1
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Olorunfemi AB, Suliman SA, Tran TT, Ayorinde B, Fowora MA, Iwalokun BA, Olowe OA, Opaleye OO, Osman M, Salako BL, Adegbola R, Thomas BN, Pallerla SR, Velavan TP, Ojurongbe O. Whole genome sequencing and phylogenetic analysis of SARS-CoV-2 strains isolated during the COVID-19 pandemic in Nigeria. IJID Reg 2024; 10:174-178. [PMID: 38322246 PMCID: PMC10845906 DOI: 10.1016/j.ijregi.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/08/2024]
Abstract
Objectives The emergence and spread of SARS-CoV-2 have stimulated ongoing research into the virus transmission dynamics, circulating variants, and potential mutations. This study was conducted to understand the genomic dynamics of the epidemic in Nigeria. Design Whole genome sequencing was conducted on SARS-CoV-2 samples collected during the first and second outbreaks using the Oxford Nanopore MinION sequencing platform. Phylogenetic analysis was conducted, and genomes were grouped into different pangolin lineages. Results The study revealed four circulating SARS-CoV-2 variants. The Alpha (B.1.1.7) variant was the most prevalent (32.7%), followed by Beta (B.1 B.1.1, L.3, and B.1.1.318) (30.8%), Eta (B.1.525) (28.9%), and Delta (B.1.617, AY.1, AY.109, and AY.36) (7.7%). Phylogenetic analysis revealed three clusters with four Nextstrain clades (20I, 20B, 21D, and 21J). The Alpha lineages (B.1.1.7) clustered with references from Italy. The Beta lineages (Clade 20B) (B.11, B.11318, and L3) and sub-lineage B.11 were distinct. Sub-lineage B.11318 is clustered with references from the USA, whereas sub-lineage L3 is clustered with references from Russia, the Philippines, Australia, and Japan. The 21D and 21J, belonging to two Pango lineages, Eta (B.1525) and Delta (B.1.617 and AY.109), showed high genetic similarity. Conclusion The phylogenetic relatedness of the lineages suggests multiple virus introduction, which could be a source of more virulent, locally adapted variants.
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Affiliation(s)
- Adedolapo B. Olorunfemi
- Center for Emerging and Re-emerging Infectious Diseases, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | | | - Tung T. Tran
- Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Vietnam
| | - Babatunde Ayorinde
- Molecular Biology & Biotechnology Department, Nigerian Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
- Central Research Laboratory, Nigerian Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
| | - Muinah A. Fowora
- Molecular Biology & Biotechnology Department, Nigerian Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
- Central Research Laboratory, Nigerian Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
| | - Bamidele A. Iwalokun
- Molecular Biology & Biotechnology Department, Nigerian Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
- Central Research Laboratory, Nigerian Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
| | - Olugbenga A. Olowe
- Center for Emerging and Re-emerging Infectious Diseases, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Oluyinka O. Opaleye
- Center for Emerging and Re-emerging Infectious Diseases, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Mohamed Osman
- Institute of Endemic Diseases, University of Khartoum, Sudan
- York Biomedical Research Institute, Department of Biology, University of York, Wentworth Way, York YO10 5DD, UK
| | - Babatunde L. Salako
- Molecular Biology & Biotechnology Department, Nigerian Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
- Central Research Laboratory, Nigerian Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
| | - Richard Adegbola
- Molecular Biology & Biotechnology Department, Nigerian Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
- Central Research Laboratory, Nigerian Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
| | - Bolaji N. Thomas
- Department of Biomedical Sciences, College of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY 14623, USA
| | - Srinivas Reddy Pallerla
- Institute for Medical Virology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
- Institute of Tropical Medicine, Universitätsklinikum Tübingen, Universität Tübingen, Germany
| | - Thirumalaisamy P. Velavan
- Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Vietnam
- Institute of Tropical Medicine, Universitätsklinikum Tübingen, Universität Tübingen, Germany
| | - Olusola Ojurongbe
- Center for Emerging and Re-emerging Infectious Diseases, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
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Eugenia Afocha E, Abiodun Iwalokun B, Deji-Agboola MA, Ayorinde James B, Abayomi Banjo T, Adu F, Chukwujekwu Ezechi O, Adegbola R, Lawal Salako B. Prevalence and spatiotemporal distribution of rotavirus diarrhea among children younger than five years old in Lagos, Nigeria. J Immunoassay Immunochem 2023; 44:117-132. [PMID: 36576163 DOI: 10.1080/15321819.2022.2159430] [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: 12/29/2022]
Abstract
Data on spatiotemporal distribution of rotavirus diarrhea are limited in many endemic settings. This study determined the prevalence and seasonal distribution of rotavirus among Nigerian children with diarrhea. Here, a total of 406 fecal samples were collected from patients attending six health facilities in Lagos between January - December 2019. Socio-demographic data of each enrolled child were collected. Rotavirus VP6 antigen was detected by enzyme-linked immunoassay (ELISA) and confirmation by VP7 gene detection by reverse transcription polymerase-chain reaction. The overall rotavirus diarrhea prevalence was 16.3% by ELISA with children above 2 years having 29.2% of this prevalence and higher occurrence in females (59.1%) than males (40.9%) (P < .05). Rotavirus diarrhea diagnosis using RT-PCR showed 100% concordance with ELISA. Cases of rotavirus diarrhea were detected from March to July and from September to November with the highest number of cases detected in May and June (22.7% each), followed by July (21.2%). The prevalence of rotavirus diarrhea remains high in Lagos with an emerging higher disease activity in children above 2. A different rotavirus transmission dynamics compared to previous studies from Nigeria and other African countries was found. VP6 ELISA may reliably be used for continuous rotavirus surveillance in Nigeria.
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Affiliation(s)
- Ebelechukwu Eugenia Afocha
- Medical Microbiology & Parasitology Department, Olabisi Onabanjo University, Nigeria.,Centre for Infectious Disease Research, Microbiology Department, Nigerian Institute of Medical Research, Nigeria
| | - Bamidele Abiodun Iwalokun
- Medical Microbiology & Parasitology Department, Olabisi Onabanjo University, Nigeria.,Molecular Biology & Biotechnology Department, Nigerian Institute of Medical Research, Nigeria.,Central Research Laboratory Department, Nigerian Institute of Medical Research, Nigeria
| | | | | | - Taiwo Abayomi Banjo
- Medical Microbiology & Parasitology Department, Olabisi Onabanjo University, Nigeria
| | - Festus Adu
- All Saints University Medical School, Cnr Hillborough and Great George Street, Common Wealth of Dominica, West Indies
| | | | - Richard Adegbola
- Centre for Infectious Disease Research, Microbiology Department, Nigerian Institute of Medical Research, Nigeria
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3
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Fowora MA, Omolopo IA, Aiyedogbon A, Abioye A, Oladele OE, Tajudeen AO, Ogunniyan T, Olanlege AL, Onyeaghasiri FU, Edu-Muyideen IO, Iwalokun B, Adegbola R, Salako BL. Multidrug-Resistant Kocuria rosea and Methicillin-Resistant Staphylococcus aureus Co-Infection in a Nigerian Patient with COVID-19: A Case Report. Am J Case Rep 2023; 24:e938761. [PMID: 36998203 PMCID: PMC10071551 DOI: 10.12659/ajcr.938761] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
BACKGROUND Bacterial Infections, especially, of the respiratory system, have been reported as one of the medical concerns in patients with the Coronavirus Disease-2019 (COVID-19), particularly those with multiple co-morbidities. We present a case of a diabetic patient with co-infection of multi-drug-resistant Kocuria rosea and methicillin-resistant Staphylococcus aureus (MRSA) who contracted COVID-19. CASE REPORT A 72-year-old man with diabetes presented with symptoms including cough, chest pain, urinary incontinence, respiratory distress, sore throat, fever, diarrhea, loss of taste, and anosmia and was confirmed to have COVID-19. At admission, he was also found to have sepsis. MRSA was isolated in conjunction with another organism, resembling coagulase-negative Staphylococcus, which was misidentified using commercial biochemical testing systems. The strain was finally confirmed to be Kocuria rosea by 16S rRNA gene sequencing. Both strains were highly resistant to multiple classes of antibiotics, but the Kocuria rosea was resistant to all the cephalosporins, fluoroquinolones, and macrolides tested. The use of ceftriaxone and ciprofloxacin did not improve his condition, which ultimately led to his death. CONCLUSIONS This case report shows that the presence of multi-drug-resistant bacteria infections can be fatal in patients with COVID-19, especially in patients with other co-morbidities like diabetes. This case report also shows that biochemical testing may be inadequate in identifying emerging bacterial infections and there is a need to include proper bacterial screening and treatment in the management of COVID-19, especially in patients with other co-morbidities and with indwelling devices.
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Affiliation(s)
- Muinah Adenike Fowora
- Department of Molecular Biology and Biotechnology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Ibilola A. Omolopo
- Department of Molecular Biology and Biotechnology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Adenike Aiyedogbon
- Department of Molecular Biology and Biotechnology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Adefunke Abioye
- Intensive Care Unit, Infectious Diseases Hospital, Lagos, Nigeria
| | - Oluwatobi E. Oladele
- Department of Molecular Biology and Biotechnology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Ahmed Oluwasegun Tajudeen
- Department of Molecular Biology and Biotechnology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Tope Ogunniyan
- Infectious Diseases Unit, Infectious Diseases Hospital, Lagos, Nigeria
| | | | | | | | - Bamidele Iwalokun
- Department of Molecular Biology and Biotechnology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Richard Adegbola
- Department of Microbiology, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Babatunde Lawal Salako
- Department of Molecular Biology and Biotechnology, Nigerian Institute of Medical Research, Lagos, Nigeria
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4
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Abdullahi A, Oladele D, Owusu M, Kemp SA, Ayorinde J, Salako A, Fink D, Ige F, Ferreira IATM, Meng B, Sylverken AA, Onwuamah C, Boadu KO, Osuolale K, Frimpong JO, Abubakar R, Okuruawe A, Abdullahi HW, Liboro G, Agyemang LD, Ayisi-Boateng NK, Odubela O, Ohihoin G, Ezechi O, Kamasah JS, Ameyaw E, Arthur J, Kyei DB, Owusu DO, Usman O, Mogaji S, Dada A, Agyei G, Ebrahimi S, Gutierrez LC, Aliyu SH, Doffinger R, Audu R, Adegbola R, Mlcochova P, Phillips RO, Solako BL, Gupta RK. SARS-COV-2 antibody responses to AZD1222 vaccination in West Africa. Nat Commun 2022; 13:6131. [PMID: 36253377 PMCID: PMC9574797 DOI: 10.1038/s41467-022-33792-x] [Citation(s) in RCA: 10] [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: 07/07/2022] [Accepted: 09/23/2022] [Indexed: 12/24/2022] Open
Abstract
Real-world data on vaccine-elicited neutralising antibody responses for two-dose AZD1222 in African populations are limited. We assessed baseline SARS-CoV-2 seroprevalence and levels of protective neutralizing antibodies prior to vaccination rollout using binding antibodies analysis coupled with pseudotyped virus neutralisation assays in two cohorts from West Africa: Nigerian healthcare workers (n = 140) and a Ghanaian community cohort (n = 527) pre and post vaccination. We found 44 and 28% of pre-vaccination participants showed IgG anti-N positivity, increasing to 59 and 39% respectively with anti-receptor binding domain (RBD) IgG-specific antibodies. Previous IgG anti-N positivity significantly increased post two-dose neutralizing antibody titres in both populations. Serological evidence of breakthrough infection was observed in 8/49 (16%). Neutralising antibodies were observed to wane in both populations, especially in anti-N negative participants with an observed waning rate of 20% highlighting the need for a combination of additional markers to characterise previous infection. We conclude that AZD1222 is immunogenic in two independent West African cohorts with high background seroprevalence and incidence of breakthrough infection in 2021. Waning titres post second dose indicates the need for booster dosing after AZD1222 in the African setting despite hybrid immunity from previous infection.
