)
| | - Rozina Thobani
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Saqib Hamid Qazi
- Department of Pediatric Surgery, Aga Khan University, Karachi, Pakistan
| | - Nasir Saddal
- Department of Surgery, National Institute of Child Health, Karachi, Pakistan
| | - Catherine Yen
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, USA
| | - Negar Aliabadi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, USA
| | - Syed Asad Ali
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan.
| |
Collapse
|
26
|
Sissoko D, Keïta M, Diallo B, Aliabadi N, Fitter DL, Dahl BA, Akoi Bore J, Raymond Koundouno F, Singethan K, Meisel S, Enkirch T, Mazzarelli A, Amburgey V, Faye O, Alpha Sall A, Magassouba N, Carroll MW, Anglaret X, Malvy D, Formenty P, Bruce Aylward R, Keïta S, Harouna Djingarey M, Loman NJ, Günther S, Duraffour S. Ebola Virus Persistence in Breast Milk After No Reported Illness: A Likely Source of Virus Transmission From Mother to Child. Clin Infect Dis 2017; 64:513-516. [PMID: 27940938 PMCID: PMC5404930 DOI: 10.1093/cid/ciw793] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 07/05/2016] [Accepted: 11/30/2016] [Indexed: 12/03/2022] Open
Abstract
A 9-month-old infant died from Ebola virus (EBOV) disease with unknown epidemiological link. While her parents did not report previous illness, laboratory investigations revealed persisting EBOV RNA in the mother’s breast milk and the father’s seminal fluid. Genomic analysis strongly suggests EBOV transmission to the child through breastfeeding.
Collapse
Affiliation(s)
- Daouda Sissoko
- INSERM U1219, Bordeaux University, Bordeaux, France.,Bordeaux University Hospital, Bordeaux, France
| | - Mory Keïta
- World Health Organization, Conakry, Guinea
| | | | - Negar Aliabadi
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David L Fitter
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Benjamin A Dahl
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph Akoi Bore
- European Mobile Laboratory Consortium, Hamburg, Germany.,Ministry of Health, Conakry, Guinea
| | - Fara Raymond Koundouno
- European Mobile Laboratory Consortium, Hamburg, Germany.,Ministry of Health, Conakry, Guinea
| | - Katrin Singethan
- European Mobile Laboratory Consortium, Hamburg, Germany.,Institute of Virology, Technische Universität München/Helmholtz Zentrum München, Munich
| | - Sarah Meisel
- European Mobile Laboratory Consortium, Hamburg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Theresa Enkirch
- European Mobile Laboratory Consortium, Hamburg, Germany.,Paul-Ehrlich-Institut, Division of Veterinary Medicine, Langen, Germany
| | - Antonio Mazzarelli
- European Mobile Laboratory Consortium, Hamburg, Germany.,National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Victoria Amburgey
- Sandia National Laboratories, Albuquerque, New Mexico.,Ratoma Ebola Diagnostic Center, Conakry, Guinea
| | | | | | - N'Faly Magassouba
- Université Gamal Abdel Nasser de Conakry, Laboratoire des Fièvres Hémorragiques en Guinée, Conakry, Guinea
| | - Miles W Carroll
- European Mobile Laboratory Consortium, Hamburg, Germany.,Public Health England, Porton Down, Salisbury.,University of Southampton, South General Hospital, Southampton, United Kingdom
| | - Xavier Anglaret
- INSERM U1219, Bordeaux University, Bordeaux, France.,PAC-CI, ANRS Research Site, Treichville University Hospital, Abidjan, Côte d'Ivoire
| | - Denis Malvy
- INSERM U1219, Bordeaux University, Bordeaux, France.,Bordeaux University Hospital, Bordeaux, France
| | | | | | | | | | - Nicholas J Loman
- Institute of Microbiology and Infection, University of Birmingham, United Kingdom
| | - Stephan Günther
- European Mobile Laboratory Consortium, Hamburg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Sophie Duraffour
- European Mobile Laboratory Consortium, Hamburg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| |
Collapse
|
27
|
Aliabadi N, Wikswo ME, Tate J, Parashar UD, Payne D. Factors Associated With Rotavirus Vaccine Uptake Among United States Children 8 Months to 5 Years Old, 2014–2015. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Negar Aliabadi
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary E. Wikswo
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jacqueline Tate
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Daniel Payne
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
28
|
