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Ballard SB, Gilman RH. Post-Rotavirus Vaccine Enteropathogen Landscape. Pediatr Rev 2023; 44:182-184. [PMID: 36854827 DOI: 10.1542/pir.2022-005565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
| | - Robert H Gilman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Chamma-Siqueira NN, Negreiros SC, Ballard SB, Farias S, Silva SP, Chenet SM, Santos EJM, Pereira de Sena LW, Póvoa da Costa F, Cardoso-Mello AGN, Marchesini PB, Peterka CRL, Viana GMR, Macedo de Oliveira A. Higher-Dose Primaquine to Prevent Relapse of Plasmodium vivax Malaria. N Engl J Med 2022; 386:1244-1253. [PMID: 35353962 PMCID: PMC9132489 DOI: 10.1056/nejmoa2104226] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND In most of the Americas, the recommended treatment to prevent relapse of Plasmodium vivax malaria is primaquine at a total dose of 3.5 mg per kilogram of body weight, despite evidence of only moderate efficacy. METHODS In this trial conducted in Brazil, we evaluated three primaquine regimens to prevent relapse of P. vivax malaria in children at least 5 years of age and in adults with microscopy-confirmed P. vivax monoinfection. All the patients received directly observed chloroquine for 3 days (total dose, 25 mg per kilogram). Group 1 received a total primaquine dose of 3.5 mg per kilogram (0.5 mg per kilogram per day) over 7 days with unobserved administration; group 2 received the same regimen as group 1 but with observed administration; and group 3 received a total primaquine dose of 7.0 mg per kilogram over 14 days (also 0.5 mg per kilogram per day) with observed administration. We monitored the patients for 168 days. RESULTS We enrolled 63 patients in group 1, 96 in group 2, and 95 in group 3. The median age of the patients was 22.4 years (range, 5.4 to 79.8). By day 28, three P. vivax recurrences were observed: 2 in group 1 and 1 in group 2. By day 168, a total of 70 recurrences had occurred: 24 in group 1, 34 in group 2, and 12 in group 3. No serious adverse events were noted. On day 168, the percentage of patients without recurrence was 58% (95% confidence interval [CI], 44 to 70) in group 1, 59% (95% CI, 47 to 69) in group 2, and 86% (95% CI, 76 to 92) in group 3. Survival analysis showed a difference in the day 168 recurrence-free percentage of 27 percentage points (97.5% CI, 10 to 44; P<0.001) between group 1 and group 3 and a difference of 27 percentage points (97.5% CI, 12 to 42; P<0.001) between group 2 and group 3. CONCLUSIONS The administration of primaquine at a total dose of 7.0 mg per kilogram had higher efficacy in preventing relapse of P. vivax malaria than a total dose of 3.5 mg per kilogram through day 168. (Supported by the U.S. Agency for International Development; ClinicalTrials.gov number, NCT03610399.).
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Affiliation(s)
- Nathália N Chamma-Siqueira
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Suiane C Negreiros
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Sarah-Blythe Ballard
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Sâmela Farias
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Sandro P Silva
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Stella M Chenet
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Eduardo J M Santos
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Luann W Pereira de Sena
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Flávia Póvoa da Costa
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Amanda G N Cardoso-Mello
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Paola B Marchesini
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Cássio R L Peterka
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Giselle M R Viana
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
| | - Alexandre Macedo de Oliveira
- From Instituto Evandro Chagas, Ministério da Saúde do Brasil, Ananindeua (N.N.C-.S., S.P.S., G.M.R.V.), Programa de Pós-Graduação em Biologia de Agentes Infecciosos e Parasitários (N.N.C.-S., E.J.M.S., F.P.C., G.M.R.V.) and Laboratório de Genética de Doenças Complexas (E.J.M.S., F.P.C.), Instituto de Ciências Biológicas, and Laboratório de Farmacocinética de Drogas Antimaláricas, Instituto de Ciências da Saúde (L.W.P.S., A.G.N.C.-M.), Universidade Federal do Pará, Belém, Secretaria de Saúde do Estado do Acre, Cruzeiro do Sul (S.C.N., S.F.), and Grupo Técnico da Malária, Coordenação-Geral de Vigilância de Zoonoses e Doenças de Transmissão Vetorial, Departamento de Imunização e Doenças Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde (P.B.M.), and Diretoria de Vigilância Epidemiológica, Subsecretaria de Vigilância em Saúde, Secretaria Estadual de Saúde do Distrito Federal (C.R.L.P.), Brasília - all in Brazil; Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services (S.-B.B.), and the Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention (S.-B.B., A.M.O.) - both in Atlanta; and Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, and Instituto de Enfermedades Tropicales, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Chachapoyas (S.M.C.) - both in Peru