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Affiliation(s)
- Adam Abdullahi
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge, UK.,Department of Medicine, University of Cambridge, Cambridge, UK.,Institute of Human Virology, Abuja, Nigeria
| | - David Oladele
- Nigeria Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
| | - Michael Owusu
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Steven A Kemp
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge, UK.,Department of Medicine, University of Cambridge, Cambridge, UK
| | - James Ayorinde
- Nigeria Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
| | - Abideen Salako
- Nigeria Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
| | - Douglas Fink
- Faculty of Infection and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Infection and Immunity, University College London, London, UK
| | - Fehintola Ige
- Nigeria Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
| | - Isabella A T M Ferreira
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge, UK.,Department of Medicine, University of Cambridge, Cambridge, UK
| | - Bo Meng
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge, UK.,Department of Medicine, University of Cambridge, Cambridge, UK
| | - Augustina Angelina Sylverken
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Chika Onwuamah
- Nigeria Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
| | | | - Kazeem Osuolale
- Nigeria Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
| | | | - Rufai Abubakar
- Nigeria Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
| | - Azuka Okuruawe
- Nigeria Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
| | | | - Gideon Liboro
- Nigeria Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
| | | | | | | | - Gregory Ohihoin
- Nigeria Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
| | - Oliver Ezechi
- Nigeria Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
| | | | - Emmanuel Ameyaw
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Derrick Boakye Kyei
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | | | - Olagoke Usman
- Federal Medical Centre, Ebutte Metta, Lagos, Nigeria
| | - Sunday Mogaji
- Federal Medical Centre, Ebutte Metta, Lagos, Nigeria
| | | | - George Agyei
- Kwadaso Seventh Day Adventist Hospital, Kumasi, Ghana
| | - Soraya Ebrahimi
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Lourdes Ceron Gutierrez
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Sani H Aliyu
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Rainer Doffinger
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Rosemary Audu
- Nigeria Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
| | - Richard Adegbola
- Nigeria Institute of Medical Research (NIMR), Yaba, Lagos, Nigeria
| | - Petra Mlcochova
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge, UK. .,Department of Medicine, University of Cambridge, Cambridge, UK.
| | - Richard Odame Phillips
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. .,Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana.
| | | | - Ravindra K Gupta
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Cambridge, UK. .,Department of Medicine, University of Cambridge, Cambridge, UK. .,Africa Health Research Institute, Durban, South Africa.
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5
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Senghore M, Chaguza C, Bojang E, Tientcheu PE, Bancroft RE, Lo SW, Gladstone RA, McGee L, Worwui A, Foster-Nyarko E, Ceesay F, Okoi CB, Klugman KP, Breiman RF, Bentley SD, Adegbola R, Antonio M, Hanage WP, Kwambana-Adams BA. Widespread sharing of pneumococcal strains in a rural African setting: proximate villages are more likely to share similar strains that are carried at multiple timepoints. Microb Genom 2022; 8. [PMID: 35119356 PMCID: PMC8942022 DOI: 10.1099/mgen.0.000732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The transmission dynamics of Streptococcus pneumoniae in sub-Saharan Africa are poorly understood due to a lack of adequate epidemiological and genomic data. Here we leverage a longitudinal cohort from 21 neighbouring villages in rural Africa to study how closely related strains of S. pneumoniae are shared among infants. We analysed 1074 pneumococcal genomes isolated from 102 infants from 21 villages. Strains were designated for unique serotype and sequence-type combinations, and we arbitrarily defined strain sharing where the pairwise genetic distance between strains could be accounted for by the mean within host intra-strain diversity. We used non-parametric statistical tests to assess the role of spatial distance and prolonged carriage on strain sharing using a logistic regression model. We recorded 458 carriage episodes including 318 (69.4 %) where the carried strain was shared with at least one other infant. The odds of strain sharing varied significantly across villages (χ2=47.5, df=21, P-value <0.001). Infants in close proximity to each other were more likely to be involved in strain sharing, but we also show a considerable amount of strain sharing across longer distances. Close geographic proximity (<5 km) between shared strains was associated with a significantly lower pairwise SNP distance compared to strains shared over longer distances (P-value <0.005). Sustained carriage of a shared strain among the infants was significantly more likely to occur if they resided in villages within a 5 km radius of each other (P-value <0.005, OR 3.7). Conversely, where both infants were transiently colonized by the shared strain, they were more likely to reside in villages separated by over 15 km (P-value <0.05, OR 1.5). PCV7 serotypes were rare (13.5 %) and were significantly less likely to be shared (P-value <0.001, OR −1.07). Strain sharing was more likely to occur over short geographical distances, especially where accompanied by sustained colonization. Our results show that strain sharing is a useful proxy for studying transmission dynamics in an under-sampled population with limited genomic data. This article contains data hosted by Microreact.
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Affiliation(s)
- Madikay Senghore
- WHO Regional Reference Laboratory (RRL), West Africa Strategy and Partnership, Medical Research Council Unit the Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia.,Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Chrispin Chaguza
- Infection Genomics, Wellcome Sanger Institute, Hinxton, UK.,Darwin College, University of Cambridge, Silver Street, Cambridge, UK.,Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Ebrima Bojang
- WHO Regional Reference Laboratory (RRL), West Africa Strategy and Partnership, Medical Research Council Unit the Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia
| | - Peggy-Estelle Tientcheu
- WHO Regional Reference Laboratory (RRL), West Africa Strategy and Partnership, Medical Research Council Unit the Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia
| | - Rowan E Bancroft
- WHO Regional Reference Laboratory (RRL), West Africa Strategy and Partnership, Medical Research Council Unit the Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia
| | - Stephanie W Lo
- Infection Genomics, Wellcome Sanger Institute, Hinxton, UK
| | | | - Lesley McGee
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Archibald Worwui
- WHO Regional Reference Laboratory (RRL), West Africa Strategy and Partnership, Medical Research Council Unit the Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia
| | - Ebenezer Foster-Nyarko
- WHO Regional Reference Laboratory (RRL), West Africa Strategy and Partnership, Medical Research Council Unit the Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia
| | - Fatima Ceesay
- WHO Regional Reference Laboratory (RRL), West Africa Strategy and Partnership, Medical Research Council Unit the Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia
| | - Catherine Bi Okoi
- WHO Regional Reference Laboratory (RRL), West Africa Strategy and Partnership, Medical Research Council Unit the Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia
| | - Keith P Klugman
- Rollins School Public Health, Emory University, Atlanta, USA
| | - Robert F Breiman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | | | - Richard Adegbola
- Immunisation and Global Health Consulting, RAMBICON, Lagos, Nigeria
| | - Martin Antonio
- WHO Regional Reference Laboratory (RRL), West Africa Strategy and Partnership, Medical Research Council Unit the Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia.,Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - William P Hanage
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Brenda A Kwambana-Adams
- WHO Regional Reference Laboratory (RRL), West Africa Strategy and Partnership, Medical Research Council Unit the Gambia at the London School of Hygiene and Tropical Medicine, Atlantic Road, Fajara, The Gambia.,NIHR Global Health Research Unit on Mucosal Pathogens, Division of Infection and Immunity, University College London, London, UK
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6
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Amoo OS, Adewara F, Tijani B, Onuigbo TI, Ikemefuna AS, Oraegbu JI, Rizvi T, Okwuraiwe A, Onwuamah C, Shaibu J, James A, Ohihoin G, Ige F, Kareithi D, David A, Karera S, Agboola H, Adeniyi A, Obi J, Achanya D, Odewale E, Oforomeh O, Liboro G, Nwogbe O, Ezechi O, Adegbola R, Audu R, Salako B. The use of DIY (Do it yourself) sampling and telemonitoring model for COVID-19 qPCR testing scale up. PLoS One 2021; 16:e0259398. [PMID: 34735503 PMCID: PMC8568151 DOI: 10.1371/journal.pone.0259398] [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: 06/15/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
The first case of COVID-19 in Nigeria was recorded on February 27, 2020, being an imported case by an Italian expatriate, to the country. Since then, there has been steady increase in the number of cases. However, the number of cases in Nigeria is low in comparison to cases reported by other countries with similar large populations, despite the poor health system prevailing in the country. This has been mainly attributed to the low testing capacity in Nigeria among other factors. Therefore, there is a need for innovative ways to increase the number of persons testing for COVID-19. The aim of the study was to pilot a nasopharyngeal swab self-sample collection model that would help increase COVID-19 testing while ensuring minimal person-to-person contact being experienced at the testing center. 216 participants took part in this study which was carried out at the Nigerian Institute of Medical Research between June and July 2020. Amongst the 216 participants, 174 tested negatives for both self-collected samples and samples collected by Professionals, 30 tested positive for both arms, with discrepancies occurring in 6 samples where the self-collected samples were positive while the ones collected by the professionals were negative. The same occurred in another set of 6 samples with the self-collected samples being negative and the professional-collected sample coming out positive, with a sensitivity of 83.3% and a specificity of 96.7%. The results of the interrater analysis are Kappa = 0.800 (95% CI, 0.690 to 0.910) which implies an outstanding agreement between the two COVID-19 sampling methods. Furthermore, since p< 0.001 Kappa (k) coefficient is statistically different from zero, our findings have shown that self-collected samples can be reliable in the diagnosis of COVID-19.
