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Simmons CP, Donald W, Tagavi L, Tarivonda L, Quai T, Tavoa R, Noran T, Manikaoti E, Kareaua L, Abwai TT, Chand D, Rama V, Deo V, Deo KK, Tavuii A, Valentine W, Prasad R, Seru E, Naituku L, Ratu A, Hesketh M, Kenny N, Beebe SC, Goundar AA, McCaw A, Buntine M, Green B, Frossard T, Gilles JRL, Joubert DA, Wilson G, Duong LQ, Bouvier JB, Stanford D, Forder C, Duyvestyn JM, Pacidônio EC, Flores HA, Wittmeier N, Retzki K, Ryan PA, Denton JA, Smithyman R, Tanamas SK, Kyrylos P, Dong Y, Khalid A, Hodgson L, Anders KL, O’Neill SL. Successful introgression of wMel Wolbachia into Aedes aegypti populations in Fiji, Vanuatu and Kiribati. PLoS Negl Trop Dis 2024; 18:e0012022. [PMID: 38484041 PMCID: PMC10980184 DOI: 10.1371/journal.pntd.0012022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 03/29/2024] [Accepted: 02/25/2024] [Indexed: 04/01/2024] Open
Abstract
Pacific Island countries have experienced periodic dengue, chikungunya and Zika outbreaks for decades. The prevention and control of these mosquito-borne diseases rely heavily on control of Aedes aegypti mosquitoes, which in most settings are the primary vector. Introgression of the intracellular bacterium Wolbachia pipientis (wMel strain) into Ae. aegypti populations reduces their vector competence and consequently lowers dengue incidence in the human population. Here we describe successful area-wide deployments of wMel-infected Ae. aegypti in Suva, Lautoka, Nadi (Fiji), Port Vila (Vanuatu) and South Tarawa (Kiribati). With community support, weekly releases of wMel-infected Ae. aegypti mosquitoes for between 2 to 5 months resulted in wMel introgression in nearly all locations. Long term monitoring confirmed a high, self-sustaining prevalence of wMel infecting mosquitoes in almost all deployment areas. Measurement of public health outcomes were disrupted by the Covid19 pandemic but are expected to emerge in the coming years.
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Affiliation(s)
| | - Wesley Donald
- Ministry of Health, Government of Vanuatu, Port Vila, Vanuatu
| | - Lekon Tagavi
- Ministry of Health, Government of Vanuatu, Port Vila, Vanuatu
| | - Len Tarivonda
- Ministry of Health, Government of Vanuatu, Port Vila, Vanuatu
| | | | | | - Tebikau Noran
- Ministry of Health and Medical Services, Kiribati Government, Kiribati
| | - Erirau Manikaoti
- Ministry of Health and Medical Services, Kiribati Government, Kiribati
| | - Lavinia Kareaua
- Ministry of Health and Medical Services, Kiribati Government, Kiribati
| | | | - Dip Chand
- Ministry of Health and Medical Services, Government of Fiji, Suva, Fiji
| | - Vineshwaran Rama
- Ministry of Health and Medical Services, Government of Fiji, Suva, Fiji
| | - Vimal Deo
- Ministry of Health and Medical Services, Government of Fiji, Suva, Fiji
| | | | - Aminiasi Tavuii
- World Mosquito Program, Monash University, Clayton, Australia
| | | | | | | | | | - Anaseini Ratu
- World Mosquito Program, Monash University, Clayton, Australia
| | - Mark Hesketh
- World Mosquito Program, Monash University, Clayton, Australia
| | - Nichola Kenny
- World Mosquito Program, Monash University, Clayton, Australia
| | - Sarah C. Beebe
- World Mosquito Program, Monash University, Clayton, Australia
| | | | - Andrew McCaw
- World Mosquito Program, Monash University, Clayton, Australia
| | - Molly Buntine
- World Mosquito Program, Monash University, Clayton, Australia
| | - Ben Green
- World Mosquito Program, Monash University, Clayton, Australia
| | - Tibor Frossard
- World Mosquito Program, Monash University, Clayton, Australia
| | | | | | - Geoff Wilson
- World Mosquito Program, Monash University, Clayton, Australia
| | - Le Quyen Duong
- World Mosquito Program, Monash University, Clayton, Australia
| | - Jean B Bouvier
- World Mosquito Program, Monash University, Clayton, Australia
| | - Darren Stanford
- World Mosquito Program, Monash University, Clayton, Australia
| | - Carolyn Forder
- World Mosquito Program, Monash University, Clayton, Australia
| | | | | | | | | | - Kate Retzki
- World Mosquito Program, Monash University, Clayton, Australia
| | - Peter A. Ryan
- World Mosquito Program, Monash University, Clayton, Australia
| | - Jai A. Denton
- World Mosquito Program, Monash University, Clayton, Australia
| | - Ruth Smithyman
- World Mosquito Program, Monash University, Clayton, Australia
| | | | - Peter Kyrylos
- World Mosquito Program, Monash University, Clayton, Australia
| | - Yi Dong
- World Mosquito Program, Monash University, Clayton, Australia
| | - Anam Khalid
- World Mosquito Program, Monash University, Clayton, Australia
| | - Lauren Hodgson
- World Mosquito Program, Monash University, Clayton, Australia
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Indriani C, Tanamas SK, Khasanah U, Ansari MR, Tantowijoyo W, Ahmad RA, Dufault SM, Jewell NP, Utarini A, Simmons CP, Anders KL. Impact of randomised wmel Wolbachia deployments on notified dengue cases and insecticide fogging for dengue control in Yogyakarta City. Glob Health Action 2023; 16:2166650. [PMID: 36700745 PMCID: PMC9894080 DOI: 10.1080/16549716.2023.2166650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Releases of Wolbachia (wMel)-infected Aedes aegypti mosquitoes significantly reduced the incidence of virologically confirmed dengue in a previous cluster randomised trial in Yogyakarta City, Indonesia. Following the trial, wMel releases were extended to the untreated control areas, to achieve city-wide coverage of Wolbachia. OBJECTIVE In this predefined analysis, we evaluated the impact of the wMel deployments in Yogyakarta on dengue hemorrhagic fever (DHF) case notifications and on the frequency of perifocal insecticide spraying by public health teams. METHODS Monthly counts of DHF cases notified to the Yogyakarta District Health Office between January 2006 and May 2022 were modelled as a function of time-varying local wMel treatment status (fully- and partially-treated vs untreated, and by quintile of wMel prevalence). The frequency of insecticide fogging in wMel-treated and untreated areas was analysed using negative binomial regression. RESULTS Notified DHF incidence was 83% lower in fully treated vs untreated periods (IRR 0.17 [95% CI 0.14, 0.20]), and 78% lower in areas with 80-100% wMel prevalence compared to areas with 0-20% wMel (IRR 0.23 [0.17, 0.30]). A similar intervention effect was observed at 60-80% wMel prevalence as at 80-100% prevalence (76% vs 78% efficacy, respectively). Pre-intervention, insecticide fogging occurred at similar frequencies in areas later randomised to wMel-treated and untreated arms of the trial. After wMel deployment, fogging occurred significantly less frequently in treated areas (IRR 0.17 [0.10, 0.30]). CONCLUSIONS Deployments of wMel-infected Aedes aegypti mosquitoes resulted in an 83% reduction in the application of perifocal insecticide spraying, consistent with lower dengue case notifications in wMel-treated areas. These results show that the Wolbachia intervention effect demonstrated previously in a cluster randomised trial was also measurable from routine surveillance data.
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Affiliation(s)
- Citra Indriani
- World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia,Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Uswatun Khasanah
- World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Muhammad Ridwan Ansari
- World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Rubangi
- Disease Control Department, Yogyakarta City Health Office, Yogyakarta, Indonesia
| | - Warsito Tantowijoyo
- World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Riris Andono Ahmad
- World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia,Department of Biostatistics, Epidemiology and Population Health, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Suzanne M. Dufault
- Division of Pulmonary and Critical Care Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | - Nicholas P. Jewell
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Adi Utarini
- World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia,Department of Health Policy and Management, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Katherine L. Anders
- World Mosquito Program, Monash University, Clayton, VIC, Australia,CONTACT Katherine L. Anders World Mosquito Program, Monash University, 12 Innovation Walk, Clayton, VIC3800, Australia
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Tanamas SK, Lim LL, Bull AL, Malloy MJ, Cheng AC, Worth LJ. Applying the standardized infection ratio for reporting surgical site infections in Australian healthcare facilities. Antimicrob Steward Healthc Epidemiol 2023; 3:e211. [PMID: 38156237 PMCID: PMC10753515 DOI: 10.1017/ash.2023.478] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 12/30/2023]
Abstract
Objective We explored the utility of the standardized infection ratio (SIR) for surgical site infection (SSI) reporting in an Australian jurisdiction. Design Retrospective chart review. Setting Statewide SSI surveillance data from 2013 to 2019. Patients Individuals who had cardiac bypass surgery (CABG), colorectal surgery (COLO), cesarean section (CSEC), hip prosthesis (HPRO), or knee prosthesis (KPRO) procedures. Methods The SIR was calculated by dividing the number of observed infections by the number of predicted infections as determined using the National Healthcare Safety Network procedure-specific risk models. In line with a minimum precision criterion, an SIR was not calculated if the number of predicted infections was <1. Results A SIR >0 (≥1 observed SSI, predicted number of SSI ≥1, no missing covariates) could be calculated for a median of 89.3% of reporting quarters for CABG, 75.0% for COLO, 69.0% for CSEC, 0% for HPRO, and 7.1% for KPRO. In total, 80.6% of the reporting quarters, when the SIR was not calculated, were due to no observed infections or predicted infections <1, and 19.4% were due to missing covariates alone. Within hospitals, the median percentage of quarters during which zero infections were observed was 8.9% for CABG, 20.0% for COLO, 25.4% for CSEC, 67.3% for HPRO, and 71.4% for KPRO. Conclusions Calculating an SIR for SSIs is challenging for hospitals in our regional network, primarily because of low event numbers and many facilities with predicted infections <1. Our SSI reporting will continue to use risk-indexed rates, in tandem with SIR values when predicted number of SSI ≥1.
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Affiliation(s)
- Stephanie K. Tanamas
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, VIC, Australia
| | - Lyn-Li Lim
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, VIC, Australia
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Ann L. Bull
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, VIC, Australia
| | - Michael J. Malloy
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Allen C. Cheng
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School and School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Monash Infectious Diseases, Monash Health and School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Leon J. Worth
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, VIC, Australia
- National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne Cancer & Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
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Velez ID, Tanamas SK, Arbelaez MP, Kutcher SC, Duque SL, Uribe A, Zuluaga L, Martínez L, Patiño AC, Barajas J, Muñoz E, Mejia Torres MC, Uribe S, Porras S, Almanza R, Pulido H, O’Neill SL, Santacruz-Sanmartin E, Gonzalez S, Ryan PA, Denton JA, Jewell NP, Dufault SM, Simmons CP, Anders KL. Reduced dengue incidence following city-wide wMel Wolbachia mosquito releases throughout three Colombian cities: Interrupted time series analysis and a prospective case-control study. PLoS Negl Trop Dis 2023; 17:e0011713. [PMID: 38032857 PMCID: PMC10688673 DOI: 10.1371/journal.pntd.0011713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/10/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND The introduction of Wolbachia (wMel strain) into Aedes aegypti mosquitoes reduces their capacity to transmit dengue and other arboviruses. Randomised and non-randomised studies in multiple countries have shown significant reductions in dengue incidence following field releases of wMel-infected Ae. aegypti. We report the public health outcomes from phased, large-scale releases of wMel-Ae. aegypti mosquitoes throughout three contiguous cities in the Aburrá Valley, Colombia. METHODOLOGY/PRINCIPAL FINDINGS Following pilot releases in 2015-2016, staged city-wide wMel-Ae. aegypti deployments were undertaken in the cities of Bello, Medellín and Itagüí (3.3 million people) between October 2016 and April 2022. The impact of the Wolbachia intervention on dengue incidence was evaluated in two parallel studies. A quasi-experimental study using interrupted time series analysis showed notified dengue case incidence was reduced by 95% in Bello and Medellín and 97% in Itagüí, following establishment of wMel at ≥60% prevalence, compared to the pre-intervention period and after adjusting for seasonal trends. A concurrent clinic-based case-control study with a test-negative design was unable to attain the target sample size of 63 enrolled virologically-confirmed dengue (VCD) cases between May 2019 and December 2021, consistent with low dengue incidence throughout the Aburrá Valley following wMel deployments. Nevertheless, VCD incidence was 45% lower (OR 0.55 [95% CI 0.25, 1.17]) and combined VCD/presumptive dengue incidence was 47% lower (OR 0.53 [95% CI 0.30, 0.93]) among participants resident in wMel-treated versus untreated neighbourhoods. CONCLUSIONS/SIGNIFICANCE Stable introduction of wMel into local Ae. aegypti populations was associated with a significant and sustained reduction in dengue incidence across three Colombian cities. These results from the largest contiguous Wolbachia releases to-date demonstrate the real-world effectiveness of the method across large urban populations and, alongside previously published results, support the reproducibility of this effectiveness across different ecological settings. TRIAL REGISTRATION NCT03631719.
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Affiliation(s)
- Ivan Dario Velez
- World Mosquito Program, Universidad de Antioquia, Medellín, Colombia
| | | | | | | | - Sandra L. Duque
- World Mosquito Program, Universidad de Antioquia, Medellín, Colombia
| | - Alexander Uribe
- World Mosquito Program, Universidad de Antioquia, Medellín, Colombia
| | - Lina Zuluaga
- World Mosquito Program, Universidad de Antioquia, Medellín, Colombia
| | - Luis Martínez
- World Mosquito Program, Universidad de Antioquia, Medellín, Colombia
| | | | - Jovany Barajas
- World Mosquito Program, Universidad de Antioquia, Medellín, Colombia
| | - Estefanía Muñoz
- World Mosquito Program, Universidad de Antioquia, Medellín, Colombia
| | | | - Sandra Uribe
- World Mosquito Program, Universidad de Antioquia, Medellín, Colombia
| | - Sandra Porras
- World Mosquito Program, Universidad de Antioquia, Medellín, Colombia
| | | | | | | | | | - Sandra Gonzalez
- World Mosquito Program, Universidad de Antioquia, Medellín, Colombia
| | - Peter A. Ryan
- World Mosquito Program, Monash University, Melbourne, Australia
| | - Jai A. Denton
- World Mosquito Program, Monash University, Melbourne, Australia
| | - Nicholas P. Jewell
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Suzanne M. Dufault
- Division of Biostatistics, Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
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Dufault SM, Tanamas SK, Indriani C, Utarini A, Ahmad RA, Jewell NP, Simmons CP, Anders KL. Disruption of spatiotemporal clustering in dengue cases by wMel Wolbachia in Yogyakarta, Indonesia. Sci Rep 2022; 12:9890. [PMID: 35701454 PMCID: PMC9198086 DOI: 10.1038/s41598-022-13749-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/27/2022] [Indexed: 10/25/2022] Open
Abstract
Dengue exhibits focal clustering in households and neighborhoods, driven by local mosquito population dynamics, human population immunity, and fine scale human and mosquito movement. We tested the hypothesis that spatiotemporal clustering of homotypic dengue cases is disrupted by introduction of the arbovirus-blocking bacterium Wolbachia (wMel-strain) into the Aedes aegypti mosquito population. We analysed 318 serotyped and geolocated dengue cases (and 5921 test-negative controls) from a randomized controlled trial in Yogyakarta, Indonesia of wMel deployments. We find evidence of spatial clustering up to 300 m among the 265 dengue cases (3083 controls) in the untreated trial arm. Participant pairs enrolled within 30 days and 50 m had a 4.7-fold increase (compared to 95% CI on permutation-based null distribution: 0.1, 1.2) in the odds of being homotypic (i.e. potentially transmission-related) as compared to pairs occurring at any distance. In contrast, we find no evidence of spatiotemporal clustering among the 53 dengue cases (2838 controls) resident in the wMel-treated arm. Introgression of wMel Wolbachia into Aedes aegypti mosquito populations interrupts focal dengue virus transmission leading to reduced case incidence; the true intervention effect may be greater than the 77% efficacy measured in the primary analysis of the Yogyakarta trial.
