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Davids M, Johnstone S, Mendes A, Brecht G, Avenant T, du Plessis N, de Villiers M, Page N, Venter M. Changes in Prevalence and Seasonality of Pathogens Identified in Acute Respiratory Tract Infections in Hospitalised Individuals in Rural and Urban Settings in South Africa; 2018-2022. Viruses 2024; 16:404. [PMID: 38543769 PMCID: PMC10974059 DOI: 10.3390/v16030404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 05/23/2024] Open
Abstract
Severe acute respiratory tract infections (SARIs) has been well described in South Africa with seasonal patterns described for influenza and respiratory syncytial virus (RSV), while others occur year-round (rhinovirus and adenovirus). This prospective syndromic hospital-based surveillance study describes the prevalence and impact of public interventions on the seasonality of other respiratory pathogens during the coronavirus disease-19 (COVID-19) pandemic. This occurred from August 2018 to April 2022, with 2595 patients who met the SARS case definition and 442 controls, from three sentinel urban and rural hospital sites in South Africa. Naso/oro-pharyngeal (NP/OP) swabs were tested using the FastTrack Diagnostics® Respiratory pathogens 33 (RUO) kit. Descriptive statistics, odds ratios, and univariate/multivariate analyses were used. Rhinovirus (14.80%, 228/1540) and Streptococcus pneumoniae (28.50%, 439/1540) were most frequently detected in NP/OP swabs and in children <1 years old (35%, 648/1876). Among others, pathogens associated with SARI cases causing disease were influenza A&B, HRV, RSV, hCoV 229e, Haemophilus influenzae, Staphylococcus aureus, and Streptococcus pneumoniae. Pre-COVID-19, seasonal trends of these pathogens correlated with previous years, with RSV and influenza A seasons only resuming after the national lockdown (2021). It is evident that stringent lockdown conditions have severe impacts on the prevalence of respiratory tract infections.
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Affiliation(s)
- Michaela Davids
- Centre for Emerging Respiratory and Arbovirus Research, Department of Medical Virology, University of Pretoria, Pretoria 0084, South Africa
| | - Siobhan Johnstone
- Centre for Enteric Diseases, Virology, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg 2192, South Africa; (S.J.); (N.P.)
| | - Adriano Mendes
- Centre for Emerging Respiratory and Arbovirus Research, Department of Medical Virology, University of Pretoria, Pretoria 0084, South Africa
| | - Gadean Brecht
- Centre for Emerging Respiratory and Arbovirus Research, Department of Medical Virology, University of Pretoria, Pretoria 0084, South Africa
| | - Theunis Avenant
- Department of Paediatrics, Kalafong Provincial Tertiary Hospital, University of Pretoria, Pretoria 0084, South Africa
| | - Nicolette du Plessis
- Department of Paediatrics, Kalafong Provincial Tertiary Hospital, University of Pretoria, Pretoria 0084, South Africa
| | - Maryke de Villiers
- Department of Internal Medicine, Kalafong Provincial Tertiary Hospital, University of Pretoria, Pretoria 0084, South Africa
| | - Nicola Page
- Centre for Enteric Diseases, Virology, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg 2192, South Africa; (S.J.); (N.P.)
- Centre of Enteric Diseases, Department of Medical Virology, University of Pretoria, Pretoria 0084, South Africa
| | - Marietjie Venter
- Centre for Emerging Respiratory and Arbovirus Research, Department of Medical Virology, University of Pretoria, Pretoria 0084, South Africa
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Wieters I, Johnstone S, Makiala-Mandanda S, Poda A, Akoua-Koffi C, Abu Sin M, Eckmanns T, Galeone V, Kaboré FN, Kahwata F, Leendertz FH, Mputu B, Ouedraogo AS, Page N, Schink SB, Touré FS, Traoré A, Venter M, Vietor AC, Schubert G, Tomczyk S. Reported antibiotic use among patients in the multicenter ANDEMIA infectious diseases surveillance study in sub-saharan Africa. Antimicrob Resist Infect Control 2024; 13:9. [PMID: 38273333 PMCID: PMC10809765 DOI: 10.1186/s13756-024-01365-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/09/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Exposure to antibiotics has been shown to be one of the drivers of antimicrobial resistance (AMR) and is critical to address when planning and implementing strategies for combatting AMR. However, data on antibiotic use in sub-Saharan Africa are still limited. Using hospital-based surveillance data from the African Network for Improved Diagnostics, Epidemiology and Management of Common Infectious Agents (ANDEMIA), we assessed self-reported antibiotic use in multiple sub-Saharan African countries. METHODS ANDEMIA included 12 urban and rural health facilities in Côte d'Ivoire, Burkina Faso, Democratic Republic of the Congo, and Republic of South Africa. Patients with acute respiratory infection (RTI), acute gastrointestinal infection (GI) and acute febrile disease of unknown cause (AFDUC) were routinely enrolled, and clinical, demographic, socio-economic and behavioral data were collected using standardized questionnaires. An analysis of ANDEMIA data from February 2018 to May 2022 was conducted. Reported antibiotic use in the ten days prior to study enrolment were described by