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Affiliation(s)
- Olufemi Samuel Amoo
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | | | | | | | | | - Joy Isioma Oraegbu
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Tazeen Rizvi
- Mobihealth International Limited, Abuja, Nigeria
| | - Azuka Okwuraiwe
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Chika Onwuamah
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Joseph Shaibu
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Ayorinde James
- Department of Biochemistry, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Greg Ohihoin
- Clinical Science Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Fehintola Ige
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | | | - Agatha David
- Clinical Science Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | | | - Hammed Agboola
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Anthony Adeniyi
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Josephine Obi
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Dominic Achanya
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Ebenezer Odewale
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Osaga Oforomeh
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Gideon Liboro
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Olayemi Nwogbe
- Department of Library and Information Technology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Oliver Ezechi
- Clinical Science Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Richard Adegbola
- Department of Biochemistry, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Rosemary Audu
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Babatunde Salako
- Department of Microbiology, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria
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7
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Iwalokun BA, Olalekan A, Adenipekun E, Ojo O, Iwalokun SO, Mutiu B, Orija O, Adegbola R, Salako B, Akinloye O. Improving the Understanding of the Immunopathogenesis of Lymphopenia as a Correlate of SARS-CoV-2 Infection Risk and Disease Progression in African Patients: Protocol for a Cross-sectional Study. JMIR Res Protoc 2021; 10:e21242. [PMID: 33621190 PMCID: PMC7935252 DOI: 10.2196/21242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/05/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic, caused by SARS-CoV-2, continues to impact health systems throughout the world with serious medical challenges being imposed on many African countries like Nigeria. Although emerging studies have identified lymphopenia as a driver of cytokine storm, disease progression, and poor outcomes in infected patients, its immunopathogenesis, as well as environmental and genetic determinants, remain unclear. Understanding the interplay of these determinants in the context of lymphopenia and COVID-19 complications in patients in Africa may help with risk stratification and appropriate deployment of targeted treatment regimens with repurposed drugs to improve prognosis. OBJECTIVE This study is designed to investigate the role of vitamin D status, vasculopathy, apoptotic pathways, and vitamin D receptor (VDR) gene polymorphisms in the immunopathogenesis of lymphopenia among African people infected with SARS-CoV-2. METHODS This cross-sectional study will enroll 230 participants, categorized as "SARS-CoV-2 negative" (n=69), "COVID-19 mild" (n=32), "hospitalized" (n=92), and "recovered" (n=37), from two health facilities in Lagos, Nigeria. Sociodemographic data, travel history, and information on comorbidities will be obtained from case files and through a pretested, interview-based structured questionnaire. Venous blood samples (5 mL) collected between 8 AM and 10 AM and aliquoted into EDTA (ethylenediaminetetraacetic acid) and plain tubes will be used for complete blood count and CD4 T cell assays to determine lymphopenia (lymphocyte count <1000 cells/µL) and CD4 T lymphocyte levels, as well as to measure the concentrations of vitamin D, caspase 3, soluble vascular cell adhesion molecule-1 (sVCAM-1), and soluble Fas ligand (sFasL) using an autoanalyzer, flow cytometry, and ELISA (enzyme-linked immunosorbent assay) techniques. Genomic DNA will be extracted from the buffy coat and used as a template for the amplification of apoptosis-related genes (Bax, Bcl-2, BCL2L12) by polymerase chain reaction (PCR) and genotyping of VDR (Apa1, Fok1, and Bsm1) gene polymorphisms by the PCR restriction fragment length polymorphism method and capillary sequencing. Total RNA will also be extracted, reverse transcribed, and subsequently quantitated by reverse transcription PCR (RT-PCR) to monitor the expression of apoptosis genes in the four participant categories. Data analyses, which include a test of association between VDR gene polymorphisms and study outcomes (lymphopenia and hypovitaminosis D prevalence, mild/moderate and severe infections) will be performed using the R statistical software. Hardy-Weinberg equilibrium and linkage disequilibrium analyses for the alleles, genotypes, and haplotypes of the genotyped VDR gene will also be carried out. RESULTS A total of 45 participants comprising 37 SARS-CoV-2-negative and 8 COVID-19-recovered individuals have been enrolled so far. Their complete blood counts and CD4 T lymphocyte counts have been determined, and their serum samples and genomic DNA and RNA samples have been extracted and stored at -20 °C until further analyses. Other expected outcomes include the prevalence and distribution of lymphopenia and hypovitaminosis D in the control (SARS-CoV-2 negative), confirmed, hospitalized, and recovered SARS-CoV-2-positive participants; association of lymphopenia with CD4 T lymphocyte level, serum vitamin D, sVCAM-1, sFasL, and caspase 3 levels in hospitalized patients with COVID-19; expression levels of apoptosis-related genes among hospitalized participants with COVID-19, and those with lymphopenia compared to those without lymphopenia; and frequency distribution of the alleles, genotypes, and haplotypes of VDR gene polymorphisms in COVID-19-infected participants. CONCLUSIONS This study will aid in the genotypic and phenotypic stratification of COVID-19-infected patients in Nigeria with and without lymphopenia to enable biomarker discovery and pave the way for the appropriate and timely deployment of patient-centered treatments to improve prognosis. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21242.
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Affiliation(s)
| | - Adesola Olalekan
- Department of Medical Laboratory Sciences, Faculty of Basic Medical Science, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Eyitayo Adenipekun
- Department of Medical Laboratory Sciences, Faculty of Basic Medical Science, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Olabisi Ojo
- Department of Natural Sciences, Albany State University, Georgia, GA, United States
| | | | - Bamidele Mutiu
- Department of Medical Microbiology & Parasitology, College of Medicine, Lagos State University, Lagos, Nigeria
| | - Oluseyi Orija
- Department of Public Health, National University, San Diego, CA, United States
| | - Richard Adegbola
- Microbiology Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | | | - Oluyemi Akinloye
- Department of Medical Laboratory Sciences, Faculty of Basic Medical Science, College of Medicine, University of Lagos, Lagos, Nigeria
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8
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Abstract
During the 20th century, the discovery of modern vaccines and ensuing mass vaccination dramatically decreased the incidence of many infectious diseases and in some cases eliminated them. Despite this, we are now witnessing a decrease in vaccine confidence that threatens to reverse the progress made. Considering the different extents of low vaccine confidence in different countries of the world, both developed and developing, we aim to contribute to the discussion of the reasons for this, and to propose some viable scientific solutions to build or help restore vaccine confidence worldwide.
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Affiliation(s)
- Selim Badur
- EM, Vaccines Scientific Affairs and Public Health, GSK, Istanbul, Turkey
| | - Martin Ota
- EM, Vaccines Scientific Affairs and Public Health, GSK, Wavre, Belgium
| | | | - Richard Adegbola
- Immunisation & Global Health Consulting, RAMBICON, Lagos, Nigeria
| | - Anil Dutta
- Vaccines R&D Medical, GSK, Wavre, Belgium
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9
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Vidal RM, Muhsen K, Tennant SM, Svennerholm AM, Sow SO, Sur D, Zaidi AKM, Faruque ASG, Saha D, Adegbola R, Hossain MJ, Alonso PL, Breiman RF, Bassat Q, Tamboura B, Sanogo D, Onwuchekwa U, Manna B, Ramamurthy T, Kanungo S, Ahmed S, Qureshi S, Quadri F, Hossain A, Das SK, Antonio M, Mandomando I, Nhampossa T, Acácio S, Omore R, Ochieng JB, Oundo JO, Mintz ED, O’Reilly CE, Berkeley LY, Livio S, Panchalingam S, Nasrin D, Farag TH, Wu Y, Sommerfelt H, Robins-Browne RM, Del Canto F, Hazen TH, Rasko DA, Kotloff KL, Nataro JP, Levine MM. Colonization factors among enterotoxigenic Escherichia coli isolates from children with moderate-to-severe diarrhea and from matched controls in the Global Enteric Multicenter Study (GEMS). PLoS Negl Trop Dis 2019; 13:e0007037. [PMID: 30608930 PMCID: PMC6343939 DOI: 10.1371/journal.pntd.0007037] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/23/2019] [Accepted: 11/28/2018] [Indexed: 12/29/2022] Open
Abstract
Background Enterotoxigenic Escherichia coli (ETEC) encoding heat-stable enterotoxin (ST) alone or with heat-labile enterotoxin (LT) cause moderate-to-severe diarrhea (MSD) in developing country children. The Global Enteric Multicenter Study (GEMS) identified ETEC encoding ST among the top four enteropathogens. Since the GEMS objective was to provide evidence to guide development and implementation of enteric vaccines and other interventions to diminish diarrheal disease morbidity and mortality, we examined colonization factor (CF) prevalence among ETEC isolates from children age <5 years with MSD and from matched controls in four African and three Asian sites. We also assessed strength of association of specific CFs with MSD. Methodology/Principal findings MSD cases enrolled at healthcare facilities over three years and matched controls were tested in a standardized manner for many enteropathogens. To identify ETEC, three E. coli colonies per child were tested by polymerase chain reaction (PCR) to detect genes encoding LT, ST; confirmed ETEC were examined by PCR for major CFs (Colonization Factor Antigen I [CFA/I] or Coli Surface [CS] antigens CS1-CS6) and minor CFs (CS7, CS12, CS13, CS14, CS17, CS18, CS19, CS20, CS21, CS30). ETEC from 806 cases had a single toxin/CF profile in three tested strains per child. Major CFs, components of multiple ETEC vaccine candidates, were detected in 66.0% of LT/ST and ST-only cases and were associated with MSD versus matched controls by conditional logistic regression (p≤0.006); major CFs detected in only 25.0% of LT-only cases weren’t associated with MSD. ETEC encoding exclusively CS14, identified among 19.9% of 291 ST-only and 1.5% of 259 LT/ST strains, were associated with MSD (p = 0.0011). No other minor CF exhibited prevalence ≥5% and significant association with MSD. Conclusions/Significance Major CF-based efficacious ETEC vaccines could potentially prevent up to 66% of pediatric MSD cases due to ST-encoding ETEC in developing countries; adding CS14 extends coverage to ~77%. Enterotoxigenic Escherichia coli (“ETEC”) were found to be one of the four most consistently important agents that cause moderate-to-severe diarrhea among children <5 years of age in a large case-control study, the Global Enteric Multicenter Study, performed in four countries in sub-Saharan Africa and three in South Asia. ETEC attach to the lining of the human small intestine by means of protein colonization factors (CFs), after which bacterial toxins stimulate intestinal secretion resulting in diarrhea. Moderate-to-severe diarrhea in young children in developing countries can lead to malnutrition and death. Vaccines are being developed to prevent ETEC diarrhea and its consequences. Several ETEC vaccines aim to stimulate antibodies (protective proteins) that will bind CFs and prevent the bacteria from attaching to intestinal cells, which should, in turn, prevent ETEC diarrhea. Different types of CFs exist. To guide the development of vaccines intending to provide broad protection against ETEC, one must know the frequency with which the different major CFs are produced by ETEC. This paper reports an extensive systematic survey of ETEC CFs and provides helpful information to guide the development of ETEC vaccines.
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Affiliation(s)
- Roberto M. Vidal
- Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Khitam Muhsen
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Sharon M. Tennant
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Ann-Mari Svennerholm
- Department of Microbiology and Immunology at Institute of Biomedicine, University of Göteborg, Göteborg, Sweden
| | - Samba O. Sow
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Dipika Sur
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Anita K. M. Zaidi
- Department of Paediatrics and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Abu S. G. Faruque
- International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh
| | - Debasish Saha
- Medical Research Council (United Kingdom) Unit, Fajara, The Gambia
| | - Richard Adegbola
- Medical Research Council (United Kingdom) Unit, Fajara, The Gambia
| | | | - Pedro L. Alonso
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Ctr. Int. Health Res. Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Robert F. Breiman
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya
- Global Disease Detection Division, Kenya Office of the US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Quique Bassat
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Ctr. Int. Health Res. Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Boubou Tamboura
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Doh Sanogo
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Uma Onwuchekwa
- Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Byomkesh Manna
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Suman Kanungo
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Shahnawaz Ahmed
- International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh
| | - Shahida Qureshi
- Department of Paediatrics and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Farheen Quadri
- Department of Paediatrics and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Anowar Hossain
- International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh
| | - Sumon K. Das
- International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh
| | - Martin Antonio
- Medical Research Council (United Kingdom) Unit, Fajara, The Gambia
| | | | | | - Sozinho Acácio
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
| | - Richard Omore
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya
| | - John B. Ochieng
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Joseph O. Oundo
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Eric D. Mintz
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ciara E. O’Reilly
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lynette Y. Berkeley
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Sofie Livio
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Sandra Panchalingam
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Dilruba Nasrin
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Tamer H. Farag
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Yukun Wu
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Halvor Sommerfelt
- Centre of Intervention Science in Maternal and Child Health, Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | - Roy M. Robins-Browne
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Victoria, Australia
| | - Felipe Del Canto
- Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Tracy H. Hazen
- The Institute of Genomic Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - David A. Rasko
- The Institute of Genomic Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Karen L. Kotloff
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - James P. Nataro
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Myron M. Levine
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, United States of America
- * E-mail:
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10
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Izurieta P, Bahety P, Adegbola R, Clarke C, Hoet B. Public health impact of pneumococcal conjugate vaccine infant immunization programs: assessment of invasive pneumococcal disease burden and serotype distribution. Expert Rev Vaccines 2018; 17:479-493. [DOI: 10.1080/14760584.2018.1413354] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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11
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Howie S, Bottomley C, Chimah O, Ideh R, Ebruke B, Okomo U, Onyeama C, Donkor S, Rodrigues O, Tapgun M, Janneh M, Oluwalana C, Kuti B, Enwere G, Esangbedo P, Doherty C, Mackenzie G, Greenwood B, Corrah T, Prentice A, Adegbola R, Zaman S. Zinc as an adjunct therapy in the management of severe pneumonia among Gambian children: randomized controlled trial. J Glob Health 2018; 8:010418. [PMID: 29713463 PMCID: PMC5908397 DOI: 10.7189/jogh.08.010418] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The benefit of zinc as an adjunct therapy for severe pneumonia is not established. We assessed the benefit of adjunct zinc therapy for severe pneumonia in children and determined whether the study children were zinc deficient. Methods This was a randomized, parallel group, double-blind, placebo-controlled trial with an allocation ratio of 1:1 conducted in children with severe pneumonia to evaluate the efficacy of daily zinc as an adjunct treatment in preventing 'treatment failure' (presence of any sign of severe pneumonia) on day-5 and day-10 and in reducing the time to resolution of signs of severe pneumonia. Six hundred and four children 2-59 months of age presenting with severe pneumonia at six urban and rural health care facilities in The Gambia were individually randomised to receive placebo (n = 301) or zinc (n = 303) for seven days. To determine if the study children were zinc deficient, supplementation was continued in a randomly selected subgroup of 121 children from each arm for six months post-enrolment, and height-gain, nutritional status, plasma zinc concentrations, and immune competence were compared. Results Percentage of treatment failure were similar in placebo and zinc arms both on day 5 (14.0% vs 14.1%) and day 10 (5.2% vs 5.9%). The time to recovery from lower chest wall indrawing and sternal retraction was longer in the placebo compared to zinc arm (24.4 vs 23.0 hours; P = 0.011 and 18.7 vs 11.0 hours; P = 0.006 respectively). The time to resolution for all respiratory symptoms of severity was not significantly different between placebo and zinc arms (42.3 vs 30.9 hours respectively; P = 0.242). In the six months follow-up sub-group, there was no significant difference in height gain, height-for-age and weight-for-height Z-scores, mid upper arm circumference, plasma zinc concentrations, and anergy at six months post-enrolment. Conclusions In this population, zinc given as an adjunct treatment for severe pneumonia showed no benefit in treatment failure rates, or clinically important benefit in time to recovery from respiratory symptoms and showed marginal benefit in rapidity of resolution of some signs of severity. This finding does not support routine use of zinc as an adjunct treatment in severe pneumonia in generally zinc replete children. Trial registration ISRCTN33548493.