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Affiliation(s)
- Suzanne M. Dufault
- grid.47840.3f0000 0001 2181 7878Division of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, USA
| | - Stephanie K. Tanamas
- grid.1002.30000 0004 1936 7857World Mosquito Program, Institute of Vector-borne Disease, Monash University, Clayton, 3800 Australia
| | - Citra Indriani
- grid.8570.a0000 0001 2152 4506World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281 Indonesia
| | - Adi Utarini
- grid.8570.a0000 0001 2152 4506World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281 Indonesia
| | - Riris Andono Ahmad
- grid.8570.a0000 0001 2152 4506World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281 Indonesia
| | - Nicholas P. Jewell
- grid.47840.3f0000 0001 2181 7878Division of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, USA ,grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, Bloomsbury, London, WC1E 7HT UK
| | - Cameron P. Simmons
- grid.1002.30000 0004 1936 7857World Mosquito Program, Institute of Vector-borne Disease, Monash University, Clayton, 3800 Australia
| | - Katherine L. Anders
- grid.1002.30000 0004 1936 7857World Mosquito Program, Institute of Vector-borne Disease, Monash University, Clayton, 3800 Australia
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Tantowijoyo W, Tanamas SK, Nurhayati I, Setyawan S, Budiwati N, Fitriana I, Ernesia I, Wardana DS, Supriyati E, Arguni E, Meitika Y, Prabowo E, Andari B, Green BR, Hodgson L, Rancès E, Ryan PA, O’Neill SL, Anders KL, Ansari MR, Indriani C, Ahmad RA, Utarini A, Simmons CP. Aedes aegypti abundance and insecticide resistance profiles in the Applying Wolbachia to Eliminate Dengue trial. PLoS Negl Trop Dis 2022; 16:e0010284. [PMID: 35442957 PMCID: PMC9060332 DOI: 10.1371/journal.pntd.0010284] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 05/02/2022] [Accepted: 02/27/2022] [Indexed: 11/21/2022] Open
Abstract
The Applying Wolbachia to Eliminate Dengue (AWED) trial was a parallel cluster randomised trial that demonstrated Wolbachia (wMel) introgression into Ae. aegypti populations reduced dengue incidence. In this predefined substudy, we compared between treatment arms, the relative abundance of Ae. aegypti and Ae. albopictus before, during and after wMel-introgression. Between March 2015 and March 2020, 60,084 BG trap collections yielded 478,254 Ae. aegypti and 17,623 Ae. albopictus. Between treatment arms there was no measurable difference in Ae. aegypti relative abundance before or after wMel-deployments, with a count ratio of 0.96 (95% CI 0.76, 1.21) and 1.00 (95% CI 0.85, 1.17) respectively. More Ae. aegypti were caught per trap per week in the wMel-intervention arm compared to the control arm during wMel deployments (count ratio 1.23 (95% CI 1.03, 1.46)). Between treatment arms there was no measurable difference in the Ae. albopictus population size before, during or after wMel-deployment (overall count ratio 1.10 (95% CI 0.89, 1.35)). We also compared insecticide resistance phenotypes of Ae. aegypti in the first and second years after wMel-deployments. Ae. aegypti field populations from wMel-treated and untreated arms were similarly resistant to malathion (0.8%), permethrin (1.25%) and cyfluthrin (0.15%) in year 1 and year 2 of the trial. In summary, we found no between-arm differences in the relative abundance of Ae. aegypti or Ae. albopictus prior to or after wMel introgression, and no between-arm difference in Ae. aegypti insecticide resistance phenotypes. These data suggest neither Aedes abundance, nor insecticide resistance, confounded the epidemiological outcomes of the AWED trial. Dengue is a mosquito-borne viral disease and a major public health problem in the tropical and subtropical world. It is caused by any of the four dengue virus serotypes. In a previously published randomised clinical trial, called the AWED trial, we demonstrated that releases of Aedes aegypti mosquitoes infected with the insect bacterium Wolbachia can reduce the case incidence of dengue by 77%. In this current study, we compared the abundance of Ae. aegypti mosquitoes in the neighbourhoods where Wolbachia-infected mosquitoes were released versus the untreated neighbourhoods. This was important to do so that scientists could understand the mechanism for how Wolbachia releases reduced dengue incidence. Between March 2015 and March 2020, we did not observe any differences in Ae. aegypti abundance before or after Wolbachia-deployments in the AWED trial area. There was also no difference in the abundance of the related mosquito, Ae. albopictus, before, during or after wMel-deployment. We also compared insecticide resistance characteristics amongst Ae. aegypti in the first and second years after Wolbachia -deployments and found no difference between mosquitoes from Wolbachia-treated and untreated neighbourhoods. These data suggest neither Aedes abundance, nor insecticide resistance, were confounding sources to the epidemiological outcomes of the AWED trial.
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Affiliation(s)
- Warsito Tantowijoyo
- World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Stephanie K. Tanamas
- World Mosquito Program, Institute of Vector-borne Disease, Monash University, Clayton, Australia
| | - Indah Nurhayati
- World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sigit Setyawan
- World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Nida Budiwati
- World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Iva Fitriana
- World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Inggrid Ernesia
- World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Dwi Satria Wardana
- World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Endah Supriyati
- World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Eggi Arguni
- World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yeti Meitika
- World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Equatori Prabowo
- World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Bekti Andari
- World Mosquito Program, Institute of Vector-borne Disease, Monash University, Clayton, Australia
| | - Benjamin R. Green
- World Mosquito Program, Institute of Vector-borne Disease, Monash University, Clayton, Australia
| | - Lauren Hodgson
- World Mosquito Program, Institute of Vector-borne Disease, Monash University, Clayton, Australia
| | - Edwige Rancès
- World Mosquito Program, Institute of Vector-borne Disease, Monash University, Clayton, Australia
| | - Peter A. Ryan
- World Mosquito Program, Institute of Vector-borne Disease, Monash University, Clayton, Australia
| | - Scott L. O’Neill
- World Mosquito Program, Institute of Vector-borne Disease, Monash University, Clayton, Australia
| | - Katherine L. Anders
- World Mosquito Program, Institute of Vector-borne Disease, Monash University, Clayton, Australia
| | - M. Ridwan Ansari
- World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Citra Indriani
- World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Biostatistics, Epidemiology and Public Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Riris Andono Ahmad
- World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Biostatistics, Epidemiology and Public Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Adi Utarini
- World Mosquito Program Yogyakarta, Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Cameron P. Simmons
- World Mosquito Program, Institute of Vector-borne Disease, Monash University, Clayton, Australia
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- * E-mail:
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Pinto SB, Riback TIS, Sylvestre G, Costa G, Peixoto J, Dias FBS, Tanamas SK, Simmons CP, Dufault SM, Ryan PA, O’Neill SL, Muzzi FC, Kutcher S, Montgomery J, Green BR, Smithyman R, Eppinghaus A, Saraceni V, Durovni B, Anders KL, Moreira LA. Effectiveness of Wolbachia-infected mosquito deployments in reducing the incidence of dengue and other Aedes-borne diseases in Niterói, Brazil: A quasi-experimental study. PLoS Negl Trop Dis 2021; 15:e0009556. [PMID: 34252106 PMCID: PMC8297942 DOI: 10.1371/journal.pntd.0009556] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [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: 01/31/2021] [Revised: 07/22/2021] [Accepted: 06/09/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The introduction of the bacterium Wolbachia (wMel strain) into Aedes aegypti mosquitoes reduces their capacity to transmit dengue and other arboviruses. Evidence of a reduction in dengue case incidence following field releases of wMel-infected Ae. aegypti has been reported previously from a cluster randomised controlled trial in Indonesia, and quasi-experimental studies in Indonesia and northern Australia. METHODOLOGY/PRINCIPAL FINDINGS Following pilot releases in 2015-2016 and a period of intensive community engagement, deployments of adult wMel-infected Ae. aegypti mosquitoes were conducted in Niterói, Brazil during 2017-2019. Deployments were phased across four release zones, with a total area of 83 km2 and a residential population of approximately 373,000. A quasi-experimental design was used to evaluate the effectiveness of wMel deployments in reducing dengue, chikungunya and Zika incidence. An untreated control zone was pre-defined, which was comparable to the intervention area in historical dengue trends. The wMel intervention effect was estimated by controlled interrupted time series analysis of monthly dengue, chikungunya and Zika case notifications to the public health surveillance system before, during and after releases, from release zones and the control zone. Three years after commencement of releases, wMel introgression into local Ae. aegypti populations was heterogeneous throughout Niterói, reaching a high prevalence (>80%) in the earliest release zone, and more moderate levels (prevalence 40-70%) elsewhere. Despite this spatial heterogeneity in entomological outcomes, the wMel intervention was associated with a 69% reduction in dengue incidence (95% confidence interval 54%, 79%), a 56% reduction in chikungunya incidence (95%CI 16%, 77%) and a 37% reduction in Zika incidence (95%CI 1%, 60%), in the aggregate release area compared with the pre-defined control area. This significant intervention effect on dengue was replicated across all four release zones, and in three of four zones for chikungunya, though not in individual release zones for Zika. CONCLUSIONS/SIGNIFICANCE We demonstrate that wMel Wolbachia can be successfully introgressed into Ae. aegypti populations in a large and complex urban setting, and that a significant public health benefit from reduced incidence of Aedes-borne disease accrues even where the prevalence of wMel in local mosquito populations is moderate and spatially heterogeneous. These findings are consistent with the results of randomised and non-randomised field trials in Indonesia and northern Australia, and are supportive of the Wolbachia biocontrol method as a multivalent intervention against dengue, chikungunya and Zika.
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Affiliation(s)
| | | | | | | | - Julia Peixoto
- World Mosquito Program, Fiocruz, Rio de Janeiro, Brazil
| | - Fernando B. S. Dias
- World Mosquito Program, Fiocruz, Rio de Janeiro, Brazil
- Gabinete da Presidência, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Stephanie K. Tanamas
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Clayton, Australia
| | - Cameron P. Simmons
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Clayton, Australia
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Suzanne M. Dufault
- Division of Biostatistics, School of Public Health, University of California, Berkeley, California, United States of America
| | - Peter A. Ryan
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Clayton, Australia
| | - Scott L. O’Neill
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Clayton, Australia
| | - Frederico C. Muzzi
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Clayton, Australia
| | - Simon Kutcher
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Clayton, Australia
| | - Jacqui Montgomery
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Clayton, Australia
| | - Benjamin R. Green
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Clayton, Australia
| | - Ruth Smithyman
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Clayton, Australia
| | | | | | - Betina Durovni
- World Mosquito Program, Fiocruz, Rio de Janeiro, Brazil
- Centre for Strategic Studies, Fiocruz, Rio de Janeiro, Brazil
| | - Katherine L. Anders
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Clayton, Australia
| | - Luciano A. Moreira
- World Mosquito Program, Fiocruz, Rio de Janeiro, Brazil
- Instituto Rene Rachou, Fiocruz, Belo Horizonte, Brazil
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Utarini A, Indriani C, Ahmad RA, Tantowijoyo W, Arguni E, Ansari MR, Supriyati E, Wardana DS, Meitika Y, Ernesia I, Nurhayati I, Prabowo E, Andari B, Green BR, Hodgson L, Cutcher Z, Rancès E, Ryan PA, O'Neill SL, Dufault SM, Tanamas SK, Jewell NP, Anders KL, Simmons CP. Efficacy of Wolbachia-Infected Mosquito Deployments for the Control of Dengue. N Engl J Med 2021; 384:2177-2186. [PMID: 34107180 PMCID: PMC8103655 DOI: 10.1056/nejmoa2030243] [Citation(s) in RCA: 209] [Impact Index Per Article: 69.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Aedes aegypti mosquitoes infected with the wMel strain of Wolbachia pipientis are less susceptible than wild-type A. aegypti to dengue virus infection. METHODS We conducted a cluster-randomized trial involving releases of wMel-infected A. aegypti mosquitoes for the control of dengue in Yogyakarta, Indonesia. We randomly assigned 12 geographic clusters to receive deployments of wMel-infected A. aegypti (intervention clusters) and 12 clusters to receive no deployments (control clusters). All clusters practiced local mosquito-control measures as usual. A test-negative design was used to assess the efficacy of the intervention. Patients with acute undifferentiated fever who presented to local primary care clinics and were 3 to 45 years of age were recruited. Laboratory testing was used to identify participants who had virologically confirmed dengue (VCD) and those who were test-negative controls. The primary end point was symptomatic VCD of any severity caused by any dengue virus serotype. RESULTS After successful introgression of wMel into the intervention clusters, 8144 participants were enrolled; 3721 lived in intervention clusters, and 4423 lived in control clusters. In the intention-to-treat analysis, VCD occurred in 67 of 2905 participants (2.3%) in the intervention clusters and in 318 of 3401 (9.4%) in the control clusters (aggregate odds ratio for VCD, 0.23; 95% confidence interval [CI], 0.15 to 0.35; P = 0.004). The protective efficacy of the intervention was 77.1% (95% CI, 65.3 to 84.9) and was similar against the four dengue virus serotypes. The incidence of hospitalization for VCD was lower among participants who lived in intervention clusters (13 of 2905 participants [0.4%]) than among those who lived in control clusters (102 of 3401 [3.0%]) (protective efficacy, 86.2%; 95% CI, 66.2 to 94.3). CONCLUSIONS Introgression of wMel into A. aegypti populations was effective in reducing the incidence of symptomatic dengue and resulted in fewer hospitalizations for dengue among the participants. (Funded by the Tahija Foundation and others; AWED ClinicalTrials.gov number, NCT03055585; Indonesia Registry number, INA-A7OB6TW.).
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Affiliation(s)
- Adi Utarini
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - Citra Indriani
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - Riris A Ahmad
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - Warsito Tantowijoyo
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - Eggi Arguni
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - M Ridwan Ansari
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - Endah Supriyati
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - D Satria Wardana
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - Yeti Meitika
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - Inggrid Ernesia
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - Indah Nurhayati
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - Equatori Prabowo
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - Bekti Andari
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - Benjamin R Green
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - Lauren Hodgson
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - Zoe Cutcher
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - Edwige Rancès
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - Peter A Ryan
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - Scott L O'Neill
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - Suzanne M Dufault
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - Stephanie K Tanamas
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - Nicholas P Jewell
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - Katherine L Anders
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
| | - Cameron P Simmons
- From the World Mosquito Program Yogyakarta, Center for Tropical Medicine (A.U., C.I., R.A.A., W.T., E.A., M.R.A., E.S., D.S.W., Y.M., I.E., I.N., E.P.), the Department of Health Policy and Management (A.U.), the Department of Biostatistics, Epidemiology, and Public Health (C.I., R.A.A.), and the Department of Child Health (E.A.), Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; the Department of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley (S.M.D., N.P.J.); the London School of Hygiene and Tropical Medicine, London (N.P.J.); Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam (C.P.S.); and the World Mosquito Program, Institute of Vector-Borne Disease, Monash University, Clayton, VIC, Australia (B.A., B.R.G., L.H., Z.C., E.R., P.A.R., S.L.O., S.M.D., S.K.T., K.L.A., C.P.S.)
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9
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Little RD, Smith SE, Cicuttini FM, Tanamas SK, Wluka AE, Hussain SM, Urquhart DM, Jones G, Wang Y. Association between increased signal intensity at the proximal patellar tendon and patellofemoral geometry in community-based asymptomatic middle-aged adults: a cross-sectional study. BMC Musculoskelet Disord 2020; 21:571. [PMID: 32828128 PMCID: PMC7443287 DOI: 10.1186/s12891-020-03589-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 08/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Histological and epidemiological data suggest that increased signal intensity at the proximal patellar tendon on magnetic resonance imaging is a response to tendon loading. As patellofemoral geometry is a mediator of loading, we examined the association between patellofemoral geometry and the prevalence of increased signal intensity at the patellar tendon in community-based middle-aged adults. METHODS Two hundred-one adults aged 25-60 years in a study of obesity and musculoskeletal health had the patellar tendon assessed from magnetic resonance imaging. Increased signal intensity at the proximal patellar tendon was defined as hyper-intense regions of characteristic pattern, size and distribution on both T1- and T2-weighted sequences. Indices of patellofemoral geometry, including Insall-Salvati ratio, patellofemoral congruence angle, sulcus angle, and lateral condyle-patella angle, were measured from magnetic resonance imaging using validated methods. Binary logistic regression was used to examine the association between patellofemoral geometrical indices and the prevalence of increased signal intensity at the patellar tendon. RESULTS The prevalence of increased signal intensity at the patellar tendon was 37.3%. A greater Insall-Salvati ratio (odds ratio 0.80, 95% confidence interval 0.66-0.97 per 0.1 change in the ratio, p = 0.02), indicative of a higher-riding patella, and a larger patellofemoral congruence angle (odds ratio 0.91, 95% confidence interval 0.85-0.98 per 5 degree change in the angle, p = 0.01), indicating a more laterally placed patella, were associated with reduced odds of increased signal intensity at the patellar tendon. Sulcus angle and lateral condyle-patella angle were not significantly associated with the odds of increased signal intensity at the patellar tendon. CONCLUSIONS In community-based asymptomatic middle-aged adults, increased signal intensity at the patellar tendon was common and associated with Insall-Salvati ratio and patellofemoral congruence angle, suggesting a biomechanical mechanism. Such work is likely to inform tissue engineering and cell regeneration approaches to improving outcomes in those with tendon pathology.
