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Bazzano AN, Keenan A, Woltz S, Subramanian A, Akpogheneta O, Coronado Daza J, Bazzano LAL. Quality and Content Concordance of International Clinical Guidelines on Hypertensive Disorders of Pregnancy Using the AGREE II Instrument: An Updated Systematic Review. J Cardiovasc Dev Dis 2023; 10:295. [PMID: 37504551 PMCID: PMC10380410 DOI: 10.3390/jcdd10070295] [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: 06/06/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023] Open
Abstract
Utilization of high-quality clinical practice guidelines has the potential to positively impact health outcomes. This study aimed to assess the quality and content concordance of national and international recommendations on hypertensive disorders of pregnancy (HDPs). Searches were conducted of the MEDLINE database and reference lists generated from national and international agencies. Covidence software was used for the management of the systematic review process, the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool was used to assess guidelines for quality, and three reviewers independently screened records. The research team identified and screened a total of 399 records of which 10 were deemed high quality. Guidelines were assessed and compared regarding the treatment, prevention, and categorization of disorders. The quality of guidelines varied across different domains, with significant variation in domain scores even within individual guidelines. Not all recommendations showed a high level of methodologic rigor, and the highest-rated guidelines were from the American Heart Association, the World Health Organization, and South Africa national guidelines. Classification of hypertension differed among the guidelines, particularly in defining chronic hypertension, severe hypertension, and preeclampsia. Prevention modalities varied across guidelines, with recommendations for aspirin, calcium supplementation, and against the use of certain approaches. Treatment modalities highlighted the importance of delivery as the definitive way to terminate hypertensive disorders of pregnancy, with other management strategies provided for symptom control. The variability in guidelines and consensus statements across different contexts may reflect regional differences in healthcare practices, available resources, and research evidence. There is potential to harmonize guidelines for HDP globally while considering the unique needs of individual countries. Where guidelines may be synthesized and condensed into an accessible format, doing so could improve their use in clinical decision-making.
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Affiliation(s)
- Alessandra N Bazzano
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Alexandra Keenan
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA 70112, USA
| | - Sara Woltz
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Advaith Subramanian
- The Murphy Institute, School of Liberal Arts, Tulane University, New Orleans, LA 70118, USA
| | - Onome Akpogheneta
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
- Infectious Diseases Program, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | | | - Lydia A L Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA 70112, USA
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2
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Alenquer M, Milheiro Silva T, Akpogheneta O, Ferreira F, Vale-Costa S, Medina-Lopes M, Batista F, Garcia AM, Barreto VM, Paulino C, Costa J, Sobral J, Diniz-da-Costa M, Ladeiro S, Corte-Real R, Delgado Alves J, Leite RB, Demengeot J, Rocha Brito MJ, Amorim MJ. Saliva molecular testing bypassing RNA extraction is suitable for monitoring and diagnosing SARS-CoV-2 infection in children. PLoS One 2022; 17:e0268388. [PMID: 35704567 PMCID: PMC9200166 DOI: 10.1371/journal.pone.0268388] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/28/2022] [Indexed: 01/08/2023] Open
Abstract
Background Adults are being vaccinated against SARS-CoV-2 worldwide, but the longitudinal protection of these vaccines is uncertain, given the ongoing appearance of SARS-CoV-2 variants. Children remain largely unvaccinated and are susceptible to infection, with studies reporting that they actively transmit the virus even when asymptomatic, thus affecting the community. Methods We investigated if saliva is an effective sample for detecting SARS-CoV-2 RNA and antibodies in children, and associated viral RNA levels to infectivity. For that, we used a saliva-based SARS-CoV-2 RT-qPCR test, preceded or not by RNA extraction, in 85 children aged 10 years and under, admitted to the hospital regardless of COVID-19 symptomatology. Amongst these, 29 (63.0%) presented at least one COVID-19 symptom, 46 (54.1%) were positive for SARS-CoV-2 infection, 28 (32.9%) were under the age of 1, and the mean (SD) age was 3.8 (3.4) years. Saliva samples were collected up to 48 h after a nasopharyngeal swab-RT-qPCR test. Results In children aged 10 years and under, the sensitivity, specificity, and accuracy of saliva-RT-qPCR tests compared to NP swab-RT-qPCR were, respectively, 84.8% (71.8%–92.4%), 100% (91.0%–100%), and 91.8% (84.0%–96.6%) with RNA extraction, and 81.8% (68.0%–90.5%), 100% (91.0%–100%), and 90.4% (82.1%–95.0%) without RNA extraction. Rescue of infectious particles from saliva was limited to CT values below 26. In addition, we found significant IgM positive responses to SARS-CoV-2 in children positive for SARS-CoV-2 by NP swab and negative by saliva compared to other groups, indicating late infection onset (>7–10 days). Conclusions Saliva is a suitable sample type for diagnosing children aged 10 years and under, including infants aged <1 year, even bypassing RNA extraction methods. Importantly, the detected viral RNA levels were significantly above the infectivity threshold in several samples. Further investigation is required to correlate SARS-CoV-2 RNA levels to viral transmission.
