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Akiso M, Muema D, Langat R, Naidoo KK, Oino G, Mutua G, Thobakgale C, Ochiel D, Chinyenze K, Anzala O, Mureithi MW. Early antiretroviral therapy and its impact on natural killer cell dynamics in HIV-1 infected men who have sex with men: a cross-sectional pilot study evaluating the impact of early ART initiation on NK cell perturbation in HIV infection. Microbiol Spectr 2024; 12:e0357023. [PMID: 38364104 DOI: 10.1128/spectrum.03570-23] [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: 10/09/2023] [Accepted: 01/17/2024] [Indexed: 02/18/2024] Open
Abstract
Phenotypic changes and functional impairment of natural killer (NK) cells occur early in HIV-1 infection. Antiretroviral therapy (ART) effectively restores CD4+ T cell counts and suppresses HIV-1 to undetectable levels. The role and efficacy of immediate ART initiation in mitigating NK cell aberrations remain to be elucidated comprehensively. This study hypothesized that HIV-1 infection negatively influences NK cell evolution and that early ART initiation restores these perturbations. Blood samples were collected longitudinally from five acutely HIV-1 infected men who have sex with men in Nairobi, Kenya. Participants were immediately initiated on ART after HIV-1 diagnosis. Blood samples were drawn pre-infection and at sequential bi-weekly post-infection time points. Peripheral blood mononuclear cells were stained with panel NK cells surface markers to assess HIV-induced phenotypic changes by flow cytometry. Some cells were also stimulated overnight with K562 cell line, IL-2, and IL-15 and stained for flow cytometry functionality. HIV-1 infection was associated with significant reductions in the production of IFN-γ (P = 0.0264), expression of CD69 (P = 0.0110), and expression of NK cell inhibitory receptor Siglec7 (P = 0.0418). We observed an increased NK cell degranulation (P = 0.0100) and an upregulated expression of cell exhaustion marker PD-1 (P = 0.0513) at post-infection time points. These changes mainly were restored upon immediate initiation of ART, except for Siglec7 expression, whose reduced expression persisted despite ART. Some HIV-associated changes in NK cells may persist despite the immediate initiation of ART in acute HIV-1 infections. Our findings suggest that understanding NK cell dynamics and their restoration after ART can offer insights into optimizing HIV-1 treatment and potentially slowing disease progression.IMPORTANCENatural killer (NK) cells play a crucial role in controlling of HIV-1 replication and progression to disease. Perturbations of their functionality may therefore result in deleterious disease outcomes. Previous studies have demonstrated reduced NK cell functionality in chronic HIV-1 infection that positively correlated to HIV-1 viral load. This may suggest that control of HIV-1 viremia in acute HIV-1 infection may aid in enhancing NK cell response boosting the inate immunity hence effective control of viral spread and establishment of viral reservoir. Antiretroviral therapy (ART) effectively supresses HIV-1 viremia to undectable levels and restores CD4+ T cell counts. Our study highlights the significant role of early ART initiation in mitigating NK cell disruptions caused by acute HIV-1 infection. Our results suggest that early initiation of ART could have benefits beyond suppressing viral load and restoring CD4+ T cell counts. In addition, it could boost the innate immunity necessary to control disease progression.
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Affiliation(s)
- Matrona Akiso
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya
| | - Daniel Muema
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
- HIV Pathogenesis Programme, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Robert Langat
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
- Division of Surgical Outcomes and Precision Medicine Research, Department of Surgery, University of Minnesota Twin Cities, Twin Cities, Minnesota, USA
| | - Kewreshini K Naidoo
- HIV Pathogenesis Programme, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Geoffrey Oino
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Gaudensia Mutua
- International AIDS Vaccine Initiative, New York, New York, USA
| | - Christina Thobakgale
- Faculty of Health Sciences, School of Pathology, University of Witwatersrand, Witwatersrand, South Africa
- Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Daniel Ochiel
- International AIDS Vaccine Initiative, New York, New York, USA
| | | | - Omu Anzala
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya
| | - Marianne W Mureithi
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya
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Colón W, Oriol Mathieu V, Hural J, Hattingh L, Adungo F, Lagatie O, Lavreys L, Allen M, Anzala O, Espy N, Fransen K, Garcia PJ, Maciel M, Murtagh M, Peel SA, Peeling RW, Tan LLJ, Warren M, Pau MG, D'Souza PM. HIV Diagnostics and Vaccines: It Takes Two to Tango. J Infect Dis 2024:jiae113. [PMID: 38451247 DOI: 10.1093/infdis/jiae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 03/08/2024] Open
Abstract
Current serological tests for HIV screening and confirmation of infection present challenges to the adoption of HIV vaccines. The detection of vaccine-induced HIV-1 antibodies in the absence of HIV-1 infection, referred to as vaccine-induced seropositivity/seroreactivity, confounds the interpretation of test results, causing misclassification of HIV-1 status with potential affiliated stigmatization. For HIV vaccines to be widely adopted with high community confidence and uptake, tests that are agnostic to vaccination status (i.e., only positive for true HIV-1 infection) of tested individuals are needed. Successful development and deployment of such tests will require HIV vaccine developers to work in concert with diagnostic developers. Such tests will need to match today's high-performance standards (accuracy, cost-effectiveness, simplicity) for use in both vaccinated and unvaccinated populations, especially in low- and middle-income countries with high HIV burden. Herein, we discuss the challenges and strategies for developing modified serological HIV tests for concurrent deployment with HIV vaccines.
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Affiliation(s)
- Will Colón
- Johnson & Johnson Global Public Health Research & Development, Beerse, Belgium
| | | | - John Hural
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | | | - Ole Lagatie
- Johnson & Johnson Global Public Health Research & Development, Beerse, Belgium
| | - Ludo Lavreys
- Janssen Vaccines and Prevention B.V., Leiden, the Netherlands
| | - Mary Allen
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Omu Anzala
- Kenya Aids Vaccine Initiative (KAVI) Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Nicole Espy
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Katrien Fransen
- HIV/STD Reference Laboratory, Clinical Virology Unit, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Patricia J Garcia
- Epidemiology, STD, and HIV Unit, School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Milton Maciel
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | - Sheila A Peel
- Diagnostics and Countermeasures Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Rosanna W Peeling
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Patricia M D'Souza
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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Nduva GM, Otieno F, Kimani J, Sein Y, Arimide DA, Mckinnon LR, Cholette F, Lawrence MK, Majiwa M, Masika M, Mutua G, Anzala O, Graham SM, Gelmon L, Price MA, Smith AD, Bailey RC, Medstrand P, Sanders EJ, Esbjörnsson J, Hassan AS. Temporal trends and transmission dynamics of pre-treatment HIV-1 drug resistance within and between risk groups in Kenya, 1986-2020. J Antimicrob Chemother 2024; 79:287-296. [PMID: 38091580 PMCID: PMC10832587 DOI: 10.1093/jac/dkad375] [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: 08/07/2023] [Accepted: 11/26/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Evidence on the distribution of pre-treatment HIV-1 drug resistance (HIVDR) among risk groups is limited in Africa. We assessed the prevalence, trends and transmission dynamics of pre-treatment HIVDR within and between MSM, people who inject drugs (PWID), female sex workers (FSWs), heterosexuals (HETs) and perinatally infected children in Kenya. METHODS HIV-1 partial pol sequences from antiretroviral-naive individuals collected from multiple sources between 1986 and 2020 were used. Pre-treatment reverse transcriptase inhibitor (RTI), PI and integrase inhibitor (INSTI) mutations were assessed using the Stanford HIVDR database. Phylogenetic methods were used to determine and date transmission clusters. RESULTS Of 3567 sequences analysed, 550 (15.4%, 95% CI: 14.2-16.6) had at least one pre-treatment HIVDR mutation, which was most prevalent amongst children (41.3%), followed by PWID (31.0%), MSM (19.9%), FSWs (15.1%) and HETs (13.9%). Overall, pre-treatment HIVDR increased consistently, from 6.9% (before 2005) to 24.2% (2016-20). Among HETs, pre-treatment HIVDR increased from 6.6% (before 2005) to 20.2% (2011-15), but dropped to 6.5% (2016-20). Additionally, 32 clusters with shared pre-treatment HIVDR mutations were identified. The majority of clusters had R0 ≥ 1.0, indicating ongoing transmissions. The largest was a K103N cluster involving 16 MSM sequences sampled between 2010 and 2017, with an estimated time to the most recent common ancestor (tMRCA) of 2005 [95% higher posterior density (HPD), 2000-08], indicating propagation over 12 years. CONCLUSIONS Compared to HETs, children and key populations had higher levels of pre-treatment HIVDR. Introduction of INSTIs after 2017 may have abrogated the increase in pre-treatment RTI mutations, albeit in the HET population only. Taken together, our findings underscore the need for targeted efforts towards equitable access to ART for children and key populations in Kenya.
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Affiliation(s)
- George M Nduva
- Department of Translational Medicine, Lund University, Lund, Sweden
- Department of HIV/STI, KEMRI/Wellcome Trust Research Programme, PO Box 230-80108 Kilifi, Kenya
| | | | - Joshua Kimani
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Yiakon Sein
- Department of HIV/STI, KEMRI/Wellcome Trust Research Programme, PO Box 230-80108 Kilifi, Kenya
| | - Dawit A Arimide
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Lyle R Mckinnon
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Francois Cholette
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
- National Microbiology Laboratory at the JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, Winnipeg, Canada
| | - Morris K Lawrence
- Department of Biochemistry and Biotechnology, Pwani University, Kilifi, Kenya
| | - Maxwell Majiwa
- Kenya Medical Research Institute/Centre for Global Health Research, Kisumu, Kenya
| | - Moses Masika
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Gaudensia Mutua
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Omu Anzala
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Susan M Graham
- Department of HIV/STI, KEMRI/Wellcome Trust Research Programme, PO Box 230-80108 Kilifi, Kenya
- Department of Medicine, Global Health and Epidemiology, University of Washington, Seattle, USA
| | - Larry Gelmon
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Matt A Price
- IAVI, NewYork, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Adrian D Smith
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Robert C Bailey
- Nyanza Reproductive Health Society, Kisumu, Kenya
- Division of Epidemiology & Biostatistics, University of Illinois at Chicago, Chicago, IL, USA
| | - Patrik Medstrand
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Eduard J Sanders
- Department of HIV/STI, KEMRI/Wellcome Trust Research Programme, PO Box 230-80108 Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Joakim Esbjörnsson
- Department of Translational Medicine, Lund University, Lund, Sweden
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Amin S Hassan
- Department of Translational Medicine, Lund University, Lund, Sweden
- Department of HIV/STI, KEMRI/Wellcome Trust Research Programme, PO Box 230-80108 Kilifi, Kenya
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Man-Lik Choi E, Abu-Baker Mustapher G, Omosa-Manyonyi G, Foster J, Anywaine Z, Musila Mutua M, Ayieko P, Vudriko T, Ann Mwangi I, Njie Y, Ayoub K, Mundia Muriuki M, Kasonia K, Edward Connor N, Florence N, Manno D, Katwere M, McLean C, Gaddah A, Luhn K, Lowe B, Greenwood B, Robinson C, Anzala O, Kaleebu P, Watson-Jones D. Safety and immunogenicity of an Ad26.ZEBOV booster vaccine in Human Immunodeficiency Virus positive (HIV+) adults previously vaccinated with the Ad26.ZEBOV, MVA-BN-Filo vaccine regimen against Ebola: A single-arm, open-label Phase II clinical trial in Kenya and Uganda. Vaccine 2023; 41:7573-7580. [PMID: 37981473 DOI: 10.1016/j.vaccine.2023.10.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/17/2023] [Accepted: 10/20/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND People living with HIV constitute an important part of the population in regions at risk of Ebola virus disease outbreaks. The two-dose Ad26.ZEBOV, MVA-BN-Filo Ebola vaccine regimen induces strong immune responses in HIV-positive (HIV+) adults but the durability of this response is unknown. It is also unclear whether this regimen can establish immune memory to enable an anamnestic response upon re-exposure to antigen. METHODS This paper describes an open-label, phase 2 trial, conducted in Kenya and Uganda, of Ad26.ZEBOV booster vaccination in HIV+ participants who had previously received the Ad26.ZEBOV, MVA-BN-Filo primary regimen. HIV+ adults with well-controlled infection and on highly active antiretroviral therapy were enrolled, vaccinated with booster, and followed for 28 days. The primary objectives were to assess Ad26.ZEBOV booster safety and antibody responses against the Ebola virus glycoprotein using the Filovirus Animal Non-Clinical Group ELISA. RESULTS The Ad26.ZEBOV booster was well-tolerated in HIV+ adults with mostly mild to moderate symptoms. No major safety concerns or serious adverse events were reported. Four and a half years after the primary regimen, 24/26 (92 %) participants were still classified as responders, with a pre-booster antibody geometric mean concentration (GMC) of 726 ELISA units (EU)/mL (95 %CI 447-1179). Seven days after the booster, the GMC increased 54-fold to 38,965 EU/mL (95 %CI 23532-64522). Twenty-one days after the booster, the GMC increased 176-fold to 127,959 EU/mL (95 %CI 93872-174422). The responder rate at both post-booster time points was 100 %. CONCLUSIONS The Ad26.ZEBOV booster is safe and highly immunogenic in HIV+ adults with well-controlled infection. The Ad26.ZEBOV, MVA-BN-Filo regimen can generate long-term immune memory persisting for at least 4·5 years, resulting in a robust anamnestic response. TRIAL REGISTRATION Pan African Clinical Trial Registry (PACTR202102747294430). CLINICALTRIALS gov (NCT05064956).
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Affiliation(s)
| | | | | | - Julie Foster
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Philip Ayieko
- London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | | | - Irene Ann Mwangi
- KAVI - Institute of Clinical Research, University of Nairobi, Nairobi, Kenya.
| | - Yusupha Njie
- London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Kakande Ayoub
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda.
| | | | - Kambale Kasonia
- London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | | | - Nambaziira Florence
- London School of Hygiene & Tropical Medicine, London, United Kingdom; MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda; Uganda Virus Research Institute, Entebbe, Uganda.
| | - Daniela Manno
- London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | | | - Chelsea McLean
- Janssen Vaccines and Prevention, Leiden, The Netherlands.
| | | | - Kerstin Luhn
- Janssen Vaccines and Prevention, Leiden, The Netherlands.
| | - Brett Lowe
- London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Brian Greenwood
- London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | | | - Omu Anzala
- KAVI - Institute of Clinical Research, University of Nairobi, Nairobi, Kenya.
| | - Pontiano Kaleebu
- London School of Hygiene & Tropical Medicine, London, United Kingdom; MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda; Uganda Virus Research Institute, Entebbe, Uganda.
| | - Deborah Watson-Jones
- London School of Hygiene & Tropical Medicine, London, United Kingdom; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania.
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Akiso M, Ameka M, Naidoo K, Langat R, Kombo J, Sikuku D, Ndung’u T, Altfeld M, Anzala O, Mureithi M. Metabolic and mitochondrial dysregulation in CD4+ T cells from HIV-positive women on combination anti-retroviral therapy. PLoS One 2023; 18:e0286436. [PMID: 37816026 PMCID: PMC10564234 DOI: 10.1371/journal.pone.0286436] [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: 05/25/2023] [Accepted: 09/20/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND For optimal functionality, immune cells require a robust and adaptable metabolic program that is fueled by dynamic mitochondrial activity. In this study, we investigate the metabolic alterations occurring in immune cells during HIV infection and antiretroviral therapy by analyzing the uptake of metabolic substrates and mitochondrial phenotypes. By delineating changes in immune cell metabolic programming during HIV, we may identify novel potential therapeutic targets to improve anti-viral immune responses. METHODS After consent and voluntary participation was confirmed, whole blood was drawn from HIV uninfected women and women with chronic HIV infection on long-term combination antiretroviral therapy (HIV/cART). Peripheral blood mononuclear cells-derived immune cells were directly incubated with different fluorescently tagged metabolites and markers of mitochondrial activity: FITC-2-NBDG (2-[N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl) amino]-2-deoxy-D-glucose), FITC-BODIPY (4,4-Difluoro-5,7-Dimethyl-4-Bora-3a,4a-Diaza-s-Indacene-3-Hexadecanoic Acid), FITC-MitoTracker Green and APC-MitoTracker Deep Red. The uptake of glucose and fats and the mitochondrial mass and potential were measured using flow cytometry. All values are reported quantitatively as geometric means of fluorescence intensity. RESULTS During chronic HIV infection, cellular uptake of glucose increases in HIV+ dendritic cells in particular. CD4+ T cells had the lowest uptake of glucose and fats compared to all other cells regardless of HIV status, while CD8+ T cells took up more fatty acids. Interestingly, despite the lower utilization of glucose and fats in CD4+ T cells, mitochondrial mass increased in HIV+ CD4+ T cells compared to HIV negative CD4+ T-cells. HIV+ CD4+ T cells also had the highest mitochondrial potential. CONCLUSIONS Significant disparities in the utilization of substrates by leukocytes during chronic HIV/cART exist. Innate immune cells increased utilization of sugars and fats while adaptive immune cells displayed lower glucose and fat utilization despite having a higher mitochondrial activity. Our findings suggest that cART treated HIV-infected CD4+ T cells be dysfunctional or may prefer alternative fuel sources not included in these studies. This underscores the importance of understanding the metabolic effects of HIV treatment on immune function.
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Affiliation(s)
- Matrona Akiso
- Department of Medical Microbiology & Immunology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
- KAVI-Institute of Clinical Research (KAVI-ICR), University of Nairobi, Nairobi, Kenya
| | - Magdalene Ameka
- KAVI-Institute of Clinical Research (KAVI-ICR), University of Nairobi, Nairobi, Kenya
| | - Kewreshini Naidoo
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Robert Langat
- KAVI-Institute of Clinical Research (KAVI-ICR), University of Nairobi, Nairobi, Kenya
- Division of Surgical Outcomes and Precision Medicine Research, Department of Surgery, University of Minnesota Twin Cities, United States of America
| | - Janet Kombo
- Department of Medical Microbiology & Immunology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
- KAVI-Institute of Clinical Research (KAVI-ICR), University of Nairobi, Nairobi, Kenya
| | - Delories Sikuku
- Department of Medical Microbiology & Immunology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Thumbi Ndung’u
- HIV Pathogenesis Programme, The Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Marcus Altfeld
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Virus Immunology Department, Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany
| | - Omu Anzala
- Department of Medical Microbiology & Immunology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
- KAVI-Institute of Clinical Research (KAVI-ICR), University of Nairobi, Nairobi, Kenya
| | - Marianne Mureithi
- Department of Medical Microbiology & Immunology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
- KAVI-Institute of Clinical Research (KAVI-ICR), University of Nairobi, Nairobi, Kenya
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Mayanja Y, Rida W, Kimani J, Ssetala A, Mpendo J, Nanvubya A, Mutua G, Anzala O, Price MA. Hepatitis B status and associated factors among participants screened for simulated HIV vaccine efficacy trials in Kenya and Uganda. PLoS One 2023; 18:e0288604. [PMID: 37459311 PMCID: PMC10351693 DOI: 10.1371/journal.pone.0288604] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 07/02/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Hepatitis B (HBV) prevalence remains high in Sub Saharan Africa and among some key populations such as those with continued exposure through sexual contact. We assessed the HBV status among potential participants who were screened for simulated HIV vaccine efficacy trials in Kenya and Uganda. METHODS We conducted a cross sectional analysis of data collected from individuals who were screened in Kenya (Nairobi) and Uganda (Entebbe and Kampala). The studies followed hypothetical procedures of an HIV vaccine efficacy trial and aimed to enroll HIV negative key and vulnerable populations at elevated risk of HIV acquisition. HBV status was the main outcome categorized using Hepatitis B surface antigen (HBsAg) and total Hepatitis B core antibody (HBcAb). Baseline characteristics potentially associated with never being infected were analyzed using logistic regression. RESULTS We screened 1,366 participants with mean age (SD) 28.7 (7.3) years. Overall, 46.6% were from Entebbe, 50.7% had secondary or higher level of education, 76.4% had informal high-risk jobs and 56.3% were male. Kampala had only female participants contributing 60.6% of females screened. Of the screened participants, 94.7% and 3.4% were negative and positive for HBsAg respectively. The prevalence on HBV infection was 3.9% among males and 2.8% among females while prevalence by site was: Entebbe (4.9%); Kampala (4.1%) and Nairobi (0.3%). The highest HBV prevalence was found among participants aged 25-29-years (5.2%), those with primary level education (4.5%), and those in informal low risk jobs (6.5%). Considering 1265 participants with complete data on HBsAg and HBcAb-Total, HBV status was never infected (67.9%), past infection (28.5%), chronic infection (3.2%) and acute infection (0.5%). Of 859 who were never infected, 685 (79.7%) were tested for anti-HBs titers of whom 60 (8.8%) had titers >10IU/L (immune due to vaccination). The odds of never being HBV infected were lower among older individuals 25-29 years (AOR 0.51; 95%CI 0.36-0.71) and ≥30 years (AOR 0.35; 95% CI 0.25-0.49). The odds were higher among participants with informal high-risk jobs from Kampala (AOR 2.21; 95% CI 1.41-3.47) and Nairobi (AOR 2.61; 95% CI 1.72-4.00) compared to those from Entebbe. CONCLUSION HBV prevalence and immunity due to vaccination were low among HIV negative individuals who are eligible for HIV vaccine trials and prevalence varies by age, education level and main occupation. Younger individuals and those recruited from existing cohorts/ clinics have a higher likelihood of having no prior HBV infection. HIV prevention intervention trials are a platform to identify individuals that need HBV vaccination.