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3
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Ballard SB, Requena D, Mayta H, Sanchez GJ, Oyola-Lozada MG, Colquechagua Aliaga FD, Cabrera L, Vittet Mondonedo MD, Taquiri C, Tilley CAPTDH, Simons CDRMP, Meza RA, Bern C, Saito M, Figueroa-Quintanilla DA, Gilman RH. Enteropathogen Changes After Rotavirus Vaccine Scale-up. Pediatrics 2022; 149:183843. [PMID: 34918158 PMCID: PMC9647525 DOI: 10.1542/peds.2020-049884] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To inform next steps in pediatric diarrhea burden reduction by understanding the shifting enteropathogen landscape after rotavirus vaccine implementation. METHODS We conducted a case-control study of 1788 medically attended children younger than 5 years, with and without gastroenteritis, after universal rotavirus vaccine implementation in Peru. We tested case and control stools for 5 viruses, 19 bacteria, and parasites; calculated coinfection-adjusted attributable fractions (AFs) to determine pathogen-specific burdens; and evaluated pathogen-specific gastroenteritis severity using Clark and Vesikari scales. RESULTS Six pathogens were independently positively associated with gastroenteritis: norovirus genogroup II (GII) (AF 29.1, 95% confidence interval [CI]: 28.0-32.3), rotavirus (AF 8.9, 95% CI: 6.8-9.7), sapovirus (AF 6.3, 95% CI: 4.3-7.4), astrovirus (AF 2.8, 95% CI: 0.0-4.0); enterotoxigenic Escherichia coli heat stable and/or heat labile and heat stable (AF 2.4, 95% CI: 0.6-3.1), and Shigella spp. (AF 2.0, 95% CI: 0.4-2.2). Among typeable rotavirus cases, we most frequently identified partially heterotypic strain G12P[8] (54 of 81, 67%). Mean severity was significantly higher for norovirus GII-positive cases relative to norovirus GII-negative cases (Vesikari [12.7 vs 11.8; P < .001] and Clark [11.7 vs 11.4; P = .016]), and cases in the 6- to 12-month age range relative to cases in other age groups (Vesikari [12.7 vs 12.0; P = .0002] and Clark [12.0 vs 11.4; P = .0016]). CONCLUSIONS Norovirus is well recognized as the leading cause of pediatric gastroenteritis in settings with universal rotavirus vaccination. However, sapovirus is often overlooked. Both norovirus and sapovirus contribute significantly to the severe pediatric disease burden in this setting. Decision-makers should consider multivalent vaccine acquisition strategies to target multiple caliciviruses in similar countries after successful rotavirus vaccine implementation.
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Affiliation(s)
- Sarah-Blythe Ballard
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland,Naval Medical Research Unit No. 6, Callao, Peru,Address correspondence to Sarah-Blythe Ballard, MD, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Room W5515, Baltimore, MD 21205. E-mail:
| | - David Requena
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Holger Mayta
- Infectious Disease Research Laboratory, Department of Cellular and Molcular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru,Asociación Benéfica PRISMA, Lima, Peru
| | - Gerardo J. Sanchez
- Infectious Disease Research Laboratory, Department of Cellular and Molcular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria G. Oyola-Lozada
- Infectious Disease Research Laboratory, Department of Cellular and Molcular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Macarena D. Vittet Mondonedo
- Infectious Disease Research Laboratory, Department of Cellular and Molcular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carmen Taquiri
- Infectious Disease Research Laboratory, Department of Cellular and Molcular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - CAPT Drake H. Tilley
- Naval Medical Research Unit No. 6, Callao, Peru,Fleet Surgical Team SEVEN, Okinawa, Japan
| | | | | | - Caryn Bern
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Mayuko Saito
- Infectious Disease Research Laboratory, Department of Cellular and Molcular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru,Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Robert H. Gilman
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland,Infectious Disease Research Laboratory, Department of Cellular and Molcular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru,Asociación Benéfica PRISMA, Lima, Peru
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4
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Alsentzer E, Ballard SB, Neyra J, Vera DM, Osorio VB, Quispe J, Blazes DL, Loayza L. Assessing 3 Outbreak Detection Algorithms in an Electronic Syndromic Surveillance System in a Resource-Limited Setting. Emerg Infect Dis 2020; 26:2196-2200. [PMID: 32818406 PMCID: PMC7454051 DOI: 10.3201/eid2609.191315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We evaluated the performance of X-bar chart, exponentially weighted moving average, and C3 cumulative sums aberration detection algorithms for acute diarrheal disease syndromic surveillance at naval sites in Peru during 2007–2011. The 3 algorithms’ detection sensitivity was 100%, specificity was 97%–99%, and positive predictive value was 27%–46%.