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Affiliation(s)
- Marta Alenquer
- Cell Biology of Viral Infection Lab, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Tiago Milheiro Silva
- Pediatric Infectious Disease Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Onome Akpogheneta
- Lymphocyte Physiology Lab, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Filipe Ferreira
- Cell Biology of Viral Infection Lab, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Sílvia Vale-Costa
- Cell Biology of Viral Infection Lab, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Mónica Medina-Lopes
- Cell Biology of Viral Infection Lab, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Frederico Batista
- Department of Medicine 4, Hospital Prof Doutor Fernando Fonseca, Amadora, Portugal
| | - Ana Margarida Garcia
- Pediatric Infectious Disease Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Vasco M. Barreto
- CEDOC NOVA, Centro de Estudos de Doenças Crónicas, Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Cathy Paulino
- Genomics Unit, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - João Costa
- Genomics Unit, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - João Sobral
- Genomics Unit, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | | | - Susana Ladeiro
- Genomics Unit, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Rita Corte-Real
- Molecular Biology Laboratory, Department of Clinical Pathology, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - José Delgado Alves
- Department of Medicine 4, Hospital Prof Doutor Fernando Fonseca, Amadora, Portugal
- CEDOC NOVA, Centro de Estudos de Doenças Crónicas, Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Ricardo B. Leite
- Genomics Unit, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Jocelyne Demengeot
- Lymphocyte Physiology Lab, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Maria João Rocha Brito
- Pediatric Infectious Disease Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Maria João Amorim
- Cell Biology of Viral Infection Lab, Instituto Gulbenkian de Ciência, Oeiras, Portugal
- * E-mail:
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3
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Faro-Viana J, Bergman ML, Gonçalves LA, Duarte N, Coutinho TP, Borges PC, Diwo C, Castro R, Matoso P, Malheiro V, Brennand A, Kosack L, Akpogheneta O, Figueira JM, Cardoso C, Casaca AM, Alves PM, Nunes T, Penha-Gonçalves C, Demengeot J. Population homogeneity for the antibody response to COVID-19 BNT162b2/Comirnaty vaccine is only reached after the second dose across all adult age ranges. Nat Commun 2022; 13:140. [PMID: 35013258 PMCID: PMC8748650 DOI: 10.1038/s41467-021-27761-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 07/05/2021] [Accepted: 12/03/2021] [Indexed: 12/13/2022] Open
Abstract
While mRNA vaccines are administrated worldwide in an effort to contain the COVID-19 pandemic, the heterogeneity of the humoral immune response they induce at the population scale remains unclear. Here, in a prospective, longitudinal, cohort-study, including 1245 hospital care workers and 146 nursing home residents scheduled for BNT162b2 vaccination, together covering adult ages from 19 to 99 years, we analyse seroconversion to SARS-CoV-2 spike protein and amount of spike-specific IgG, IgM and IgA before vaccination, and 3-5 weeks after each dose. We show that immunogenicity after a single vaccine dose is biased to IgG, heterogeneous and reduced with increasing age. The second vaccine dose normalizes IgG seroconversion in all age strata. These findings indicate two dose mRNA vaccines is required to reach population scale humoral immunity. The results advocate for the interval between the two doses not to be extended, and for serological monitoring of elderly and immunosuppressed vaccinees.
