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Patterson J, Cleary S, Norman JM, Van Zyl H, Awine T, Mayet S, Kagina B, Muloiwa R, Hussey G, Silal SP. Modelling the Cost-Effectiveness of Hepatitis A in South Africa. Vaccines (Basel) 2024; 12:116. [PMID: 38400100 PMCID: PMC10893480 DOI: 10.3390/vaccines12020116] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/14/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
The World Health Organization (WHO) recommends the consideration of introducing routine hepatitis A vaccination into national immunization schedules for children ≥ 1 years old in countries with intermediate HAV endemicity. Recent data suggest that South Africa is transitioning from high to intermediate HAV endemicity, thus it is important to consider the impact and cost of potential routine hepatitis A vaccination strategies in the country. An age-structured compartmental model of hepatitis A transmission was calibrated with available data from South Africa, incorporating direct costs of hepatitis A treatment and vaccination. We used the calibrated model to evaluate the impact and costs of several childhood hepatitis A vaccination scenarios from 2023 to 2030. We assessed how each scenario impacted the burden of hepatitis A (symptomatic hepatitis A cases and mortality) as well as calculated the incremental cost per DALY averted as compared to the South African cost-effectiveness threshold. All costs and outcomes were discounted at 5%. For the modelled scenarios, the median estimated cost of the different vaccination strategies ranged from USD 1.71 billion to USD 2.85 billion over the period of 2023 to 2030, with the cost increasing for each successive scenario and approximately 39-52% of costs being due to vaccination. Scenario 1, which represented the administration of one dose of the hepatitis A vaccine in children < 2 years old, requires approximately 5.3 million vaccine doses over 2023-2030 and is projected to avert a total of 136,042 symptomatic cases [IQR: 88,842-221,483] and 31,106 [IQR: 22,975-36,742] deaths due to hepatitis A over the period of 2023 to 2030. The model projects that Scenario 1 would avert 8741 DALYs over the period of 2023 to 2030; however, it is not cost-effective against the South African cost-effectiveness threshold with an ICER per DALY averted of USD 21,006. While Scenario 3 and 4 included the administration of more vaccine doses and averted more symptomatic cases of hepatitis A, these scenarios were absolutely dominated owing to the population being infected before vaccination through the mass campaigns at older ages. The model was highly sensitive to variation of access to liver transplant in South Africa. When increasing the access to liver transplant to 100% for the baseline and Scenario 1, the ICER for Scenario 1 becomes cost-effective against the CET (ICER = USD 2425). Given these findings, we recommend further research is conducted to understand the access to liver transplants in South Africa and better estimate the cost of liver transplant care for hepatitis A patients. The modelling presented in this paper has been used to develop a user-friendly application for vaccine policy makers to further interrogate the model outcomes and consider the costs and benefits of introducing routine hepatitis A vaccination in South Africa.
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Affiliation(s)
- Jenna Patterson
- Vaccines for Africa Initiative, School of Public Health, University of Cape Town, Cape Town 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Susan Cleary
- School of Public Health, University of Cape Town, Cape Town 7925, South Africa
| | - Jared Michael Norman
- Modelling and Simulation Hub, Africa (MASHA), Department of Statistical Sciences, University of Cape Town, Cape Town 7700, South Africa
| | - Heiletjé Van Zyl
- Modelling and Simulation Hub, Africa (MASHA), Department of Statistical Sciences, University of Cape Town, Cape Town 7700, South Africa
| | - Timothy Awine
- Modelling and Simulation Hub, Africa (MASHA), Department of Statistical Sciences, University of Cape Town, Cape Town 7700, South Africa
| | - Saadiyah Mayet
- Modelling and Simulation Hub, Africa (MASHA), Department of Statistical Sciences, University of Cape Town, Cape Town 7700, South Africa
| | - Benjamin Kagina
- Vaccines for Africa Initiative, School of Public Health, University of Cape Town, Cape Town 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Rudzani Muloiwa
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town 7700, South Africa
| | - Gregory Hussey
- Vaccines for Africa Initiative, School of Public Health, University of Cape Town, Cape Town 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Sheetal Prakash Silal
- Modelling and Simulation Hub, Africa (MASHA), Department of Statistical Sciences, University of Cape Town, Cape Town 7700, South Africa
- Centre for Global Health, Nuffield Department of Medicine, Oxford University, Oxford OX3 7LG, UK
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Manga N, Amponsah-Dacosta E, Hussey G, Muloiwa R, Kagina BM. Expanding the reach of vaccinology training in Africa: leveraging the success of the Annual African Vaccinology Course. Front Health Serv 2023; 3:1119858. [PMID: 37727323 PMCID: PMC10505672 DOI: 10.3389/frhs.2023.1119858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/14/2023] [Indexed: 09/21/2023]
Abstract
Introduction It is estimated that one in five African children lack access to recommended life-saving vaccines. This situation has been exacerbated by the COVID-19 pandemic which disrupted routine immunization services in several parts of the region. To better support recovery efforts and get immunization programmes back on track, policy makers, programme managers, immunization providers and academics need continuous upskilling. Unfortunately, the vaccinology training needed by these cadres remains limited and oftentimes inaccessible within our context. In addition, cadres should be continuously updated on advances in vaccinology so as to keep abreast with this rapidly evolving field. This calls for new and accessible approaches to training vaccinologists in Africa where the demand is high. Methods The aim of this proof-of-concept study was to ascertain the training needs of alumni of the Annual African Vaccinology Course and assess the effectiveness of an online webinar series in meeting those needs. Results We found that alumni from across Africa required refresher training to gain up-to-date information about new developments in vaccinology, leverage opportunities to reinforce and consolidate their knowledge, and exchange country-specific experiences with their counterparts. A prominent motivation for refresher training was the rapid developments and challenges brought on by the COVID-19 pandemic. Drawing on the expressed needs of our alumni, we developed a webinar training series. This series aimed to provide participants with training on current and emerging trends in vaccinology with a focus on the regional context. Online participation in the webinar series was found to be comparable to previous in-person training, reaching a diverse group of cadres, and allowing for participation of a richer global faculty due to fewer cost constraints. Further to this, a post-training survey indicated that generally, alumni training needs were successfully met. Discussion The findings suggest that an online approach can be used to expand the reach of vaccinology training in Africa.
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Affiliation(s)
- Nayna Manga
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Edina Amponsah-Dacosta
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Gregory Hussey
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rudzani Muloiwa
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Pediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Benjamin M. Kagina
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Amponsah-Dacosta E, Muloiwa R, Wiysonge CS, Gold M, Hussey G, Kagina BM. Developing vaccinology expertise for Africa: fifteen years and counting. Pan Afr Med J 2021; 38:313. [PMID: 34285736 PMCID: PMC8265242 DOI: 10.11604/pamj.2021.38.313.26744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/19/2021] [Indexed: 11/17/2022] Open
Abstract
For 15 years, the Annual African Vaccinology Course (AAVC) hosted by the Vaccines for Africa Initiative, has been at the forefront of vaccinology training in Africa. The AAVC was developed in 2005 in response to the growing demand for vaccinology training in Africa. To date, 958 policy makers, immunization managers, public and private health practitioners, scientists, postgraduate and postdoctoral students have been trained. These participants are from 44 of the 54 African countries. The course content covers diverse topics such as considerations for new vaccine introduction, mathematical modelling, and emerging and re-emerging vaccine preventable diseases. As the landscape of vaccinology continues to evolve, the AAVC aims to expand the reach of vaccinology training using blended learning approaches which will incorporate online and face-to-face formats, while expanding access to this popular course. Ultimately, the AAVC endeavours to develop a big pool of vaccinology expertise in Africa and to strengthen regional ownership for immunization programmes.
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Affiliation(s)
- Edina Amponsah-Dacosta
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rudzani Muloiwa
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Paediatrics and Child health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Charles Shey Wiysonge
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Michael Gold
- Discipline of Paediatrics, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Gregory Hussey
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Benjamin Mugo Kagina
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Müller J, Tanner R, Matsumiya M, Snowden MA, Landry B, Satti I, Harris SA, O’Shea MK, Stockdale L, Marsay L, Chomka A, Harrington-Kandt R, Thomas ZRM, Naranbhai V, Stylianou E, Mbandi SK, Hatherill M, Hussey G, Mahomed H, Tameris M, McClain JB, Evans TG, Hanekom WA, Scriba TJ, McShane H, Fletcher HA. Cytomegalovirus infection is a risk factor for tuberculosis disease in infants. JCI Insight 2019; 4:130090. [PMID: 31697647 PMCID: PMC6962026 DOI: 10.1172/jci.insight.130090] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 05/07/2019] [Accepted: 10/23/2019] [Indexed: 02/05/2023] Open
Abstract
Immune activation is associated with increased risk of tuberculosis (TB) disease in infants. We performed a case-control analysis to identify drivers of immune activation and disease risk. Among 49 infants who developed TB disease over the first 2 years of life, and 129 healthy matched controls, we found the cytomegalovirus-stimulated (CMV-stimulated) IFN-γ response to be associated with CD8+ T cell activation (Spearman's rho, P = 6 × 10-8). A CMV-specific IFN-γ response was also associated with increased risk of developing TB disease (conditional logistic regression; P = 0.043; OR, 2.2; 95% CI, 1.02-4.83) and shorter time to TB diagnosis (Log Rank Mantel-Cox, P = 0.037). CMV+ infants who developed TB disease had lower expression of NK cell-associated gene signatures and a lower frequency of CD3-CD4-CD8- lymphocytes. We identified transcriptional signatures predictive of TB disease risk among CMV ELISpot-positive (area under the receiver operating characteristic [AUROC], 0.98, accuracy, 92.57%) and -negative (AUROC, 0.9; accuracy, 79.3%) infants; the CMV- signature was validated in an independent infant study (AUROC, 0.71; accuracy, 63.9%). A 16-gene signature that previously identified adolescents at risk of developing TB disease did not accurately classify case and control infants in this study. Understanding the microbial drivers of T cell activation, such as CMV, could guide new strategies for prevention of TB disease in infants.
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Affiliation(s)
- Julius Müller
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rachel Tanner
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Magali Matsumiya
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | | | - Iman Satti
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stephanie A. Harris
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Matthew K. O’Shea
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Lisa Stockdale
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Leanne Marsay
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Agnieszka Chomka
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- The Kennedy Institute and
| | - Rachel Harrington-Kandt
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Zita-Rose Manjaly Thomas
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Vivek Naranbhai
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Elena Stylianou
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stanley Kimbung Mbandi
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Mark Hatherill
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Gregory Hussey
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Hassan Mahomed
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Michele Tameris
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | | | | | - Willem A. Hanekom
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Thomas J. Scriba
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & Division of Immunology, Department of Pathology, University of Cape Town, South Africa
| | - Helen McShane
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Helen A. Fletcher
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- London School of Hygiene & Tropical Medicine, London, United Kingdom
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Hussey H, Abdullahi L, Collins J, Muloiwa R, Hussey G, Kagina B. Varicella zoster virus-associated morbidity and mortality in Africa - a systematic review. BMC Infect Dis 2017; 17:717. [PMID: 29137604 PMCID: PMC5686819 DOI: 10.1186/s12879-017-2815-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 11/02/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Varicella zoster virus (VZV) causes varicella and herpes zoster. These vaccine preventable diseases are common globally. Most available data on VZV epidemiology are from industrialised temperate countries and cannot be used to guide decisions on the immunization policy against VZV in Africa. This systematic review aims to review the published data on VZV morbidity and mortality in Africa. METHODS All published studies conducted in Africa from 1974 to 2015 were eligible. Eligible studies must have reported any VZV epidemiological measure (incidence, prevalence, hospitalization rate and mortality rate). For inclusion in the review, studies must have used a defined VZV case definition, be it clinical or laboratory-based. RESULTS Twenty articles from 13 African countries were included in the review. Most included studies were cross-sectional, conducted on hospitalized patients, and half of the studies used varying serological methods for diagnosis. VZV seroprevalence was very high among adults. Limited data on VZV seroprevalence in children showed very low seropositivity to anti-VZV antibodies. Co-morbidity with VZV was common. CONCLUSION There is lack of quality data that could be used to develop VZV control programmes, including vaccination, in Africa. TRIAL REGISTRATION PROSPERO 2015: CRD42015026144 .