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Affiliation(s)
- Robert D Little
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Samuel E Smith
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Flavia M Cicuttini
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Stephanie K Tanamas
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Anita E Wluka
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Donna M Urquhart
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Yuanyuan Wang
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
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10
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Anders KL, Indriani C, Ahmad RA, Tantowijoyo W, Arguni E, Andari B, Jewell NP, Dufault SM, Ryan PA, Tanamas SK, Rancès E, O'Neill SL, Simmons CP, Utarini A. Update to the AWED (Applying Wolbachia to Eliminate Dengue) trial study protocol: a cluster randomised controlled trial in Yogyakarta, Indonesia. Trials 2020; 21:429. [PMID: 32450914 PMCID: PMC7249400 DOI: 10.1186/s13063-020-04367-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 03/29/2020] [Accepted: 05/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The AWED (Applying Wolbachia to Eliminate Dengue) trial is a parallel, two-arm, non-blinded cluster randomised controlled trial that is under way in Yogyakarta, Indonesia, with the aim of measuring the efficacy of Wolbachia-infected Aedes aegypti deployments in reducing dengue incidence in an endemic setting. Enrolment began in January 2018 and is ongoing. The original study protocol was published in April 2018. Here, we describe amendments that have been made to the study protocol since commencement of the trial. METHODS The key protocol amendments are (1) a revised study duration with planned end of participant enrolment in August 2020, (2) the addition of new secondary objectives (i) to estimate serotype-specific efficacy of the Wolbachia intervention and (ii) to compare Ae. aegypti abundance in intervention versus untreated clusters, (3) an additional exposure classification for the per-protocol analysis where the Wolbachia exposure index is calculated using only the cluster-level Wolbachia prevalence in the participant's cluster of residence, (4) power re-estimation using a multinomial sampling method that better accounts for randomness in sampling, and (5) the addition of two trial stopping rules to address the potential for persistently low rates of virologically confirmed dengue case enrolment and Wolbachia contamination into untreated clusters. Additional minor changes to the protocol are also described. DISCUSSION The findings from this study will provide the first experimental evidence for the efficacy of Wolbachia in reducing dengue incidence. Enrolment in the trial will conclude this year (2020) and results will be reported shortly thereafter. TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT03055585. Registered on 14 February 2017. Last updated 22 March 2020.
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Affiliation(s)
- Katherine L Anders
- Institute of Vector Borne Disease, Monash University, 12 Innovation Walk, Melbourne, 3800, Victoria, Australia.
| | - Citra Indriani
- Department of Biostatistics, Epidemiology and Population Health and Centre for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Jl. Medika, Yogyakarta, 55281, Indonesia
| | - Riris Andono Ahmad
- Department of Biostatistics, Epidemiology and Population Health and Centre for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Jl. Medika, Yogyakarta, 55281, Indonesia
| | - Warsito Tantowijoyo
- World Mosquito Program, Centre for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Jl. Medika, Yogyakarta, 55281, Indonesia
| | - Eggi Arguni
- Department of Pediatrics and Centre for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Jl. Medika, Yogyakarta, 55281, Indonesia
| | - Bekti Andari
- Centre for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Jl. Medika, Yogyakarta, 55281, Indonesia
| | - Nicholas P Jewell
- Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Suzanne M Dufault
- School of Public Health, University of California, 2121 Berkeley Way, Berkeley, 94720-7360, CA, USA
| | - Peter A Ryan
- Institute of Vector Borne Disease, Monash University, 12 Innovation Walk, Melbourne, 3800, Victoria, Australia
| | - Stephanie K Tanamas
- Institute of Vector Borne Disease, Monash University, 12 Innovation Walk, Melbourne, 3800, Victoria, Australia
| | - Edwige Rancès
- Institute of Vector Borne Disease, Monash University, 12 Innovation Walk, Melbourne, 3800, Victoria, Australia
| | - Scott L O'Neill
- Institute of Vector Borne Disease, Monash University, 12 Innovation Walk, Melbourne, 3800, Victoria, Australia
| | - Cameron P Simmons
- Institute of Vector Borne Disease, Monash University, 12 Innovation Walk, Melbourne, 3800, Victoria, Australia
| | - Adi Utarini
- Department of Health Policy and Management, and Centre for Tropical Medicine, Faculty of Medicine, Universitas Gadjah Mada, Jl. Medika, Yogyakarta, 55281, Indonesia
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11
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Indriani C, Tantowijoyo W, Rancès E, Andari B, Prabowo E, Yusdi D, Ansari MR, Wardana DS, Supriyati E, Nurhayati I, Ernesia I, Setyawan S, Fitriana I, Arguni E, Amelia Y, Ahmad RA, Jewell NP, Dufault SM, Ryan PA, Green BR, McAdam TF, O'Neill SL, Tanamas SK, Simmons CP, Anders KL, Utarini A. Reduced dengue incidence following deployments of Wolbachia-infected Aedes aegypti in Yogyakarta, Indonesia: a quasi-experimental trial using controlled interrupted time series analysis. Gates Open Res 2020; 4:50. [PMID: 32803130 PMCID: PMC7403856 DOI: 10.12688/gatesopenres.13122.1] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Ae. aegypti mosquitoes stably transfected with the intracellular bacterium Wolbachia pipientis ( wMel strain) have been deployed for biocontrol of dengue and related arboviral diseases in multiple countries. Field releases in northern Australia have previously demonstrated near elimination of local dengue transmission from Wolbachia-treated communities, and pilot studies in Indonesia have demonstrated the feasibility and acceptability of the method. We conducted a quasi-experimental trial to evaluate the impact of scaled Wolbachia releases on dengue incidence in an endemic setting in Indonesia. Methods: In Yogyakarta City, Indonesia, following extensive community engagement, wMel Wolbachia-carrying mosquitoes were released every two weeks for 13-15 rounds over seven months in 2016-17, in a contiguous 5 km 2 area (population 65,000). A 3 km 2 area (population 34,000) on the opposite side of the city was selected a priori as an untreated control area. Passive surveillance data on notified hospitalised dengue patients was used to evaluate the epidemiological impact of Wolbachia deployments, using controlled interrupted time-series analysis. Results: Rapid and sustained introgression of wMel Wolbachia into local Ae. aegypti populations was achieved. Thirty-four dengue cases were notified from the intervention area and 53 from the control area (incidence 26 vs 79 per 100,000 person-years) during 24 months following Wolbachia deployment. This corresponded in the regression model to a 73% reduction in dengue incidence (95% confidence interval 49%,86%) associated with the Wolbachia intervention. Exploratory analysis including 6 months additional post-intervention observations showed a small strengthening of this effect (30 vs 115 per 100,000 person-years; 76% reduction in incidence, 95%CI 60%,86%). Conclusions: We demonstrate a significant reduction in dengue incidence following successful introgression of Wolbachia into local Ae. aegypti populations in an endemic setting in Indonesia. These findings are consistent with previous field trials in northern Australia, and support the effectiveness of this novel approach for dengue control.
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Affiliation(s)
- Citra Indriani
- Centre of Tropical Medicine, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Epidemiology Biostatistics and Public Health, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Warsito Tantowijoyo
- Centre of Tropical Medicine, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Edwige Rancès
- Institute of Vector Borne Disease, Monash University, Melbourne, Australia
| | - Bekti Andari
- Centre of Tropical Medicine, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Equatori Prabowo
- Centre of Tropical Medicine, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Dedik Yusdi
- Centre of Tropical Medicine, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Muhammad Ridwan Ansari
- Centre of Tropical Medicine, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Dwi Satria Wardana
- Centre of Tropical Medicine, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Endah Supriyati
- Centre of Tropical Medicine, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Indah Nurhayati
- Centre of Tropical Medicine, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Inggrid Ernesia
- Centre of Tropical Medicine, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sigit Setyawan
- Centre of Tropical Medicine, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Iva Fitriana
- Centre of Tropical Medicine, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Eggi Arguni
- Centre of Tropical Medicine, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Paediatrics, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Riris Andono Ahmad
- Centre of Tropical Medicine, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Epidemiology Biostatistics and Public Health, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Nicholas P. Jewell
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, USA
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzanne M. Dufault
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, USA
| | - Peter A. Ryan
- Institute of Vector Borne Disease, Monash University, Melbourne, Australia
| | - Benjamin R. Green
- Institute of Vector Borne Disease, Monash University, Melbourne, Australia
| | - Thomas F. McAdam
- Institute of Vector Borne Disease, Monash University, Melbourne, Australia
| | - Scott L. O'Neill
- Institute of Vector Borne Disease, Monash University, Melbourne, Australia
| | | | - Cameron P. Simmons
- Institute of Vector Borne Disease, Monash University, Melbourne, Australia
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Adi Utarini
- Centre of Tropical Medicine, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Health Policy and Management, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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12
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Ryan PA, Turley AP, Wilson G, Hurst TP, Retzki K, Brown-Kenyon J, Hodgson L, Kenny N, Cook H, Montgomery BL, Paton CJ, Ritchie SA, Hoffmann AA, Jewell NP, Tanamas SK, Anders KL, Simmons CP, O'Neill SL. Establishment of wMel Wolbachia in Aedes aegypti mosquitoes and reduction of local dengue transmission in Cairns and surrounding locations in northern Queensland, Australia. Gates Open Res 2020; 3:1547. [PMID: 31667465 DOI: 10.12688/gatesopenres.13061.1] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 01/13/2023] Open
Abstract
Background: The wMel strain of Wolbachia has been successfully introduced into Aedes aegypti mosquitoes and subsequently shown in laboratory studies to reduce transmission of a range of viruses including dengue, Zika, chikungunya, yellow fever, and Mayaro viruses that cause human disease. Here we report the entomological and epidemiological outcomes of staged deployment of Wolbachia across nearly all significant dengue transmission risk areas in Australia. Methods: The wMel strain of Wolbachia was backcrossed into the local Aedes aegypti genotype (Cairns and Townsville backgrounds) and mosquitoes were released in the field by staff or via community assisted methods. Mosquito monitoring was undertaken and mosquitoes were screened for the presence of Wolbachia. Dengue case notifications were used to track dengue incidence in each location before and after releases. Results: Empirical analyses of the Wolbachia mosquito releases, including data on the density, frequency and duration of Wolbachia mosquito releases, indicate that Wolbachia can be readily established in local mosquito populations, using a variety of deployment options and over short release durations (mean release period 11 weeks, range 2-22 weeks). Importantly, Wolbachia frequencies have remained stable in mosquito populations since releases for up to 8 years. Analysis of dengue case notifications data demonstrates near-elimination of local dengue transmission for the past five years in locations where Wolbachia has been established. The regression model estimate of Wolbachia intervention effect from interrupted time series analyses of case notifications data prior to and after releases, indicated a 96% reduction in dengue incidence in Wolbachia treated populations (95% confidence interval: 84 - 99%). Conclusion: Deployment of the wMel strain of Wolbachia into local Ae. aegypti populations across the Australian regional cities of Cairns and most smaller regional communities with a past history of dengue has resulted in the reduction of local dengue transmission across all deployment areas.
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Affiliation(s)
- Peter A Ryan
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
| | - Andrew P Turley
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
| | - Geoff Wilson
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
| | - Tim P Hurst
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia.,Biosecurity and Agricultural Services, Department of Jobs, Precincts and Regions, Victoria State Government, Atwood, Victoria, Australia
| | - Kate Retzki
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
| | - Jack Brown-Kenyon
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
| | - Lauren Hodgson
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
| | - Nichola Kenny
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
| | - Helen Cook
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
| | - Brian L Montgomery
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia.,Metro South Public Health Unit, Queensland Health, Coopers Plains, Queensland, Australia
| | - Christopher J Paton
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Scott A Ritchie
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Ary A Hoffmann
- School of Biosciences, Bio21 Institute, University of Melbourne, Parkville, Victoria, Australia
| | - Nicholas P Jewell
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California, USA.,Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK
| | - Stephanie K Tanamas
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
| | - Katherine L Anders
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
| | - Cameron P Simmons
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia.,Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Scott L O'Neill
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
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13
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Ryan PA, Turley AP, Wilson G, Hurst TP, Retzki K, Brown-Kenyon J, Hodgson L, Kenny N, Cook H, Montgomery BL, Paton CJ, Ritchie SA, Hoffmann AA, Jewell NP, Tanamas SK, Anders KL, Simmons CP, O'Neill SL. Establishment of wMel Wolbachia in Aedes aegypti mosquitoes and reduction of local dengue transmission in Cairns and surrounding locations in northern Queensland, Australia. Gates Open Res 2020; 3:1547. [PMID: 31667465 PMCID: PMC6801363 DOI: 10.12688/gatesopenres.13061.2] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [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] [Accepted: 04/01/2020] [Indexed: 01/14/2023] Open
Abstract
Background: The
wMel strain of
Wolbachia has been successfully introduced into
Aedes aegypti mosquitoes and subsequently shown in laboratory studies to reduce transmission of a range of viruses including dengue, Zika, chikungunya, yellow fever, and Mayaro viruses that cause human disease. Here we report the entomological and epidemiological outcomes of staged deployment of
Wolbachia across nearly all significant dengue transmission risk areas in Australia. Methods: The
wMel strain of
Wolbachia was backcrossed into the local
Aedes aegypti genotype (Cairns and Townsville backgrounds) and mosquitoes were released in the field by staff or via community assisted methods. Mosquito monitoring was undertaken and mosquitoes were screened for the presence of
Wolbachia. Dengue case notifications were used to track dengue incidence in each location before and after releases. Results: Empirical analyses of the
Wolbachia mosquito releases, including data on the density, frequency and duration of
Wolbachia mosquito releases, indicate that
Wolbachia can be readily established in local mosquito populations, using a variety of deployment options and over short release durations (mean release period 11 weeks, range 2-22 weeks). Importantly,
Wolbachia frequencies have remained stable in mosquito populations since releases for up to 8 years. Analysis of dengue case notifications data demonstrates near-elimination of local dengue transmission for the past five years in locations where
Wolbachia has been established. The regression model estimate of
Wolbachia intervention effect from interrupted time series analyses of case notifications data prior to and after releases, indicated a 96% reduction in dengue incidence in
Wolbachia treated populations (95% confidence interval: 84 – 99%). Conclusion: Deployment of the
wMel strain of
Wolbachia into local
Ae. aegypti populations across the Australian regional cities of Cairns and most smaller regional communities with a past history of dengue has resulted in the reduction of local dengue transmission across all deployment areas.
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Affiliation(s)
- Peter A Ryan
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
| | - Andrew P Turley
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
| | - Geoff Wilson
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
| | - Tim P Hurst
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia.,Biosecurity and Agricultural Services, Department of Jobs, Precincts and Regions, Victoria State Government, Atwood, Victoria, Australia
| | - Kate Retzki
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
| | - Jack Brown-Kenyon
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
| | - Lauren Hodgson
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
| | - Nichola Kenny
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
| | - Helen Cook
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
| | - Brian L Montgomery
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia.,Metro South Public Health Unit, Queensland Health, Coopers Plains, Queensland, Australia
| | - Christopher J Paton
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Scott A Ritchie
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Ary A Hoffmann
- School of Biosciences, Bio21 Institute, University of Melbourne, Parkville, Victoria, Australia
| | - Nicholas P Jewell
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California, USA.,Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK
| | - Stephanie K Tanamas
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
| | - Katherine L Anders
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
| | - Cameron P Simmons
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia.,Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Scott L O'Neill
- Institute of Vector-Borne Disease, Monash University, Clayton, Victoria, 3800, Australia
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14
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O'Neill SL, Ryan PA, Turley AP, Wilson G, Retzki K, Iturbe-Ormaetxe I, Dong Y, Kenny N, Paton CJ, Ritchie SA, Brown-Kenyon J, Stanford D, Wittmeier N, Jewell NP, Tanamas SK, Anders KL, Simmons CP. Scaled deployment of Wolbachia to protect the community from dengue and other Aedes transmitted arboviruses. Gates Open Res 2019; 2:36. [PMID: 30596205 DOI: 10.12688/gatesopenres.12844.2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2018] [Indexed: 11/20/2022] Open
Abstract
Background: A number of new technologies are under development for the control of mosquito transmitted viruses, such as dengue, chikungunya and Zika that all require the release of modified mosquitoes into the environment. None of these technologies has been able to demonstrate evidence that they can be implemented at a scale beyond small pilots. Here we report the first successful citywide scaled deployment of Wolbachia in the northern Australian city of Townsville. Methods: The wMel strain of Wolbachia was backcrossed into a local Aedes aegypti genotype and mass reared mosquitoes were deployed as eggs using mosquito release containers (MRCs). In initial stages these releases were undertaken by program staff but in later stages this was replaced by direct community release including the development of a school program that saw children undertake releases. Mosquito monitoring was undertaken with Biogents Sentinel (BGS) traps and individual mosquitoes were screened for the presence of Wolbachia with a Taqman qPCR or LAMP diagnostic assay. Dengue case notifications from Queensland Health Communicable Disease Branch were used to track dengue cases in the city before and after release. Results: Wolbachia was successfully established into local Ae. aegypti mosquitoes across 66 km 2 in four stages over 28 months with full community support. A feature of the program was the development of a scaled approach to community engagement. Wolbachia frequencies have remained stable since deployment and to date no local dengue transmission has been confirmed in any area of Townsville after Wolbachia has established, despite local transmission events every year for the prior 13 years and an epidemiological context of increasing imported cases. Conclusion: Deployment of Wolbachia into Ae. aegypti populations can be readily scaled to areas of ~60km 2 quickly and cost effectively and appears in this context to be effective at stopping local dengue transmission.