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Affiliation(s)
- Yunia Mayanja
- Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Wasima Rida
- Biostatistics Consultant, Arlington, Virginia, United States of America
| | - Joshua Kimani
- SWOP-PHDA, University of Nairobi/University of Manitoba, Nairobi, Kenya
| | - Ali Ssetala
- Uganda Virus Research Institute/ International AIDS Vaccine Initiative (UVRI-IAVI) HIV Vaccine Programme, Entebbe, Uganda
| | - Juliet Mpendo
- Uganda Virus Research Institute/ International AIDS Vaccine Initiative (UVRI-IAVI) HIV Vaccine Programme, Entebbe, Uganda
| | - Annet Nanvubya
- Uganda Virus Research Institute/ International AIDS Vaccine Initiative (UVRI-IAVI) HIV Vaccine Programme, Entebbe, Uganda
| | | | - Omu Anzala
- KAVI- Institute for Clinical Research, Nairobi, Kenya
| | - Matt A. Price
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States of America
- IAVI, New York, New York, United States of America
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Mulinge MM, Oluoch JO, Abisi HK, Otieno LE, Anzala O, Wamalwa DC, Nduati RW, Kimani J, Herbeck J, McKinnon L. Age and CD4+ T cell counts are inversely associated with HIV drug resistance mutations in treatment naive female sex workers. Medicine (Baltimore) 2023; 102:e34060. [PMID: 37327289 PMCID: PMC10270489 DOI: 10.1097/md.0000000000034060] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
The increasing prevalence of human immunodeficiency virus (HIV) drug resistance mutations (HIVDRM) in untreated seropositive persons has consequences for future treatment options. This is extremely important in key populations such as female sex workers (FSWs), where the prevalence of pretreatment drug resistance (PDR) and associated risk factors are unknown. In this study, we analyzed PDR and associated risk factors in recently diagnosed and treatment-naive FSWs in Nairobi, Kenya. In this cross-sectional study, we used 64 HIV-seropositive plasma samples collected from FSWs between November 2020 and April 2021. To identify HIVDRM, the pol gene was amplified and genotyped using sanger sequencing. The effects of age, tropism, CD4+ T cell count, subtype, and location on HIVDRM counts were examined using Poisson regression. Overall, the prevalence of PDR was 35.9% (95% CI: 24.3-48.9), which was strongly influenced by K103N and M184V mutations, which confer resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) and nucleoside reverse transcriptase inhibitors (NRTI), respectively. Subtype A1 was predominant followed by subtype D with a notable increase in inter-subtype recombinants. We found statistically significant evidence that age was inversely related to HIVDRM. A FSW who is 1 year older had 12% less HIVDRM (incidence rate ratios [IRR]: 0.88; 95% CI: 0.82-0.95; P < .001), after adjusting for CD4+ T cell count, subtype, location, and tropism. Similarly, an increase in CD4+ T cell count by 1 unit, was associated with 0.4% fewer HIVDRM (IRR: 0.996; 95% CI: 0.994-0.998; P = .001), while controlling for the other variables. HIV-1 tropism was not associated with HIVDRM counts. In conclusion, our findings show a high prevalence of NNRTIs. Lower CD4+ T cell counts and younger age were significant risk factors that influenced HIVDRM loads. This finding underscores the relevance of targeted interventions and the importance of continuing to focus on FSWs as a way of addressing the HIV epidemic.
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Affiliation(s)
- Martin M. Mulinge
- Department of Biochemistry, University of Nairobi, Nairobi, Kenya
- Kenya AIDS Vaccine Initiative - Institute of Clinical Research (KAVI-ICR), University of Nairobi, Nairobi, Kenya
| | - Jeff O. Oluoch
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Hellen K. Abisi
- Department of Biochemistry, University of Nairobi, Nairobi, Kenya
| | - Leon E. Otieno
- Molecular Medicine and Infectious Diseases Laboratory, University of Nairobi, Kenya
| | - Omu Anzala
- Kenya AIDS Vaccine Initiative - Institute of Clinical Research (KAVI-ICR), University of Nairobi, Nairobi, Kenya
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Dalton C. Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Ruth W. Nduati
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Joshua Kimani
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Joshua Herbeck
- Department of Global Health, University of Washington, Seattle, WA
| | - Lyle McKinnon
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
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8
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Samandari T, Ongalo J, McCarthy K, Biegon RK, Madiega P, Mithika A, Orinda J, Mboya GM, Mwaura P, Anzala O, Onyango C, Oluoch FO, Osoro EM, Dutertre CA, Tan N, Hang SK, Hariharaputran S, Lye DC, Herman-Roloff A, Le Bert N, Bertoletti A. Prevalence and functional profile of SARS-CoV-2 T cells in asymptomatic Kenyan adults. J Clin Invest 2023:170011. [PMID: 37219944 DOI: 10.1172/jci170011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND SARS-CoV-2 infection in Africa has been characterized by less severe disease than elsewhere but the profile of SARS-CoV-2 specific adaptive immunity in this largely asymptomatic spread has not been studied. METHODS We collected blood and nasopharyngeal samples from rural Kenyans (n=80) without respiratory symptoms since 2019, had no contact with COVID-19 cases or received COVID-19 vaccines and were negative for current SARS-CoV-2 infection. We analyzed spike-specific antibodies and T cells specific for SARS-CoV-2 structural (membrane, nucleocapsid and spike) and accessory (ORF3a, ORF7, ORF8) proteins. Pre-pandemic samples collected in urban Nairobi, Kenya (n=13) between 2015-2016 and samples of mild-moderately symptomatic COVID-19 convalescents (n=36) living in the urban environment of Singapore were also studied. RESULTS Among asymptomatic Kenyans, we detected anti-spike antibodies in 41.0% and T cell responses against ≥2 SARS-CoV-2 proteins in 82.5%. The pre-pandemic samples from Nairobi had low-level, monospecific responses. Furthermore, distinct from cellular immunity in European and Asian COVID-19 convalescents, strong T cell immunogenicity was observed against viral accessory proteins (ORF3a, ORF8) and not structural proteins, as well as a higher IL-10/IFN-γ ratio cytokine profile. CONCLUSIONS The high incidence of T cell responses against different SARS-CoV-2 proteins in largely seronegative participants suggests that serosurveys underestimate SARS-CoV-2 prevalence in settings where asymptomatic infections prevail. Similar observations have been made with other coronavirus infections such as MERS and SARS-CoV-1. The functional and antigen-specific profile of SARS-CoV-2 specific T cells in these African individuals suggests that genetic or environmental factors play a role in the development of protective antiviral immunity. FUNDINGS U.S. Centers for Disease Control and Prevention, Division of Global Health Protection; the Singapore Ministry of Health's National Medical Research Council.
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Affiliation(s)
- Taraz Samandari
- U.S. Centers for Disease Control & Prevention, Nairobi, Kenya
| | - Joshua Ongalo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Kimberly McCarthy
- U.S. Centers for Disease Control & Prevention, U.S. Centers for Disease Control & Prevention, Kisumu, Kenya
| | - Richard K Biegon
- Immunology Section, Moi University School of Medicine, Eldoret, Kenya
| | - Philister Madiega
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Anne Mithika
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Joseph Orinda
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Grace M Mboya
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Patrick Mwaura
- KAVI Institute of Research, University of Nairobi, Nairobi, Kenya
| | - Omu Anzala
- KAVI Institute of Research, University of Nairobi, Nairobi, Kenya
| | - Clayton Onyango
- U.S. Centers for Disease Control & Prevention, Nairobi, Kenya
| | - Fredrick O Oluoch
- Department of Health & Sanitation, County Government of Kisumu, Kisumu, Kenya
| | - Eric M Osoro
- Global Health, Washington State University Global Health Kenya, Nairobi, Kenya
| | - Charles-Antoine Dutertre
- Department of Immunohematology, Institut Cochin, INSERM U1016, CNRS UMR8104, Université Paris Descartes, Paris, France
| | - Nicole Tan
- Programme in Emerging Infectious Diseases, Duke University-National University of Singapore Medical School, Singapore, Singapore
| | - Shou Kit Hang
- Programme in Emerging Infectious Diseases, Duke University-National University of Singapore Medical School, Singapore, Singapore
| | - Smrithi Hariharaputran
- Programme in Emerging Infectious Diseases, Duke University-National University of Singapore Medical School, Singapore, Singapore
| | - David C Lye
- National Centre for Infectious Diseases, Singapore, Singapore
| | | | - Nina Le Bert
- Programme in Emerging Infectious Diseases, Duke University-National University of Singapore Medical School, Singapore, Singapore
| | - Antonio Bertoletti
- Programme in Emerging Infectious Diseases, Duke University-National University of Singapore Medical School, Singapore, Singapore
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9
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McLean C, Barry H, Kieh M, Anywaine Z, Tapima Rogers B, Doumbia S, Sirima SB, Serry-Bangura A, Habib Beavogui A, Gaddah A, Katwere M, Hendriks J, Keshinro B, Eholie S, Kibuuka H, Kennedy SB, Anzala O, Samai M, D'Ortenzio E, Leigh B, Sow S, Thiébaut R, Greenwood B, Watson-Jones D, Douoguih M, Luhn K, Robinson C. Immune response of a two-dose heterologous Ebola vaccine regimen: summary of three African clinical trials using a single validated Filovirus Animal Nonclinical Group enzyme-linked immunosorbent assay in a single accredited laboratory. EBioMedicine 2023; 91:104562. [PMID: 37099841 PMCID: PMC10149382 DOI: 10.1016/j.ebiom.2023.104562] [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: 09/01/2022] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND This analysis evaluated the immune response to the two-dose, heterologous Ad26.ZEBOV, MVA-BN-Filo Ebola virus vaccine regimen, administered 56-days apart, from multiple African sites based on results from one analytic laboratory. METHODS Immunogenicity across three trials (EBL2002, EBL2004/PREVAC, EBL3001) conducted in East and West Africa is summarised. Vaccine-induced Ebola glycoprotein-binding antibody concentrations were analysed by Q2 Solutions laboratory at baseline, 21 days (EBL2002 and EBL3001) or 28 days (EBL2004) post-dose 2 (regimen completion), and 12 months post-dose 1 using the validated Filovirus Animal Nonclinical Group Ebola glycoprotein enzyme-linked immunosorbent assay (ELISA). Responders were defined as those with a >2.5-fold increase from baseline or the lower limit of quantification (LLOQ) if FINDINGS At 21 or 28 (21/28) days post-dose 2, the geometric mean concentration (GMC) range was 3810-7518 ELISA units (EU)/mL (percent responders: ≥98%) in adults, 9929-13532 EU/mL (≥98%) in adolescents aged 12-17 years, 10,212-17388 EU/mL (≥99%) in older children, and 22,568-25111 EU/mL (≥98%) in younger children. When stratified by country, GMCs at 21/28 days post-dose 2 were generally similar among adults and within paediatric cohorts (percent responders: 95%-100%). At month 12, GMC range was 259-437 EU/mL (percent responders: 49%-88%) in adults and 386-1139 EU/mL (70%-100%) in paediatric participants. INTERPRETATION Based on data from a single laboratory using a single validated assay, Ad26.ZEBOV, MVA-BN-Filo induced a strong humoral immune response, with ≥95% of participants across countries classified as responders at 21/28 days post-dose 2 (regimen completion), regardless of age. FUNDING Janssen Vaccines & Prevention BV; Innovative Medicines Initiative.
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Affiliation(s)
- Chelsea McLean
- Janssen Vaccines and Prevention BV, Leiden, the Netherlands.
| | | | - Mark Kieh
- Partnership for Research on Ebola Virus in Liberia (PREVAIL), Monrovia, Liberia
| | - Zacchaeus Anywaine
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Seydou Doumbia
- University Clinical Research Center, University of Sciences, Technique and Technology of Bamako, Bamako, Mali
| | - Sodiomon B Sirima
- Groupe de Recherche Action en Santé (GRAS), Ouagadougou, Burkina Faso
| | | | - Abdoul Habib Beavogui
- Centre National de Formation et de Recherche en Santé Rurale de Mafèrinyah, Mafèrinyah, Guinea
| | | | | | - Jenny Hendriks
- Janssen Vaccines and Prevention BV, Leiden, the Netherlands
| | | | - Serge Eholie
- Medical School, University Felix Houphouet Boigny, Abidjan, Cote d'Ivoire
| | - Hannah Kibuuka
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Stephen B Kennedy
- Partnership for Research on Ebola Virus in Liberia (PREVAIL), Monrovia, Liberia
| | - Omu Anzala
- Kenya AIDS Vaccine Initiative (KAVI), University of Nairobi, Nairobi, Kenya
| | | | - Eric D'Ortenzio
- ANRS Emerging Infectious Diseases, Institut national de la santé et de la recherche médicale (Inserm), Paris, France
| | - Bailah Leigh
- University of Sierra Leone, Freetown, Sierra Leone
| | - Samba Sow
- Centre pour le Développement des Vaccins, Bamako, Mali
| | - Rodolphe Thiébaut
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
| | | | - Deborah Watson-Jones
- London School of Hygiene and Tropical Medicine, London, UK; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | | | - Kerstin Luhn
- Janssen Vaccines and Prevention BV, Leiden, the Netherlands
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10
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Kareinen L, Airas N, Kotka ST, Masika MM, Aaltonen K, Anzala O, Ogola J, Webala PW, Vapalahti O, Sironen T, Forbes KM. No Substantial Histopathologic Changes in Mops condylurus Bats Naturally Infected with Bombali Virus, Kenya. Emerg Infect Dis 2023; 29:1029-1032. [PMID: 37081584 PMCID: PMC10124661 DOI: 10.3201/eid2905.221336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
We found similar mild perivascular inflammation in lungs of Bombali virus-positive and -negative Mops condylurus bats in Kenya, indicating the virus is well-tolerated. Our findings indicate M. condylurus bats may be a reservoir host for Bombali virus. Increased surveillance of these bats will be important to reduce potential virus spread.
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11
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Kerama C, Horne D, Ong’ang’o J, Anzala O. Rethinking the syndemic of tuberculosis and dysglycaemia: a Kenyan perspective on dysglycaemia as a neglected risk factor for tuberculosis. Bull Natl Res Cent 2023; 47:53. [PMID: 37073382 PMCID: PMC10098226 DOI: 10.1186/s42269-023-01029-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/09/2023] [Indexed: 05/03/2023]
Abstract
Background The END TB 2035 goal has a long way to go in low-income and low/middle-income countries (LICs and LMICs) from the perspective of a non-communicable disease (NCD) control interaction with tuberculosis (TB). The World Health Organization has identified diabetes as a determinant for, and an important yet neglected risk factor for tuberculosis. National guidelines have dictated testing time points, but these tend to be at an isolated time point rather than over a period of time. This article aims to give perspective on the syndemic interaction of tuberculosis and dysglycaemia and how the gaps in addressing the two may hamper progress towards END TB 2035. Main text Glycated haemoglobin (HbA1C) has a strong predictive association with the progression to subsequent diabetes. Therefore, screening using this measure could be a good way to screen at TB initiation therapy, in lieu of using the random blood sugar or fasting plasma glucose only. HbA1C has an observed gradient with mortality risk making it an informative predictor of outcomes. Determining the progression of dysglycaemia from diagnosis to end of treatment and shortly after may offer information on the best time point to screen and follow-up. Despite TB and Human Immunodeficiency Virus (HIV) disease care being free, hidden costs remain. These costs are additive if there is accompanying dysglycaemia. Regardless of receiving TB treatment, it is estimated that almost half of persons affected by pulmonary TB develop post-TB lung disease (PTLD) as an outcome and the contribution of dysglycaemia is not well described. Conclusions Establishing costs of treating TB with diabetes/prediabetes alone and in the additional context of HIV co-infection will inform policy makers on what it takes, financially, to treat these patients and subsidize dysglycaemia care. In Kenya, cardiovascular disease is only rivalled by infectious disease as a cause of mortality, and diabetes is a well-described risk factor for cardiac disease. In poor countries, communicable diseases are responsible for majority of the mortality burden, but societal shifts and rural-urban migration may have contributed to the observed increase of NCDs.
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Affiliation(s)
- Cheryl Kerama
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute (CRDR-KEMRI), Past Government Chemist, Opposite Diabetes Clinic, Nairobi, Kenya
- Division of Medical Microbiology and Immunology, Kenya AIDS Vaccine Initiative-Institute for Clinical Research (KAVI-ICR), Nairobi, Kenya
| | - David Horne
- Division of Pulmonary and Critical Care and Sleep Medicine, University of Washington, Seattle, WA USA
| | - Jane Ong’ang’o
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute (CRDR-KEMRI), Past Government Chemist, Opposite Diabetes Clinic, Nairobi, Kenya
| | - Omu Anzala
- Division of Medical Microbiology and Immunology, Kenya AIDS Vaccine Initiative-Institute for Clinical Research (KAVI-ICR), Nairobi, Kenya
- School of Medicine, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
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12
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Njaanake KH, Omondi J, Mwangi I, Jaoko WG, Anzala O. Urinary interleukins (IL)-6 and IL-10 in schoolchildren from an area with low prevalence of Schistosoma haematobium infections in coastal Kenya. PLOS Glob Public Health 2023; 3:e0001726. [PMID: 37018184 PMCID: PMC10075406 DOI: 10.1371/journal.pgph.0001726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/24/2023] [Indexed: 04/12/2023]
Abstract
Urinary cytokines are gaining traction as tools for assessing morbidity in infectious and non-infectious inflammatory diseases of the urogenital tract. However, little is known about the potential of these cytokines in assessing morbidity due to S. haematobium infections. Factors that may influence the urinary cytokine levels as morbidity markers also remain unknown. Therefore the objective of the present study was to assess how urinary interleukins (IL-) 6 and 10 are associated with gender, age, S. haematobium infections, haematuria and urinary tract pathology and; 2) to assess the effects of urine storage temperatures on the cytokines. This was a cross-sectional study in 2018 involving 245 children aged 5-12 years from a S. haematobium endemic area of coastal Kenya. The children were examined for S. haematobium infections, urinary tract morbidity, haematuria and urinary cytokines (IL-6 and IL-10). Urine specimens were also stored at -20°C, 4°C or 25°C for 14 days before being assayed for IL6 and IL-10 using ELISA. The overall prevalence of S. haematobium infections, urinary tract pathology, haematuria, urinary IL-6 and urinary IL-10 were 36.3%, 35.8%, 14.8%, 59.4% and 80.5%, respectively. There were significant associations between prevalence of urinary IL-6, but not IL-10, and age, S. haematobium infection and haematuria (p = 0.045, 0.011 and 0.005, respectively) but not sex or ultrasound-detectable pathology. There were significant differences in IL-6 and IL-10 levels between urine specimens stored at -20°C and those stored at 4°C (p<0.001) and, between those stored at 4°C and those stored at 25°C (p<0.001). Urinary IL-6, but not IL-10, was associated with children's age, S. haematobium infections and haematuria. However, both urinary IL-6 and IL-10 were not associated with urinary tract morbidity. Both IL-6 and IL-10 were sensitive to urine storage temperatures.