substance and by the WHO AWaRe classification ("Access", "Watch", "Reserve", and "Not recommended" antibiotics). Frequency of antibiotic use was stratified by location, disease syndrome and individual patient factors. RESULTS Among 19,700 ANDEMIA patients, 7,258 (36.8%) reported antibiotic use. A total of 9,695 antibiotics were reported, including 54.7% (n = 5,299) from the WHO Access antibiotic group and 44.7% (n = 4,330) from the WHO Watch antibiotic group. The Watch antibiotic ceftriaxone was the most commonly reported antibiotic (n = 3,071, 31.7%). Watch antibiotic use ranged from 17.4% (56/322) among RTI patients in Côte d'Ivoire urban facilities to 73.7% (630/855) among AFDUC patients in Burkina Faso urban facilities. Reported antibiotic use included WHO Not recommended antibiotics but no Reserve antibiotics. CONCLUSIONS Reported antibiotic use data from this multicenter study in sub-Saharan Africa revealed a high proportion of WHO Watch antibiotics. Differences in Watch antibiotic use were found by disease syndrome, country and health facility location, which calls for a more differentiated approach to antibiotic use interventions including further evaluation of accessibility and affordability of patient treatment.
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Affiliation(s)
- Imke Wieters
- Institute of Tropical Medicine and International Health, Charité- Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
- Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany.
| | - Siobhan Johnstone
- Center for Enteric Diseases, National Health Laboratory Service, National Institute for Communicable Diseases, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - Sheila Makiala-Mandanda
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Armel Poda
- Centre Hospitalier Universitaire Sourô Sanou de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Chantal Akoua-Koffi
- Centre Hospitalier Universitaire Bouaké, Bouaké, Ivory Coast
- Université Alassane Ouattara de Bouaké, Bouaké, Ivory Coast
| | - Muna Abu Sin
- Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Tim Eckmanns
- Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | | | | | - François Kahwata
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Fabian H Leendertz
- Helmholtz Institute for One Health, Fleischmannstraße 42, 17489, Greifswald, Germany
| | - Benoit Mputu
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Abdoul-Salam Ouedraogo
- Centre Hospitalier Universitaire Sourô Sanou de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
- Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Nicola Page
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, 31 Bophelo Rd, Prinshof 349-Jr, Pretoria, 0084, South Africa
- Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | | | | | | | - Marietjie Venter
- Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | | | - Grit Schubert
- Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Sara Tomczyk
- Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
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Ellison R, Emberson J, Epp R, Er A, Espino-Obrero M, Estcourt S, Estienne L, Evans G, Evans J, Evans S, Fabbri G, Fajardo-Moser M, Falcone C, Fani F, Faria-Shayler P, Farnia F, Farrugia D, Fechter M, Fellowes D, Feng F, Fernandez J, Ferraro P, Field A, Fikry S, Finch J, Finn H, Fioretto P, Fish R, Fleischer A, Fleming-Brown D, Fletcher L, Flora R, Foellinger C, Foligno N, Forest S, Forghani Z, Forsyth K, Fottrell-Gould D, Fox P, Frankel A, Fraser D, Frazier R, Frederick K, Freking N, French H, Froment A, Fuchs B, Fuessl L, Fujii H, Fujimoto A, Fujita A, Fujita K, Fujita Y, Fukagawa M, Fukao Y, Fukasawa A, Fuller T, Funayama T, Fung E, Furukawa M, Furukawa Y, Furusho M, Gabel S, Gaidu J, Gaiser S, Gallo K, Galloway C, Gambaro G, Gan CC, Gangemi C, Gao M, Garcia K, Garcia M, Garofalo C, Garrity M, Garza A, Gasko S, Gavrila M, Gebeyehu B, Geddes A, Gentile G, George A, George J, Gesualdo L, Ghalli F, Ghanem A, Ghate T, Ghavampour S, Ghazi A, Gherman A, Giebeln-Hudnell U, Gill B, Gillham S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura 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Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, 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Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori 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Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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Chhabra P, Tully DC, Mans J, Niendorf S, Barclay L, Cannon JL, Montmayeur AM, Pan CY, Page N, Williams R, Tutill H, Roy S, Celma C, Beard S, Mallory ML, Manouana GP, Velavan TP, Adegnika AA, Kremsner PG, Lindesmith LC, Hué S, Baric RS, Breuer J, Vinjé J. Emergence of Novel Norovirus GII.4 Variant. Emerg Infect Dis 2024; 30:163-167. [PMID: 38063078 PMCID: PMC10756382 DOI: 10.3201/eid3001.231003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
We detected a novel GII.4 variant with an amino acid insertion at the start of epitope A in viral protein 1 of noroviruses from the United States, Gabon, South Africa, and the United Kingdom collected during 2017-2022. Early identification of GII.4 variants is crucial for assessing pandemic potential and informing vaccine development.