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Affiliation(s)
- João Faro-Viana
- CHLO, Centro Hospitalar de Lisboa Ocidental, Serviço de Patologia Clínica, Lisbon, 1449-005, Portugal
| | | | | | - Nádia Duarte
- IGC, Instituto Gulbenkian de Ciência, Oeiras, 2780-156, Portugal
| | - Teresa P Coutinho
- CIISA, Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Lisbon, 1300-477, Portugal
| | | | - Christian Diwo
- IGC, Instituto Gulbenkian de Ciência, Oeiras, 2780-156, Portugal
| | - Rute Castro
- IBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, 2780-901, Portugal
| | - Paula Matoso
- IGC, Instituto Gulbenkian de Ciência, Oeiras, 2780-156, Portugal
| | - Vanessa Malheiro
- IGC, Instituto Gulbenkian de Ciência, Oeiras, 2780-156, Portugal
| | - Ana Brennand
- IGC, Instituto Gulbenkian de Ciência, Oeiras, 2780-156, Portugal
| | - Lindsay Kosack
- IGC, Instituto Gulbenkian de Ciência, Oeiras, 2780-156, Portugal
| | | | - João M Figueira
- CHLO, Centro Hospitalar de Lisboa Ocidental, Serviço de Patologia Clínica, Lisbon, 1449-005, Portugal
| | - Conceição Cardoso
- CHLO, Centro Hospitalar de Lisboa Ocidental, Serviço de Patologia Clínica, Lisbon, 1449-005, Portugal
| | - Ana M Casaca
- CHLO, Centro Hospitalar de Lisboa Ocidental, Serviço de Patologia Clínica, Lisbon, 1449-005, Portugal
| | - Paula M Alves
- IBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, 2780-901, Portugal
- ITQB NOVA, Instituto de Tecnológia Química e Biológica António Xavier, Universidade Nova de Lisboa, Oeiras, 2780-157, Portugal
| | - Telmo Nunes
- CIISA, Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Lisbon, 1300-477, Portugal
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Weigert A, Bergman ML, Gonçalves LA, Godinho I, Duarte N, Abrantes R, Borges P, Brennand A, Malheiro V, Matoso P, Akpogheneta O, Kosack L, Cruz P, Nogueira E, Pereira M, Ferreira A, Marques M, Nunes T, Faro-Viana J, Demengeot J, Penha-Gonçalves C. Longitudinal Analysis of Antibody Responses to the mRNA BNT162b2 Vaccine in Patients Undergoing Maintenance Hemodialysis: A 6-Month Follow-Up. Front Med (Lausanne) 2021; 8:796676. [PMID: 35004771 PMCID: PMC8740691 DOI: 10.3389/fmed.2021.796676] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 11/24/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Patients on hemodialysis (HD) are at higher risk for COVID-19, overall are poor responders to vaccines, and were prioritized in the Portuguese vaccination campaign. Objective: This work aimed at evaluating in HD patients the immunogenicity of BTN162b2 after the two doses induction phase, the persistence of specific antibodies along time, and factors predicting these outcomes. Methods: We performed a prospective, 6-month long longitudinal cohort analysis of 156 HD patients scheduled to receive BTN162b2. ELISA quantified anti-spike IgG, IgM, and IgA levels in sera were collected every 3 weeks during the induction phase (t0 before vaccine; t1, d21 post first dose; and t2 d21 post second dose), and every 3-4 months during the waning phase (t3, d140, and t4, d180 post first dose). The age-matched control cohort was similarly analyzed from t0 to t2. Results: Upon exclusion of participants identified as previously exposed to SARS-CoV-2, seroconversion at t1 was lower in patients than controls (29 and 50%, respectively, p = 0.0014), while the second vaccine dose served as a boost in both cohorts (91 and 95% positivity, respectively, at t2, p = 0.2463). Lower response in patients than controls at t1 was a singularity of the participants ≤ 70 years (p = 2.01 × 10-05), associated with immunosuppressive therapies (p = 0.013), but not with lack of responsiveness to hepatitis B. Anti-spike IgG, IgM, and IgA levels decreased at t3, with IgG levels further waning at t4 and resulting in >30% seronegativity. Anti-spike IgG levels at t1 and t4 were correlated (ρ = 0.65, p < 2.2 × 10-16). Conclusions: While most HD patients seroconvert upon 2 doses of BNT162b2 vaccination, anti-spike antibodies levels wane over the following 4 months, leading to early seroreversion in a sizeable fraction of the patients. These findings warrant close monitoring of COVID-19 infection in vaccinated HD patients, and advocate for further studies following reinforced vaccination schedules.