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Affiliation(s)
- Kariuki H. Njaanake
- Department of Medical Microbiology, College of Health Sciences, University of Nairobi, Nairobi, Kenya
- KAVI- Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Job Omondi
- Department of Medical Microbiology, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Irene Mwangi
- KAVI- Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Walter G. Jaoko
- Department of Medical Microbiology, College of Health Sciences, University of Nairobi, Nairobi, Kenya
- KAVI- Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Omu Anzala
- Department of Medical Microbiology, College of Health Sciences, University of Nairobi, Nairobi, Kenya
- KAVI- Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
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13
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Sabo MC, Balkus JE, Richardson BA, Srinivasan S, Kimani J, Anzala O, Schwebke J, Fiedler TL, Fredricks DN, McClelland RS. Next generation sequencing to examine associations between vaginal washing and vaginal microbiota: A cohort study. Int J STD AIDS 2023:9564624231160806. [PMID: 36945124 DOI: 10.1177/09564624231160806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND The association between vaginal washing and HIV risk may be mediated by vaginal washing-associated changes in vaginal microbiota. METHODS Data from a cohort of HIV-negative US and Kenyan women enrolled in the Preventing Vaginal Infections trial were analyzed. Vaginal fluid samples and vaginal washing data were collected every 2 months for 12 months. Bacterial relative abundances were measured by broad-range 16S rRNA gene polymerase chain reaction with next generation sequencing. Generalized estimating equations were used to evaluate the association between vaginal washing and i) the Shannon Diversity Index (SDI); and ii) mean change in percent bacterial relative abundances, with application of a 10% false discovery rate (FDR). RESULTS Participants (N = 111) contributed 93/630 (14.8%) vaginal washing visits. Mean SDI was 0.74 points higher (95% CI 0.35, 1.14; p < 0.001) at washing visits among US participants (N = 26). Vaginal washing was not associated with SDI in Kenyan participants (N = 85). There were no associations between vaginal washing and vaginal bacterial relative abundances after applying the FDR. CONCLUSIONS The discordant results in Kenyan versus US women suggests the link between vaginal washing and sub-optimal vaginal microbiota may be context specific. Vaginal microbial shifts may not fully explain the association between vaginal washing and HIV acquisition.
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Affiliation(s)
- Michelle C Sabo
- Department of Medicine, 7284University of Washington, Seattle, WA, United States
| | - Jennifer E Balkus
- Department of Global Health, 7284University of Washington, Seattle, WA, United States
- Department of Epidemiology, 7284University of Washington, Seattle, WA, United States
- Vaccine and Infectious Disease Division, 561181Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Barbra A Richardson
- Department of Global Health, 7284University of Washington, Seattle, WA, United States
- Vaccine and Infectious Disease Division, 561181Fred Hutchinson Cancer Research Center, Seattle, WA, United States
- Department of Biostatistics, 7284University of Washington, Seattle, WA, United States
| | - Sujatha Srinivasan
- Vaccine and Infectious Disease Division, 561181Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Joshua Kimani
- Institute for Tropical and Infectious Diseases, 107854University of Nairobi, Nairobi, Kenya
| | - Omu Anzala
- Department of Medical Microbiology, 107854University of Nairobi, Nairobi, Kenya
| | - Jane Schwebke
- Division of Infectious Diseases, 9967University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tina L Fiedler
- Vaccine and Infectious Disease Division, 561181Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - David N Fredricks
- Department of Medicine, 7284University of Washington, Seattle, WA, United States
- Vaccine and Infectious Disease Division, 561181Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - R Scott McClelland
- Department of Medicine, 7284University of Washington, Seattle, WA, United States
- Department of Global Health, 7284University of Washington, Seattle, WA, United States
- Department of Epidemiology, 7284University of Washington, Seattle, WA, United States
- Department of Medical Microbiology, 107854University of Nairobi, Nairobi, Kenya
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14
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Armstrong E, Hemmerling A, Joag V, Huibner S, Kulikova M, Crawford E, Castañeda GR, Anzala O, Obila O, Shahabi K, Ravel J, Coburn B, Cohen CR, Kaul R. Treatment Success Following Standard Antibiotic Treatment for Bacterial Vaginosis Is Not Associated With Pretreatment Genital Immune or Microbial Parameters. Open Forum Infect Dis 2023; 10:ofad007. [PMID: 36726539 PMCID: PMC9887266 DOI: 10.1093/ofid/ofad007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
Background Bacterial vaginosis (BV) is a proinflammatory genital condition associated with adverse reproductive health outcomes, including increased HIV incidence. However, BV recurrence rates are high after standard antibiotic treatment. While the composition of the vaginal microbiota before BV treatment may be linked to BV recurrence, it is unclear whether the preceding genital immune milieu is predictive of treatment success. Methods Here we assessed whether baseline vaginal soluble immune factors or the composition of the vaginal microbiota predicted treatment success 1 month after metronidazole treatment in 2 separate cohorts of women with BV, 1 in the United States and 1 in Kenya; samples within 48 hours of BV treatment were also available for the US cohort. Results Neither soluble immune factors nor the composition of the vaginal microbiota before BV treatment was associated with treatment response in either cohort. In the US cohort, although the absolute abundances of key vaginal bacterial taxa pretreatment were not associated with treatment response, participants with sustained BV clearance had a more pronounced reduction in the absolute abundance of Gardnerella vaginalis immediately after treatment. Conclusions Pretreatment immune and microbial parameters were not predictive of BV treatment success in these clinical cohorts.
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Affiliation(s)
- Eric Armstrong
- Correspondence: Eric Armstrong, BSc, 1 King’s College Circle, Room 6356 Toronto, ON, Canada M5S 1A8 (); or Rupert Kaul, MD, PhD, 1 King’s College Circle, Room 6356, Toronto, ON, Canada M5S 1A8 ()
| | - Anke Hemmerling
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Vineet Joag
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sanja Huibner
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maria Kulikova
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Emily Crawford
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, California, USA
| | | | - Omu Anzala
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Onyango Obila
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Kamnoosh Shahabi
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA,Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Bryan Coburn
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Craig R Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Rupert Kaul
- Correspondence: Eric Armstrong, BSc, 1 King’s College Circle, Room 6356 Toronto, ON, Canada M5S 1A8 (); or Rupert Kaul, MD, PhD, 1 King’s College Circle, Room 6356, Toronto, ON, Canada M5S 1A8 ()
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15
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Nasimiyu C, Ngere I, Dawa J, Amoth P, Oluga O, Ngunu C, Mirieri H, Gachohi J, Dayan M, Liku N, Njoroge R, Odinoh R, Owaka S, Khamadi SA, Konongoi SL, Galo S, Elamenya L, Mureithi M, Anzala O, Breiman R, Osoro E, Njenga MK. Near-Complete SARS-CoV-2 Seroprevalence among Rural and Urban Kenyans despite Significant Vaccine Hesitancy and Refusal. Vaccines (Basel) 2022; 11:68. [PMID: 36679913 PMCID: PMC9862465 DOI: 10.3390/vaccines11010068] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022] Open
Abstract
Considering the early inequity in global COVID-19 vaccine distribution, we compared the level of population immunity to SARS-CoV-2 with vaccine uptake and refusal between rural and urban Kenya two years after the pandemic onset. A population-based seroprevalence study was conducted in the city of Nairobi (n = 781) and a rural western county (n = 810) between January and February 2022. The overall SARS-CoV-2 seroprevalence was 90.2% (95% CI, 88.6−91.2%), including 96.7% (95% CI, 95.2−97.9%) among urban and 83.6% (95% CI, 80.6−86.0%) among rural populations. A comparison of immunity profiles showed that >50% of the rural population were strongly immunoreactive compared to <20% of the urban population, suggesting more recent infections or vaccinations in the rural population. More than 45% of the vaccine-eligible (≥18 years old) persons had not taken a single dose of the vaccine (hesitancy), including 47.6% and 46.9% of urban and rural participants, respectively. Vaccine refusal was reported in 19.6% of urban and 15.6% of rural participants, attributed to concern about vaccine safety (>75%), inadequate information (26%), and concern about vaccine effectiveness (9%). Less than 2% of vaccine refusers cited religious or cultural beliefs. These findings indicate that despite vaccine inequity, hesitancy, and refusal, herd immunity had been achieved in Kenya and likely other African countries by early 2022, with natural infections likely contributing to most of this immunity. However, vaccine campaigns should be sustained due to the need for repeat boosters associated with waning of SARS-CoV-2 immunity and emergence of immune-evading virus variants.
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Affiliation(s)
- Carolyne Nasimiyu
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
- KAVI-Institute for Clinical Research, University of Nairobi, Nairobi 00202, Kenya
| | - Isaac Ngere
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
| | - Jeanette Dawa
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
| | - Patrick Amoth
- Directorate of Public Health, Kenya Ministry of Health, Nairobi 00100, Kenya
| | - Ouma Oluga
- Directorate of Health, Nairobi Metropolitan Services, Nairobi 00100, Kenya
| | - Carol Ngunu
- Directorate of Health, Nairobi Metropolitan Services, Nairobi 00100, Kenya
| | - Harriet Mirieri
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
| | - John Gachohi
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi P.O. Box 62000-00200, Kenya
| | - Moshe Dayan
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
| | - Nzisa Liku
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
| | - Ruth Njoroge
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
| | - Raymond Odinoh
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
| | - Samuel Owaka
- Center for Virus Research, Kenya Medical Research Institute, Nairobi 00200, Kenya
| | - Samoel A. Khamadi
- Center for Virus Research, Kenya Medical Research Institute, Nairobi 00200, Kenya
| | - Samson L. Konongoi
- Center for Virus Research, Kenya Medical Research Institute, Nairobi 00200, Kenya
| | - Sudi Galo
- Department of Health Services, County Government of Kakamega, Kakamega 50100, Kenya
| | - Linet Elamenya
- Department of Health Services, County Government of Kakamega, Kakamega 50100, Kenya
| | - Marianne Mureithi
- KAVI-Institute for Clinical Research, University of Nairobi, Nairobi 00202, Kenya
| | - Omu Anzala
- KAVI-Institute for Clinical Research, University of Nairobi, Nairobi 00202, Kenya
| | - Robert Breiman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Eric Osoro
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
| | - M. Kariuki Njenga
- Global Health Program, Washington State University (WSU), Nairobi 00100, Kenya
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, WA 99163, USA
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16
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Abisi HK, Otieno LE, Irungu E, Onyambu FG, Chepchirchir A, Anzala O, Wamalwa DC, Nduati RW, McKinnon L, Kimani J, Mulinge MM. Net charge and position 22 of the V3 loop are associated with HIV-1 tropism in recently infected female sex workers in Nairobi, Kenya. Medicine (Baltimore) 2022; 101:e32024. [PMID: 36626483 PMCID: PMC9750520 DOI: 10.1097/md.0000000000032024] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Human immunodeficiency virus (HIV) infection affects around 37 million people worldwide, and in Kenya, key populations especially female sex workers (FSW), are thought to play a substantial role in the wider, mostly heterosexual HIV-1 transmission structure. Notably, HIV tropism has been found to correlate with HIV-1 transmission and disease progression in HIV-infected patients. In this study, recently infected FSWs from Nairobi, Kenya, were assessed for HIV tropism and the factors related to it. We used a cross-sectional study design to analyze 76 HIV-1 positive plasma samples obtained from FSWs enrolled in sex worker outreach program clinics in Nairobi between November 2020 and April 2021. The effects of clinical, demographic, and viral genetic characteristics were determined using multivariable logistic regression. HIV-1 subtype A1 accounted for 89.5% of all cases, with a prevalence of CXCR4-tropic viruses of 26.3%. WebPSSMR5X4 and Geno2Pheno [G2P:10-15% false positive rate] showed high concordance of 88%. Subjects infected with CXCR4-tropic viruses had statistically significant lower baseline CD4+T-cell counts than those infected with CCR5-tropic viruses (P = .044). Using multivariable logistic regression and adjusting for potential confounders, we found that net charge, the amino acid at position 22 of the V3 loop, and the geographic location of the subject were associated with tropism. A unit increase in V3 loop's net-charge increased the odds of a virus being CXCR4-tropic by 2.4 times (OR = 2.40, 95%CI = 1.35-5.00, P = .007). Second, amino acid threonine at position 22 of V3 loop increased the odds of a strain being X4 by 55.7 times compared to the alanine which occurred in CCR5-tropic strains (OR = 55.7, 95%CI = 4.04-84.1, P < .003). The Kawangware sex worker outreach program clinic was associated with CXCR4-tropic strains (P = .034), but there was there was no evidence of a distinct CXCR4-tropic transmission cluster. In conclusion, this study revealed a high concordance of WebPSSMR5X4 and Geno2Pheno in predicting HIV tropism. The most striking finding was that amino acid position 22 of the V3 loop is linked to tropism in HIV-1 subtype A1. Additional studies with a large dataset are warranted to confirm our findings.
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Affiliation(s)
- Hellen K Abisi
- Department of Biochemistry, University of Nairobi, Nairobi, Kenya
| | - Leon E Otieno
- Molecular Medicine and Infectious Diseases Laboratory, University of Nairobi, Nairobi, Kenya
| | - Erastus Irungu
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Frank G Onyambu
- School of Health Sciences, Meru University of Science and Technology, Meru, Kenya
| | | | - Omu Anzala
- Kenya AIDS Vaccine Initiative - Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Dalton C Wamalwa
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Ruth W Nduati
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Lyle McKinnon
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Manitoba, MB, Canada
| | - Joshua Kimani
- Partners for Health and Development in Africa (PHDA), Nairobi, Kenya
| | - Martin M Mulinge
- Department of Biochemistry, University of Nairobi, Nairobi, Kenya
- Kenya AIDS Vaccine Initiative - Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
- * Correspondence: Martin M Mulinge, University of Nairobi, Chiromo Campus - Nairobi 30197-00100, Kenya (e-mail: )
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17
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Kimani TN, Nyamai M, Owino L, Makori A, Ombajo LA, Maritim M, Anzala O, Thumbi SM. Infectious disease modelling for SARS-CoV-2 in Africa to guide policy: A systematic review. Epidemics 2022; 40:100610. [PMID: 35868211 PMCID: PMC9281458 DOI: 10.1016/j.epidem.2022.100610] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 06/13/2022] [Accepted: 07/12/2022] [Indexed: 01/21/2023] Open
Abstract
Applied epidemiological models have played a critical role in understanding the transmission and control of disease outbreaks. Their utility and accuracy in decision-making on appropriate responses during public health emergencies is however a factor of their calibration to local data, evidence informing model assumptions, speed of obtaining and communicating their results, ease of understanding and willingness by policymakers to use their insights. We conducted a systematic review of infectious disease models focused on SARS-CoV-2 in Africa to determine: a) spatial and temporal patterns of SARS-CoV-2 modelling in Africa, b) use of local data to calibrate the models and local expertise in modelling activities, and c) key modelling questions and policy insights. We searched PubMed, Embase, Web of Science and MedRxiv databases following the PRISMA guidelines to obtain all SARS-CoV-2 dynamic modelling papers for one or multiple African countries. We extracted data on countries studied, authors and their affiliations, modelling questions addressed, type of models used, use of local data to calibrate the models, and model insights for guiding policy decisions. A total of 74 papers met the inclusion criteria, with nearly two-thirds of these coming from 6% (3) of the African countries. Initial papers were published 2 months after the first cases were reported in Africa, with most papers published after the first wave. More than half of all papers (53, 78%) and (48, 65%) had a first and last author affiliated to an African institution respectively, and only 12% (9) used local data for model calibration. A total of 60% (46) of the papers modelled assessment of control interventions. The transmission rate parameter was found to drive the most uncertainty in the sensitivity analysis for majority of the models. The use of dynamic models to draw policy insights was crucial and therefore there is need to increase modelling capacity in the continent.
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Affiliation(s)
- Teresia Njoki Kimani
- KAVI-Institute of Clinical Research, University of Nairobi, Kenya; Center for Epidemiological Modelling and Analysis, University of Nairobi, Kenya; Paul G Allen School for Global Animal Health, Washington State University, United States; Ministry of Health Kenya, Kiambu County, Kenya.
| | - Mutono Nyamai
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Kenya; Paul G Allen School for Global Animal Health, Washington State University, United States; Institute of Tropical and Infectious Diseases, University of Nairobi, Kenya
| | - Lillian Owino
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Kenya; Institute of Tropical and Infectious Diseases, University of Nairobi, Kenya
| | - Anita Makori
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Kenya; Paul G Allen School for Global Animal Health, Washington State University, United States; Institute of Tropical and Infectious Diseases, University of Nairobi, Kenya
| | - Loice Achieng Ombajo
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Kenya; Department of Clinical Medicine and Therapeutics, University of Nairobi, Kenya
| | - MaryBeth Maritim
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Kenya
| | - Omu Anzala
- KAVI-Institute of Clinical Research, University of Nairobi, Kenya
| | - S M Thumbi
- Center for Epidemiological Modelling and Analysis, University of Nairobi, Kenya; Paul G Allen School for Global Animal Health, Washington State University, United States; Institute of Tropical and Infectious Diseases, University of Nairobi, Kenya; Department of Clinical Medicine and Therapeutics, University of Nairobi, Kenya; South African Center for Epidemiological Modelling and Analysis, South Africa; Institute of Immunology and Infection Research, University of Edinburgh, Scotland
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18
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Kuja JO, Kanoi BN, Balboa RF, Shiluli C, Maina M, Waweru H, Gathii K, Mungai M, Masika M, Anzala O, Mwau M, Clark TG, Waitumbi J, Gitaka J. Genomic surveillance of SARS-COV-2 reveals diverse circulating variant lineages in Nairobi and Kiambu Counties, Kenya. BMC Genomics 2022; 23:627. [PMID: 36050650 PMCID: PMC9434529 DOI: 10.1186/s12864-022-08853-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/19/2022] [Indexed: 11/10/2022] Open
Abstract
Genomic surveillance and identification of COVID-19 outbreaks are important in understanding the genetic diversity, phylogeny, and lineages of SARS-CoV-2. Genomic surveillance provides insights into circulating infections, and the robustness and design of vaccines and other infection control approaches. We sequenced 57 SARS-CoV-2 isolates from a Kenyan clinical population, of which 55 passed quality checks using the Ultrafast Sample placement on the Existing tRee (UShER) workflow. Phylo-genome-temporal analyses across two regions in Kenya (Nairobi and Kiambu County) revealed that B.1.1.7 (Alpha; n = 32, 56.1%) and B.1 (n = 9, 15.8%) were the predominant lineages, exhibiting low Ct values (5-31) suggesting high infectivity, and variant mutations across the two regions. Lineages B.1.617.2, B.1.1, A.23.1, A.2.5.1, B.1.596, A, and B.1.405 were also detected across sampling sites within target populations. The lineages and genetic isolates were traced back to China (A), Costa Rica (A.2.5.1), Europe (B.1, B.1.1, A.23.1), the USA (B.1.405, B.1.596), South Africa (B.1.617.2), and the United Kingdom (B.1.1.7), indicating multiple introduction events. This study represents one of the genomic SARS-CoV-2 epidemiology studies in the Nairobi metropolitan area, and describes the importance of continued surveillance for pandemic control.
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Affiliation(s)
- Josiah O Kuja
- Mount Kenya University, Thika, Kenya.