Sejvar JJ, Lopez AS, Cortese MM, Leshem E, Pastula DM, Miller L, Glaser C, Kambhampati A, Shioda K, Aliabadi N, Fischer M, Gregoricus N, Lanciotti R, Nix WA, Sakthivel SK, Schmid DS, Seward JF, Tong S, Oberste MS, Pallansch M, Feikin D. Acute Flaccid Myelitis in the United States, August-December 2014: Results of Nationwide Surveillance. Clin Infect Dis 2016; 63:737-745. [PMID: 27318332 DOI: 10.1093/cid/ciw372] [Citation(s) in RCA: 153] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/20/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND During late summer/fall 2014, pediatric cases of acute flaccid myelitis (AFM) occurred in the United States, coincident with a national outbreak of enterovirus D68 (EV-D68)-associated severe respiratory illness. METHODS Clinicians and health departments reported standardized clinical, epidemiologic, and radiologic information on AFM cases to the Centers for Disease Control and Prevention (CDC), and submitted biological samples for testing. Cases were ≤21 years old, with acute onset of limb weakness 1 August-31 December 2014 and spinal magnetic resonance imaging (MRI) showing lesions predominantly restricted to gray matter. RESULTS From August through December 2014, 120 AFM cases were reported from 34 states. Median age was 7.1 years (interquartile range, 4.8-12.1 years); 59% were male. Most experienced respiratory (81%) or febrile (64%) illness before limb weakness onset. MRI abnormalities were predominantly in the cervical spinal cord (103/118). All but 1 case was hospitalized; none died. Cerebrospinal fluid (CSF) pleocytosis (>5 white blood cells/µL) was common (81%). At CDC, 1 CSF specimen was positive for EV-D68 and Epstein-Barr virus by real-time polymerase chain reaction, although the specimen had >3000 red blood cells/µL. The most common virus detected in upper respiratory tract specimens was EV-D68 (from 20%, and 47% with specimen collected ≤7 days from respiratory illness/fever onset). Continued surveillance in 2015 identified 16 AFM cases reported from 13 states. CONCLUSIONS Epidemiologic data suggest this AFM cluster was likely associated with the large outbreak of EV-D68-associated respiratory illness, although direct laboratory evidence linking AFM with EV-D68 remains inconclusive. Continued surveillance will help define the incidence, epidemiology, and etiology of AFM.
Collapse
Affiliation(s)
- James J Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases
| | - Adriana S Lopez
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Margaret M Cortese
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eyal Leshem
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel M Pastula
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins
| | - Lisa Miller
- Epidemiology Division, Colorado Department of Public Health and Environment, Denver
| | - Carol Glaser
- Division of Communicable Disease Control, California Department of Public Health, Richmond
| | - Anita Kambhampati
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute of Science and Education, Tennessee
| | - Kayoko Shioda
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute of Science and Education, Tennessee
| | - Negar Aliabadi
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marc Fischer
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins
| | - Nicole Gregoricus
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert Lanciotti
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins
| | - W Allan Nix
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Senthilkumar K Sakthivel
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - D Scott Schmid
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jane F Seward
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Suxiang Tong
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - M Steven Oberste
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark Pallansch
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel Feikin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
29
|
Aliabadi N, Tate JE, Parashar UD. Potential safety issues and other factors that may affect the introduction and uptake of rotavirus vaccines. Clin Microbiol Infect 2016; 22 Suppl 5:S128-S135. [PMID: 27129416 DOI: 10.1016/j.cmi.2016.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 10/13/2015] [Revised: 02/22/2016] [Accepted: 03/13/2016] [Indexed: 10/21/2022]
Abstract
Rotavirus vaccines have demonstrated significant impact in reducing the burden of morbidity and mortality from childhood diarrhoea in countries that have implemented routine vaccination to date. Despite this success, in many countries, rotavirus vaccine coverage remains lower than that of other routine childhood vaccines. Several issues may potentially affect vaccine uptake, namely safety concerns related to intussusception with consequent age restrictions on rotavirus vaccination, contamination with porcine circovirus, vaccine-derived reassortant strains and hospitalization in newborn nurseries at time of administration of live oral rotavirus vaccine. In addition to these safety concerns, other factors may also affect uptake, including lower vaccine efficacy in the developing world, potential emergence of strains escaping from vaccine protection resulting in lower overall impact of a vaccination programme and sustainable vaccine financing. Although further work is needed to address some of these concerns, global policy bodies have reaffirmed that the benefits of rotavirus vaccination outweigh the risks, and vaccine use is recommended globally.