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5
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Alsentzer E, Ballard SB, Neyra J, Vera DM, Osorio VB, Quispe J, Blazes DL, Loayza L. Assessing 3 Outbreak Detection Algorithms in an Electronic Syndromic Surveillance System in a Resource-Limited Setting. Emerg Infect Dis 2020. [DOI: 10.3201/eid09.191315] [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: 11/19/2022] Open
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6
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Ballard SB, Tallant A, Guerra RG, Quigley D, Stiegmann R, Mirelman AJ, Riddle MS, Gilman RH. Application of a cost-effectiveness analysis of pathogen-specific vaccines against gastroenteritis to a military population in a developing country setting. Vaccine 2020; 38:2292-2297. [PMID: 32019702 DOI: 10.1016/j.vaccine.2020.01.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 10/25/2022]
Abstract
Vaccine implementation planning in low- and middle-income countries (LMIC) often focuses on children without considering special adult populations. We adapted an economic model developed by the United States Department of Defense (DoD) to evaluate the cost-effectiveness of vaccine acquisition strategies for Campylobacter-, ETEC-, Shigella-, and norovirus-associated gastroenteritis. We compared implementation costs with current medical management in the Peruvian armed forces, a special population of low- and middle-income (LMIC) adults with a high incidence of infectious gastroenteritis. Pathogen-specific vaccine implementation resulted in calculated cost-effectiveness ratio (CER) per duty day lost averted (CERDDL) of $13,741; $1,272; $301; and $803, and a CER per diarrhea day averted of $2,130; $215; $51; and $199 for Campylobacter, ETEC, Shigella, and norovirus, respectively. These estimates compare favorably to CERDDL estimates from high-income military population and suggest that implementing vaccines gastroenteritis may be cost-effective in the Peruvian military population.
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Affiliation(s)
- Sarah-Blythe Ballard
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St. Rm. W5519, Baltimore, MD 25101, United States; Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, United States.
| | - Aaron Tallant
- Department of Internal Medicine, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23518, United States.
| | - Rosio G Guerra
- Tropical and Infectious Disease Area, Transmissible Diseases Services, Peruvian Navy Medical Center, Alerta DISAMAR System, Peruvian Navy Health Directorate, Cuadra 36 S/N Avenida Venezuela, Bellavista, Callao, Peru.
| | - Dawn Quigley
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, United States.
| | - Regan Stiegmann
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, United States.
| | - Andrew J Mirelman
- Centre for Health Economics, University of York, Heslington, York YO10 5DD, United Kingdom.
| | - Mark S Riddle
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, United States.
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St. Rm. W5519, Baltimore, MD 25101, United States.
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7
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Pisanic N, Ballard SB, Colquechagua FD, François R, Exum N, Yori PP, Schwab KJ, Granger DA, Detrick B, Olortegui MP, Mayta H, Sánchez GJ, Gilman RH, Heaney CD, Vinjé J, Kosek MN. Minimally Invasive Saliva Testing to Monitor Norovirus Infection in Community Settings. J Infect Dis 2020; 219:1234-1242. [PMID: 30517651 PMCID: PMC6452293 DOI: 10.1093/infdis/jiy638] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/28/2018] [Indexed: 12/12/2022] Open
Abstract
Background Norovirus is a leading cause of acute gastroenteritis worldwide. Routine norovirus diagnosis requires stool collection. The goal of this study was to develop and validate a noninvasive method to diagnose norovirus to complement stool diagnostics and to facilitate studies on transmission. Methods A multiplex immunoassay to measure salivary immunoglobulin G (IgG) responses to 5 common norovirus genotypes (GI.1, GII.2, GII.4, GII.6, and GII.17) was developed. The assay was validated using acute and convalescent saliva samples collected from Peruvian children <5 years of age with polymerase chain reaction (PCR)–diagnosed norovirus infections (n = 175) and controls (n = 32). The assay sensitivity and specificity were calculated to determine infection status based on fold rise of salivary norovirus genotype-specific IgG using norovirus genotype from stool as reference. Results The salivary assay detected recent norovirus infections and correctly assigned the infecting genotype. Sensitivity was 71% and specificity was 96% across the evaluated genotypes compared to PCR-diagnosed norovirus infection. Conclusions This saliva-based assay will be a useful tool to monitor norovirus transmission in high-risk settings such as daycare centers or hospitals. Cross-reactivity is limited between the tested genotypes, which represent the most commonly circulating genotypes.