- University of Copenhagen, Copenhagen, Denmark.
| | | | | | | | | | | | - Kimita Gathii
- United States Army Medical Research Directorate, Kisumu, Kenya
| | - Mary Mungai
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Omu Anzala
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Matilu Mwau
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Taane G Clark
- London School of Hygiene & Tropical Medicine, London, UK
| | - John Waitumbi
- United States Army Medical Research Directorate, Kisumu, Kenya
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19
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Njuguna N, Mugo N, Anzala O, Mureithi M, Irungu E, Wamicwe J, Baeten JM, Heffron R. An empiric tool to identify Kenyans living with HIV who will have unsuppressed viremia 18 months following treatment initiation to guide differentiated care models. PLoS One 2022; 17:e0271520. [PMID: 35853007 PMCID: PMC9295938 DOI: 10.1371/journal.pone.0271520] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 07/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background
With the global push towards universal access to Antiretroviral Treatment (ART), patient numbers are increasing, further straining already under-resourced healthcare systems in sub-Saharan Africa. A simple scoring tool could be useful in optimizing differentiated service delivery by identifying individuals likely to have unsuppressed viral load.
Methods
Using existing data of patients accessing ART at public health facilities that were extracted from the Kenya Electronic Medical Record (KenyaEMR) and standard methods of developing a clinical prediction tool; we created and validated a risk scoring tool to identify persons likely to be virally unsuppressed at 18 months post-ART initiation. Data from the KenyaEMR were cleaned, merged and reviewed for completeness. We utilized multivariate modelling to determine key predictors of viral load suppression that could be measured in clinical settings.
Results
We assessed clinical reports of 3,968 patients on ART who had been on ART for at least 18 months and had at least one viral load result and were ≥ 18 years old. Of these, the majority (81%) were virally suppressed 18 months post-ART initiation. The final risk score included age, sex, body mass index at HIV diagnosis, number of years of formal education, disclosure status, and duration of time between HIV diagnosis and initiating ART. The maximum risk score was 78; a risk score of ≥22 was associated with unsuppressed viral load (>1000copies/mL). The area under the curve (AUC) for the probability of the risk score to correctly predict unsuppressed viral load was 0.55 (95% CI: 0.52 to 0.56). Internal and external validation showed similar predictive ability.
Conclusions
Routinely collected variables in a public HIV clinic medical record predicts, with modest accuracy, individuals likely to have unsuppressed HIV viremia 18 months after they initiate ART. The use and application of this tool could improve and complement efficiency in differentiated care models for patients on ART.
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Affiliation(s)
- Njambi Njuguna
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- FHI 360, Nairobi, Kenya
- * E-mail:
| | - Nelly Mugo
- Kenya Medical Research Institute, Nairobi, Kenya
- Partners in Health and Research Development, Thika, Kenya
- Departments of Epidemiology and Global Health, University of Washington, Seattle, Washington, United States of America
| | - Omu Anzala
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Marianne Mureithi
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Elizabeth Irungu
- Kenya Medical Research Institute, Nairobi, Kenya
- Partners in Health and Research Development, Thika, Kenya
- Departments of Epidemiology and Global Health, University of Washington, Seattle, Washington, United States of America
| | | | - Jared M. Baeten
- Departments of Epidemiology and Global Health, University of Washington, Seattle, Washington, United States of America
- Gilead Sciences, Foster City, CA, United States of America
| | - Renee Heffron
- Departments of Epidemiology and Global Health, University of Washington, Seattle, Washington, United States of America
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20
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Masika MM, Korhonen EM, Smura T, Uusitalo R, Ogola J, Mwaengo D, Jääskeläinen AJ, Alburkat H, Gwon YD, Evander M, Anzala O, Vapalahti O, Huhtamo E. Serological Evidence of Exposure to Onyong-Nyong and Chikungunya Viruses in Febrile Patients of Rural Taita-Taveta County and Urban Kibera Informal Settlement in Nairobi, Kenya. Viruses 2022; 14:v14061286. [PMID: 35746757 PMCID: PMC9230508 DOI: 10.3390/v14061286] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/28/2022] [Accepted: 06/08/2022] [Indexed: 02/01/2023] Open
Abstract
Several alphaviruses, such as chikungunya (CHIKV) and Onyong-nyong (ONNV), are endemic in Kenya and often cause outbreaks in different parts of the country. We assessed the seroprevalence of alphaviruses in patients with acute febrile illness in two geographically distant areas in Kenya with no previous record of alphavirus outbreaks. Blood samples were collected from febrile patients in health facilities located in the rural Taita-Taveta County in 2016 and urban Kibera informal settlement in Nairobi in 2017 and tested for CHIKV IgG and IgM antibodies using an in-house immunofluorescence assay (IFA) and a commercial ELISA test, respectively. A subset of CHIKV IgG or IgM antibody-positive samples were further analyzed using plaque reduction neutralization tests (PRNT) for CHIKV, ONNV, and Sindbis virus. Out of 537 patients, 4 (0.7%) and 28 (5.2%) had alphavirus IgM and IgG antibodies, respectively, confirmed on PRNT. We show evidence of previous and current exposure to alphaviruses based on serological testing in areas with no recorded history of outbreaks.
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Affiliation(s)
- Moses Muia Masika
- KAVI Institute of Clinical Research, University of Nairobi, POB 19676, Nairobi 00202, Kenya; (J.O.); (O.A.)
- Department of Medical Microbiology, University of Nairobi, POB 19676, Nairobi 00202, Kenya;
- Correspondence: ; Tel.: +254-721770306
| | - Essi M. Korhonen
- Department of Virology, University of Helsinki, 00014 Helsinki, Finland; (E.M.K.); (T.S.); (R.U.); (A.J.J.); (H.A.); (O.V.); (E.H.)
- Department of Veterinary Biosciences, University of Helsinki, 00014 Helsinki, Finland
| | - Teemu Smura
- Department of Virology, University of Helsinki, 00014 Helsinki, Finland; (E.M.K.); (T.S.); (R.U.); (A.J.J.); (H.A.); (O.V.); (E.H.)
- HUS Diagnostic Center, HUSLAB, Virology and Immunology, Helsinki University Hospital, 00029 Helsinki, Finland
| | - Ruut Uusitalo
- Department of Virology, University of Helsinki, 00014 Helsinki, Finland; (E.M.K.); (T.S.); (R.U.); (A.J.J.); (H.A.); (O.V.); (E.H.)
- Department of Veterinary Biosciences, University of Helsinki, 00014 Helsinki, Finland
- Department of Geosciences and Geography, University of Helsinki, 00014 Helsinki, Finland
| | - Joseph Ogola
- KAVI Institute of Clinical Research, University of Nairobi, POB 19676, Nairobi 00202, Kenya; (J.O.); (O.A.)
- Department of Medical Microbiology, University of Nairobi, POB 19676, Nairobi 00202, Kenya;
| | - Dufton Mwaengo
- Department of Medical Microbiology, University of Nairobi, POB 19676, Nairobi 00202, Kenya;
| | - Anne J. Jääskeläinen
- Department of Virology, University of Helsinki, 00014 Helsinki, Finland; (E.M.K.); (T.S.); (R.U.); (A.J.J.); (H.A.); (O.V.); (E.H.)
- HUS Diagnostic Center, HUSLAB, Virology and Immunology, Helsinki University Hospital, 00029 Helsinki, Finland
| | - Hussein Alburkat
- Department of Virology, University of Helsinki, 00014 Helsinki, Finland; (E.M.K.); (T.S.); (R.U.); (A.J.J.); (H.A.); (O.V.); (E.H.)
| | - Yong-Dae Gwon
- Department of Clinical Microbiology, Umeå University, 90185 SE Umeå, Sweden; (Y.-D.G.); (M.E.)
| | - Magnus Evander
- Department of Clinical Microbiology, Umeå University, 90185 SE Umeå, Sweden; (Y.-D.G.); (M.E.)
| | - Omu Anzala
- KAVI Institute of Clinical Research, University of Nairobi, POB 19676, Nairobi 00202, Kenya; (J.O.); (O.A.)
- Department of Medical Microbiology, University of Nairobi, POB 19676, Nairobi 00202, Kenya;
| | - Olli Vapalahti
- Department of Virology, University of Helsinki, 00014 Helsinki, Finland; (E.M.K.); (T.S.); (R.U.); (A.J.J.); (H.A.); (O.V.); (E.H.)
- Department of Veterinary Biosciences, University of Helsinki, 00014 Helsinki, Finland
- HUS Diagnostic Center, HUSLAB, Virology and Immunology, Helsinki University Hospital, 00029 Helsinki, Finland
| | - Eili Huhtamo
- Department of Virology, University of Helsinki, 00014 Helsinki, Finland; (E.M.K.); (T.S.); (R.U.); (A.J.J.); (H.A.); (O.V.); (E.H.)
- Department of Veterinary Biosciences, University of Helsinki, 00014 Helsinki, Finland
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21
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Wagstaffe HR, Anzala O, Kibuuka H, Anywaine Z, Sirima SB, Thiébaut R, Richert L, Levy Y, Lacabaratz C, Bockstal V, Luhn K, Douoguih M, Goodier MR. NK Cell Subset Redistribution and Antibody Dependent Activation after Ebola Vaccination in Africans. Vaccines (Basel) 2022; 10:vaccines10060884. [PMID: 35746491 PMCID: PMC9230153 DOI: 10.3390/vaccines10060884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/21/2022] Open
Abstract
Natural killer cells play an important role in the control of viral infections both by regulating acquired immune responses and as potent innate or antibody-mediated cytotoxic effector cells. NK cells have been implicated in control of Ebola virus infections and our previous studies in European trial participants have demonstrated durable activation, proliferation and antibody-dependent NK cell activation after heterologous two-dose Ebola vaccination with adenovirus type 26.ZEBOV followed by modified vaccinia Ankara-BN-Filo. Regional variation in immunity and environmental exposure to pathogens, in particular human cytomegalovirus, have profound impacts on NK cell functional capacity. We therefore assessed the NK cell phenotype and function in African trial participants with universal exposure to HCMV. We demonstrate a significant redistribution of NK cell subsets after vaccine dose two, involving the enrichment of less differentiated CD56dimCD57− and CD56dimFcεR1γ+ (canonical) cells and the increased proliferation of these subsets. Sera taken after vaccine dose two support robust antibody-dependent NK cell activation in a standard NK cell readout; these responses correlate strongly with the concentration of anti-Ebola glycoprotein specific antibodies. These sera also promote comparable IFN-γ production in autologous NK cells taken at baseline and post-vaccine dose two. However, degranulation responses of post-vaccination NK cells were reduced compared to baseline NK cells and these effects could not be directly attributed to alterations in NK cell phenotype after vaccination. These studies demonstrate consistent changes in NK cell phenotypic composition and robust antibody-dependent NK cell function and reveal novel characteristics of these responses after heterologous two dose Ebola vaccination in African individuals.
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Affiliation(s)
- Helen R. Wagstaffe
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
- Department of Infectious Disease, Imperial College London, London W2 1PG, UK
| | - Omu Anzala
- KAVI—Institute of Clinical Research University of Nairobi, Nairobi 19676, Kenya;
| | - Hannah Kibuuka
- Makerere University—Walter Reed Project, Kampala 16524, Uganda;
| | - Zacchaeus Anywaine
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda;
| | - Sodiomon B. Sirima
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), Unité de Recherche Clinique de Banfora, 1487 Avenue Kumda Yonré, Ouagadougou 01 BP 2208, Burkina Faso;
| | - Rodolphe Thiébaut
- Bordeaux Population Health Research Center, University Bordeaux, Inserm, UMR 1219, 33000 Bordeaux, France; (R.T.); (L.R.)
- CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, F-33000 Bordeaux, France
- Inria SISTM Team, F-33405 Talence, France
| | - Laura Richert
- Bordeaux Population Health Research Center, University Bordeaux, Inserm, UMR 1219, 33000 Bordeaux, France; (R.T.); (L.R.)
- CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, F-33000 Bordeaux, France
- Inria SISTM Team, F-33405 Talence, France
| | - Yves Levy
- Inserm U955, Vaccine Research Institute, Université Paris-Est Créteil, Hôpital Henri Mondor, 94010 Creteil, France; (Y.L.); (C.L.)
| | - Christine Lacabaratz
- Inserm U955, Vaccine Research Institute, Université Paris-Est Créteil, Hôpital Henri Mondor, 94010 Creteil, France; (Y.L.); (C.L.)
| | - Viki Bockstal
- Janssen Vaccines and Prevention, 2333 CP Leiden, The Netherlands; (V.B.); (K.L.); (M.D.)
| | - Kerstin Luhn
- Janssen Vaccines and Prevention, 2333 CP Leiden, The Netherlands; (V.B.); (K.L.); (M.D.)
| | - Macaya Douoguih
- Janssen Vaccines and Prevention, 2333 CP Leiden, The Netherlands; (V.B.); (K.L.); (M.D.)
| | - Martin R. Goodier
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
- Flow Cytometry and Immunology Platform, MRC Unit the Gambia at London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
- Correspondence:
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22
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Ombajo LA, Mutono N, Sudi P, Mutua M, Sood M, Loo AM, Juma P, Odhiambo J, Shah R, Wangai F, Maritim M, Anzala O, Amoth P, Kamuri E, Munyu W, Thumbi SM. Epidemiological and clinical characteristics of patients hospitalised with COVID-19 in Kenya: a multicentre cohort study. BMJ Open 2022; 12:e049949. [PMID: 35589368 PMCID: PMC9121111 DOI: 10.1136/bmjopen-2021-049949] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To assess outcomes of patients admitted to hospital with COVID-19 and to determine the predictors of mortality. SETTING This study was conducted in six facilities, which included both government and privately run secondary and tertiary level facilities in the central and coastal regions of Kenya. PARTICIPANTS We enrolled 787 reverse transcriptase-PCR-confirmed SARS-CoV2-infected persons. Patients whose records could not be accessed were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was COVID-19-related death. We used Cox proportional hazards regressions to determine factors related to in-hospital mortality. RESULTS Data from patients with 787 COVID-19 were available. The median age was 43 years (IQR 30-53), with 505 (64%) being men. At admission, 455 (58%) were symptomatic with an additional 63 (9%) developing clinical symptoms during hospitalisation. The most common symptoms were cough (337, 43%), loss of taste or smell (279, 35%) and fever (126, 16%). Comorbidities were reported in 340 (43%), with cardiovascular disease, diabetes and HIV documented in 130 (17%), 116 (15%), 53 (7%), respectively. 90 (11%) were admitted to the Intensive Care Unit (ICU) for a mean of 11 days, 52 (7%) were ventilated with a mean of 10 days, 107 (14%) died. The risk of death increased with age (HR 1.57 (95% CI 1.13 to 2.19)) for persons >60 years compared with those <60 years old; having comorbidities (HR 2.34 (1.68 to 3.25)) and among men (HR 1.76 (1.27 to 2.44)) compared with women. Elevated white cell count and aspartate aminotransferase were associated with higher risk of death. CONCLUSIONS The risk of death from COVID-19 is high among older patients, those with comorbidities and among men. Clinical parameters including patient clinical signs, haematology and liver function tests were associated with risk of death and may guide stratification of high-risk patients.
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Affiliation(s)
- Loice Achieng Ombajo
- Clinical Medicine and Therapeutics, University of Nairobi College of Health Sciences, Nairobi, Kenya
- Center for Epidemiological Modelling and Analysis, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Nyamai Mutono
- Paul G Allen School for Global Health, Washington State University, Pullman, Washington, USA
| | - Paul Sudi
- Infectious Disease Unit, Kenyatta National Hospital, Nairobi, Kenya
| | - Mbuvi Mutua
- Infectious Disease Unit, Kenyatta National Hospital, Nairobi, Kenya
| | - Mohammed Sood
- Department of Medicine, Coast General Teaching and Referral Hospital, Mombasa, Kenya
| | - Alliyy Muhammad Loo
- Department of Medicine, Coast General Teaching and Referral Hospital, Mombasa, Kenya
| | - Phoebe Juma
- Department of Medicine, Nairobi Hospital, Nairobi, Kenya
| | | | - Reena Shah
- Department of Medicine, The Aga Khan University Hospital Nairobi, Nairobi, Kenya
| | - Frederick Wangai
- Clinical Medicine and Therapeutics, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Marybeth Maritim
- Clinical Medicine and Therapeutics, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Omu Anzala
- Kenya AIDS Vaccine Initiative, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - Patrick Amoth
- Office of The Director General, Kenya Ministry of Health, Nairobi, Kenya
| | - Evans Kamuri
- Infectious Disease Unit, Kenyatta National Hospital, Nairobi, Kenya
| | - Waweru Munyu
- Department of Medicine, The Aga Khan University Hospital Nairobi, Nairobi, Kenya
| | - S M Thumbi
- Center for Epidemiological Modelling and Analysis, University of Nairobi College of Health Sciences, Nairobi, Kenya
- Paul G Allen School for Global Health, Washington State University, Pullman, Washington, USA
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23
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Sankaradoss A, Jagtap S, Nazir J, Moula SE, Modak A, Fialho J, Iyer M, Shastri JS, Dias M, Gadepalli R, Aggarwal A, Vedpathak M, Agrawal S, Pandit A, Nisheetha A, Kumar A, Bordoloi M, Shafi M, Shelar B, Balachandra SS, Damodar T, Masika MM, Mwaura P, Anzala O, Muthumani K, Sowdhamini R, Medigeshi GR, Roy R, Pattabiraman C, Krishna S, Sreekumar E. Immune profile and responses of a novel dengue DNA vaccine encoding an EDIII-NS1 consensus design based on Indo-African sequences. Mol Ther 2022; 30:2058-2077. [PMID: 34999210 PMCID: PMC8736276 DOI: 10.1016/j.ymthe.2022.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/24/2021] [Accepted: 01/05/2022] [Indexed: 12/30/2022] Open
Abstract
The ongoing COVID-19 pandemic highlights the need to tackle viral variants, expand the number of antigens, and assess diverse delivery systems for vaccines against emerging viruses. In the present study, a DNA vaccine candidate was generated by combining in tandem envelope protein domain III (EDIII) of dengue virus serotypes 1-4 and a dengue virus (DENV)-2 non-structural protein 1 (NS1) protein-coding region. Each domain was designed as a serotype-specific consensus coding sequence derived from different genotypes based on the whole genome sequencing of clinical isolates in India and complemented with data from Africa. This sequence was further optimized for protein expression. In silico structural analysis of the EDIII consensus sequence revealed that epitopes are structurally conserved and immunogenic. The vaccination of mice with this construct induced pan-serotype neutralizing antibodies and antigen-specific T cell responses. Assaying intracellular interferon (IFN)-γ staining, immunoglobulin IgG2(a/c)/IgG1 ratios, and immune gene profiling suggests a strong Th1-dominant immune response. Finally, the passive transfer of immune sera protected AG129 mice challenged with a virulent, non-mouse-adapted DENV-2 strain. Our findings collectively suggest an alternative strategy for dengue vaccine design by offering a novel vaccine candidate with a possible broad-spectrum protection and a successful clinical translation either as a stand alone or in a mix and match strategy.