Collapse
Affiliation(s)
- N Aliabadi
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - J E Tate
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - U D Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
30
|
Aliabadi N, Messacar K, Pastula DM, Leshem E, Robinson CC, Nix WA, Oberste MS, Sejvar J, Feikin D, Dominguez S. A Case Control Study of Acute Flaccid Myelitis and Enterovirus-D68, Colorado, 2014. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv131.174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
31
|
Aliabadi N, Parashar UD, Tate J, Haynes A. Sustained Decrease in Rotavirus Activity After Implementation of Rotavirus Vaccines Through the National Respiratory and Enteric Virus Surveillance System (NREVSS)—United States, 2000-2015. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv131.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
32
|
Aliabadi N, Carballo-Dieguez A, Bakken S, Rojas M, Brown W, Carry M, Mosley JP, Gelaude D, Schnall R. Using the Information-Motivation-Behavioral Skills Model to Guide the Development of an HIV Prevention Smartphone Application for High-Risk MSM. AIDS Educ Prev 2015; 27:522-37. [PMID: 26595265 PMCID: PMC4868035 DOI: 10.1521/aeap.2015.27.6.522] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
HIV remains a significant public health problem among men who have sex with men (MSM). MSM comprise 2% of the U.S. population, but constitute 56% of persons living with HIV. Mobile health technology is a promising tool for HIV prevention. The purpose of this study was to identify the desired content, features and functions of a mobile application (app) for HIV prevention in high-risk MSM. We conducted five focus group sessions with 33 MSM. Focus group recordings were transcribed and coded using themes informed by the information-motivation-behavioral (IMB) skills model. Participants identified information needs related to HIV prevention: HIV testing and prophylaxis distribution centers, support groups/peers, and HIV/STI disease/treatment information. Areas of motivation to target for the app included: attitudes and intentions. Participants identified behavioral skills to address with an app: using condoms correctly, negotiating safer sex, recognizing signs of HIV/STI. Findings from this work provide insight into the desired content of a mobile app for HIV prevention in high-risk MSM.
Collapse
Affiliation(s)
- Negar Aliabadi
- Division of General Medicine, Columbia University, New York, New York
| | | | - Suzanne Bakken
- Division of General Medicine, Columbia University, New York, New York
| | - Marlene Rojas
- Division of General Medicine, Columbia University, New York, New York
| | | | - Monique Carry
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jocelyn Patterson Mosley
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Deborah Gelaude
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rebecca Schnall
- Division of General Medicine, Columbia University, New York, New York
| |
Collapse
|
33
|
Aliabadi N, Lopman BA, Parashar UD, Hall AJ. Progress toward norovirus vaccines: considerations for further development and implementation in potential target populations. Expert Rev Vaccines 2015. [PMID: 26224658 DOI: 10.1586/14760584.2015.1073110] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Human norovirus infection causes significant medical and financial costs in the USA and abroad. Some populations, including young children, the elderly, and the immunocompromised, are at heightened risk of infection with this virus and subsequent complications, while others, such as healthcare workers and food handlers are at increased risk of transmitting it, and some are at risk of both. Human noroviruses are heterogeneous with new strains emerging periodically. In addition to viral diversity, incompletely understood characteristics, such as virus-host cell binding and duration of immunity after infection add to the challenges of creating a norovirus vaccine. Although much progress has been made in recent years, many questions remain to be answered. In this review, we discuss the important areas and relevant literature in considering human norovirus vaccine development and potential targets for implementation.