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Affiliation(s)
- André Weigert
- DaVita Óbidos, Óbidos, Portugal
- Serviço de Nefrologia, Centro Hospitalar de Lisboa Ocidental, Hospital Santa Cruz, Carnaxide, Portugal
- Faculdade de Medicina, Instituto de Farmacologia e Neurociências, Universidade de Lisboa, Lisboa, Portugal
| | | | | | - Iolanda Godinho
- DaVita Óbidos, Óbidos, Portugal
- Serviço de Nefrologia e Transplantação Renal, Centro Hospitalar de Lisboa Norte EPE, Lisboa, Portugal
| | - Nádia Duarte
- IGC, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Rita Abrantes
- DaVita Óbidos, Óbidos, Portugal
- Serviço de Nefrologia, Centro Hospitalar do Médio Tejo, Torres Novas, Portugal
| | | | - Ana Brennand
- IGC, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | | | - Paula Matoso
- IGC, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | | | | | - Pedro Cruz
- DaVita Óbidos, Óbidos, Portugal
- Serviço de Nefrologia, Hospital Das Forças Armadas, Lisboa, Portugal
| | - Estela Nogueira
- DaVita Óbidos, Óbidos, Portugal
- Serviço de Nefrologia e Transplantação Renal, Centro Hospitalar de Lisboa Norte EPE, Lisboa, Portugal
| | | | | | | | - Telmo Nunes
- CIISA, Centro de Investigação Interdisciplinar em Sanidade Animal, Faculdade de Medicina Veterinária, Universidade de Lisboa, Lisboa, Portugal
| | - João Faro-Viana
- Serviço de Patologia Clínica, Centro Hospitalar de Lisboa Ocidental EPE, Carnaxide, Portugal
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5
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Castro R, Nobre LS, Eleutério RP, Thomaz M, Pires A, Monteiro SM, Mendes S, Gomes RA, Clemente JJ, Sousa MFQ, Pinto F, Silva AC, Freitas MC, Lemos AR, Akpogheneta O, Kosack L, Bergman ML, Duarte N, Matoso P, Costa J, Bandeiras TM, Gomes-Alves P, Gonçalves CP, Demengeot J, Alves PM. Production of high-quality SARS-CoV-2 antigens: Impact of bioprocess and storage on glycosylation, biophysical attributes, and ELISA serologic tests performance. Biotechnol Bioeng 2021; 118:2202-2219. [PMID: 33624859 PMCID: PMC8014509 DOI: 10.1002/bit.27725] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/22/2020] [Accepted: 02/18/2021] [Indexed: 12/17/2022]
Abstract
Serological assays are valuable tools to study SARS-CoV-2 spread and, importantly, to identify individuals that were already infected and would be potentially immune to a virus reinfection. SARS-CoV-2 Spike protein and its receptor binding domain (RBD) are the antigens with higher potential to develop SARS-CoV-2 serological assays. Moreover, structural studies of these antigens are key to understand the molecular basis for Spike interaction with angiotensin converting enzyme 2 receptor, hopefully enabling the development of COVID-19 therapeutics. Thus, it is urgent that significant amounts of this protein became available at the highest quality. In this study, we produced Spike and RBD in two human derived cell hosts: HEK293-E6 and Expi293F™. We evaluated the impact of different and scalable bioprocessing approaches on Spike and RBD production yields and, more importantly, on these antigens' quality attributes. Using negative and positive sera collected from human donors, we show an excellent performance of the produced antigens, assessed in serologic enzyme-linked immunosorbent assay (ELISA) tests, as denoted by the high specificity and sensitivity of the test. We show robust Spike productions with final yields of approx. 2 mg/L of culture that were maintained independently of the production scale or cell culture strategy. To the best of our knowledge, the final yield of 90 mg/L of culture obtained for RBD production, was the highest reported to date. An in-depth characterization of SARS-CoV-2 Spike and RBD proteins was performed, namely the antigen's oligomeric state, glycosylation profiles, and thermal stability during storage. The correlation of these quality attributes with ELISA performance show equivalent reactivity to SARS-CoV-2 positive serum, for all Spike and RBD produced, and for all storage conditions tested. Overall, we provide straightforward protocols to produce high-quality SARS-CoV-2 Spike and RBD antigens, that can be easily adapted to both academic and industrial settings; and integrate, for the first time, studies on the impact of bioprocess with an in-depth characterization of these proteins, correlating antigen's glycosylation and biophysical attributes to performance of COVID-19 serologic tests.