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Affiliation(s)
| | | | - Janet Mans
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
| | - Sandra Niendorf
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
| | - Leslie Barclay
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
| | - Jennifer L. Cannon
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
| | - Anna M. Montmayeur
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
| | - Chao-Yang Pan
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
| | - Nicola Page
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
| | - Rachel Williams
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
| | - Helena Tutill
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
| | - Sunando Roy
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
| | - Cristina Celma
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
| | - Stuart Beard
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
| | - Michael L. Mallory
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
| | - Gédéon Prince Manouana
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
| | - Thirumalaisamy P. Velavan
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
| | - Ayola Akim Adegnika
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
| | - Peter G. Kremsner
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
| | - Lisa C. Lindesmith
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
| | - Stéphane Hué
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
| | - Ralph S. Baric
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
| | - Judith Breuer
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
| | - Jan Vinjé
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA (P. Chhabra, L. Barclay, J.L. Cannon, A.M. Montmayeur, J. Vinjé)
- London School of Hygiene & Tropical Medicine, London, UK (D.C. Tully, S. Hué)
- University of Pretoria, Pretoria, South Africa (J. Mans, N. Page)
- Robert Koch Institut, Berlin, Germany (S. Niendorf)
- California Department of Public Health, Richmond, California, USA (C.-Y. Pan)
- National Institute for Communicable Diseases, Sandringham, South Africa (N. Page)
- UCL Great Ormond Street Institute of Child Health, London (R. Williams, H. Tutill, S. Roy, J. Breuer)
- UK Health Security Agency, London (C. Celma, S. Beard)
- University of North Carolina, Chapel Hill, North Carolina, USA (M.L. Mallory, L.C. Lindesmith, R.S. Baric)
- Universitätsklinikum Tübingen, Tübingen, Germany (G.P. Manouana, T.P. Velavan, A.A. Adegnika)
- Centre de Recherches Médicales de Lambaréné, Lambarene, Gabon (G.P. Manouana, A.A. Adegnika, P.G. Kremsner)
- Vietnamese-German Center for Medical Research, Hanoi, Vietnam (T.P. Velavan)
- Duy Tan University, Da Nang, Vietnam (T.P. Velavan)
- German Center for Infection Research, Tübingen (A.A. Adegnika)
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Judge PK, Staplin N, Mayne KJ, Wanner C, Green JB, Hauske SJ, Emberson JR, Preiss D, Ng SYA, Roddick AJ, Sammons E, Zhu D, Hill M, Stevens W, Wallendszus K, Brenner S, Cheung AK, Liu ZH, Li J, Hooi LS, Liu WJ, Kadowaki T, Nangaku M, Levin A, Cherney D, Maggioni AP, Pontremoli R, Deo R, Goto S, Rossello X, Tuttle KR, Steubl D, Massey D, Landray MJ, Baigent C, Haynes R, Herrington WG, Abat S, Abd Rahman R, Abdul Cader R, Abdul Hafidz MI, Abdul Wahab MZ, Abdullah NK, Abdul-Samad T, Abe M, Abraham N, Acheampong S, Achiri P, Acosta