Collapse
Affiliation(s)
- Negar Aliabadi
- Centers for Disease Control and Prevention, Division of Viral Diseases, Epidemiology Branch, Viral Gastroenterology Team, Atlanta, USA
| | | | | | | |
Collapse
|
34
|
Aliabadi N, Tate JE, Haynes AK, Parashar UD. Sustained decrease in laboratory detection of rotavirus after implementation of routine vaccination—United States, 2000-2014. MMWR Morb Mortal Wkly Rep 2015; 64:337-42. [PMID: 25856253 PMCID: PMC4584623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Rotavirus infection is the leading cause of severe gastroenteritis among infants and young children worldwide. Before the introduction of rotavirus vaccine in the United States in 2006, rotavirus infection caused significant morbidity among U.S. children, with an estimated 55,000-70,000 hospitalizations and 410,000 clinic visits annually. The disease showed a characteristic winter-spring seasonality and geographic pattern, with annual seasonal activity beginning in the West during December-January, extending across the country, and ending in the Northeast during April-May. To characterize changes in rotavirus disease trends and seasonality following introduction of rotavirus vaccines in the United States, CDC compared data from CDC's National Respiratory and Enteric Virus Surveillance System (NREVSS), a passive laboratory reporting system, for prevaccine (2000-2006) and postvaccine (2007-2014) years. National declines in rotavirus detection were noted, ranging from 57.8%-89.9% in each of the 7 postvaccine years compared with all 7 prevaccine years combined. A biennial pattern of rotavirus activity emerged in the postvaccine era, with years of low activity and highly erratic seasonality alternating with years of moderately increased activity and seasonality similar to that seen in the prevaccine era. These results demonstrate the substantial and sustained effect of rotavirus vaccine in reducing the circulation and changing the epidemiology of rotavirus among U.S. children.
Collapse
Affiliation(s)
- Negar Aliabadi
- Epidemic Intelligence Service, CDC,Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC,Corresponding author: Negar Aliabadi, , 404.639.6367
| | - Jacqueline E. Tate
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Amber K. Haynes
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Umesh D. Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| |
Collapse
|
35
|
Pastula DM, Aliabadi N, Haynes AK, Messacar K, Schreiner T, Maloney J, Dominguez SR, Davizon ES, Leshem E, Fischer M, Nix WA, Oberste MS, Seward J, Feikin D, Miller L. Acute neurologic illness of unknown etiology in children - Colorado, August-September 2014. MMWR Morb Mortal Wkly Rep 2014; 63:901-2. [PMID: 25299607 PMCID: PMC4584613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
On September 12, 2014, CDC was notified by the Colorado Department of Public Health and Environment of a cluster of nine children evaluated at Children's Hospital Colorado with acute neurologic illness characterized by extremity weakness, cranial nerve dysfunction (e.g., diplopia, facial droop, dysphagia, or dysarthria), or both. Neurologic illness onsets occurred during August 8-September 15, 2014. The median age of the children was 8 years (range = 1-18 years). Other than neck, back, or extremity pain in some patients, all had normal sensation. All had a preceding febrile illness, most with upper respiratory symptoms, occurring 3-16 days (median = 7 days) before onset of neurologic illness. Seven of eight patients with magnetic resonance imaging of the spinal cord had nonenhancing lesions of the gray matter of the spinal cord spanning multiple levels, and seven of nine with magnetic resonance imaging of the brain had nonenhancing brainstem lesions (most commonly the dorsal pons). Two of five with magnetic resonance imaging of the lumbosacral region had gadolinium enhancement of the ventral nerve roots of the cauda equina. Eight children were up to date on polio vaccination. Eight have not yet fully recovered neurologically.
Collapse
Affiliation(s)
| | | | - Amber K. Haynes
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Kevin Messacar
- Children’s Hospital Colorado and University of Colorado School of Medicine
| | - Teri Schreiner
- Children’s Hospital Colorado and University of Colorado School of Medicine
| | - John Maloney
- Children’s Hospital Colorado and University of Colorado School of Medicine
| | | | | | - Eyal Leshem
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Marc Fischer
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - W. Allan Nix
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - M. Steven Oberste
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Jane Seward
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Daniel Feikin
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Lisa Miller
- Colorado Department of Public Health and Environment
| |
Collapse
|
36
|
Schurgin S, Dolan S, Perlstein A, Sullivan MP, Aliabadi N, Grinspoon S. Effects of testosterone administration on growth hormone pulse dynamics in human immunodeficiency virus-infected women. J Clin Endocrinol Metab 2004; 89:3290-7. [PMID: 15240605 DOI: 10.1210/jc.2003-032112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The effects of testosterone administration on the GH axis in androgen-deficient HIV-infected women are unknown. In this study, we determined the effects of transdermal testosterone administration on GH secretory dynamics and pulse characteristics in this population. GH-IGF-I parameters were determined in response to testosterone (4.1 mg/patch, twice a week; estimated delivery rate, 150 microg/d) vs. placebo over 6 months in 31 HIV-infected women. IGF-I increased significantly in the testosterone-treated compared with the placebo-treated patients [37 (-4, 73) vs. -30 (-98, 39) ng/ml, P = 0.01; 4.8 (-0.5, 9.6) vs. -3.9 (-12.8, 5.1) nmol/liter]. GH pulse frequency increased significantly in the testosterone-treated compared with the placebo-treated subjects [1.0 (1.0, 2.0) vs. 0.0 (-0.5, 1.5) peaks per 12 h, respectively; P = 0.02]. Before testosterone administration, overnight GH pulse amplitude was significantly related to IGF-I in univariate (r = 0.41, P = 0.03) and multivariate regression analysis; however, free testosterone, estradiol, and body mass index were not significantly correlated with baseline IGF-I. In contrast, after 6 months of treatment with testosterone, the change in IGF-I was significantly correlated to the change in free testosterone in univariate (r = 0.40, P = 0.04) and multivariate regression analysis. For each 1.0 pg/ml (3.5 pmol/liter) increase in free testosterone, IGF-I increased 19 ng/ml (2.5 nmol/liter), controlling for estradiol, body mass index, and GH pulse parameters (r(2) = 0.64). We demonstrate that IGF-I increases in response to physiologic, transdermal testosterone in HIV-infected women. The mechanism of this effect is unknown, but may involve a direct effect of testosterone on IGF-I, independent of changes in GH pulse dynamics.