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Affiliation(s)
- Scott L O'Neill
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Peter A Ryan
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Andrew P Turley
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Geoff Wilson
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Kate Retzki
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | | | - Yi Dong
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Nichola Kenny
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Christopher J Paton
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, 4878, Australia
| | - Scott A Ritchie
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, 4878, Australia
| | - Jack Brown-Kenyon
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Darren Stanford
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Natalie Wittmeier
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Nicholas P Jewell
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, USA.,Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK.,Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Stephanie K Tanamas
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Katherine L Anders
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Cameron P Simmons
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
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15
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Moreno-Betancur M, Carlin JB, Brilleman SL, Tanamas SK, Peeters A, Wolfe R. Survival analysis with time-dependent covariates subject to missing data or measurement error: Multiple Imputation for Joint Modeling (MIJM). Biostatistics 2019; 19:479-496. [PMID: 29040396 DOI: 10.1093/biostatistics/kxx046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 08/22/2017] [Indexed: 11/14/2022] Open
Abstract
Modern epidemiological studies collect data on time-varying individual-specific characteristics, such as body mass index and blood pressure. Incorporation of such time-dependent covariates in time-to-event models is of great interest, but raises some challenges. Of specific concern are measurement error, and the non-synchronous updating of covariates across individuals, due for example to missing data. It is well known that in the presence of either of these issues the last observation carried forward (LOCF) approach traditionally used leads to bias. Joint models of longitudinal and time-to-event outcomes, developed recently, address these complexities by specifying a model for the joint distribution of all processes and are commonly fitted by maximum likelihood or Bayesian approaches. However, the adequate specification of the full joint distribution can be a challenging modeling task, especially with multiple longitudinal markers. In fact, most available software packages are unable to handle more than one marker and offer a restricted choice of survival models. We propose a two-stage approach, Multiple Imputation for Joint Modeling (MIJM), to incorporate multiple time-dependent continuous covariates in the semi-parametric Cox and additive hazard models. Assuming a primary focus on the time-to-event model, the MIJM approach handles the joint distribution of the markers using multiple imputation by chained equations, a computationally convenient procedure that is widely available in mainstream statistical software. We developed an R package "survtd" that allows MIJM and other approaches in this manuscript to be applied easily, with just one call to its main function. A simulation study showed that MIJM performs well across a wide range of scenarios in terms of bias and coverage probability, particularly compared with LOCF, simpler two-stage approaches, and a Bayesian joint model. The Framingham Heart Study is used to illustrate the approach.
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Affiliation(s)
- Margarita Moreno-Betancur
- Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne, VIC, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, 50 Flemington Rd, Parkville, VIC, Australia
| | - John B Carlin
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Samuel L Brilleman
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Anna Peeters
- School of Health and Social Development, Deakin University, Burwood, Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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16
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O'Neill SL, Ryan PA, Turley AP, Wilson G, Retzki K, Iturbe-Ormaetxe I, Dong Y, Kenny N, Paton CJ, Ritchie SA, Brown-Kenyon J, Stanford D, Wittmeier N, Jewell NP, Tanamas SK, Anders KL, Simmons CP. Scaled deployment of Wolbachia to protect the community from dengue and other Aedes transmitted arboviruses. Gates Open Res 2019. [PMID: 30596205 DOI: 10.12688/gatesopenres.12844.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 11/20/2022] Open
Abstract
Background: A number of new technologies are under development for the control of mosquito transmitted viruses, such as dengue, chikungunya and Zika that all require the release of modified mosquitoes into the environment. None of these technologies has been able to demonstrate evidence that they can be implemented at a scale beyond small pilots. Here we report the first successful citywide scaled deployment of Wolbachia in the northern Australian city of Townsville. Methods: The wMel strain of Wolbachia was backcrossed into a local Aedes aegypti genotype and mass reared mosquitoes were deployed as eggs using mosquito release containers (MRCs). In initial stages these releases were undertaken by program staff but in later stages this was replaced by direct community release including the development of a school program that saw children undertake releases. Mosquito monitoring was undertaken with Biogents Sentinel (BGS) traps and individual mosquitoes were screened for the presence of Wolbachia with a Taqman qPCR or LAMP diagnostic assay. Dengue case notifications from Queensland Health Communicable Disease Branch were used to track dengue cases in the city before and after release. Results: Wolbachia was successfully established into local Ae. aegypti mosquitoes across 66 km 2 in four stages over 28 months with full community support. A feature of the program was the development of a scaled approach to community engagement. Wolbachia frequencies have remained stable since deployment and to date no local dengue transmission has been confirmed in any area of Townsville after Wolbachia has established, despite local transmission events every year for the prior 13 years and an epidemiological context of increasing imported cases. Conclusion: Deployment of Wolbachia into Ae. aegypti populations can be readily scaled to areas of ~60km 2 quickly and cost effectively and appears in this context to be effective at stopping local dengue transmission.
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Affiliation(s)
- Scott L O'Neill
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Peter A Ryan
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Andrew P Turley
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Geoff Wilson
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Kate Retzki
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | | | - Yi Dong
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Nichola Kenny
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Christopher J Paton
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, 4878, Australia
| | - Scott A Ritchie
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, 4878, Australia
| | - Jack Brown-Kenyon
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Darren Stanford
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Natalie Wittmeier
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Nicholas P Jewell
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, USA.,Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK.,Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Stephanie K Tanamas
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Katherine L Anders
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Cameron P Simmons
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
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17
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O'Neill SL, Ryan PA, Turley AP, Wilson G, Retzki K, Iturbe-Ormaetxe I, Dong Y, Kenny N, Paton CJ, Ritchie SA, Brown-Kenyon J, Stanford D, Wittmeier N, Jewell NP, Tanamas SK, Anders KL, Simmons CP. Scaled deployment of Wolbachia to protect the community from dengue and other Aedes transmitted arboviruses. Gates Open Res 2019; 2:36. [PMID: 30596205 PMCID: PMC6305154 DOI: 10.12688/gatesopenres.12844.3] [Citation(s) in RCA: 173] [Impact Index Per Article: 34.6] [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] [Accepted: 08/09/2019] [Indexed: 11/21/2022] Open
Abstract
Background: A number of new technologies are under development for the control of mosquito transmitted viruses, such as dengue, chikungunya and Zika that all require the release of modified mosquitoes into the environment. None of these technologies has been able to demonstrate evidence that they can be implemented at a scale beyond small pilots. Here we report the first successful citywide scaled deployment of
Wolbachia in the northern Australian city of Townsville. Methods: The
wMel strain of
Wolbachia was backcrossed into a local
Aedes aegypti genotype and mass reared mosquitoes were deployed as eggs using mosquito release containers (MRCs). In initial stages these releases were undertaken by program staff but in later stages this was replaced by direct community release including the development of a school program that saw children undertake releases. Mosquito monitoring was undertaken with Biogents Sentinel (BGS) traps and individual mosquitoes were screened for the presence of
Wolbachia with a Taqman qPCR or LAMP diagnostic assay. Dengue case notifications from Queensland Health Communicable Disease Branch were used to track dengue cases in the city before and after release. Results:
Wolbachia was successfully established into local
Ae. aegypti mosquitoes across 66 km
2 in four stages over 28 months with full community support. A feature of the program was the development of a scaled approach to community engagement.
Wolbachia frequencies have remained stable since deployment and to date no local dengue transmission has been confirmed in any area of Townsville after
Wolbachia has established, despite local transmission events every year for the prior 13 years and an epidemiological context of increasing imported cases. Conclusion: Deployment of
Wolbachia into
Ae. aegypti populations can be readily scaled to areas of ~60km
2 quickly and cost effectively and appears in this context to be effective at stopping local dengue transmission
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Affiliation(s)
- Scott L O'Neill
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Peter A Ryan
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Andrew P Turley
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Geoff Wilson
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Kate Retzki
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | | | - Yi Dong
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Nichola Kenny
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Christopher J Paton
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, 4878, Australia
| | - Scott A Ritchie
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, QLD, 4878, Australia
| | - Jack Brown-Kenyon
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Darren Stanford
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Natalie Wittmeier
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Nicholas P Jewell
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, USA.,Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK.,Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Stephanie K Tanamas
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Katherine L Anders
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Cameron P Simmons
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
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18
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Durovni B, Saraceni V, Eppinghaus A, Riback TIS, Moreira LA, Jewell NP, Dufault SM, O'Neill SL, Simmons CP, Tanamas SK, Anders KL. The impact of large-scale deployment of Wolbachia mosquitoes on dengue and other Aedes-borne diseases in Rio de Janeiro and Niterói, Brazil: study protocol for a controlled interrupted time series analysis using routine disease surveillance data. F1000Res 2019; 8:1328. [PMID: 33447371 PMCID: PMC7780340 DOI: 10.12688/f1000research.19859.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Rio de Janeiro and Niterói are neighbouring cities in southeastern Brazil which experience large dengue epidemics every 2 to 5 years, with >100,000 cases notified in epidemic years. Costs of vector control and direct and indirect costs due to the
Aedes-borne diseases dengue, chikungunya and Zika were estimated to total $650 million USD in 2016, but traditional vector control strategies have not been effective in preventing mosquito-borne disease outbreaks. The
Wolbachia method is a novel and self-sustaining approach for the biological control of
Aedes-borne diseases, in which the transmission potential of
Aedes aegypti mosquitoes is reduced by stably transfecting them with the
Wolbachia bacterium (
wMel strain). This paper describes a study protocol for evaluating the effect of large-scale non-randomised releases of
Wolbachia-infected mosquitoes on the incidence of dengue, Zika and chikungunya in the two cities of Niterói and Rio de Janeiro. This follows a lead-in period since 2014 involving intensive community engagement, regulatory and public approval, entomological surveys, and small-scale pilot releases. Method: The
Wolbachia releases during 2017-2019 covered a combined area of 170 km
2 with a resident population of 1.2 million, across Niterói and Rio de Janeiro. Untreated areas with comparable historical dengue profiles and demographic characteristics have been identified
a priori as comparative control areas in each city. The proposed pragmatic epidemiological approach combines a controlled interrupted time series analysis of routinely notified suspected and laboratory-confirmed dengue and chikungunya cases, together with monitoring of
Aedes-borne disease activity utilising outbreak signals routinely used in public health disease surveillance. Discussion: If the current project is successful, this model for control of mosquito-borne disease through
Wolbachia releases can be expanded nationally and regionally.
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Affiliation(s)
- Betina Durovni
- Centre for Strategic Studies, Fiocruz, Rio de Janeiro, Brazil.,World Mosquito Program, Fiocruz, Rio de Janeiro, Brazil
| | | | | | | | - Luciano A Moreira
- World Mosquito Program, Fiocruz, Rio de Janeiro, Brazil.,Instituto Rene Rachou, Fiocruz, Belo Horizonte, Brazil
| | - Nicholas P Jewell
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.,Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzanne M Dufault
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Scott L O'Neill
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Cameron P Simmons
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Stephanie K Tanamas
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Katherine L Anders
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
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19
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Velez ID, Santacruz E, Kutcher SC, Duque SL, Uribe A, Barajas J, Gonzalez S, Patino AC, Zuluaga L, Martínez L, Muñoz E, Mejia MC, Arbelaez MP, Pulido H, Jewell NP, Dufault SM, O'Neill SL, Simmons CP, Anders KL, Tanamas SK. The impact of city-wide deployment of Wolbachia-carrying mosquitoes on arboviral disease incidence in Medellín and Bello, Colombia: study protocol for an interrupted time-series analysis and a test-negative design study. F1000Res 2019; 8:1327. [PMID: 34900237 PMCID: PMC8637243 DOI: 10.12688/f1000research.19858.1] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2020] [Indexed: 08/23/2023] Open
Abstract
Background: Dengue, chikungunya and Zika are viral infections transmitted by Aedes aegypti mosquitoes, and present major public health challenges in tropical regions. Traditional vector control methods have been ineffective at halting disease transmission. The World Mosquito Program has developed a novel approach to arbovirus control using Ae. aegypti stably transfected with the Wolbachia bacterium, which have significantly reduced ability to transmit dengue, Zika and chikungunya in laboratory experiments. Field releases in eight countries have demonstrated Wolbachia establishment in local Ae. aegypti populations. Methods: We describe a pragmatic approach to measuring the epidemiological impact of city-wide Wolbachia deployments in Bello and Medellín, Colombia. First, an interrupted time-series analysis will compare the incidence of dengue, chikungunya and Zika case notifications before and after Wolbachia releases, across the two municipalities. Second, a prospective case-control study using a test-negative design will be conducted in one quadrant of Medellín. Three of the six contiguous release zones in the case-control area were allocated to receive the first Wolbachia deployments in the city and three to be treated last, approximating a parallel two-arm trial for the >12-month period during which Wolbachia exposure remains discordant. Allocation, although non-random, aimed to maximise balance between arms in historical dengue incidence and demographics. Arboviral disease cases and arbovirus-negative controls will be enrolled concurrently from febrile patients presenting to primary care, with case/control status classified retrospectively following laboratory diagnostic testing. Intervention effect is estimated from an aggregate odds ratio comparing Wolbachia-exposure odds among test-positive cases versus test-negative controls. Discussion: The study findings will add to an accumulating body of evidence from global field sites on the efficacy of the Wolbachia method in reducing arboviral disease incidence, and can inform decisions on wider public health implementation of this intervention in the Americas and beyond. Trial registration: ClinicalTrials.gov: NCT03631719. Registered on 15 August 2018.
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Affiliation(s)
- Ivan D. Velez
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Eduardo Santacruz
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Simon C. Kutcher
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Sandra L. Duque
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Alexander Uribe
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Jovany Barajas
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Sandra Gonzalez
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | | | - Lina Zuluaga
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Luis Martínez
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Estefanía Muñoz
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | | | | | | | - Nicholas P. Jewell
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
- Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzanne M Dufault
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Scott L. O'Neill
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Cameron P. Simmons
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Katherine L. Anders
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Stephanie K. Tanamas
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
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20
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Velez ID, Santacruz E, Kutcher SC, Duque SL, Uribe A, Barajas J, Gonzalez S, Patino AC, Zuluaga L, Martínez L, Muñoz E, Mejia MC, Arbelaez MP, Pulido H, Jewell NP, Dufault SM, O'Neill SL, Simmons CP, Anders KL, Tanamas SK. The impact of city-wide deployment of Wolbachia-carrying mosquitoes on arboviral disease incidence in Medellín and Bello, Colombia: study protocol for an interrupted time-series analysis and a test-negative design study. F1000Res 2019; 8:1327. [PMID: 34900237 PMCID: PMC8637243 DOI: 10.12688/f1000research.19858.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Dengue, chikungunya and Zika are viral infections transmitted by Aedes aegypti mosquitoes, and present major public health challenges in tropical regions. Traditional vector control methods have been ineffective at halting disease transmission. The World Mosquito Program has developed a novel approach to arbovirus control using Ae. aegypti stably transfected with the Wolbachia bacterium, which have significantly reduced ability to transmit dengue, Zika and chikungunya in laboratory experiments. Field releases in eight countries have demonstrated Wolbachia establishment in local Ae. aegypti populations. Methods: We describe a pragmatic approach to measuring the epidemiological impact of city-wide Wolbachia deployments in Bello and Medellín, Colombia. First, an interrupted time-series analysis will compare the incidence of dengue, chikungunya and Zika case notifications before and after Wolbachia releases, across the two municipalities. Second, a prospective case-control study using a test-negative design will be conducted in one quadrant of Medellín. Three of the six contiguous release zones in the case-control area were allocated to receive the first Wolbachia deployments in the city and three to be treated last, approximating a parallel two-arm trial for the >12-month period during which Wolbachia exposure remains discordant. Allocation, although non-random, aimed to maximise balance between arms in historical dengue incidence and demographics. Arboviral disease cases and arbovirus-negative controls will be enrolled concurrently from febrile patients presenting to primary care, with case/control status classified retrospectively following laboratory diagnostic testing. Intervention effect is estimated from an aggregate odds ratio comparing Wolbachia-exposure odds among test-positive cases versus test-negative controls. Discussion: The study findings will add to an accumulating body of evidence from global field sites on the efficacy of the Wolbachia method in reducing arboviral disease incidence, and can inform decisions on wider public health implementation of this intervention in the Americas and beyond. Trial registration: ClinicalTrials.gov: NCT03631719. Registered on 15 August 2018.