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Affiliation(s)
- Nora Pisanic
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Sarah-Blythe Ballard
- Departments of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore.,Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Fabiola D Colquechagua
- Infectious Diseases Research Laboratory, Department of Cellular and Molecular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ruthly François
- Departments of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Natalie Exum
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Pablo Peñataro Yori
- Departments of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Kellogg J Schwab
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Douglas A Granger
- Institute for Interdisciplinary Salivary Bioscience, University of California, Irvine.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, Maryland.,Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Barbara Detrick
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Holger Mayta
- Infectious Diseases Research Laboratory, Department of Cellular and Molecular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gerardo J Sánchez
- Infectious Diseases Research Laboratory, Department of Cellular and Molecular Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H Gilman
- Departments of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Christopher D Heaney
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore.,Departments of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jan Vinjé
- National Calicivirus Laboratory, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Margaret N Kosek
- Departments of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore
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8
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Villena FE, Gomez-Puerta LA, Jhonston EJ, Del Alcazar OM, Maguiña JL, Albujar C, Laguna-Torres VA, Recuenco SE, Ballard SB, Ampuero JS. First Report of Trypanosoma cruzi Infection in Salivary Gland of Bats from the Peruvian Amazon. Am J Trop Med Hyg 2018; 99:723-728. [PMID: 30014825 PMCID: PMC6169177 DOI: 10.4269/ajtmh.17-0816] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 11/07/2022] Open
Abstract
In the Americas, 8 million people are infected with Chagas disease, and an additional 90 million people are at risk for infection. Little is known about the role bats play in the sylvatic transmission cycle of Trypanosoma cruzi, the parasite causing Chagas disease. Here, we captured bats in the villages of Palmiche, Pachacutec, Nuevo San Martin, and Mayuriaga located in the Datem del Marañon Province in Loreto, Peru. Venous blood samples were collected by cardiac puncture or from the upper extremities, and trypanosomatids were identified by microscopy and molecularly. We collected blood samples from 121 bats on filter paper for molecular studies and 111 slides for microscopic examination of thin and thick blood smears from 16 different bat species. The prevalence of trypanosomatids in all bats species was 34.7% (42/121) and the prevalence of T. cruzi was 4.1% (5/121). In hematophagous bat species, the prevalence of trypanosomatids and T. cruzi was 36.9% (27/73) and 2.7% (2/73), respectively. In non-hematophagous bats, the prevalences of trypanosomatids and T. cruzi were 31.2% (15/48) and 6.2% (3/48), respectively. Also, we confirm the presence of T. cruzi in salivary glands of hematophagous bats Diaemus youngi. These results suggest a sylvatic cycle of trypanosomatid transmission in which bats may harbor infectious T. cruzi parasites that could be transmitted to humans via hematophagous bat bites or salivary contamination by non-hematophagous bats of vegetables consumed by humans.
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Affiliation(s)
- Fredy E Villena
- U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | - Luis A Gomez-Puerta
- School of Veterinary Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru.,U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | - Erik J Jhonston
- Facultad de Medicina de la Universidad Nacional de la Amazonia Peruana, Loreto, Peru
| | - O Melisa Del Alcazar
- Departamento de Mastozoología, Museo de Historia Natural, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Jorge L Maguiña
- U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | | | - V Alberto Laguna-Torres
- Instituto de Medicina Tropical Daniel A. Carrión, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Sergio E Recuenco
- Departamento de Medicina Preventiva y Salud Pública, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Julia S Ampuero
- U.S. Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
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9
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Lamm R, Alves C, Perrotta G, Murphy M, Messina C, Sanchez JF, Perez E, Rosales LA, Lescano AG, Smith E, Valdivia H, Fuhrer J, Ballard SB. Prevalence of and Factors Associated with Negative Microscopic Diagnosis of Cutaneous Leishmaniasis in Rural Peru. Am J Trop Med Hyg 2018; 99:331-337. [PMID: 29869605 DOI: 10.4269/ajtmh.17-0909] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Cutaneous leishmaniasis is endemic to South America where diagnosis is most commonly conducted via microscopy. Patients with suspected leishmaniasis were referred for enrollment by the Ministry of Health (MoH) in Lima, Iquitos, Puerto Maldonado, and several rural areas of Peru. A 43-question survey requesting age, gender, occupation, characterization of the lesion(s), history of leishmaniasis, and insect-deterrent behaviors was administered. Polymerase chain reaction (PCR) was conducted on lesion materials at the Naval Medical Research Unit No. 6 in Lima, and the results were compared with those obtained by the MoH using microscopy. Factors associated with negative microscopy and positive PCR results were identified using χ2 test, t-test, and multivariate logistic regression analyses. Negative microscopy with positive PCR occurred in 31% (123/403) of the 403 cases. After adjusting for confounders, binary multivariate logistic regression analyses revealed that negative microscopy with positive PCR was associated with patients who were male (adjusted odds ration [OR] = 1.93 [1.06-3.53], P = 0.032), had previous leishmaniasis (adjusted OR = 2.93 [1.65-5.22], P < 0.0001), had larger lesions (adjusted OR = 1.02 [1.003-1.03], P = 0.016), and/or had a longer duration between lesion appearance and PCR testing (adjusted OR = 1.12 [1.02-1.22], P = 0.017). Future research should focus on further exploration of these underlying variables, discovery of other factors that may be associated with negative microscopy diagnosis, and the development and implementation of improved testing in endemic regions.