Collapse
Affiliation(s)
- Sunita Schurgin
- Program in Nutritional Metabolism, Longfellow 207, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | | | | | | | | | | |
Collapse
|
37
|
Dolan S, Wilkie S, Aliabadi N, Sullivan MP, Basgoz N, Davis B, Grinspoon S. Effects of Testosterone Administration in Human Immunodeficiency Virus–Infected Women With Low Weight. ACTA ACUST UNITED AC 2004; 164:897-904. [PMID: 15111377 DOI: 10.1001/archinte.164.8.897] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The prevalence of human immunodeficiency virus (HIV) disease is increasing among women, many of whom remain symptomatic with low weight and poor functional status. Although androgen levels may often be reduced in such patients, the safety, tolerability, and efficacy of testosterone administration in this population remains unknown. METHODS A total of 57 HIV-infected women with free testosterone levels less than the median of the reference range and weight less than 90% of ideal body weight or weight loss greater than 10% were randomly assigned to receive transdermal testosterone (4 mg/patch) twice weekly or placebo for 6 months. Muscle mass was assessed by urinary creatinine excretion. Muscle function was assessed by the Tufts Quantitative Muscle Function Test. Treatment effect at 6 months was determined by analysis of covariance. Results are mean +/- SEM unless otherwise specified. RESULTS At baseline, subjects were low weight (body mass index [calculated as weight in kilograms divided by the square of height in meters] 20.6 +/- 0.4), with significant weight loss from pre-illness maximum weight (18.7% +/- 1.2%), and demonstrated reduced muscle function (upper and lower extremity muscle strength, 83% and 67%, respectively, of predicted range). Testosterone treatment resulted in significant increases in testosterone levels vs placebo (total testosterone: 37 +/- 5 vs -2 +/- 2 ng/dL [1.3 +/- 0.2 vs -0.1 +/- 0.1 nmol/L] [P<.001]; free testosterone: 3.7 +/- 0.5 vs -0.4 +/- 0.3 pg/mL [12.8 +/- 1.7 vs -1.4 vs 1.0 pmol/L] [P<.001]) and was well tolerated, without adverse effects on immune function, lipid and glucose levels, liver function, or body composition or the adverse effect of hirsutism. Muscle mass tended to increase (1.4 +/- 0.6 vs 0.3 +/- 0.8 kg; P =.08), and shoulder flexion (0.4 +/- 0.3 vs -0.5 +/- 0.3 kg; P =.02), elbow flexion (0.3 +/- 0.4 vs -0.7 +/- 0.4 kg; P =.04), knee extension (0.2 +/- 1.0 vs -1.7 +/- 1.3 kg; P =.02), and knee flexion (0.7 +/- 0.5 vs 0.3 +/- 0.7 kg; P =.04) increased in the testosterone-treated compared with the placebo-treated subjects. CONCLUSIONS Testosterone administration is well-tolerated and increases muscle strength in low-weight HIV-infected women. Testosterone administration may be a useful adjunctive therapy to maintain muscle function in symptomatic HIV-infected women.