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Affiliation(s)
- Rute Castro
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal
| | - Lígia S Nobre
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal
| | - Rute P Eleutério
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal
| | - Mónica Thomaz
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal.,ITQB NOVA, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Av. da República, Oeiras, Portugal
| | - António Pires
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal
| | - Sandra M Monteiro
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal
| | - Sónia Mendes
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal
| | - Ricardo A Gomes
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal
| | - João J Clemente
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal
| | - Marcos F Q Sousa
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal.,ITQB NOVA, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Av. da República, Oeiras, Portugal
| | - Filipe Pinto
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal
| | - Ana C Silva
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal
| | - Micael C Freitas
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal.,ITQB NOVA, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Av. da República, Oeiras, Portugal
| | - Ana R Lemos
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal.,ITQB NOVA, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Av. da República, Oeiras, Portugal
| | | | | | | | - Nadia Duarte
- IGC, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Paula Matoso
- IGC, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Júlia Costa
- ITQB NOVA, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Av. da República, Oeiras, Portugal
| | - Tiago M Bandeiras
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal.,ITQB NOVA, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Av. da República, Oeiras, Portugal
| | - Patricia Gomes-Alves
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal.,ITQB NOVA, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Av. da República, Oeiras, Portugal
| | | | | | - Paula M Alves
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal.,ITQB NOVA, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Av. da República, Oeiras, Portugal
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Akpogheneta O, Dicks S, Grant D, Kanneh Z, Jusu B, Edem-Hotah J, Kanneh L, Alhasan F, Gbakie M, Schieffelin J, Ijaz S, Tedder R, Bower H. Boosting understanding of Lassa Fever virus epidemiology: Field testing a novel assay to identify past Lassa Fever virus infection in blood and oral fluids of survivors and unexposed controls in Sierra Leone. PLoS Negl Trop Dis 2021; 15:e0009255. [PMID: 33788861 PMCID: PMC8041174 DOI: 10.1371/journal.pntd.0009255] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 04/12/2021] [Accepted: 02/18/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite identification 50 years ago, the true burden of Lassa Fever (LF) across Africa remains undefined for reasons including research focus on hospitalised patients, lack of validated field-feasible tools which reliably identify past infection, and the fact that all assays require blood samples making large-scale surveys difficult. Designated a priority pathogen of epidemic potential requiring urgent research by the World Health Organisation, a better understanding of LF sero-epidemiology is essential to developing and evaluating new interventions including vaccines. We describe the first field testing of a novel species-neutral Double Antigen Binding Assay (DABA) designed to detect antibodies to LF in plasma and oral fluid. METHODOLOGY/PRINCIPAL FINDINGS Paired plasma and oral fluid were collected in Sierra Leone from survivors discharged from Kenema Government Hospital Lassa Fever Unit between 1980 and 2018, and from controls recruited in Freetown in 2019. Epidemiological sensitivity and specificity of the DABA measured against historical diagnosis in survivors and self-declared non-exposed controls was 81.7% (95% CI 70.7%- 89.9%) and 83.3% (72.7%- 91.1%) respectively in plasma, and 71.8% (60.0%- 81.9%) and 83.3% (72.7%- 91.1%) respectively in oral fluid. Antibodies were identified in people infected up to 15 years and, in one case, 40 years previously. Participants found oral fluid collection easy and painless with 80% happy to give an oral fluid sample regularly. CONCLUSIONS/SIGNIFICANCE Given the difficulties of assay validation in a resource-limited setting, including unexpected exposures and diagnostics of varying accuracy, the new assay performed well in both plasma and oral fluid. Sensitivity and specificity are expected to be higher when case/control ascertainment is more definitive and further work is planned to investigate this. Even at the performance levels achieved, the species-neutral DABA has the potential to facilitate the large-scale seroprevalence surveys needed to underpin essential developments in LF control, as well as support zoonotic investigations.