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Affiliation(s)
- Hannah Hussey
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Leila Abdullahi
- Vaccines for Africa Initiative, Division of Medical Microbiology & Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Jamie Collins
- Department of Biostatistics, School of Public Health, Harvard Medical School, Boston, MA USA
| | - Rudzani Muloiwa
- Department of Paediatrics & Child Health, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Gregory Hussey
- Vaccines for Africa Initiative, Division of Medical Microbiology & Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Benjamin Kagina
- Vaccines for Africa Initiative, Division of Medical Microbiology & Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Vaccines for Africa Initiative, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
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Meiring S, Hussey G, Jeena P, Parker S, Von Gottberg A. Recommendations for the use of meningococcal vaccines in South Africa. S Afr J Infect Dis 2017. [DOI: 10.4102/sajid.v32i3.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Although meningococcal disease (MD) incidence in South Africa is low, Neisseria meningitidis (NM) causes severe disease that is often life-threatening and can cause long-term disabilities. A quadrivalent protein-conjugated meningococcal vaccine (MCV4) is available, and provides protection against 75% of disease causing serogroups in South Africa. Recommendations: We advise vaccination of persons at high risk of meningococcal disease including those with complement deficiency and asplenia; laboratory personnel from reference laboratories who work with NM; and travellers to Saudi Arabia. The need for routine vaccine against meningococcal disease in South Africa is controversial given the current burden of disease. However, due to the high morbidity/mortality of MD we recommend that clinicians consider vaccination of healthy infants and children; HIV-infected persons with a CD4 count 25%; students attending college /university /military academies; and miners.Conclusion: Protein-conjugated meningococcal vaccine is preferable to the polysaccharide vaccine given the ability of the protein-conjugated meningococcal vaccine to induce immune memory, allow for booster responses and eliminate carriage of the organism in the person vaccinated.
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Meiring S, Hussey G, Jeena P, Parker S, von Gottberg A. Recommendations for the use of meningococcal vaccines in South Africa. S Afr J Infect Dis 2017. [DOI: 10.1080/23120053.2017.1359939] [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: 10/19/2022] Open
Affiliation(s)
- Susan Meiring
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, a division of the National Health Laboratory Services, Johannesburg, South Africa
| | - Gregory Hussey
- Vaccines for Africa Initiative, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Prakash Jeena
- Department of Paediatrics, University of KwaZulu-Natal, Durban, South Africa
| | - Salim Parker
- General Practitioner, South African Society of Travel Medicine, Cape Town, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, a division of the National Health Laboratory Services, Johannesburg, South Africa
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Fletcher HA, Snowden MA, Landry B, Rida W, Satti I, Harris SA, Matsumiya M, Tanner R, O'Shea MK, Dheenadhayalan V, Bogardus L, Stockdale L, Marsay L, Chomka A, Harrington-Kandt R, Manjaly-Thomas ZR, Naranbhai V, Stylianou E, Darboe F, Penn-Nicholson A, Nemes E, Hatherill M, Hussey G, Mahomed H, Tameris M, McClain JB, Evans TG, Hanekom WA, Scriba TJ, McShane H. T-cell activation is an immune correlate of risk in BCG vaccinated infants. Nat Commun 2016; 7:11290. [PMID: 27068708 PMCID: PMC4832066 DOI: 10.1038/ncomms11290] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/22/2016] [Indexed: 01/23/2023] Open
Abstract
Vaccines to protect against tuberculosis (TB) are urgently needed. We performed a case-control analysis to identify immune correlates of TB disease risk in Bacille Calmette-Guerin (BCG) immunized infants from the MVA85A efficacy trial. Among 53 TB case infants and 205 matched controls, the frequency of activated HLA-DR(+) CD4(+) T cells associates with increased TB disease risk (OR=1.828, 95% CI=1.25-2.68, P=0.002, FDR=0.04, conditional logistic regression). In an independent study of Mycobacterium tuberculosis-infected adolescents, activated HLA-DR(+) CD4(+) T cells also associate with increased TB disease risk (OR=1.387, 95% CI=1.068-1.801, P=0.014, conditional logistic regression). In infants, BCG-specific T cells secreting IFN-γ associate with reduced risk of TB (OR=0.502, 95% CI=0.29-0.86, P=0.013, FDR=0.14). The causes and impact of T-cell activation on disease risk should be considered when designing and testing TB vaccine candidates for these populations.
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Affiliation(s)
- Helen A. Fletcher
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7DQ, UK
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London W1CE7HT, UK
| | | | | | - Wasima Rida
- Biostatistics Consultant, 1129 N. Illinois Street, Arlington, Virginia 22205, USA
| | - Iman Satti
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7DQ, UK
| | - Stephanie A. Harris
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7DQ, UK
| | - Magali Matsumiya
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7DQ, UK
| | - Rachel Tanner
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7DQ, UK
| | - Matthew K. O'Shea
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7DQ, UK
| | | | | | - Lisa Stockdale
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7DQ, UK
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London W1CE7HT, UK
| | - Leanne Marsay
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford OX3 7LE, UK
| | - Agnieszka Chomka
- Kennedy Institute, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LF, UK
| | | | | | - Vivek Naranbhai
- Wellcome Trust Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford OX37BN, UK
| | - Elena Stylianou
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7DQ, UK
| | - Fatoumatta Darboe
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Department of Paediatrics and Child Health, University of Cape Town, Cape Town 7935, South Africa
| | - Adam Penn-Nicholson
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Department of Paediatrics and Child Health, University of Cape Town, Cape Town 7935, South Africa
| | - Elisa Nemes
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Department of Paediatrics and Child Health, University of Cape Town, Cape Town 7935, South Africa
| | - Mark Hatherill
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Department of Paediatrics and Child Health, University of Cape Town, Cape Town 7935, South Africa
| | - Gregory Hussey
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Department of Paediatrics and Child Health, University of Cape Town, Cape Town 7935, South Africa
| | - Hassan Mahomed
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Department of Paediatrics and Child Health, University of Cape Town, Cape Town 7935, South Africa
| | - Michele Tameris
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Department of Paediatrics and Child Health, University of Cape Town, Cape Town 7935, South Africa
| | | | | | - Willem A. Hanekom
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Department of Paediatrics and Child Health, University of Cape Town, Cape Town 7935, South Africa
| | - Thomas J. Scriba
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, Department of Paediatrics and Child Health, University of Cape Town, Cape Town 7935, South Africa
| | - Helen McShane
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7DQ, UK
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Wiysonge CS, Waggie Z, Hawkridge A, Schoub B, Madhi SA, Rees H, Hussey G. Advocating for efforts to protect African children, families, and communities from the threat of infectious diseases: report of the First International African Vaccinology Conference. Pan Afr Med J 2016; 23:53. [PMID: 27217879 PMCID: PMC4862784 DOI: 10.11604/pamj.2016.23.53.9097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 02/18/2016] [Indexed: 11/17/2022] Open
Abstract
One means of improving healthcare workers’ knowledge of and attitudes to vaccines is through running vaccine conferences which are accessible, affordable, and relevant to their everyday work. Various vaccinology conferences are held each year worldwide. These meetings focus heavily on basic science with much discussion about new developments in vaccines, and relatively little coverage of policy, advocacy, and communication issues. A negligible proportion of delegates at these conferences come from Africa, home to almost 40% of the global burden of vaccine-preventable diseases. To the best of our knowledge, no major vaccinology conference has ever been held on the African continent apart from World Health Organization (WHO) meetings. The content of the first International African Vaccinology Conference was planned to be different; to focus on the science, with a major part of discussions being on clinical, programmatic, policy, and advocacy issues. The conference was held in Cape Town, South Africa, from 8 to 11 November 2012. The theme of the conference was “Advocating for efforts to protect African children, families, and communities from the threat of infectious diseases”. There were more than 550 registered participants from 55 countries (including 37 African countries). There were nine pre-conference workshops, ten plenary sessions, and 150 oral and poster presentations. The conference discussed the challenges to universal immunisation in Africa as well as the promotion of dialogue and communication on immunisation among all stakeholders. There was general acknowledgment that giant strides have been made in Africa since the global launch of the Expanded Programme on Immunisation in 1974. For example, there has been significant progress in introducing new and under-utilised vaccines; including hepatitis B, Haemophilus influenza type b, pneumococcal conjugate, rotavirus, meningococcal A conjugate, and human papillomavirus vaccines. In May 2012, African countries endorsed the Global Vaccine Action Plan at the World Health Assembly. However, more than six million children remain incompletely vaccinated in Africa leading to more than one million vaccine-preventable deaths annually. In addition, there are persistent problems with leadership and planning, vaccine stock management, supply chain capacity and quality, provider-parent communication, and financial sustainability. The conference delegates agreed to move from talking to taking concrete actions around children's health, and to ensure that African governments commit to saving children's lives. They would advocate for lower costs of immunisation programmes in Africa, perhaps through bulk buying and improved administration of vaccine rollout through the New Partnership for Africa's Development.
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Affiliation(s)
- Charles Shey Wiysonge
- Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Zainab Waggie
- Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Anthony Hawkridge
- Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Department of Health, Provincial Government of the Western Cape, Cape Town, South Africa
| | - Barry Schoub
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Shabir Ahmed Madhi
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Helen Rees
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Gregory Hussey
- Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Luabeya KKA, Tameris MD, Geldenhuys HD, Mulenga H, Van Schalkwyk A, Hughes EJ, Toefey A, Scriba TJ, Hussey G, Mahomed H, McShane H, Landry B, Hanekom WA, Hatherill M. Risk of Disease After Isoniazid Preventive Therapy for Mycobacterium tuberculosis Exposure in Young HIV-uninfected Children. Pediatr Infect Dis J 2015; 34:1218-22. [PMID: 26252568 PMCID: PMC4604652 DOI: 10.1097/inf.0000000000000874] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The risk of developing tuberculosis (TB) disease in HIV-uninfected children after isoniazid preventive therapy (IPT) for a positive QuantiFERON-TB Gold In-Tube test (QFT-GIT) is unknown. The aim of this study was to evaluate risk of TB disease after IPT in young HIV-uninfected children with a positive QFT-GIT result, or household TB contact. METHODS HIV-uninfected South African infants aged 4-6 months were screened for enrolment in a TB vaccine trial. Baseline household TB contact and positive QFT-GIT result were exclusion criteria, and these infants were referred for IPT. Outcome data are reported for 36 months after IPT referral. RESULTS Four thousand seven hundred forty-nine infants were screened. Household TB contact was reported in 131 (2.8%) infants; 279 (6.0%) were QFT-GIT positive, and 138 of these 410 infants (34.0%) started IPT. Forty-four cases of TB disease (11.0%) were recorded within 991 child years of observation. TB disease incidence was 4.8 versus 3.6 per 100 child years in household exposed versus QFT-GIT-positive children [incidence rate ratio: 1.35; 95% confidence interval (CI): 0.67-2.88] and 2.4 versus 5.5 per 100 child years in children who received versus did not receive IPT, respectively (incidence rate ratio: 0.44; 95% CI: 0.17-0.96). Adjusted hazard ratio (Cox regression) for TB disease was 0.48 (95% CI: 0.21-1.05) for those who received IPT. CONCLUSION In young HIV-uninfected children, the effect of IPT on risk of TB disease is similar, whether TB exposure was defined by household contact history or by positive QFT-GIT result. International IPT guidelines for HIV-uninfected children with a positive QFT-GIT result should be updated.