Collapse
Affiliation(s)
- Sara Dolan
- Neuroendocrine Unit and Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
OBJECTIVES Although bone density has been previously investigated in HIV-infected men, little is known regarding bone density in HIV-infected women. METHODS AND DESIGN Bone density was measured by dual-energy X-ray absorptiometry in 84 ambulatory, HIV-infected females and 63 healthy female control subjects similar in age (41 +/-1 versus 41+/- 1 years, P = 0.83), body mass index (26.0 +/- 0.6 versus 27.0 +/- 0.5 kg/m, P = 0.44) and racial background (% non-Caucasian, 61 versus 51%; P = 0.24, HIV-infected versus control). RESULTS Lumbar spine (1.02+/- 0.02 versus 1.07 +/- 0.02 g/cm, P = 0.03) and total hip (0.93 +/-0.01 versus 0.99 +/- 0.01 g/cm, P = 0.004) bone density were reduced in HIV-infected compared with control subjects. Osteopenia was demonstrated in 54 versus 30% (P = 0.004) of HIV-infected versus control subjects and was 2.5 times more likely in a multivariate model accounting for age, race, menstrual function and body mass index. Urinary N-telopeptides of type 1 collagen (NTx) (39.6 +/- 3.5 versus 29.9 +/- 2.0 nM/mM urine creatinine, P = 0.03) and osteoprotegerin (4.76 +/- 0.23 versus 3.39 +/- 0.17 pmol/l, P < or = 0.0001) were increased in HIV-infected compared with control subjects. Among the HIV-infected women, bone density correlated with weight (r = 0.41, P < 0.001) and inversely with urinary NTx (r = -0.28, P = 0.01). Bone density did not differ by current or past protease inhibitor, nucleoside reverse trancriptase inhibitor, or non-nucleoside reverse transcriptase inhibitor exposure. CONCLUSIONS HIV-infected women demonstrate reduced bone density. Altered nutritional status, hormonal function and body composition may contribute to lower bone density in HIV-infected women. Consideration should be given to testing bone density in HIV-infected women with risk factors for osteopenia.
Collapse
Affiliation(s)
- Sara E Dolan
- Neuroendocrine Unit and Program in Nutritional Metabolism, Massachusetts General Hospital, Boston 02114, USA
| | | | | | | | | | | |
Collapse
|
39
|
Dolan S, Montagno A, Wilkie S, Aliabadi N, Sullivan M, Zahka N, Sherman JC, Grinspoon S. Neurocognitive function in HIV-infected patients with low weight and weight loss. J Acquir Immune Defic Syndr 2003; 34:155-64. [PMID: 14526204 DOI: 10.1097/00126334-200310010-00005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine neurocognitive function in HIV-infected subjects with low weight and weight loss. DESIGN Cross-sectional cohort. METHODS Baseline data from male and female participants in longitudinal treatment studies of AIDS wasting were analyzed. Fifty-seven HIV-infected women (age: 38 +/- 5 years, education level: 12.3 +/- 2.3 years) and 24 HIV-infected men (age: 37 +/- 5 years, education level: 13.5 +/- 2.9 years) with weight <90% IBW or loss of >10% of preillness weight maximum underwent standardized neurocognitive testing to measure intellectual functioning, attention, memory, and fine motor dexterity. The z scores were determined using age- and gender-specific normative data. RESULTS Among women, IQ (87 +/- 13, z score: -0.8 +/- 0.8 SD) and executive functioning scores (-0.7 +/- 1.2 SD) were below average but within normal limits. In contrast, performance (z scores) on measures of verbal learning (-2.5 +/- 1.5 SD), visuospatial abilities (-2.5 +/- 2.0 SD), and motor coordination (-2.3 +/- 3.3 SD) fell significantly below normal limits. Among men, IQ score was 96 +/- 13 SD (z score: -0.3 +/- 0.8 SD). Performance was below average on measures of verbal learning (-1.0 +/- 1.7 SD) and visual construction (-1.6 +/- 1.7 SD) but within normal limits on executive functioning (-0.1 +/- 1.0 SD). CONCLUSIONS HIV-infected women at low weight demonstrate significantly reduced verbal learning, memory, and motor function, whereas HIV-infected men at low weight demonstrate more moderate impairment in verbal learning and other measures of neurocognitive function.