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Affiliation(s)
- Ryan Lamm
- Stony Brook University School of Medicine, Stony Brook, New York.,Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.,US Naval Medical Research Unit No. 6, Lima, Peru
| | | | - Grace Perrotta
- Stony Brook University School of Medicine, Stony Brook, New York
| | - Meagan Murphy
- Stony Brook University School of Medicine, Stony Brook, New York
| | | | - Juan F Sanchez
- Universidad Peruana Cayetano Heredia, Lima, Peru.,School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru.,US Naval Medical Research Unit No. 6, Lima, Peru
| | - Erika Perez
- US Naval Medical Research Unit No. 6, Lima, Peru
| | | | - Andres G Lescano
- Universidad Peruana Cayetano Heredia, Lima, Peru.,US Naval Medical Research Unit No. 6, Lima, Peru
| | - Edward Smith
- US Naval Medical Research Unit No. 6, Lima, Peru
| | | | - Jack Fuhrer
- Stony Brook University School of Medicine, Stony Brook, New York
| | - Sarah-Blythe Ballard
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,US Naval Medical Research Unit No. 6, Lima, Peru
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10
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Ballard SB, Salinger A, Arguin PM, Desai M, Tan KR. Updated CDC Recommendations for Using Artemether-Lumefantrine for the Treatment of Uncomplicated Malaria in Pregnant Women in the United States. MMWR Morb Mortal Wkly Rep 2018; 67:424-431. [PMID: 29649190 PMCID: PMC5898222 DOI: 10.15585/mmwr.mm6714a4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Malaria infection during pregnancy is associated with an increased risk for maternal and fetal complications. In the United States, treatment options for uncomplicated, chloroquine-resistant Plasmodium falciparum and P. vivax malaria in pregnant women are limited to mefloquine or quinine plus clindamycin (1). However, limited availability of quinine and increasing resistance to mefloquine restrict these options. Strong evidence now demonstrates that artemether-lumefantrine (AL) (Coartem) is effective and safe in the treatment of malaria in pregnancy. The World Health Organization (WHO) has endorsed artemisinin-based combination therapies (ACTs), such as AL, for treatment of uncomplicated malaria during the second and third trimesters of pregnancy and is currently considering whether to add ACTs, including AL, as an option for malaria treatment during the first trimester (2,3). This policy note reviews the evidence and updates CDC recommendations to include AL as a treatment option for uncomplicated malaria during the second and third trimesters of pregnancy and during the first trimester of pregnancy when other treatment options are unavailable. These updated recommendations reflect current evidence and are consistent with WHO treatment guidelines.
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11
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Jennings MC, Tilley DH, Ballard SB, Villanueva M, Costa FM, Lopez M, Steinberg HE, Luna CG, Meza R, Silva ME, Gilman RH, Simons MP, Maves RC, Cabada MM. Case-Case Analysis Using 7 Years of Travelers' Diarrhea Surveillance Data: Preventive and Travel Medicine Applications in Cusco, Peru. Am J Trop Med Hyg 2017; 96:1097-1106. [PMID: 28167602 PMCID: PMC5417202 DOI: 10.4269/ajtmh.16-0633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
AbstractIn Cusco, Peru, and South America in general, there is a dearth of travelers' diarrhea (TD) data concerning the clinical features associated with enteropathogen-specific infections and destination-specific risk behaviors. Understanding these factors would allow travel medicine providers to tailor interventions to patients' risk profiles and travel destination. To characterize TD etiology, evaluate region-specific TD risk factors, and examine relationships between preventive recommendations and risk-taking behaviors among medium- to long-term travelers' from high-income countries, we conducted this case-case analysis using 7 years of prospective surveillance data from adult travelers' presenting with TD to a physician in Cusco. At the time of enrollment, participants provided a stool sample and answered survey questions about demographics, risk behaviors, and the clinical features of illness. Stool samples were tested for norovirus (NV), bacteria, and parasites using conventional methods. Data obtained were then analyzed using case-case methods. NV (14%), enterotoxigenic Escherichia coli (11%), and Campylobacter (9%), notably ciprofloxacin-resistant Campylobacter, were the most frequently identified pathogens among adults with TD. Coinfection with multiple enteropathogens occurred in 5% of cases. NV caused severe disease relative to other TD-associated pathogens identified, confining over 90% of infected individuals to bed. Destination-specific risk factors include consumption of the local beverage "chicha," which was associated with Cryptosporidium infection. Preventive interventions, such as vaccines, directed against these pathogens could significantly reduce the burden of TD.