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Affiliation(s)
- Kany Kany A. Luabeya
- From the South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town; Western Cape Government; Stellenbosch University, Cape Town, South Africa; Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; and Aeras, Rockville, Maryland
| | - Michele D. Tameris
- From the South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town; Western Cape Government; Stellenbosch University, Cape Town, South Africa; Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; and Aeras, Rockville, Maryland
| | - Hennie D. Geldenhuys
- From the South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town; Western Cape Government; Stellenbosch University, Cape Town, South Africa; Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; and Aeras, Rockville, Maryland
| | - Humphrey Mulenga
- From the South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town; Western Cape Government; Stellenbosch University, Cape Town, South Africa; Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; and Aeras, Rockville, Maryland
| | - Amaryl Van Schalkwyk
- From the South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town; Western Cape Government; Stellenbosch University, Cape Town, South Africa; Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; and Aeras, Rockville, Maryland
| | - Elizabeth J. Hughes
- From the South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town; Western Cape Government; Stellenbosch University, Cape Town, South Africa; Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; and Aeras, Rockville, Maryland
| | - Asma Toefey
- From the South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town; Western Cape Government; Stellenbosch University, Cape Town, South Africa; Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; and Aeras, Rockville, Maryland
| | - Thomas J. Scriba
- From the South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town; Western Cape Government; Stellenbosch University, Cape Town, South Africa; Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; and Aeras, Rockville, Maryland
| | - Gregory Hussey
- From the South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town; Western Cape Government; Stellenbosch University, Cape Town, South Africa; Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; and Aeras, Rockville, Maryland
| | - Hassan Mahomed
- From the South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town; Western Cape Government; Stellenbosch University, Cape Town, South Africa; Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; and Aeras, Rockville, Maryland
| | - Helen McShane
- From the South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town; Western Cape Government; Stellenbosch University, Cape Town, South Africa; Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; and Aeras, Rockville, Maryland
| | - Bernard Landry
- From the South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town; Western Cape Government; Stellenbosch University, Cape Town, South Africa; Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; and Aeras, Rockville, Maryland
| | - Willem A. Hanekom
- From the South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town; Western Cape Government; Stellenbosch University, Cape Town, South Africa; Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; and Aeras, Rockville, Maryland
| | - Mark Hatherill
- From the South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town; Western Cape Government; Stellenbosch University, Cape Town, South Africa; Jenner Institute, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; and Aeras, Rockville, Maryland
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Geldenhuys HD, Whitelaw A, Tameris MD, Van As D, Luabeya KKA, Mahomed H, Hussey G, Hanekom WA, Hatherill M. A controlled trial of sputum induction and routine collection methods for TB diagnosis in a South African community. Eur J Clin Microbiol Infect Dis 2014; 33:2259-66. [PMID: 25022447 DOI: 10.1007/s10096-014-2198-4] [Citation(s) in RCA: 8] [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] [Received: 03/04/2014] [Accepted: 06/27/2014] [Indexed: 01/26/2023]
Abstract
The diagnostic yield of pulmonary tuberculosis (TB) by sputum induction (SI) at the first point of contact with health services, conducted in all patients with suspected TB regardless of the ability to expectorate spontaneously, has not been evaluated. We compared the diagnostic yield of SI to routine sputum collection in a South African community setting. Ambulatory patients with suspected TB provided a 'spot' expectorated sputum sample, an SI sample by hypertonic (5 %) saline nebulization, and early morning expectorated sputum sample. The diagnostic yield of sputum smear microscopy and liquid culture (denominator all subjects with any positive Mycobacterium tuberculosis culture), and time-to-positivity of culture were compared between SI and expectorated samples. A total of 555 subjects completed the SI procedure, of whom 132 (24 %) were human immunodeficiency virus (HIV)-infected. One hundred and twenty-nine samples (129, 23 %) were M. tuberculosis culture-positive. The time-to-positivity of Mycobacteria Growth Indicator Tube (MGIT) culture was shorter for SI (median difference 2 days, p = 0.63) and for early morning expectorated sputum (median difference 2 days, p = 0.02) compared to spot expectorated sputum. However, there was no difference in the culture-positive diagnostic yield between SI and spot expectorated sputum [difference +0.7 %; confidence interval (CI) -7.0 to +8.5 %, p = 0.82] or SI and early morning expectorated sputum (difference +4.7 %; CI -3.2 to +12.5 %, p = 0.20) for all subjects or for HIV-infected subjects. SI reduces the time to positive M. tuberculosis culture, but does not increase the rate of positive culture compared to routine expectorated sputum collection. SI cannot be recommended as the routine collection method at first contact among ambulatory patients with suspected TB in high-burden communities.
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Affiliation(s)
- H D Geldenhuys
- South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa,
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Rustomjee R, Lockhart S, Shea J, Fourie PB, Hindle Z, Steel G, Hussey G, Ginsberg A, Brennan MJ. Novel licensure pathways for expeditious introduction of new tuberculosis vaccines: A discussion of the adaptive licensure concept. Tuberculosis (Edinb) 2014; 94:178-82. [DOI: 10.1016/j.tube.2013.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 11/06/2013] [Accepted: 11/07/2013] [Indexed: 10/25/2022]
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Tameris M, McShane H, McClain JB, Landry B, Lockhart S, Luabeya AK, Geldenhuys H, Shea J, Hussey G, van der Merwe L, de Kock M, Scriba T, Walker R, Hanekom W, Hatherill M, Mahomed H. Lessons learnt from the first efficacy trial of a new infant tuberculosis vaccine since BCG. Tuberculosis (Edinb) 2013; 93:143-9. [PMID: 23410889 PMCID: PMC3608032 DOI: 10.1016/j.tube.2013.01.003] [Citation(s) in RCA: 30] [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: 12/22/2012] [Revised: 01/09/2013] [Accepted: 01/21/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND New tuberculosis (TB) vaccines are being developed to combat the global epidemic. A phase IIb trial of a candidate vaccine, MVA85A, was conducted in a high burden setting in South Africa to evaluate proof-of-concept efficacy for prevention of TB in infants. OBJECTIVE To describe the study design and implementation lessons from an infant TB vaccine efficacy trial. METHODS This was a randomised, controlled, double-blind clinical trial comparing the safety and efficacy of MVA85A to Candin control administered to 4-6-month-old, BCG-vaccinated, HIV-negative infants at a rural site in South Africa. Infants were followed up for 15-39 months for incident TB disease based on pre-specified endpoints. RESULTS 2797 infants were enrolled over 22 months. Factors adversely affecting recruitment and the solutions that were implemented are discussed. Slow case accrual led to six months extension of trial follow up. CONCLUSION The clinical, regulatory and research environment for modern efficacy trials of new TB vaccines are substantially different to that when BCG vaccine was first evaluated in infants. Future infant TB vaccine trials will need to allocate sufficient resources and optimise operational efficiency. A stringent TB case definition is necessary to maximize specificity, and TB case accrual must be monitored closely.
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Affiliation(s)
- Michele Tameris
- South African TB Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine (IIDMM) and School of Child and Adolescent Health, University of Cape Town, Brewelskloof Hospital, Haarlem Street, Worcester, Western Cape 6850, South Africa
| | - Helen McShane
- Jenner Institute, University of Oxford, United Kingdom
| | | | | | | | - Angelique K.K. Luabeya
- South African TB Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine (IIDMM) and School of Child and Adolescent Health, University of Cape Town, Brewelskloof Hospital, Haarlem Street, Worcester, Western Cape 6850, South Africa
| | - Hennie Geldenhuys
- South African TB Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine (IIDMM) and School of Child and Adolescent Health, University of Cape Town, Brewelskloof Hospital, Haarlem Street, Worcester, Western Cape 6850, South Africa
| | - Jacqui Shea
- Oxford Emergent Tuberculosis Consortium, United Kingdom
| | - Gregory Hussey
- Vaccines for Africa, Institute of Infectious Disease and Molecular Medicine and Department of Medical Microbiology, University of Cape Town, South Africa
| | - Linda van der Merwe
- South African TB Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine (IIDMM) and School of Child and Adolescent Health, University of Cape Town, Brewelskloof Hospital, Haarlem Street, Worcester, Western Cape 6850, South Africa
| | - Marwou de Kock
- South African TB Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine (IIDMM) and School of Child and Adolescent Health, University of Cape Town, Brewelskloof Hospital, Haarlem Street, Worcester, Western Cape 6850, South Africa
| | - Thomas Scriba
- South African TB Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine (IIDMM) and School of Child and Adolescent Health, University of Cape Town, Brewelskloof Hospital, Haarlem Street, Worcester, Western Cape 6850, South Africa
| | | | - Willem Hanekom
- South African TB Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine (IIDMM) and School of Child and Adolescent Health, University of Cape Town, Brewelskloof Hospital, Haarlem Street, Worcester, Western Cape 6850, South Africa
| | - Mark Hatherill
- South African TB Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine (IIDMM) and School of Child and Adolescent Health, University of Cape Town, Brewelskloof Hospital, Haarlem Street, Worcester, Western Cape 6850, South Africa
| | - Hassan Mahomed
- South African TB Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine (IIDMM) and School of Child and Adolescent Health, University of Cape Town, Brewelskloof Hospital, Haarlem Street, Worcester, Western Cape 6850, South Africa
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Geldenhuys H, Waggie Z, Jacks M, Geldenhuys M, Traut L, Tameris M, Hatherill M, Hanekom WA, Sutter R, Hussey G, Mahomed H. Vaccine trials in the developing world: operational lessons learnt from a phase IV poliomyelitis vaccine trial in South Africa. Vaccine 2012; 30:5839-43. [PMID: 22835741 DOI: 10.1016/j.vaccine.2012.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 11/15/2011] [Accepted: 07/12/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Conducting vaccine trials in developing nations is necessary but operationally complex. We describe operational lessons learnt from a phase IV poliomyelitis vaccine trial in a semi-rural region of South Africa. METHODS We reviewed operational data collected over the duration of the trial with respect to staff recruitment and training, participant recruitment and retention, and cold chain maintenance. RESULTS-LESSONS LEARNT: The recruitment model we used that relied on the 24h physical presence of a team member in the birthing unit was expensive and challenging to manage. Forecasting of enrolment rates was complicated by incomplete baseline data and by the linear nature of forecasts that do not take into account changing variables. We found that analyzing key operational data to monitor progress of the trial enabled us to identify problem areas timeously, and to facilitate a collegial problem-solving process by the extended trial team. Pro-actively nurturing a working relationship with the public sector health care system and the community was critical to our success. Despite the wide geographical area and lack of fixed addresses, we maintained an excellent retention rate through community assistance and the use of descriptive residential information. Training needs of team members were ongoing and dynamic and we discovered that these needs that were best met by an in-house, targeted and systemized training programme. The use of vaccine refrigerators instead of standard frost-free refrigerators is cost-effective and necessary to maintain the cold-chain. CONCLUSION Operational challenges of a vaccine trial in developing world populations include inexperienced staff, the close liaison required between researchers and public health care services, impoverished participants that require complex recruitment and retention strategies, and challenges of distance and access. These challenges can be overcome by innovative strategies that allow for the unique characteristics of the setting, trial population, and trial team.
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Affiliation(s)
- H Geldenhuys
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine (IIDMM), University of Cape Town, South Africa.
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Moyo S, Verver S, Hawkridge A, Geiter L, Hatherill M, Workman L, Ontong C, Msemburi W, Tameris M, Geldenhuys H, Mulenga H, Snowden MA, Hanekom WA, Hussey G, Mahomed H. Tuberculosis case finding for vaccine trials in young children in high-incidence settings: a randomised trial. Int J Tuberc Lung Dis 2012; 16:185-91. [PMID: 22236918 DOI: 10.5588/ijtld.11.0348] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING A high tuberculosis (TB) burden rural area in South Africa. OBJECTIVE To compare TB case yield and disease profile among bacille Calmette-Guérin (BCG) vaccinated children using two case-finding strategies from birth until 2 years of age. DESIGN BCG-vaccinated infants were enrolled within 2 weeks of birth and randomised to 3-monthly home visits for questionnaire-based TB screening plus record surveillance of TB registers, hospital admission and X-ray lists at health facilities for TB suspects and cases (Group 1), or record surveillance (as above) only (Group 2). Both groups received a close-out visit after 2 years. Participants were evaluated for suspected TB disease using standardised investigations. RESULTS A total of 4786 infants were enrolled: 2392 were randomised to Group 1 and 2394 to Group 2. The case-finding rate was significantly greater in Group 1 (2.2/100 py) than in Group 2 (0.8/100 py), with a case-finding rate ratio of 2.6 (95%CI 1.8-4.0, P < 0.001). Although the proportion of cases with bacteriological confirmation was lower in Group 1, this difference did not reach statistical significance. There was also no significant difference in the proportions with TB symptoms and signs. CONCLUSION Home visits combined with record surveillance detected significantly more cases than record surveillance with a single study-end visit. The TB case profile did not differ significantly between the two groups.
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Affiliation(s)
- S Moyo
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine & School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
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Moyo S, Isaacs F, Gelderbloem S, Verver S, Hawkridge AJ, Hatherill M, Tameris M, Geldenhuys H, Workman L, Pai M, Hussey G, Hanekom WA, Mahomed H. Tuberculin skin test and QuantiFERON® assay in young children investigated for tuberculosis in South Africa. Int J Tuberc Lung Dis 2012; 15:1176-81, i. [PMID: 21943841 DOI: 10.5588/ijtld.10.0770] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Although the literature on interferon-gamma release assays on tuberculosis (TB) in children has increased, data pertaining to young children remain relatively limited. OBJECTIVE To compare results from the tuberculin skin test (TST) and the QuantiFERON®-TB Gold In-Tube assay (QFT) in children aged <3 years investigated for TB disease. DESIGN TB suspects were evaluated by medical history and examination, TST, QFT, chest radiography, induced sputum and gastric washings for smear and culture for Mycobacterium tuberculosis. RESULTS A total of 400 children were enrolled. Among 397 children with both test results, 68 (17%) were QFT-positive and 72 (18%) were TST-positive (≥10 mm). Agreement between the tests was excellent (94%, κ = 0.79, 95%CI 0.69-0.89). TB disease was diagnosed in 52/397 (13%) participants: 3 definite, 35 probable and 14 possible TB. QFT sensitivity and specificity for TB disease were respectively 38% and 81%. TST sensitivity and specificity were respectively 35% and 84%. CONCLUSION While TST and QFT had excellent concordance in this population, both tests had much lower sensitivity for TB disease than has been reported for other age groups. Our results suggested equivalent performance of QFT and TST in the diagnosis of TB disease in young children in a high-burden setting.
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Affiliation(s)
- S Moyo
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
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Waggie Z, Geldenhuys H, Sutter RW, Jacks M, Mulenga H, Mahomed H, De Kock M, Hanekom W, Pallansch MA, Kahn AL, Burton AH, Sreevatsava M, Hussey G. Randomized Trial of Type 1 and Type 3 Oral Monovalent Poliovirus Vaccines in Newborns in Africa. J Infect Dis 2011; 205:228-36. [DOI: 10.1093/infdis/jir721] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Gonzalez-Angulo Y, Wiysonge CS, Geldenhuys H, Hanekom W, Mahomed H, Hussey G, Hatherill M. Sputum induction for the diagnosis of pulmonary tuberculosis: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis 2011; 31:1619-30. [PMID: 22095153 DOI: 10.1007/s10096-011-1485-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 10/31/2011] [Indexed: 10/15/2022]
Abstract
Sputum induction (SI) has been proposed as the optimal sample collection method for patients with paucibacillary tuberculosis (TB). Studies reporting the culture of Mycobacterium tuberculosis from SI were reviewed. A random-effects meta-analysis of diagnostic yield (numerator M. tuberculosis SI culture-positive cases; denominator all culture-positive cases) was conducted. Diagnostic yields (95% confidence intervals, CIs) were displayed as Forest plots. Heterogeneity was evaluated using Chi-squared and I-squared tests and meta-regression analysis. Ninety publications were screened, 28 full-text papers reviewed, and 17 analyzed. Collectively, n=627 SI culture-positive cases among n=975 culture-confirmed TB cases were reported. The diagnostic yield of SI ranged from 35 to 95%. The pooled diagnostic yield was 74% (CI 65-81%), with significant heterogeneity (p<0.0001, I2=86%). There were no statistically significant differences in the yield between sub-groups defined by human immunodeficiency virus (HIV) prevalence or age. Univariate analysis demonstrated that the use of fiberoptic bronchoscopy (FOB) as the comparator method was associated with a 22% reduction (CI 2-42%) in the diagnostic yield of SI. However, after adjustment for confounding, the meta-regression analysis showed that FOB usage (p=0.21) and saline concentration (p=0.31) were not independently associated with the diagnostic yield. SI will detect approximately three-quarters of M. tuberculosis culture-positive cases under study conditions. Significant heterogeneity in the diagnostic yield was not explained by HIV prevalence, age, or the use of FOB as the comparator method. The use of a particular nebulized saline concentration for SI cannot be recommended on the basis of this meta-regression analysis.
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Affiliation(s)
- Y Gonzalez-Angulo
- South African Tuberculosis Vaccine Initiative (SATVI), Wernher Beit Building N2.10, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa
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Randhawa AK, Shey MS, Keyser A, Peixoto B, Wells RD, de Kock M, Lerumo L, Hughes J, Hussey G, Hawkridge A, Kaplan G, Hanekom WA, Hawn TR. Association of human TLR1 and TLR6 deficiency with altered immune responses to BCG vaccination in South African infants. PLoS Pathog 2011; 7:e1002174. [PMID: 21852947 PMCID: PMC3154845 DOI: 10.1371/journal.ppat.1002174] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [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: 10/26/2010] [Accepted: 06/06/2011] [Indexed: 12/19/2022] Open
Abstract
The development of effective immunoprophylaxis against tuberculosis (TB) remains a global priority, but is hampered by a partially protective Bacillus Calmette-Guérin (BCG) vaccine and an incomplete understanding of the mechanisms of immunity to Mycobacterium tuberculosis. Although host genetic factors may be a primary reason for BCG's variable and inadequate efficacy, this possibility has not been intensively examined. We hypothesized that Toll-like receptor (TLR) variation is associated with altered in vivo immune responses to BCG. We examined whether functionally defined TLR pathway polymorphisms were associated with T cell cytokine responses in whole blood stimulated ex vivo with BCG 10 weeks after newborn BCG vaccination of South African infants. In the primary analysis, polymorphism TLR6_C745T (P249S) was associated with increased BCG-induced IFN-γ in both discovery (n = 240) and validation (n = 240) cohorts. In secondary analyses of the combined cohort, TLR1_T1805G (I602S) and TLR6_G1083C (synonymous) were associated with increased IFN-γ, TLR6_G1083C and TLR6_C745T were associated with increased IL-2, and TLR1_A1188T was associated with increased IFN-γ and IL-2. For each of these polymorphisms, the hypo-responsive allele, as defined by innate immunity signaling assays, was associated with increased production of TH1-type T cell cytokines (IFN-γ or IL-2). After stimulation with TLR1/6 lipopeptide ligands, PBMCs from TLR1/6-deficient individuals (stratified by TLR1_T1805G and TLR6_C745T hyporesponsive genotypes) secreted lower amounts of IL-6 and IL-10 compared to those with responsive TLR1/6 genotypes. In contrast, no IL-12p70 was secreted by PBMCs or monocytes. These data support a mechanism where TLR1/6 polymorphisms modulate TH1 T-cell polarization through genetic regulation of monocyte IL-10 secretion in the absence of IL-12. These studies provide evidence that functionally defined innate immune gene variants are associated with the development of adaptive immune responses after in vivo vaccination against a bacterial pathogen in humans. These findings could potentially guide novel adjuvant vaccine strategies as well as have implications for IFN-γ-based diagnostic testing for TB. Tuberculosis (TB) is one of the leading infectious causes of death worldwide. The current vaccine for TB, BCG, is widely used but it is not highly effective in preventing disease. We investigated the role of host genetics in the immune response to BCG vaccination. We found that variants of innate immunity genes (TLR1 and TLR6) were associated with BCG-induced immune responses after vaccination. These findings may guide new strategies for vaccine development as well as diagnosis of TB.
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Affiliation(s)
- April Kaur Randhawa
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Muki S. Shey
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, South Africa
| | - Alana Keyser
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, South Africa
| | - Blas Peixoto
- Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, United States of America
| | - Richard D. Wells
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Marwou de Kock
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, South Africa
| | - Lesedi Lerumo
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, South Africa
| | - Jane Hughes
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, South Africa
| | - Gregory Hussey
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, South Africa
| | - Anthony Hawkridge
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, South Africa
| | - Gilla Kaplan
- Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, United States of America
| | - Willem A. Hanekom
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, South Africa
| | - Thomas R. Hawn
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States of America
- * E-mail:
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Mulenga H, Moyo S, Workman L, Hawkridge T, Verver S, Tameris M, Geldenhuys H, Hanekom W, Mahomed H, Hussey G, Hatherill M. Phenotypic variability in childhood TB: Implications for diagnostic endpoints in tuberculosis vaccine trials. Vaccine 2011; 29:4316-21. [DOI: 10.1016/j.vaccine.2011.04.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 03/15/2011] [Accepted: 04/05/2011] [Indexed: 11/15/2022]
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21
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Gibbs D, Brown M, Hussey G, Naylor A. The Ectatic Aorta: No Benefit in Surveillance. J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Kagina BMN, Abel B, Scriba TJ, Hughes EJ, Keyser A, Soares A, Gamieldien H, Sidibana M, Hatherill M, Gelderbloem S, Mahomed H, Hawkridge A, Hussey G, Kaplan G, Hanekom WA. Specific T cell frequency and cytokine expression profile do not correlate with protection against tuberculosis after bacillus Calmette-Guérin vaccination of newborns. Am J Respir Crit Care Med 2010; 182:1073-9. [PMID: 20558627 PMCID: PMC2970848 DOI: 10.1164/rccm.201003-0334oc] [Citation(s) in RCA: 317] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 06/16/2010] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Immunogenicity of new tuberculosis (TB) vaccines is commonly assessed by measuring the frequency and cytokine expression profile of T cells. OBJECTIVES We tested whether this outcome correlates with protection against childhood TB disease after newborn vaccination with bacillus Calmette-Guérin (BCG). METHODS Whole blood from 10-week-old infants, routinely vaccinated with BCG at birth, was incubated with BCG for 12 hours, followed by cryopreservation for intracellular cytokine analysis. Infants were followed for 2 years to identify those who developed culture-positive TB-these infants were regarded as not protected against TB. Infants who did not develop TB disease despite exposure to TB in the household, and another group of randomly selected infants who were never evaluated for TB, were also identified-these groups were regarded as protected against TB. Cells from these groups were thawed, and CD4, CD8, and γδ T cell-specific expression of IFN-γ, TNF-α, IL-2, and IL-17 measured by flow cytometry. MEASUREMENTS AND MAIN RESULTS A total of 5,662 infants were enrolled; 29 unprotected and two groups of 55 protected infants were identified. There was no difference in frequencies of BCG-specific CD4, CD8, and γδ T cells between the three groups of infants. Although BCG induced complex patterns of intracellular cytokine expression, there were no differences between protected and unprotected infants. CONCLUSIONS The frequency and cytokine profile of mycobacteria-specific T cells did not correlate with protection against TB. Critical components of immunity against Mycobacterium tuberculosis, such as CD4 T cell IFN-γ production, may not necessarily translate into immune correlates of protection against TB disease.
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Affiliation(s)
- Benjamin M. N. Kagina
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; Aeras Global Tuberculosis Vaccine Foundation, Rockville, Maryland; and Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
| | - Brian Abel
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; Aeras Global Tuberculosis Vaccine Foundation, Rockville, Maryland; and Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
| | - Thomas J. Scriba
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; Aeras Global Tuberculosis Vaccine Foundation, Rockville, Maryland; and Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
| | - Elizabeth J. Hughes
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; Aeras Global Tuberculosis Vaccine Foundation, Rockville, Maryland; and Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
| | - Alana Keyser
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; Aeras Global Tuberculosis Vaccine Foundation, Rockville, Maryland; and Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
| | - Andreia Soares
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; Aeras Global Tuberculosis Vaccine Foundation, Rockville, Maryland; and Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
| | - Hoyam Gamieldien
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; Aeras Global Tuberculosis Vaccine Foundation, Rockville, Maryland; and Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
| | - Mzwandile Sidibana
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; Aeras Global Tuberculosis Vaccine Foundation, Rockville, Maryland; and Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
| | - Mark Hatherill
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; Aeras Global Tuberculosis Vaccine Foundation, Rockville, Maryland; and Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
| | - Sebastian Gelderbloem
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; Aeras Global Tuberculosis Vaccine Foundation, Rockville, Maryland; and Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
| | - Hassan Mahomed
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; Aeras Global Tuberculosis Vaccine Foundation, Rockville, Maryland; and Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
| | - Anthony Hawkridge
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; Aeras Global Tuberculosis Vaccine Foundation, Rockville, Maryland; and Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
| | - Gregory Hussey
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; Aeras Global Tuberculosis Vaccine Foundation, Rockville, Maryland; and Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
| | - Gilla Kaplan
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; Aeras Global Tuberculosis Vaccine Foundation, Rockville, Maryland; and Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
| | - Willem A. Hanekom
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine and School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; Aeras Global Tuberculosis Vaccine Foundation, Rockville, Maryland; and Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
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Abstract
New vaccines are urgently needed if we want to reach the goal of substantially reducing the incidence of tuberculosis by 2050. Despite a steady increase in funding over the past decade, there is still a striking financial shortfall for vaccine research and development for tuberculosis. Yet, around ten vaccine candidates have left the laboratory stage and entered clinical trials. These vaccines are either aimed at replacing the present vaccine, BCG, or at enhancing immunity induced by BCG. However, these pre-exposure candidates are designed for prevention of disease and will therefore neither eradicate the pathogen, nor prevent stable infection. Long-term vaccination strategies need to target these more ambitious goals. Even though vaccine development will have a price, the return of investment will greatly exceed original costs.
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Affiliation(s)
- Stefan H E Kaufmann
- Department of Immunology, Max Planck Institute for Infection Biology, Berlin, Germany.
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Zipursky S, Wiysonge CS, Hussey G. Knowledge and attitudes towards vaccines and immunization among adolescents in South Africa. Hum Vaccin 2010; 6:455-61. [PMID: 20543585 DOI: 10.4161/hv.6.6.11660] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Despite evidence showing their benefits, routine adolescent immunization programmes are still lacking across Africa. In 2008 we conducted a qualitative study of adolescents' knowledge and attitudes towards immunization in a peri-urban community in South Africa. Results show that while vaccination as a concept is acceptable amongst adolescents, low levels of knowledge about vaccines, the process of being vaccinated, as well as unfamiliarity with the concept of preventative medicine in general will likely hinder achieving high and equitable routine adolescent immunization coverage. Effective educational programs and integrated adolescent healthcare strategies will be critical to delivering successful immunization services to this group.
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Affiliation(s)
- Simona Zipursky
- Department of Public Health, University of Oxford, Oxford, UK
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Shey MS, Randhawa AK, Bowmaker M, Smith E, Scriba TJ, de Kock M, Mahomed H, Hussey G, Hawn TR, Hanekom WA. Single nucleotide polymorphisms in toll-like receptor 6 are associated with altered lipopeptide- and mycobacteria-induced interleukin-6 secretion. Genes Immun 2010; 11:561-72. [PMID: 20445564 PMCID: PMC3518443 DOI: 10.1038/gene.2010.14] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Toll-like receptors (TLRs) are critical mediators of the immune response to pathogens. The influence of human TLR6 polymorphisms on susceptibility to infection is only partially understood. Most microbes contain lipopeptides recognized by TLR2/1 or TLR2/6 heterodimers. Our aim was to determine whether single nucleotide polymorphisms (SNPs) in TLR6 are associated with altered immune responses to lipopeptides and whole mycobacteria. We sequenced the TLR6 coding region in 100 healthy South African adults to assess genetic variation and determined associations between polymorphisms and lipopeptide- and mycobacteria-induced IL-6 production in whole blood. We found 2 polymorphisms, C745T and G1083C that were associated with altered IL-6 secretion. G1083C was associated with altered IL-6 levels in response to lipopeptides, Mycobacterium tuberculosis lysate (Mtb, P = 0.018) and BCG (P = 0.039). The 745T allele was also associated with lower NF-κB signaling in response to di-acylated lipopeptide, PAM2 (P = 0.019) or Mtb (P = 0.026) in a HEK293 cell line reconstitution assay, compared with the 745C allele. We conclude that TLR6 polymorphisms may be associated with altered lipopeptide-induced cytokine responses and recognition of Mtb. These studies provide new insight into the role of TLR6 variation and the innate immune response to human infection.
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Affiliation(s)
- M S Shey
- South African Tuberculosis Vaccine Initiative, University of Cape Town, South Africa
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26
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Cilliers K, Labadarios D, Schaaf HS, Willemse M, Maritz JS, Werely CJ, Hussey G, Donald PR. Pyridoxal-5-phosphate plasma concentrations in children receiving tuberculosis chemotherapy including isoniazid. Acta Paediatr 2010; 99:705-710. [PMID: 20146723 DOI: 10.1111/j.1651-2227.2010.01696.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Little is known about pyridoxine nutriture of children treated with isoniazid (INH) regimens. This study documents plasma pyridoxal 5'-phosphate (PLP) concentrations in children, HIV-infected and HIV-uninfected, receiving INH regimens. METHODS Children from the Western Cape of South Africa hospitalized for tuberculosis (TB) management were studied. Plasma PLP concentrations were determined on enrolment, 1-month after commencing TB treatment, and again after 4-month's treatment. The children received a supplement meeting pyridoxine requirements. RESULTS Nineteen HIV-infected and 33 HIV-uninfected children received INH (dosage range 4-20 mg/kg) daily. Mean PLP plasma concentrations on enrolment were 8.32 (SD 6.75) ng/mL and 11.28 (SD 3.02) ng/mL in HIV-infected and HIV-uninfected children, respectively (p = 0.11) and after 4-month's treatment 6.75 (SD 2.71) ng/mL and 14.76 (SD 7.96) ng/mL (p < 0.001). On enrolment 9 (50%) HIV-infected and 5 (15%) HIV-uninfected children (p = 0.016) had suboptimal PLP concentrations (<6 ng/mL); after 4-month's treatment 8 (42%) and 2 (6%) (p = 0.004). CONCLUSION Plasma PLP concentrations in children treated for TB were low on enrolment in HIV-infected and HIV-uninfected children; after 4-month's treatment low values were still common in HIV-infected children. Additional pyridoxine supplementation of malnourished children treated for tuberculosis is advisable, particularly those HIV-infected.
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Affiliation(s)
- K Cilliers
- Department of Human Nutrition, Faculty of Health Sciences, Stellenbosch University, Tygerberg 7505, South AfricaHuman Sciences Research Council, Knowledge Systems, Cape Town, South AfricaDepartment of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Tygerberg, South AfricaBiostatistics Unit of the South African Medical Research Council, Cape Town, South AfricaDivision of Molecular Biology and Human Genetics and the MRC Centre for Molecular and Cellular Biology, DST/NRF Centre of Excellence for Biomedical TB Research, Faculty of Health Sciences, Stellenbosch University, Tygerberg 7505, South AfricaInstitute of Infectious Diseases and Molecular Medicine, University of Cape Town, Rondebosch 7701, South Africa
| | - D Labadarios
- Department of Human Nutrition, Faculty of Health Sciences, Stellenbosch University, Tygerberg 7505, South AfricaHuman Sciences Research Council, Knowledge Systems, Cape Town, South AfricaDepartment of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Tygerberg, South AfricaBiostatistics Unit of the South African Medical Research Council, Cape Town, South AfricaDivision of Molecular Biology and Human Genetics and the MRC Centre for Molecular and Cellular Biology, DST/NRF Centre of Excellence for Biomedical TB Research, Faculty of Health Sciences, Stellenbosch University, Tygerberg 7505, South AfricaInstitute of Infectious Diseases and Molecular Medicine, University of Cape Town, Rondebosch 7701, South Africa
| | - H S Schaaf
- Department of Human Nutrition, Faculty of Health Sciences, Stellenbosch University, Tygerberg 7505, South AfricaHuman Sciences Research Council, Knowledge Systems, Cape Town, South AfricaDepartment of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Tygerberg, South AfricaBiostatistics Unit of the South African Medical Research Council, Cape Town, South AfricaDivision of Molecular Biology and Human Genetics and the MRC Centre for Molecular and Cellular Biology, DST/NRF Centre of Excellence for Biomedical TB Research, Faculty of Health Sciences, Stellenbosch University, Tygerberg 7505, South AfricaInstitute of Infectious Diseases and Molecular Medicine, University of Cape Town, Rondebosch 7701, South Africa
| | - M Willemse
- Department of Human Nutrition, Faculty of Health Sciences, Stellenbosch University, Tygerberg 7505, South AfricaHuman Sciences Research Council, Knowledge Systems, Cape Town, South AfricaDepartment of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Tygerberg, South AfricaBiostatistics Unit of the South African Medical Research Council, Cape Town, South AfricaDivision of Molecular Biology and Human Genetics and the MRC Centre for Molecular and Cellular Biology, DST/NRF Centre of Excellence for Biomedical TB Research, Faculty of Health Sciences, Stellenbosch University, Tygerberg 7505, South AfricaInstitute of Infectious Diseases and Molecular Medicine, University of Cape Town, Rondebosch 7701, South Africa
| | - J S Maritz
- Department of Human Nutrition, Faculty of Health Sciences, Stellenbosch University, Tygerberg 7505, South AfricaHuman Sciences Research Council, Knowledge Systems, Cape Town, South AfricaDepartment of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Tygerberg, South AfricaBiostatistics Unit of the South African Medical Research Council, Cape Town, South AfricaDivision of Molecular Biology and Human Genetics and the MRC Centre for Molecular and Cellular Biology, DST/NRF Centre of Excellence for Biomedical TB Research, Faculty of Health Sciences, Stellenbosch University, Tygerberg 7505, South AfricaInstitute of Infectious Diseases and Molecular Medicine, University of Cape Town, Rondebosch 7701, South Africa
| | - C J Werely
- Department of Human Nutrition, Faculty of Health Sciences, Stellenbosch University, Tygerberg 7505, South AfricaHuman Sciences Research Council, Knowledge Systems, Cape Town, South AfricaDepartment of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Tygerberg, South AfricaBiostatistics Unit of the South African Medical Research Council, Cape Town, South AfricaDivision of Molecular Biology and Human Genetics and the MRC Centre for Molecular and Cellular Biology, DST/NRF Centre of Excellence for Biomedical TB Research, Faculty of Health Sciences, Stellenbosch University, Tygerberg 7505, South AfricaInstitute of Infectious Diseases and Molecular Medicine, University of Cape Town, Rondebosch 7701, South Africa
| | - G Hussey
- Department of Human Nutrition, Faculty of Health Sciences, Stellenbosch University, Tygerberg 7505, South AfricaHuman Sciences Research Council, Knowledge Systems, Cape Town, South AfricaDepartment of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Tygerberg, South AfricaBiostatistics Unit of the South African Medical Research Council, Cape Town, South AfricaDivision of Molecular Biology and Human Genetics and the MRC Centre for Molecular and Cellular Biology, DST/NRF Centre of Excellence for Biomedical TB Research, Faculty of Health Sciences, Stellenbosch University, Tygerberg 7505, South AfricaInstitute of Infectious Diseases and Molecular Medicine, University of Cape Town, Rondebosch 7701, South Africa
| | - P R Donald
- Department of Human Nutrition, Faculty of Health Sciences, Stellenbosch University, Tygerberg 7505, South AfricaHuman Sciences Research Council, Knowledge Systems, Cape Town, South AfricaDepartment of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Tygerberg, South AfricaBiostatistics Unit of the South African Medical Research Council, Cape Town, South AfricaDivision of Molecular Biology and Human Genetics and the MRC Centre for Molecular and Cellular Biology, DST/NRF Centre of Excellence for Biomedical TB Research, Faculty of Health Sciences, Stellenbosch University, Tygerberg 7505, South AfricaInstitute of Infectious Diseases and Molecular Medicine, University of Cape Town, Rondebosch 7701, South Africa
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Moyo S, Verver S, Mahomed H, Hawkridge A, Kibel M, Hatherill M, Tameris M, Geldenhuys H, Hanekom W, Hussey G. Age-related tuberculosis incidence and severity in children under 5 years of age in Cape Town, South Africa. Int J Tuberc Lung Dis 2010; 14:149-154. [PMID: 20074404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
SETTING Limited data are available on the characteristics of tuberculosis (TB) disease in young children, especially in high-burden countries. OBJECTIVE To assess the incidence and severity of TB in children aged <5 years. METHODS TB records and chest radiographs of children born in Cape Town in 1999 and diagnosed with TB between 1999 and 2004 were reviewed retrospectively. RESULTS A total of 1607 cases were registered. The cumulative incidence of definite (bacteriologically confirmed) and probable (radiological evidence and > or =1 TB clinical feature) TB in children aged <5 years was 2.9% and was highest between the ages of 12 and 23 months. Of 1233 children with definite or probable TB, 506 (41%) had severe disease (dissemination, cavities or >1 lobe involved). The under 5 years incidence of disseminated TB was 0.33%. Of 239 (15%) cases that were bacteriologically confirmed, clinical features typical of TB disease were individually present in <60%. The most common combined symptoms were cough for >2 weeks and weight loss, occurring in 43/239 (18%). CONCLUSION TB incidence was high, and peaked in children aged 12-23 months. Many children experienced severe disease. A fifth of children with microbiologically confirmed disease presented with only one feature typically associated with TB.
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Affiliation(s)
- S Moyo
- South African Tuberculosis Vaccine Initiative, University of Cape Town, Cape Town, South Africa.
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Hatherill M, Hanslo M, Hawkridge T, Little F, Workman L, Mahomed H, Tameris M, Moyo S, Geldenhuys H, Hanekom W, Geiter L, Hussey G. Structured approaches for the screening and diagnosis of childhood tuberculosis in a high prevalence region of South Africa. Bull World Health Organ 2009; 88:312-20. [PMID: 20431796 DOI: 10.2471/blt.09.062893] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 09/11/2009] [Accepted: 10/07/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To measure agreement between nine structured approaches for diagnosing childhood tuberculosis; to quantify differences in the number of tuberculosis cases diagnosed with the different approaches, and to determine the distribution of cases in different categories of diagnostic certainty. METHODS We investigated 1445 children aged < 2 years during a vaccine trial (2001-2006) in a rural South African community. Clinical, radiological and microbiological data were collected prospectively. Tuberculosis case status was determined using each of the nine diagnostic approaches. We calculated differences in case frequency and categorical agreement for binary (tuberculosis/not tuberculosis) outcomes using McNemar's test (with 95% confidence intervals, CIs) and Cohen's kappa coefficient (Kappa). FINDINGS Tuberculosis case frequency ranged from 6.9% to 89.2% (median: 41.7). Significant differences in case frequency (P < 0.05) occurred in 34 of the 36 pair-wise comparisons between structured diagnostic approaches (range of absolute differences: 1.5-82.3%). Kappa ranged from 0.02 to 0.71 (median: 0.18). The two systems that yielded the highest case frequencies (89.2% and 70.0%) showed fair agreement (Kappa: 0.33); the two that yielded the lowest case frequencies (6.9% and 10.0%) showed slight agreement (Kappa: 0.18). CONCLUSION There is only slight agreement between structured approaches for the screening and diagnosis of childhood tuberculosis and high variability between them in terms of case yield. Diagnostic systems that yield similarly low case frequencies may be identifying different subpopulations of children. The study findings do not support the routine clinical use of structured approaches for the definitive diagnosis of childhood tuberculosis, although high-yielding systems may be useful screening tools.
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Affiliation(s)
- Mark Hatherill
- School of Child and Adolescent Health, University of Cape Town, Anzio Road, Cape Town, 7925, South Africa.
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Affiliation(s)
- A Tomkins
- Clinical Nutrition Unit, Centre for Human Nutrition, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT
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Salem M, Rayt H, Hussey G, Rafelt S, Nelson C, Sayers R, Naylor A, Nasim A. Should Asian Men be Included in Abdominal Aortic Aneurysm Screening Programmes? Eur J Vasc Endovasc Surg 2009; 38:748-9. [DOI: 10.1016/j.ejvs.2009.07.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 07/21/2009] [Indexed: 10/20/2022]
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Nqoko BS, Day C, Mansoor N, de Kock M, Hughes J, Hussey G, Hanekom W. P16-05. Upregulation of PD-1 and CTLA-4 on HIV-specific T cells in HIV-infected infants. Retrovirology 2009. [PMCID: PMC2767731 DOI: 10.1186/1742-4690-6-s3-p234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Hatherill M, Adams V, Hughes J, De Kock M, Mavakla W, Pienaar B, Mahomed H, Hussey G, Hanekom WA. The potential impact of helminth infection on trials of novel tuberculosis vaccines. Vaccine 2009; 27:4743-4. [DOI: 10.1016/j.vaccine.2009.05.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 05/08/2009] [Indexed: 10/20/2022]
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Wiysonge CS, Waggie Z, Rhoda L, Hussey G. Vaccines for Africa (VACFA) website--an innovative immunisation advocacy tool. S Afr Med J 2009; 99:275. [PMID: 19588779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
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Wiysonge CS, Waggie Z, Rhoda L, Hussey G. Improving communication for immunisation in Africa: contribution of the Vaccines for Africa website. Pan Afr Med J 2009; 2:3. [PMID: 21532899 PMCID: PMC2984270] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 04/12/2009] [Indexed: 10/24/2022] Open
Abstract
ABOUT THE AUTHORS: C. Wiysonge is a medical epidemiologist and Vaccinology Programme Manager at the Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa. He previously worked for the Expanded Programme on Immunisation in Cameroon and has been a consultant on vaccines and immunisation for WHO and the GAVI Alliance. Z. Waggie is a Paediatrician and Senior Clinical Research Officer at the Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa. L. Rhoda is a communications specialist and Communications Manager at the South African Tuberculosis Vaccine Initiative, University of Cape Town, South Africa. G. Hussey is a Paediatric Infectious Diseases Clinical Specialist and Professor of Child and Adolescent Health, Director of the Institute of Infectious Disease and Molecular Medicine, and Director of the South African Tuberculosis Vaccine Initiative, University of Cape Town, South Africa. He has been a WHO part-time consultant on vaccines and immunisation for the past 10 years.
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Affiliation(s)
- Charles Shey Wiysonge
- School of Child and Adolescent Health and Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
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Hatherill M, Hawkridge T, Zar HJ, Whitelaw A, Tameris M, Workman L, Geiter L, Hanekom WA, Hussey G. Induced sputum or gastric lavage for community-based diagnosis of childhood pulmonary tuberculosis? Arch Dis Child 2009; 94:195-201. [PMID: 18829621 DOI: 10.1136/adc.2007.136929] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [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: 11/04/2022]
Abstract
OBJECTIVES To compare the diagnostic yield of Mycobacterium tuberculosis from induced sputum (IS) and gastric lavage (GL) among children in a community setting. METHODS Specimen-collection methods for bacteriological confirmation of pulmonary tuberculosis (PTB) were compared during a tuberculosis vaccine trial near Cape Town, South Africa (2001-2006). Children with a tuberculosis contact or compatible symptoms were investigated for suspected PTB. Diagnostic yields from 764 paired IS and GL specimens were compared in 191 culture-confirmed cases. MEASUREMENTS AND MAIN RESULTS The crude yield of M tuberculosis was 10.4%, n = 108 by IS (5.8%) and n = 127 by GL (6.8%), from a total of 194 cases, of which three had incomplete IS/GL specimen pairs. Agreement between IS and GL was poor (kappa = 0.31). The comparative yield of a single IS sample (38%) was equivalent to a single GL sample (42%), with a difference in yield of -4% (95% CI -15% to +7%). The combined yield of same-day IS and GL specimens (67%) was equivalent to two consecutive GL specimens (66%), with a difference in yield of 1% (95% CI -9% to 11%), but significantly greater than two consecutive IS specimens (55%), with a difference in yield of 12% (95% CI 2% to 21%). The adjusted odds of a M tuberculosis culture were increased by a positive tuberculin skin test or chest radiograph compatible with PTB. CONCLUSIONS In this community setting, the diagnostic yield of a single IS sample was equivalent to that of a single GL sample. The optimal diagnostic yield may be obtained from paired IS and GL specimens taken on a single day or two GL specimens taken on consecutive days.
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Affiliation(s)
- M Hatherill
- South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine (IIDMM), University of Cape Town, Cape Town, South Africa.
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Nicol MP, Davies MA, Wood K, Hatherill M, Workman L, Hawkridge A, Eley B, Wilkinson KA, Wilkinson RJ, Hanekom WA, Beatty D, Hussey G. Comparison of T-SPOT.TB assay and tuberculin skin test for the evaluation of young children at high risk for tuberculosis in a community setting. Pediatrics 2009; 123:38-43. [PMID: 19117858 DOI: 10.1542/peds.2008-0611] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [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: 11/24/2022] Open
Abstract
OBJECTIVE We wished to compare the sensitivity of an enzyme-linked immunospot assay (T-SPOT.TB; Oxford Immunotec, Oxford, United Kingdom) and the tuberculin skin test for the detection of tuberculosis infection in very young children being evaluated for active tuberculosis in a rural community setting. METHODS Children with a history of exposure to tuberculosis and children presenting to a local clinic or hospital with symptoms suggesting tuberculosis were admitted to a dedicated case verification ward. T-SPOT.TB testing was performed, and children were evaluated with a clinical examination, a tuberculin skin test, chest radiographs, and cultures of induced sputum and gastric lavage specimens. The diagnosis was determined by using a clinical algorithm. RESULTS A total of 243 children (median age: 18 months) were recruited, of whom 214 (88%) had interpretable T-SPOT.TB results. Children > or =12 months of age were more likely than younger children to have positive T-SPOT.TB results, whereas tuberculin skin test results were unaffected by age. The sensitivity of the T-SPOT.TB was no better than that of the tuberculin skin test for culture-confirmed tuberculosis (50% and 80%, respectively) and was poorer for the combined group of culture-confirmed and clinically probable tuberculosis (40% and 52%, respectively). For the 50 children clinically categorized as not having tuberculosis, the specificity of both the T-SPOT.TB and the tuberculin skin test was 84%. CONCLUSIONS For young children presenting in a community setting after exposure to tuberculosis or with symptoms suggesting tuberculosis, T-SPOT.TB cannot be used to exclude active disease. The sensitivity of this assay may be impaired for very young children.
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Affiliation(s)
- Mark P Nicol
- School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
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Abel B, Mansoor N, Scriba T, Tameris M, De Kock M, Hawkridge A, Boom H, Kaplan G, Hussey G, Hanekom W. Dramatically Impaired BCG‐specific Immune Response in HIV+ Infants. FASEB J 2008. [DOI: 10.1096/fasebj.22.2_supplement.496] [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: 11/11/2022]
Affiliation(s)
- Brian Abel
- South African Tuberculosis Vaccine InitiativeUniversity of Cape TownCape TownSouth Africa
| | - Nazma Mansoor
- South African Tuberculosis Vaccine InitiativeUniversity of Cape TownCape TownSouth Africa
| | - Thomas Scriba
- South African Tuberculosis Vaccine InitiativeUniversity of Cape TownCape TownSouth Africa
| | - Michelle Tameris
- South African Tuberculosis Vaccine InitiativeUniversity of Cape TownCape TownSouth Africa
| | - Marwou De Kock
- South African Tuberculosis Vaccine InitiativeUniversity of Cape TownCape TownSouth Africa
| | - Anthony Hawkridge
- South African Tuberculosis Vaccine InitiativeUniversity of Cape TownCape TownSouth Africa
- Aeras Global Tuberculosis Vaccine FoundationCape TownSouth Africa
| | | | | | - Gregory Hussey
- South African Tuberculosis Vaccine InitiativeUniversity of Cape TownCape TownSouth Africa
| | - Willem Hanekom
- South African Tuberculosis Vaccine InitiativeUniversity of Cape TownCape TownSouth Africa
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Afoakwa E, Badham J, Blaauw R, Bourne L, Conradie N, Cooper P, Dannhauser A, Downs J, Faber M, Gericke G, Hanekom S, Hattingh Z, Hendricks M, Herselman M, Hussey G, Jerling J, Jooste P, Kinabo J, Kogi-Makau W, Kruger S, Kunneke E, Labuschagne I, MacIntyre U, Marais D, Marais M, Matji J, Maunder E, Muhammed Dhansay A, Naudé C, Norris S, Pettifor J, Saloojee H, Schaaf H, Schonfeldt H, Senekal M, Smalberger R, Smith A, Smuts M, Steenkamp L, Steyn N, Swart R, Van der Spuy D, Van Graan A, Van Jaarsveld P, Van Stuijvenberg M, Venter C, Venter I, Visser J, Vorster E, Walsh C, Wenhold F, Wentzel-Viljoen E, Wolmarans P. Editor’s Note. South African Journal of Clinical Nutrition 2008. [DOI: 10.1080/16070658.2008.11734170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hussey G. Prospects for new tuberculosis vaccines. S Afr Med J 2007; 97:1001-1002. [PMID: 18000591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Affiliation(s)
- Gregory Hussey
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town.
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Abstract
The world is witnessing an escalation of the tuberculosis (TB) epidemic, particularly in sub-Saharan Africa and South-East Asia. The problem has been compounded by the evolution of the human immunodeficiency virus pandemic, the increase in multidrug-resistant TB and the emergence of extensively drug-resistant TB. This has led to renewed interest in vaccines aimed at preventing tuberculosis. The current Bacille Calmette-Guérin (BCG) vaccine prevents the invasive complications of childhood tuberculosis, such as meningitis and miliary disease, but provides variable protection against adult pulmonary disease. This review discusses the history of the BCG vaccine, the reasons for its variable efficacy, protective immunity and TB, and the evolution of and obstacles to development of new candidate vaccines. Several new TB vaccines have demonstrated promising results in animal models; a number have gone into phase I clinical trials in humans, and it is anticipated that phase III trials will commence by 2009. Licensing of an effective new TB vaccine by 2015 is thus a possibility.
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Affiliation(s)
- Gregory Hussey
- South African Tuberculosis Vaccine Initiative, University of Cape Town, Anzio Road, Observatory, 7925, South Africa.
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Abstract
BACKGROUND Haemophilus influenzae (H. influenzae) is an important cause of meningitis and pneumonia in children. Vaccine cost is a significant barrier to use in low income countries. Determining the size of the effects of the vaccine will enable cost-effectiveness comparisons with competing priorities in low income countries. OBJECTIVES 1. To determine the effects of conjugate Hib vaccine in preventing Hib disease or death in children under five years of age.2. To determine any variation in effect with type of vaccine, number of doses, age at first dose, in children with known HIV infection, or in high and low income countries.3. To determine any serious adverse outcomes. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2006); MEDLINE (January 1966 to December 2006); EMBASE (1990 to June 2006) and scanned reference lists and contacting of authors of trial reports. Reports in all languages were considered. SELECTION CRITERIA All randomised controlled trials (RCTs) or quasi-RCTs of conjugate H. influenzae type b vaccines compared with placebo or no treatment in children who were followed until at least two years of age. DATA COLLECTION AND ANALYSIS Two review authors independently selected eligible studies and extracted data. MAIN RESULTS Six studies were included in the review, and four in the meta-analyses. The overall quality of the trials was good. The relative risk for invasive Hib disease was 0.20 (95% confidence interval (CI) 0.07 to 0.54; random-effects model), but there was statistically significant unexplained variation (heterogeneity) in the effects of the four trials in the meta-analysis (P = 0.002). The size of the effects did not appear to differ consistently with different vaccine types, the number of vaccine doses, age at first vaccination or use in high income versus low income countries, but the CIs for the effect estimates were wide. Hib-related mortality data showed a non-significant trend towards benefit (relative risk was 0.29; 95% CI 0.07 to 1.20; random-effects model). The relative risk for all cause mortality in the two trials from which data were available were 1.01 (95% CI 0.38 to 2.67, random-effects model) and 0.97. No serious adverse effects were reported in any of the trials. AUTHORS' CONCLUSIONS Hib vaccine is safe and effective. In resource-poor settings, decisions to use the vaccine will depend on its cost, the local burden of Hib disease and competing priorities.
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Affiliation(s)
- G Swingler
- University of Cape Town, ICH Building, Red Cross Childlren's Hospital, School of Child and Adolescent Health, Klipfontein Road, Rondebosch, Cape Town, South Africa 7700.
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Cowburn C, Hatherill M, Eley B, Nuttall J, Hussey G, Reynolds L, Waggie Z, Vivian L, Argent A. Short-term mortality and implementation of antiretroviral treatment for critically ill HIV-infected children in a developing country. Arch Dis Child 2007; 92:234-41. [PMID: 16670122 PMCID: PMC2083402 DOI: 10.1136/adc.2005.074856] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the short-term outcome of critically ill HIV-infected children with access to highly active antiretroviral therapy (HAART) in a developing region. METHODS Prospective observational study conducted in a paediatric teaching hospital in Cape Town, South Africa. All children admitted to the paediatric intensive care unit (PICU) with suspected HIV infection were screened. Data are n (%) with 95% confidence intervals. RESULTS Sixty eight of 96 HIV antibody-positive children, median age 3 months, were confirmed HIV-infected. Predicted PICU mortality was 0.42. Fifty one children (75%; 95% CI 65 to 85%) survived to PICU discharge, but hospital survival was only 51% (95% CI 40 to 63%). Limitation of intervention (LOI) decisions were a factor in the majority of PICU and ward deaths. Twenty one PICU survivors (31%; 95% CI 20 to 42%) commenced HAART, and two children were already on treatment. Nineteen children (28%) were considered to be established on HAART after 1 month. Thirteen HIV-infected children (19%; 95% CI 10 to 28%), representing 25% (95% CI 14 to 37%) of all PICU survivors, and 68% (95% CI 48 to 89%) of those PICU survivors who were established on HAART remain well on treatment after median 350 days. CONCLUSION The majority of HIV-infected children survived to discharge from PICU, but only half survived to hospital discharge. LOI decisions, usually made in PICU, directly influenced short-term survival and the opportunity to commence HAART. Although few critically ill HIV-infected children survived to become established on HAART, the long-term outcome of children on HAART is encouraging and warrants further investigation.
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Affiliation(s)
- C Cowburn
- Infectious Diseases Clinic, Red Cross Children's Hospital and University of Cape Town, Cape Town, South Africa.
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Zar HJ, Cotton MF, Strauss S, Karpakis J, Hussey G, Schaaf HS, Rabie H, Lombard CJ. Effect of isoniazid prophylaxis on mortality and incidence of tuberculosis in children with HIV: randomised controlled trial. BMJ 2007; 334:136. [PMID: 17085459 PMCID: PMC1779846 DOI: 10.1136/bmj.39000.486400.55] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2006] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To investigate the impact of isoniazid prophylaxis on mortality and incidence of tuberculosis in children with HIV. DESIGN Two centre prospective double blind placebo controlled trial. PARTICIPANTS Children aged > or =8 weeks with HIV. INTERVENTIONS Isoniazid or placebo given with co-trimoxazole either daily or three times a week. SETTING Two tertiary healthcare centres in South Africa. MAIN OUTCOME MEASURES Mortality, incidence of tuberculosis, and adverse events. RESULTS Data on 263 children (median age 24.7 months) were available when the data safety monitoring board recommended discontinuing the placebo arm; 132 (50%) were taking isoniazid. Median follow-up was 5.7 (interquartile range 2.0-9.7) months. Mortality was lower in the isoniazid group than in the placebo group (11 (8%) v 21 (16%), hazard ratio 0.46, 95% confidence interval 0.22 to 0.95, P=0.015) by intention to treat analysis. The benefit applied across Centers for Disease Control clinical categories and in all ages. The reduction in mortality was similar in children on three times a week or daily isoniazid. The incidence of tuberculosis was lower in the isoniazid group (5 cases, 3.8%) than in the placebo group (13 cases, 9.9%) (hazard ratio 0.28, 0.10 to 0.78, P=0.005). All cases of tuberculosis confirmed by culture were in children in the placebo group. CONCLUSIONS Prophylaxis with isoniazid has an early survival benefit and reduces incidence of tuberculosis in children with HIV. Prophylaxis may offer an effective public health intervention to reduce mortality in such children in settings with a high prevalence of tuberculosis. TRIAL REGISTRATION Clinical Trials NCT00330304.
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Affiliation(s)
- Heather J Zar
- School of Child and Adolescent Health, Red Cross Children's Hospital, University of Cape Town, South Africa.
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Hatherill M, Hawkridge T, Whitelaw A, Tameris M, Mahomed H, Moyo S, Hanekom W, Hussey G. Isolation of non-tuberculous mycobacteria in children investigated for pulmonary tuberculosis. PLoS One 2006; 1:e21. [PMID: 17183648 PMCID: PMC1762386 DOI: 10.1371/journal.pone.0000021] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Accepted: 09/18/2006] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the frequency and clinical significance of non-tuberculous mycobacteria (NTM) isolates among children investigated for pulmonary tuberculosis in a rural South African community. Methods Children were investigated for pulmonary tuberculosis as part of a tuberculosis vaccine surveillance program (2001–2005). The clinical features of children in whom NTM were isolated, from induced sputum or gastric lavage, were compared to those with culture-proven M. tuberculosis. Results Mycobacterial culture demonstrated 114 NTM isolates from 109 of the 1,732 children investigated, a crude yield of 6% (95% CI 5–7). The comparative yield of positive NTM cultures from gastric lavage was 40% (95% CI 31–50), compared to 67% (95% CI 58–76) from induced sputum. 95% of children with NTM isolates were symptomatic. Two children were HIV-infected. By contrast, M. tuberculosis was isolated in 187 children, a crude yield of 11% (95% CI 9–12). Compared to those with culture-proven M. tuberculosis, children with NTM isolates were less likely to demonstrate acid-fast bacilli on direct smear microscopy (OR 0.19; 95% 0.0–0.76). Children with NTM were older (p<0.0001), and more likely to demonstrate constitutional symptoms (p = 0.001), including fever (p = 0.003) and loss of weight or failure to gain weight (p = 0.04), but less likely to demonstrate a strongly positive tuberculin skin test (p<0.0001) or radiological features consistent with pulmonary tuberculosis (p = 0.04). Discussion NTM were isolated in 6% of all children investigated for pulmonary tuberculosis and in more than one third of those with a positive mycobacterial culture. NTM may complicate the diagnosis of PTB in regions that lack capacity for mycobacterial species identification. The association of NTM isolates with constitutional symptoms suggestive of host recognition requires further investigation.
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Affiliation(s)
- Mark Hatherill
- South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa.
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Davids V, Hanekom W, Gelderbloem SJ, Hawkridge A, Hussey G, Sheperd R, Workman L, Soler J, Murray RA, Ress SR, Kaplan G. Dose-dependent immune response to Mycobacterium bovis BCG vaccination in neonates. Clin Vaccine Immunol 2006; 14:198-200. [PMID: 17182761 PMCID: PMC1797790 DOI: 10.1128/cvi.00309-06] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In 10-week-old infants vaccinated at birth with Japanese Mycobacterium bovis BCG, the number of dermal needle penetrations correlated positively with frequency of proliferating CD4(+) T cells in whole blood following BCG stimulation for 6 days but did not correlate with secreted cytokine levels after 7 h or interferon CD4(+) T-cell frequency after 12 h of BCG stimulation.
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Affiliation(s)
- Virginia Davids
- South African Tuberculosis Vaccine Initiative (SATVI), Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Zar HJ, Langdon G, Apolles P, Eley B, Hussey G, Smith P. Oral trimethoprim-sulphamethoxazole levels in stable HIV-infected children. S Afr Med J 2006; 96:627-9. [PMID: 16909188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Effective treatment of Pneumocystis jiroveci pneumonia (PCP) requires therapeutic serum concentrations of 5-10 microg/ml trimethoprim (TMP); consequently intravenous trimethoprim-sulphamethoxazole (TMP-SMZ) is recommended therapy. However, oral therapy is desirable as the intravenous route is costly, time-consuming, more difficult to administer and carries a risk of needlestick injury. OBJECTIVE To investigate whether therapeutic TMP levels for treatment of PCP can be attained with oral therapy in HIV-infected children. METHODS A prospective dose-escalation study was undertaken of serum TMP levels attained following oral doses of TMP of 5 mg/kg, 10 mg/kg or 20 mg/kg in stable HIV-infected children. Children who received a 20 mg/kg dose were randomised to get a second dose (5 or 10 mg/kg TMP) at 6 hours. TMP levels were measured at baseline, peak (3 hours), and trough (6 hours) using liquid chromatography. An additional TMP level was taken at 9 hours in those who received a second TMP dose. RESULTS Median (25th-75th percentile) peak serum TMP levels following a 5 mg/kg, 10 mg/kg or 20 mg/kg oral loading dose were 0.93 (0.5-1.5) microg/ml, 1.94 (1.4-2.2) microg/ml and 7.68 (6.1-7.8) microg/ml respectively. Peak TMP levels at 9 hours after a second TMP dose of 5 or 10 mg/kg were 6.98 (3.4-8.8) microg/ml and 9.25 (8.2-10.3) microg/ml respectively. CONCLUSION Therapeutic concentrations of TMP for treatment of P. jiroveci can be attained with an oral loading dose of 20 mg/kg and sustained with a second dose at 6 hours of either 5 mg or 10 mg/kg in stable HIV-infected children.
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Affiliation(s)
- Heather J Zar
- School of Child and Adolescent Health, Red Cross War Memorial Children's Hospital, Cape Town.
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Zar HJ, Hanslo D, Apolles P, Swingler G, Hussey G. Induced sputum versus gastric lavage for microbiological confirmation of pulmonary tuberculosis in infants and young children: a prospective study. Lancet 2005; 365:130-4. [PMID: 15639294 DOI: 10.1016/s0140-6736(05)17702-2] [Citation(s) in RCA: 308] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND For microbiological confirmation of diagnosis of pulmonary tuberculosis in young children, sequential gastric lavages are recommended; sputum induction has not been regarded as feasible or useful. We aimed to compare the yield of Mycobacterium tuberculosis from repeated induced sputum with that from gastric lavage in young children from an area with a high rate of HIV and tuberculosis. METHODS We studied 250 children aged 1 month to 5 years who were admitted for suspected pulmonary tuberculosis in Cape Town, South Africa. Sputum induction and gastric lavage were done on three consecutive days according to a standard procedure. Specimens were stained for acid-fast bacilli; each sample was cultured singly for M tuberculosis. FINDINGS Median age of children was 13 months (IQR 6-24). A positive smear or culture for M tuberculosis was obtained from 62 (25%) children; of these, 58 (94%) were positive by culture, whereas almost half (29 [47%]) were smear positive. Samples from induced sputum and gastric lavage were positive in 54 (87%) and 40 (65%) children, respectively (difference in yield 5.6% [1.4-9.8%], p=0.018). The yield from one sample from induced sputum was similar to that from three gastric lavages (p=1.0). Microbiological yield did not differ between HIV-infected and HIV-uninfected children (p=0.17, odds ratio 0.7 [95% CI 0.3-1.3]). All sputum induction procedures were well tolerated; minor side-effects were increased coughing, epistaxis, vomiting, or wheezing. INTERPRETATION Sputum induction is safe and useful for microbiological confirmation of tuberculosis in young children. This technique is preferable to gastric lavage for diagnosis of pulmonary tuberculosis in both HIV-infected and HIV-uninfected infants and children.
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Affiliation(s)
- Heather J Zar
- School of Child and Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.
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Eley B, Nuttall J, Davies MA, Smith L, Cowburn C, Buys H, Hussey G. Initial experience of a public sector antiretroviral treatment programme for HIV-infected children and their infected parents. S Afr Med J 2004; 94:643-6. [PMID: 15352588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVE To describe the initial experience of treating HIV-infected children and their infected parents with antiretroviral therapy. DESIGN Prospective, cohort study. SETTING Tertiary, referral hospital. PATIENTS HIV-infected children and their parents. METHODS This report focuses on the early response of children to highly active antiretroviral therapy (HAART). Children were followed up at 4-weekly intervals. Monitoring included initial and yearly viral load measurements, baseline and 6-monthly CD4 counts and 4-weekly adherence checks. RESULTS Between August 2002 and June 2003, 80 children were enrolled in the programme, representing a follow-up period of 23.9 patient-years. Seventy-five children had severe clinical disease, severe immune suppression, or a combination of the two. The response of children who had received HAART for > or = 6 months (N = 17) was assessed. There was no change in mass z-score (p = 0.11) or length z-score (p = 0.37), but a significant increase in CD4 percentage (p < 0.0001) during the first 6 months of therapy. Six-month viral loads were available for 12 children. There was a significant drop in viral load (p = 0.001) and 9 achieved undetectable levels by 6 months. Most children achieved > or = 85% adherence. By June 2002, 67 children (84%) were relatively well, 1 had B-cell lymphoma, 7 (8.8%) had died, 4 (5%) were lost to follow-up and 1 was withdrawn from the programme. Of 57 children who completed 3 months of HAART, 12 were admitted a total of 17 times for infectious complications. There were no severe drug reactions. Three of 7 mothers on HAART received treatment through the programme. CONCLUSION These initial results suggest that many HIV-infected children in the public sector will benefit from antiretroviral therapy. However, both ambulatory and inpatient facilities are required to manage children on HAART comprehensively.
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Affiliation(s)
- Brian Eley
- Department of Paediatrics and Child Health, Red Cross Children's Hospital and University of Cape Town
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Hussey G, Hawkridge T, Eley B, Nuttall J, Kibel M, Geiter L, Barker L, Behr M, Demers AM. Adverse Effects of Bacille Calmette-Guerin Vaccination in HIV-Positive Infants. Clin Infect Dis 2004; 38:1333-4; author reply 1334-5. [PMID: 15127353 DOI: 10.1086/383154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Etiebet MA, Fransman D, Forsyth B, Coetzee N, Hussey G. Integrating prevention of mother-to-child HIV transmission into antenatal care: learning from the experiences of women in South Africa. AIDS Care 2004; 16:37-46. [PMID: 14660142 DOI: 10.1080/09540120310001633958] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In 1999, for the first time in South Africa, a Mother-to-Child HIV Transmission (MTCT) prevention programme was implemented at the routine primary care level and not as part of a research protocol. A total of 264 women attending prenatal care in these clinics were interviewed in Xhosa using a standardized questionnaire. All had been offered HIV testing, and 95% had accepted. Women who had not been tested were four times more likely to believe that in the community families reject HIV-positive women (p<0.005). Of women who tested, 19% were HIV positive and 83% had told their partner that they had taken the test. HIV-positive women who had not disclosed testing to their partners were three times more likely to believe that, in the community, partners are violent towards HIV-positive women (p<0.005); 86% stated that they would have taken AZT if found to be HIV positive. Only 11% considered that the use of formula feeding indicated that a woman was HIV positive. In conclusion, routine prenatal HIV testing and interventions to reduce perinatal HIV transmission are acceptable to the majority of women in a South African urban township, despite an awareness of discrimination in the community towards HIV-positive women.
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Affiliation(s)
- M-A Etiebet
- Yale University School of Medicine, New Haven, CT, USA.
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