Collapse
Affiliation(s)
- Sara Dolan
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Huang JS, Wilkie SJ, Dolan S, Gallafent JH, Aliabadi N, Sullivan MP, Grinspoon S. Reduced testosterone levels in human immunodeficiency virus-infected women with weight loss and low weight. Clin Infect Dis 2003; 36:499-506. [PMID: 12567309 DOI: 10.1086/367642] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2002] [Accepted: 11/26/2002] [Indexed: 11/03/2022] Open
Abstract
Risk factors for hypoandrogenemia among low-weight, human immunodeficiency virus (HIV)-infected patients are not known. Testosterone levels of 69 HIV-infected women with low weight and weight loss were compared with levels for 25 healthy, age- and body mass index-matched control subjects. HIV-infected subjects were of low weight, with a mean (+/- standard deviation) weight loss of -17.6% +/- 9.7% from preillness maximum, and 42% of HIV-infected subjects had a body mass index of <20 kg/m(2). Forty-nine percent of the HIV-infected population versus 8% of the control population exhibited low free testosterone levels (P<.001). Among HIV-infected women, when we controlled for chronic hepatitis status, age, and time of blood sampling, weight loss of >10% of maximum weight was a significant predictor of low free testosterone levels. Free testosterone levels did not differ by drug class or antiretroviral regimen. In conclusion, decreased androgen levels are common among HIV-infected women reporting significant weight loss, independent of exposure to antiretroviral medications.
Collapse
Affiliation(s)
- Jeannie S Huang
- Neuroendocrine Unit and Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA
| | | | | | | | | | | | | |
Collapse
|
41
|
Hadigan C, Rabe J, Meininger G, Aliabadi N, Breu J, Grinspoon S. Inhibition of lipolysis improves insulin sensitivity in protease inhibitor-treated HIV-infected men with fat redistribution. Am J Clin Nutr 2003; 77:490-4. [PMID: 12540412 DOI: 10.1093/ajcn/77.2.490] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fatty acid concentrations are increased in patients with HIV and fat redistribution and may contribute to insulin resistance in this population. OBJECTIVE We determined the effects of acute inhibition of lipolysis on insulin sensitivity in HIV-infected patients with fat redistribution who were receiving a protease inhibitor. DESIGN Seven HIV-infected men [age: 45 +/- 2 y; body mass index (in kg/m(2)): 28.8 +/- 1.9] with a fasting insulin concentration > or= 104 pmol/L (15 micro IU/mL), combined visceral adiposity and peripheral lipoatrophy, and receiving a protease inhibitor were studied. Tolbutamide-modified frequently sampled intravenous-glucose-tolerance tests (FSIGTTs) were performed after randomized double-blind administration of acipimox (500 mg at -90 and 0 min), a potent inhibitor of lipolysis, and placebo. The subjects completed 2 FSIGTTs separated by 3-7 d. RESULTS At baseline, fasting insulin and fatty acid concentrations were 27.6 +/- 5.0 micro IU/mL and 0.83 +/- 0.08 mmol/L (normal range: 0.1-0.6 mmol/L), respectively. Fatty acid concentrations were significantly reduced after acipimox compared with placebo (fatty acid area under the curve: acipimox = 73 +/- 8 compared with placebo = 122 +/- 12 mmol x 270 min/L, P = 0.002). Acipimox treatment resulted in a significant increase in the insulin sensitivity index (acipimox = 1.63 +/- 0.5 compared with placebo = 0.88 +/- 0.3 x 10(-4) x min(-1) x micro IU/mL, P = 0.015). CONCLUSIONS Acute inhibition of lipolysis and reduction in fatty acid concentrations are associated with improved insulin sensitivity in patients with HIV lipodystrophy and hyperinsulinemia. Further studies are needed to determine whether long-term antilipolytic strategies to reduce fatty acid concentrations may be useful in treating the metabolic disturbances associated with HIV lipodystrophy.