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Affiliation(s)
- Arun Sankaradoss
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India,Corresponding author: National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India.
| | - Suraj Jagtap
- Department of Chemical Engineering, Indian Institute of Science, Bangalore 560012, India
| | - Junaid Nazir
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India
| | - Shefta E. Moula
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India
| | - Ayan Modak
- Molecular Virology Laboratory, Rajiv Gandhi Centre for Biotechnology (RGCB), Thiruvananthapuram, Kerala 695014, India
| | - Joshuah Fialho
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India
| | - Meenakshi Iyer
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India
| | - Jayanthi S. Shastri
- Department of Microbiology, T.N.Medical College & B.y.L.Nair Hospital, Mumbai 400008, India
| | - Mary Dias
- Division of Infectious Disease, St. John's Medical College and Hospital, Bangalore 560034, India
| | - Ravisekhar Gadepalli
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Alisha Aggarwal
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur 342005, India
| | - Manoj Vedpathak
- Department of Microbiology, T.N.Medical College & B.y.L.Nair Hospital, Mumbai 400008, India
| | - Sachee Agrawal
- Department of Microbiology, T.N.Medical College & B.y.L.Nair Hospital, Mumbai 400008, India
| | - Awadhesh Pandit
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India
| | - Amul Nisheetha
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India
| | - Anuj Kumar
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India
| | - Mahasweta Bordoloi
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India
| | - Mohamed Shafi
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India
| | - Bhagyashree Shelar
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India
| | - Swathi S. Balachandra
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India
| | - Tina Damodar
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India
| | - Moses Muia Masika
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi 19676-00202, Kenya
| | - Patrick Mwaura
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi 19676-00202, Kenya
| | - Omu Anzala
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi 19676-00202, Kenya
| | - Kar Muthumani
- Vaccine and Immunotherapy Center, Wistar Institute, Philadelphia, PA 19104, USA
| | - Ramanathan Sowdhamini
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India
| | | | - Rahul Roy
- Department of Chemical Engineering, Indian Institute of Science, Bangalore, India,Molecular Biophysics Unit, Indian Institute of Science, Bangalore, India,Center for Biosystems Science and Engineering, Indian Institute of Science, Bangalore 560012, India
| | - Chitra Pattabiraman
- Department of Neurovirology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Sudhir Krishna
- National Centre for Biological Sciences, Tata Institute of Fundamental Research, Bangalore 560065, India,School of Interdisciplinary Life Sciences, Indian Institute of Technology Goa, Ponda 404401, India
| | - Easwaran Sreekumar
- Molecular Virology Laboratory, Rajiv Gandhi Centre for Biotechnology (RGCB), Thiruvananthapuram, Kerala 695014, India,Corresponding author: Molecular Virology Laboratory, Rajiv Gandhi Centre for Biotechnology (RGCB), Thiruvananthapuram, Kerala 695014, India
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24
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Carter KA, Balkus JE, Anzala O, Kimani J, Hoffman NG, Fiedler TL, Mochache V, Fredricks DN, McClelland RS, Srinivasan S. Associations Between Vaginal Bacteria and Bacterial Vaginosis Signs and Symptoms: A Comparative Study of Kenyan and American Women. Front Cell Infect Microbiol 2022; 12:801770. [PMID: 35310847 PMCID: PMC8931342 DOI: 10.3389/fcimb.2022.801770] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/14/2022] [Indexed: 12/30/2022] Open
Abstract
Background Bacterial colonization and associations with bacterial vaginosis (BV) signs and symptoms (Amsel criteria) may vary between populations. We assessed relationships between vaginal bacteria and Amsel criteria among two populations. Methods Kenyan participants from the placebo arm of the Preventing Vaginal Infections (PVI) trial and participants from a Seattle-based cross-sectional BV study were included. Amsel criteria were recorded at study visits, and the vaginal microbiota was characterized using 16S rRNA gene sequencing. Logistic regression models, accounting for repeat visits as appropriate, were fit to evaluate associations between bacterial relative abundance and each Amsel criterion. Results Among 84 PVI participants (496 observations) and 220 Seattle participants, the prevalence of amine odor was 25% and 40%, clue cells 16% and 37%, vaginal discharge 10% and 52%, elevated vaginal pH 69% and 67%, and BV 13% and 44%, respectively. BV-associated bacterium 1 (BVAB1) was positively associated with all Amsel criteria in both populations. Eggerthella type 1, Fannyhessea (Atopobium) vaginae, Gardnerella spp., Sneathia amnii, and Sneathia sanguinegens were positively associated with all Amsel criteria in the Seattle study, and all but discharge in the PVI trial. Conclusions Core vaginal bacteria are consistently associated with BV signs and symptoms across two distinct populations of women.
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Affiliation(s)
- Kayla A. Carter
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- *Correspondence: Kayla A. Carter,
| | - Jennifer E. Balkus
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Omu Anzala
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Joshua Kimani
- Institute for Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Noah G. Hoffman
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
| | - Tina L. Fiedler
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Vernon Mochache
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - David N. Fredricks
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
| | - Raymond Scott McClelland
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Sujatha Srinivasan
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
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25
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Nduva GM, Otieno F, Kimani J, Wahome E, McKinnon LR, Cholette F, Majiwa M, Masika M, Mutua G, Anzala O, Graham SM, Gelmon L, Price MA, Smith AD, Bailey RC, Baele G, Lemey P, Hassan AS, Sanders EJ, Esbjörnsson J. Quantifying rates of HIV-1 flow between risk groups and geographic locations in Kenya: A country-wide phylogenetic study. Virus Evol 2022; 8:veac016. [PMID: 35356640 PMCID: PMC8962731 DOI: 10.1093/ve/veac016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 12/14/2022] Open
Abstract
In Kenya, HIV-1 key populations including men having sex with men (MSM), people who inject drugs (PWID) and female sex workers (FSW) are thought to significantly contribute to HIV-1 transmission in the wider, mostly heterosexual (HET) HIV-1 transmission network. However, clear data on HIV-1 transmission dynamics within and between these groups are limited. We aimed to empirically quantify rates of HIV-1 flow between key populations and the HET population, as well as between different geographic regions to determine HIV-1 'hotspots' and their contribution to HIV-1 transmission in Kenya. We used maximum-likelihood phylogenetic and Bayesian inference to analyse 4058 HIV-1 pol sequences (representing 0.3 per cent of the epidemic in Kenya) sampled 1986-2019 from individuals of different risk groups and regions in Kenya. We found 89 per cent within-risk group transmission and 11 per cent mixing between risk groups, cyclic HIV-1 exchange between adjoining geographic provinces and strong evidence of HIV-1 dissemination from (i) West-to-East (i.e. higher-to-lower HIV-1 prevalence regions), and (ii) heterosexual-to-key populations. Low HIV-1 prevalence regions and key populations are sinks rather than major sources of HIV-1 transmission in Kenya. Targeting key populations in Kenya needs to occur concurrently with strengthening interventions in the general epidemic.
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Affiliation(s)
- George M Nduva
- Department of Translational Medicine, Lund University, Faculty of Medicine, Lund University, Box 117 SE-221 00 Lund, Sweden
- Kenya Medical Research Institute-Wellcome Trust Research Programme, KEMRI-Center For Geographic Medicine Research, P.O. Box 230-80108, Kilifi, Kenya
| | - Frederick Otieno
- Nyanza Reproductive Health Society, United Mall, P.O. Box 1764, Kisumu, Kenya
| | - Joshua Kimani
- Department of Medical Microbiology, University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Max Rady College of Medicine, Room 543-745 Bannatyne Avenue, University of Manitoba (Bannatyne campus), Winnipeg MB R3E 0J9, Canada
| | - Elizabeth Wahome
- Kenya Medical Research Institute-Wellcome Trust Research Programme, KEMRI-Center For Geographic Medicine Research, P.O. Box 230-80108, Kilifi, Kenya
| | - Lyle R McKinnon
- Department of Medical Microbiology, University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Max Rady College of Medicine, Room 543-745 Bannatyne Avenue, University of Manitoba (Bannatyne campus), Winnipeg MB R3E 0J9, Canada
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella 4013, South Africa
| | - Francois Cholette
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Max Rady College of Medicine, Room 543-745 Bannatyne Avenue, University of Manitoba (Bannatyne campus), Winnipeg MB R3E 0J9, Canada
- National Microbiology Laboratory at the JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, 745 Logan Avenue, Winnipeg, Canada
| | - Maxwell Majiwa
- Kenya Medical Research Institute/Center for Global Health Research, KEMRI-CGHR, P.O. Box 20778-00202, Kisumu, Kenya
| | - Moses Masika
- Faculty of Health Sciences 3RD Floor Wing B, KAVI Institute of Clinical Research, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya
| | - Gaudensia Mutua
- Faculty of Health Sciences 3RD Floor Wing B, KAVI Institute of Clinical Research, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya
| | - Omu Anzala
- Faculty of Health Sciences 3RD Floor Wing B, KAVI Institute of Clinical Research, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya
| | - Susan M Graham
- Kenya Medical Research Institute-Wellcome Trust Research Programme, KEMRI-Center For Geographic Medicine Research, P.O. Box 230-80108, Kilifi, Kenya
- Department of Epidemiology, University of Washington, Office of the Chair, UW Box # 351619, Seattle, DC, USA
| | - Larry Gelmon
- Department of Medical Microbiology, University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Max Rady College of Medicine, Room 543-745 Bannatyne Avenue, University of Manitoba (Bannatyne campus), Winnipeg MB R3E 0J9, Canada
| | - Matt A Price
- IAVI Global Headquarters, 125 Broad Street, 9th Floor, New York, NY 10004, USA
- Department of Epidemiology and Biostatistics, University of California, Mission Hall: Global Health & Clinical Sciences Building, 550 16th Street, 2nd Floor, San Francisco, CA 94158-2549, USA
| | - Adrian D Smith
- Nuffield Department of Medicine, The University of Oxford, Old Road Campus, Headington, Oxford OX3 7BN, UK
| | - Robert C Bailey
- Nyanza Reproductive Health Society, United Mall, P.O. Box 1764, Kisumu, Kenya
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, 1603 W Taylor St, Chicago, IL 60612, USA
| | - Guy Baele
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Clinical and Evolutionary and Computational Virology, Rega-Herestraat 49-box 1040, Leuven 3000, Belgium
| | - Philippe Lemey
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Clinical and Evolutionary and Computational Virology, Rega-Herestraat 49-box 1040, Leuven 3000, Belgium
| | - Amin S Hassan
- Department of Translational Medicine, Lund University, Faculty of Medicine, Lund University, Box 117 SE-221 00 Lund, Sweden
- Kenya Medical Research Institute-Wellcome Trust Research Programme, KEMRI-Center For Geographic Medicine Research, P.O. Box 230-80108, Kilifi, Kenya
| | - Eduard J Sanders
- Kenya Medical Research Institute-Wellcome Trust Research Programme, KEMRI-Center For Geographic Medicine Research, P.O. Box 230-80108, Kilifi, Kenya
- Nuffield Department of Medicine, The University of Oxford, Old Road Campus, Headington, Oxford OX3 7BN, UK
| | - Joakim Esbjörnsson
- Department of Translational Medicine, Lund University, Faculty of Medicine, Lund University, Box 117 SE-221 00 Lund, Sweden
- Nuffield Department of Medicine, The University of Oxford, Old Road Campus, Headington, Oxford OX3 7BN, UK
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26
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Mutai WC, Mureithi M, Anzala O, Kullin B, Ofwete R, Kyany' A C, Odoyo E, Musila L, Revathi G. Assessment of independent comorbidities and comorbidity measures in predicting healthcare facility-onset Clostridioides difficile infection in Kenya. PLOS Glob Public Health 2022; 2:e0000090. [PMID: 36962261 PMCID: PMC10022263 DOI: 10.1371/journal.pgph.0000090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/04/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Clostridioides difficile is primarily associated with hospital-acquired diarrhoea. The disease burden is aggravated in patients with comorbidities due to increased likelihood of polypharmacy, extended hospital stays and compromised immunity. The study aimed to investigate comorbidity predictors of healthcare facility-onset C. difficile infection (HO-CDI) in hospitalized patients. METHODOLOGY We performed a cross sectional study of 333 patients who developed diarrhoea during hospitalization. The patients were tested for CDI. Data on demographics, admission information, medication exposure and comorbidities were collected. The comorbidities were also categorised according to Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI). Comorbidity predictors of HO-CDI were identified using multiple logistic regression analysis. RESULTS Overall, 230/333 (69%) patients had comorbidities, with the highest proportion being in patients aged over 60 years. Among the patients diagnosed with HO-CDI, 63/71(88.7%) reported comorbidities. Pairwise comparison between HO-CDI patients and comparison group revealed significant differences in hypertension, anemia, tuberculosis, diabetes, chronic kidney disease and chronic obstructive pulmonary disease. In the multiple logistic regression model significant predictors were chronic obstructive pulmonary disease (odds ratio [OR], 9.51; 95% confidence interval [CI], 1.8-50.1), diabetes (OR, 3.56; 95% CI, 1.11-11.38), chronic kidney disease (OR, 3.88; 95% CI, 1.57-9.62), anemia (OR, 3.67; 95% CI, 1.61-8.34) and hypertension (OR, 2.47; 95% CI, 1.-6.07). Among the comorbidity scores, CCI score of 2 (OR 6.67; 95% CI, 2.07-21.48), and ECI scores of 1 (OR, 4.07; 95% CI, 1.72-9.65), 2 (OR 2.86; 95% CI, 1.03-7.89), and ≥ 3 (OR, 4.87; 95% CI, 1.40-16.92) were significantly associated with higher odds of developing HO-CDI. CONCLUSION Chronic obstructive pulmonary disease, chronic kidney disease, anemia, diabetes, and hypertension were associated with an increased risk of developing HO-CDI. Besides, ECI proved to be a better predictor for HO-CDI. Therefore, it is imperative that hospitals should capitalize on targeted preventive approaches in patients with these underlying conditions to reduce the risk of developing HO-CDI and limit potential exposure to other patients.
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Affiliation(s)
- Winnie C Mutai
- Department of Medical Microbiology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Marianne Mureithi
- Department of Medical Microbiology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Omu Anzala
- Department of Medical Microbiology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Brian Kullin
- Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Robert Ofwete
- Department of Medical Microbiology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Cecilia Kyany' A
- US Army Medical Research Directorate-Africa, Kenya, Nairobi, Kenya
| | - Erick Odoyo
- US Army Medical Research Directorate-Africa, Kenya, Nairobi, Kenya
| | - Lillian Musila
- US Army Medical Research Directorate-Africa, Kenya, Nairobi, Kenya
| | - Gunturu Revathi
- Department of Pathology, Division of Medical Microbiology, Aga Khan University Hospital, Nairobi, Kenya
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27
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Odera S, Mureithi M, Aballa A, Onyango N, Kazungu S, Ogolla S, Kaiyare G, Anzala O, Oyugi J. Association between human leukocyte antigen class II (HLA-DRB and -DQB)alleles and outcome of exposure to Mycobacterium tuberculosis: a cross-sectional study in Nairobi, Kenya. Pan Afr Med J 2022; 41:149. [PMID: 35519172 PMCID: PMC9046861 DOI: 10.11604/pamj.2022.41.149.30056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 02/02/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Susan Odera
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya
- Corresponding author: Susan Odera, Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya.
| | - Marianne Mureithi
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya
- Kenya Aids Vaccine Initiative (KAVI) Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Andrew Aballa
- Department of Medical Laboratory Sciences, School of Medicine, Kenyatta University, Nairobi, Kenya
| | - Noel Onyango
- Department of Clinical Medicine and Therapeutics, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Samwel Kazungu
- Kenya Aids Vaccine Initiative (KAVI) Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Simon Ogolla
- Kenya Aids Vaccine Initiative (KAVI) Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | | | - Omu Anzala
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya
- Kenya Aids Vaccine Initiative (KAVI) Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Julius Oyugi
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
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Anywaine Z, Barry H, Anzala O, Mutua G, Sirima SB, Eholie S, Kibuuka H, Bétard C, Richert L, Lacabaratz C, McElrath MJ, De Rosa SC, Cohen KW, Shukarev G, Katwere M, Robinson C, Gaddah A, Heerwegh D, Bockstal V, Luhn K, Leyssen M, Thiébaut R, Douoguih M. Safety and immunogenicity of 2-dose heterologous Ad26.ZEBOV, MVA-BN-Filo Ebola vaccination in children and adolescents in Africa: A randomised, placebo-controlled, multicentre Phase II clinical trial. PLoS Med 2022; 19:e1003865. [PMID: 35015777 PMCID: PMC8752100 DOI: 10.1371/journal.pmed.1003865] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/09/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Reoccurring Ebola outbreaks in West and Central Africa have led to serious illness and death in thousands of adults and children. The objective of this study was to assess safety, tolerability, and immunogenicity of the heterologous 2-dose Ad26.ZEBOV, MVA-BN-Filo vaccination regimen in adolescents and children in Africa. METHODS AND FINDINGS In this multicentre, randomised, observer-blind, placebo-controlled Phase II study, 131 adolescents (12 to 17 years old) and 132 children (4 to 11 years old) were enrolled from Eastern and Western Africa and randomised 5:1 to receive study vaccines or placebo. Vaccine groups received intramuscular injections of Ad26.ZEBOV (5 × 1010 viral particles) and MVA-BN-Filo (1 × 108 infectious units) 28 or 56 days apart; placebo recipients received saline. Primary outcomes were safety and tolerability. Solicited adverse events (AEs) were recorded until 7 days after each vaccination and serious AEs (SAEs) throughout the study. Secondary and exploratory outcomes were humoral immune responses (binding and neutralising Ebola virus [EBOV] glycoprotein [GP]-specific antibodies), up to 1 year after the first dose. Enrolment began on February 26, 2016, and the date of last participant last visit was November 28, 2018. Of the 263 participants enrolled, 217 (109 adolescents, 108 children) received the 2-dose regimen, and 43 (20 adolescents, 23 children) received 2 placebo doses. Median age was 14.0 (range 11 to 17) and 7.0 (range 4 to 11) years for adolescents and children, respectively. Fifty-four percent of the adolescents and 51% of the children were male. All participants were Africans, and, although there was a slight male preponderance overall, the groups were well balanced. No vaccine-related SAEs were reported; solicited AEs were mostly mild/moderate. Twenty-one days post-MVA-BN-Filo vaccination, binding antibody responses against EBOV GP were observed in 100% of vaccinees (106 adolescents, 104 children). Geometric mean concentrations tended to be higher after the 56-day interval (adolescents 13,532 ELISA units [EU]/mL, children 17,388 EU/mL) than the 28-day interval (adolescents 6,993 EU/mL, children 8,007 EU/mL). Humoral responses persisted at least up to Day 365. A limitation of the study is that the follow-up period was limited to 365 days for the majority of the participants, and so it was not possible to determine whether immune responses persisted beyond this time period. Additionally, formal statistical comparisons were not preplanned but were only performed post hoc. CONCLUSIONS The heterologous 2-dose vaccination was well tolerated in African adolescents and children with no vaccine-related SAEs. All vaccinees displayed anti-EBOV GP antibodies after the 2-dose regimen, with higher responses in the 56-day interval groups. The frequency of pyrexia after vaccine or placebo was higher in children than in adolescents. These data supported the prophylactic indication against EBOV disease in a paediatric population, as licenced in the EU. TRIAL REGISTRATION ClinicalTrials.gov NCT02564523.
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Affiliation(s)
- Zacchaeus Anywaine
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | - Omu Anzala
- KAVI - Institute of Clinical Research University of Nairobi, Nairobi, Kenya
| | - Gaudensia Mutua
- KAVI - Institute of Clinical Research University of Nairobi, Nairobi, Kenya
| | - Sodiomon B. Sirima
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), Unité de Recherche Clinique de Banfora, Banfora, Burkina Faso
| | - Serge Eholie
- Unit of Infectious and Tropical Diseases, BPV3, Treichville University Teaching Hospital, Abidjan, Côte d’Ivoire
| | - Hannah Kibuuka
- Makerere University - Walter Reed Project, Kampala, Uganda
| | - Christine Bétard
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219; Inria SISTM team; CHU Bordeaux; CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, Bordeaux, France
| | - Laura Richert
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219; Inria SISTM team; CHU Bordeaux; CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, Bordeaux, France
- Vaccine Research Institute (VRI), Créteil, France
| | - Christine Lacabaratz
- Vaccine Research Institute (VRI), Créteil, France
- Université Paris-Est Créteil, Faculté de Médecine, INSERM U955, Team 16, Créteil, France
| | - M. Juliana McElrath
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Stephen C. De Rosa
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Kristen W. Cohen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | | | | | | | | | | | - Viki Bockstal
- Janssen Vaccines and Prevention, Leiden, the Netherlands
| | - Kerstin Luhn
- Janssen Vaccines and Prevention, Leiden, the Netherlands
| | | | - Rodolphe Thiébaut
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219; Inria SISTM team; CHU Bordeaux; CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, Bordeaux, France
- Vaccine Research Institute (VRI), Créteil, France
- * E-mail:
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Ogola JG, Alburkat H, Masika M, Korhonen E, Uusitalo R, Nyaga P, Anzala O, Vapalahti O, Sironen T, Forbes KM. Seroevidence of Zoonotic Viruses in Rodents and Humans in Kibera Informal Settlement, Nairobi, Kenya. Vector Borne Zoonotic Dis 2021; 21:973-978. [DOI: 10.1089/vbz.2021.0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Joseph Ganda Ogola
- Department of Medical Microbiology, KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
- Department of Virology, University of Helsinki, Helsinki, Finland
| | - Hussein Alburkat
- Department of Virology, University of Helsinki, Helsinki, Finland
| | - Moses Masika
- Department of Medical Microbiology, KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Essi Korhonen
- Department of Virology, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
| | - Ruut Uusitalo
- Department of Virology, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
- Department of Geosciences and Geography, University of Helsinki, Helsinki, Finland
| | - Philip Nyaga
- Department of Pathology, Microbiology and Parasitology, University of Nairobi, Nairobi, Kenya
| | - Omu Anzala
- Department of Medical Microbiology, KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Olli Vapalahti
- Department of Virology, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
| | - Tarja Sironen
- Department of Virology, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
| | - Kristian M. Forbes
- Department of Biological Sciences, University of Arkansas, Fayetteville, Arkansas, USA
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Barry H, Mutua G, Kibuuka H, Anywaine Z, Sirima SB, Meda N, Anzala O, Eholie S, Bétard C, Richert L, Lacabaratz C, McElrath MJ, De Rosa S, Cohen KW, Shukarev G, Robinson C, Gaddah A, Heerwegh D, Bockstal V, Luhn K, Leyssen M, Douoguih M, Thiébaut R. Safety and immunogenicity of 2-dose heterologous Ad26.ZEBOV, MVA-BN-Filo Ebola vaccination in healthy and HIV-infected adults: A randomised, placebo-controlled Phase II clinical trial in Africa. PLoS Med 2021; 18:e1003813. [PMID: 34714820 PMCID: PMC8555783 DOI: 10.1371/journal.pmed.1003813] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/13/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND We investigated safety, tolerability, and immunogenicity of the heterologous 2-dose Ebola vaccination regimen in healthy and HIV-infected adults with different intervals between Ebola vaccinations. METHODS AND FINDINGS In this randomised, observer-blind, placebo-controlled Phase II trial, 668 healthy 18- to 70-year-olds and 142 HIV-infected 18- to 50-year-olds were enrolled from 1 site in Kenya and 2 sites each in Burkina Faso, Cote d'Ivoire, and Uganda. Participants received intramuscular Ad26.ZEBOV followed by MVA-BN-Filo at 28-, 56-, or 84-day intervals, or saline. Females represented 31.4% of the healthy adult cohort in contrast to 69.7% of the HIV-infected cohort. A subset of healthy adults received booster vaccination with Ad26.ZEBOV or saline at Day 365. Following vaccinations, adverse events (AEs) were collected until 42 days post last vaccination and serious AEs (SAEs) were recorded from signing of the ICF until the end of the study. The primary endpoint was safety, and the secondary endpoint was immunogenicity. Anti-Ebola virus glycoprotein (EBOV GP) binding and neutralising antibodies were measured at baseline and at predefined time points throughout the study. The first participant was enrolled on 9 November 2015, and the date of last participant's last visit was 12 February 2019. No vaccine-related SAEs and mainly mild-to-moderate AEs were observed among the participants. The most frequent solicited AEs were injection-site pain (local), and fatigue, headache, and myalgia (systemic), respectively. Twenty-one days post-MVA-BN-Filo vaccination, geometric mean concentrations (GMCs) with 95% confidence intervals (CIs) of EBOV GP binding antibodies in healthy adults in 28-, 56-, and 84-day interval groups were 3,085 EU/mL (2,648 to 3,594), 7,518 EU/mL (6,468 to 8,740), and 7,300 EU/mL (5,116 to 10,417), respectively. In HIV-infected adults in 28- and 56-day interval groups, GMCs were 4,207 EU/mL (3,233 to 5,474) and 5,283 EU/mL (4,094 to 6,817), respectively. Antibody responses were observed until Day 365. Ad26.ZEBOV booster vaccination after 1 year induced an anamnestic response. Study limitations include that some healthy adult participants either did not receive dose 2 or received dose 2 outside of their protocol-defined interval and that the follow-up period was limited to 365 days for most participants. CONCLUSIONS Ad26.ZEBOV, MVA-BN-Filo vaccination was well tolerated and immunogenic in healthy and HIV-infected African adults. Increasing the interval between vaccinations from 28 to 56 days improved the magnitude of humoral immune responses. Antibody levels persisted to at least 1 year, and Ad26.ZEBOV booster vaccination demonstrated the presence of vaccination-induced immune memory. These data supported the approval by the European Union for prophylaxis against EBOV disease in adults and children ≥1 year of age. TRIAL REGISTRATION ClinicalTrials.gov NCT02564523.
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Affiliation(s)
| | - Gaudensia Mutua
- KAVI—Institute of Clinical Research University of Nairobi, Nairobi, Kenya
| | - Hannah Kibuuka
- Makerere University—Walter Reed Project, Kampala, Uganda
| | - Zacchaeus Anywaine
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Sodiomon B. Sirima
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), Unité de Recherche Clinique de Banfora, Ouagadougou, Burkina Faso
| | | | - Omu Anzala
- KAVI—Institute of Clinical Research University of Nairobi, Nairobi, Kenya
| | - Serge Eholie
- Unit of Infectious and Tropical Diseases, BPV3, Treichville University Teaching Hospital, Abidjan, Côte d’Ivoire
| | - Christine Bétard
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219; Inria SISTM team; CHU Bordeaux; CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, F-33000, Bordeaux, France
| | - Laura Richert
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219; Inria SISTM team; CHU Bordeaux; CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, F-33000, Bordeaux, France
- Vaccine Research Institute (VRI), Créteil, France
| | - Christine Lacabaratz
- Vaccine Research Institute (VRI), Créteil, France
- Université Paris-Est Créteil, Faculté de Médecine, INSERM U955, Team 16, Créteil, France
| | - M. Juliana McElrath
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Stephen De Rosa
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Kristen W. Cohen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | | | | | | | | | - Viki Bockstal
- Janssen Vaccines and Prevention, Leiden, the Netherlands
| | - Kerstin Luhn
- Janssen Vaccines and Prevention, Leiden, the Netherlands
| | | | | | - Rodolphe Thiébaut
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219; Inria SISTM team; CHU Bordeaux; CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, F-33000, Bordeaux, France
- Vaccine Research Institute (VRI), Créteil, France
- * E-mail:
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31
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Wanjala NF, Joseph G, Anthony M, Primus O, Ogeng'o JJ, Anzala O, Dohil I, Agak GW. Keloids: Does Patients' Sex Influence the Presentation and Recurrence post-excision? J Plast Reconstr Aesthet Surg 2021; 75:366-368. [PMID: 34642061 DOI: 10.1016/j.bjps.2021.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/20/2021] [Accepted: 08/26/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - O Primus
- Dept of Surgery, University of Nairobi
| | | | - Omu Anzala
- International AIDS Vaccine Initiative, University of Nairobi
| | - Isabella Dohil
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at University of California (UCLA), Los Angeles, CA, USA, 90095
| | - George W Agak
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at University of California (UCLA), Los Angeles, CA, USA, 90095
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32
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Ngere I, Dawa J, Hunsperger E, Otieno N, Masika M, Amoth P, Makayotto L, Nasimiyu C, Gunn BM, Nyawanda B, Oluga O, Ngunu C, Mirieri H, Gachohi J, Marwanga D, Munywoki PK, Odhiambo D, Alando MD, Breiman RF, Anzala O, Njenga MK, Bulterys M, Herman-Roloff A, Osoro E. High seroprevalence of SARS-CoV-2 but low infection fatality ratio eight months after introduction in Nairobi, Kenya. Int J Infect Dis 2021; 112:25-34. [PMID: 34481966 PMCID: PMC8411609 DOI: 10.1016/j.ijid.2021.08.062] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/12/2021] [Accepted: 08/26/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The lower than expected COVID-19 morbidity and mortality in Africa has been attributed to multiple factors, including weak surveillance. This study estimated the burden of SARS-CoV-2 infections eight months into the epidemic in Nairobi, Kenya. METHODS A population-based, cross-sectional survey was conducted using multi-stage random sampling to select households within Nairobi in November 2020. Sera from consenting household members were tested for antibodies to SARS-CoV-2. Seroprevalence was estimated after adjusting for population structure and test performance. Infection fatality ratios (IFRs) were calculated by comparing study estimates with reported cases and deaths. RESULTS Among 1,164 individuals, the adjusted seroprevalence was 34.7% (95% CI 31.8-37.6). Half of the enrolled households had at least one positive participant. Seropositivity increased in more densely populated areas (spearman's r=0.63; p=0.009). Individuals aged 20-59 years had at least two-fold higher seropositivity than those aged 0-9 years. The IFR was 40 per 100,000 infections, with individuals ≥60 years old having higher IFRs. CONCLUSION Over one-third of Nairobi residents had been exposed to SARS-CoV-2 by November 2020, indicating extensive transmission. However, the IFR was >10-fold lower than that reported in Europe and the USA, supporting the perceived lower morbidity and mortality in sub-Saharan Africa.
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Affiliation(s)
- Isaac Ngere
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Jeanette Dawa
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Elizabeth Hunsperger
- Center for Global Health, US Centers for Disease Control and Prevention (CDC)-Kenya, Nairobi, Kenya
| | - Nancy Otieno
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Moses Masika
- KAVI-Institute for Clinical Research, University of Nairobi, Nairobi, Kenya
| | | | - Lyndah Makayotto
- Department of Health, Nairobi Metropolitan Services, Nairobi, Kenya
| | - Carolyne Nasimiyu
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Bronwyn M Gunn
- Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Bryan Nyawanda
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Ouma Oluga
- Department of Health, Nairobi Metropolitan Services, Nairobi, Kenya
| | - Carolyne Ngunu
- Department of Health, Nairobi Metropolitan Services, Nairobi, Kenya
| | - Harriet Mirieri
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - John Gachohi
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA; School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Kiambu, Kenya
| | - Doris Marwanga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Patrick K Munywoki
- Center for Global Health, US Centers for Disease Control and Prevention (CDC)-Kenya, Nairobi, Kenya
| | - Dennis Odhiambo
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Moshe D Alando
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | | | - Omu Anzala
- KAVI-Institute for Clinical Research, University of Nairobi, Nairobi, Kenya
| | - M Kariuki Njenga
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA
| | - Marc Bulterys
- Center for Global Health, US Centers for Disease Control and Prevention (CDC)-Kenya, Nairobi, Kenya
| | - Amy Herman-Roloff
- Center for Global Health, US Centers for Disease Control and Prevention (CDC)-Kenya, Nairobi, Kenya
| | - Eric Osoro
- Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School of Global Health, Washington State University (WSU), Pullman, USA.
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Abstract
ABSTRACT Keloids are fibroproliferative disorders characterized by high recurrence rates, with few factors known to influence the same. We conducted a study to determine whether keloid histology influences recurrence. This was a prospective longitudinal study to determine whether histopathological parameters of keloid influence recurrence. Patients with keloids managed by surgical excision were followed up at Kenyatta National Hospital between August 2018 and July 2020. The excised keloids were processed for histology using hematoxylin,/eosin, Masson, and trichrome stains. The slides were analyzed for inflammatory cells, fibroblasts, and capillary density using the hot spot technique and correlated to keloid recurrence. Postoperative follow-up was for a minimum of 1 year. A total of 90 patients with 104 keloids were recruited in the study. Overall keloid recurrence rate was 28.6%. There was a correlation between the absolute count of more than 50 per High power field of lymphocytes, fibroblasts, and macrophages with recurrence of the disease. The sensitivity and specificity for the above parameters were lymphocytes 48% and 81%, macrophages 57% and 83%, mast cells 32% and 33%, and fibroblasts 41% and 91%, respectively. There was no correlation between mast cells and vascularity status with recurrence. Routine histology should, therefore, be performed to determine these parameters. Close monitoring and second-line therapy should be considered for patients with elevated macrophages and/or lymphocytes so as to reduce the risk of recurrence.
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Affiliation(s)
| | - Kelsey Ouyang
- Department of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Omu Anzala
- KAVI-Institute of Aids Vaccine Initiative, University of Nairobi, Nairobi, Kenya
| | - Julius Ogeng'o
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya; and
| | - George W Agak
- Department of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Daniel Zuriel
- Department of Pathology, University of Nairobi, Nairobi, Kenya
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Juma M, Sankaradoss A, Ndombi R, Mwaura P, Damodar T, Nazir J, Pandit A, Khurana R, Masika M, Chirchir R, Gachie J, Krishna S, Sowdhamini R, Anzala O, Meenakshi IS. Antimicrobial Resistance Profiling and Phylogenetic Analysis of Neisseria gonorrhoeae Clinical Isolates From Kenya in a Resource-Limited Setting. Front Microbiol 2021; 12:647565. [PMID: 34385981 PMCID: PMC8353456 DOI: 10.3389/fmicb.2021.647565] [Citation(s) in RCA: 4] [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: 01/12/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background Africa has one of the highest incidences of gonorrhea. Neisseria gonorrhoeae is gaining resistance to most of the available antibiotics, compromising treatment across the world. Whole-genome sequencing (WGS) is an efficient way of predicting AMR determinants and their spread in the population. Recent advances in next-generation sequencing technologies like Oxford Nanopore Technology (ONT) have helped in the generation of longer reads of DNA in a shorter duration with lower cost. Increasing accuracy of base-calling algorithms, high throughput, error-correction strategies, and ease of using the mobile sequencer MinION in remote areas lead to its adoption for routine microbial genome sequencing. To investigate whether MinION-only sequencing is sufficient for WGS and downstream analysis in resource-limited settings, we sequenced the genomes of 14 suspected N. gonorrhoeae isolates from Nairobi, Kenya. Methods Using WGS, the isolates were confirmed to be cases of N. gonorrhoeae (n = 9), and there were three co-occurrences of N. gonorrhoeae with Moraxella osloensis and N. meningitidis (n = 2). N. meningitidis has been implicated in sexually transmitted infections in recent years. The near-complete N. gonorrhoeae genomes (n = 10) were analyzed further for mutations/factors causing AMR using an in-house database of mutations curated from the literature. Results We observe that ciprofloxacin resistance is associated with multiple mutations in both gyrA and parC. Mutations conferring tetracycline (rpsJ) and sulfonamide (folP) resistance and plasmids encoding beta-lactamase were seen in all the strains, and tet(M)-containing plasmids were identified in nine strains. Phylogenetic analysis clustered the 10 isolates into clades containing previously sequenced genomes from Kenya and countries across the world. Based on homology modeling of AMR targets, we see that the mutations in GyrA and ParC disrupt the hydrogen bonding with quinolone drugs and mutations in FolP may affect interaction with the antibiotic. Conclusion Here, we demonstrate the utility of mobile DNA sequencing technology in producing a consensus genome for sequence typing and detection of genetic determinants of AMR. The workflow followed in the study, including AMR mutation dataset creation and the genome identification, assembly, and analysis, can be used for any clinical isolate. Further studies are required to determine the utility of real-time sequencing in outbreak investigations, diagnosis, and management of infections, especially in resource-limited settings.
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Affiliation(s)
- Meshack Juma
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Arun Sankaradoss
- National Centre for Biological Sciences, Tata Institute of Fundamental Research (TIFR), Bengaluru, India
| | - Redcliff Ndombi
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Patrick Mwaura
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Tina Damodar
- National Centre for Biological Sciences, Tata Institute of Fundamental Research (TIFR), Bengaluru, India
| | - Junaid Nazir
- National Centre for Biological Sciences, Tata Institute of Fundamental Research (TIFR), Bengaluru, India
| | - Awadhesh Pandit
- National Centre for Biological Sciences, Tata Institute of Fundamental Research (TIFR), Bengaluru, India
| | - Rupsy Khurana
- National Centre for Biological Sciences, Tata Institute of Fundamental Research (TIFR), Bengaluru, India
| | - Moses Masika
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Ruth Chirchir
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - John Gachie
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Sudhir Krishna
- National Centre for Biological Sciences, Tata Institute of Fundamental Research (TIFR), Bengaluru, India.,School of Interdisciplinary Life Sciences, Indian Institute of Technology Goa, Ponda, India
| | - Ramanathan Sowdhamini
- National Centre for Biological Sciences, Tata Institute of Fundamental Research (TIFR), Bengaluru, India
| | - Omu Anzala
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Iyer S Meenakshi
- National Centre for Biological Sciences, Tata Institute of Fundamental Research (TIFR), Bengaluru, India
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Carter KA, Srinivasan S, Fiedler TL, Anzala O, Kimani J, Mochache V, Wallis JM, Fredricks DN, McClelland RS, Balkus JE. Vaginal Bacteria and Risk of Incident and Persistent Infection With High-Risk Subtypes of Human Papillomavirus: A Cohort Study Among Kenyan Women. Sex Transm Dis 2021; 48:499-507. [PMID: 33346587 PMCID: PMC8184569 DOI: 10.1097/olq.0000000000001343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Bacterial vaginosis (BV) is associated with an increased risk of high-risk human papillomavirus (hrHPV), whereas Lactobacillus-dominated vaginal microbiotas are associated with reduced burden of hrHPV. Few epidemiologic studies have prospectively investigated the relationships between vaginal bacteria and hrHPV, particularly among women from countries in Africa. METHODS We conducted a prospective cohort study nested within the Preventing Vaginal Infections trial to evaluate associations between vaginal bacteria and hrHPV incidence and persistence. Sexually active, HIV-seronegative women aged 18 to 45 years who had a vaginal infection at screening were eligible to enroll. Analyses were restricted to participants enrolled in Kenya and randomized to placebo. At enrollment and months 2, 4, 6, 8, 10, and 12, hrHPV testing, quantitative polymerase chain reaction (measuring taxon quantity per swab), and 16S rRNA gene amplicon sequencing of the vaginal microbiota were performed. Generalized estimating equations multinomial logistic regression models were fit to evaluate associations between vaginal bacteria and incident and persistent hrHPV. RESULTS Eighty-four participants were included in this analysis. Higher concentrations of Lactobacillus crispatus were inversely associated with persistent hrHPV detection. Specifically, 1 tertile higher L. crispatus concentration was associated with 50% reduced odds of persistent hrHPV detection (odds ratio, 0.50; 95% confidence interval, 0.29-0.85). CONCLUSIONS This study is consistent with reports that vaginal L. crispatus is associated with reduced susceptibility to hrHPV persistence. Evidence from in vitro studies provides insight into potential mechanisms by which L. crispatus may mediate hrHPV risk. Future studies should further explore in vivo mechanisms that may drive this relationship and opportunities for intervention.
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Affiliation(s)
- Kayla A. Carter
- Department of Epidemiology, University of Washington; Seattle, WA, USA
| | - Sujatha Srinivasan
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center; Seattle, WA, USA
| | - Tina L. Fiedler
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center; Seattle, WA, USA
| | - Omu Anzala
- Department of Medical Microbiology, University of Nairobi; Nairobi, Kenya
| | - Joshua Kimani
- University of Nairobi Institute for Tropical and Infectious Diseases, University of Nairobi; Nairobi, Kenya
| | - Vernon Mochache
- Department of Epidemiology, University of Washington; Seattle, WA, USA
| | - Jacqueline M. Wallis
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center; Seattle, WA, USA
| | - David N. Fredricks
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center; Seattle, WA, USA
- Department of Medicine, University of Washington; Seattle, WA, USA
| | - R. Scott McClelland
- Department of Epidemiology, University of Washington; Seattle, WA, USA
- University of Nairobi Institute for Tropical and Infectious Diseases, University of Nairobi; Nairobi, Kenya
- Department of Medicine, University of Washington; Seattle, WA, USA
- Department of Global Health, University of Washington; Seattle, WA, USA
| | - Jennifer E. Balkus
- Department of Epidemiology, University of Washington; Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center; Seattle, WA, USA
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Kareinen L, Ogola J, Kivistö I, Smura T, Aaltonen K, Jääskeläinen AJ, Kibiwot S, Masika MM, Nyaga P, Mwaengo D, Anzala O, Vapalahti O, Webala PW, Forbes KM, Sironen T. Range Expansion of Bombali Virus in Mops condylurus Bats, Kenya, 2019. Emerg Infect Dis 2021; 26:3007-3010. [PMID: 33219788 PMCID: PMC7706938 DOI: 10.3201/eid2612.202925] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Previously identified only in Sierra Leone, Guinea, and southeastern Kenya, Bombali virus–infected Mops condylurus bats were recently found »750 km away in western Kenya. This finding supports the role of M. condylurus bats as hosts and the potential for Bombali virus circulation across the bats’ range in sub-Saharan Africa.
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Nangole FW, Ouyang K, Anzala O, Ogengo J, Agak GW. Multiple Cytokines Elevated in Patients with Keloids: Is It an Indication of Auto-Inflammatory Disease? J Inflamm Res 2021; 14:2465-2470. [PMID: 34140794 PMCID: PMC8203597 DOI: 10.2147/jir.s312091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/13/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Inflammation seems to play a major role in the pathophysiology of keloids. However, the role of cytokines in keloid pathophysiology has not been fully evaluated with only a few cytokines studied. We undertook this study to compare various cytokines in patients with keloids and a control group of patients without keloids nor family history of keloids so as to determine which cytokines are elevated and could thus be critical in keloid formation. METHODS This was a cross-sectional study of patients with keloids and a control group of those without. Patients in both groups were matched for age, sex and body mass index. Their plasma was analyzed for both inflammatory and anti-inflammatory cytokines using the Bio-flex ElisaTM method. Comparisons of cytokines means in both groups were done using Student's t-test. RESULTS A total of 84 participants with 42 participants in each group were followed during the study. Male to female ratio was 1:2. Age ranges were similar with a mean of 29.6 years. A total of 28 cytokines were assayed. Statistically significant differences were noted in 15 of the 28 cytokines assayed with 11 being elevated more in keloid patients with only four in the non-keloid forming group. Among elevated cytokines in keloid patients were granulocyte colony-stimulating factors, granulocyte-monocyte-colony-stimulating factors, interleukins 4, 6 and 13. CONCLUSION Patients with keloids have significantly higher cytokines compared with non-keloid forming patients. This finding suggests that keloid formation could be influenced by multiple inflammatory cytokines, an indication that the patient's immune system could play a role in keloid formation akin to auto-inflammatory disease.
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Affiliation(s)
| | - Kelsey Ouyang
- Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Omu Anzala
- Institute of Aids Vaccine Initiative, University of Nairobi, Nairobi, Kenya
| | - Julius Ogengo
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - George W Agak
- Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Eastment MC, Balkus JE, Richardson BA, Srinivasan S, Kimani J, Anzala O, Schwebke J, Fiedler TL, Fredricks DN, McClelland RS. Association Between Vaginal Bacterial Microbiota and Vaginal Yeast Colonization. J Infect Dis 2021; 223:914-923. [PMID: 32726445 PMCID: PMC7938175 DOI: 10.1093/infdis/jiaa459] [Citation(s) in RCA: 8] [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: 04/14/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Vaginal yeast is frequently found with Lactobacillus-dominant microbiota. The relationship between vaginal yeast and other bacteria has not been well characterized. METHODS These analyses utilized data from the Preventing Vaginal Infections trial. Relative abundance of vaginal bacteria from 16S ribosomal ribonucleic acid gene amplicon sequencing and quantities of 10 vaginal bacteria using taxon-directed polymerase chain reaction assays were compared at visits with and without detection of yeast on microscopy, culture, or both. RESULTS Higher relative abundances of Megasphaera species type 1 (risk ratio [RR], 0.70; 95% confidence interval [CI], 0.52-0.95), Megasphaera species type 2 (RR, 0.81; 95% CI, 0.67-0.98), and Mageeibacillus indolicus (RR, 0.46; 95% CI, 0.25-0.83) were associated with lower risk of detecting yeast. In contrast, higher relative abundances of Bifidobacterium bifidum, Aerococcus christensenii, Lactobacillus mucosae, Streptococcus equinus/infantarius/lutentiensis, Prevotella bivia, Dialister propionicifaciens, and Lactobacillus crispatus/helveticus were associated with yeast detection. Taxon-directed assays confirmed that increasing quantities of both Megasphaera species and M indolicus were associated with lower risk of detecting yeast, whereas increasing quantities of L crispatus were associated with higher risk of detecting yeast. CONCLUSIONS Despite an analysis that examined associations between multiple vaginal bacteria and the presence of yeast, only a small number of vaginal bacteria were strongly and significantly associated with the presence or absence of yeast.
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Affiliation(s)
- McKenna C Eastment
- University of Washington, Department of Medicine, Seattle, Washington, USA
| | - Jennifer E Balkus
- Department of Global Health, Seattle, Washington, USA
- Department of Epidemiology, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, Washington, USA
| | - Barbra A Richardson
- Department of Global Health, Seattle, Washington, USA
- Department of Biostatistics, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, Washington, USA
| | - Sujatha Srinivasan
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, Washington, USA
| | - Joshua Kimani
- University of Nairobi, Institute of Tropical and Infectious Diseases, Nairobi, Kenya
| | - Omu Anzala
- Kenya AIDS Vaccine Initiative (KAVI)-Institute of Clinical Research, Nairobi, Kenya
| | - Jane Schwebke
- University of Alabama at Birmingham, Division of Infectious Diseases, Birmingham, Alabama, USA
| | - Tina L Fiedler
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, Washington, USA
| | - David N Fredricks
- University of Washington, Department of Medicine, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, Washington, USA
| | - R Scott McClelland
- University of Washington, Department of Medicine, Seattle, Washington, USA
- Department of Global Health, Seattle, Washington, USA
- Department of Epidemiology, Seattle, Washington, USA
- University of Nairobi, Institute of Tropical and Infectious Diseases, Nairobi, Kenya
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Price MA, Kilembe W, Ruzagira E, Karita E, Inambao M, Sanders EJ, Anzala O, Allen S, Edward VA, Kaleebu P, Fast PE, Rida W, Kamali A, Hunter E, Tang J, Lakhi S, Mutua G, Bekker LG, Abu-Baker G, Tichacek A, Chetty P, Latka MH, Maenetje P, Makkan H, Hare J, Kibengo F, Priddy F, Landais E, Chinyenze K, Gilmour J. Cohort Profile: IAVI's HIV epidemiology and early infection cohort studies in Africa to support vaccine discovery. Int J Epidemiol 2021; 50:29-30. [PMID: 32879950 PMCID: PMC7938500 DOI: 10.1093/ije/dyaa100] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Matt A Price
- IAVI, New York, USA & Nairobi, Kenya
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA
| | - William Kilembe
- Rwanda Zambia Emory HIV Research Group, Lusaka & Ndola, Zambia; Kigali, Rwanda
- Emory University, Atlanta, GA, USA
| | - Eugene Ruzagira
- Medical Research Council, Uganda Virus Research Institute, and London School of Hygiene and Tropical Medicine Uganda Research Unit (MULS), Entebbe & Masaka, Uganda
| | - Etienne Karita
- Rwanda Zambia Emory HIV Research Group, Lusaka & Ndola, Zambia; Kigali, Rwanda
- Emory University, Atlanta, GA, USA
| | - Mubiana Inambao
- Rwanda Zambia Emory HIV Research Group, Lusaka & Ndola, Zambia; Kigali, Rwanda
- Emory University, Atlanta, GA, USA
| | - Eduard J Sanders
- Kenyan Medical Research Institute-Wellcome Trust, Kilifi, Kenya
- Nuffield Department of Clinical Medicine, Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Headington, UK
| | - Omu Anzala
- KAVI-Institute of Clinical Research, Nairobi, Kenya
| | - Susan Allen
- Rwanda Zambia Emory HIV Research Group, Lusaka & Ndola, Zambia; Kigali, Rwanda
- Emory University, Atlanta, GA, USA
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Vinodh A Edward
- The Aurum Institute, Johannesburg and Rustenburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Advancing Care and Treatment for TB/HIV, A Collaborating Centre of the South African Medical Research Council, Cape Town, South Africa
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Pontiano Kaleebu
- Medical Research Council, Uganda Virus Research Institute, and London School of Hygiene and Tropical Medicine Uganda Research Unit (MULS), Entebbe & Masaka, Uganda
| | - Patricia E Fast
- IAVI, New York, USA & Nairobi, Kenya
- Pediatric Infectious Diseases, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Wasima Rida
- Biostatistics Consultant, Arlington, VA, USA
| | | | - Eric Hunter
- Rwanda Zambia Emory HIV Research Group, Lusaka & Ndola, Zambia; Kigali, Rwanda
- Emory University, Atlanta, GA, USA
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Jianming Tang
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shabir Lakhi
- Rwanda Zambia Emory HIV Research Group, Lusaka & Ndola, Zambia; Kigali, Rwanda
- Emory University, Atlanta, GA, USA
| | | | - Linda Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Ggayi Abu-Baker
- Medical Research Council, Uganda Virus Research Institute, and London School of Hygiene and Tropical Medicine Uganda Research Unit (MULS), Entebbe & Masaka, Uganda
| | - Amanda Tichacek
- Rwanda Zambia Emory HIV Research Group, Lusaka & Ndola, Zambia; Kigali, Rwanda
- Emory University, Atlanta, GA, USA
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Mary H Latka
- The Aurum Institute, Johannesburg and Rustenburg, South Africa
| | - Pholo Maenetje
- The Aurum Institute, Johannesburg and Rustenburg, South Africa
| | - Heeran Makkan
- The Aurum Institute, Johannesburg and Rustenburg, South Africa
| | - Jonathan Hare
- IAVI Human Immunology Laboratory, Imperial College, London, UK
| | - Freddie Kibengo
- Medical Research Council, Uganda Virus Research Institute, and London School of Hygiene and Tropical Medicine Uganda Research Unit (MULS), Entebbe & Masaka, Uganda
| | | | - Elise Landais
- IAVI, New York, USA & Nairobi, Kenya
- IAVI Neutralizing Antibody Center, The Scripps Research Institute, La Jolla, CA, USA
- Department of Immunology and Microbiology, The Scripps Research Institute, La Jolla, CA, USA
| | | | - Jill Gilmour
- IAVI Human Immunology Laboratory, Imperial College, London, UK
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Langat RK, Farah B, Indangasi J, Ogola S, Omosa-Manyonyi G, Anzala O, Bizimana J, Tekirya E, Ngetsa C, Silwamba M, Muyanja E, Chetty P, Jangano M, Hills N, Gilmour J, Dally L, Cox JH, Hayes P. Performance of International AIDS Vaccine Initiative African clinical research laboratories in standardised ELISpot and peripheral blood mononuclear cell processing in support of HIV vaccine clinical trials. Afr J Lab Med 2021; 10:1056. [PMID: 33833946 PMCID: PMC8014752 DOI: 10.4102/ajlm.v10i1.1056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/23/2020] [Indexed: 11/28/2022] Open
Abstract
Background Standardisation of procedures for performing cellular functional assays across laboratories participating in multicentre clinical trials is key for generating comparable and reliable data. Objective This article describes the performance of accredited laboratories in Africa and Europe on testing done in support of clinical trials. Methods For enzyme-linked immunospot assay (ELISpot) proficiency, characterised peripheral blood mononuclear cells (PBMCs) obtained from 48 HIV-negative blood donors in Johannesburg, South Africa, were sent to participating laboratories between February 2010 and February 2014. The PBMCs were tested for responses against cytomegalovirus, Epstein Barr and influenza peptide pools in a total of 1751 assays. In a separate study, a total of 1297 PBMC samples isolated from healthy HIV-negative participants in clinical trials of two prophylactic HIV vaccine candidates in Kenya, Uganda, Rwanda and Zambia were analysed for cell viability, cell yield and cell recovery from frozen PBMCs. Results Most (99%) of the 1751 ELISpot proficiency assays had data within acceptable ranges with low responses to mock stimuli. No significant statistical difference were observed in ELISpot responses at the five laboratories actively conducting immunological analyses. Of the 1297 clinical trial PBMCs processed, 94% had cell viability above 90% and 96% had cell yield above 0.7 million per mL of blood in freshly isolated cells. All parameters were within the predefined acceptance criteria. Conclusion We demonstrate that multiple laboratories can generate reliable, accurate and comparable data by using standardised procedures, having regular training, having regular equipment maintenance and using centrally sourced reagents.
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Affiliation(s)
- Robert K Langat
- Kenya AIDS Vaccine Initiative, Institute of Clinical Research, University of Nairobi, Nairobi, Kenya.,International AIDS Vaccine Initiative (IAVI), Human Immunology Laboratory, Imperial College, London, United Kingdom
| | - Bashir Farah
- Kenya AIDS Vaccine Initiative, Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Jackton Indangasi
- Kenya AIDS Vaccine Initiative, Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Simon Ogola
- Kenya AIDS Vaccine Initiative, Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Gloria Omosa-Manyonyi
- Kenya AIDS Vaccine Initiative, Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Omu Anzala
- Kenya AIDS Vaccine Initiative, Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | | | | | - Caroline Ngetsa
- Kenya Medical Research Institute Centre for Geographical Medicine Research Coast, Mombasa, Kenya
| | | | - Enoch Muyanja
- Ugandan Virus Research Institute-IAVI, Entebbe, Uganda
| | - Paramesh Chetty
- International AIDS Vaccine Initiative, Johannesburg, South Africa
| | | | - Nancy Hills
- School of Medicine, University of California, San Francisco, California, United States
| | - Jill Gilmour
- International AIDS Vaccine Initiative (IAVI), Human Immunology Laboratory, Imperial College, London, United Kingdom
| | - Len Dally
- Emmes Corporation, Rockville, Maryland, United States
| | - Josephine H Cox
- Clinical Trials Program, Vaccine Research Center, National Institutes of Health, Bethesda, Maryland, United States
| | - Peter Hayes
- International AIDS Vaccine Initiative (IAVI), Human Immunology Laboratory, Imperial College, London, United Kingdom
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Mutai WC, Mureithi MW, Anzala O, Revathi G, Kullin B, Burugu M, Kyany'a C, Odoyo E, Otieno P, Musila L. High Prevalence of Multidrug-Resistant Clostridioides difficile Following Extensive Use of Antimicrobials in Hospitalized Patients in Kenya. Front Cell Infect Microbiol 2021; 10:604986. [PMID: 33628744 PMCID: PMC7897694 DOI: 10.3389/fcimb.2020.604986] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 09/10/2020] [Accepted: 12/14/2020] [Indexed: 01/02/2023] Open
Abstract
Introduction Clostridioides difficile is a neglected pathogen in many African countries as it is generally not regarded as one of the major contributors toward the diarrheal disease burden in the continent. However, several studies have suggested that C. difficile infection (CDI) may be underreported in many African settings. The aim of this study was to determine the prevalence of CDI in hospitalized patients, evaluate antimicrobial exposure, and detect toxin and antimicrobial resistance profiles of the isolated C. difficile strains. Methods In this cross-sectional study, 333 hospitalized patients with hospital-onset diarrhoea were selected. The stool samples were collected and cultured on cycloserine-cefoxitin egg yolk agar (CCEY). Isolates were presumptively identified by phenotypic characteristics and Gram stain and confirmed by singleplex real-time PCR (qPCR) assays detecting the species-specific tpi gene, toxin A (tcdA) gene, toxin B (tcdB) gene, and the binary toxin (cdtA/cdtB) genes. Confirmed C. difficile isolates were tested against a panel of eight antimicrobials (vancomycin, metronidazole, rifampicin, ciprofloxacin, tetracycline, clindamycin, erythromycin, and ceftriaxone) using E-test strips. Results C. difficile was detected in 57 (25%) of diarrheal patients over the age of two, 56 (98.2%) of whom received antimicrobials before the diarrheal episode. Amongst the 71 confirmed isolates, 69 (97.1%) harbored at least one toxin gene. More than half of the toxigenic isolates harbored a truncated tcdA gene. All isolates were sensitive to vancomycin, while three isolates (2.1%) were resistant to metronidazole (MIC >32 mg/L). High levels of resistance were observed to rifampicin (65/71, 91.5%), erythromycin (63/71, 88.7%), ciprofloxacin (59/71, 83.1%), clindamycin (57/71, 80.3%), and ceftriaxone (36/71, 50.7.8%). Among the resistant isolates, 61 (85.9%) were multidrug-resistant. Conclusion Multidrug-resistant C. difficile strains were a significant cause of healthcare facility-onset C. difficile infections in patients with prior antimicrobial exposure in this Kenyan hospital.
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Affiliation(s)
- Winnie C Mutai
- Department of Medical Microbiology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Marianne W Mureithi
- Department of Medical Microbiology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Omu Anzala
- Department of Medical Microbiology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Gunturu Revathi
- Department of Pathology, Division of Medical Microbiology, Aga Khan University Hospital, Nairobi, Kenya
| | - Brian Kullin
- Department of Molecular and Cell Biology, Faculty of Science, University of Cape Town, Cape Town, South Africa
| | - Magdaline Burugu
- Department of Medical Microbiology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | | | - Erick Odoyo
- US Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Peter Otieno
- US Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Lillian Musila
- US Army Medical Research Directorate-Africa, Nairobi, Kenya
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Forbes KM, Anzala O, Carlson CJ, Kelvin AA, Kuppalli K, Leroy EM, Maganga GD, Masika MM, Mombo IM, Mwaengo DM, Niama RF, Nziza J, Ogola J, Pickering BS, Rasmussen AL, Sironen T, Vapalahti O, Webala PW, Kindrachuk J. Towards a coordinated strategy for intercepting human disease emergence in Africa. The Lancet Microbe 2021; 2:e51-e52. [DOI: 10.1016/s2666-5247(20)30220-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 01/06/2023] Open
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Sabo M, Balkus J, Richardson B, Srinivasan S, Kimani J, Anzala O, Schwebke J, Fiedler T, Fredricks D, McClelland R. Analysis of the association between vaginal washing and changes in vaginal microbiota using broad range polymerase chain reaction with 16S rRNA gene amplicon sequencing. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2020.08.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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44
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Odera S, Mureithi M, Aballa A, Onyango N, Anzala O, Oyugi J. Latent tuberculosis among household contacts of pulmonary tuberculosis cases in Nairobi, Kenya. Pan Afr Med J 2020; 37:87. [PMID: 33244350 PMCID: PMC7680229 DOI: 10.11604/pamj.2020.37.87.21102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/19/2020] [Indexed: 11/12/2022] Open
Abstract
Introduction Household Contacts (HHCs) of Pulmonary Tuberculosis (PTB) patients have a higher risk of latent tuberculosis infection (LTBI). However, its prevalence and risk factors among adults living with PTB patients are poorly documented in Kenya. Objective to determine the prevalence and risk factors for LTBI among adult HHCs of PTB patients in Kenya. Methods this was an analytical cross-sectional study of HHCs of PTB patients in Nairobi, Kenya. Socio-demographic data was captured on questionnaires and blood samples drawn for Interferon gamma (IFN-γ) quantification. Univariate and multivariate analyses using the Statistical Package for Social Scientists (SPSS) was used to determine the prevalence of LTBI and risk factors at 95% Confidence Interval (CI). Results a total of 166 PTB patients yielded 175 HHCs of whom 29.7% (52/125) were males and 70.3% (123/125) were females. A majority of HHCs [65.7% (115/175)] lived in a single-room house with the patient and [37.7% (66/175)] were in the age group 30-39-years. The overall prevalence of LTBI was 55.7%, peaking among spouses of the patients [70.0% (14/20) and the 30-39 year age group [63.5% (42/66)]. Potential risk factors for LTBI included cohabiting with a PTB patient for 8 to 12 weeks [OR = 3.6 (0.70-18.5), p = 0.107], being a spouse of the patient [OR = 2.0 (0.72-5.47), p = 0.173] and sharing a single room with the patient [OR = 1.58 (0.84 - 2.97), p = 0.158]. Conclusion the high prevalence of LTBI among adult HHCs of PTB patients in this population demonstrates the need for targeted contact-screening programs in high TB transmission settings.
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Affiliation(s)
- Susan Odera
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Marianne Mureithi
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.,KAVI-Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Andrew Aballa
- Department of Medical Laboratory Sciences, School of Medicine, Kenyatta University, Nairobi, Kenya
| | - Noel Onyango
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Kenya
| | - Omu Anzala
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.,KAVI-Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Julius Oyugi
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.,University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi Kenya
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45
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Dawa J, Emukule GO, Barasa E, Widdowson MA, Anzala O, van Leeuwen E, Baguelin M, Chaves SS, Eggo RM. Seasonal influenza vaccination in Kenya: an economic evaluation using dynamic transmission modelling. BMC Med 2020; 18:223. [PMID: 32814581 PMCID: PMC7438179 DOI: 10.1186/s12916-020-01687-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 06/29/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There is substantial burden of seasonal influenza in Kenya, which led the government to consider introducing a national influenza vaccination programme. Given the cost implications of a nationwide programme, local economic evaluation data are needed to inform policy on the design and benefits of influenza vaccination. We set out to estimate the cost-effectiveness of seasonal influenza vaccination in Kenya. METHODS We fitted an age-stratified dynamic transmission model to active surveillance data from patients with influenza from 2010 to 2018. Using a societal perspective, we developed a decision tree cost-effectiveness model and estimated the incremental cost-effectiveness ratio (ICER) per disability-adjusted life year (DALY) averted for three vaccine target groups: children 6-23 months (strategy I), 2-5 years (strategy II) and 6-14 years (strategy III) with either the Southern Hemisphere influenza vaccine (Strategy A) or Northern Hemisphere vaccine (Strategy B) or both (Strategy C: twice yearly vaccination campaigns, or Strategy D: year-round vaccination campaigns). We assessed cost-effectiveness by calculating incremental net monetary benefits (INMB) using a willingness-to-pay (WTP) threshold of 1-51% of the annual gross domestic product per capita ($17-$872). RESULTS The mean number of infections across all ages was 2-15 million per year. When vaccination was well timed to influenza activity, the annual mean ICER per DALY averted for vaccinating children 6-23 months ranged between $749 and $1385 for strategy IA, $442 and $1877 for strategy IB, $678 and $4106 for strategy IC and $1147 and $7933 for strategy ID. For children 2-5 years, it ranged between $945 and $1573 for strategy IIA, $563 and $1869 for strategy IIB, $662 and $4085 for strategy IIC, and $1169 and $7897 for strategy IID. For children 6-14 years, it ranged between $923 and $3116 for strategy IIIA, $1005 and $2223 for strategy IIIB, $883 and $4727 for strategy IIIC and $1467 and $6813 for strategy IIID. Overall, no vaccination strategy was cost-effective at the minimum ($17) and median ($445) WTP thresholds. Vaccinating children 6-23 months once a year had the highest mean INMB value at $872 (WTP threshold upper limit); however, this strategy had very low probability of the highest net benefit. CONCLUSION Vaccinating children 6-23 months once a year was the most favourable vaccination option; however, the strategy is unlikely to be cost-effective given the current WTP thresholds.
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Affiliation(s)
- Jeanette Dawa
- KAVI-Institute of Clinical Research, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
- Washington State University Global Health Programs Kenya Office, Nairobi, Kenya.
| | - Gideon O Emukule
- Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
- Center for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Marc Alain Widdowson
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Omu Anzala
- KAVI-Institute of Clinical Research, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | | | - Marc Baguelin
- London School of Hygiene & Tropical Medicine, London, UK
- Imperial College London, London, UK
| | - Sandra S Chaves
- Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya
- Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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46
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Joag V, Obila O, Gajer P, Scott MC, Dizzell S, Humphrys M, Shahabi K, Huibner S, Shannon B, Tharao W, Mureithi M, Oyugi J, Kimani J, Kaushic C, Ravel J, Anzala O, Kaul R. Impact of Standard Bacterial Vaginosis Treatment on the Genital Microbiota, Immune Milieu, and Ex Vivo Human Immunodeficiency Virus Susceptibility. Clin Infect Dis 2020; 68:1675-1683. [PMID: 30407498 DOI: 10.1093/cid/ciy762] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [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: 05/12/2018] [Accepted: 08/31/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Genital immunology is a key determinant of human immunodeficiency virus (HIV) susceptibility. Both factors are modulated by bacterial vaginosis (BV) and, to some extent, by Lactobacillus iners, the genital Lactobacillus spp. that predominates in African, Caribbean, and other Black (ACB) women. We conducted a clinical trial to assess the impact of oral metronidazole treatment on the genital immune parameters of HIV acquisition risks in Kenyan women with BV. METHODS The primary endpoint was ex vivo cervical CD4+ T-cell HIV susceptibility after 1 month; secondary endpoints included genital cytokine/chemokine levels, cervical immune cell populations, and the composition of the cervico-vaginal microbiota by 16S ribosomal RNA gene amplicon sequencing. RESULTS BV resolved (Nugent score ≤ 3) at 1 month in 20/45 participants, and cervical CD4+ T-cell HIV entry was moderately reduced in all participants, regardless of treatment outcome. Resolution of BV and reduced abundances of BV-associated gram-negative taxa correlated with reduced genital interleukin (IL)-1α/β. However, BV resolution and the concomitant colonization by Lactobacillus iners substantially increased several genital chemokines associated with HIV acquisition, including interferon-γ inducible protein (IP)-10, macrophage inflammatory protein (MIP)-3α, and monokine induced by gamma interferon (MIG). In an independent cohort of ACB women, most of whom were BV-free, vaginal chemokines were again closely linked with L. iners abundance, though not other Lactobacillus spp. CONCLUSIONS BV treatment reduced genital CD4+ T-cell HIV susceptibility and IL-1 levels, but dramatically increased the genital chemokines that may enhance HIV susceptibility; the latter effect was related to the restoration of an Lactobacillus iners-dominated microbiota. Further studies are needed before treatment of asymptomatic BV can be recommended for HIV prevention in ACB communities.
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Affiliation(s)
- Vineet Joag
- Department of Immunology, University of Toronto, Ontario, Canada
| | - Onyango Obila
- Department of Medical Microbiology, University of Nairobi.,Kenya AIDS Vaccine Initiative, Institute of Clinical Research, Nairobi
| | - Pawel Gajer
- Institute for Genome Sciences.,Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore
| | - Milcah Carol Scott
- Department of Microbiology and Immunology, University of Minnesota, Minneapolis
| | - Sara Dizzell
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton
| | - Michael Humphrys
- Institute for Genome Sciences.,Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore
| | | | | | - Brett Shannon
- Department of Immunology, University of Toronto, Ontario, Canada
| | - Wangari Tharao
- Women's Health in Women's Hands Community Health Centre, Toronto, Ontario
| | - Marianne Mureithi
- Department of Medical Microbiology, University of Nairobi.,Kenya AIDS Vaccine Initiative, Institute of Clinical Research, Nairobi
| | - Julius Oyugi
- Department of Medical Microbiology, University of Nairobi.,Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada
| | - Joshua Kimani
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada
| | - Charu Kaushic
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton
| | - Jacques Ravel
- Institute for Genome Sciences.,Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore
| | - Omu Anzala
- Department of Medical Microbiology, University of Nairobi.,Kenya AIDS Vaccine Initiative, Institute of Clinical Research, Nairobi
| | - Rupert Kaul
- Department of Immunology, University of Toronto, Ontario, Canada.,Department of Medicine, University of Toronto
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47
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Mpendo J, Mutua G, Nanvubya A, Anzala O, Nyombayire J, Karita E, Dally L, Hannaman D, Price M, Fast PE, Priddy F, Gelderblom HC, Hills NK. Acceptability and tolerability of repeated intramuscular electroporation of Multi-antigenic HIV (HIVMAG) DNA vaccine among healthy African participants in a phase 1 randomized controlled trial. PLoS One 2020; 15:e0233151. [PMID: 32469893 PMCID: PMC7259687 DOI: 10.1371/journal.pone.0233151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 04/24/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction Intramuscular electroporation (IM/EP) is a vaccine delivery technique that improves the immunogenicity of DNA vaccines. We evaluated the acceptability and tolerability of electroporation among healthy African study participants. Methods Forty-five participants were administered a DNA vaccine (HIV-MAG) or placebo by electroporation at three visits occurring at four week-intervals. At the end of each visit, participants were asked to rate pain at four times: (1) when the device was placed on the skin and vaccine injected, before the electrical stimulation, (2) at the time of electrical stimulation and muscle contraction, and (3) at 10 minutes and (4) 30 minutes after the procedure was completed. For analyses, pain level was dichotomized as either “acceptable” (none/slight/uncomfortable) or “too much” (Intense, severe, and very severe) and examined over time using repeated measures models. Optional brief comments made by participants were summarized anecdotally. Results All 45 participants completed all three vaccination visits; none withdrew from the study due to the electroporation procedure. Most (76%) reported pain levels as acceptable at every time point across all vaccination visits. The majority of “unacceptable” pain was reported at the time of electrical stimulation. The majority of the participants (97%) commented that they preferred electroporation to standard injection. Conclusion Repeated intramuscular electroporation for vaccine delivery was found to be acceptable and feasible among healthy African HIV vaccine trial participants. The majority of participants reported an acceptable pain level at all vaccination time points. Further investigation may be warranted into the value of EP to improve immunization outcomes. ClinicalTrials.gov NCT01496989
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Affiliation(s)
- Juliet Mpendo
- Uganda Virus Research Institute-International AIDS Vaccine Initiative, HIV Vaccine Program, Entebbe, Uganda
- * E-mail:
| | - Gaudensia Mutua
- Kenya AIDS Vaccine Initiative, University of Nairobi, Nairobi, Kenya
| | - Annet Nanvubya
- Uganda Virus Research Institute-International AIDS Vaccine Initiative, HIV Vaccine Program, Entebbe, Uganda
| | - Omu Anzala
- Kenya AIDS Vaccine Initiative, University of Nairobi, Nairobi, Kenya
| | | | | | - Len Dally
- EMMES Corporation, Rockville, Maryland, United States of America
| | - Drew Hannaman
- Ichor Medical Systems, Inc., San Diego, California, United States of America
| | - Matt Price
- International AIDS Vaccine Initiative (IAVI), New York, NY, United States of America
| | - Patricia E. Fast
- International AIDS Vaccine Initiative (IAVI), New York, NY, United States of America
| | - Frances Priddy
- International AIDS Vaccine Initiative (IAVI), New York, NY, United States of America
| | - Huub C. Gelderblom
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Nancy K. Hills
- University of California at San Francisco, San Francisco, California, United States of America
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48
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Masika MM, Korhonen EM, Smura T, Uusitalo R, Vapalahti K, Mwaengo D, Jääskeläinen AJ, Anzala O, Vapalahti O, Huhtamo E. Detection of dengue virus type 2 of Indian origin in acute febrile patients in rural Kenya. PLoS Negl Trop Dis 2020; 14:e0008099. [PMID: 32126086 PMCID: PMC7069648 DOI: 10.1371/journal.pntd.0008099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 03/13/2020] [Accepted: 01/29/2020] [Indexed: 01/25/2023] Open
Abstract
Dengue virus (DENV) has caused recent outbreaks in coastal cities of Kenya, but the epidemiological situation in other areas of Kenya is largely unknown. We investigated the role of DENV infection as a cause of acute febrile disease in non-epidemic settings in rural and urban study areas in Kenya. Altogether, 560 patients were sampled in 2016–2017 in rural Taita–Taveta County (n = 327) and urban slums of Kibera, Nairobi (n = 233). The samples were studied for DENV IgM, IgG, NS1 antigen and flaviviral RNA. IgG seroprevalence was found to be higher in Taita–Taveta (14%) than in Nairobi (3%). Five Taita–Taveta patients were positive for flaviviral RNA, all identified as DENV-2, cosmopolitan genotype. Local transmission in Taita–Taveta was suspected in a patient without travel history. The sequence analysis suggested that DENV-2 strains circulating in coastal and southern Kenya likely arose from a single introduction from India. The molecular clock analyses dated the most recent ancestor to the Kenyan strains a year before the large 2013 outbreak in Mombasa. After this, the virus has been detected in Kilifi in 2014, from our patients in Taita–Taveta in 2016, and in an outbreak in Malindi in 2017. The results highlight that silent transmission occurs between epidemics and also affects rural areas. More information is needed to understand the local epidemiological characteristics and future risks of dengue in Kenya. Dengue virus (DENV) is an emerging mosquito-borne global health threat in the tropics and subtropics. The majority of the world’s population live in areas at risk of dengue that can cause a wide variety of symptoms from febrile illness to haemorrhagic fever. Information of DENV in Africa is limited and fragmented. In Kenya, dengue is a recognized disease in coastal cities that have experienced recent outbreaks. We investigated the role of DENV infection as a cause of acute febrile disease in non-epidemic settings in rural and urban study areas in Kenya. We found DENV-2 in five febrile patients from rural Taita–Taveta, where no dengue has been reported before. Genetic analysis of the virus suggests it to be most likely of Indian origin. This Indian origin DENV-2 was detected in the Mombasa outbreak in 2013, in Kilifi in 2014, in Taita–Taveta in 2016 (our study samples) and again in the Malindi outbreak in 2017. The results suggest that dengue is unrecognized in rural Kenya and more studies are needed for local risk assessment. Our findings of virus transmission between epidemics contribute to better understanding of the epidemiological situation and origins of DENV in Kenya.
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Affiliation(s)
- Moses Muia Masika
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Essi M. Korhonen
- Department of Virology, Medicum, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
- * E-mail:
| | - Teemu Smura
- Department of Virology, Medicum, University of Helsinki, Helsinki, Finland
| | - Ruut Uusitalo
- Department of Virology, Medicum, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
- Department of Geosciences and Geography, University of Helsinki, Helsinki, Finland
| | - Katariina Vapalahti
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
| | - Dufton Mwaengo
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Anne J. Jääskeläinen
- Department of Virology, Medicum, University of Helsinki, Helsinki, Finland
- Department of Virology and Immunology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Omu Anzala
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
- KAVI Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Olli Vapalahti
- Department of Virology, Medicum, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
- Department of Virology and Immunology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eili Huhtamo
- Department of Virology, Medicum, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland
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49
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Price MA, Rida W, Kilembe W, Karita E, Inambao M, Ruzagira E, Kamali A, Sanders EJ, Anzala O, Hunter E, Allen S, Edward VA, Wall KM, Tang J, Fast PE, Kaleebu P, Lakhi S, Mutua G, Bekker LG, Abu-Baker G, Tichacek A, Chetty P, Latka MH, Maenetje P, Makkan H, Kibengo F, Priddy F, Gilmour J. Control of the HIV-1 Load Varies by Viral Subtype in a Large Cohort of African Adults With Incident HIV-1 Infection. J Infect Dis 2020; 220:432-441. [PMID: 30938435 PMCID: PMC6603968 DOI: 10.1093/infdis/jiz127] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 03/22/2019] [Indexed: 12/14/2022] Open
Abstract
Few human immunodeficiency virus (HIV)–infected persons can maintain low viral levels without therapeutic intervention. We evaluate predictors of spontaneous control of the viral load (hereafter, “viral control”) in a prospective cohort of African adults shortly after HIV infection. Viral control was defined as ≥2 consecutively measured viral loads (VLs) of ≤10 000 copies/mL after the estimated date of infection, followed by at least 4 subsequent measurements for which the VL in at least 75% was ≤10 000 copies/mL in the absence of ART. Multivariable logistic regression characterized predictors of viral control. Of 590 eligible volunteers, 107 (18.1%) experienced viral control, of whom 25 (4.2%) maintained a VL of 51–2000 copies/mL, and 5 (0.8%) sustained a VL of ≤50 copies/mL. The median ART-free follow-up time was 3.3 years (range, 0.3–9.7 years). Factors independently associated with control were HIV-1 subtype A (reference, subtype C; adjusted odds ratio [aOR], 2.1 [95% confidence interval {CI}, 1.3–3.5]), female sex (reference, male sex; aOR, 1.8 [95% CI, 1.1–2.8]), and having HLA class I variant allele B*57 (reference, not having this allele; aOR, 1.9 [95% CI, 1.0–3.6]) in a multivariable model that also controlled for age at the time of infection and baseline CD4+ T-cell count. We observed strong associations between infecting HIV-1 subtype, HLA type, and sex on viral control in this cohort. HIV-1 subtype is important to consider when testing and designing new therapeutic and prevention technologies, including vaccines.
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Affiliation(s)
- Matt A Price
- International AIDS Vaccine Initiative, New York, New York.,Department of Epidemiology and Biostatistics, University of California-San Francisco
| | | | - William Kilembe
- Rwanda Zambia HIV Research Group, Lusaka and Ndola.,Rwanda Zambia HIV Research Group, Zambia and Kigali.,Rwanda Zambia HIV Research Group, Rwanda
| | - Etienne Karita
- Rwanda Zambia HIV Research Group, Lusaka and Ndola.,Rwanda Zambia HIV Research Group, Zambia and Kigali.,Rwanda Zambia HIV Research Group, Rwanda
| | - Mubiana Inambao
- Rwanda Zambia HIV Research Group, Lusaka and Ndola.,Rwanda Zambia HIV Research Group, Zambia and Kigali.,Rwanda Zambia HIV Research Group, Rwanda
| | | | - Anatoli Kamali
- International AIDS Vaccine Initiative, New York, New York
| | - Eduard J Sanders
- Kenyan Medical Research Institute-Wellcome Trust, Kilifi, Nairobi, Kenya.,Nuffield Department of Clinical Medicine, Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Headington, London, United Kingdom
| | - Omu Anzala
- KAVI Institute of Clinical Research, Nairobi, Kenya
| | - Eric Hunter
- Rwanda Zambia HIV Research Group, Lusaka and Ndola.,Rwanda Zambia HIV Research Group, Zambia and Kigali.,Rwanda Zambia HIV Research Group, Rwanda.,Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Lusaka and Ndola.,Rwanda Zambia HIV Research Group, Zambia and Kigali.,Rwanda Zambia HIV Research Group, Rwanda.,Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
| | - Vinodh A Edward
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut.,The Aurum Institute, South Africa.,School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, South Africa.,Advancing Care and Treatment for TB/HIV, South African Medical Research Council, Johannesburg, South Africa
| | - Kristin M Wall
- Rwanda Zambia HIV Research Group, Lusaka and Ndola.,Rwanda Zambia HIV Research Group, Zambia and Kigali.,Rwanda Zambia HIV Research Group, Rwanda.,Department of Epidemiology, Emory University, Atlanta, Georgia
| | - Jianming Tang
- Department of Medicine, University of Alabama-Birmingham
| | | | | | - Shabir Lakhi
- Rwanda Zambia HIV Research Group, Lusaka and Ndola.,Rwanda Zambia HIV Research Group, Zambia and Kigali.,Rwanda Zambia HIV Research Group, Rwanda
| | | | | | | | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Lusaka and Ndola.,Rwanda Zambia HIV Research Group, Zambia and Kigali.,Rwanda Zambia HIV Research Group, Rwanda.,Department of Epidemiology, Emory University, Atlanta, Georgia
| | - Paramesh Chetty
- International AIDS Vaccine Initiative, New York, New York.,International AIDS Vaccine Initiative Human Immunology Laboratory, London, United Kingdom
| | | | | | | | | | - Fran Priddy
- International AIDS Vaccine Initiative, New York, New York
| | - Jill Gilmour
- International AIDS Vaccine Initiative Human Immunology Laboratory, London, United Kingdom
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50
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Forbes KM, Webala PW, Jääskeläinen AJ, Abdurahman S, Ogola J, Masika MM, Kivistö I, Alburkat H, Plyusnin I, Levanov L, Korhonen EM, Huhtamo E, Mwaengo D, Smura T, Mirazimi A, Anzala O, Vapalahti O, Sironen T. Bombali Virus in Mops condylurus Bat, Kenya. Emerg Infect Dis 2019; 25:955-957. [PMID: 31002301 PMCID: PMC6478230 DOI: 10.3201/eid2505.181666] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Bombali virus (genus Ebolavirus) was identified in organs and excreta of an Angolan free-tailed bat (Mops condylurus) in Kenya. Complete genome analysis revealed 98% nucleotide sequence similarity to the prototype virus from Sierra Leone. No Ebola virus–specific RNA or antibodies were detected from febrile humans in the area who reported contact with bats.
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