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Affiliation(s)
- Onome Akpogheneta
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Steve Dicks
- Blood Borne Virus Unit, Public Health England, Colindale, United Kingdom
- Microbiology Services, NHS Blood and Transplant, London, United Kingdom
| | - Donald Grant
- Kenema Government Hospital Lassa Fever Unit, Kenema, Sierra Leone
| | - Zainab Kanneh
- Kenema Government Hospital Lassa Fever Unit, Kenema, Sierra Leone
| | - Brima Jusu
- Kenema Government Hospital Lassa Fever Unit, Kenema, Sierra Leone
| | - Joseph Edem-Hotah
- Faculty of Nursing, University of Sierra Leone, Freetown, Sierra Leone
| | - Lansana Kanneh
- Kenema Government Hospital Lassa Fever Unit, Kenema, Sierra Leone
| | - Foday Alhasan
- Kenema Government Hospital Lassa Fever Unit, Kenema, Sierra Leone
| | - Michael Gbakie
- Kenema Government Hospital Lassa Fever Unit, Kenema, Sierra Leone
| | - John Schieffelin
- Sections of Infectious Disease, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Samreen Ijaz
- Blood Borne Virus Unit, Public Health England, Colindale, United Kingdom
| | - Richard Tedder
- Department of Infectious Disease, Imperial College, London, United Kingdom
| | - Hilary Bower
- UK Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine/Public Health England, London, United Kingdom
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7
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Dias S, Gama A, Abrantes P, Gomes I, Fonseca M, Reigado V, Simões D, Carreiras E, Mora C, Pinto Ferreira A, Akpogheneta O, Martins MO. Patterns of Sexual Risk Behavior, HIV Infection, and Use of Health Services Among Sub-Saharan African Migrants in Portugal. J Sex Res 2020; 57:906-913. [PMID: 31002270 DOI: 10.1080/00224499.2019.1601154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study identified patterns of sexual risk behavior among a sub-Saharan African migrant (SAM) population in Portugal and examined its associations with human immunodeficiency virus (HIV) prevalence, sociodemographics, use of sexual health services, and HIV testing. A cross-sectional biobehavioral survey was conducted with a venue-based sample of 790 SAMs. Data were collected using questionnaires and rapid HIV tests. Cluster analysis identified five subgroups with differing levels of HIV infection (2.5% to 11.3%). In Cluster 1, most participants reported sexual abstinence over the past year and the remaining used condoms consistently; this cluster had the highest HIV prevalence (11.3%). In Cluster 2, most reported one sexual partner and all reported unprotected sex; all HIV-positive participants in this cluster were unaware of their HIV-positive status. In Clusters 3 and 4, most had four or more partners, yet all used condoms. In Cluster 3, 56.5% reported both regular and occasional partners. In Cluster 4, 74% had only occasional partners; all engaged in commercial sex. In Cluster 5, all reported four or more partners and condomless sex. In all subgroups we found low rates of HIV testing and high unawareness of HIV serostatus. Targeted prevention interventions are needed to reduce unprotected sexual relations and undiagnosed infection, as well as improve linkage to sexual health services.