JA, Adeleke A, Adell V, Adewuyi-Dalton R, Adnan N, Africano A, Agharazii M, Aguilar F, Aguilera A, Ahmad M, Ahmad MK, Ahmad NA, Ahmad NH, Ahmad NI, Ahmad Miswan N, Ahmad Rosdi H, Ahmed I, Ahmed S, Ahmed S, Aiello J, Aitken A, AitSadi R, Aker S, Akimoto S, Akinfolarin A, Akram S, Alberici F, Albert C, Aldrich L, Alegata M, Alexander L, Alfaress S, Alhadj Ali M, Ali A, Ali A, Alicic R, Aliu A, Almaraz R, Almasarwah R, Almeida J, Aloisi A, Al-Rabadi L, Alscher D, Alvarez P, Al-Zeer B, Amat M, Ambrose C, Ammar H, An Y, Andriaccio L, Ansu K, Apostolidi A, Arai N, Araki H, Araki S, Arbi A, Arechiga O, Armstrong S, Arnold T, Aronoff S, Arriaga W, Arroyo J, Arteaga D, Asahara S, Asai A, Asai N, Asano S, Asawa M, Asmee MF, Aucella F, Augustin M, Avery A, Awad A, Awang IY, Awazawa M, Axler A, Ayub W, Azhari Z, Baccaro R, Badin C, Bagwell B, Bahlmann-Kroll E, Bahtar AZ, Baigent C, Bains D, Bajaj H, Baker R, Baldini E, Banas B, Banerjee D, Banno S, Bansal S, Barberi S, Barnes S, Barnini C, Barot C, Barrett K, Barrios R, Bartolomei Mecatti B, Barton I, Barton J, Basily W, Bavanandan S, Baxter A, Becker L, Beddhu S, Beige J, Beigh S, Bell S, Benck U, Beneat A, Bennett A, Bennett D, Benyon S, Berdeprado J, Bergler T, Bergner A, Berry M, Bevilacqua M, Bhairoo J, Bhandari S, Bhandary N, Bhatt A, Bhattarai M, Bhavsar M, Bian W, Bianchini F, Bianco S, Bilous R, Bilton J, Bilucaglia D, Bird C, Birudaraju D, Biscoveanu M, Blake C, Bleakley N, Bocchicchia K, Bodine S, Bodington R, Boedecker S, Bolduc M, Bolton S, Bond C, Boreky F, Boren K, Bouchi R, Bough L, Bovan D, Bowler C, Bowman L, Brar N, Braun C, Breach A, Breitenfeldt M, Brenner S, Brettschneider B, Brewer A, Brewer G, Brindle V, Brioni E, Brown C, Brown H, Brown L, Brown R, Brown S, Browne D, Bruce K, Brueckmann M, Brunskill N, Bryant M, Brzoska M, Bu Y, Buckman C, Budoff M, Bullen M, Burke A, Burnette S, Burston C, Busch M, Bushnell J, Butler S, Büttner C, Byrne C, Caamano A, Cadorna J, Cafiero C, Cagle M, Cai J, Calabrese K, Calvi C, Camilleri B, Camp S, Campbell D, Campbell R, Cao H, Capelli I, Caple M, Caplin B, Cardone A, Carle J, Carnall V, Caroppo M, Carr S, Carraro G, Carson M, Casares P, Castillo C, Castro C, Caudill B, Cejka V, Ceseri M, Cham L, Chamberlain A, Chambers J, Chan CBT, Chan JYM, Chan YC, Chang E, Chang E, Chant T, Chavagnon T, Chellamuthu P, Chen F, Chen J, Chen P, Chen TM, Chen Y, Chen Y, Cheng C, Cheng H, Cheng MC, Cherney D, Cheung AK, Ching CH, Chitalia N, Choksi R, Chukwu C, Chung K, Cianciolo G, Cipressa L, Clark S, Clarke H, Clarke R, Clarke S, Cleveland B, Cole E, Coles H, Condurache L, Connor A, Convery K, Cooper A, Cooper N, Cooper Z, Cooperman L, Cosgrove L, Coutts P, Cowley A, Craik R, Cui G, Cummins T, Dahl N, Dai H, Dajani L, D'Amelio A, Damian E, Damianik K, Danel L, Daniels C, Daniels T, Darbeau S, Darius H, Dasgupta T, Davies J, Davies L, Davis A, Davis J, Davis L, Dayanandan R, Dayi S, Dayrell R, De Nicola L, Debnath S, Deeb W, Degenhardt S, DeGoursey K, Delaney M, Deo R, DeRaad R, Derebail V, Dev D, Devaux M, Dhall P, Dhillon G, Dienes J, Dobre M, Doctolero E, Dodds V, Domingo D, Donaldson D, Donaldson P, Donhauser C, Donley V, Dorestin S, Dorey S, Doulton T, Draganova D, Draxlbauer K, Driver F, Du H, Dube F, Duck T, Dugal T, Dugas J, Dukka H, Dumann H, Durham W, Dursch M, Dykas R, Easow R, Eckrich E, Eden G, Edmerson E, Edwards H, Ee LW, Eguchi J, Ehrl Y, Eichstadt K, Eid W, Eilerman B, Ejima Y, Eldon H, