1
|
Rogers NT, Conway DI, Mytton O, Roberts CH, Rutter H, Sherriff A, White M, Adams J. Estimated impact of the UK soft drinks industry levy on childhood hospital admissions for carious tooth extractions: interrupted time series analysis. BMJ Nutr Prev Health 2023; 6:243-252. [PMID: 38264366 PMCID: PMC10800259 DOI: 10.1136/bmjnph-2023-000714] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/18/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Tooth extraction due to dental caries is associated with socioeconomic deprivation and is a major reason for elective childhood hospital admissions in England. Consumption of sugar-sweetened beverages is a risk factor for dental caries. We examined whether the soft drinks industry levy (SDIL), announced in March 2016 and implemented in April 2018, was associated with changes in incidence rates of hospital admissions for carious tooth extraction in children, 22 months post-SDIL implementation. Methods Changes in incidence rates of monthly National Health Service hospital admissions for extraction of teeth due to a primary diagnosis of dental caries (International Classification of Diseases; ICD-10 code: K02) in England, between January 2012 and February 2020, were estimated using interrupted time series and compared with a counterfactual scenario where SDIL was not announced or implemented. Periodical changes in admissions, autocorrelation and population structure were accounted for. Estimates were calculated overall, by Index of Multiple Deprivation (IMD) fifths and by age group (0-4 years, 5-9 years, 10-14 years, 15-18 years). Results Compared with the counterfactual scenario, there was a relative reduction of 12.1% (95% CI 17.0% to 7.2%) in hospital admissions for carious tooth extractions in all children (0-18 years). Children aged 0-4 years and 5-9 years had relative reductions of 28.6% (95% CI 35.6% to 21.5%) and 5.5% (95% CI 10.5% to 0.5%), respectively; no change was observed for older children. Reductions were observed in children living in most IMD areas regardless of deprivation. Conclusion The UK SDIL was associated with reductions in incidence rates of childhood hospital admissions for carious tooth extractions, across most areas regardless of deprivation status and especially in younger children. Trial registration number ISRCTN18042742.
Collapse
Affiliation(s)
- Nina Trivedy Rogers
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - David I Conway
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Oliver Mytton
- Institute of Child Health, University College London, London, UK
| | - Chrissy H Roberts
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Andrea Sherriff
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| |
Collapse
|
2
|
Barton A, Pickering H, Payne T, Faal N, Sillah A, Harte A, Bailey RL, Mabey DCW, Roberts CH, Holland MJ. Sequence based HLA-DRB1, -DQB1 and -DPB1 allele and haplotype frequencies in The Gambia. Hum Immunol 2023; 84:69-70. [PMID: 36335053 DOI: 10.1016/j.humimm.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 12/14/2022]
Abstract
Class II HLA loci DRB1, DQB1 and DPB1 were typed for a total of 939 Gambian participants by locus-specific amplicon sequencing. Participants were from multiple regions of The Gambia and drawn from two studies: a family study aiming to identify associations between host genotype and trachomatous scarring (N = 796) and a cohort study aiming to identify correlates of immunity to trachoma (N = 143). All loci deviated from Hardy-Weinberg equilibrium, likely due to the family-based nature of the study: 608 participants had at least one other family member included in the study population. The most common alleles for HLA-DRB1, DQB1 and DPB1 respectively were DRB1*13:04 (18.8 %), DQB1*03:19 (27.9 %) and DPB1*01:01 (25.4 %). Participants belonged to a variety of ethnicities, including the Mandinka, Fula, Wolof and Jola ethnic groups.
Collapse
Affiliation(s)
- Amber Barton
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Harry Pickering
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Thomas Payne
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Nkoyo Faal
- Medical Research Council Gambia at LSHTM, Atlantic Boulevard, Fajara, Banjul, Gambia
| | - Ansumana Sillah
- National Eye Health Programme, Ministry of Health, Banjul, Gambia
| | - Anna Harte
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Robin L Bailey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - David C W Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Chrissy H Roberts
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Martin J Holland
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Medical Research Council Gambia at LSHTM, Atlantic Boulevard, Fajara, Banjul, Gambia.
| |
Collapse
|
3
|
Barton A, Ramadhani A, Mafuru E, Mtuy T, Massae P, Malissa A, Derrick T, Houghton J, Harte A, Payne T, Pickering H, Burton MJ, Roberts CH, Holland MJ. HLA-A, -B, -C, -DPB1, -DQB1 and -DRB1 allele frequencies of North Tanzanian Maasai. Hum Immunol 2023; 84:67-68. [PMID: 36335052 DOI: 10.1016/j.humimm.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
Locus-specific amplicon sequencing was used to HLA type 336 participants of Maasai ethnicity at the HLA-A, -B, -C, -DRB1, -DQB1 and -DPB1 loci. Participants were recruited from three study villages in North Tanzania, for the purpose of investigating risk factors for trachomatous scarring in children. Other than HLA-A, all loci significantly deviated from Hardy-Weinberg equilibrium, possibly due to high relatedness between individuals: 238 individuals shared a house with at least one another participant. The most frequent allele for each locus were A*68:02 (14.3 %), B*53:01 (8.4 %), C*06:02 (19.2 %), DRB1*13:02 (17.7 %), DQB1*02:01 (16.9 %) and DPB1*01:01 (15.7 %), while the most common inferred haplotype was A*68:02 ∼ B*18:01 ∼ C*07:04 ∼ DRB1*08:04 ∼ DQB1*04:02 ∼ DPB1*04:01 (1.3 %).
Collapse
Affiliation(s)
- Amber Barton
- Clinical Research Department, Faculty of Infectious and Tropiclal Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Athumani Ramadhani
- Eye Health Project, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Elias Mafuru
- Eye Health Project, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Tara Mtuy
- Clinical Research Department, Faculty of Infectious and Tropiclal Diseases, London School of Hygiene and Tropical Medicine, London, UK; Eye Health Project, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Patrick Massae
- Eye Health Project, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Aiweda Malissa
- Eye Health Project, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Tamsyn Derrick
- Clinical Research Department, Faculty of Infectious and Tropiclal Diseases, London School of Hygiene and Tropical Medicine, London, UK; Eye Health Project, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Joanna Houghton
- Clinical Research Department, Faculty of Infectious and Tropiclal Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Harte
- Clinical Research Department, Faculty of Infectious and Tropiclal Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Thomas Payne
- Clinical Research Department, Faculty of Infectious and Tropiclal Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Harry Pickering
- Clinical Research Department, Faculty of Infectious and Tropiclal Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew J Burton
- Clinical Research Department, Faculty of Infectious and Tropiclal Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Chrissy H Roberts
- Clinical Research Department, Faculty of Infectious and Tropiclal Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin J Holland
- Clinical Research Department, Faculty of Infectious and Tropiclal Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| |
Collapse
|
4
|
Waites W, Pearson CAB, Gaskell KM, House T, Pellis L, Johnson M, Gould V, Hunt A, Stone NRH, Kasstan B, Chantler T, Lal S, Roberts CH, Goldblatt D, Marks M, Eggo RM. Transmission dynamics of SARS-CoV-2 in a strictly-Orthodox Jewish community in the UK. Sci Rep 2022; 12:8550. [PMID: 35595824 PMCID: PMC9121858 DOI: 10.1038/s41598-022-12517-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 05/12/2022] [Indexed: 11/22/2022] Open
Abstract
Some social settings such as households and workplaces, have been identified as high risk for SARS-CoV-2 transmission. Identifying and quantifying the importance of these settings is critical for designing interventions. A tightly-knit religious community in the UK experienced a very large COVID-19 epidemic in 2020, reaching 64.3% seroprevalence within 10 months, and we surveyed this community both for serological status and individual-level attendance at particular settings. Using these data, and a network model of people and places represented as a stochastic graph rewriting system, we estimated the relative contribution of transmission in households, schools and religious institutions to the epidemic, and the relative risk of infection in each of these settings. All congregate settings were important for transmission, with some such as primary schools and places of worship having a higher share of transmission than others. We found that the model needed a higher general-community transmission rate for women (3.3-fold), and lower susceptibility to infection in children to recreate the observed serological data. The precise share of transmission in each place was related to assumptions about the internal structure of those places. Identification of key settings of transmission can allow public health interventions to be targeted at these locations.
Collapse
Affiliation(s)
- William Waites
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
- Department of Computer and Information Sciences, University of Strathclyde, Glasgow, Scotland, UK.
| | - Carl A B Pearson
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Katherine M Gaskell
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Thomas House
- School of Mathematics, University of Manchester, Manchester, UK
| | - Lorenzo Pellis
- School of Mathematics, University of Manchester, Manchester, UK
| | - Marina Johnson
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, UK
| | - Victoria Gould
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Adam Hunt
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, UK
| | - Neil R H Stone
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- Hospital for Tropical Diseases, University College London Hospital NHS Foundation Trust, London, UK
| | - Ben Kasstan
- Centre for Health, Law and Society, University of Bristol Law School, Bristol, UK
- Department of Sociology and Anthropology, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Sham Lal
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Chrissy H Roberts
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - David Goldblatt
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, London, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
- Hospital for Tropical Diseases, University College London Hospital NHS Foundation Trust, London, UK
| | - Rosalind M Eggo
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| |
Collapse
|
5
|
Kasstan B, Mounier-Jack S, Letley L, Gaskell KM, Roberts CH, Stone NRH, Lal S, Eggo RM, Marks M, Chantler T. Localising vaccination services: Qualitative insights on public health and minority group collaborations to co-deliver coronavirus vaccines. Vaccine 2022; 40:2226-2232. [PMID: 35216844 PMCID: PMC8849863 DOI: 10.1016/j.vaccine.2022.02.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 01/15/2023]
Abstract
Ethnic and religious minorities have been disproportionately affected by the SARS-CoV-2 pandemic and are less likely to accept coronavirus vaccinations. Orthodox (Haredi) Jewish neighbourhoods in England experienced high incidences of SARS-CoV-2 in 2020-21 and measles outbreaks (2018-19) due to suboptimal childhood vaccination coverage. The objective of our study was to explore how the coronavirus vaccination programme (CVP) was co-delivered between public health services and an Orthodox Jewish health organisation. Methods included 28 semi-structured interviews conducted virtually with public health professionals, community welfare and religious representatives, and household members. We examined CVP delivery from the perspectives of those involved in organising services and vaccine beneficiaries. Interview data was contextualised within debates of the CVP in Orthodox (Haredi) Jewish print and social media. Thematic analysis generated five considerations: i) Prior immunisation-related collaboration with public health services carved a role for Jewish health organisations to host and promote coronavirus vaccination sessions, distribute appointments, and administer vaccines ii) Public health services maintained responsibility for training, logistics, and maintaining vaccination records; iii) The localised approach to service delivery promoted vaccination in a minority with historically suboptimal levels of coverage; iv) Co-delivery promoted trust in the CVP, though a minority of participants maintained concerns around safety; v) Provision of CVP information and stakeholders' response to situated (context-specific) challenges and concerns. Drawing on this example of CVP co-delivery, we propose that a localised approach to delivering immunisation programmes could address service provision gaps in ways that involve trusted community organisations. Localisation of vaccination services can include communication or implementation strategies, but both approaches involve consideration of investment, engagement and coordination, which are not cost-neutral. Localising vaccination services in collaboration with welfare groups raises opportunities for the on-going CVP and other immunisation programmes, and constitutes an opportunity for ethnic and religious minorities to collaborate in safeguarding community health.
Collapse
Affiliation(s)
- Ben Kasstan
- Centre for Health, Law & Society, University of Bristol Law School, Bristol BS8 1RJ, UK; Department of Sociology & Anthropology, Hebrew University of Jerusalem, Har HaTzofim, Jerusalem 91905, Israel
| | - Sandra Mounier-Jack
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Louise Letley
- Immunisation and Countermeasures, National Infection Service, Public Health England, London, UK
| | - Katherine M Gaskell
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Chrissy H Roberts
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Neil R H Stone
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Hospital for Tropical Diseases, University College London Hospital NHS Foundation Trust, London, UK
| | - Sham Lal
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Rosalind M Eggo
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT UK
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Hospital for Tropical Diseases, University College London Hospital NHS Foundation Trust, London, UK; Division of Infection and Immunity, University College London, London, WC1E 6BT, UK
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| |
Collapse
|
6
|
Watson-Jones D, Kavunga-Membo H, Grais RF, Ahuka S, Roberts N, Edmunds WJ, Choi EM, Roberts CH, Edwards T, Camacho A, Lees S, Leyssen M, Spiessens B, Luhn K, Douoguih M, Hatchett R, Bausch DG, Muyembe JJ. Protocol for a phase 3 trial to evaluate the effectiveness and safety of a heterologous, two-dose vaccine for Ebola virus disease in the Democratic Republic of the Congo. BMJ Open 2022; 12:e055596. [PMID: 35260458 PMCID: PMC8905941 DOI: 10.1136/bmjopen-2021-055596] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Ebola virus disease (EVD) continues to be a significant public health problem in sub-Saharan Africa, especially in the Democratic Republic of the Congo (DRC). Large-scale vaccination during outbreaks may reduce virus transmission. We established a large population-based clinical trial of a heterologous, two-dose prophylactic vaccine during an outbreak in eastern DRC to determine vaccine effectiveness. METHODS AND ANALYSIS This open-label, non-randomised, population-based trial enrolled eligible adults and children aged 1 year and above. Participants were offered the two-dose candidate EVD vaccine regimen VAC52150 (Ad26.ZEBOV, Modified Vaccinia Ankara (MVA)-BN-Filo), with the doses being given 56 days apart. After vaccination, serious adverse events (SAEs) were passively recorded until 1 month post dose 2. 1000 safety subset participants were telephoned at 1 month post dose 2 to collect SAEs. 500 pregnancy subset participants were contacted to collect SAEs at D7 and D21 post dose 1 and at D7, 1 month, 3 months and 6 months post dose 2, unless delivery was before these time points. The first 100 infants born to these women were given a clinical examination 3 months post delivery. Due to COVID-19 and temporary suspension of dose 2 vaccinations, at least 50 paediatric and 50 adult participants were enrolled into an immunogenicity subset to examine immune responses following a delayed second dose. Samples collected predose 2 and at 21 days post dose 2 will be tested using the Ebola viruses glycoprotein Filovirus Animal Non-Clinical Group ELISA. For qualitative research, in-depth interviews and focus group discussions were being conducted with participants or parents/care providers of paediatric participants. ETHICS AND DISSEMINATION Approved by Comité National d'Ethique et de la Santé du Ministère de la santé de RDC, Comité d'Ethique de l'Ecole de Santé Publique de l'Université de Kinshasa, the LSHTM Ethics Committee and the MSF Ethics Review Board. Findings will be presented to stakeholders and conferences. Study data will be made available for open access. TRIAL REGISTRATION NUMBER NCT04152486.
Collapse
Affiliation(s)
- Deborah Watson-Jones
- London School of Hygiene & Tropical Medicine, London, UK
- Mwanza Intervention Trials Unit, Mwanza, Tanzania, United Republic of
| | - Hugo Kavunga-Membo
- L'Institut National de Recherche Biomédicale, Goma, Democratic Republic of the Congo
| | | | - Steve Ahuka
- L'Institut National de Recherche Biomédicale, Goma, Democratic Republic of the Congo
| | | | - W John Edmunds
- London School of Hygiene & Tropical Medicine, London, UK
| | - Edward M Choi
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Tansy Edwards
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Shelley Lees
- London School of Hygiene & Tropical Medicine, London, UK
| | - Maarten Leyssen
- Janssen Vaccines and Prevention BV, Leiden, Zuid-Holland, The Netherlands
| | - Bart Spiessens
- Janssen Vaccines and Prevention BV, Leiden, Zuid-Holland, The Netherlands
| | - Kerstin Luhn
- Janssen Vaccines and Prevention BV, Leiden, Zuid-Holland, The Netherlands
| | - Macaya Douoguih
- Janssen Vaccines and Prevention BV, Leiden, Zuid-Holland, The Netherlands
| | | | - Daniel G Bausch
- London School of Hygiene & Tropical Medicine, London, UK
- UK Public Health Rapid Support Team, Public Health England and LSHTM, London, UK
| | - Jean-Jacques Muyembe
- L'Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| |
Collapse
|
7
|
Roberts CH, Brindle H, Rogers NT, Eggo RM, Enria L, Lees S. Vaccine Confidence and Hesitancy at the Start of COVID-19 Vaccine Deployment in the UK: An Embedded Mixed-Methods Study. Front Public Health 2021; 9:745630. [PMID: 34858927 PMCID: PMC8632016 DOI: 10.3389/fpubh.2021.745630] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Approval for the use of COVID-19 vaccines has been granted in a number of countries but there are concerns that vaccine uptake may be low amongst certain groups. Methods: This study used a mixed methods approach based on online survey and an embedded quantitative/qualitative design to explore perceptions and attitudes that were associated with intention to either accept or refuse offers of vaccination in different demographic groups during the early stages of the UK's mass COVID-19 vaccination programme (December 2020). Analysis used multivariate logistic regression, structural text modeling and anthropological assessments. Results: Of 4,535 respondents, 85% (n = 3,859) were willing to have a COVID-19 vaccine. The rapidity of vaccine development and uncertainties about safety were common reasons for COVID-19 vaccine hesitancy. There was no evidence for the widespread influence of mis-information, although broader vaccine hesitancy was associated with intentions to refuse COVID-19 vaccines (OR 20.60, 95% CI 14.20–30.30, p < 0.001). Low levels of trust in the decision-making (OR 1.63, 95% CI 1.08, 2.48, p = 0.021) and truthfulness (OR 8.76, 95% CI 4.15–19.90, p < 0.001) of the UK government were independently associated with higher odds of refusing COVID-19 vaccines. Compared to political centrists, conservatives and liberals were, respectively, more (OR 2.05, 95%CI 1.51–2.80, p < 0.001) and less (OR 0.30, 95% CI 0.22–0.41, p < 0.001) likely to refuse offered vaccines. Those who were willing to be vaccinated cited both personal and public protection as reasons, with some alluding to having a sense of collective responsibility. Conclusion: Dominant narratives of COVID-19 vaccine hesitancy are misconceived as primarily being driven by misinformation. Key indicators of UK vaccine acceptance include prior behaviors, transparency of the scientific process of vaccine development, mistrust in science and leadership and individual political views. Vaccine programmes should leverage the sense of altruism, citizenship and collective responsibility that motivated many participants to get vaccinated.
Collapse
Affiliation(s)
- Chrissy H Roberts
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Brindle
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nina T Rogers
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Rosalind M Eggo
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Luisa Enria
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Shelley Lees
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
8
|
Marks M, Lal S, Brindle H, Gsell PS, MacGregor M, Stott C, van de Rijdt M, Almazor GG, Golia S, Watson C, Diallo A, Toure A, Houlihan C, Keating P, Martin H, Restrepo AMH, Anokwa Y, Roberts CH. Electronic Data Management for Vaccine Trials in Low Resource Settings: Upgrades, Scalability, and Impact of ODK. Front Public Health 2021; 9:665584. [PMID: 34805059 PMCID: PMC8599145 DOI: 10.3389/fpubh.2021.665584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/30/2021] [Indexed: 11/14/2022] Open
Abstract
Background: ODK provides software and standards that are popular solutions for off-grid electronic data collection and has substantial code overlap and interoperability with a number of related software products including CommCare, Enketo, Ona, SurveyCTO, and KoBoToolbox. These tools provide open-source options for off-grid use in public health data collection, management, analysis, and reporting. During the 2018–2020 Ebola epidemic in the North Kivu and Ituri regions of Democratic Republic of Congo, we used these tools to support the DRC Ministère de la Santé RDC and World Health Organization in their efforts to administer an experimental vaccine (VSV-Zebov-GP) as part of their strategy to control the transmission of infection. Method: New functions were developed to facilitate the use of ODK, Enketo and R in large scale data collection, aggregation, monitoring, and near-real-time analysis during clinical research in health emergencies. We present enhancements to ODK that include a built-in audit-trail, a framework and companion app for biometric registration of ISO/IEC 19794-2 fingerprint templates, enhanced performance features, better scalability for studies featuring millions of data form submissions, increased options for parallelization of research projects, and pipelines for automated management and analysis of data. We also developed novel encryption protocols for enhanced web-form security in Enketo. Results: Against the backdrop of a complex and challenging epidemic response, our enhanced platform of open tools was used to collect and manage data from more than 280,000 eligible study participants who received VSV-Zebov-GP under informed consent. These data were used to determine whether the VSV-Zebov-GP was safe and effective and to guide daily field operations. Conclusions: We present open-source developments that make electronic data management during clinical research and health emergencies more viable and robust. These developments will also enhance and expand the functionality of a diverse range of data collection platforms that are based on the ODK software and standards.
Collapse
Affiliation(s)
- Michael Marks
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sham Lal
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Brindle
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Matthew MacGregor
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | | | - Suman Golia
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Conall Watson
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | | | - Patrick Keating
- Médecins Sans Frontières UK, London, United Kingdom.,UK Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | | | - Chrissy H Roberts
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
9
|
Gaskell KM, Johnson M, Gould V, Hunt A, Stone NRH, Waites W, Kasstan B, Chantler T, Lal S, Roberts CH, Goldblatt D, Eggo RM, Marks M. SARS-CoV-2 seroprevalence in a strictly-Orthodox Jewish community in the UK: A retrospective cohort study. Lancet Reg Health Eur 2021; 6:100127. [PMID: 34308409 PMCID: PMC8291041 DOI: 10.1016/j.lanepe.2021.100127] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Ethnic and religious minorities have been disproportionately affected by SARS-CoV-2 worldwide. The UK strictly-Orthodox Jewish community has been severely affected by the pandemic. This group shares characteristics with other ethnic minorities including larger family sizes, higher rates of household crowding and relative socioeconomic deprivation. We studied a UK strictly-Orthodox Jewish population to understand transmission of COVID-19 within this community. METHODS We performed a household-focused cross-sectional SARS-CoV-2 serosurvey between late-October and early December 2020 prior to the third national lockdown. Randomly-selected households completed a standardised questionnaire and underwent serological testing with a multiplex assay for SARS-CoV-2 IgG antibodies. We report clinical illness and testing before the serosurvey, seroprevalence stratified by age and sex. We used random-effects models to identify factors associated with infection and antibody titres. FINDINGS A total of 343 households, consisting of 1,759 individuals, were recruited. Serum was available for 1,242 participants. The overall seroprevalence for SARS-CoV-2 was 64.3% (95% CI 61.6-67.0%). The lowest seroprevalence was 27.6% in children under 5 years and rose to 73.8% in secondary school children and 74% in adults. Antibody titres were higher in symptomatic individuals and declined over time since reported COVID-19 symptoms, with the decline more marked for nucleocapsid titres. INTERPRETATION In this tight-knit religious minority population in the UK, we report one of the highest SARS-CoV-2 seroprevalence levels in the world to date, which was markedly higher than the reported 10% seroprevalence in London at the time of the study. In the context of this high force of infection, all age groups experienced a high burden of infection. Actions to reduce the burden of disease in this and other minority populations are urgently required. FUNDING This work was jointly funded by UKRI and NIHR [COV0335; MR/V027956/1], a donation from the LSHTM Alumni COVID-19 response fund, HDR UK, the MRC and the Wellcome Trust.
Collapse
Affiliation(s)
- Katherine M Gaskell
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Marina Johnson
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, UK
| | - Victoria Gould
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Adam Hunt
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, UK
| | - Neil RH Stone
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Hospital for Tropical Diseases, University College London Hospital NHS Foundation Trust, London, UK
| | - William Waites
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT UK
- School of Informatics, University of Edinburgh, Edinburgh, Scotland, EH8 9AB
| | - Ben Kasstan
- Centre for Health, Law and Society, University of Bristol Law School, Bristol BS1 1RJ, UK
- Department of Sociology and Anthropology, Hebrew University of Jerusalem, Jerusalem 9190501, UK
| | - Tracey Chantler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Sham Lal
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Chrissy H. Roberts
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - David Goldblatt
- Great Ormond Street Institute of Child Health Biomedical Research Centre, University College London, UK
| | - Rosalind M Eggo
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT UK
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Hospital for Tropical Diseases, University College London Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
10
|
Marks M, Millat-Martinez P, Ouchi D, Roberts CH, Alemany A, Corbacho-Monné M, Ubals M, Tobias A, Tebé C, Ballana E, Bassat Q, Baro B, Vall-Mayans M, G-Beiras C, Prat N, Ara J, Clotet B, Mitjà O. Transmission of COVID-19 in 282 clusters in Catalonia, Spain: a cohort study. Lancet Infect Dis 2021; 21:629-636. [PMID: 33545090 PMCID: PMC7906723 DOI: 10.1016/s1473-3099(20)30985-3] [Citation(s) in RCA: 289] [Impact Index Per Article: 96.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/24/2020] [Accepted: 12/14/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Scarce data are available on what variables affect the risk of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the development of symptomatic COVID-19, and, particularly, the relationship with viral load. We aimed to analyse data from linked index cases of COVID-19 and their contacts to explore factors associated with transmission of SARS-CoV-2. METHODS In this cohort study, patients were recruited as part of a randomised controlled trial done between March 17 and April 28, 2020, that aimed to assess if hydroxychloroquine reduced transmission of SARS-CoV-2. Patients with COVID-19 and their contacts were identified by use of the electronic registry of the Epidemiological Surveillance Emergency Service of Catalonia (Spain). Patients with COVID-19 included in our analysis were aged 18 years or older, not hospitalised, had quantitative PCR results available at baseline, had mild symptom onset within 5 days before enrolment, and had no reported symptoms of SARS-CoV-2 infections in their accommodation or workplace within the 14 days before enrolment. Contacts included were adults with a recent history of exposure and absence of COVID-19-like symptoms within the 7 days preceding enrolment. Viral load of contacts, measured by quantitative PCR from a nasopharyngeal swab, was assessed at enrolment, at day 14, and whenever the participant reported COVID-19-like symptoms. We assessed risk of transmission and developing symptomatic disease and incubation dynamics using regression analysis. We assessed the relationship of viral load and characteristics of cases (age, sex, number of days from reported symptom onset, and presence or absence of fever, cough, dyspnoea, rhinitis, and anosmia) and associations between risk of transmission and characteristics of the index case and contacts. FINDINGS We identified 314 patients with COVID-19, with 282 (90%) having at least one contact (753 contacts in total), resulting in 282 clusters. 90 (32%) of 282 clusters had at least one transmission event. The secondary attack rate was 17% (125 of 753 contacts), with a variation from 12% when the index case had a viral load lower than 1 × 106 copies per mL to 24% when the index case had a viral load of 1 × 1010 copies per mL or higher (adjusted odds ratio per log10 increase in viral load 1·3, 95% CI 1·1-1·5). Increased risk of transmission was also associated with household contact (3·0, 1·59-5·65) and age of the contact (per year: 1·02, 1·01-1·04). 449 contacts had a positive PCR result at baseline. 28 (6%) of 449 contacts had symptoms at the first visit. Of 421 contacts who were asymptomatic at the first visit, 181 (43%) developed symptomatic COVID-19, with a variation from approximately 38% in contacts with an initial viral load lower than 1 × 107 copies per mL to greater than 66% for those with an initial viral load of 1 × 1010 copies per mL or higher (hazard ratio per log10 increase in viral load 1·12, 95% CI 1·05-1·20; p=0·0006). Time to onset of symptomatic disease decreased from a median of 7 days (IQR 5-10) for individuals with an initial viral load lower than 1 × 107 copies per mL to 6 days (4-8) for those with an initial viral load between 1 × 107 and 1 × 109 copies per mL, and 5 days (3-8) for those with an initial viral load higher than 1 × 109 copies per mL. INTERPRETATION In our study, the viral load of index cases was a leading driver of SARS-CoV-2 transmission. The risk of symptomatic COVID-19 was strongly associated with the viral load of contacts at baseline and shortened the incubation time of COVID-19 in a dose-dependent manner. FUNDING YoMeCorono, Generalitat de Catalunya. TRANSLATIONS For the Catalan translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Michael Marks
- Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, University College London Hospital, London, UK.
| | - Pere Millat-Martinez
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Dan Ouchi
- IrsiCaixa AIDS Research Institute, Badalona, Spain
| | - Chrissy H Roberts
- Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrea Alemany
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain
| | - Marc Corbacho-Monné
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain; Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Maria Ubals
- Infectious Disease Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain
| | - Cristian Tebé
- Biostatistics Unit, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Ester Ballana
- IrsiCaixa AIDS Research Institute, Badalona, Spain; Infectious Disease Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Quique Bassat
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain; Catalan Institution for Research and Advanced Studies, Barcelona, Spain
| | - Bàrbara Baro
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Martí Vall-Mayans
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain; Infectious Disease Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Camila G-Beiras
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain
| | - Nuria Prat
- Infectious Disease Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Jordi Ara
- Infectious Disease Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Bonaventura Clotet
- IrsiCaixa AIDS Research Institute, Badalona, Spain; Fight AIDS and Infectious Diseases Foundation, Badalona, Spain; Infectious Disease Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Càtedra de Malalties Infeccioses i Immunitat, Universitat de Vic, Universtiat Central de Catalunya, Vic, Spain
| | - Oriol Mitjà
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain; Infectious Disease Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Clinical Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; Càtedra de Malalties Infeccioses i Immunitat, Universitat de Vic, Universtiat Central de Catalunya, Vic, Spain; Lihir Medical Centre, International SOS, Lihir Island, Papua New Guinea
| |
Collapse
|
11
|
Macleod CK, Butcher R, Javati S, Gwyn S, Jonduo M, Abdad MY, Roberts CH, Keys D, Koim SP, Ko R, Garap J, Pahau D, Houinei W, Martin DL, Pomat WS, Solomon AW. Trachoma, Anti-Pgp3 Serology, and Ocular Chlamydia trachomatis Infection in Papua New Guinea. Clin Infect Dis 2021; 72:423-430. [PMID: 31965155 PMCID: PMC7850549 DOI: 10.1093/cid/ciaa042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/19/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In Melanesia, the prevalence of trachomatous inflammation-follicular (TF) suggests that public health-level interventions against active trachoma are needed. However, the prevalence of trachomatous trichiasis is below the threshold for elimination as a public health problem and evidence of conjunctival infection with trachoma's causative organism (Chlamydia trachomatis [CT]) is rare. Here, we examine the prevalence of ocular infection with CT and previous exposure to CT in three evaluation units (EUs) of Papua New Guinea. METHODS All individuals aged 1-9 years who were examined for clinical signs of trachoma in 3 Global Trachoma Mapping Project EUs were eligible to take part in this study (N = 3181). Conjunctival swabs were collected from 349 children with TF and tested by polymerase chain reaction to assess for ocular CT infection. Dried blood spots were collected from 2572 children and tested for anti-Pgp3 antibodies using a multiplex assay. RESULTS The proportion of children with TF who had CT infection was low across all 3 EUs (overall 2%). Anti-Pgp3 seroprevalence was 5.2% overall and there was no association between anti-Pgp3 antibody level and presence of TF. In 2 EUs, age-specific seroprevalence did not increase significantly with increasing age in the 1- to 9-year-old population. In the third EU, there was a statistically significant change with age but the overall seroprevalence and peak age-specific seroprevalence was very low. CONCLUSIONS Based on these results, together with similar findings from the Solomon Islands and Vanuatu, the use of TF to guide antibiotic mass drug administration decisions in Melanesia should be reviewed.
Collapse
Affiliation(s)
- Colin K Macleod
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robert Butcher
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Javati
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Sarah Gwyn
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marinjho Jonduo
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Mohammad Yazid Abdad
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
- National Centre for Infectious Diseases, Singapore
| | - Chrissy H Roberts
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Drew Keys
- Brien Holden Vision Institute Foundation, Sydney, Australia
| | | | - Robert Ko
- Department of Ophthalmology, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Jambi Garap
- Department of Ophthalmology, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - David Pahau
- Department of Ophthalmology, Boram General Hospital, Wewak, Papua New Guinea
| | - Wendy Houinei
- Neglected Tropical Diseases, National Department of Health, Port Moresby, Papua New Guinea
| | - Diana L Martin
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William S Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Anthony W Solomon
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
12
|
Middleton J, Abdad MY, Beauchamp E, Colthart G, Cooper MJF, Dem F, Fairhead J, Grundy CL, Head MG, Inacio J, Jimbudo M, Jones CI, Konecna M, Laman M, MacGregor H, Novotny V, Peck M, Paliau J, Philip J, Pomat W, Roberts CH, Sui S, Stewart AJ, Walker SL, Cassell JA. Health service needs and perspectives of remote forest communities in Papua New Guinea: study protocol for combined clinical and rapid anthropological assessments with parallel treatment of urgent cases. BMJ Open 2020; 10:e041784. [PMID: 33130572 PMCID: PMC7733180 DOI: 10.1136/bmjopen-2020-041784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Our project follows community requests for health service incorporation into conservation collaborations in the rainforests of Papua New Guinea (PNG). This protocol is for health needs assessments, our first step in coplanning medical provision in communities with no existing health data. METHODS AND ANALYSIS The study includes clinical assessments and rapid anthropological assessment procedures (RAP) exploring the health needs and perspectives of partner communities in two areas, conducted over 6 weeks fieldwork. First, in Wanang village (population c.200), which is set in lowland rainforest. Second, in six communities (population c.3000) along an altitudinal transect up the highest mountain in PNG, Mount Wilhelm. Individual primary care assessments incorporate physical examinations and questioning (providing qualitative and quantitative data) while RAP includes focus groups, interviews and field observations (providing qualitative data). Given absence of in-community primary care, treatments are offered alongside research activity but will not form part of the study. Data are collected by a research fellow, primary care clinician and two PNG research technicians. After quantitative and qualitative analyses, we will report: ethnoclassifications of disease, causes, symptoms and perceived appropriate treatment; community rankings of disease importance and service needs; attitudes regarding health service provision; disease burdens and associations with altitudinal-related variables and cultural practices. To aid wider use study tools are in online supplemental file, and paper and ODK versions are available free from the corresponding author. ETHICS AND DISSEMINATION Challenges include supporting informed consent in communities with low literacy and diverse cultures, moral duties to provide treatment alongside research in medically underserved areas while minimising risks of therapeutic misconception and inappropriate inducement, and PNG research capacity building. Brighton and Sussex Medical School (UK), PNG Institute of Medical Research and PNG Medical Research Advisory Committee have approved the study. Dissemination will be via journals, village meetings and plain language summaries.
Collapse
Affiliation(s)
- Jo Middleton
- Primary Care and Public Health, and NIHR Global Health Research Unit on Neglected Tropical Diseases, Brighton and Sussex Medical School, Falmer, UK
- Evolution, behaviour and environment, School of Life Sciences, University of Sussex, Falmer, UK
| | - Mohammad Yazid Abdad
- Papua New Guinea Institute of Medical Research, Goroka/Madang, Papua New Guinea
- Infectious Disease Research Laboratory, National Centre for Infectious Diseases, Singapore
| | - Emilie Beauchamp
- International Institute for Environment and Development, London, UK
| | - Gavin Colthart
- Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, UK
- Medicine, James Cook University, Townsville, North Queensland, Australia
| | - Maxwell J F Cooper
- Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, UK
| | - Francesca Dem
- New Guinea Binatang Research Centre, Nagada, Papua New Guinea
| | - James Fairhead
- Anthropology, School of Global Studies, University of Sussex, Falmer, UK
| | - Caroline L Grundy
- Sussex Sustainability Research Programme, University of Sussex, Falmer, UK
| | - Michael G Head
- Faculty of Medicine and Global Health Research Institute, University of Southampton, Southampton, UK
| | - Joao Inacio
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
- Global Health and Tropical Medicine, New University of Lisbon Institute of Hygiene and Tropical Medicine, Lisboa, Portugal
| | - Mavis Jimbudo
- New Guinea Binatang Research Centre, Nagada, Papua New Guinea
| | | | - Martina Konecna
- Zoology, Faculty of Science, University of South Bohemia, Ceske Budejovice, Czech Republic
| | - Moses Laman
- Papua New Guinea Institute of Medical Research, Goroka/Madang, Papua New Guinea
| | | | - Vojtech Novotny
- Zoology, Faculty of Science, University of South Bohemia, Ceske Budejovice, Czech Republic
- Ecology, Biology Centre, Institute of Entomology, Ceske Budejovice, Czech Republic
| | - Mika Peck
- Evolution, behaviour and environment, School of Life Sciences, University of Sussex, Falmer, UK
| | - Jason Paliau
- New Guinea Binatang Research Centre, Nagada, Papua New Guinea
| | - Jonah Philip
- New Guinea Binatang Research Centre, Nagada, Papua New Guinea
| | - Willie Pomat
- Papua New Guinea Institute of Medical Research, Goroka/Madang, Papua New Guinea
| | - Chrissy H Roberts
- Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Shen Sui
- New Guinea Binatang Research Centre, Nagada, Papua New Guinea
| | - Alan J Stewart
- Evolution, behaviour and environment, School of Life Sciences, University of Sussex, Falmer, UK
| | - Stephen L Walker
- Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- Hospital for Tropical Diseases and Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jackie A Cassell
- Primary Care and Public Health, and NIHR Global Health Research Unit on Neglected Tropical Diseases, Brighton and Sussex Medical School, Falmer, UK
| |
Collapse
|
13
|
Rogers NT, Waterlow NR, Brindle H, Enria L, Eggo RM, Lees S, Roberts CH. Behavioral Change Towards Reduced Intensity Physical Activity Is Disproportionately Prevalent Among Adults With Serious Health Issues or Self-Perception of High Risk During the UK COVID-19 Lockdown. Front Public Health 2020; 8:575091. [PMID: 33102424 PMCID: PMC7554527 DOI: 10.3389/fpubh.2020.575091] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [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: 06/22/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022] Open
Abstract
Objectives: We assessed whether lockdown had a disproportionate impact on physical activity behavior in groups who were, or who perceived themselves to be, at heightened risk from COVID-19. Methods: Physical activity intensity (none, mild, moderate, or vigorous) before and during the UK COVID-19 lockdown was self-reported by 9,190 adults between 2020-04-06 and 2020-04-22. Physician-diagnosed health conditions and topic composition of open-ended text on participants' coping strategies were tested for associations with changes in physical activity. Results: Most (63.9%) participants maintained their normal physical activity intensity during lockdown, 25.0% changed toward less intensive activity and 11.1% were doing more. Doing less intensive physical activity was associated with obesity (OR 1.25, 95% CI 1.08–1.42), hypertension (OR 1.25, 1.10–1.40), lung disease (OR 1.23, 1.08–1.38), depression (OR 2.05, 1.89–2.21), and disability (OR 2.13, 1.87–2.39). Being female (OR 1.25, 1.12–1.38), living alone (OR 1.20, 1.05–1.34), or without access to a garden (OR 1.74, 1.56–1.91) were also associated with doing less intensive physical activity, but being in the highest income group (OR 1.73, 1.37–2.09) or having school-age children (OR 1.29, 1.10–1.49) were associated with doing more. Younger adults were more likely to change their PA behavior compared to older adults. Structural topic modeling of narratives on coping strategies revealed associations between changes in physical activity and perceptions of personal or familial risks at work or at home. Conclusions: Policies on maintaining or improving physical activity intensity during lockdowns should consider (1) vulnerable groups of adults including those with chronic diseases or self-perceptions of being at risk and (2) the importance of access to green or open spaces in which to exercise.
Collapse
Affiliation(s)
- Nina Trivedy Rogers
- University College London (UCL) Research Department of Epidemiology & Public Health, London, United Kingdom
| | - Naomi R Waterlow
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hannah Brindle
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Luisa Enria
- Department of Social & Policy Sciences, University of Bath, Bath, United Kingdom
| | - Rosalind M Eggo
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Shelley Lees
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chrissy H Roberts
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
14
|
Naker K, Gaskell KM, Dorjravdan M, Dambaa N, Roberts CH, Moore DAJ. An e-registry for household contacts exposed to multidrug resistant TB in Mongolia. BMC Med Inform Decis Mak 2020; 20:188. [PMID: 32787837 PMCID: PMC7425559 DOI: 10.1186/s12911-020-01204-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The WHO recommends that individuals exposed to persons with multidrug resistant tuberculosis (MDRTB) should be screened for active TB and followed up for 2 years to detect and treat secondary cases early. Resource prioritisation means this is rarely undertaken and where it is performed it's usually using a paper-based record, without collation of data. Electronic data collection into a web-based registry offers the opportunity for simplified and systematic TB contact surveillance with automatic synthesis of data at local, regional and national level. This pilot study was designed to explore the feasibility of usage of a novel e-registry tool and explore obstacles and facilitating factors to implementation. METHODS In parallel with their paper records, seven dispensaries in Ulaanbaatar, Mongolia collected standardized data electronically using Open Data Kit (ODK). Patients with MDRTB and their contacts were recruited during a single clinic visit. Staff and patients were interviewed to gain insights into acceptability and to identify areas for improvement. RESULTS Seventy household contacts of 32 MDR-TB index patients were recruited. 7/70 contacts (10%) traced had active TB at the time they were recruited to the e-registry. Paper registry satisfaction was low; 88% of staff preferred the e-registry as it was perceived as faster and more secure. Patients and their contacts were generally supportive of the e-registry; however, a significant minority 10/42 (24%) of index cases who were invited, declined to participate in the e-registry, with data security cited as their top concern. CONCLUSION E-registries are a promising tool for MDRTB contact tracing, but their acceptability amongst patients should not be taken for granted.
Collapse
Affiliation(s)
- Kush Naker
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Katherine M Gaskell
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Munhjargal Dorjravdan
- National Centre of Communicable Diseases, Nam Yan Zhu Street, 13th Khoroo, Ulaanbaatar, Mongolia
| | - Naranzul Dambaa
- National Centre of Communicable Diseases, Nam Yan Zhu Street, 13th Khoroo, Ulaanbaatar, Mongolia
| | - Chrissy H Roberts
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - David A J Moore
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| |
Collapse
|
15
|
Polonsky JA, Baidjoe A, Kamvar ZN, Cori A, Durski K, Edmunds WJ, Eggo RM, Funk S, Kaiser L, Keating P, de Waroux OLP, Marks M, Moraga P, Morgan O, Nouvellet P, Ratnayake R, Roberts CH, Whitworth J, Jombart T. Outbreak analytics: a developing data science for informing the response to emerging pathogens. Philos Trans R Soc Lond B Biol Sci 2020; 374:20180276. [PMID: 31104603 PMCID: PMC6558557 DOI: 10.1098/rstb.2018.0276] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Despite continued efforts to improve health systems worldwide, emerging pathogen epidemics remain a major public health concern. Effective response to such outbreaks relies on timely intervention, ideally informed by all available sources of data. The collection, visualization and analysis of outbreak data are becoming increasingly complex, owing to the diversity in types of data, questions and available methods to address them. Recent advances have led to the rise of outbreak analytics, an emerging data science focused on the technological and methodological aspects of the outbreak data pipeline, from collection to analysis, modelling and reporting to inform outbreak response. In this article, we assess the current state of the field. After laying out the context of outbreak response, we critically review the most common analytics components, their inter-dependencies, data requirements and the type of information they can provide to inform operations in real time. We discuss some challenges and opportunities and conclude on the potential role of outbreak analytics for improving our understanding of, and response to outbreaks of emerging pathogens. This article is part of the theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control‘. This theme issue is linked with the earlier issue ‘Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes’.
Collapse
Affiliation(s)
- Jonathan A Polonsky
- 1 Department of Health Emergency Information and Risk Assessment, World Health Organization , Avenue Appia 20, 1211 Geneva , Switzerland.,3 Faculty of Medicine, University of Geneva , 1 rue Michel-Servet, 1211 Geneva , Switzerland
| | - Amrish Baidjoe
- 4 Department of Infectious Disease Epidemiology, School of Public Health, MRC Centre for Global Infectious Disease Analysis, Imperial College London , Medical School Building, St Mary's Campus, Norfolk Place London W2 1PG , UK
| | - Zhian N Kamvar
- 4 Department of Infectious Disease Epidemiology, School of Public Health, MRC Centre for Global Infectious Disease Analysis, Imperial College London , Medical School Building, St Mary's Campus, Norfolk Place London W2 1PG , UK
| | - Anne Cori
- 4 Department of Infectious Disease Epidemiology, School of Public Health, MRC Centre for Global Infectious Disease Analysis, Imperial College London , Medical School Building, St Mary's Campus, Norfolk Place London W2 1PG , UK
| | - Kara Durski
- 2 Department of Infectious Hazard Management, World Health Organization , Avenue Appia 20, 1211 Geneva , Switzerland
| | - W John Edmunds
- 5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,6 Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK
| | - Rosalind M Eggo
- 5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,6 Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK
| | - Sebastian Funk
- 5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,6 Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK
| | - Laurent Kaiser
- 3 Faculty of Medicine, University of Geneva , 1 rue Michel-Servet, 1211 Geneva , Switzerland
| | - Patrick Keating
- 5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,8 UK Public Health Rapid Support Team , London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT , UK
| | - Olivier le Polain de Waroux
- 5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,8 UK Public Health Rapid Support Team , London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT , UK.,9 Public Health England , Wellington House, 133-155 Waterloo Road, London SE1 8UG , UK
| | - Michael Marks
- 7 Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK
| | - Paula Moraga
- 10 Centre for Health Informatics, Computing and Statistics (CHICAS), Lancaster Medical School, Lancaster University , Lancaster LA1 4YW , UK
| | - Oliver Morgan
- 1 Department of Health Emergency Information and Risk Assessment, World Health Organization , Avenue Appia 20, 1211 Geneva , Switzerland
| | - Pierre Nouvellet
- 4 Department of Infectious Disease Epidemiology, School of Public Health, MRC Centre for Global Infectious Disease Analysis, Imperial College London , Medical School Building, St Mary's Campus, Norfolk Place London W2 1PG , UK.,11 School of Life Sciences, University of Sussex , Sussex House, Brighton BN1 9RH , UK
| | - Ruwan Ratnayake
- 5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,6 Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK
| | - Chrissy H Roberts
- 7 Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK
| | - Jimmy Whitworth
- 5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,8 UK Public Health Rapid Support Team , London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT , UK
| | - Thibaut Jombart
- 4 Department of Infectious Disease Epidemiology, School of Public Health, MRC Centre for Global Infectious Disease Analysis, Imperial College London , Medical School Building, St Mary's Campus, Norfolk Place London W2 1PG , UK.,5 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine , Keppel St, London WC1E 7HT , UK.,8 UK Public Health Rapid Support Team , London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT , UK
| |
Collapse
|
16
|
Baltas I, Pickering H, Beale M, Holland M, Versteeg A, Mabey D, Roberts CH, Kako H, Solomon A, Thompson N, Marks M, Butcher R. Genetic diversity of urogenital Chlamydia trachomatis before and after mass drug administration for trachoma. Access Microbiol 2020. [DOI: 10.1099/acmi.fis2019.po0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ioannis Baltas
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London
| | - Harry Pickering
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London
| | - Mathew Beale
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Martin Holland
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London
| | - Aalbartus Versteeg
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London
| | - David Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London
| | - Chrissy H. Roberts
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London
| | - Henry Kako
- Solomon Islands Ministry of Health, Honiara, Solomon Islands
| | - Anthony Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London
| | - Nick Thompson
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London
| | - Michael Marks
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London
| | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London
| |
Collapse
|
17
|
Handley BL, Butcher R, Taoaba R, Roberts CH, Cama A, Müeller A, Solomon AW, Tekeraoi R, Marks M. Absence of Serological Evidence of Exposure to Treponema pallidum among Children Suggests Yaws Is No Longer Endemic in Kiribati. Am J Trop Med Hyg 2020; 100:940-942. [PMID: 30719964 PMCID: PMC6447131 DOI: 10.4269/ajtmh.18-0799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Yaws is a neglected tropical disease targeted for eradication by 2020. Kiribati, a Pacific Island nation, was previously endemic for yaws but lacks recent data from which its current endemicity status could be determined. This study tested antibody responses to Treponema pallidum to determine if transmission of yaws is taking place among children in Kiribati. Using a commercially available T. pallidum particle agglutination kit (Serodia®, Fujirebio Inc., Tokyo, Japan), we tested dried blood spots, collected during population-based trachoma prevalence surveys on Tarawa Atoll and Kiritimati Island, for long-lived treponemal antibodies. Dried blood spots from 1,420 children aged 1-9 years were tested. Only two were positive, suggesting T. pallidum is not being widely transmitted among children in the settings sampled. These data require support from additional surveys to demonstrate the absence of clinical signs of disease and molecular evidence of infection, to confirm that yaws is no longer endemic in Kiribati.
Collapse
Affiliation(s)
- Becca L Handley
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Raebwebwe Taoaba
- Eye Department, Ministry of Health and Medical Services, South Tarawa, Kiribati
| | - Chrissy H Roberts
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anasaini Cama
- The International Agency for the Prevention of Blindness, Melbourne, Australia.,The Fred Hollows Foundation, Sydney, Australia
| | - Andreas Müeller
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.,Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.,Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rabebe Tekeraoi
- Eye Department, Ministry of Health and Medical Services, South Tarawa, Kiribati
| | - Michael Marks
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
18
|
Rogers NT, Waterlow NR, Brindle H, Enria L, Eggo RM, Lees S, Roberts CH. Behavioral Change Towards Reduced Intensity Physical Activity Is Disproportionately Prevalent Among Adults With Serious Health Issues or Self-Perception of High Risk During the UK COVID-19 Lockdown. Front Public Health 2020. [PMID: 33102424 DOI: 10.17037/data.00001753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Objectives: We assessed whether lockdown had a disproportionate impact on physical activity behavior in groups who were, or who perceived themselves to be, at heightened risk from COVID-19. Methods: Physical activity intensity (none, mild, moderate, or vigorous) before and during the UK COVID-19 lockdown was self-reported by 9,190 adults between 2020-04-06 and 2020-04-22. Physician-diagnosed health conditions and topic composition of open-ended text on participants' coping strategies were tested for associations with changes in physical activity. Results: Most (63.9%) participants maintained their normal physical activity intensity during lockdown, 25.0% changed toward less intensive activity and 11.1% were doing more. Doing less intensive physical activity was associated with obesity (OR 1.25, 95% CI 1.08-1.42), hypertension (OR 1.25, 1.10-1.40), lung disease (OR 1.23, 1.08-1.38), depression (OR 2.05, 1.89-2.21), and disability (OR 2.13, 1.87-2.39). Being female (OR 1.25, 1.12-1.38), living alone (OR 1.20, 1.05-1.34), or without access to a garden (OR 1.74, 1.56-1.91) were also associated with doing less intensive physical activity, but being in the highest income group (OR 1.73, 1.37-2.09) or having school-age children (OR 1.29, 1.10-1.49) were associated with doing more. Younger adults were more likely to change their PA behavior compared to older adults. Structural topic modeling of narratives on coping strategies revealed associations between changes in physical activity and perceptions of personal or familial risks at work or at home. Conclusions: Policies on maintaining or improving physical activity intensity during lockdowns should consider (1) vulnerable groups of adults including those with chronic diseases or self-perceptions of being at risk and (2) the importance of access to green or open spaces in which to exercise.
Collapse
Affiliation(s)
- Nina Trivedy Rogers
- University College London (UCL) Research Department of Epidemiology & Public Health, London, United Kingdom
| | - Naomi R Waterlow
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hannah Brindle
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Luisa Enria
- Department of Social & Policy Sciences, University of Bath, Bath, United Kingdom
| | - Rosalind M Eggo
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Shelley Lees
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chrissy H Roberts
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
19
|
Pickering H, Palmer CD, Houghton J, Makalo P, Joof H, Derrick T, Goncalves A, Mabey DCW, Bailey RL, Burton MJ, Roberts CH, Burr SE, Holland MJ. Conjunctival Microbiome-Host Responses Are Associated With Impaired Epithelial Cell Health in Both Early and Late Stages of Trachoma. Front Cell Infect Microbiol 2019; 9:297. [PMID: 31552195 PMCID: PMC6736612 DOI: 10.3389/fcimb.2019.00297] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Received: 04/02/2019] [Accepted: 07/31/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Trachoma, a neglected tropical disease, is the leading infectious cause of blindness and visual impairment worldwide. Host responses to ocular chlamydial infection resulting in chronic inflammation and expansion of non-chlamydial bacteria are hypothesized risk factors for development of active trachoma and conjunctival scarring. Methods: Ocular swabs from trachoma endemic populations in The Gambia were selected from archived samples for 16S sequencing and host conjunctival gene expression. We recruited children with active trachoma and adults with conjunctival scarring, alongside corresponding matched controls. Findings: In children, active trachoma was not associated with significant changes in the ocular microbiome. Haemophilus enrichment was associated with antimicrobial responses but not linked to active trachoma. Adults with scarring trachoma had a reduced ocular bacterial diversity compared to controls, with increased relative abundance of Corynebacterium. Increased abundance of Corynebacterium in scarring disease was associated with innate immune responses to the microbiota, dominated by altered mucin expression and increased matrix adhesion. Interpretation: In the absence of current Chlamydia trachomatis infection, changes in the ocular microbiome associate with differential expression of antimicrobial and inflammatory genes that impair epithelial cell health. In scarring trachoma, expansion of non-pathogenic bacteria such as Corynebacterium and innate responses are coincident, warranting further investigation of this relationship. Comparisons between active and scarring trachoma supported the relative absence of type-2 interferon responses in scarring, whilst highlighting a common suppression of re-epithelialization with altered epithelial and bacterial adhesion, likely contributing to development of scarring pathology.
Collapse
Affiliation(s)
- Harry Pickering
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christine D Palmer
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Joanna Houghton
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pateh Makalo
- Disease Control and Elimination Theme, MRC Unit the Gambia at LSHTM, Banjul, Gambia
| | - Hassan Joof
- Disease Control and Elimination Theme, MRC Unit the Gambia at LSHTM, Banjul, Gambia
| | - Tamsyn Derrick
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Adriana Goncalves
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David C W Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robin L Bailey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matthew J Burton
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chrissy H Roberts
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah E Burr
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Disease Control and Elimination Theme, MRC Unit the Gambia at LSHTM, Banjul, Gambia
| | - Martin J Holland
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Disease Control and Elimination Theme, MRC Unit the Gambia at LSHTM, Banjul, Gambia
| |
Collapse
|
20
|
Ramadhani AM, Derrick T, Macleod D, Massae P, Malisa A, Mbuya K, Mtuy T, Makupa W, Roberts CH, Bailey RL, Mabey DCW, Holland MJ, Burton MJ. Ocular immune responses, Chlamydia trachomatis infection and clinical signs of trachoma before and after azithromycin mass drug administration in a treatment naïve trachoma-endemic Tanzanian community. PLoS Negl Trop Dis 2019; 13:e0007559. [PMID: 31306419 PMCID: PMC6658141 DOI: 10.1371/journal.pntd.0007559] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 07/25/2019] [Accepted: 06/18/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Trachoma, caused by Chlamydia trachomatis, remains the leading infectious cause of blindness worldwide. Persistence and progression of the resulting clinical disease appears to be an immunologically mediated process. Azithromycin, which is distributed at the community level for trachoma control, has immunomodulatory properties. We investigated the impact of one round of oral azithromycin on conjunctival immune responses, C. trachomatis infection and clinical signs three- and six- months post treatment relative to three pre-treatment time-points. METHODOLOGY A cohort of children aged 6 to 10 years were recruited from a trachoma endemic region of northern Tanzania and were visited five times in a 12-month period. They were examined for clinical signs of trachoma and conjunctival swabs were collected for laboratory analysis. C. trachomatis infection was detected and the expression of 46 host genes was quantified using quantitative PCR. All community members were offered azithromycin treatment immediately after the six-month timepoint according to international guidelines. FINDINGS The prevalence of C. trachomatis infection and inflammatory disease signs were significantly reduced three- and six- months post-mass drug administration (MDA). C. trachomatis infection was strongly associated with clinical signs at all five time-points. A profound anti-inflammatory effect on conjunctival gene expression was observed 3 months post-MDA, however, gene expression had largely returned to pre-treatment levels of variation by 6 months. This effect was less marked, but still observed, after adjusting for C. trachomatis infection and when the analysis was restricted to individuals who were free from both infection and clinical disease at all five time-points. Interestingly, a modest effect was also observed in individuals who did not receive treatment. CONCLUSION Conjunctival inflammation is the major clinical risk factor for progressive scarring trachoma, therefore, the reduction in inflammation associated with azithromycin treatment may be beneficial in limiting the development of potentially blinding disease sequelae. Future work should seek to determine whether this effect is mediated directly through inhibition of pro-inflammatory intracellular signalling molecules, through reductions in concurrent, sub-clinical infections, and/or through reduction of infection exposure.
Collapse
Affiliation(s)
- Athumani M. Ramadhani
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Tamsyn Derrick
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - David Macleod
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Aiweda Malisa
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Kelvin Mbuya
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Tara Mtuy
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Chrissy H. Roberts
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robin L. Bailey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David C. W. Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin J. Holland
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Matthew J. Burton
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
21
|
Boelen L, Debebe B, Silveira M, Salam A, Makinde J, Roberts CH, Wang ECY, Frater J, Gilmour J, Twigger K, Ladell K, Miners KL, Jayaraman J, Traherne JA, Price DA, Qi Y, Martin MP, Macallan DC, Thio CL, Astemborski J, Kirk G, Donfield SM, Buchbinder S, Khakoo SI, Goedert JJ, Trowsdale J, Carrington M, Kollnberger S, Asquith B. Inhibitory killer cell immunoglobulin-like receptors strengthen CD8 + T cell-mediated control of HIV-1, HCV, and HTLV-1. Sci Immunol 2018; 3:eaao2892. [PMID: 30413420 PMCID: PMC6277004 DOI: 10.1126/sciimmunol.aao2892] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 06/06/2018] [Accepted: 10/09/2018] [Indexed: 01/05/2023]
Abstract
Killer cell immunoglobulin-like receptors (KIRs) are expressed predominantly on natural killer cells, where they play a key role in the regulation of innate immune responses. Recent studies show that inhibitory KIRs can also affect adaptive T cell-mediated immunity. In mice and in human T cells in vitro, inhibitory KIR ligation enhanced CD8+ T cell survival. To investigate the clinical relevance of these observations, we conducted an extensive immunogenetic analysis of multiple independent cohorts of HIV-1-, hepatitis C virus (HCV)-, and human T cell leukemia virus type 1 (HTLV-1)-infected individuals in conjunction with in vitro assays of T cell survival, analysis of ex vivo KIR expression, and mathematical modeling of host-virus dynamics. Our data suggest that functional engagement of inhibitory KIRs enhances the CD8+ T cell response against HIV-1, HCV, and HTLV-1 and is a significant determinant of clinical outcome in all three viral infections.
Collapse
Affiliation(s)
- Lies Boelen
- Department of Medicine, Imperial College London, London, UK
| | - Bisrat Debebe
- Department of Medicine, Imperial College London, London, UK
| | - Marcos Silveira
- Department of Medicine, Imperial College London, London, UK
- Faculty of Engineering, São Paulo State University-UNESP, São Paulo, Brazil
| | - Arafa Salam
- Institute for Infection and Immunity, St. George's, University of London, London, UK
| | - Julia Makinde
- International AIDS Vaccine Initiative Human Immunology Laboratory, London, UK
| | - Chrissy H Roberts
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Eddie C Y Wang
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - John Frater
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Jill Gilmour
- International AIDS Vaccine Initiative Human Immunology Laboratory, London, UK
| | - Katie Twigger
- Department of Medicine, Imperial College London, London, UK
| | - Kristin Ladell
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Kelly L Miners
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Jyothi Jayaraman
- Immunology Division, Department of Pathology, University of Cambridge, Cambridge, UK
| | - James A Traherne
- Immunology Division, Department of Pathology, University of Cambridge, Cambridge, UK
| | - David A Price
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Ying Qi
- Cancer and Inflammation Program, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Maureen P Martin
- Cancer and Inflammation Program, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Derek C Macallan
- Institute for Infection and Immunity, St. George's, University of London, London, UK
| | | | | | | | | | - Susan Buchbinder
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Salim I Khakoo
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - James J Goedert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - John Trowsdale
- Immunology Division, Department of Pathology, University of Cambridge, Cambridge, UK
| | - Mary Carrington
- Cancer and Inflammation Program, Leidos Biomedical Research Inc., Frederick National Laboratory for Cancer Research, Frederick, MD, USA
- Ragon Institute of MGH, MIT and Harvard, Boston, MA, USA
| | - Simon Kollnberger
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Becca Asquith
- Department of Medicine, Imperial College London, London, UK.
| |
Collapse
|
22
|
Habtamu E, Wondie T, Aweke S, Tadesse Z, Zerihun M, Gashaw B, Roberts CH, Kello AB, Mabey DCW, Rajak SN, Callahan EK, Macleod D, Weiss HA, Burton MJ. Oral doxycycline for the prevention of postoperative trachomatous trichiasis in Ethiopia: a randomised, double-blind, placebo-controlled trial. Lancet Glob Health 2018; 6:e579-e592. [PMID: 29653629 PMCID: PMC5912946 DOI: 10.1016/s2214-109x(18)30111-6] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/11/2018] [Accepted: 02/22/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Trachomatous trichiasis is treated surgically to prevent sight loss. Unfavourable surgical outcomes remain a major challenge. We investigated the hypothesis that doxycycline might reduce the risk of postoperative trichiasis following surgery in patients with trachomatous trichiasis through anti-matrix metalloproteinase and anti-inflammatory activity. METHODS In this randomised, double-blind, placebo-controlled trial, adults (aged >18 years) with upper lid trachomatous trichiasis in association with tarsal conjunctive scarring were recruited through community-based screening and surgical outreach campaigns in Ethiopia. Individuals who had previously had eyelid surgery were excluded. Participants were randomly assigned (1:1), with random block sizes of four or six, to receive oral doxycycline (100 mg once a day) or placebo for 28 days immediately after trichiasis surgery. Randomisation was stratified by surgeon. Patients, investigators, surgeons, and all other study team members were masked to study group allocation and treatment. Participants were examined at 10 days, and 1, 6, and 12 months after surgery. The primary outcome was the cumulative proportion of individuals who developed postoperative trichiasis by 12 months. Primary analyses were done in all participants who attended at least one of the four follow-up assessments. Safety analyses were done in all participants who attended either the 10 day or 1 month follow-up assessments. This trial is registered with the Pan African Clinical Trials Registry, number PACTR201512001370307. FINDINGS Between Dec 21, 2015, and April 6, 2016, 1000 patients with trichiasis were enrolled and randomly assigned to treatment (499 patients to doxycycline, 501 patients to placebo). All but one participant attended at least one follow-up assessment. Thus, 999 participants were assessed for the primary outcome: 498 in the doxycycline group and 501 in the placebo group. By month 12, 58 (12%) of 498 patients in the doxycycline group and 62 (12%) of 501 patients in the placebo group had developed postoperative trichiasis (adjusted odds ratio 0·91, 95% CI 0·61 to 1·34, p=0·63), with a risk difference of -0·5% (-4·5% to 3·5%). Significantly more patients in the doxycycline group had an adverse event than in the placebo group (18 [4%] of 498 vs six [1%] of 501; odds ratio 3·09, 95% CI 1·21-7·84; p=0·02). The most frequent adverse events in the doxycycline group were gastritis symptoms (n=9), constipation (n=4), and diarrhoea (n=4). INTERPRETATION Doxycycline did not reduce the risk of postoperative trichiasis and is therefore not indicated for the improvement of outcomes following trachomatous trichiasis surgery. Surgical programmes should continue to make efforts to strengthen surgical training and supervision to improve outcomes. FUNDING The Wellcome Trust.
Collapse
Affiliation(s)
- Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | | | | | | | - Chrissy H Roberts
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | - David C W Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Saul N Rajak
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - David Macleod
- Medical Research Council Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen A Weiss
- Medical Research Council Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
23
|
Last A, Burr S, Alexander N, Harding-Esch E, Roberts CH, Nabicassa M, Cassama ETDS, Mabey D, Holland M, Bailey R. Spatial clustering of high load ocular Chlamydia trachomatis infection in trachoma: a cross-sectional population-based study. Pathog Dis 2018; 75:3791466. [PMID: 28472466 PMCID: PMC5808645 DOI: 10.1093/femspd/ftx050] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 10/31/2016] [Accepted: 05/02/2017] [Indexed: 11/12/2022] Open
Abstract
Chlamydia trachomatis (Ct) is the most common cause of bacterial sexually transmitted infection and infectious cause of blindness (trachoma) worldwide. Understanding the spatial distribution of Ct infection may enable us to identify populations at risk and improve our understanding of Ct transmission. In this study, we sought to investigate the spatial distribution of Ct infection and the clinical features associated with high Ct load in trachoma-endemic communities on the Bijagós Archipelago (Guinea Bissau). We collected 1507 conjunctival samples and corresponding detailed clinical data during a cross-sectional population-based geospatially representative trachoma survey. We used droplet digital PCR to estimate Ct load on conjunctival swabs. Geostatistical tools were used to investigate clustering of ocular Ct infections. Spatial clusters (independent of age and gender) of individuals with high Ct loads were identified using local indicators of spatial association. We did not detect clustering of individuals with low load infections. These data suggest that infections with high bacterial load may be important in Ct transmission. These geospatial tools may be useful in the study of ocular Ct transmission dynamics and as part of trachoma surveillance post-treatment, to identify clusters of infection and thresholds of Ct load that may be important foci of re-emergent infection in communities.
Collapse
Affiliation(s)
- Anna Last
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Sarah Burr
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, PO Box 273 Banjul, Atlantic Boulevard, Fajara, The Gambia
| | - Neal Alexander
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Emma Harding-Esch
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Chrissy H Roberts
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Meno Nabicassa
- Programa Nacional de Saúde de Visão, Ministério de Saúde Publica, PO Box 50, Avenida de Unidade Africana, Bisssau, Guiné Bissau
| | | | - David Mabey
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Martin Holland
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Robin Bailey
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| |
Collapse
|
24
|
Butcher R, Sokana O, Jack K, Sui L, Russell C, Last A, Martin DL, Burton MJ, Solomon AW, Mabey DCW, Roberts CH. Clinical signs of trachoma are prevalent among Solomon Islanders who have no persistent markers of prior infection with Chlamydia trachomatis. Wellcome Open Res 2018; 3:14. [PMID: 29588922 PMCID: PMC5854984 DOI: 10.12688/wellcomeopenres.13423.2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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] [Accepted: 02/09/2018] [Indexed: 01/15/2023] Open
Abstract
Background: The low population prevalence of trachomatous trichiasis and high prevalence of trachomatous inflammation–follicular (TF) provide contradictory estimates of the magnitude of the public health threat from trachoma in the Solomon Islands. Improved characterisation of the biology of trachoma in the region may support policy makers as they decide what interventions are required. Here, age-specific profiles of anti-Pgp3 antibodies and conjunctival scarring were examined to determine whether there is evidence of ongoing transmission and pathology from ocular
Chlamydia trachomatis (
Ct)
infection. Methods: A total of 1511 individuals aged ≥1 year were enrolled from randomly selected households in 13 villages in which >10% of children aged 1–9 years had TF prior to a single round of azithromycin mass drug administration undertaken six months previously. Blood was collected to be screened for antibodies to the
Ct antigen Pgp3. Tarsal conjunctival photographs were collected for analysis of scarring severity. Results: Anti-Pgp3 seropositivity was 18% in 1–9 year olds, sharply increasing around the age of sexual debut to reach 69% in those over 25 years. Anti-Pgp3 seropositivity did not increase significantly between the ages of 1–9 years and was not associated with TF (p=0.581) or scarring in children (p=0.472). Conjunctival scars were visible in 13.1% of photographs. Mild (p<0.0001) but not severe (p=0.149) scars increased in prevalence with age. Conclusions: Neither conjunctival scars nor lymphoid follicles were associated with antibodies to
Ct, suggesting that they are unlikely to be a direct result of ocular
Ct infection
. Clinical signs of trachoma were prevalent in this population but were not indicative of the underlying rates of
Ct infection. The current World Health Organization guidelines for trachoma elimination indicated that this population should receive intervention with mass distribution of antibiotics, but the data presented here suggest that this may not have been appropriate.
Collapse
Affiliation(s)
- Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Oliver Sokana
- Eye Department, Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Kelvin Jack
- Eye Department, Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Leslie Sui
- Primary Care Department, Lata Hospital, Lata, Solomon Islands
| | | | - Anna Last
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Diana L Martin
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew J Burton
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony W Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - David C W Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Chrissy H Roberts
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
25
|
Butcher RMR, Sokana O, Jack K, Kalae E, Sui L, Russell C, Houghton J, Palmer C, Holland MJ, Le Mesurier RT, Solomon AW, Mabey DCW, Roberts CH. Active Trachoma Cases in the Solomon Islands Have Varied Polymicrobial Community Structures but Do Not Associate with Individual Non-Chlamydial Pathogens of the Eye. Front Med (Lausanne) 2018; 4:251. [PMID: 29410954 PMCID: PMC5787070 DOI: 10.3389/fmed.2017.00251] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/19/2017] [Indexed: 11/17/2022] Open
Abstract
Background Several non-chlamydial microbial pathogens are associated with clinical signs of active trachoma in trachoma-endemic communities with a low prevalence of ocular Chlamydia trachomatis (Ct) infection. In the Solomon Islands, the prevalence of Ct among children is low despite the prevalence of active trachoma being moderate. Therefore, we set out to investigate whether active trachoma was associated with a common non-chlamydial infection or with a dominant polymicrobial community dysbiosis in the Solomon Islands. Methods We studied DNA from conjunctival swabs collected from 257 Solomon Islanders with active trachoma and matched controls. Droplet digital PCR was used to test for pathogens suspected to be able to induce follicular conjunctivitis. Polymicrobial community diversity and composition were studied by sequencing of hypervariable regions of the 16S ribosomal ribonucleic acid gene in a subset of 54 cases and 53 controls. Results Although Ct was associated with active trachoma, the number of infections was low (cases, 3.9%; controls, 0.4%). Estimated prevalence (cases and controls, respectively) of each non-chlamydial infection was as follows: Staphylococcus aureus: 1.9 and 1.9%, Adenoviridae: 1.2 and 1.2%, coagulase-negative Staphylococcus: 5.8 and 4.3%, Haemophilus influenzae: 7.4 and 11.7%, Moraxella catarrhalis: 2.3 and 4.7%, and Streptococcus pneumoniae: 7.0 and 6.2%. There was no statistically significant association between the clinical signs of trachoma and the presence or load of any of the non-Ct infections that were assayed. Interindividual variations in the conjunctival microbiome were characterized by differences in the levels of Corynebacterium, Propionibacterium, Helicobacter, and Paracoccus, but diversity and relative abundance of these specific genera did not differ significantly between cases and controls. Discussion It is unlikely that the prevalent trachoma-like follicular conjunctivitis in this region of the Solomon Islands has a dominant bacterial etiology. Before implementing community-wide azithromycin distribution for trachoma, policy makers should consider that clinical signs of trachoma can be observed in the absence of any detectable azithromycin-susceptible organism.
Collapse
Affiliation(s)
- Robert M R Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Oliver Sokana
- Eye Department, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Kelvin Jack
- Eye Department, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Eric Kalae
- Primary Care Department, Lata Hospital, Santa Cruz Island, Solomon Islands
| | - Leslie Sui
- Primary Care Department, Lata Hospital, Santa Cruz Island, Solomon Islands
| | | | - Joanna Houghton
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Christine Palmer
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Martin J Holland
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Anthony W Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David C W Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Chrissy H Roberts
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
26
|
Last AR, Burr SE, Harding-Esch E, Cassama E, Nabicassa M, Roberts CH, Mabey DCW, Holland MJ, Bailey RL. The impact of a single round of community mass treatment with azithromycin on disease severity and ocular Chlamydia trachomatis load in treatment-naïve trachoma-endemic island communities in West Africa. Parasit Vectors 2017; 10:624. [PMID: 29282126 PMCID: PMC5745817 DOI: 10.1186/s13071-017-2566-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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] [Received: 12/12/2016] [Accepted: 12/03/2017] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Trachoma, a neglected tropical disease, is caused by ocular infection with Chlamydia trachomatis (Ct). The World Health Organization (WHO) recommends three annual rounds of community mass drug treatment with azithromycin (MDA) if the prevalence of follicular trachoma in 1-9 year olds (TF1-9) exceeds 10% at district level to achieve an elimination target of district-level TF1-9 below 5% after. To evaluate this strategy in treatment-naïve trachoma-endemic island communities in Guinea Bissau, we conducted a cross-sectional population-based trachoma survey on four islands. The upper tarsal conjunctivae of each participant were clinically assessed for trachoma and conjunctival swabs were obtained (n = 1507). We used a droplet digital PCR assay to detect Ct infection and estimate bacterial load. We visited the same households during a second cross-sectional survey and repeated the ocular examination and obtained conjunctival swabs from these households one year after MDA (n = 1029). RESULTS Pre-MDA TF1-9 was 22.0% (136/618). Overall Ct infection prevalence (CtI) was 18.6% (25.4% in 1-9 year olds). Post-MDA (estimated coverage 70%), TF1-9 and CtI were significantly reduced (7.4% (29/394, P < 0.001) and 3.3% (34/1029, P < 0.001) (6.6% in 1-9 year olds, P < 0.001), respectively. Median ocular Ct load was reduced from 2038 to 384 copies/swab (P < 0.001). Following MDA cases of Ct infection were highly clustered (Moran's I 0.27, P < 0.001), with fewer clusters of Ct infection overall, fewer clusters of cases with high load infections and less severe disease. CONCLUSIONS Despite a significant reduction in the number of clusters of Ct infection, mean Ct load, disease severity and presence of clusters of cases of high load Ct infection suggesting the beginning of trachoma control in isolated island communities, following a single round of MDA we demonstrate that transmission is still ongoing. These detailed data are useful in understanding the epidemiology of ocular Ct infection in the context of MDA and the tools employed may have utility in determining trachoma elimination and surveillance activities in similar settings.
Collapse
Affiliation(s)
- Anna R Last
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Sarah E Burr
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, P.OBox 273, Banjul, Atlantic Boulevard, Fajara, The, Gambia
| | - Emma Harding-Esch
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Eunice Cassama
- Programa Nacional de Saúde de Visão, Ministério de Saúde Publica, P.O. Box 50, Avenida de Unidade Africana, Bisssau, Guinea-Bissau
| | - Meno Nabicassa
- Programa Nacional de Saúde de Visão, Ministério de Saúde Publica, P.O. Box 50, Avenida de Unidade Africana, Bisssau, Guinea-Bissau
| | - Chrissy H Roberts
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - David C W Mabey
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Martin J Holland
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Robin L Bailey
- Clinical Research Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| |
Collapse
|
27
|
Migchelsen SJ, Sepúlveda N, Martin DL, Cooley G, Gwyn S, Pickering H, Joof H, Makalo P, Bailey R, Burr SE, Mabey DCW, Solomon AW, Roberts CH. Serology reflects a decline in the prevalence of trachoma in two regions of The Gambia. Sci Rep 2017; 7:15040. [PMID: 29118442 PMCID: PMC5678181 DOI: 10.1038/s41598-017-15056-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/16/2017] [Indexed: 11/09/2022] Open
Abstract
Trachoma is caused by Chlamydia trachomatis (Ct). It is targeted for global elimination as a public health problem. In 2014, a population-based cross-sectional study was performed in two previously trachoma-endemic areas of The Gambia. Participants of all ages from Lower River Region (LRR) (N = 1028) and Upper River Region (URR) (N = 840) underwent examination for trachoma and had blood collected for detection of antibodies against the Ct antigen Pgp3, by ELISA. Overall, 30 (1.6%) individuals had active trachoma; the prevalence in children aged 1–9 years was 3.4% (25/742) with no statistically significant difference in prevalence between the regions. There was a significant difference in overall seroprevalence by region: 26.2% in LRR and 17.1% in URR (p < 0.0001). In children 1–9 years old, seroprevalence was 4.4% in LRR and 3.9% in URR. Reversible catalytic models using information on age-specific seroprevalence demonstrated a decrease in the transmission of Ct infection in both regions, possibly reflecting the impact of improved access to water, health and sanitation as well as mass drug administration campaigns. Serological testing for antibodies to Ct antigens is potentially useful for trachoma programmes, but consideration should be given to the co-endemicity of sexually transmitted Ct infections.
Collapse
Affiliation(s)
- Stephanie J Migchelsen
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Nuno Sepúlveda
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Centro de Estatística e Aplicações, Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
| | - Diana L Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gretchen Cooley
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah Gwyn
- IHRC, Inc., Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Harry Pickering
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hassan Joof
- Disease Control and Elimination Theme, Medical Research Council, The Gambia Unit, Fajara, The Gambia
| | - Pateh Makalo
- Disease Control and Elimination Theme, Medical Research Council, The Gambia Unit, Fajara, The Gambia
| | - Robin Bailey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah E Burr
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Disease Control and Elimination Theme, Medical Research Council, The Gambia Unit, Fajara, The Gambia
| | - David C W Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anthony W Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Chrissy H Roberts
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
28
|
Ramadhani AM, Derrick T, Macleod D, Massae P, Mtuy T, Jeffries D, Roberts CH, Bailey RL, Mabey DCW, Holland MJ, Burton MJ. Immunofibrogenic Gene Expression Patterns in Tanzanian Children with Ocular Chlamydia trachomatis Infection, Active Trachoma and Scarring: Baseline Results of a 4-Year Longitudinal Study. Front Cell Infect Microbiol 2017; 7:406. [PMID: 28966918 PMCID: PMC5605569 DOI: 10.3389/fcimb.2017.00406] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/31/2017] [Indexed: 12/11/2022] Open
Abstract
Trachoma, caused by Chlamydia trachomatis, is the world's leading infectious cause of blindness and remains a significant public health problem. Much of trachomatous disease pathology is thought to be caused indirectly by host cellular and immune responses, however the immune response during active trachoma and how this initiates progressive scarring is not clearly understood. Defining protective vs. pathogenic immune response to C. trachomatis is important for vaccine design and evaluation. This study reports the baseline results of a longitudinal cohort of Tanzanian children, who were monitored for 4 years in order to determine the immunofibrogenic and infectious correlates of progressive scarring trachoma. In this cohort baseline, 506 children aged 6-10 years were assessed for clinical signs, infection status and the expression of 91 genes of interest prior to mass azithromycin administration for trachoma control. C. trachomatis was detected using droplet digital PCR and gene expression was measured using quantitative real-time PCR. The prevalence of follicles, papillary inflammation and scarring were 33.6, 31.6, and 28.5%, respectively. C. trachomatis was detected in 78/506 (15.4%) individuals, 62/78 of whom also had follicles. C. trachomatis infection was associated with a strong upregulation of IFNG and IL22, the enrichment of Th1 and NK cell pathways and Th17 cell-associated cytokines. In individuals with inflammation in the absence of infection the IFNG/IL22 and NK cell response was reduced, however, pro-inflammatory, growth and matrix factors remained upregulated and mucins were downregulated. Our data suggest that, strong IFNG/IL22 responses, probably related to Th1 and NK cell involvement, is important for clearance of C. trachomatis and that the residual pro-inflammatory and pro-fibrotic phenotype that persists after infection might contribute to pathological scarring. Interestingly, females appear more susceptible to developing papillary inflammation and scarring than males, even at this young age, despite comparable levels of C. trachomatis infection. Females also had increased expression of a number of IFNγ pathway related genes relative to males, suggesting that overexpression of this pathway in response to infection might contribute to more severe scarring. Longitudinal investigation of these factors will reveal their relative contributions to protection from C. trachomatis infection and development of scarring complications.
Collapse
Affiliation(s)
- Athumani M Ramadhani
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical MedicineLondon, United Kingdom
- Kilimanjaro Christian Medical CentreMoshi, Tanzania
| | - Tamsyn Derrick
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical MedicineLondon, United Kingdom
- Kilimanjaro Christian Medical CentreMoshi, Tanzania
| | - David Macleod
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineLondon, United Kingdom
| | | | - Tara Mtuy
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical MedicineLondon, United Kingdom
- Kilimanjaro Christian Medical CentreMoshi, Tanzania
| | - David Jeffries
- Support Services (Statistics), Medical Research Council Unit The GambiaFajara, Gambia
| | - Chrissy H Roberts
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical MedicineLondon, United Kingdom
| | - Robin L Bailey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical MedicineLondon, United Kingdom
| | - David C W Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical MedicineLondon, United Kingdom
| | - Martin J Holland
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical MedicineLondon, United Kingdom
| | - Matthew J Burton
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical MedicineLondon, United Kingdom
| |
Collapse
|
29
|
Pickering H, Teng A, Faal N, Joof H, Makalo P, Cassama E, Nabicassa M, Last AR, Burr SE, Rowland-Jones SL, Thomson NR, Roberts CH, Mabey DCW, Bailey RL, Hayward RD, de la Maza LM, Holland MJ. Genome-wide profiling of humoral immunity and pathogen genes under selection identifies immune evasion tactics of Chlamydia trachomatis during ocular infection. Sci Rep 2017; 7:9634. [PMID: 28851925 PMCID: PMC5575166 DOI: 10.1038/s41598-017-09193-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/24/2017] [Indexed: 11/09/2022] Open
Abstract
The frequency and duration of Chlamydia trachomatis (Ct) ocular infections decrease with age, suggesting development of partial immunity. However, there is a lack of clear correlates of immunity to Ct infection in humans. We screened sera from a cohort of Gambian children followed for six-months against a Ct-proteome microarray. At genome sequence level, we detected signatures of selection from a population of ocular Ct isolates from Guinea-Bissau. Together these approaches allowed us to highlight the focus of humoral responses and hypothesise new modes of pathogen immune evasion. Children who were susceptible to frequent and/or prolonged Ct infection had a less focussed antibody response, including preferential recognition of forty-two antigens. There was evidence of positive and purifying selection across the genome, but little balancing selection. In contrast, most antigens that were associated with susceptibility were under neutral selection. These data suggest an evasion strategy in which Ct presents a large panel of irrelevant antigens to the immune system to block or misdirect protective responses. Development of a focused immune response, possibly induced through vaccination, may be an effective strategy to promote protection to Ct infection.
Collapse
Affiliation(s)
- Harry Pickering
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom.
| | - Andy Teng
- ImmPORT Therapeutics, Inc./Antigen Discovery Inc., 1 Technology Dr., Suite E309, Irvine, CA, 92618, United States
| | - Nkoyo Faal
- Disease Control and Elimination Theme, Medical Research Council The Gambia Unit, Fajara, Banjul, The Gambia
| | - Hassan Joof
- Disease Control and Elimination Theme, Medical Research Council The Gambia Unit, Fajara, Banjul, The Gambia
| | - Pateh Makalo
- Disease Control and Elimination Theme, Medical Research Council The Gambia Unit, Fajara, Banjul, The Gambia
| | - Eunice Cassama
- Programa Nacional de Saúde de Visão, Ministério de Saúde Publica, Bissau, Guinea-Bissau
| | - Meno Nabicassa
- Programa Nacional de Saúde de Visão, Ministério de Saúde Publica, Bissau, Guinea-Bissau
| | - Anna R Last
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom
| | - Sarah E Burr
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom.,Disease Control and Elimination Theme, Medical Research Council The Gambia Unit, Fajara, Banjul, The Gambia
| | - Sarah L Rowland-Jones
- Disease Control and Elimination Theme, Medical Research Council The Gambia Unit, Fajara, Banjul, The Gambia
| | - Nicholas R Thomson
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom.,Pathogen Genomics, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, United Kingdom
| | - Chrissy H Roberts
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom
| | - David C W Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom
| | - Robin L Bailey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom
| | - Richard D Hayward
- Institute of Structural and Molecular Biology, Birkbeck & University College London, Malet Street, London, WC1E 7HX, United Kingdom
| | - Luis M de la Maza
- Department of Pathology and Laboratory Medicine, Medical Sciences I, Room D440, University of California, Irvine, CA, 92697-4800, United States
| | - Martin J Holland
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom.,Disease Control and Elimination Theme, Medical Research Council The Gambia Unit, Fajara, Banjul, The Gambia
| |
Collapse
|
30
|
Walker SL, Lebas E, De Sario V, Deyasso Z, Doni SN, Marks M, Roberts CH, Lambert SM. The prevalence and association with health-related quality of life of tungiasis and scabies in schoolchildren in southern Ethiopia. PLoS Negl Trop Dis 2017; 11:e0005808. [PMID: 28771469 PMCID: PMC5557602 DOI: 10.1371/journal.pntd.0005808] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/15/2017] [Accepted: 07/17/2017] [Indexed: 11/18/2022] Open
Abstract
Background The prevalence of skin disease in low and middle income countries is high and communicable skin diseases are a significant public health problem. Tungiasis is an ectoparasite infestation caused by the flea Tunga penetrans, which has a widespread geographical distribution. Tungiasis causes painful skin lesions and may affect activities of daily living. Objective We wished to determine the prevalence and impact of tungiasis and scabies in schoolchildren in southern Ethiopia. Methods A cross-sectional study was performed in which students were examined by dermatologists and the skin disorders recorded. Individuals with pyogenic skin infections, scabies and tungiasis were also invited to complete the Children’s Dermatology Life Quality Index. Results There was a high burden of skin disease amongst this cohort with more than 40% having an ectodermal parasitic skin disease. The majority of these were due to tungiasis. Tungiasis was evident in more than a third of children and was associated with onychodystophy. There was a significant association between wearing “closed” footwear and a greater number of tungiasis lesions but not tungiasis per se. Dermatophyte infections, acne and plantar maceration secondary to occlusive footwear were also common. Scabies and tungiasis appeared to have a significant negative effect on quality of life. Conclusion Tungiasis is highly prevalent in schoolchildren in the part of Ethiopia where the study was conducted and is associated with a deleterious effect on quality of life. The role of footwear in both preventing and possibly exacerbating cutaneous ailments in this setting requires further study. Skin disorders are very common in all geographical locations and especially so in low and middle income countries. In these settings many of the commonest skin disorders are communicable. Human ectoparasites such as lice and scabies mites live on the skin and Tunga penetrans fleas enter the skin to shed their eggs and complete their lifecycle. All of these ectoparasites cause significant morbidity particularly in poorer communities. We have shown that the infestations of scabies and tungiasis were the commonest skin disorders in the Ethiopian schoolchildren examined in this study. These conditions are associated with a significant impact on the quality of life of these children as measured by the Children’s Dermatology Life Quality Index. Footwear protects individuals from many conditions both infectious and non-infectious however in this cohort footwear was associated with maceration of the skin and this requires further investigation.
Collapse
Affiliation(s)
- Stephen L. Walker
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Eglantine Lebas
- Department of Dermatopathology, St. John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Dermatology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | | | | | | | - Michael Marks
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, London, United Kingdom
| | | | - Saba M. Lambert
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Family Medicine, Suisse Clinic, Addis Ababa, Ethiopia
| |
Collapse
|
31
|
Butcher R, Houghton J, Derrick T, Ramadhani A, Herrera B, Last AR, Massae PA, Burton MJ, Holland MJ, Roberts CH. Reduced-cost Chlamydia trachomatis-specific multiplex real-time PCR diagnostic assay evaluated for ocular swabs and use by trachoma research programmes. J Microbiol Methods 2017; 139:95-102. [PMID: 28487054 PMCID: PMC5496587 DOI: 10.1016/j.mimet.2017.04.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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] [Received: 01/30/2017] [Revised: 04/21/2017] [Accepted: 04/22/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Trachoma, caused by the intracellular bacterium Chlamydia trachomatis (Ct), is the leading infectious cause of preventable blindness. Many commercial platforms are available that provide highly sensitive and specific detection of Ct DNA. However, the majority of these commercial platforms are inaccessible for population-level surveys in resource-limited settings typical to trachoma control programmes. We developed two low-cost quantitative PCR (qPCR) tests for Ct using readily available reagents on standard real-time thermocyclers. METHODS Each multiplex qPCR test targets one genomic and one plasmid Ct target in addition to an endogenous positive control for Homo sapiens DNA. The quantitative performance of the qPCR assays in clinical samples was determined by comparison to a previously evaluated droplet digital PCR (ddPCR) test. The diagnostic performance of the qPCR assays were evaluated against a commercial assay (artus C. trachomatis Plus RG PCR, Qiagen) using molecular diagnostics quality control standards and clinical samples. We examined the yield of Ct DNA prepared from five different DNA extraction kits and a cold chain-free dry-sample preservation method using swabs spiked with fixed concentrations of human and Ct DNA. RESULTS The qPCR assay was highly reproducible (Ct plasmid and genomic targets mean total coefficients of variance 41.5% and 48.3%, respectively). The assay detected 8/8 core specimens upon testing of a quality control panel and performed well in comparison to commercially marketed comparator test (sensitivity and specificity>90%). Optimal extraction and sample preservation methods for research applications were identified. CONCLUSION We describe a pipeline from collection to diagnosis providing the most efficient sample preservation and extraction with significant per test cost savings over a commercial qPCR diagnostic assay. The assay and its evaluation should allow control programs wishing to conduct independent research within the context of trachoma control, access to an affordable test with defined performance characteristics.
Collapse
Affiliation(s)
- Robert Butcher
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom.
| | - Jo Houghton
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Tamsyn Derrick
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom; Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Athumani Ramadhani
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom; Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Beatriz Herrera
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Anna R Last
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | | | - Matthew J Burton
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Martin J Holland
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Chrissy H Roberts
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| |
Collapse
|
32
|
Macleod C, Yalen C, Butcher R, Mudaliar U, Natutusau K, Rainima-Qaniuci M, Haffenden C, Watson C, Cocks N, Cikamatana L, Roberts CH, Marks M, Rafai E, Mabey DCW, Kama M, Solomon AW. Eyelash Epilation in the Absence of Trichiasis: Results of a Population-Based Prevalence Survey in the Western Division of Fiji. PLoS Negl Trop Dis 2017; 11:e0005277. [PMID: 28114364 PMCID: PMC5256864 DOI: 10.1371/journal.pntd.0005277] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/21/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The WHO definition of trachomatous trichiasis (TT) is "at least one eyelash touching the globe, or evidence of recent epilation of in-turned eyelashes", reflecting the fact that epilation is used as a self-management tool for TT. In Fiji's Western Division, a high TT prevalence (8.7% in those aged ≥15 years) was reported in a 2012 survey, yet a 2013 survey found no TT and Fijian ophthalmologists rarely see TT cases. Local anecdote suggests that eyelash epilation is a common behaviour, even in the absence of trichiasis. Epilators may have been identified as TT cases in previous surveys. METHODS We used a preliminary focus group to design an interview questionnaire, and subsequently conducted a population-based prevalence survey to estimate the prevalence of epilation in the absence of trichiasis, and factors associated with this behaviour, in the Western Division of Fiji. RESULTS We sampled 695 individuals aged ≥15 years from a total of 457 households in 23 villages. 125 participants (18%) reported epilating their eyelashes at least once within the past year. Photographs were obtained of the eyes of 121/125 (97%) individuals who epilated, and subsequent analysis by an experienced trachoma grader found no cases of trachomatous conjunctival scarring or trichiasis. The age- and sex- adjusted prevalence of epilation in those aged ≥15 years was 8.6% (95% CI 5.7-11.3%). iTaukei ethnicity, female gender, and a higher frequency of drinking kava root were independently associated with epilation. CONCLUSION Epilation occurs in this population in the absence of trichiasis, with sufficient frequency to have markedly inflated previous estimates of local TT prevalence. Individuals with epilated eyelashes should be confirmed as having epilated in-turned eyelashes in an eye with scarring of the conjunctiva before being counted as cases of TT.
Collapse
Affiliation(s)
- Colin Macleod
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Chelsea Yalen
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Umesh Mudaliar
- Ophthalmology Department, Lautoka Hospital, Lautoka, Fiji
| | | | | | - Chris Haffenden
- Department of the History of Science and Ideas, Uppsala University, Uppsala, Sweden
| | - Conall Watson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Naomi Cocks
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Luisa Cikamatana
- Ophthalmology Department, Lautoka Hospital, Lautoka, Fiji
- Department of Communicable Diseases, Ministry of Health, Suva, Fiji
| | - Chrissy H. Roberts
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Michael Marks
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, London, United Kingdom
| | - Eric Rafai
- Department of Communicable Diseases, Ministry of Health, Suva, Fiji
| | - David C. W. Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mike Kama
- Department of Communicable Diseases, Ministry of Health, Suva, Fiji
| | - Anthony W. Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, London, United Kingdom
| |
Collapse
|
33
|
Abstract
The health impact of many copy number variants in our genome remains still largely to be discovered. Detecting and genotyping this often complex variation presents a technical challenge. Here we describe a 96-well format droplet digital PCR (ddPCR) protocol for genotyping a common copy variant in the human haptoglobin gene. ddPCR allows for high-throughput and accurate quantitation of gene copy numbers.
Collapse
Affiliation(s)
- Suvi K Härmälä
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Robert Butcher
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Chrissy H Roberts
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
| |
Collapse
|
34
|
Cocks N, Rainima-Qaniuci M, Yalen C, Macleod C, Nakolinivalu A, Migchelsen S, Roberts CH, Butcher R, Kama M, Mabey D, Marks M. Community seroprevalence survey for yaws and trachoma in the Western Division of Fiji. Trans R Soc Trop Med Hyg 2016; 110:582-587. [PMID: 27852877 PMCID: PMC5155547 DOI: 10.1093/trstmh/trw069] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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] [Received: 09/13/2016] [Revised: 10/16/2016] [Accepted: 10/20/2016] [Indexed: 11/17/2022] Open
Abstract
Background Both yaws and trachoma are endemic in several countries in the Pacific. In co-endemic countries there may be potential synergies between both control programmes. Methods We undertook a cluster randomised trachoma and yaws seroprevalence survey of children in the Western Division of Fiji. Children were examined for skin lesions consistent with active yaws. A dried blood spot was collected which was tested using the Treponema pallidum particle agglutination (TPPA) test and an ELISA to detect antibodies against Pgp3. Results A total of 607 children from 305 households across 23 villages were recruited into the survey. On skin examination, no child had clinical evidence of yaws, and the TPPA assay was negative in all children (0%, 95% CI 0.0–0.6). The seroprevalence of Pgp3 antibodies was 20.9% (95% CI 17.8–24.6%). Discussion In this study there was neither clinical nor serological evidence that transmission of yaws was ongoing. The Pgp3 seroprevalence pattern was consistent with either low level transmission of ocular Chlamydia trachomatis or exposure to C. trachomatis in the birth canal which is consistent with a survey conducted in the same region in 2013. These data suggest neither yaws nor ocular chlamydia infection are a significant public health problem in the Western Division of Fiji.
Collapse
Affiliation(s)
- Naomi Cocks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | | | - Chelsea Yalen
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Colin Macleod
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | | | - Stephanie Migchelsen
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Chrissy H Roberts
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Robert Butcher
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Mike Kama
- Fiji Centre for Communicable Disease, Ministry of Health, Suva, Fiji
| | - David Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.,Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London WC1E 6JB, UK
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK .,Hospital for Tropical Diseases, University College London Hospitals NHS Trust, London WC1E 6JB, UK
| |
Collapse
|
35
|
Butcher RMR, Sokana O, Jack K, Macleod CK, Marks M, Kalae E, Sui L, Russell C, Tutill HJ, Williams RJ, Breuer J, Willis R, Le Mesurier RT, Mabey DCW, Solomon AW, Roberts CH. Correction: Low Prevalence of Conjunctival Infection with Chlamydia trachomatis in a Treatment-Naïve Trachoma-Endemic Region of the Solomon Islands. PLoS Negl Trop Dis 2016; 10:e0005051. [PMID: 27695076 PMCID: PMC5047450 DOI: 10.1371/journal.pntd.0005051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pntd.0004863.].
Collapse
|
36
|
Goncalves A, Makalo P, Joof H, Burr S, Ramadhani A, Massae P, Malisa A, Mtuy T, Derrick T, Last AR, Nabicassa M, Cassama E, Houghton J, Palmer CD, Pickering H, Burton MJ, Mabey DCW, Bailey RL, Goodier MR, Holland MJ, Roberts CH. Differential frequency of NKG2C/KLRC2 deletion in distinct African populations and susceptibility to Trachoma: a new method for imputation of KLRC2 genotypes from SNP genotyping data. Hum Genet 2016; 135:939-51. [PMID: 27312142 PMCID: PMC4947484 DOI: 10.1007/s00439-016-1694-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/02/2016] [Indexed: 11/26/2022]
Abstract
NKG2C is an activating receptor that is preferentially expressed on natural killer (NK) cells. The gene encoding NKG2C (killer cell lectin-like receptor C2, KLRC2) is present at different copy numbers in the genomes of different individuals. Deletion at the NKG2C locus was investigated in a case-control study of 1522 individuals indigenous to East- and West-Africa and the association with the ocular Chlamydia trachomatis infection and its sequelae was explored. The frequency of homozygous KLRC2 deletion was 13.7 % in Gambians and 4.7 % in Tanzanians. A significantly higher frequency of the deletion allele was found in West-Africans from the Gambia and Guinea-Bissau (36.2 % p = 2.105 × 10(-8), 26.8 % p = 0.050; respectively) in comparison to East-African Tanzanians where the frequency of the deletion is comparable to other human populations (20.9 %). We found no evidence for an association between the numbers of KLRC2 gene copies and the clinical manifestations of trachoma (follicular trachoma or conjunctival scarring). A new method for imputation of KLRC2 genotypes from single nucleotide polymorphism (SNP) data in 2621 individuals from the Gambia further confirmed these results. Our data suggest that NKG2C does not play a major role in trachomatous disease. We found that the deletion allele is present at different frequencies in different populations but the reason behind these differences is currently not understood. The new method offers the potential to use SNP arrays from genome wide association studies to study the frequency of KLRC2 deletion in other populations and its association with other diseases.
Collapse
Affiliation(s)
- Adriana Goncalves
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Pateh Makalo
- Disease Control and Elimination Theme, Medical Research Council Unit, Fajara, The Gambia
| | - Hassan Joof
- Disease Control and Elimination Theme, Medical Research Council Unit, Fajara, The Gambia
| | - Sarah Burr
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Disease Control and Elimination Theme, Medical Research Council Unit, Fajara, The Gambia
| | | | | | - Aiweda Malisa
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Tara Mtuy
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Tamsyn Derrick
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Anna R Last
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Meno Nabicassa
- Programa Nacional de Saude de Visao, Ministerio de Saude Publica, Bissau, Guinea-Bissau
| | - Eunice Cassama
- Programa Nacional de Saude de Visao, Ministerio de Saude Publica, Bissau, Guinea-Bissau
| | - Joanna Houghton
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Christine D Palmer
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Harry Pickering
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew J Burton
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - David C W Mabey
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Robin L Bailey
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin R Goodier
- Department of Immunology and Infectious Disease, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin J Holland
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Disease Control and Elimination Theme, Medical Research Council Unit, Fajara, The Gambia
| | - Chrissy H Roberts
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| |
Collapse
|
37
|
Macleod CK, Butcher R, Mudaliar U, Natutusau K, Pavluck AL, Willis R, Alexander N, Mabey DCW, Cikamatana L, Kama M, Rafai E, Roberts CH, Solomon AW. Low Prevalence of Ocular Chlamydia trachomatis Infection and Active Trachoma in the Western Division of Fiji. PLoS Negl Trop Dis 2016; 10:e0004798. [PMID: 27404379 PMCID: PMC4942140 DOI: 10.1371/journal.pntd.0004798] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 06/02/2016] [Indexed: 12/04/2022] Open
Abstract
Background Trachoma is the leading infectious cause of blindness and is caused by ocular infection with the bacterium Chlamydia trachomatis (Ct). While the majority of the global disease burden is found in sub-Saharan Africa, the Western Pacific Region has been identified as trachoma endemic. Population surveys carried out throughout Fiji have shown an abundance of both clinically active trachoma and trachomatous trichiasis in all divisions. This finding is at odds with the clinical experience of local healthcare workers who do not consider trachoma to be highly prevalent. We aimed to determine whether conjunctival infection with Ct could be detected in one administrative division of Fiji. Methods A population-based survey of 2306 individuals was conducted using the Global Trachoma Mapping Project methodology. Population prevalence of active trachoma in children and trichiasis in adults was estimated using the World Health Organization simplified grading system. Conjunctival swabs were collected from 1009 children aged 1–9 years. DNA from swabs was tested for the presence of the Ct plasmid and human endogenous control. Results The prevalence of active trachoma in 1–9 year olds was 3.4%. The age-adjusted prevalence was 2.8% (95% CI: 1.4–4.3%). The unadjusted prevalence of ocular Ct infection in 1–9 year-olds was 1.9% (19/1009), and the age-adjusted infection prevalence was 2.3% (95% CI: 0.4–2.5%). The median DNA load was 41 Ct plasmid copies per swab (min 20, first quartile 32, mean 6665, third quartile 161, max 86354). There was no association between current infection and follicular trachoma. No cases of trachomatous trichiasis were identified. Discussion The Western Division of Fiji has a low prevalence of clinical trachoma. Ocular Ct infections were observed, but they were predominantly low load infections and were not correlated with clinical signs. Our study data suggest that trachoma does not meet the WHO definition of a public health problem in this Division of Fiji, but the inconsistency with previous studies warrants further investigation. Trachoma, caused by ocular strains of Chlamydia trachomatis, represents a major global public health issue, and is the subject of an international elimination campaign. Until recently, data on trachoma in the Pacific Island states have been sparse. The most recent studies have conflicted in their estimates of trachomatous disease burden in Fiji, therefore, surveys using alternative markers (infection testing plus grading) to those already used (grading alone) are warranted to try to shed further light on trachoma epidemiology in this setting. We used an externally validated clinical assessment protocol to show that evidence of active trachoma is present at a low prevalence, and we did not find any cases of trichiasis, the sight-threatening stage of trachoma. From testing of conjunctival swabs with a validated, next-generation PCR, we also found that C. trachomatis was present at a low prevalence. Our clinical data suggest that trachoma does not meet the WHO definition of a public health problem in this Division of Fiji, but the inconsistency with previous studies warrants further investigation.
Collapse
Affiliation(s)
- Colin K. Macleod
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Sightsavers, Haywards Heath, United Kingdom
- * E-mail:
| | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Umesh Mudaliar
- Ophthalmology Department, Lautoka Hospital, Lautoka, Fiji
| | | | | | - Rebecca Willis
- Taskforce for Global Health, Atlanta, Georgia, United States of America
| | - Neal Alexander
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David C. W. Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Mike Kama
- Fiji Centre for Communicable Disease, Ministry of Health, Suva, Fiji
| | - Eric Rafai
- Fiji Centre for Communicable Disease, Ministry of Health, Suva, Fiji
| | - Chrissy H. Roberts
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anthony W. Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
38
|
Derrick T, Last AR, Burr SE, Roberts CH, Nabicassa M, Cassama E, Bailey RL, Mabey DCW, Burton MJ, Holland MJ. Inverse relationship between microRNA-155 and -184 expression with increasing conjunctival inflammation during ocular Chlamydia trachomatis infection. BMC Infect Dis 2016; 16:60. [PMID: 26842862 PMCID: PMC4739388 DOI: 10.1186/s12879-016-1367-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 01/22/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Trachoma, a preventable blinding eye disease, is initiated by ocular infection with Chlamydia trachomatis (Ct). We previously showed that microRNAs (miR) -147b and miR-1285 were up-regulated in inflammatory trachomatous scarring. During the initial stage of disease, follicular trachoma with current Ct infection, the differential expression of miR has not yet been investigated. METHODS Conjunctival samples were collected from 163 children aged 1-9 years old living in a trachoma-endemic region of Guinea Bissau, West Africa. Small RNA sequencing (RNAseq) was carried out on samples from five children with follicular trachoma and current Ct infection and five children with healthy conjunctivae and no Ct infection. Small RNAseq was also carried out on human epithelial cell lines infected with ocular Ct strains A2497 and isogenic plasmid-free A2497 in vitro. Results were validated by quantitative PCR (qPCR) in 163 clinical samples. RESULTS Differential expression of RNAseq data identified 12 miR with changes in relative expression during follicular trachoma, of which 9 were confirmed as differentially expressed by qPCR (miR-155, miR-150, miR-142, miR-181b, miR-181a, miR-342, miR-132, miR-4728 and miR-184). MiR-155 and miR-184 expression had a direct relationship with the degree of clinical inflammation. MiR-155 was up-regulated (OR = 2.533 ((95 % CI = 1.291-4.971); P = 0.0069) and miR-184 was down-regulated (OR = 0.416 ((95 % CI = 0.300-0.578); P = 1.61*10(-7)) as the severity of clinical inflammation increased. Differential miR expression was not detected in HEp-2 or HCjE epithelial cells 48 h post infection with Ct in vitro. HCjE cells, a conjunctival epithelial cell line, had a markedly different miR background expression compared to HEp-2 cells. CONCLUSIONS In follicular trachoma, expression of miR-155 and miR-184 is correlated with the severity of inflammation. This likely reflects host regulation of the immune response and a prolonged period of wound healing following the clearance of Ct. Prolonged healing may be associated with subsequent development of scarring trachoma.
Collapse
Affiliation(s)
- Tamsyn Derrick
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Anna R Last
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Sarah E Burr
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia, Fajara, The Gambia.
| | - Chrissy H Roberts
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Meno Nabicassa
- Programa Nacional de Saúde de Visão, Ministério de Saúde Publica, Bissau, Guinea Bissau.
| | - Eunice Cassama
- Programa Nacional de Saúde de Visão, Ministério de Saúde Publica, Bissau, Guinea Bissau.
| | - Robin L Bailey
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - David C W Mabey
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Matthew J Burton
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Martin J Holland
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| |
Collapse
|
39
|
Habtamu E, Wondie T, Aweke S, Tadesse Z, Zerihun M, Zewudie Z, Kello AB, Roberts CH, Emerson PM, Bailey RL, Mabey DCW, Rajak SN, Callahan K, Weiss HA, Burton MJ. Posterior lamellar versus bilamellar tarsal rotation surgery for trachomatous trichiasis in Ethiopia: a randomised controlled trial. Lancet Glob Health 2016; 4:e175-84. [PMID: 26774708 PMCID: PMC5075282 DOI: 10.1016/s2214-109x(15)00299-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 11/29/2015] [Accepted: 12/03/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Eyelid surgery is done to correct trachomatous trichiasis to prevent blindness. However, recurrent trichiasis is frequent. Two procedures are recommended by WHO and are in routine practice: bilamellar tarsal rotation (BLTR) and posterior lamellar tarsal rotation (PLTR). This study was done to identify which procedure gives the better results. METHODS A randomised, controlled, single masked clinical trial was done in Ethiopia. Participants had upper lid trachomatous trichiasis with one or more eyelashes touching the eye or evidence of epilation, in association with tarsal conjunctival scarring. Exclusion criteria were age less than 18 years, recurrent trichiasis after previous surgery, hypertension, and pregnancy. Participants were randomly assigned (1:1) to either BLTR or PLTR surgery, stratified by surgeon. The sequences were computer-generated by an independent statistician. Surgery was done in a community setting following WHO guidelines. Participants were examined at 6 months and 12 months by assessors masked to allocation. The primary outcome was the cumulative proportion of individuals who developed recurrent trichiasis by 12 months. Primary analyses were by modified intention to treat. The intervention effect was estimated by logistic regression, controlled for surgeon as a fixed effect in the model. The trial is registered with the Pan African Clinical Trials Registry (number PACTR201401000743135). FINDINGS 1000 participants with trichiasis were recruited, randomly assigned, and treated (501 in the BLTR group and 499 in the PLTR group) between Feb 13, 2014, and May 31, 2014. Eight participants were not seen at either 6 month or 12 month follow-up visits and were excluded from the analysis: three from the PLTR group and five from the BLTR group. The follow-up rate at 12 months was 98%. Cumulative recurrent trichiasis by 12 months was more frequent in the BLTR group than in the PLTR group (110/496 [22%] vs 63/496 [13%]; adjusted odds ratio [OR] 1·96 [95% CI 1·40-2·75]; p=0·0001), with a risk difference of 9·50% (95% CI 4·79-14·16). INTERPRETATION PLTR surgery was superior to BLTR surgery for management of trachomatous trichiasis, and could be the preferred procedure for the programmatic management of trachomatous trichiasis. FUNDING The Wellcome Trust.
Collapse
Affiliation(s)
- Esmael Habtamu
- London School of Hygiene & Tropical Medicine, London, UK,The Carter Center, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | | | | | - Robin L Bailey
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Saul N Rajak
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Helen A Weiss
- London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew J Burton
- London School of Hygiene & Tropical Medicine, London, UK,Correspondence to: Dr Matthew J Burton, International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UKCorrespondence to: Dr Matthew J BurtonInternational Centre for Eye HealthFaculty of Infectious and Tropical DiseasesLondon School of Hygiene & Tropical MedicineKeppel StreetLondonWC1E 7HTUK
| |
Collapse
|
40
|
Zhou Y, Holland MJ, Makalo P, Joof H, Roberts CH, Mabey DC, Bailey RL, Burton MJ, Weinstock GM, Burr SE. The conjunctival microbiome in health and trachomatous disease: a case control study. Genome Med 2014; 6:99. [PMID: 25484919 PMCID: PMC4256740 DOI: 10.1186/s13073-014-0099-x] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 10/28/2014] [Indexed: 02/02/2023] Open
Abstract
Background Trachoma, caused by Chlamydia trachomatis, remains the world’s leading infectious cause of blindness. Repeated ocular infection during childhood leads to scarring of the conjunctiva, in-turning of the eyelashes (trichiasis) and corneal opacity in later life. There is a growing body of evidence to suggest non-chlamydial bacteria are associated with clinical signs of trachoma, independent of C. trachomatis infection. Methods We used deep sequencing of the V1-V3 region of the bacterial 16S rRNA gene to characterize the microbiome of the conjunctiva of 220 residents of The Gambia, 105 with healthy conjunctivae and 115 with clinical signs of trachoma in the absence of detectable C. trachomatis infection. Deep sequencing was carried out using the Roche-454 platform. Sequence data were processed and analyzed through a pipeline developed by the Human Microbiome Project. Results The microbiome of healthy participants was influenced by age and season of sample collection with increased richness and diversity seen in younger participants and in samples collected during the dry season. Decreased diversity and an increased abundance of Corynebacterium and Streptococcus were seen in participants with conjunctival scarring compared to normal controls. Abundance of Corynebacterium was higher still in adults with scarring and trichiasis compared to adults with scarring only. Conclusions Our results indicate that changes in the conjunctival microbiome occur in trachomatous disease; whether these are a cause or a consequence is yet unknown. Electronic supplementary material The online version of this article (doi:10.1186/s13073-014-0099-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Yanjiao Zhou
- The Genome Institute, Washington University, St Louis, MO 63108 USA ; Department of Pediatrics, Washington University School of Medicine, St Louis, MO 63130 USA
| | - Martin J Holland
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | - Pateh Makalo
- Disease Control and Elimination Theme, Medical Research Council Unit, Fajara, POB273 The Gambia
| | - Hassan Joof
- Disease Control and Elimination Theme, Medical Research Council Unit, Fajara, POB273 The Gambia
| | - Chrissy H Roberts
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | - David Cw Mabey
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | - Robin L Bailey
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | - Matthew J Burton
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | - George M Weinstock
- The Genome Institute, Washington University, St Louis, MO 63108 USA ; The Jackson Laboratory for Genomic Medicine, Farmington, CT 06030 USA
| | - Sarah E Burr
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK ; Disease Control and Elimination Theme, Medical Research Council Unit, Fajara, POB273 The Gambia
| |
Collapse
|
41
|
Jarvis JN, Bicanic T, Loyse A, Meintjes G, Hogan L, Roberts CH, Shoham S, Perfect JR, Govender NP, Harrison TS. Very low levels of 25-hydroxyvitamin D are not associated with immunologic changes or clinical outcome in South African patients with HIV-associated cryptococcal meningitis. Clin Infect Dis 2014; 59:493-500. [PMID: 24825871 PMCID: PMC4111915 DOI: 10.1093/cid/ciu349] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Vitamin D deficiency may increase susceptibility to opportunistic infections in HIV-infected individuals. We found no evidence that vitamin D deficiency increases risk of cryptococcal meningitis or leads to impaired immune responses or microbiological clearance in HIV-infected patients with cryptococcal meningitis. Background. Vitamin D deficiency is associated with impaired immune responses and increased susceptibility to a number of intracellular pathogens in individuals infected with human immunodeficiency virus (HIV). It is not known whether such an association exists with Cryptococcus neoformans. Methods. Levels of 25-hydroxyvitamin D (25[OH]D) were measured in 150 patients with cryptococcal meningitis (CM) and 150 HIV-infected controls in Cape Town, South Africa, and associations between vitamin D deficiency and CM were examined. The 25-hydroxyvitamin D levels and cryptococcal notifications were analyzed for evidence of reciprocal seasonality. Associations between 25(OH)D levels and disease severity, immune responses, and microbiological clearance were investigated in the patients with CM. Results. Vitamin D deficiency (plasma 25[OH]D ≤50 nmol/L) was present in 74% of patients. Vitamin D deficiency was not associated with CM (adjusted odds ratio, 0.93 [95% confidence interval, .6–1.6]; P = .796). Levels of 25(OH)D showed marked seasonality, but no reciprocal seasonality was seen in CM notifications. No significant associations were found between 25(OH)D levels and fungal burden or levels of tumor necrosis factor α, interferon γ, interleukin 6, soluble CD14, or neopterin in cerebrospinal fluid. Rates of fungal clearance did not vary according to vitamin D status. Conclusions. Vitamin D deficiency does not predispose to the development of CM, or lead to impaired immune responses or microbiological clearance in HIV-infected patients with CM.
Collapse
Affiliation(s)
- Joseph N Jarvis
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom Botswana-University of Pennsylvania Partnership, Gaborone, Botswana Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tihana Bicanic
- Research Centre for Infection and Immunity, Division of Clinical Sciences, St George's University of London, United Kingdom
| | - Angela Loyse
- Research Centre for Infection and Immunity, Division of Clinical Sciences, St George's University of London, United Kingdom
| | - Graeme Meintjes
- Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, South Africa Department of Medicine, Imperial College London, United Kingdom
| | - Louise Hogan
- Research Centre for Infection and Immunity, Division of Clinical Sciences, St George's University of London, United Kingdom
| | - Chrissy H Roberts
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Shmuel Shoham
- Transplant and Oncology Infectious Diseases Program, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John R Perfect
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Nelesh P Govender
- National Institute for Communicable Diseases-Centre for Opportunistic, Tropical and Hospital Infections, National Health Laboratory Service and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Thomas S Harrison
- Research Centre for Infection and Immunity, Division of Clinical Sciences, St George's University of London, United Kingdom
| |
Collapse
|
42
|
Roberts CH, Jiang W, Jayaraman J, Trowsdale J, Holland MJ, Traherne JA. Killer-cell Immunoglobulin-like Receptor gene linkage and copy number variation analysis by droplet digital PCR. Genome Med 2014; 6:20. [PMID: 24597950 PMCID: PMC4062048 DOI: 10.1186/gm537] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 03/03/2014] [Indexed: 01/19/2023] Open
Abstract
The Killer-cell Immunoglobulin-like Receptor (KIR) gene complex has considerable biomedical importance. Patterns of polymorphism in the KIR region include variability in the gene content of haplotypes and diverse structural arrangements. Droplet digital PCR (ddPCR) was used to identify different haplotype motifs and to enumerate KIR copy number variants (CNVs). ddPCR detected a variety of KIR haplotype configurations in DNA from well-characterized cell lines. Mendelian segregation of ddPCR-estimated KIR2DL5 CNVs was observed in Gambian families and CNV typing of other KIRs was shown to be accurate when compared to an established quantitative PCR method.
Collapse
Affiliation(s)
- Chrissy H Roberts
- London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Wei Jiang
- Cambridge Institute for Medical Research, Addenbrooke's Hospital, Cambridge CB2 0XY, UK ; Division of Immunology, Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK
| | - Jyothi Jayaraman
- Cambridge Institute for Medical Research, Addenbrooke's Hospital, Cambridge CB2 0XY, UK ; Division of Immunology, Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK
| | - John Trowsdale
- Cambridge Institute for Medical Research, Addenbrooke's Hospital, Cambridge CB2 0XY, UK ; Division of Immunology, Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK
| | - Martin J Holland
- London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - James A Traherne
- Cambridge Institute for Medical Research, Addenbrooke's Hospital, Cambridge CB2 0XY, UK ; Division of Immunology, Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK
| |
Collapse
|
43
|
Walker SL, Roberts CH, Atkinson SE, Khadge S, Macdonald M, Neupane KD, Ranjit C, Sapkota BR, Dhakal S, Hawksworth RA, Mahat K, Ruchal S, Hamal S, Hagge DA, Lockwood DNJ. The effect of systemic corticosteroid therapy on the expression of toll-like receptor 2 and toll-like receptor 4 in the cutaneous lesions of leprosy Type 1 reactions. Br J Dermatol 2012; 167:29-35. [PMID: 22348338 DOI: 10.1111/j.1365-2133.2012.10891.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Leprosy is complicated by immunological reactions which can occur before, during and after successful completion of multidrug therapy. Genetic studies have suggested that polymorphisms in toll-like receptors (TLRs) may affect the susceptibility of an individual with leprosy to developing Type 1 reactions. OBJECTIVES To examine the gene and protein expression of TLRs in the cutaneous lesions of leprosy Type 1 reactions at the onset of reaction and during systemic corticosteroid therapy. METHODS Patients who were being treated for leprosy type 1 reactions with corticosteroids as part of a randomized controlled trial of corticosteroid treatment had skin biopsies performed before, during and at the end of treatment. The gene and protein expression of TLR2 and TLR4 were measured. RESULTS We have demonstrated that the gene hARP-P0 is a suitable control gene for TLR gene expression studies in this population. The gene and protein expression of TLR2 and TLR4 were both reduced significantly during corticosteroid treatment. CONCLUSIONS This is the first study to examine the expression of TLR2 and TLR4 in vivo in individuals experiencing leprosy Type 1 reactions. The data support the possibility of an important role for TLR2 and TLR4 in the pathogenesis of this important complication of leprosy.
Collapse
Affiliation(s)
- S L Walker
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
McLaughlin SD, Clark SK, Roberts CH, Perry-Woodford ZL, Tekkis PP, Ciclitira PJ, Nicholls RJ. Extended spectrum beta-lactamase-producing bacteria and Clostridium difficile in patients with pouchitis. Aliment Pharmacol Ther 2010; 32:664-9. [PMID: 20626734 DOI: 10.1111/j.1365-2036.2010.04401.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment with fluoroquinolones is associated with the development of Clostridium difficile and extended spectrum beta-lactamase-producing bacteria (ESBL). Clostridium difficile and ESBL are resistant to many antibiotics and each may cause pouchitis after restorative proctocolectomy (RPC) refractory to empirical antibiotic therapy. AIM To assess the prevalence and establish risk factors for the development of ESBL and Clostridium difficile toxins (CDT) in RPC patients with recurrent or refractory pouchitis under follow-up at our institution over a 1-year period. METHOD An enzyme-linked immunosorbent assay was used to detect CDT and a culture technique was used to identity ESBL in faecal samples. All patients had previously received fluoroquinolone treatment. RESULTS Forty-eight patients (35 (74%) men; median age 42 years) underwent testing at a median interval from RPC of 8 (range 1-25) years. No patient had a positive CDT result, but ESBL bacteria were identified in 16 (33%) samples. ESBL positivity was significantly related to prepouch ileitis (P = 0.035) and maintenance antibiotic therapy (P = 0.039). CONCLUSIONS Extended spectrum beta-lactamase, but not CDT, is a common finding in faecal samples from patients with recurrent or refractory pouchitis. Treatment with maintenance antibiotics and prepouch ileitis are risk factors for developing ESBL-producing bacteria.
Collapse
Affiliation(s)
- S D McLaughlin
- Department of Gastroenterology, St Mark's Hospital, London, UK.
| | | | | | | | | | | | | |
Collapse
|
45
|
Roberts CH, Mayor NP, Madrigal JA, Marsh SGE. Short template amplicon and multiplex megaprimer-enabled relay (STAMMER) sequencing, a simultaneous approach to higher throughput sequence-based typing of polymorphic genes. Immunogenetics 2010; 62:253-60. [PMID: 20204613 DOI: 10.1007/s00251-010-0432-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 02/05/2010] [Indexed: 11/28/2022]
Abstract
Sequence-based typing (SBT) is a powerful method of genotyping in highly polymorphic gene systems. In standard SBT methods, both strands of a double-stranded template amplicon are sequenced in separate reactions in order to achieve high quality data across the region of interest. The amount of informative data that is obtained from the second strand sequence is often low, whilst the impact of performing second strand sequencing on costs and throughput are significant. Here we present short template amplicon and multiplex megaprimer-enabled relay (STAMMER) sequencing, a novel simultaneous sequence-based typing methodology that allows the detection of any practical amount of useful sequence from a plurality of distinct polymerase chain reaction products in a single sequencing reaction. In addition to simultaneous bidirectional sequencing, we show how the STAMMER approach can be used to simultaneously sequence a number of regions of interest that are not physically linked within the range of a single sequencing reaction. The efficiencies of this method could impact significantly on the output of SBT laboratories.
Collapse
|
46
|
Robinson J, Roberts CH, Dodi IA, Madrigal JA, Pawelec G, Wedel L, Marsh SGE. The European searchable tumour line database. Cancer Immunol Immunother 2009; 58:1501-6. [PMID: 19172270 PMCID: PMC11029873 DOI: 10.1007/s00262-008-0656-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Accepted: 12/31/2008] [Indexed: 10/21/2022]
Abstract
The European Searchable Tumour line Database (ESTDAB) ( http://www.ebi.ac.uk/ipd/estdab ) is a freely available and fully searchable database of melanoma-derived cell lines, which have been characterised for over 250 immunologically relevant markers by a consortium of European scientists. The database is linked to a cell bank, which can provide melanoma cell lines to non-profit investigators for a nominal handling charge. All cells are fully HLA typed at the genomic and surface expression levels. The expression of a number of surface antigens, apoptotic markers, tumour-associated antigens and extracellular matrix proteins has also been determined. Cytokine secretion has been tested and polymorphisms in cytokine genes have been identified. Glycans at the cell surface were identified and glycosyltransferase activity quantified. Cell lines with a particular constellation of these parameters can be sought online via the ESTDAB interface, which is included as part of the Immuno-Polymorphism Database (IPD) section of the European Bioinformatics Institute's (EBI) website.
Collapse
Affiliation(s)
- James Robinson
- Anthony Nolan Research Institute, Royal Free Hospital, Hampstead, London NW3 2QG, UK.
| | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
Killer-cell immunoglobulin-like receptor (KIR) genes are highly polymorphic and polymorphisms have been found in all KIR exons. Although less is known of the introns, these also appear to be polymorphic. To generate a comprehensive database of KIR genomic sequences, which will aid in the design of KIR typing reagents, we have established a method for cloning and sequencing of KIR genes from genomic DNA. We cloned and sequenced the entire KIR2DL4 gene from genomic DNA using long template touchdown PCR and high capacity cloning vectors. Overlapping secondary amplicons were modified to include a nucleotide analogue that reduced sequencing problems associated with secondary structure formation in the KIR sequence. Using a modified sequencing chemistry we were able to sequence approximately 11,000 bases confirming the previously published KIR2DL4*005 allele sequence.
Collapse
Affiliation(s)
- C H Roberts
- Anthony Nolan Research Institute and Department of Haematology, Royal Free and UCL School of Medicine, London, UK
| | | | | |
Collapse
|
48
|
Roberts CH, Turino C, Madrigal JA, Marsh SGE. Enrichment of individual KIR2DL4 sequences from genomic DNA using long-template PCR and allele-specific hybridization to magnetic bead-bound oligonucleotide probes. ACTA ACUST UNITED AC 2007; 69:597-601. [PMID: 17498270 DOI: 10.1111/j.1399-0039.2007.00818.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
DNA enrichment by allele-specific hybridization (DEASH) was used as a means to isolate individual alleles of the killer cell immunoglobulin-like receptor (KIR2DL4) gene from heterozygous genomic DNA. Using long-template polymerase chain reaction (LT-PCR), the complete KIR2DL4 gene was amplified from a cell line that had previously been characterized for its KIR gene content by PCR using sequence-specific primers (PCR-SSP). The whole gene amplicons were sequenced and we identified two heterozygous positions in accordance with the predictions of the PCR-SSP. The amplicons were then hybridized to allele-specific, biotinylated oligonucleotide probes and through binding to streptavidin-coated beads, the targeted alleles were enriched. A second PCR amplified only the exonic regions of the enriched allele, and these were then sequenced in full. We show DEASH to be capable of enriching single alleles from a heterozygous PCR product, and through sequencing the enriched DNA, we are able to produce complete coding sequences of the KIR2DL4 alleles in accordance with the typing predicted by PCR-SSP.
Collapse
Affiliation(s)
- C H Roberts
- Anthony Nolan Research Institute, The Royal Free Hospital, London, UK
| | | | | | | |
Collapse
|
49
|
Mytton OT, McGready R, Lee SJ, Roberts CH, Ashley EA, Carrara VI, Thwai KL, Jay MP, Wiangambun T, Singhasivanon P, Nosten F. Safety of benzyl benzoate lotion and permethrin in pregnancy: a retrospective matched cohort study. BJOG 2007; 114:582-7. [PMID: 17439567 DOI: 10.1111/j.1471-0528.2007.01290.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [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] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the safety of benzyl benzoate lotion (BBL) and permethrin, topical treatments for scabies, during pregnancy. DESIGN A retrospective controlled cohort study. POPULATION Refugee and migrant women attending antenatal clinics (ANC) on the Thai-Burmese border between August 1993 and April 2006. METHODS Women treated with either BBL (25%) or permethrin (4%) were identified from a manual search of antenatal records. Each case of scabies was matched with four scabies-free controls for gravidity, age, smoking status, malaria, period of treatment and gestational age at treatment. Conditional Poisson regression was used to estimate risk ratios for outcomes of pregnancy (proportion of abortions, congenital abnormalities, neonatal deaths, stillbirths and premature babies), mean birthweight and estimated median gestational age, for scabies and scabies-free women, independently for BBL and permethrin. RESULTS There were no statistically significant differences in pregnancy outcomes between women who were treated with either BBL (n = 444) compared with their matched controls (n = 1,776) or permethrin (n = 196) treated women and their matched controls (n = 784). Overall, only 10.9% (n = 66) of treatments were in the first trimester. Retreatment rates were higher with BBL 16.4%, than permethrin 9.7%, P = 0.038. Scabies was more common during cooler periods. CONCLUSION We found no evidence of adverse effects on pregnancy outcome due to topical 25% BBL or 4% permethrin.
Collapse
Affiliation(s)
- O T Mytton
- Shoklo Malaria Research Unit, PO Box 46 Mae Sot, Tak, Thailand
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Rodriguez T, Méndez R, Roberts CH, Ruiz-Cabello F, Dodi IA, Nevot MAL, Paco L, Maleno I, Marsh SGE, Pawelec G, Garrido F. High frequency of homozygosity of the HLA region in melanoma cell lines reveals a pattern compatible with extensive loss of heterozygosity. Cancer Immunol Immunother 2005; 54:141-8. [PMID: 15592718 PMCID: PMC11032966 DOI: 10.1007/s00262-004-0561-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2004] [Accepted: 04/17/2004] [Indexed: 11/29/2022]
Abstract
Malignant transformation of cells is frequently associated with abnormalities in human leukocyte antigen (HLA) expression. MHC class I loss or down-regulation in cancer cells is a major immune escape route used by a large variety of human tumours to evade antitumour immune responses mediated by cytotoxic T lymphocytes. The goal of our study was to explore HLA genotyping and phenotyping in a variety of melanoma tumour cell lines. A total of 91 melanoma cell lines were characterised for HLA class I and II genotype. In addition, 61 out of the 91 cell lines were also analysed for HLA class I and II cell surface molecule expression by flow cytometry. Unexpectedly, we found that 19.7% of the melanoma cell lines were homozygous for HLA class I genotypes, sometimes associated with HLA class II homozygosity (8.79%) and sometimes not (10.98%). The frequency of homozygosity was significantly higher compared with the control groups (1.6%). To identify the reasons underlying the high frequency of HLA homozygosity we searched for genomic deletions using eight pairs of highly polymorphic microsatellite markers covering the entire extended HLA complex on the short arm of chromosome 6. Our results were compatible with hemizygous deletions and suggest that loss of heterozygosity on chromosome arm 6p is a common feature in melanoma cell lines. In fact, although autologous normal DNA from the patients was not available and could not be tested, the retention in some cases of heterozygosity for a number of microsatellite markers would indicate a hemizygous deletion. In the rest of the cases, markers at 6p and 6q showed a single allele pattern indicating the probable loss of part or the whole of chromosome 6. These results led us to conclude that loss of heterozygosity in chromosome 6 is nonrandom and is possibly an immunologically relevant event in human malignant melanoma. Other well-established altered HLA class I phenotypes were also detected by flow cytometry that correspond to HLA class I total loss and HLA-ABC and/or specific HLA-B locus down-regulation.
Collapse
Affiliation(s)
- Teresa Rodriguez
- Departamento de Análisis Clínicos, Hospital Universitario Virgen de las Nieves, Universidad de Granada, Avd. Fuerzas Armadas 2, 18014 Granada, Spain
| | - Rosa Méndez
- Departamento de Análisis Clínicos, Hospital Universitario Virgen de las Nieves, Universidad de Granada, Avd. Fuerzas Armadas 2, 18014 Granada, Spain
| | - Chrissy H. Roberts
- Anthony Nolan Research Institute, The Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG UK
| | - Francisco Ruiz-Cabello
- Departamento de Análisis Clínicos, Hospital Universitario Virgen de las Nieves, Universidad de Granada, Avd. Fuerzas Armadas 2, 18014 Granada, Spain
| | - I. Anthony Dodi
- Anthony Nolan Research Institute, The Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG UK
| | - Miguel Angel López Nevot
- Departamento de Análisis Clínicos, Hospital Universitario Virgen de las Nieves, Universidad de Granada, Avd. Fuerzas Armadas 2, 18014 Granada, Spain
| | - Laura Paco
- Departamento de Análisis Clínicos, Hospital Universitario Virgen de las Nieves, Universidad de Granada, Avd. Fuerzas Armadas 2, 18014 Granada, Spain
| | - Isabel Maleno
- Departamento de Análisis Clínicos, Hospital Universitario Virgen de las Nieves, Universidad de Granada, Avd. Fuerzas Armadas 2, 18014 Granada, Spain
| | - Steven G. E. Marsh
- Anthony Nolan Research Institute, The Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG UK
| | - Graham Pawelec
- Section for Transplantation Immunology and Immunohaematology, Zentrum für Medizinische Forschung, Waldhörnlestr. 22, 72072 Tübingen, Germany
| | - Federico Garrido
- Departamento de Análisis Clínicos, Hospital Universitario Virgen de las Nieves, Universidad de Granada, Avd. Fuerzas Armadas 2, 18014 Granada, Spain
| |
Collapse
|