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Affiliation(s)
- Stephen Howie
- Medical Research Council Unit The Gambia, Fajara, Gambia.,Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.,Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | | | - Readon Ideh
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | - Bernard Ebruke
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | - Uduak Okomo
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | | | - Simon Donkor
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | | | - Mary Tapgun
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | - Marie Janneh
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | | | - Bankole Kuti
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | - Godwin Enwere
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | | | - Conor Doherty
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | - Grant Mackenzie
- Medical Research Council Unit The Gambia, Fajara, Gambia.,London School of Hygiene and Tropical Medicine, London, UK.,Murdoch Childrens Research Institute, Melbourne, Australia
| | | | - Tumani Corrah
- Medical Research Council Unit The Gambia, Fajara, Gambia
| | - Andrew Prentice
- Medical Research Council Unit The Gambia, Fajara, Gambia.,London School of Hygiene and Tropical Medicine, London, UK
| | | | - Syed Zaman
- Medical Research Council Unit The Gambia, Fajara, Gambia.,London School of Hygiene and Tropical Medicine, London, UK.,Liverpool School of Tropical Medicine, Liverpool, UK
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12
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Kwambana-Adams B, Hanson B, Worwui A, Agbla S, Foster-Nyarko E, Ceesay F, Ebruke C, Egere U, Zhou Y, Ndukum M, Sodergren E, Barer M, Adegbola R, Weinstock G, Antonio M. Rapid replacement by non-vaccine pneumococcal serotypes may mitigate the impact of the pneumococcal conjugate vaccine on nasopharyngeal bacterial ecology. Sci Rep 2017; 7:8127. [PMID: 28811633 PMCID: PMC5557800 DOI: 10.1038/s41598-017-08717-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/13/2017] [Indexed: 01/07/2023] Open
Abstract
There is growing concern that interventions that alter microbial ecology can adversely affect health. We characterised the impact of the seven-valent pneumococcal conjugate vaccine (PCV7) on pneumococcal carriage and the bacterial component of the nasopharyngeal microbiome during infancy. Newborns were recruited into three groups as follows: Group1 (n = 33) was the control group and comprised infants who received PCV7 after 6 months and came from unvaccinated communities. Group 2 (n = 30) came from unvaccinated communities and Group 3 (n = 39) came from vaccinated communities. Both group 2 and 3 received PCV7 at 2, 3 and 4 months. Culture and 16 S rRNA gene sequencing were performed on nasopharyngeal specimens collected at regular intervals from infants. Nasopharyngeal carriage of PCV7 serotypes in Group 1 was significantly higher than in Group 2 and 3 (p < 0.01). However, pneumococcal carriage remained comparable due to an expansion of non-vaccine serotypes in Groups 2 and 3. Determination of phylogenetic dis(similarities) showed that the bacterial community structures were comparable across groups. A mixed effects model showed no difference in community richness (p = 0.15) and Shannon α-diversity (p = 0.48) across the groups. Immediate replacement of pneumococcal vaccine serotypes with non-vaccine serotypes may mitigate the impact of PCV7 on nasopharyngeal bacterial community structure and ecology.
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Affiliation(s)
- Brenda Kwambana-Adams
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia (MRCG), Fajara, The Gambia.
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Blake Hanson
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Archibald Worwui
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia (MRCG), Fajara, The Gambia
| | - Schadrac Agbla
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia (MRCG), Fajara, The Gambia
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ebenezer Foster-Nyarko
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia (MRCG), Fajara, The Gambia
| | - Fatima Ceesay
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia (MRCG), Fajara, The Gambia
| | - Chinelo Ebruke
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia (MRCG), Fajara, The Gambia
- London School of Hygiene and Tropical Medicine, London, UK
| | - Uzochukwu Egere
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia (MRCG), Fajara, The Gambia
| | - Yanjiao Zhou
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Maze Ndukum
- The Genome Instituted (Washington University in St Louis), St. Louis, Missouri, USA
| | - Erica Sodergren
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Michael Barer
- Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | | | - George Weinstock
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Martin Antonio
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia (MRCG), Fajara, The Gambia
- London School of Hygiene and Tropical Medicine, London, UK
- Division of Microbiology & Immunity, Warwick Medical School, University Of Warwick, Coventry, UK
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13
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Sow SO, Muhsen K, Nasrin D, Blackwelder WC, Wu Y, Farag TH, Panchalingam S, Sur D, Zaidi AKM, Faruque ASG, Saha D, Adegbola R, Alonso PL, Breiman RF, Bassat Q, Tamboura B, Sanogo D, Onwuchekwa U, Manna B, Ramamurthy T, Kanungo S, Ahmed S, Qureshi S, Quadri F, Hossain A, Das SK, Antonio M, Hossain MJ, Mandomando I, Nhampossa T, Acácio S, Omore R, Oundo JO, Ochieng JB, Mintz ED, O’Reilly CE, Berkeley LY, Livio S, Tennant SM, Sommerfelt H, Nataro JP, Ziv-Baran T, Robins-Browne RM, Mishcherkin V, Zhang J, Liu J, Houpt ER, Kotloff KL, Levine MM. The Burden of Cryptosporidium Diarrheal Disease among Children < 24 Months of Age in Moderate/High Mortality Regions of Sub-Saharan Africa and South Asia, Utilizing Data from the Global Enteric Multicenter Study (GEMS). PLoS Negl Trop Dis 2016; 10:e0004729. [PMID: 27219054 PMCID: PMC4878811 DOI: 10.1371/journal.pntd.0004729] [Citation(s) in RCA: 165] [Impact Index Per Article: 20.6] [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: 01/21/2016] [Accepted: 05/02/2016] [Indexed: 11/18/2022] Open
Abstract
Background The importance of Cryptosporidium as a pediatric enteropathogen in developing countries is recognized. Methods Data from the Global Enteric Multicenter Study (GEMS), a 3-year, 7-site, case-control study of moderate-to-severe diarrhea (MSD) and GEMS-1A (1-year study of MSD and less-severe diarrhea [LSD]) were analyzed. Stools from 12,110 MSD and 3,174 LSD cases among children aged <60 months and from 21,527 randomly-selected controls matched by age, sex and community were immunoassay-tested for Cryptosporidium. Species of a subset of Cryptosporidium-positive specimens were identified by PCR; GP60 sequencing identified anthroponotic C. parvum. Combined annual Cryptosporidium-attributable diarrhea incidences among children aged <24 months for African and Asian GEMS sites were extrapolated to sub-Saharan Africa and South Asian regions to estimate region-wide MSD and LSD burdens. Attributable and excess mortality due to Cryptosporidium diarrhea were estimated. Findings Cryptosporidium was significantly associated with MSD and LSD below age 24 months. Among Cryptosporidium-positive MSD cases, C. hominis was detected in 77.8% (95% CI, 73.0%-81.9%) and C. parvum in 9.9% (95% CI, 7.1%-13.6%); 92% of C. parvum tested were anthroponotic genotypes. Annual Cryptosporidium-attributable MSD incidence was 3.48 (95% CI, 2.27–4.67) and 3.18 (95% CI, 1.85–4.52) per 100 child-years in African and Asian infants, respectively, and 1.41 (95% CI, 0.73–2.08) and 1.36 (95% CI, 0.66–2.05) per 100 child-years in toddlers. Corresponding Cryptosporidium-attributable LSD incidences per 100 child-years were 2.52 (95% CI, 0.33–5.01) and 4.88 (95% CI, 0.82–8.92) in infants and 4.04 (95% CI, 0.56–7.51) and 4.71 (95% CI, 0.24–9.18) in toddlers. We estimate 2.9 and 4.7 million Cryptosporidium-attributable cases annually in children aged <24 months in the sub-Saharan Africa and India/Pakistan/Bangladesh/Nepal/Afghanistan regions, respectively, and ~202,000 Cryptosporidium-attributable deaths (regions combined). ~59,000 excess deaths occurred among Cryptosporidium-attributable diarrhea cases over expected if cases had been Cryptosporidium-negative. Conclusions The enormous African/Asian Cryptosporidium disease burden warrants investments to develop vaccines, diagnostics and therapies. Cryptosporidium is a protozoan that causes diarrhea and malnutrition in young children in developing countries, and is associated with diarrhea cases and outbreaks in developed countries. To date, limited information exists on the burden of Cryptosporidium diarrheal disease in sub-Saharan Africa and South Asia, where most diarrheal disease deaths occur. We estimated the burden of Cryptosporidium-diarrhea and associated deaths in these regions using data from the Global Enteric Multicenter Study (GEMS). Cryptosporidium was associated with diarrhea mainly in children aged <24 months. Infections began in the first few months of life but clinical episodes of Cryptosporidium-associated diarrhea illness peaked at age 6–11 months. The annual number of Cryptosporidium-attributable diarrhea episodes was estimated at 2.9 and 4.7 million in children aged <24 months in sub-Saharan Africa and in the India/Pakistan/Bangladesh/Afghanistan/Nepal region of South Asia, respectively. In both regions combined, Cryptosporidium is estimated to contribute to approximately 202,000 deaths per year, and to ~59,000 more deaths in Cryptosporidium-attributable cases than if those cases had been negative for Cryptosporidium. Our study highlights the enormous burden attributable to Cryptosporidium in Africa and Asia, which underscores the need for developing vaccines and treatments to reduce this burden.