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Affiliation(s)
- Mary Carol Jennings
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Preventive Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Drake H Tilley
- Bacteriology Department, Naval Medical Research Unit No. 6, Lima, Peru
| | - Sarah-Blythe Ballard
- Parasitology Department, Naval Medical Research Unit No. 6, Lima, Peru.,Asociación Benéfica PRISMA, Lima, Peru.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Miguel Villanueva
- Hematology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Martha Lopez
- Collaborative Research Center, Universidad Peruana Cayetano Heredia, Cusco, Peru.,Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Hannah E Steinberg
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - C Giannina Luna
- Virology Department, Naval Medical Research Unit No. 6, Lima, Peru
| | - Rina Meza
- Bacteriology Department, Naval Medical Research Unit No. 6, Lima, Peru
| | - Maria E Silva
- Virology Department, Naval Medical Research Unit No. 6, Lima, Peru
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mark P Simons
- Bacteriology Department, Naval Medical Research Unit No. 6, Lima, Peru
| | - Ryan C Maves
- Division of Infectious Diseases, Naval Medical Center San Diego, San Diego, California.,Bacteriology Department, Naval Medical Research Unit No. 6, Lima, Peru
| | - Miguel M Cabada
- Collaborative Research Center, Universidad Peruana Cayetano Heredia, Cusco, Peru.,Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
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Strong BL, Ballard SB, Braund W. The American College of Preventive Medicine Policy Recommendations on Reducing and Preventing Firearm-Related Injuries and Deaths. Am J Prev Med 2016; 51:1084-1089. [PMID: 27743624 DOI: 10.1016/j.amepre.2016.09.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/08/2016] [Accepted: 09/19/2016] [Indexed: 01/07/2023]
Abstract
The American College of Preventive Medicine Policy Committee makes policy guidelines and recommendations on preventive medicine and public health topics for public health decision makers. After a review of the current evidence available in 2016, the College is providing a consensus-based set of policy recommendations designed to reduce firearm-related morbidity and mortality in the U.S. These guidelines address seven general areas pertaining to the public health threat posed by firearms: gun sales and background checks, assault weapons and high-capacity weapons, mental health, research funding, gun storage laws, and physician counseling.
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Ballard SB, Reaves EJ, Luna CG, Silva ME, Rocha C, Heitzinger K, Saito M, Apaza S, Espetia S, Blazes DL, Tilley DH, Guzmán Aguilar RC, Gilman RH, Bausch DG. Epidemiology and Genetic Characterization of Noroviruses among Adults in an Endemic Setting, Peruvian Amazon Basin, 2004-2011. PLoS One 2015; 10:e0131646. [PMID: 26161556 PMCID: PMC4498765 DOI: 10.1371/journal.pone.0131646] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 06/05/2015] [Indexed: 11/24/2022] Open
Abstract
Background Successful vaccination strategies against norovirus will require understanding the burden of disease and relevant genotypes in populations. However, few data are available from cohort studies of adults living in low- and middle-income countries (LMIC). Materials and Methods We conducted a nested case-control study within a Peruvian military cohort to characterize the burden of norovirus infection, predominant genotypes, and associated symptoms from 2004 through 2011. Randomly selected case and control stools were tested for norovirus, bacteria, and parasites. The odds ratio of the association between norovirus infection and diarrhea was estimated using multiple logistic regression and co-infection adjusted attributable fractions were calculated. Results Of the 3,818 cohort study participants, 624 developed diarrhea. Overall and norovirus-associated diarrhea incidence rates were 42.3 and 6.0 per 100 person-years, respectively. The most prevalent norovirus genogroup was GII (72.5%, 29/40), which was associated with diarrhea (AOR 3.4, 95% CI: 1.3–8.7, P = 0.012). The co-infection adjusted GII attributable fraction was 6.4%. Discussion Norovirus was a frequent cause of diarrhea in an adult population followed longitudinally in an LMIC setting. Vaccine strategies should consider targeting adults in endemic settings and special populations that could serve as community transmission sources.