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Affiliation(s)
- Ivan D Velez
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Eduardo Santacruz
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Simon C Kutcher
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Sandra L Duque
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Alexander Uribe
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Jovany Barajas
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Sandra Gonzalez
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | | | - Lina Zuluaga
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Luis Martínez
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | - Estefanía Muñoz
- World Mosquito Program, Universidad de Antioquia, Medellin, Colombia
| | | | | | | | - Nicholas P Jewell
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.,Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzanne M Dufault
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Scott L O'Neill
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Cameron P Simmons
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Katherine L Anders
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Stephanie K Tanamas
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
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Durovni B, Saraceni V, Eppinghaus A, Riback TIS, Moreira LA, Jewell NP, Dufault SM, O'Neill SL, Simmons CP, Tanamas SK, Anders KL. The impact of large-scale deployment of Wolbachia mosquitoes on dengue and other Aedes-borne diseases in Rio de Janeiro and Niterói, Brazil: study protocol for a controlled interrupted time series analysis using routine disease surveillance data. F1000Res 2019; 8:1328. [PMID: 33447371 DOI: 10.12688/f1000research.19859.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2019] [Indexed: 01/15/2023] Open
Abstract
Background: Rio de Janeiro and Niterói are neighbouring cities in southeastern Brazil which experience large dengue epidemics every 2 to 5 years, with >100,000 cases notified in epidemic years. Costs of vector control and direct and indirect costs due to the Aedes-borne diseases dengue, chikungunya and Zika were estimated to total $650 million USD in 2016, but traditional vector control strategies have not been effective in preventing mosquito-borne disease outbreaks. The Wolbachia method is a novel and self-sustaining approach for the biological control of Aedes-borne diseases, in which the transmission potential of Aedes aegypti mosquitoes is reduced by stably transfecting them with the Wolbachia bacterium ( wMel strain). This paper describes a study protocol for evaluating the effect of large-scale non-randomised releases of Wolbachia--infected mosquitoes on the incidence of dengue, Zika and chikungunya in the two cities of Niterói and Rio de Janeiro. This follows a lead-in period since 2014 involving intensive community engagement, regulatory and public approval, entomological surveys, and small-scale pilot releases. Method: The Wolbachia releases during 2017-2019 covered a combined area of 170 km 2 with a resident population of 1.2 million, across Niterói and Rio de Janeiro. Untreated areas with comparable historical dengue profiles and demographic characteristics have been identified a priori as comparative control areas in each city. The proposed pragmatic epidemiological approach combines a controlled interrupted time series analysis of routinely notified suspected and laboratory-confirmed dengue and chikungunya cases, together with monitoring of Aedes-borne disease activity utilising outbreak signals routinely used in public health disease surveillance. Discussion: If the current project is successful, this model for control of mosquito-borne disease through Wolbachia releases can be expanded nationally and regionally.
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Affiliation(s)
- Betina Durovni
- Centre for Strategic Studies, Fiocruz, Rio de Janeiro, Brazil.,World Mosquito Program, Fiocruz, Rio de Janeiro, Brazil
| | | | | | | | - Luciano A Moreira
- World Mosquito Program, Fiocruz, Rio de Janeiro, Brazil.,Instituto Rene Rachou, Fiocruz, Belo Horizonte, Brazil
| | - Nicholas P Jewell
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.,Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzanne M Dufault
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Scott L O'Neill
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Cameron P Simmons
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Stephanie K Tanamas
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
| | - Katherine L Anders
- World Mosquito Program, Institute of Vector Borne Disease, Monash University, Melbourne, VIC, Australia
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22
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Tabesh M, Magliano DJ, Tanamas SK, Surmont F, Bahendeka S, Chiang CE, Elgart JF, Gagliardino JJ, Kalra S, Krishnamoorthy S, Luk A, Maegawa H, Motala AA, Pirie F, Ramachandran A, Tayeb K, Vikulova O, Wong J, Shaw JE. Diabetes management and treatment approaches outside of North America and West Europe in 2006 and 2015. Acta Diabetol 2019; 56:889-897. [PMID: 30963308 DOI: 10.1007/s00592-018-01284-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Received: 09/14/2018] [Accepted: 12/29/2018] [Indexed: 02/06/2023]
Abstract
AIMS The impact of introducing new classes of glucose-lowering medication (GLM) on diabetes management remains unclear, especially outside North America and Western Europe. Therefore, we aimed to analyse trends in glycaemic control and the usage of new and old GLMs in people with type 2 diabetes from 2006 to 2015. METHODS Summary data from clinical services from nine countries outside North America and Western Europe were collected and pooled for statistical analysis. Each site summarized individual-level data from out-patient medical records for 2006 and 2015. Data included: demographics; HbA1c and fasting plasma glucose levels; and the proportions of patients taking GLM as monotherapy, combination therapy and/or insulin. RESULTS Between 2006 and 2015, glycaemic control remained stable, although body mass index and duration of diabetes increased in most sites. The proportion of people on GLM increased, and the therapeutic regimens became more complex. There were increases in the use of insulin and triple therapy in most sites, while monotherapy, particularly in relation to sulphonylureas, decreased. Despite the introduction of new GLMs, such as DPP-4 inhibitors, insulin use increased over time. CONCLUSIONS There was no clear evidence that the use of new classes of GLMs was associated with improvements in glycaemic control or reduced the reliance on insulin. These findings were consistent across a range of economic and geographic settings.
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Affiliation(s)
- Maryam Tabesh
- Baker Heart and Diabetes Institute, Level 4, Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Level 4, Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Stephanie K Tanamas
- Baker Heart and Diabetes Institute, Level 4, Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | | | - Silver Bahendeka
- MKPGMS-Uganda Martyrs University and St. Francis Hospital Nsambya, Kampala, Uganda
| | - Chern-En Chiang
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jorge F Elgart
- Facultad de Ciencias Médicas UNLP, CENEXA, Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET), La Plata, Argentina
| | - Juan J Gagliardino
- Facultad de Ciencias Médicas UNLP, CENEXA, Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET), La Plata, Argentina
| | - Sanjay Kalra
- Bharti Research Institute of Diabetes and Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | | | - Andrea Luk
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Sha Tin, Hong Kong SAR, China
| | | | - Ayesha A Motala
- Department of Diabetes and Endocrinology, University of KwaZulu Natal, Durban, South Africa
| | - Fraser Pirie
- Department of Diabetes and Endocrinology, University of KwaZulu Natal, Durban, South Africa
| | | | - Khaled Tayeb
- Diabetes Center at Al-Noor Specialist Hospital, Mecca, Saudi Arabia
| | - Olga Vikulova
- FGBU "Endocrinology Research Center" Ministry of Health, Moscow, Russia
| | - Jencia Wong
- Royal Prince Alfred Hospital Diabetes Centre, University of Sydney, Sydney, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Level 4, Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Saulnier PJ, Darshi M, Wheelock KM, Looker HC, Fufaa GD, Knowler WC, Weil EJ, Tanamas SK, Lemley KV, Saito R, Natarajan L, Nelson RG, Sharma K. Urine metabolites are associated with glomerular lesions in type 2 diabetes. Metabolomics 2018; 14:84. [PMID: 30830355 PMCID: PMC6461445 DOI: 10.1007/s11306-018-1380-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 06/02/2018] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Little is known about the association of urine metabolites with structural lesions in persons with diabetes. OBJECTIVES We examined the relationship between 12 urine metabolites and kidney structure in American Indians with type 2 diabetes. METHODS Data were from a 6-year clinical trial that assessed renoprotective efficacy of losartan, and included a kidney biopsy at the end of the treatment period. Metabolites were measured in urine samples collected within a median of 6.5 months before the research biopsy. Associations of the creatinine-adjusted urine metabolites with kidney structural variables were examined by Pearson's correlations and multivariable linear regression after adjustment for age, sex, diabetes duration, hemoglobin A1c, mean arterial pressure, glomerular filtration rate (iothalamate), and losartan treatment. RESULTS Participants (n = 62, mean age 45 ± 10 years) had mean ± standard deviation glomerular filtration rate of 137 ± 50 ml/min and median (interquartile range) urine albumin:creatinine ratio of 34 (14-85) mg/g near the time of the biopsy. Urine aconitic and glycolic acids correlated positively with glomerular filtration surface density (partial r = 0.29, P = 0.030 and r = 0.50, P < 0.001) and total filtration surface per glomerulus (partial r = 0.32, P = 0.019 and r = 0.43, P = 0.001). 2-ethyl 3-OH propionate correlated positively with the percentage of fenestrated endothelium (partial r = 0.32, P = 0.019). Citric acid correlated negatively with mesangial fractional volume (partial r=-0.36, P = 0.007), and homovanillic acid correlated negatively with podocyte foot process width (partial r=-0.31, P = 0.022). CONCLUSIONS Alterations of urine metabolites may associate with early glomerular lesions in diabetic kidney disease.
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Affiliation(s)
- Pierre-Jean Saulnier
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
- Clinical Investigation Center CIC1402, CHU Poitiers, University of Poitiers, INSERM, Poitiers, France
| | | | - Kevin M Wheelock
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - Helen C Looker
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - Gudeta D Fufaa
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - William C Knowler
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - E Jennifer Weil
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - Stephanie K Tanamas
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | | | - Rintaro Saito
- University of California San Diego, San Diego, CA, USA
| | | | - Robert G Nelson
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA.
- National Institutes of Health, 1550 East Indian School Road, Phoenix, AZ, 85014-4972, USA.
| | - Kumar Sharma
- University of California San Diego, San Diego, CA, USA
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Wheelock KM, Saulnier PJ, Tanamas SK, Vijayakumar P, Weil EJ, Looker HC, Hanson RL, Lemley KV, Yee B, Knowler WC, Hadjadj S, Najafian B, Mauer M, Nelson RG. White blood cell fractions correlate with lesions of diabetic kidney disease and predict loss of kidney function in Type 2 diabetes. Nephrol Dial Transplant 2018; 33:1001-1009. [PMID: 28992267 PMCID: PMC9719839 DOI: 10.1093/ndt/gfx231] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/07/2017] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Inflammation linked to diabetic kidney disease (DKD) may affect white blood cell (WBC) counts and differentials. We examined the cross-sectional associations of total WBC count and WBC fractions with structural lesions of DKD in 108 Pima Indians with Type 2 diabetes who underwent research kidney biopsies. We also examined the longitudinal association of these WBC variables with renal function loss (RFL) in 941 Europeans with Type 2 diabetes from the SURDIAGENE study. METHODS Associations of WBC variables with morphometric parameters were assessed by linear regression. RFL was defined as≥40% loss of estimated glomerular filtration rate from baseline. Associations with RFL were evaluated by Cox regression. Hazard ratios (HRs) were reported per standard deviation increment of each WBC variable. RESULTS After multivariable adjustment, lymphocyte (r = -0.20, P = 0.043) and eosinophil (r = 0.21, P = 0.032) fractions in the Pima Indians correlated with glomerular basement membrane width. Eosinophil fraction also correlated with glomerular filtration surface density (r = -0.21, P = 0.031). Lymphocyte fraction (r = 0.25, P = 0.013), neutrophil fraction (r = -0.23, P = 0.021) and the neutrophil:lymphocyte ratio (r = -0.22, P = 0.024) correlated with percentage of normally fenestrated endothelial cells. During median follow-up of 4.5 years, 321 SURDIAGENE participants developed RFL. Lower lymphocyte fraction [HR = 0.67, 95% confidence interval (95% CI) 0.60-0.76] and higher neutrophil fraction (HR = 1.35, 95% CI 1.20-1.52), total WBC count (HR = 1.20, 95% CI 1.08-1.35) and neutrophil:lymphocyte ratio (HR = 1.44, 95% CI 1.28-1.62) each predicted RFL in this cohort. CONCLUSIONS WBC fractions associate with morphometric lesions of DKD and predict RFL in individuals with Type 2 diabetes.
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Affiliation(s)
| | | | | | | | - E Jennifer Weil
- Phoenix Epidemiology and Clinical Research Branch, Phoenix, AZ, USA
| | - Helen C Looker
- Phoenix Epidemiology and Clinical Research Branch, Phoenix, AZ, USA
| | - Robert L Hanson
- Phoenix Epidemiology and Clinical Research Branch, Phoenix, AZ, USA
| | - Kevin V Lemley
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Berne Yee
- Southwest Kidney Institute, Phoenix, AZ, USA
| | | | - Samy Hadjadj
- CHU Poitiers Inserm, Clinical Investigation Center CIC1402, Poitiers, France
| | - Behzad Najafian
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Michael Mauer
- Department of Nephrology, University of Minnesota, Minneapolis, MN, USA
| | - Robert G Nelson
- Correspondence and offprint requests to: Robert G. Nelson; E-mail:
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Gearon E, Tanamas SK, Stevenson C, Loh VHY, Peeters A. Changes in waist circumference independent of weight: Implications for population level monitoring of obesity. Prev Med 2018; 111:378-383. [PMID: 29199118 DOI: 10.1016/j.ypmed.2017.11.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/27/2017] [Accepted: 11/27/2017] [Indexed: 12/14/2022]
Abstract
UNLABELLED Population monitoring of obesity is most commonly conducted using body mass index (BMI). We test the hypothesis that because of increases in waist circumference (WC) independent of increases in weight, BMI alone detects an increasingly smaller proportion of the population with obesity. METHODS Australian adults with measured height, weight, and WC were selected from three nationally representative cross-sectional surveys (1989, 1999-2000, 2011-12; n=8313, 5903 & 3904). Participants were defined as having obesity using classifications for an obese BMI (≥30kg·m-2) and substantially-increased-risk WC (≥88cm [women], ≥102cm [men]). Age-standardised prevalence of obesity according to BMI and/or WC, and the proportion of these detected by BMI and by WC were compared across surveys. FINDINGS Between 1989 and 2011-12, weight and WC increased by 5.4kg and 10.7cm (women), and by 7.0kg and 7.3cm (men). For women and men, 63% and 38% of increases in WC were independent of increases in weight. Over this period, the prevalence of obesity according to BMI and/or WC increased by 25.3 percentage-points for women (18.9% to 44.3%) and 21.1 percentage-points for men (17.1% to 38.2%). The proportion of these detected by BMI decreased for women by 20 percentage-points (77% to 57%) with no change for men. The proportion of these detected by WC increased for women and men by 10 percentage-points (87% to 97%) and 6 percentage-points (85% to 91%) respectively. CONCLUSION BMI alone is detecting a decreasing proportion of those considered obese by BMI and/or WC. Renewed discussion regarding how we monitor obesity at the population level is required.
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Affiliation(s)
- Emma Gearon
- Global Obesity Centre, Deakin University, Locked Bag 20000, Geelong, Victoria 3220, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Locked Bag 20000, Geelong, Victoria 3220, Australia.
| | - Stephanie K Tanamas
- Department of Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 1550 E. Indian School Rd., Phoenix, AZ 85014, United States.
| | - Christopher Stevenson
- School of Health and Social Development, Deakin University, Locked Bag 20000, Geelong, Victoria 3220, Australia.
| | - Venurs H Y Loh
- Institute for Health and Ageing, Australian Catholic University, Level 6, 215 Spring Street, Melbourne, Victoria 3000, Australia.
| | - Anna Peeters
- Global Obesity Centre, Deakin University, Locked Bag 20000, Geelong, Victoria 3220, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Locked Bag 20000, Geelong, Victoria 3220, Australia.