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Affiliation(s)
- Samba O. Sow
- Centre pour le Développement des Vaccins, Bamako, Mali
| | - Khitam Muhsen
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Dilruba Nasrin
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - William C. Blackwelder
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Yukun Wu
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Emergent Biosolutions, Gaithersburg, Maryland, United States of America
| | - Tamer H. Farag
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Sandra Panchalingam
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Dipika Sur
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Anita K. M. Zaidi
- Department of Paediatrics and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Abu S. G. Faruque
- International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh
| | - Debasish Saha
- Medical Research Council (United Kingdom) Unit, Fajara, Gambia
- GSK Vaccines, Wavre, Belgium
| | - Richard Adegbola
- Medical Research Council (United Kingdom) Unit, Fajara, Gambia
- GSK Vaccines, Wavre, Belgium
| | - Pedro L. Alonso
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Robert F. Breiman
- Global Disease Detection Division, Kenya Office of the US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Quique Bassat
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | | | - Doh Sanogo
- Centre pour le Développement des Vaccins, Bamako, Mali
| | | | - Byomkesh Manna
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Suman Kanungo
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Shahnawaz Ahmed
- International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh
| | - Shahida Qureshi
- Department of Paediatrics and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Farheen Quadri
- Department of Paediatrics and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Anowar Hossain
- International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh
| | - Sumon K. Das
- International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh
| | - Martin Antonio
- Medical Research Council (United Kingdom) Unit, Fajara, Gambia
| | | | - Inacio Mandomando
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
| | - Sozinho Acácio
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique
| | - Richard Omore
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Joseph O. Oundo
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya
| | - John B. Ochieng
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Eric D. Mintz
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ciara E. O’Reilly
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lynette Y. Berkeley
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Sofie Livio
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Sharon M. Tennant
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Halvor Sommerfelt
- Centre of Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, and Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
| | - James P. Nataro
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Roy M. Robins-Browne
- Department of Microbiology and Immunology, The University of Melbourne, Murdoch Children’s Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Vladimir Mishcherkin
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Jixian Zhang
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, United States of America
| | - Jie Liu
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, United States of America
| | - Eric R. Houpt
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, United States of America
| | - Karen L. Kotloff
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Myron M. Levine
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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Adegbola R, Nesin M, Wairagkar N. Immunogenicity and efficacy of influenza immunization during pregnancy: recent and ongoing studies. Am J Obstet Gynecol 2012; 207:S28-32. [PMID: 22920055 DOI: 10.1016/j.ajog.2012.07.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 06/26/2012] [Accepted: 07/02/2012] [Indexed: 11/18/2022]
Abstract
Pregnant women and young infants are at increased risk from influenza. The World Health Organization and public health guidelines from Australia, Canada, and the United States recommend immunizing pregnant women with trivalent inactivated influenza vaccine. However, there are multiple barriers to the uptake of this recommendation. Additionally, current vaccines are not licensed for infants <6 months of age. Immunizing pregnant women would provide protection to both mothers and infants. The Bill & Melinda Gates Foundation (BMGF) and the National Institute of Allergy and Infectious Diseases (NIAID) are trying to address some of the issues associated with maternal immunization, which could be an effective intervention in both high- and low-resource settings to combat the significant maternal and infant morbidity and mortality due to influenza. BMGF and NIAID efforts are complementary to each other, focusing on evaluating the immunogenicity, efficacy, and safety of influenza vaccines during pregnancy; and the potential effect of maternal immunization on outcomes in infants in low-resource populations.
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15
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Velez Edwards DR, Tacconelli A, Wejse C, Hill PC, Morris GAJ, Edwards TL, Gilbert JR, Myers JL, Park YS, Stryjewski ME, Abbate E, Estevan R, Rabna P, Novelli G, Hamilton CD, Adegbola R, Østergaard L, Williams SM, Scott WK, Sirugo G. MCP1 SNPs and pulmonary tuberculosis in cohorts from West Africa, the USA and Argentina: lack of association or epistasis with IL12B polymorphisms. PLoS One 2012; 7:e32275. [PMID: 22384203 PMCID: PMC3288089 DOI: 10.1371/journal.pone.0032275] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 01/25/2012] [Indexed: 11/20/2022] Open
Abstract
The monocyte chemotactic protein-1 (MCP-1) is a chemokine that plays an important role in the recruitment of monocytes to M. tuberculosis infection sites, and previous studies have reported that genetic variants in MCP1 are associated with differential susceptibility to pulmonary tuberculosis (PTB). We examined eight MCP1 single nucleotide polymorphisms (SNPs) in a multi-ethnic, case-control design that included: 321 cases and 346 controls from Guinea-Bissau, 258 cases and 271 controls from The Gambia, 295 cases and 179 controls from the U.S. (African-Americans), and an additional set of 237 cases and 144 controls of European ancestry from the U.S. and Argentina. Two locus interactions were also examined for polymorphisms in MCP1 and interleukin 12B (IL12B), another gene implicated in PTB risk. Examination of previously associated MCP1 SNPs rs1024611 (-2581A/G), rs2857656 (-362G/C) and rs4586 (+900C/T) did not show evidence for association. One interaction between rs2857656 and IL12B SNP rs2288831 was observed among Africans but the effect was in the opposite direction in Guineans (OR = 1.90, p = 0.001) and Gambians (OR = 0.64, p = 0.024). Our data indicate that the effect of genetic variation within MCP1 is not clear cut and additional studies will be needed to elucidate its role in TB susceptibility.
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Affiliation(s)
- Digna R. Velez Edwards
- Dr. John T. Macdonald Foundation Department of Human Genetics and Miami Institute of Human Genomics, University of Miami, Miami, Florida, United States of America
- Center for Human Genetics Research, Vanderbilt University, Nashville, Tennessee, United States of America
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, and Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Alessandra Tacconelli
- Centro di Genetica, Centro di Ricerca Scientifica, Ospedale San Pietro FBF, Rome, Italy
| | - Christian Wejse
- Bandim Health Project, Danish Epidemiology Science Centre and Statens Serum Institute, Bissau, Guinea-Bissau
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
- Center for Global Health, School of Public Health, Aarhus University, Skejby, Denmark
| | - Philip C. Hill
- MRC Laboratories, Fajara, The Gambia (West Africa)
- Centre for International Health, University of Otago School of Medicine, Dunedin, New Zealand
| | | | - Todd L. Edwards
- Dr. John T. Macdonald Foundation Department of Human Genetics and Miami Institute of Human Genomics, University of Miami, Miami, Florida, United States of America
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - John R. Gilbert
- Dr. John T. Macdonald Foundation Department of Human Genetics and Miami Institute of Human Genomics, University of Miami, Miami, Florida, United States of America
| | - Jamie L. Myers
- Dr. John T. Macdonald Foundation Department of Human Genetics and Miami Institute of Human Genomics, University of Miami, Miami, Florida, United States of America
| | - Yo Son Park
- Dr. John T. Macdonald Foundation Department of Human Genetics and Miami Institute of Human Genomics, University of Miami, Miami, Florida, United States of America
| | - Martin E. Stryjewski
- Division of Infectious Diseases, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno” (CEMIC), Buenos Aires, Argentina
| | - Eduardo Abbate
- Department of Medicine, Hospital F. J. Muñiz, Buenos Aires, Argentina
| | - Rosa Estevan
- Department of Medicine, Hospital F. J. Muñiz, Buenos Aires, Argentina
| | - Paulo Rabna
- Bandim Health Project, Danish Epidemiology Science Centre and Statens Serum Institute, Bissau, Guinea-Bissau
| | - Giuseppe Novelli
- Centro di Genetica, Centro di Ricerca Scientifica, Ospedale San Pietro FBF, Rome, Italy
- Dipartimento di Biopatologia e Diagnostica per Immagini, Università di Tor Vergata, Rome, Italy
| | - Carol D. Hamilton
- Family Health International 360, Research Triangle Park, North Carolina, United States of America
- Duke University Medical Center, Durham, North Carolina, United States of America
| | - Richard Adegbola
- MRC Laboratories, Fajara, The Gambia (West Africa)
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Lars Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
| | - Scott M. Williams
- Center for Human Genetics Research, Vanderbilt University, Nashville, Tennessee, United States of America
| | - William K. Scott
- Dr. John T. Macdonald Foundation Department of Human Genetics and Miami Institute of Human Genomics, University of Miami, Miami, Florida, United States of America
| | - Giorgio Sirugo
- Centro di Genetica, Centro di Ricerca Scientifica, Ospedale San Pietro FBF, Rome, Italy
- MRC Laboratories, Fajara, The Gambia (West Africa)
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16
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Obaro S, Lawson L, Essen U, Ibrahim K, Brooks K, Otuneye A, Shetima D, Ahmed P, Ajose T, Olugbile M, Idiong D, Ogundeji D, Ochigbo C, Olanipekun G, Khalife W, Adegbola R. Community acquired bacteremia in young children from central Nigeria--a pilot study. BMC Infect Dis 2011; 11:137. [PMID: 21595963 PMCID: PMC3111365 DOI: 10.1186/1471-2334-11-137] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 05/19/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reports of the etiology of bacteremia in children from Nigeria are sparse and have been confounded by wide spread non-prescription antibiotic use and suboptimal laboratory culture techniques. We aimed to determine causative agents and underlying predisposing conditions of bacteremia in Nigerian children using data arising during the introduction of an automated blood culture system accessed by 7 hospitals and clinics in the Abuja area. METHODS Between September 2008 and November 2009, we enrolled children with clinically suspected bacteremia at rural and urban clinical facilities in Abuja or within the Federal Capital Territory of Nigeria. Blood was cultured using an automated system with antibiotic removing device. We documented clinical features in all children and tested for prior antibiotic use in a random sample of sera from children from each site. RESULTS 969 children aged 2 months-5 years were evaluated. Mean age was 21±15.2 months. All children were not systematically screened but there were 59 (6%) children with established diagnosis of sickle cell disease and 42 (4.3%) with HIV infection. Overall, 212 (20.7%) had a positive blood culture but in only 105 (10.8%) were these considered to be clinically significant. Three agents, Staphylococcus aureus (20.9%), Salmonella typhi (20.9%) and Acinetobacter (12.3%) accounted for over half of the positive cultures. Streptococcus pneumoniae and non-typhi Salmonellae each accounted for 7.6%. Although not the leading cause of bacteremia, Streptococcus pneumoniae was the single leading cause of all deaths that occurred during hospitalization and after hospital discharge. CONCLUSION S. typhi is a significant cause of vaccine-preventable morbidity while S. pneumoniae may be a leading cause of mortality in this setting. This observation contrasts with reports from most other African countries where non-typhi Salmonellae are predominant in young children. Expanded surveillance is required to confirm the preliminary observations from this pilot study to inform implementation of appropriate public health control measures.
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Affiliation(s)
- Stephen Obaro
- Michigan State University, East Lansing, MI 48824, USA.
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17
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Morris GAJ, Edwards DRV, Hill PC, Wejse C, Bisseye C, Olesen R, Edwards TL, Gilbert JR, Myers JL, Stryjewski ME, Abbate E, Estevan R, Hamilton CD, Tacconelli A, Novelli G, Brunetti E, Aaby P, Sodemann M, Østergaard L, Adegbola R, Williams SM, Scott WK, Sirugo G. Interleukin 12B (IL12B) genetic variation and pulmonary tuberculosis: a study of cohorts from The Gambia, Guinea-Bissau, United States and Argentina. PLoS One 2011; 6:e16656. [PMID: 21339808 PMCID: PMC3037276 DOI: 10.1371/journal.pone.0016656] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [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: 08/25/2010] [Accepted: 01/09/2011] [Indexed: 11/18/2022] Open
Abstract
We examined whether polymorphisms in interleukin-12B (IL12B) associate with susceptibility to pulmonary tuberculosis (PTB) in two West African populations (from The Gambia and Guinea-Bissau) and in two independent populations from North and South America. Nine polymorphisms (seven SNPs, one insertion/deletion, one microsatellite) were analyzed in 321 PTB cases and 346 controls from Guinea-Bissau and 280 PTB cases and 286 controls from The Gambia. For replication we studied 281 case and 179 control African-American samples and 221 cases and 144 controls of European ancestry from the US and Argentina. First-stage single locus analyses revealed signals of association at IL12B 3′ UTR SNP rs3212227 (unadjusted allelic p = 0.04; additive genotypic p = 0.05, OR = 0.78, 95% CI [0.61–0.99]) in Guinea-Bissau and rs11574790 (unadjusted allelic p = 0.05; additive genotypic p = 0.05, OR = 0.76, 95% CI [0.58–1.00]) in The Gambia. Association of rs3212227 was then replicated in African-Americans (rs3212227 allelic p = 0.002; additive genotypic p = 0.05, OR = 0.78, 95% CI [0.61–1.00]); most importantly, in the African-American cohort, multiple significant signals of association (seven of the nine polymorphisms tested) were detected throughout the gene. These data suggest that genetic variation in IL12B, a highly relevant candidate gene, is a risk factor for PTB in populations of African ancestry, although further studies will be required to confirm this association and identify the precise mechanism underlying it.