Collapse
Affiliation(s)
- Colleen Hadigan
- Neuroendocrine Unit and the Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, 02114, USA.
| | | | | | | | | | | |
Collapse
|
42
|
Meininger G, Hadigan C, Laposata M, Brown J, Rabe J, Louca J, Aliabadi N, Grinspoon S. Elevated concentrations of free fatty acids are associated with increased insulin response to standard glucose challenge in human immunodeficiency virus-infected subjects with fat redistribution. Metabolism 2002; 51:260-6. [PMID: 11833059 DOI: 10.1053/meta.2002.29999] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fat redistribution, defined by both increased abdominal visceral fat and/or decreased abdominal, extremity, and facial subcutaneous fat, is increasingly recognized among human immunodeficiency virus (HIV)-infected patients treated with combination antiretroviral therapy. Fat redistribution in this population is associated with insulin resistance and dyslipidemia and is often referred to as the HIV lipodystrophy syndrome (LIPO). Fatty acids are known to modulate insulin resistance in other disease states, but a comprehensive evaluation of fatty acids has not been undertaken among HIV-infected patients with fat redistribution. In this study, we investigated fatty acid concentrations in 64 HIV-infected individuals (45 men and 19 women) with evidence of fat redistribution (LIPO) in comparison to 30 HIV-infected individuals (20 men and 10 women) without evidence of fat redistribution (NONLIPO) and 32 HIV-negative healthy control subjects (C) (21 males and 11 females) of similar age and body mass index (BMI). Glucose, insulin, and free fatty acid (FFA) levels were measured in response to a 75-g oral glucose tolerance test (OGTT) in the LIPO, NONLIPO, and C subjects. In addition, fasting lipids were obtained, and body composition was determined by anthropometric measurements and dual-energy x-ray absorptiometry (DXA). Fasting FFA concentrations were significantly increased in the LIPO group as compared with NONLIPO and C subjects (0.74 +/- 0.03 v 0.60 +/- 0.04 [mean +/- SEM] mmol/L, P =.002, LIPO v NONLIPO; 0.74 +/- 0.03 v 0.59 +/- 0.03 mmol/L, P =.001, LIPO v C). In contrast, fasting FFA concentrations were not increased in the NONLIPO group (0.60 +/- 0.04 v 0.59 +/- 0.03, P =.909, NONLIPO v C). Similarly, fasting triglycerides and 120-minute OGTT FFA were significantly increased in the LIPO group as compared with the NONLIPO and C group. FFA decreased in HIV-infected LIPO, NONLIPO, and C subjects in response to OGTT, but the 120-minute FFA concentrations remained significantly elevated in LIPO patients compared with NONLIPO and C subjects. In a multivariate regression model of LIPO patients, fasting FFA (P =.027) was a strong independent predictor of insulin area under the curve (AUC), controlling for age, BMI, gender, and body composition (r(2) for model =.31). No differences were observed in FFA concentrations in the LIPO group in an analysis based on current protease inhibitor (PI) use. These data suggest that FFA concentrations are increased in HIV-infected patients with fat redistribution. Increased fasting concentrations of fatty acids are associated with abnormal insulin responses to standard glucose challenge in HIV-infected patients with fat redistribution. Further studies are necessary to determine the mechanism of increased fatty acid concentrations and the role played by increased FFA in mediating insulin resistance in this population.
Collapse
Affiliation(s)
- Gary Meininger
- Department of Pathology, Massachusetts General Hospital and Children's Hospital, Boston, MA 02114, USA
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Fielding JR, Aliabadi N, Renshaw AA, Silverman SG. Staging of 119 patients with renal cell carcinoma: the yield and cost-effectiveness of pelvic CT. AJR Am J Roentgenol 1999; 172:23-5. [PMID: 9888732 DOI: 10.2214/ajr.172.1.9888732] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The goal of this study was to determine the yield and cost-effectiveness of pelvic CT in staging renal cell carcinoma. MATERIALS AND METHODS The records of 119 patients who underwent preoperative CT of the abdomen and pelvis during a 6-year interval and then underwent partial or radical nephrectomy for renal cell carcinoma were reviewed for CT findings and pathologic stage. Pelvic CT findings were divided into three categories: benign and likely insignificant, benign and likely significant, and probably malignant. The effect of CT findings on further testing and the scheduling of surgery was assessed. An estimate of the cost of pelvic CT scans and other radiologic tests was made using 1997 Medicare reimbursement rates. RESULTS Total estimated cost of the 119 CT examinations of the pelvis was $40,698 ($342 each). No findings of probable malignancy were identified. In 27 patients, CT showed benign findings; these results did not cause planned surgery to be delayed. Three of these 27 patients underwent further radiologic tests at an estimated total cost of $243. CONCLUSION CT of the pelvis has a negligible yield in the staging of renal cell carcinoma and should not be routinely performed. The findings on CT of the pelvis did not generate a significant number of other tests.
Collapse
Affiliation(s)
- J R Fielding
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | | | | | | |
Collapse
|