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Affiliation(s)
- Sarah-Blythe Ballard
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Emerging Infectious Diseases Department, United States Medical Research Unit No. 6, Lima, Peru
- * E-mail:
| | - Erik J. Reaves
- Emerging Infectious Diseases Department, United States Medical Research Unit No. 6, Lima, Peru
| | - C. Giannina Luna
- Emerging Infectious Diseases Department, United States Medical Research Unit No. 6, Lima, Peru
| | - Maria E. Silva
- Emerging Infectious Diseases Department, United States Medical Research Unit No. 6, Lima, Peru
| | - Claudio Rocha
- Bacteriology Department, United States Medical Research Unit No. 6, Lima, Peru
| | - Kristen Heitzinger
- Bacteriology Department, United States Medical Research Unit No. 6, Lima, Peru
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Mayuko Saito
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Laboratorios de Investigación y Desarrollamiento, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Sonia Apaza
- Laboratorios de Investigación y Desarrollamiento, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Susan Espetia
- Laboratorios de Investigación y Desarrollamiento, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - David L. Blazes
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Drake H. Tilley
- Bacteriology Department, United States Medical Research Unit No. 6, Lima, Peru
| | | | - Robert H. Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Asociación Benéfica PRISMA, Lima, Peru
| | - Daniel G. Bausch
- Emerging Infectious Diseases Department, United States Medical Research Unit No. 6, Lima, Peru
- Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
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14
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Ballard SB, Osorio VB. U.S. Civil Air Show Crashes, 1993 to 2013: Burden, Fatal Risk Factors, and Evaluation of a Risk Index for Aviation Crashes. Transp Res Rec 2015; 2471:1-9. [PMID: 27773963 PMCID: PMC5070662 DOI: 10.3141/2471-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study provides new public health data about U.S. civil air shows. Risk factors for fatalities in civil air show crashes were analyzed. The value of the FIA score in predicting fatal outcomes was evaluated. With the use of the FAA's General Aviation and Air Taxi Survey and the National Transportation Safety Board's data, the incidence of civil air show crashes from 1993 to 2013 was calculated. Fatality risk factors for crashes were analyzed by means of regression methods. The FIA index was validated to predict fatal outcomes by using the factors of fire, instrument conditions, and away-from-airport location, and was evaluated through receiver operating characteristic (ROC) curves. The civil air show crash rate was 31 crashes per 1,000 civil air events. Of the 174 civil air show crashes that occurred during the study period, 91 (52%) involved at least one fatality; on average, 1.1 people died per fatal crash. Fatalities were associated with four major risk factors: fire [adjusted odds ratio (AOR) = 7.1, 95% confidence interval (CI) = 2.4 to 20.6, P < .001], pilot error (AOR = 5.2, 95% CI = 1.8 to 14.5, P = .002), aerobatic flight (AOR = 3.6, 95% CI = 1.6 to 8.2, P = .002), and off-airport location (AOR = 3.4, 95% CI = 1.5 to 7.5, P = .003). The area under the FIA score's ROC curve was 0.71 (95% CI = 0.64 to 0.78). Civil air show crashes were marked by a high risk of fatal outcomes to pilots in aerobatic performances but rare mass casualties. The FIA score was not a valid measurement of fatal risk in civil air show crashes.
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Affiliation(s)
- Sarah-Blythe Ballard
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21201
| | - Victor B Osorio
- Biomedical Informatics Department, Naval Medical Research Unit 6, 3230 Lima Place, Washington, DC 20521-3230
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15
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Abstract
The U.S. Title 14 Code of Federal Regulations defines commercial air tours as "flight[s] conducted for compensation or hire in an airplane or helicopter where a purpose of the flight is sightseeing." The incidence of air tour crashes in the United States is disproportionately high relative to similar commercial aviation operations, and air tours operating under Part 91 governance crash significantly more than those governed by Part 135. This paper reviews the government and industry response to four specific areas of air tour safety concern: surveillance of flight operations, pilot factors, regulatory standardization, and maintenance quality assurance. It concludes that the government and industry have successfully addressed many of these tenet issues, most notably by: advancing the operations surveillance infrastructure through implementation of en route, ground-based, and technological surveillance methods; developing Aeronautical Decision Making and cue-based training programs for air tour pilots; consolidating federal air tour regulations under Part 136; and developing public-private partnerships for raising maintenance operating standards and improving quality assurance programs. However, opportunities remain to improve air tour safety by: increasing the number and efficiency of flight surveillance programs; addressing pilot fatigue with more restrictive flight hour limitations for air tour pilots; ensuring widespread uptake of maintenance quality assurance programs, especially among high-risk operators not currently affiliated with private air tour safety programs; and eliminating the 25-mile exception allowing Part 91 operators to conduct commercial air tours without the safety oversight required of Part 135 operators.
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Affiliation(s)
- Sarah-Blythe Ballard
- Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Abstract
INTRODUCTION Hot-air balloon tours are FAR Part 91-governed balloon rides conducted for compensation or hire. Part 91, General Aviation, in general involves the least strict federal regulations and accounts for the majority of aviation crashes and fatalities. METHODS National Transportation Safety Board reports of hot-air balloon tour crashes in the United States from 2000 through 2011 were read and analyzed. RESULTS During the 12-yr period, 78 hot-air balloon tours crashed, involving 518 occupants. There were 91 serious injuries and 5 fatalities; 83% of crashes resulted in one or more serious or fatal outcomes. Of the serious injuries characterized, 56% were lower extremity fractures. Most crashes (81%) occurred during landing; 65% involved hard landings. Fixed object collisions contributed to 50% of serious injuries and all 5 fatalities. During landing sequences, gondola dragging, tipping, bouncing, and occupant ejection were associated with poor outcomes. Of the crashes resulting in serious or fatal outcomes, 20% of balloons were significantly damaged or destroyed. DISCUSSION The incidence of morbidity and mortality is high among hot-air balloon tour crashes, and the proportion of balloon crashes attributed to paid rides appears to have increased over time. In addition to examining the role of restraint systems, personal protective equipment, and power line emergency procedures in ballooning, injury prevention efforts should target factors such hard landings, object strikes, gondola instability, and occupant ejections, which are associated with balloon injuries and deaths. Crash outcomes may also improve with vehicle engineering that enables balloons themselves to absorb impact forces.
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Affiliation(s)
- Sarah-Blythe Ballard
- Department of International Health, and Johns Hopkins Center for Injury Research and Policy, John Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Rm. W519, Baltimore, MD 21201, USA.
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Ballard SB, Beaty LP, Baker SP. US commercial air tour crashes, 2000-2011: burden, fatal risk factors, and FIA Score validation. Accid Anal Prev 2013; 57:49-54. [PMID: 23631935 PMCID: PMC3669244 DOI: 10.1016/j.aap.2013.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 03/19/2013] [Accepted: 03/21/2013] [Indexed: 06/02/2023]
Abstract
INTRODUCTION This study provides new public health data concerning the US commercial air tour industry. Risk factors for fatality in air tour crashes were analyzed to determine the value of the FIA Score in predicting fatal outcomes. METHODS Using the Federal Aviation Administration's (FAA) General Aviation and Air Taxi Survey and National Transportation Safety Board data, the incidence of commercial air tour crashes from 2000 through 2010 was calculated. Fatality risk factors for crashes occurring from 2000 through 2011 were analyzed using regression methods. The FIA Score, Li and Baker's fatality risk index, was validated using receiver operating characteristic (ROC) curves. RESULTS The industry-wide commercial air tour crash rate was 2.7 per 100,000 flight hours. The incidence rates of Part 91 and 135 commercial air tour crashes were 3.4 and 2.3 per 100,000 flight hours, respectively (relative risk [RR] 1.5, 95% confidence interval [CI] 1.1-2.1, P=0.015). Of the 152 air tour crashes that occurred from 2000 through 2011, 30 (20%) involved at least one fatality and, on average, 3.5 people died per fatal crash. Fatalities were associated with three major risk factors: fire (adjusted odds ratio [AOR] 5.1, 95% CI 1.5-16.7, P=0.008), instrument meteorological conditions (AOR 5.4, 95% CI 1.1-26.4, P=0.038), and off-airport location (AOR 7.2, 95% CI 1.6-33.2, P=0.011). The area under the FIA Score's ROC curve was 0.79 (95% CI 0.71-0.88). DISCUSSION Commercial air tour crash rates were high relative to similar commercial aviation operations. Disparities between Part 91 and 135 air tour crash rates reflect regulatory disparities that require FAA action. The FIA Score appeared to be a valid measurement of fatal risk in air tour crashes. The FIA should prioritize interventions that address the three major risk factors identified by this study.
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Affiliation(s)
- Sarah-Blythe Ballard
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, United States.
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