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Affiliation(s)
| | - Digna R. Velez Edwards
- Unità di Genetica Medica, Ospedale San Pietro FBF, Rome, Italy
- Dr. John T. Macdonald Foundation Department of Human Genetics and Hussman Institute of Human Genomics, University of Miami, Florida, United States of America
| | - Philip C. Hill
- MRC Laboratories, Fajara, The Gambia (West Africa)
- Centre for International Health, University of Otago School of Medicine, New Zealand
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
- Bandim Health Project, Danish Epidemiology Science Centre and Statens Serum Institute, Bissau, Guinea-Bissau
| | | | - Rikke Olesen
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
| | - Todd L. Edwards
- Unità di Genetica Medica, Ospedale San Pietro FBF, Rome, Italy
- Dr. John T. Macdonald Foundation Department of Human Genetics and Hussman Institute of Human Genomics, University of Miami, Florida, United States of America
| | - John R. Gilbert
- Dr. John T. Macdonald Foundation Department of Human Genetics and Hussman Institute of Human Genomics, University of Miami, Florida, United States of America
| | - Jamie L. Myers
- Dr. John T. Macdonald Foundation Department of Human Genetics and Hussman Institute of Human Genomics, University of Miami, Florida, United States of America
| | - Martin E. Stryjewski
- Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno” (CEMIC), Division of Infectious Diseases, Department of Medicine, Buenos Aires, Argentina
| | - Eduardo Abbate
- Hospital F.J. Muñiz, Department of Medicine, Buenos Aires, Argentina
| | - Rosa Estevan
- Hospital F.J. Muñiz, Department of Medicine, Buenos Aires, Argentina
| | - Carol D. Hamilton
- Family Health International, Research Triangle Park, North Carolina, United States of America and Duke University Medical Center, Durham, North Carolina, United States of America
| | | | - Giuseppe Novelli
- Dipartimento di Biopatologia e Diagnostica per Immagini, Università di Tor Vergata, Rome, Italy
| | - Ercole Brunetti
- Unità di Genetica Medica, Ospedale San Pietro FBF, Rome, Italy
| | - Peter Aaby
- Bandim Health Project, Danish Epidemiology Science Centre and Statens Serum Institute, Bissau, Guinea-Bissau
| | | | - Lars Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
| | | | - Scott M. Williams
- Center for Human Genetics Research, Vanderbilt University, Nashville, Tennessee, United States of America
| | - William K. Scott
- Dr. John T. Macdonald Foundation Department of Human Genetics and Hussman Institute of Human Genomics, University of Miami, Florida, United States of America
- * E-mail: (WKS); (GS)
| | - Giorgio Sirugo
- Unità di Genetica Medica, Ospedale San Pietro FBF, Rome, Italy
- * E-mail: (WKS); (GS)
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18
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Weinberger DM, Harboe ZB, Sanders EAM, Ndiritu M, Klugman KP, Rückinger S, Dagan R, Adegbola R, Cutts F, Johnson HL, O'Brien KL, Scott JA, Lipsitch M. Association of serotype with risk of death due to pneumococcal pneumonia: a meta-analysis. Clin Infect Dis 2010; 51:692-9. [PMID: 20715907 DOI: 10.1086/655828] [Citation(s) in RCA: 253] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The 92 capsular serotypes of Streptococcus pneumoniae differ greatly in nasopharyngeal carriage prevalence, invasiveness, and disease incidence. There has been some debate, though, regarding whether serotype independently affects the outcome of invasive pneumococcal disease (IPD). Published studies have shown variable results with regard to case-fatality ratios for specific serotypes and the role of host factors in affecting these relationships. We evaluated whether risk of death due to IPD is a stable serotype-associated property across studies and then compared the pooled effect estimates with epidemiologic and biological correlates. METHODS We performed a systematic review and meta-analysis of serotype-specific disease outcomes for patients with pneumonia and meningitis. Study-specific estimates of risk of death (risk ratio [RR]) were pooled from 9 studies that provided serotype-specific data on pneumonia and meningitis using a random-effects method with serotype 14 as the reference. Pooled RRs were compared with RRs from adults with low comorbidity scores to evaluate potential confounding by host factors. RESULTS Significant differences were found in the RR estimates among serotypes in patients with bacteremic pneumonia. Overall, serotypes 1, 7F, and 8 were associated with decreased RRs, and serotypes 3, 6A, 6B, 9N, and 19F were associated with increased RRs. Outcomes among meningitis patients did not differ significantly among serotypes. Serotypes with increased RRs had a high carriage prevalence, had low invasiveness, and were more heavily encapsulated in vitro. CONCLUSIONS These results suggest that IPD outcome, like other epidemiologic measures, is a stable serotype-associated property.
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Affiliation(s)
- Daniel M Weinberger
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, USA.
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Juhas M, Power PM, Harding RM, Ferguson DJP, Dimopoulou ID, Elamin ARE, Mohd-Zain Z, Hood DW, Adegbola R, Erwin A, Smith A, Munson RS, Harrison A, Mansfield L, Bentley S, Crook DW. Sequence and functional analyses of Haemophilus spp. genomic islands. Genome Biol 2008; 8:R237. [PMID: 17996041 PMCID: PMC2258188 DOI: 10.1186/gb-2007-8-11-r237] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [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: 06/29/2007] [Revised: 09/14/2007] [Accepted: 11/08/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A major part of horizontal gene transfer that contributes to the diversification and adaptation of bacteria is facilitated by genomic islands. The evolution of these islands is poorly understood. Some progress was made with the identification of a set of phylogenetically related genomic islands among the Proteobacteria, recognized from the investigation of the evolutionary origins of a Haemophilus influenzae antibiotic resistance island, namely ICEHin1056. More clarity comes from this comparative analysis of seven complete sequences of the ICEHin1056 genomic island subfamily. RESULTS These genomic islands have core and accessory genes in approximately equal proportion, with none demonstrating recent acquisition from other islands. The number of variable sites within core genes is similar to that found in the host bacteria. Furthermore, the GC content of the core genes is similar to that of the host bacteria (38% to 40%). Most of the core gene content is formed by the syntenic type IV secretion system dependent conjugative module and replicative module. GC content and lack of variable sites indicate that the antibiotic resistance genes were acquired relatively recently. An analysis of conjugation efficiency and antibiotic susceptibility demonstrates that phenotypic expression of genomic island-borne genes differs between different hosts. CONCLUSION Genomic islands of the ICEHin1056 subfamily have a longstanding relationship with H. influenzae and H. parainfluenzae and are co-evolving as semi-autonomous genomes within the 'supragenomes' of their host species. They have promoted bacterial diversity and adaptation through becoming efficient vectors of antibiotic resistance by the recent acquisition of antibiotic resistance transposons.
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Affiliation(s)
- Mario Juhas
- Clinical Microbiology and Infectious Diseases, NDCLS, University of Oxford, Headley Way, Oxford OX3 9DU, UK.
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Lagunju IA, Falade AG, Akinbami FO, Adegbola R, Bakare RA. Childhood bacterial meningitis in Ibadan, Nigeria--antibiotic sensitivity pattern of pathogens, prognostic indices and outcome. Afr J Med Med Sci 2008; 37:185-191. [PMID: 18939404] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Bacterial meningitis remains a major cause of morbidity, mortality and neurodisability in childhood, particularly in the developing world where effective vaccines against the usual pathogens responsible for the disease are not in routine use. To describe the patterns and outcome of bacterial meningitis among children admitted into the University College Hospital (UCH), Ibadan, Nigeria. All children who satisfied the case definition for meningitis, admitted into the paediatric wards of the University College Hospital, UCH, Ibadan over a period of 30 months were prospectively enrolled and blood and CSF samples were taken for bacteriological analyses. A total of 97 children, 62 males and 35 females were studied. Their ages ranged between 2 months and 12 years, mean age 33.0 (SD=41.7) months, with 80.4% of the cases below the age of 5 years. Haemophilus influenzae type b (Hib) was the leading pathogen, found in 16 (55.1%) of the 29 cases of definite meningitis. Other isolates include Streptococcus pneumoniae (24.1%), Klebsiella spp (7.0%), Staphylococcus aureus (7.0%), Escherichia coli (3.4%) and Pseudomonas spp. (3.4%). Hib and pneumococcus showed varying degrees of resistance to chloramphenicol, penicillin and cotrimoxazole. Twenty six (26.8%) of the cases died and 67.6% of the survivors developed significant neurological sequele. Bacterial meningitis remains a major cause of childhood mortality and neurodisability. Hib and pneumococcus remain the major pathogens responsible for this dreadful disease in Ibadan, Nigeria. The increasing emergence of antibiotic resistance calls for institution of adequate control measures, particularly routine childhood immunisation against the disease.
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Affiliation(s)
- I A Lagunju
- Department of Paediatrics, University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria.
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21
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Enwere G, Cheung YB, Zaman SMA, Akano A, Oluwalana C, Brown O, Vaughan A, Adegbola R, Greenwood B, Cutts F. Epidemiology and clinical features of pneumonia according to radiographic findings in Gambian children. Trop Med Int Health 2007; 12:1377-85. [DOI: 10.1111/j.1365-3156.2007.01922.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hill P, Jeffries D, Brookes R, Fox A, Jackson-Sillah D, Lugos M, Donkor S, de Jong B, Corrah T, Adegbola R, McAdam K. P1625 Using ELISPOT to expose false positive skin test conversion in tuberculosis contacts. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71464-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Howie S, Zaman SMA, Omoruyi O, Adegbola R, Prentice A. Severe pneumonia research and the problem of case definition: the example of zinc trials. Am J Clin Nutr 2007; 85:242-3; author reply 243. [PMID: 17209204 DOI: 10.1093/ajcn/85.1.242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Enwere G, Biney E, Cheung YB, Zaman SMA, Okoko B, Oluwalana C, Vaughan A, Greenwood B, Adegbola R, Cutts FT. Epidemiologic and clinical characteristics of community-acquired invasive bacterial infections in children aged 2-29 months in The Gambia. Pediatr Infect Dis J 2006; 25:700-5. [PMID: 16874169 DOI: 10.1097/01.inf.0000226839.30925.a5] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The incidence of community-acquired bacteremia (CAB) in Africa is several-fold higher than in industrialized countries. We report here the incidence of invasive bacterial infections in rural Gambia and compare the clinical characteristics of children with pneumococcal infection with those of children with extraintestinal nontyphoidal salmonella infection (NTS) or other bacterial infections. METHODS As part of a pneumococcal conjugate vaccine trial, we investigated children aged 2-29 months who presented with signs suggestive of invasive bacterial infections. RESULTS The incidence of invasive bacterial infections in all subjects was 1009 (95% CI, 903-1124) cases per 100,000 person-years. It was 1108 (95% CI, 953-1282) among children who had not received pneumococcal conjugate vaccine. Incidence decreased with increasing age but remained relatively high in 24- to 29-month-olds for pneumococcal infections. Pneumococcal infection was more frequent than NTS infections in the hot dry season. Respiratory symptoms and signs, consolidation on chest radiograph, and a primary diagnosis of pneumonia were more frequent in children with pneumococcal infection than in those with NTS or other infections. Diarrhea, laboratory evidence of malaria infection, and a primary diagnosis of malaria were more common in children with NTS infections. CONCLUSIONS Bacterial infections continue to cause significant morbidity in rural Africa. Although vaccines could greatly reduce the pneumococcal burden, a high index of suspicion and appropriate use of antimicrobials are needed to manage other causes of invasive bacterial infections.