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Affiliation(s)
- Sónia Dias
- Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública , Universidade NOVA de Lisboa
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL
| | - Ana Gama
- Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública , Universidade NOVA de Lisboa
| | - Patrícia Abrantes
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL
| | - Isabel Gomes
- Center for Mathematics and Applications, Faculty of Sciences and Technology, Nova University of Lisbon
| | - Miguel Fonseca
- Center for Mathematics and Applications, Faculty of Sciences and Technology, Nova University of Lisbon
| | - Vera Reigado
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL
| | | | - Emília Carreiras
- AJPAS - Associação de Intervenção Comunitária, Desenvolvimento Social e de Saúde
| | - Cristina Mora
- AJPAS - Associação de Intervenção Comunitária, Desenvolvimento Social e de Saúde
| | | | - Onome Akpogheneta
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL
| | - Maria O Martins
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL
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Dias S, Gama A, Abrantes P, Akpogheneta O, Reigado V, Ferreira A, Carreiras E, Mora C, Simões D, Martins M. 5.5-O3Examining sexual risk, HIV infection and health services use: a cluster analysis with sub-Saharan African migrants. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Dias
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Portugal
| | - A Gama
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Portugal
| | - P Abrantes
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Portugal
| | - O Akpogheneta
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Portugal
| | - V Reigado
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Portugal
| | - A Ferreira
- Ser + - Associação Portuguesa para a Prevenção e Desafio à Sida, Cascais, Portugal
| | - E Carreiras
- AJPAS - Associação de Intervenção Comunitária, Desenvolvimento Social e de Saúde, Portugal
| | - C Mora
- AJPAS - Associação de Intervenção Comunitária, Desenvolvimento Social e de Saúde, Portugal
| | - D Simões
- GAT - Grupo de Ativistas em Tratamentos, Portugal
| | - M Martins
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Portugal
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White MT, Griffin JT, Akpogheneta O, Conway DJ, Koram KA, Riley EM, Ghani AC. Dynamics of the Antibody Response to Plasmodium falciparum Infection in African Children. J Infect Dis 2014; 210:1115-22. [DOI: 10.1093/infdis/jiu219] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Akpogheneta O. Why HIV leads infectious disease priorities. Lancet Infect Dis 2011; 11:502-503. [PMID: 21842547 DOI: 10.1016/s1473-3099(11)70160-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Akpogheneta O, Gil-Lamaignere C, Maloukou A, Roilides E. Antifungal activity of human polymorphonuclear and mononuclear phagocytes against non-fumigatus Aspergillus species. Mycoses 2003; 46:77-83. [PMID: 12870194 DOI: 10.1046/j.1439-0507.2003.00852.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Human phagocytic defenses against non-fumigatus aspergilli were compared with those against Aspergillus fumigatus. Monocyte-derived macrophages exhibited lower phagocytic capacities against non-fumigatus aspergilli, particularly A. nidulans and A. niger, compared with A fumigatus (P < 0.05). Non-opsonized hyphae suppressed oxidative burst (as measured by superoxide anion production) of polymorphonuclear leukocytes (PMNs). Further, these cells responded with less vigorous oxidative burst to serum-opsonized hyphae of non-fumigatus Aspergillus species, particularly A. flavus and A. terreus, compared with A. fumigatus (P < or = 0.05). Similarly, PMNs induced less hyphal damage assessed by XTT colorimetric assay to non-fumigatus species, particularly A. flavus and A. nidulans, compared with A. fumigatus (P < 0.05). Thus, non-fumigatus aspergilli are generally more resistant to mononuclear and polymorphonuclear phagocytes than A. fumigatus, a finding which should be considered during management of invasive aspergillosis caused by these species.
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Affiliation(s)
- O Akpogheneta
- 3rd Department of Pediatrics, Aristotle University of Thessaloniki, Hippokration Hospital, 49, Konstantinoupoleos St, GR-546 42 Thessaloniki, Greece
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Roilides E, Lyman CA, Filioti J, Akpogheneta O, Sein T, Lamaignere CG, Petraitiene R, Walsh TJ. Amphotericin B formulations exert additive antifungal activity in combination with pulmonary alveolar macrophages and polymorphonuclear leukocytes against Aspergillus fumigatus. Antimicrob Agents Chemother 2002; 46:1974-6. [PMID: 12019118 PMCID: PMC127213 DOI: 10.1128/aac.46.6.1974-1976.2002] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Deoxycholate amphotericin B (DAMB) and amphotericin B lipid complex (ABLC) additively augmented the fungicidal activity of pulmonary alveolar macrophages against the conidia of Aspergillus fumigatus. DAMB, ABLC, and liposomal amphotericin B similarly displayed additive effects with polymorphonuclear leukocytes in damaging the hyphal elements of A. fumigatus.
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Affiliation(s)
- Emmanuel Roilides
- 3rd Department of Pediatrics, University of Thessaloniki, Hippokration Hospital, Thessaloniki GR-54642, Greece
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