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26
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Tanamas SK, Reddy SP, Chambers MA, Clark EJ, Dunnigan DL, Hanson RL, Nelson RG, Knowler WC, Sinha M. Effect of severe obesity in childhood and adolescence on risk of type 2 diabetes in youth and early adulthood in an American Indian population. Pediatr Diabetes 2018; 19:622-629. [PMID: 29282818 DOI: 10.1111/pedi.12627] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/20/2017] [Accepted: 11/27/2017] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES The risk of early-onset type 2 diabetes associated with the severity of obesity in youth is not well understood. This study aims to determine metabolic alterations and type 2 diabetes risk among American Indian children who are obese or severely obese. METHODS Incidence rates of diabetes before 20 years (youth-onset) and 45 years were computed in 2728 children who were from 5 to <10 years and 4317 adolescents who were from 10 to <18 years without diabetes examined between 1965 and 2007. Obesity was defined as age-sex-adjusted body mass index (BMI) ≥95th percentile, and its severity was quantified as the percentage of the 95th percentile (%BMIp95 ). RESULTS In the younger cohort, 0.9% of those non-obese and 2.9% of those with 100% to <120%BMIp95 had impaired glucose tolerance (IGT) compared to 8.6% of those with ≥140%BMIp95 . In the older cohort, 2.9% of those non-obese and 9.8% of those with 100% to <120%BMIp95 had IGT compared to 13.3% of those with ≥160%BMIp95 . The incidence of youth-onset diabetes was 3.8 and 4.9/1000 person-years in the child and adolescent cohorts, respectively, and before the age of 45 was 12.3 and 16.8/1000 person-years, respectively. Incidence rates of youth-onset diabetes in those with the most severe obesity (≥140%BMIp95 ) were 2.3 to 5.1 times as high as in those with the least severe obesity (100 to <120%BMIp95 ), and for onset of diabetes before the age of 45 were 1.6 to 2.2 times as high. CONCLUSIONS Severe obesity in an American Indian population is a major driver of type 2 diabetes developing in adolescents and young adults.
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Affiliation(s)
- Stephanie K Tanamas
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Phoenix, Arizona
| | - Sanil P Reddy
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Phoenix, Arizona
| | - Melissa A Chambers
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Phoenix, Arizona.,Division of Endocrinology and Diabetes, Phoenix Children's Hospital, Phoenix, Arizona
| | - Elena J Clark
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Phoenix, Arizona
| | - Diana L Dunnigan
- Department of Pediatrics, Phoenix Indian Medical Center, Phoenix, Arizona
| | - Robert L Hanson
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Phoenix, Arizona
| | - Robert G Nelson
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Phoenix, Arizona
| | - William C Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Phoenix, Arizona
| | - Madhumita Sinha
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Phoenix, Arizona
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Tanamas SK, Saulnier PJ, Hanson RL, Nelson RG, Hsueh WC, Sievers ML, Bennett PH, Knowler WC. Serum lipids and mortality in an American Indian population: A longitudinal study. J Diabetes Complications 2018; 32:18-26. [PMID: 29103893 PMCID: PMC7293874 DOI: 10.1016/j.jdiacomp.2017.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND In Caucasians, lower triglycerides (TG), total or LDL cholesterol and high HDL cholesterol are generally associated with lower mortality. However, low cholesterol is associated with higher mortality in some Asian populations. This study examines the relationship between serum lipids and mortality in American Indians. METHODS 2125 American Indians aged ≥40years were examined biennially between 1993 and 2007. Vital status was determined through 2011. Mortality rates, adjusted for age, sex and diabetes, were calculated using Poisson regression. RESULTS The median baseline age was 46years and 61% were women. Over a median follow-up of 10.1years, 522 deaths occurred. Relationships between baseline lipids, except for HDL cholesterol, and all-cause mortality were negative and linear in persons without diabetes and U-shaped in persons with diabetes. For HDL cholesterol, the relationship was U-shaped in the total cohort. Cardiovascular mortality was positively associated with total, LDL and non-HDL cholesterol whereas lower lipid concentrations were adversely associated with mortality from liver disease or external causes, except for HDL cholesterol, where associations were positive. CONCLUSION The common belief that low cholesterol and TG are beneficial for health is not universally observed; evidence suggests increased mortality at both ends of the cholesterol and TG distributions.
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Affiliation(s)
- Stephanie K Tanamas
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, United States.
| | - Pierre-Jean Saulnier
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, United States; CHU Poitiers, University of Poitiers, Inserm, Clinical Investigation Center CIC1402, Poitiers, France
| | - Robert L Hanson
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, United States.
| | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, United States.
| | - Wen-Chi Hsueh
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, United States.
| | - Maurice L Sievers
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, United States.
| | - Peter H Bennett
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, United States.
| | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, United States.
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Chambers M, Tanamas SK, Clark EJ, Dunnigan DL, Kapadia CR, Hanson RL, Nelson RG, Knowler WC, Sinha M. Growth Tracking in Severely Obese or Underweight Children. Pediatrics 2017; 140:peds.2017-2248. [PMID: 29114063 PMCID: PMC5703793 DOI: 10.1542/peds.2017-2248] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 09/12/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To illustrate the difficulties in optimal growth monitoring of children with severe obesity or underweight by using the Centers for Disease Control and Prevention (CDC) 2000 age- and sex-specific BMI percentile growth charts. We also aimed to examine the utility of a new modified CDC BMI z score chart to monitor growth in children with normal and extreme BMI percentiles by using real-life clinical scenarios. METHODS Modified BMI z score charts were created by using the 2000 CDC algorithm. Three cases of children with extreme BMI values and abnormal growth patterns were plotted by using the standard CDC 2000 clinical growth chart, the modified BMI z score chart, and the CDC BMI percentile chart, modified to include the percentage of the 95th percentile (%BMIp95) curves. RESULTS Children with severe obesity could not be plotted on the standard CDC BMI percentile chart because their BMI points lay above the chart cutoff. Children with a low BMI (<3%) were also difficult to track on the standard BMI percentile chart. The addition of the %BMIp95 scale to the standard BMI percentile chart allowed tracking of severely obese children; however, it did not address severely underweight children and required a change of units within the chart when transitioning from normal to obese BMIs. The modified BMI z score chart allowed uniform tracking. CONCLUSIONS The modified CDC z score chart is suitable for growth tracking of children with normal and extreme growth patterns; the measures correlate well with the %BMIp95, and the chart can be incorporated easily into existing electronic health record systems for clinical use.
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Affiliation(s)
- Melissa Chambers
- Division of Endocrinology and Diabetes, Phoenix Children’s Hospital, Phoenix, Arizona
| | - Stephanie K. Tanamas
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona; and
| | - Elena J. Clark
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona; and
| | | | - Chirag R. Kapadia
- Division of Endocrinology and Diabetes, Phoenix Children’s Hospital, Phoenix, Arizona
| | - Robert L. Hanson
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona; and
| | - Robert G. Nelson
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona; and
| | - William C. Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona; and
| | - Madhumita Sinha
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona; and
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Wheelock KM, Saulnier PJ, Tanamas SK, Vijayakumar P, Weil EJ, Looker HC, Hanson RL, Lemley KV, Yee B, Knowler WC, Hadjadj S, Najafian B, Mauer M, Nelson RG. White blood cell fractions correlate with lesions of diabetic kidney disease and predict loss of kidney function in Type 2 diabetes. Nephrol Dial Transplant 2017; 32:2145. [PMID: 29088394 DOI: 10.1093/ndt/gfx303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Saulnier PJ, Dieter BP, Tanamas SK, McPherson SM, Wheelock KM, Knowler WC, Looker HC, Meek RL, Nelson RG, Tuttle KR. Association of Serum Amyloid A with Kidney Outcomes and All-Cause Mortality in American Indians with Type 2 Diabetes. Am J Nephrol 2017; 46:276-284. [PMID: 28934744 DOI: 10.1159/000481269] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/30/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Serum amyloid A (SAA) induces inflammation and apoptosis in kidney cells and is found to be causing the pathologic changes that are associated with diabetic kidney disease (DKD). Higher serum SAA concentrations were previously associated with increased risk of end-stage renal disease (ESRD) and death in persons with type 2 diabetes and advanced DKD. We explored the prognostic value of SAA in American Indians with type 2 diabetes without DKD or with early DKD. METHODS SAA concentration was measured in serum samples obtained at the start of follow-up. Multivariate proportional hazards models were employed to examine the magnitude of the risk of ESRD or death across tertiles of SAA concentration after adjustment for traditional risk factors. The C statistic was used to assess the additional predictive value of SAA relative to traditional risk factors. RESULTS Of 256 participants (mean ± SD glomerular filtration rate [iothalamate] = 148 ± 45 mL/min, and median [interquartile range] urine albumin/creatinine = 39 [14-221] mg/g), 76 developed ESRD and 125 died during a median follow-up period of 15.2 and 15.7 years, respectively. After multivariable proportional hazards regression, participants in the 2 highest SAA tertiles together exhibited a 53% lower risk of ESRD (hazard ratio [HR] 0.47, 95% CI 0.29-0.78), and a 30% lower risk of death (HR 0.70, 95% CI 0.48-1.02), compared with participants in the lowest SAA tertile, although the lower risk of death was not statistically significant. Addition of SAA to the ESRD model increased the C statistic from 0.814 to 0.815 (p = 0.005). CONCLUSIONS Higher circulating SAA concentration is associated with a reduced risk of ESRD in American Indians with type 2 diabetes.
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Tanamas SK, Hanson RL, Nelson RG, Knowler WC. Effect of different methods of accounting for antihypertensive treatment when assessing the relationship between diabetes or obesity and systolic blood pressure. J Diabetes Complications 2017; 31:693-699. [PMID: 28139345 PMCID: PMC7293873 DOI: 10.1016/j.jdiacomp.2016.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/07/2016] [Accepted: 12/13/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Underlying blood pressure is that observed in the absence of antihypertensive treatment or, among those treated, the estimate of that which would be observed without treatment. This study aims to examine the relationships between diabetes or obesity and underlying systolic blood pressure adjusted for antihypertensive treatment by several methods. METHODS Data from two population studies were analyzed-an American Indian community in Arizona and the National Health and Nutrition Examination Surveys. Antihypertensive treatment was accounted for using: no adjustment; antihypertensive use as a covariate; blood pressure dichotomized into normotension and hypertension; addition of a fixed treatment effect; non-parametric algorithm; and censored normal regression. RESULTS The magnitude of association at each time point differed by adjustment method particularly where there was a difference in prevalence of antihypertensive use between people with and without diabetes or obesity. The common methods of ignoring antihypertensive treatment or including it as a covariate in a regression model underestimated the effects of diabetes and obesity on underlying blood pressure, compared to the recommended method of the censored normal regression. CONCLUSION Proper accounting for antihypertensive treatment is needed in interpreting variables that affect blood pressure.
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Affiliation(s)
- Stephanie K Tanamas
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ.
| | - Robert L Hanson
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ.
| | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ.
| | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ.
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Saulnier PJ, Wheelock KM, Howell S, Weil EJ, Tanamas SK, Knowler WC, Lemley KV, Mauer M, Yee B, Nelson RG, Beisswenger PJ. Advanced Glycation End Products Predict Loss of Renal Function and Correlate With Lesions of Diabetic Kidney Disease in American Indians With Type 2 Diabetes. Diabetes 2016; 65:3744-3753. [PMID: 27609106 PMCID: PMC5127241 DOI: 10.2337/db16-0310] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 09/05/2016] [Indexed: 12/20/2022]
Abstract
We examined associations of advanced glycation end products (AGEs) with renal function loss (RFL) and its structural determinants in American Indians with type 2 diabetes. Data were from a 6-year clinical trial that assessed renoprotective efficacy of losartan. Participants remained under observation after the trial concluded. Glomerular filtration rate (GFR) was measured annually. Kidney biopsies were performed at the end of the trial. Five AGEs were measured in serum collected at enrollment and at kidney biopsy. RFL was defined as ≥40% decline of measured GFR from baseline. Of 168 participants (mean baseline age 41 years, HbA1c 9.2%, GFR 164 mL/min, and albumin-to-creatinine ratio 31 mg/g), 104 reached the RFL end point during median follow-up of 8.0 years. After multivariable adjustment, each doubling of carboxyethyl lysine (hazard ratio [HR] 1.60 [95% CI 1.08-2.37]) or methylglyoxal hydroimidazolone (HR 1.30 [95% CI 1.02-1.65]) concentration was associated with RFL. Carboxyethyl lysine, carboxymethyl lysine, and methylglyoxal hydroimidazolone correlated positively with cortical interstitial fractional volume (partial r = 0.23, P = 0.03; partial r = 0.25, P = 0.02; and partial r = 0.31, P = 0.003, respectively). Glyoxyl hydroimidazolone and methylglyoxal hydroimidazolone correlated negatively with total filtration surface per glomerulus (partial r = -0.26, P = 0.01; and partial r = -0.21, P = 0.046, respectively). AGEs improve prediction of RFL and its major structural correlates.
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Affiliation(s)
- Pierre-Jean Saulnier
- Phoenix Epidemiology and Clinical Research Branch, Phoenix, AZ
- CHU Poitiers, University of Poitiers, Clinical Investigation Center, INSERM CIC1402, Poitiers, France
| | | | | | - E Jennifer Weil
- Phoenix Epidemiology and Clinical Research Branch, Phoenix, AZ
| | | | | | - Kevin V Lemley
- Department of Pediatrics, University of Southern California Keck School of Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Michael Mauer
- Department of Pediatrics and Medicine, University of Minnesota, Minneapolis, MN
| | - Berne Yee
- Southwest Kidney Institute, Phoenix, AZ
| | - Robert G Nelson
- Phoenix Epidemiology and Clinical Research Branch, Phoenix, AZ
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Tanamas SK, Saulnier PJ, Fufaa GD, Wheelock KM, Weil EJ, Hanson RL, Knowler WC, Bennett PH, Nelson RG. Long-term Effect of Losartan on Kidney Disease in American Indians With Type 2 Diabetes: A Follow-up Analysis of a Randomized Clinical Trial. Diabetes Care 2016; 39:2004-2010. [PMID: 27612501 PMCID: PMC5079606 DOI: 10.2337/dc16-0795] [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: 04/11/2016] [Accepted: 08/19/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether early administration of losartan slows progression of diabetic kidney disease over an extended period. RESEARCH DESIGN AND METHODS We conducted a 6-year clinical trial in 169 American Indians with type 2 diabetes and urine albumin/creatinine ratio <300 mg/g; 84 participants were randomly assigned to receive losartan and 85 to placebo. Primary outcome was a decline in glomerular filtration rate (GFR; iothalamate) to ≤60 mL/min or to half the baseline value in persons who entered with GFR <120 mL/min. At enrollment, GFR averaged 165 mL/min (interquartile range 49-313 mL/min). During the trial, nine persons reached the primary outcome with a hazard ratio (HR; losartan vs. placebo) of 0.50 (95% CI 0.12-1.99). Participants were then followed posttrial for up to 12 years, with treatment managed outside the study. The effect of losartan on the primary GFR outcome was then reanalyzed for the entire study period, including the clinical trial and posttrial follow-up. RESULTS After completion of the clinical trial, treatment with renin-angiotensin system inhibitors was equivalent in both groups. During a median of 13.5 years following randomization, 29 participants originally assigned to losartan and 35 to placebo reached the primary GFR outcome with an HR of 0.72 (95% CI 0.44-1.18). CONCLUSIONS Long-term risk of GFR decline was not significantly different between persons randomized to early treatment with losartan and those randomized to placebo. Accordingly, we found no evidence of an extended benefit of early losartan treatment on slowing GFR decline in persons with type 2 diabetes.
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Affiliation(s)
- Stephanie K Tanamas
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
| | - Pierre-Jean Saulnier
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ.,Centre Hospitalier Universitaire Poitiers, INSERM, Clinical Investigation Centre CIC1402, Poitiers, France
| | - Gudeta D Fufaa
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
| | - Kevin M Wheelock
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
| | - E Jennifer Weil
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
| | - Robert L Hanson
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
| | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
| | - Peter H Bennett
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
| | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
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Tanamas SK, Wong E, Backholer K, Abdullah A, Wolfe R, Barendregt J, Peeters A. Age of onset of obesity and risk of type 2 diabetes. Aust N Z J Public Health 2016; 40:579-581. [PMID: 27774719 DOI: 10.1111/1753-6405.12593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/01/2015] [Revised: 04/01/2016] [Accepted: 06/01/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To compare a simple measure - age of onset of obesity - to an obese-years construct (a product of duration and magnitude of obesity) as risk factors for type 2 diabetes. METHOD Participants from the Framingham Heart Study who were not obese and did not have diabetes at baseline were included (n=4,320). The Akaike Information Criterion (AIC) was computed to compare four Cox proportional hazards models with incident diabetes as the outcome and: (i) obese-years; (ii) age of onset of obesity; (iii) body mass index (BMI); and (iv) age of onset of obesity plus magnitude of BMI combined, as exposures. RESULTS AIC indicated that the model with obese-years provided a more effective explanation of incidence of type 2 diabetes compared to the remaining three models. Models including age of onset of obesity plus BMI were not appreciably different from the model with BMI alone, except in those aged ≥60. CONCLUSIONS While obese-years was the optimal obesity construct to explain risk of type 2 diabetes, age of onset may be a useful, practical addition to current BMI in the elderly. IMPLICATIONS Where computation of obese-years is not possible or impractical, age of onset of obesity combined with BMI may provide a useful alternative.
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Affiliation(s)
| | - Evelyn Wong
- Baker IDI Heart and Diabetes Institute, Victoria.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria
| | - Kathryn Backholer
- Baker IDI Heart and Diabetes Institute, Victoria.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria
| | - Asnawi Abdullah
- Department of Biostatistics and Population Health, Faculty of Public Health, University Muhammadiyah Aceh, Indonesia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria
| | | | - Anna Peeters
- Baker IDI Heart and Diabetes Institute, Victoria.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria
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Tanamas SK, Lean MEJ, Combet E, Vlassopoulos A, Zimmet PZ, Peeters A. Changing guards: time to move beyond body mass index for population monitoring of excess adiposity. QJM 2016; 109:443-446. [PMID: 26527773 DOI: 10.1093/qjmed/hcv201] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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] [Received: 06/04/2015] [Indexed: 11/14/2022] Open
Abstract
With the obesity epidemic, and the effects of aging populations, human phenotypes have changed over two generations, possibly more dramatically than in other species previously. As obesity is an important and growing hazard for population health, we recommend a systematic evaluation of the optimal measure(s) for population-level excess body fat. Ideal measure(s) for monitoring body composition and obesity should be simple, as accurate and sensitive as possible, and provide good categorization of related health risks. Combinations of anthropometric markers or predictive equations may facilitate better use of anthropometric data than single measures to estimate body composition for populations. Here, we provide new evidence that increasing proportions of aging populations are at high health-risk according to waist circumference, but not body mass index (BMI), so continued use of BMI as the principal population-level measure substantially underestimates the health-burden from excess adiposity.
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Affiliation(s)
- S K Tanamas
- From the 1Baker IDI Heart and Diabetes Institute, the Alfred Centre, Level 4, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - M E J Lean
- Human Nutrition, School of Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Royal Infirmary Campus, Alexandra Parade, Glasgow G31 2ER, UK
| | - E Combet
- Human Nutrition, School of Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Royal Infirmary Campus, Alexandra Parade, Glasgow G31 2ER, UK
| | - A Vlassopoulos
- Human Nutrition, School of Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Royal Infirmary Campus, Alexandra Parade, Glasgow G31 2ER, UK
| | - P Z Zimmet
- From the 1Baker IDI Heart and Diabetes Institute, the Alfred Centre, Level 4, 99 Commercial Road, Melbourne, Victoria 3004, Australia
| | - A Peeters
- From the 1Baker IDI Heart and Diabetes Institute, the Alfred Centre, Level 4, 99 Commercial Road, Melbourne, Victoria 3004, Australia
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Barr EL, Reutens A, Magliano DJ, Wolfe R, Lu ZX, Sikaris KA, Tanamas SK, Atkins R, Chadban S, Shaw JE, Polkinghorne KR. Cystatin C estimated glomerular filtration rate and all-cause and cardiovascular disease mortality risk in the general population: AusDiab study. Nephrology (Carlton) 2016; 22:243-250. [PMID: 26938304 DOI: 10.1111/nep.12759] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/23/2016] [Accepted: 02/28/2016] [Indexed: 11/27/2022]
Abstract
AIMS Uncertainties about the role of cystatin C-based estimated glomerular filtration rate (eGFR) in the prediction of cardiovascular disease (CVD) beyond traditional CVD risk factors remain. We assessed contributions of eGFR to CVD and mortality in the general population. METHODS Using 14 year follow-up data on 9353 adults without a reported history of CVD from the Australian Diabetes, Obesity and Lifestyle study, we assessed the contributions of eGFR (assessed by cystatin C (eGFRcysC ) and serum creatinine (eGFRcr ) and albuminuria (uACR) to total and CVD mortality. RESULTS After adjusting for age, sex, CVD risk factors and uACR, compared with an eGFRcysC >90 mL/min per 1.73 m2 , eGFRcysC <60 mL/min per 1.73 m2 was associated with 56% and 73% increases in the risks for all-cause and CVD mortality, respectively. The respective changes for the c-statistic when eGFRcysC was added to a risk prediction model were 0.003 (95% confidence interval: 0.001 to 0.005) and 0.002 (95% confidence interval: -0.001 to 0.006). The net proportion of non-events assigned a lower-risk category significantly improved with the addition of eGFR (non-event net reclassification index eGFRcr : 1.0% and eGFRcysC : 1.5%) for all-cause mortality, but for CVD mortality, improvements were only significant when eGFR was combined with uACR. The net proportion of events assigned a higher-risk category was not significantly improved. CONCLUSION In our community-based cohort, reduced eGFRcysC was associated with all-cause and CVD mortality. The addition of chronic kidney disease measures to risk prediction models improved overall risk stratification among those at low risk as opposed to those at high baseline risk of mortality.
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Affiliation(s)
- Elizabeth Lm Barr
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Anne Reutens
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zhong X Lu
- Melbourne Pathology, Melbourne, Victoria, Australia
| | | | | | - Robert Atkins
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Steve Chadban
- Sydney University, Sydney, New South Wales, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Kevan R Polkinghorne
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Nephrology, Monash Medical Centre, Melbourne, Victoria, Australia
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Tanamas SK, Ng WL, Backholer K, Hodge A, Zimmet PZ, Peeters A. Quantifying the proportion of deaths due to body mass index- and waist circumference-defined obesity. Obesity (Silver Spring) 2016; 24:735-42. [PMID: 26833753 DOI: 10.1002/oby.21386] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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] [Received: 06/25/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the risk of mortality associated with and quantify the deaths attributable to combinations of body mass index (BMI) and waist circumference (WC). METHODS This study included 41,439 participants. For the hazard ratio (HR) calculation, adiposity categories were defined as: BMI(N) /WC(N) , BMI(N) /WC(O) , BMI(O) /WC(N) , and BMI(O) /WC(O) (N = non-obese, O = obese). For the population attributable fraction analysis, obesity was classified as: (i) obese by BMI and/or WC; (ii) obese by BMI; and (iii) obese by WC. Mortality data was complete to the end of 2012. RESULTS The prevalence of BMI(N) /WC(N) , BMI(N) /WC(O) , BMI(O) /WC(N) , and BMI(O) /WC(O) was 73%, 6%, 6%, and 15%, respectively. There was an increased risk of all-cause and cardiovascular disease (CVD) mortality in those with BMI(N) /WC(O) (HR (95% CI) 1.2 (1.2, 1.3) and 1.3 (1.1, 1.6)) and BMI(O) /WC(O) (1.3 (1.3, 1.4) and 1.7 (1.5, 1.9)) compared to those with BMI(N) /WC(N) . The estimated proportion of all-cause and CVD mortality attributable to obesity defined using WC or using BMI and/or WC was higher compared to obesity defined using BMI. CONCLUSIONS Current population obesity monitoring misses those with BMI(N) /WC(O) who are at increased risk of mortality. By targeting reductions in population WC, the potential exists to prevent more deaths in the population than if we continue to target reductions in BMI alone.
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Affiliation(s)
- Stephanie K Tanamas
- Obesity and Population Health, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Winda L Ng
- Obesity and Population Health, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Kathryn Backholer
- Obesity and Population Health, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Allison Hodge
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, 3004, Australia
| | - Paul Z Zimmet
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, 3004, Australia
| | - Anna Peeters
- Obesity and Population Health, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Sugiyama T, Shibata A, Koohsari MJ, Tanamas SK, Oka K, Salmon J, Dunstan DW, Owen N. Neighborhood environmental attributes and adults' maintenance of regular walking. Med Sci Sports Exerc 2016; 47:1204-10. [PMID: 25251048 DOI: 10.1249/mss.0000000000000528] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Environmental initiatives to support walking are keys to noncommunicable disease prevention, but the relevant evidence comes mainly from cross-sectional studies. We examined neighborhood environmental attributes associated cross-sectionally with walking and those associated prospectively with walking maintenance. METHODS Data were from the Australian Diabetes, Obesity and Lifestyle study collected in 2004-2005 (baseline) and in 2011-2012 (follow-up). Participants who did not move residence during the study period (n = 2684, age range: 30-77 yr at baseline) were categorized as regular walkers (walked five times per week or more) or not at baseline. Regular walkers were divided into those who stopped and those who maintained regular walking at follow-up. Regression analyses examined relationships of regular walking and walking maintenance with perceived attributes of neighborhood destinations and pedestrian environments. RESULTS Regular walking at baseline was significantly associated with availability of shops (odds ratio [OR] = 1.13, 95% confidence interval [CI] = 1.04-1.22), many alternative routes (OR = 1.12, 95% CI = 1.01-1.23), park or nature reserve (OR = 1.13, 95% CI = 1.02-1.26), bicycle or walking tracks (OR = 1.08, 95% CI = 1.00-1.17), and feeling safe to walk (OR = 1.18, 95% CI = 1.01-1.38). Maintenance of regular walking was associated with the availability of multiple alternative routes (OR = 1.19, 95% CI = 1.03-1.38). Having many alternative routes and walking tracks was associated with walking maintenance among those who were not or had stopped working. CONCLUSIONS Neighborhood destinations (shops and parks) and pedestrian environments (alternative routes, walking trails, and safety from crime) were found to be associated with regular walking, but only pedestrian environment attributes were found to be related to the maintenance of regular walking. Further evidence from prospective studies is required to identify other neighborhood environmental attributes that might support walking maintenance.
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Affiliation(s)
- Takemi Sugiyama
- 1School of Population Health, University of South Australia, Adelaide, South Australia, AUSTRALIA; 2Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, AUSTRALIA; 3Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, JAPAN; 4School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, AUSTRALIA; 5School of Sport Sciences, Waseda University, Tokyo, JAPAN; 6School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, AUSTRALIA; 7School of Population Health, The University of Queensland, Brisbane, Queensland, AUSTRALIA; 8Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, AUSTRALIA; 9School of Sport Science, Exercise and Health, The University of Western Australia, Perth, Western Australia, AUSTRALIA; and 10Central Clinical School, Monash University, Melbourne, Victoria, AUSTRALIA
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Sugiyama T, Wijndaele K, Koohsari MJ, Tanamas SK, Dunstan DW, Owen N. Adverse associations of car time with markers of cardio-metabolic risk. Prev Med 2016; 83:26-30. [PMID: 26656405 PMCID: PMC5405044 DOI: 10.1016/j.ypmed.2015.11.029] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/20/2015] [Accepted: 11/29/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine associations of time spent sitting in cars with markers of cardio-metabolic risk in Australian adults. METHOD Data were from 2800 participants (age range: 34-65) in the 2011-12 Australian Diabetes, Obesity and Lifestyle Study. Self-reported time spent in cars was categorized into four groups: ≤15min/day; >15 to ≤30min/day; >30 to ≤60min/day; and >60min/day. Markers of cardio-metabolic risk were body mass index (BMI), waist circumference, systolic and diastolic blood pressure, triglycerides, HDL (high-density lipoprotein)-cholesterol, fasting plasma glucose, 2-h plasma glucose, a clustered cardio-metabolic risk score, and having the metabolic syndrome or not. Multilevel linear and logistic regression analyses examined associations of car time with each cardio-metabolic risk outcome, adjusting for socio-demographic and behavioral variables and medication use for blood pressure and cholesterol/triglycerides. RESULTS Compared to spending 15min/day or less in cars, spending more than 1h/day in cars was significantly associated with higher BMI, waist circumference, fasting plasma glucose, and clustered cardio-metabolic risk, after adjusting for socio-demographic attributes and potentially relevant behaviors including leisure-time physical activity and dietary intake. Gender interactions showed car time to be associated with higher BMI in men only. CONCLUSIONS Prolonged time spent sitting in cars, in particular over 1h/day, was associated with higher total and central adiposity and a more-adverse cardio-metabolic risk profile. Further studies, ideally using objective measures of sitting time in cars and prospective designs, are needed to confirm the impact of car use on cardio-metabolic disease risk.
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Affiliation(s)
- Takemi Sugiyama
- Centre for Design Innovation, Faculty of Health Arts & Design, Swinburne University of Technology, Melbourne, VIC, Australia; School of Population Health, University of South Australia, Adelaide, SA, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Katrien Wijndaele
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Mohammad Javad Koohsari
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - David W Dunstan
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia; School of Population Health, The University of QLD, Brisbane, QLD, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Sport Science, Exercise and Health The University of Western Australia, Perth, WA, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia; Mary MacKillop Institute of Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Neville Owen
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; School of Population Health, The University of QLD, Brisbane, QLD, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
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Tanamas SK, Permatahati V, Ng WL, Backholer K, Wolfe R, Shaw JE, Peeters A. Estimating the proportion of metabolic health outcomes attributable to obesity: a cross-sectional exploration of body mass index and waist circumference combinations. BMC Obes 2016; 3:4. [PMID: 26855785 PMCID: PMC4734864 DOI: 10.1186/s40608-016-0085-5] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 01/26/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Recent evidence suggests that a substantial subgroup of the population who have a high-risk waist circumference (WC) do not have an obese body mass index (BMI). This study aimed to explore whether including those with a non-obese BMI but high risk WC as 'obese' improves prediction of adiposity-related metabolic outcomes. METHODS Eleven thousand, two hundred forty-seven participants were recruited. Height, weight and WC were measured. Ten thousand, six hundred fifty-nine participants with complete data were included. Adiposity categories were defined as: BMI(N)/WC(N), BMI(N)/WC(O), BMI(O)/WC(N), and BMI(O)/WC(O) (N = non-obese and O = obese). Population attributable fraction, area under the receiver operating characteristic curve (AUC), and odds ratios (OR) were calculated. RESULTS Participants were on average 48 years old and 50 % were men. The proportions of BMI(N)/WC(N), BMI(N)/WC(O), BMI(O)/WC(N) and BMI(O)/WC(O) were 68, 12, 2 and 18 %, respectively. A lower proportion of diabetes was attributable to obesity defined using BMI alone compared to BMI and WC combined (32 % vs 47 %). AUC for diabetes was also lower when obesity was defined using BMI alone (0.62 vs 0.66). Similar results were observed for all outcomes. The odds for hypertension, dyslipidaemia, diabetes and CVD were increased for those with BMI(N)/WC(O) (OR range 1.8-2.7) and BMI(O)/WC(O) (OR 1.9-4.9) compared to those with BMI(N)/WC(N). CONCLUSIONS Current population monitoring, assessing obesity by BMI only, misses a proportion of the population who are at increased health risk through excess adiposity. Improved identification of those at increased health risk needs to be considered for better prioritisation of policy and resources.
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Affiliation(s)
- Stephanie K Tanamas
- Obesity and Population Health, Baker IDI Heart and Diabetes Institute, the Alfred Centre Level 4, 99 Commercial Road, Melbourne, VIC 3004 Australia
| | - Viandini Permatahati
- Obesity and Population Health, Baker IDI Heart and Diabetes Institute, the Alfred Centre Level 4, 99 Commercial Road, Melbourne, VIC 3004 Australia
| | - Winda L Ng
- Obesity and Population Health, Baker IDI Heart and Diabetes Institute, the Alfred Centre Level 4, 99 Commercial Road, Melbourne, VIC 3004 Australia
| | - Kathryn Backholer
- Obesity and Population Health, Baker IDI Heart and Diabetes Institute, the Alfred Centre Level 4, 99 Commercial Road, Melbourne, VIC 3004 Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, the Alfred Centre Level 6, 99 Commercial Road, Melbourne, VIC 3004 Australia
| | - Jonathan E Shaw
- Obesity and Population Health, Baker IDI Heart and Diabetes Institute, the Alfred Centre Level 4, 99 Commercial Road, Melbourne, VIC 3004 Australia
| | - Anna Peeters
- Obesity and Population Health, Baker IDI Heart and Diabetes Institute, the Alfred Centre Level 4, 99 Commercial Road, Melbourne, VIC 3004 Australia
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Tanamas SK, Magliano DJ, Balkau B, Tuomilehto J, Kowlessur S, Söderberg S, Zimmet PZ, Shaw JE. The performance of diabetes risk prediction models in new populations: the role of ethnicity of the development cohort. Acta Diabetol 2015; 52:91-101. [PMID: 24996544 DOI: 10.1007/s00592-014-0607-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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] [Received: 03/02/2014] [Accepted: 05/23/2014] [Indexed: 10/25/2022]
Abstract
It is believed that diabetes risk scores need to be ethnic specific. However, this prerequisite has not been tested. We examined the performance of several risk models, developed in various populations, in a Europid and a South Asian population. The performance of 14 published risk prediction models were tested in two prospective studies: the Australian Diabetes, Obesity and Lifestyle (AusDiab) study and the Mauritius non-communicable diseases survey. Eight models were developed in Europid populations; the remainder in various non-Europid populations. Model performance was assessed using area under the receiver operating characteristic curves (discrimination), Hosmer-Lemeshow tests (goodness-of-fit) and Brier scores (accuracy). In both AusDiab and Mauritius, discrimination was highest for a model developed in a mixed population (non-Hispanic white and African American) and lowest for a model developed in a Europid population. Discrimination for all scores was higher in AusDiab than in Mauritius. For almost all models, goodness-of-fit was poor irrespective of the ethnicity of the development cohort, and accuracy was higher in AusDiab compared to Mauritius. Our results suggest that similarity of ethnicity or similarity of diabetes risk may not be the best way of identifying models that will perform well in another population. Differences in study methodology likely account for much of the difference in the performance. Thus, identifying models which use measurements that are clearly described and easily reproducible for both research and clinical settings may be more important.