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Greenaway C, Lienhardt C, Adegbola R, Brusasca P, McAdam K, Menzies D. Humoral response to Mycobacterium tuberculosis antigens in patients with tuberculosis in the Gambia. Int J Tuberc Lung Dis 2005; 9:1112-9. [PMID: 16229222] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE To determine and compare the sensitivity and specificity of four common mycobacterial antigens with three RD-1 region antigens in the serological diagnosis of active pulmonary tuberculosis (PTB) in the Gambia. DESIGN Serum from 300 Gambians (100 with active PTB, 100 of their household contacts, and 100 community controls) was tested using an ELISA method to detect antibodies to seven mycobacterial antigens (three encoded in the RD-1 region [ESAT-6, CFP-10 and Rv3871] and four common [38 kDa, GLU-S, 19 kDa and 14 kDa]). Individuals with active TB were recruited from one of the National Leprosy and TB Control Program clinics in the western region of the Gambia, and neighborhood controls were an age-matched individual living within five houses of the case. RESULTS The sensitivity of the RD-1 antigens ranged from 34% to 67%, while specificity ranged from 51% to 71%. The sensitivity of the common antigens ranged from 24% to 75% and specificity from 26% to 75%. CONCLUSION In countries with high rates of TB, such as the Gambia, the clinical utility of serological testing to diagnose active TB remains limited, even with newer antigens encoded in the RD-1 region of Mycobacterium tuberculosis.
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Affiliation(s)
- C Greenaway
- Division of Infectious Diseases and Medical Microbiology, SMBD-Jewish General Hospital, Montreal, Quebec, Canada.
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Lienhardt C, Fielding K, Sillah JS, Bah B, Gustafson P, Warndorff D, Palayew M, Lisse I, Donkor S, Diallo S, Manneh K, Adegbola R, Aaby P, Bah-Sow O, Bennett S, McAdam K. Investigation of the risk factors for tuberculosis: a case-control study in three countries in West Africa. Int J Epidemiol 2005; 34:914-23. [PMID: 15914505 DOI: 10.1093/ije/dyi100] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Host-related and environment-related factors have been shown to play a role in the development of tuberculosis (TB), but few studies were carried out to identify their respective roles in resource-poor countries. METHODS A multicentre case-control study was conducted in Guinée, Guinea Bissau, and The Gambia, from January 1999 to March 2001. Cases were newly detected smear positive TB patients. Two controls were recruited for each case, one within the household of the case, and one in the community. RESULTS Regarding host-related factors, univariate analysis by conditional logistic regression of 687 matched pairs of cases and household controls showed that TB was associated with male sex, family history of TB, absence of a BCG scar, smoking, alcohol, anaemia, HIV infection, and history and treatment of worm infection. In a multivariable model based on 601 matched pairs, male sex, family history of TB, smoking, and HIV infection were independent risk factors of TB. The investigation of environmental factors based on the comparison of 816 cases/community control pairs showed that the risk of TB was associated with single marital status, family history of TB, adult crowding, and renting the house. In a final model assessing the combined effect of host and environmental factors, TB was associated with male sex, HIV infection, smoking (with a dose-effect relationship), history of asthma, family history of TB, marital status, adult crowding, and renting the house. CONCLUSION TB is a multifactorial disorder, in which environment interacts with host-related factors. This study provided useful information for the assessment of host and environmental factors of TB for the improvement of TB control activities in developing countries.
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Rathman G, Sillah J, Hill PC, Murray JF, Adegbola R, Corrah T, Lienhardt C, McAdam KPWJ. Clinical and radiological presentation of 340 adults with smear-positive tuberculosis in The Gambia. Int J Tuberc Lung Dis 2003; 7:942-7. [PMID: 14552563] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
SETTING Four clinics in The Gambia. OBJECTIVE To document clinical and radiographic presentations of sputum smear-positive tuberculosis in adults. DESIGN Newly diagnosed acid-fast bacilli (AFB) smear, culture-positive tuberculosis patients aged > or = 15 years were interviewed and examined, and underwent tuberculin skin testing, HIV testing and chest X-ray reviewed by a chest physician using set criteria. RESULTS Of 340 patients enrolled (median age 29 years; males 73%), 8.3% were HIV-positive. One-third reported haemoptysis, > 90% reported weight loss and fever, and wasting was the most common sign (69%). Crepitations were the most frequent auscultatory finding (41%). The most common radiological lesion was a patchy infiltrate (> 90%). Cavitation was present in 206 patients (60.6%), most frequently occurred in the upper lung fields, was associated with increasing bacterial load in the sputum, and was less prevalent in HIV-positive patients (45% vs. 62%; P = 0.07). Auscultatory and chest X-ray findings matched only one-third of the time. CONCLUSION In our setting, wasting is the most common clinical sign of sputum smear-positive tuberculosis. Auscultatory findings correlate poorly with radiological abnormalities. Cavitation is associated with increasing bacterial load in the sputum, and is therefore a strong indicator for early treatment.
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Affiliation(s)
- G Rathman
- University of Minnesota, Department of Medicine, Minneapolis, Minnesota, USA
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Abstract
AIM Investigation of the natural history of trachomatous trichiasis in the Gambia and of the outcome of self epilation and surgery for the condition. METHODS A 1 year longitudinal study of 190 subjects with trichiasis was performed. Major trichiasis cases (five lashes or more) were referred for surgery and minor trichiasis cases were advised to epilate. Outcome measures included progression of trichiasis and corneal scarring; attendance for and results of surgery. RESULTS 34 of 148 (23%, 95% CI 16 to 31) subjects with major trichiasis attended for surgery over the year. Progression from minor to major trichiasis occurred in 18 of 55 subjects (33%, 95% CI 21 to 47). Progression of corneal scarring occurred in 60 of 167 patients (36%, 95% CI 29 to 44). Clinically active trachoma and conjunctival bacterial isolation predicted progression of corneal opacity. Surgery was successful in 39 of 54 (72%) eyes. CONCLUSIONS Despite the overall decline in trachoma in the Gambia, patients with both minor and major trichiasis remain at risk of developing corneal opacity. Active trachomatous inflammation and additional infection with bacteria may accelerate this process. Antibiotic treatment for trichiasis patients (in addition to surgery) should be investigated. Surgery for minor trichiasis may be indicated. Regular audit of surgical results is necessary with retraining where needed.
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Affiliation(s)
- R J C Bowman
- International Centre for Eye Health, 11-43 Bath Street, London EC1V 9EL, UK.
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Abstract
Modern biotechnology has made possible the rapid development and introduction into clinical care of a wide spectrum of potent antimicrobial agents. However, the battle against Streptococcus pneumoniae (pneumococcus) has remained fierce, as acquisition of resistance is even more rapid and these antimicrobial agents are rendered ineffective. Obtaining appropriate antibiotic treatment for severe invasive pneumococcal infections is now a major challenge in many regions of the world. The ground-breaking success of Haemophilus influenzae type b (Hib) conjugate vaccine has brought hope for the conquest of other capsulate bacteria. Recent results of efficacy trials of a heptavalent pneumococcal conjugate vaccine bring hope that protein conjugate vaccines will have a similar impact on pneumococcal disease. These multivalent vaccine formulations include pneumococcal serotypes that most often acquire antibiotic resistance and there is hope that the widespread application of these vaccines will decrease the incidence of multi-drug-resistant infections. The potential reduction of pneumococcal disease could even extend to unimmunised younger siblings and the elderly residing with immunised young children, through its herd effect. However, in view of the multiplicity of serotypes and the biology of the pneumococcus, optimism must be tempered by caution.
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Affiliation(s)
| | - Richard Adegbola
- Department of Paediatrics, Imperial College School of Medicine, St Mary's Hospital, Norfolk Place, London W2 1PG, UK and *Medical Research Council Laboratories, PO Box 273, Fajara, The Gambia, West Africa
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Leach A, McArdle TF, Banya WA, Krubally O, Greenwood AM, Rands C, Adegbola R, de Francisco A, Greenwood BM. Neonatal mortality in a rural area of The Gambia. Ann Trop Paediatr 1999; 19:33-43. [PMID: 10605518 DOI: 10.1080/02724939992617] [Citation(s) in RCA: 46] [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] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Childhood mortality in Upper River Division, The Gambia is high, 99 per 1000 mid-year population, and 27% of deaths occur is the neonatal period. The aims of the present study were to describe patterns of neonatal death and to identify risk factors. Cause of death was investigated using a neonatal post-mortem questionnaire, and a population-based, matched case-control study was conducted to identify potential risk factors. The neonatal mortality rate in Upper River Division was 39 per 1000 live births (95% CI 36.8-41.2). The rates in the early and late neonatal periods were 21.0 (19.4-22.6) and 18.0 (16.5-19.5), respectively. Infection accounted for 57% of all deaths. In the early neonatal period, 30% of deaths were due to prematurity. Only 55% of babies who died presented for treatment and 84% died at home. Risk factors for neonatal death were primiparity (OR 2.18), previous stillbirth (OR 3.19), prolonged labour (OR 2.80) and pre-lacteal feeding (OR 3.38). A protective effect was seen in association with delivery by a trained traditional birth attendant (OR 0.34) and the application of shea nut butter, a traditional medicine, to the cord stump (OR 0.07). This study has identified the need to understand the reasons underlying the widespread use of pre-lacteal feeds and the barriers to health service use in this community in order to plan effective interventions.
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Affiliation(s)
- A Leach
- Medical Research Council Laboratories, Fajara, The Gambia, West Africa.
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Abstract
Over a 4 year period, 1991 to 1994, 420 patients with acute bacterial meningitis were admitted to a tertiary urban hospital in The Gambia. Organisms were isolated from the cerebrospinal fluid in 64 per cent of cases. In the neonatal period Streptococcus pneumoniae was the single most common organism isolated. Amongst infants and children the two major pathogens were Haemophilus influenzae and S. pneumoniae. In the first year of life, children with S. pneumoniae meningitis were younger than those with H. influenzae infection (median age 3 months versus 6 months, p < 0.00003) and they had a higher case fatality rate (37 per cent versus 17 per cent, p = 0.002). In view of the high case fatality rate, there is a need to review overall case management. This will include a review of more effective antibiotics, the possible role of dexamethasone, and the inclusion of efficacious vaccines against H. influenzae and S. pneumoniae disease.
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Affiliation(s)
- A Palmer
- Royal Victoria Hospital, Banjul, The Gambia
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Usen S, Weber M, Mulholland K, Jaffar S, Oparaugo A, Omosigho C, Adegbola R, Greenwood B. Clinical predictors of hypoxaemia in Gambian children with acute lower respiratory tract infection: prospective cohort study. BMJ 1999; 318:86-91. [PMID: 9880280 PMCID: PMC27680 DOI: 10.1136/bmj.318.7176.86] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/28/1998] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine clinical correlates and outcome of hypoxaemia in children admitted to hospital with an acute lower respiratory tract infection. DESIGN Prospective cohort study. SETTING Paediatric wards of the Royal Victoria Hospital and the hospital of the Medical Research Council's hospital in Banjul, the Gambia. SUBJECTS 1072 of 42 848 children, aged 2 to 33 months, who were enrolled in a randomised trial of a Haemophilus influenzae type b vaccine in the western region of the Gambia, and who were admitted with an acute lower respiratory tract infection to two of three hospitals. MAIN OUTCOME MEASURES Prevalence of hypoxaemia, defined as an arterial oxygen saturation <90% recorded by pulse oximetry, and the relation between hypoxaemia and aetiological agents. RESULTS 1072 children aged 2-33 months were enrolled. Sixty three (5.9%) had an arterial oxygen saturation <90%. A logistic regression model showed that cyanosis, a rapid respiratory rate, grunting, head nodding, an absence of a history of fever, and no spontaneous movement during examination were the best independent predictors of hypoxaemia. The presence of an inability to cry, head nodding, or a respiratory rate >/= 90 breaths/min formed the best predictors of hypoxaemia (sensitivity 70%, specificity 79%). Hypoxaemic children were five times more likely to die than non-hypoxaemic children. The presence of malaria parasitaemia had no effect on the prevalence of hypoxaemia or on its association with respiratory rate. CONCLUSION In children with an acute lower respiratory tract infection, simple physical signs that require minimal expertise to recognise can be used to determine oxygen therapy and to aid in screening for referral. The association between hypoxaemia and death highlights the need for early recognition of the condition and the potential benefit of treatment.