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Affiliation(s)
- Stephanie K Tanamas
- Baker IDI Heart and Diabetes Institute, 99 Commercial Road, Melbourne, VIC, 3004, Australia,
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Wong E, Tanamas SK, Wolfe R, Backholer K, Stevenson C, Abdullah A, Peeters A. The role of obesity duration on the association between obesity and risk of physical disability. Obesity (Silver Spring) 2015; 23:443-7. [PMID: 25451850 DOI: 10.1002/oby.20936] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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] [Received: 06/17/2014] [Accepted: 09/23/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To relate measured obesity duration in mid-life with subsequent incidence of physical disability over and above body mass index (BMI) attained. METHODS Framingham Offspring Study is a longitudinal study that began in 1971. Examination 5 (1991-1995; "baseline") and disability onset ascertained from examinations 6-8 (2008) were used. About 2,095 disability-free participants aged 45-65 years at baseline were included. Obesity (BMI ≥ 30 kg/m(2) ) duration was calculated between examination 1 and examination 5. Cox regression was used to analyze time to disability. RESULTS 204 participants developed disability (incidence rate=7.9 per 1,000 person-years). Obesity duration ranged from 0 to 22 years (mean of 2.0 years overall, 8.3 years for those with baseline obesity). Obesity duration increased risk of new disability (hazard ratio [HR] 1.07 per year of obesity; 95% confidence interval [CI] 1.05-1.09). This association was attenuated on further adjustment for baseline BMI (HR 1.03; 95% CI 1.00-1.06). CONCLUSIONS Being obese for longer during mid-life increases the risk of later-life disability over and above attained BMI. These results support the need for prevention of weight gain in young adults to avoid an increasing burden of physical disability in later life.
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Affiliation(s)
- Evelyn Wong
- Obesity and Population Health, Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Abstract
OBJECTIVE To examine the association between obese-years and the risk of cardiovascular disease (CVD). STUDY DESIGN Prospective cohort study. SETTING Boston, USA. PARTICIPANTS 5036 participants of the Framingham Heart Study were examined. METHODS Obese-years was calculated by multiplying for each participant the number of body mass index (BMI) units above 29 kg/m(2) by the number of years lived at that BMI during approximately 50 years of follow-up. The association between obese-years and CVD was analysed using time-dependent Cox regression adjusted for potential confounders and compared with other models using the Akaike information criterion (AIC). The lowest AIC indicated better fit. PRIMARY OUTCOME CVD RESULTS The median cumulative obese-years was 24 (range 2-556 obese-years). During 138,918 person-years of follow-up, 2753 (55%) participants were diagnosed with CVD. The incidence rates and adjusted HR (AHR) for CVD increased with an increase in the number of obese-years. AHR for the categories 1-24.9, 25-49.9, 50-74.9 and ≥75 obese-years were, respectively, 1.31 (95% CI 1.15 to 1.48), 1.37 (95% CI 1.14 to 1.65), 1.62 (95% CI 1.32 to 1.99) and 1.80 (95% CI 1.54 to 2.10) compared with those who were never obese (ie, had zero obese-years). The effect of obese-years was stronger in males than females. For every 10 unit increase in obese-years, the AHR of CVD increased by 6% (95% CI 4% to 8%) for males and 3% (95% CI 2% to 4%) for females. The AIC was lowest for the model containing obese-years compared with models containing either the level of BMI or the duration of obesity alone. CONCLUSIONS This study demonstrates that obese-years metric conceptually captures the cumulative damage of obesity on body systems, and is found to provide slightly more precise estimation of the risk of CVD than the level or duration of obesity alone.
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Affiliation(s)
- Asnawi Abdullah
- Department of Biostatistics and Population Health, Faculty of Public Health, University Muhammadiyah Aceh, Banda Aceh, Aceh, Indonesia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Fauzi Ali Amin
- Department of Public Health Nutrition, Faculty of Public Health, University Muhammadiyah Aceh, Banda Aceh, Aceh, Indonesia
| | - Johannes Stoelwinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jan Barendregt
- School of Population Health, University Queensland, Herston, Queensland, Australia
| | - Anna Peeters
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Tanamas SK, Shaw JE, Backholer K, Magliano DJ, Peeters A. Twelve-year weight change, waist circumference change and incident obesity: the Australian diabetes, obesity and lifestyle study. Obesity (Silver Spring) 2014; 22:1538-45. [PMID: 24436317 DOI: 10.1002/oby.20704] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [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] [Received: 12/17/2013] [Revised: 01/07/2014] [Accepted: 01/10/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study aimed to describe the changes in weight and waist circumference (WC), examine the incidence of obesity as defined by body mass index (BMI) and WC, and describe the changes in the prevalence of obesity over 12 years. METHODS In 1999/2000, 11,247 adults aged ≥25 years were recruited from 42 randomly selected areas across Australia. In total, 44.6% of eligible participants completed follow-up in 2011/12. Height, weight, and WC were measured at both surveys. RESULTS People who were 25-34 years of age at baseline gained an average of 6.7 kg weight and 6.6 cm WC, whereas those aged ≥75 years lost an average of 4.5 kg and gained an average of 0.8 cm. Women had a greater increase in WC than men, but did not differ in terms of weight gain. The 12-year incidence of obesity was 15.0% when defined by BMI and 31.8% when defined by WC. According to BMI and WC combined, the percentage of the cohort that was normal weight decreased from 33 to 21% and the percentage that was obese increased from 32 to 49% between baseline and 2012. CONCLUSIONS In addition to BMI, assessment of WC should be incorporated more frequently when assessing population trends of obesity and the burden of disease associated with excess adiposity.
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Affiliation(s)
- Stephanie K Tanamas
- Obesity and Population Health, Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Fillipas S, Tanamas SK, Davies-Tuck ML, Wluka AE, Wang Y, Holland AE, Cherry CL, Cicuttini F. The relationship between body composition and knee structure in patients with human immunodeficiency virus. Int J STD AIDS 2014; 26:133-8. [PMID: 24700199 DOI: 10.1177/0956462414531404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 11/16/2022]
Abstract
Obesity is a risk factor for osteoarthritis. Antiretroviral therapy (ART)-treated HIV-infected patients are frequently affected by overweight and obesity, and may be at increased risk of osteoarthritis. BMI however is a measure which does not discriminate adipose from non-adipose body mass, or fat distribution, which may have different effects. This study aimed to examine relationships between body composition and knee cartilage volume, as assessed by magnetic resonance imaging in HIV infection. 35 ART-treated HIV-infected men aged 51.7 years (mean) 7.9 (SD) and 18 healthy men aged 49.5 years (mean) 6.4 (SD) participated. Cartilage volume was measured on magnetic resonance imaging of the dominant knee using validated methods. Body composition was measured using dual x-ray absorptiometry. HIV-infected participants had less total body and gynoid fat (kg) (p = 0.04 and p = 0.007, respectively) and more percent android fat mass and percent trunk fat mass (p = 0.001 and p < 0.001, respectively) than controls. In HIV-infected participants there was an inverse association between total body fat mass and average tibial cartilage volume (R = -8.01, 95% CI -15.66, -0.36). Also, in HIV-infected participants there was an inverse association between android fat mass and average cartilage volume (R = -90.91, 95% CI -158.66, -23.16). This preliminary study found that both total body and android fat mass were inversely related to average knee cartilage volume in ambulant, ART-treated HIV-infected adults. These findings are features of early knee osteoarthritis and this may be of future significance in HIV.
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Affiliation(s)
- S Fillipas
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia Alfred Hospital, Melbourne, Australia
| | - S K Tanamas
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - M L Davies-Tuck
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - A E Wluka
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Y Wang
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - A E Holland
- Alfred Hospital, Melbourne, Australia La Trobe University, Bundoora, VIC, Australia
| | - C L Cherry
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia Alfred Hospital, Melbourne, Australia Burnet Institute, Melbourne, VIC, Australia
| | - F Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia Alfred Hospital, Melbourne, Australia
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Teichtahl AJ, Wluka AE, Tanamas SK, Wang Y, Strauss BJ, Proietto J, Dixon JB, Jones G, Forbes A, Cicuttini FM. Weight change and change in tibial cartilage volume and symptoms in obese adults. Ann Rheum Dis 2014; 74:1024-9. [PMID: 24519241 DOI: 10.1136/annrheumdis-2013-204488] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 01/24/2014] [Indexed: 01/13/2023]
Abstract
INTRODUCTION There is a paucity of data examining the effects of weight change on knee joint structures and symptoms. This study examined the effect of weight change on change in knee cartilage volume and symptoms in an obese cohort. METHODS 112 obese subjects (Body Mass Index ≥30 kg/m(2)) were recruited from various community sources to examine the effect of obesity on musculoskeletal health. Tibial cartilage volume, determined by MRI, and knee symptoms, determined by the Western Ontario and McMaster Osteoarthritis Index (WOMAC) were collected at baseline and an average of 2.3 years later. RESULTS Percentage weight change was associated with change in medial tibial cartilage volume (β -1.2 mm(3), 95% CI -2.3 to -0.1 mm(3), p=0.03) that was consistent throughout the spectrum of weight loss through to mild weight gain. Percentage weight change was not associated with change in the lateral tibial (p=0.93) or patella (p=0.32) cartilage volumes. Percentage weight change was associated with change in all WOMAC subscales (all p≤0.01): pain (β -1.8 mm, 95% CI -3.2 to -0.4 mm), stiffness (β -1.6 mm, 95% CI -2.5 to -0.7 mm) and function (β -6.9 mm, 95% CI -11.6 to -2.1 mm). CONCLUSIONS The linearity of effect implies that weight loss is associated with reduced medial cartilage volume loss and improved knee symptoms, while weight gain is associated with increased medial cartilage volume loss and worse knee symptoms. These results suggest that in obese people, small amounts of weight change may have the potential for a disease modifying effect on both knee joint structure and symptoms. While weight loss is an important primary management strategy in obese individuals, avoidance of further weight gain should also be a clinical goal.
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Affiliation(s)
- Andrew J Teichtahl
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
| | - Anita E Wluka
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
| | - Stephanie K Tanamas
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
| | - Yuanyuan Wang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
| | - Boyd J Strauss
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joseph Proietto
- Department of Medicine, University of Melbourne, Austin Health, Melbourne, Victoria, Australia
| | - John B Dixon
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Graeme Jones
- Menzies Research Institute, Hobart, Tasmania, Australia
| | - Andrew Forbes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
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Lambert GW, Hering D, Esler MD, Marusic P, Lambert EA, Tanamas SK, Shaw J, Krum H, Dixon JB, Barton DA, Schlaich MP. Response to Quality of Life After Renal Denervation. Hypertension 2013; 61:e39. [DOI: 10.1161/hypertensionaha.113.01042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Dagmara Hering
- Baker IDI Heart and Diabetes InstituteMelbourne, Australia
| | | | - Petra Marusic
- Baker IDI Heart and Diabetes InstituteMelbourne, Australia
| | | | | | - Jonathan Shaw
- Baker IDI Heart and Diabetes InstituteMelbourne, Australia
| | - Henry Krum
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourne, Australia
| | - John B. Dixon
- Baker IDI Heart and Diabetes InstituteMelbourne, Australia
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Grantham NM, Magliano DJ, Tanamas SK, Söderberg S, Schlaich MP, Shaw JE. Higher heart rate increases risk of diabetes among men: The Australian Diabetes Obesity and Lifestyle (AusDiab) Study. Diabet Med 2013; 30:421-7. [PMID: 23088496 DOI: 10.1111/dme.12045] [Citation(s) in RCA: 27] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 09/03/2012] [Accepted: 10/15/2012] [Indexed: 12/01/2022]
Abstract
AIMS A very limited number of prospective studies have reported conflicting data on the relation between heart rate and diabetes risk. Our aim therefore was to determine in a large, national, population-based cohort if heart rate predicts the development of diabetes. METHODS The Australian Diabetes Obesity and Lifestyle study followed up 6537 people over 5 years. Baseline measurements included questionnaires, anthropometrics and blood and urine collection. Heart rate was recorded in beats per min (Dinamap). An oral glucose tolerance test was performed at baseline and follow-up, and diabetes was defined using World Health Organization criteria. RESULTS A total of 5817 participants were eligible for analysis, 221 of whom developed diabetes. Compared with participants with a heart rate < 60 b min(-1), those with a heart rate ≥ 80 b min(-1) were more likely to develop diabetes (odds ratio 1.89, 95% CI 1.07-3.35) over 5 years, independent of traditional risk factors. This relationship was highly significant, particularly in non-obese men (odds ratio 5.61, 95% CI 1.75-17.98), but not in their obese counterparts or in women. CONCLUSIONS Resting heart rate is associated with an increased risk of diabetes over a 5-year period, particularly among non-obese men. This suggests that sympathetic overactivity may be a contributing factor to the development of diabetes, and that resting heart rate may be useful in predicting risk of Type 2 diabetes in non-obese men.
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Affiliation(s)
- N M Grantham
- Baker IDI Heart and Diabetes Institute, Melbourne, Vic., Australia
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Tanamas SK, Wluka AE, Davies-Tuck M, Wang Y, Strauss BJ, Proietto J, Dixon JB, Jones G, Forbes A, Cicuttini FM. Association of weight gain with incident knee pain, stiffness, and functional difficulties: A longitudinal study. Arthritis Care Res (Hoboken) 2012; 65:34-43. [DOI: 10.1002/acr.21745] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 05/11/2012] [Indexed: 01/23/2023]
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Lambert GW, Hering D, Esler MD, Marusic P, Lambert EA, Tanamas SK, Shaw J, Krum H, Dixon JB, Barton DA, Schlaich MP. Health-related quality of life after renal denervation in patients with treatment-resistant hypertension. Hypertension 2012; 60:1479-84. [PMID: 23071129 DOI: 10.1161/hypertensionaha.112.200865] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Recent studies have demonstrated the effectiveness of radiofrequency ablation of the renal sympathetic nerves in reducing blood pressure (BP) in patients with resistant hypertension. The effect of renal denervation on health-related quality of life (QoL) has not been evaluated. Using the Medical Outcomes Study 36-Item Short-Form Health Survey and Beck Depression Inventory-II, we examined QoL before and 3 months after renal denervation in patients with uncontrolled BP. For baseline comparisons, matched data were extracted from the Australian Diabetes, Obesity, and Lifestyle database. Before renal denervation, patients with resistant hypertension (n = 62) scored significantly worse in 5 of the eight 36-Item Short-Form Health Survey domains and the Mental Component Summary score. Three months after denervation (n = 40), clinic BP was reduced (change in systolic and diastolic BP, -16 ± 4 and -6 ± 2 mm Hg, respectively; P<0.01). The Mental Component Summary score improved (47.6 ± 1.1 versus 52 ± 1; P = 0.001) as a result of increases in the vitality, social function, role emotion, and mental health domains. Beck Depression Inventory scores were also improved, particularly with regard to symptoms of sadness (P = 0.01), tiredness (P<0.001), and libido (P<0.01). The magnitude of BP reduction or BP level achieved at 3 months bore no association to the change in QoL. Renal denervation was without a detrimental effect on any elements of the 36-Item Short-Form Health Survey. These results indicate that patients with severe hypertension resistant to therapy present with a marked reduction in subjective QoL. In this pre- and post-hypothesis generating study, several aspects of QoL were improved after renal denervation; however, this was not directly associated with the magnitude of BP reduction.
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Affiliation(s)
- Gavin W Lambert
- Human Neurotransmitters, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
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