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Affiliation(s)
- S Usen
- Medical Research Council Laboratories, PO Box 273, Fajara, Gambia.
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Abstract
As part of a treatment trial of cerebral malaria, blood cultures were done in 276 Gambian children, aged between 1 and 9 years, with cerebral malaria. Fourteen (5%) of these were positive. The organisms isolated were Staphylococcus aureus (6), coliforms (4), Pseudomonas spp. (2), Salmonella spp. (1) and Streptococcus spp. (1). Thirteen of these children survived, most without appropriate antibiotic treatment. Most of the retrieved organisms were therefore suspected to be contaminants. Bacteraemia complicating cerebral malaria is not common in The Gambia, and routine antibiotic treatment of children with cerebral malaria is not warranted.
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Affiliation(s)
- G Enwere
- Royal Victoria Hospital, Banjul, The Gambia Laboratory, Fajara, The Gambia
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Hassan-King M, Adegbola R, Baldeh I, Mulholland K, Omosigho C, Oparaugo A, Usen S, Palmer A, Schneider G, Secka O, Weber M, Greenwood B. A polymerase chain reaction for the diagnosis of Haemophilus influenzae type b disease in children and its evaluation during a vaccine trial. Pediatr Infect Dis J 1998; 17:309-12. [PMID: 9576385 DOI: 10.1097/00006454-199804000-00008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Determination of the etiology of pneumonia in young children is difficult because blood culture, the usual method of diagnosis, is positive in only a small proportion of cases. For this reason vaccine trials that include bacterial pneumonia as an endpoint must be large. OBJECTIVES To determine whether a diagnostic test based on a polymerase chain reaction could be used as an alternative to conventional blood culture for diagnosis of invasive Haemophilus influenzae type b (Hib) infections in young children investigated during the course of a large vaccine trial. METHODS DNA was extracted from blood culture supernatants and probed for the presence of Hib DNA with a PCR assay with primers derived from the cap gene locus of Hib. Results of the PCR assay were compared with those obtained by conventional culture techniques. RESULTS Blood cultures were obtained from 1544 children with suspected pneumonia, meningitis or septicemia and from 31 healthy control children who were contacts of cases. Blood culture supernatants were tested for Hib DNA in the PCR test. The sensitivity and specificity of a positive PCR test in blood culture supernatant as against culture of Hib from any normally sterile site were 100 and 99%, respectively. Eleven children had positive Hib PCR tests on blood culture supernatants but were negative by culture. In one of these cases Hib was isolated from a lung aspirate and in two other patients H. influenzae strains other than Hib were obtained from the cerebrospinal fluid. Eight of these 11 children were in the control group. When the results of the PCR assay were used to determine vaccine efficacy, a value of 86% was obtained compared with a figure of 95% obtained when conventional culture techniques were used. CONCLUSIONS An Hib PCR assay on blood culture supernatants proved to be sensitive and specific for the diagnosis of Hib disease in children. The distribution of PCR-positive, culture-negative cases between Hib-vaccinated and control groups paralleled that of culture-positive cases, suggesting that most of these children had been infected with Hib. A trial of a highly efficacious vaccine provides a novel way for evaluating new diagnostic tests for which there is no standard diagnostic test of 100% reliability.
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Affiliation(s)
- M Hassan-King
- The Medical Research Council Laboratories, Fajara, The Gambia
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Usen S, Adegbola R, Mulholland K, Jaffar S, Hilton S, Oparaugo A, Omosigho C, Lahai G, Corrah T, Palmer A, Schneider G, Weber M, Greenwood B. Epidemiology of invasive pneumococcal disease in the Western Region, The Gambia. Pediatr Infect Dis J 1998; 17:23-8. [PMID: 9469390 DOI: 10.1097/00006454-199801000-00006] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Streptococcus pneumoniae is a major cause of morbidity and mortality in young children in the developing world. The recent development of pneumococcal polysaccharide/protein conjugate vaccines may make possible prevention of this infection. However, little is known about the epidemiology of invasive pneumococcal disease in children in the developing world. OBJECTIVES To determine the incidence and epidemiologic features of invasive pneumococcal disease in children resident in a semiurban area of The Gambia. METHOD The study was part of a large trial of an Haemophilus influenzae type b vaccine that recruited 42 848 children at the age of 2 months during the period March, 1993, to October, 1995. Follow-up of study children continued until December 31, 1995; therefore the first children to enter the trial were followed for 2.5 years and the last for just a few months. During the period of surveillance, 2256 children were investigated for possible invasive pneumococcal disease when they presented to a hospital or health center. RESULTS We detected 110 cases of pneumococcal disease. Pneumonia was the most common form of invasive pneumococcal disease observed (75.5% of patients). The incidence of pneumococcal disease was 224 [95% confidence interval (CI) 171, 277] per 100,000 child years among children ages 2 to 11 months, 139 (95% CI 93, 184) per 100,000 among children ages 12 to 23 months and 82 (95% CI 21, 143) per 100,000 among children ages 24 to 35 months. Pneumococci of serogroups 14, 6, 5, 23, 19, 46 and 2 were isolated most frequently. Susceptibility to pneumococcal disease was not increased significantly among Haemophilus influenzae type b-vaccinated children. CONCLUSIONS The pneumococcus is a major cause of bacterial infection in The Gambia. A proposed nine-valent pneumococcal conjugate vaccine for developing countries containing conjugates of serogroups 1, 4, 5, 6, 9, 14, 18, 19 and 23 would cover 74% of cases of invasive pneumococcal disease in children resident in the Western Region of The Gambia.
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Affiliation(s)
- S Usen
- Medical Research Council Laboratories, Fajara, The Gambia, West Africa
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Mulholland K, Hilton S, Adegbola R, Usen S, Oparaugo A, Omosigho C, Weber M, Palmer A, Schneider G, Jobe K, Lahai G, Jaffar S, Secka O, Lin K, Ethevenaux C, Greenwood B. Randomised trial of Haemophilus influenzae type-b tetanus protein conjugate vaccine [corrected] for prevention of pneumonia and meningitis in Gambian infants. Lancet 1997; 349:1191-7. [PMID: 9130939 DOI: 10.1016/s0140-6736(96)09267-7] [Citation(s) in RCA: 309] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND In developing countries, pneumonia and meningitis due to Haemophilus influenzae type b (Hib) are common in children under age 12 months and the mortality from meningitis is high. Protein-polysaccharide conjugate vaccines have brought Hib disease under control in industrialised countries. We did a double-blind randomised trial in The Gambia to assess the efficacy of a Hib conjugate vaccine for the prevention of meningitis, pneumonia, and other invasive diseases due to Hib. METHODS Between March, 1993, and October, 1995, 42,848 infants were randomly allocated the conjugate vaccine Hib polysaccharide tetanus protein (PRP-T) mixed with diphtheria-tetanus-pertussis vaccine (DTP), or DTP alone at age 2 months, 3 months, and 4 months. Children who presented with signs of invasive Hib were investigated by blood culture and, where appropriate, by lumbar puncture, chest radiograph, or percutaneous lung aspirate. Children were followed up for between 5 and 36 months. FINDINGS The median ages at which children received the study vaccine were 11 weeks, 18 weeks, and 24 weeks. 83% of children enrolled received all three doses of vaccine. 17 cases of culture-positive Hib pneumonia, 28 of Hib meningitis, and five of other forms of invasive Hib disease were detected amongst the study children. The efficacy of the vaccine for the prevention of all invasive disease after three doses was 95% (PRP-T vaccinees 1, controls 19 [95% CI 67-100]), for the prevention of Hib pneumonia after two or three doses, 100% (vaccinees 0, controls 10 [55-100]), and for the prevention of radiologically defined pneumonia at any time after enrollment, 21.1% (PRP-T vaccinees 198, controls 251 [4.6-34.9]). INTERPRETATION PRP-T conjugate Hib vaccine prevented most cases of meningitis and pneumonia due to Hib in Gambian infants. The reduction in the overall incidence of radiologically defined pneumonia in PRP-T vaccinees suggests that about 20% of episodes of pneumonia in young Gambian children are due to Hib. The introduction of Hib vaccines into developing countries should substantially reduce childhood mortality due to pneumonia and meningitis.
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Affiliation(s)
- K Mulholland
- Medical Research Council Laboratories, Fajara, The Gambia
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Hassan-King M, Baldeh I, Adegbola R, Omosigho C, Usen SO, Oparaugo A, Greenwood BM. Detection of Haemophilus influenzae and Streptococcus pneumoniae DNA in blood culture by a single PCR assay. J Clin Microbiol 1996; 34:2030-2. [PMID: 8818907 PMCID: PMC229179 DOI: 10.1128/jcm.34.8.2030-2032.1996] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A multiplex PCR assay was developed to screen blood cultures from children in The Gambia with suspected pneumonia for the simultaneous detection of Haemophilus influenzae type b and Streptococcus pneumoniae isolates. Analysis of 295 blood cultures showed that PCR detected the organisms in all samples positive by culture in two samples infected with H. influenzae type b and four samples infected with S. pneumoniae that were culture negative, indicating that this method is sensitive for detecting these organisms in blood cultures.
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Affiliation(s)
- M Hassan-King
- Medical Research Council Laboratories, Fajara, The Gambia, West Africa
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Eyitayo CA, Coker AO, Adegbola R, Johnson T, Olukoya DK, Odugbemi T. Antibiotic susceptibility patterns and plasmid profile of Helicobacter isolates from Nigeria. West Afr J Med 1992; 11:190-4. [PMID: 1476963] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Antibiotic susceptibility testing and plasmid screening of 50 local isolates of Campylobacter coli and Campylobacter jejuni were done. All isolates were sensitive to ofloxacin but were resistant to ampicillin, cloxacillin, penicillin, streptomycin and aztreonam. A large number of isolates were sensitive to nalidixic acid (96%), ceftriaxone (96%) and chloramphenicol (86%). It is noteworthy that nine (18%) of the isolates were resistant to each of erythromycin, 15 (30%) were found to harbour plasmid DNA ranging in sizes from 2.0 to 45 megadalton. Resistance to tetracycline in one isolate was associated with the carriage of a 45-megadalton plasmid.
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Affiliation(s)
- C A Eyitayo
- Department of Medical Microbiology, University of Lagos, Nigeria
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Abstract
Fifty-six strains from nine Serratia species, grown under a variety of cultural conditions, were examined in rocked-tile tests for the presence of haemagglutinins (HAs) and with the electron microscope for fimbriae. All strains were haemagglutinating; most (71%) formed two or three of the different kinds of HA detected. These were: (i) a mannose-sensitive HA (MS-HA); (ii) a mannose-resistant, klebsiella-like HA (MR/K-HA); (iii) two mannose-resistant, proteus-like HAs (MR/P-HA), one of which showed broad-spectrum HA activity against different species of erythrocytes and the other narrow-spectrum HA activity. Five types of fimbriae associated with the different HAs were observed. This description of the fimbrial HAs in nine species of Serratia is the most comprehensive so far produced and should provide a basis for future studies directed towards elucidating the ecological role of the adhesins in in-vivo colonization by serratiae as commensals or pathogens.
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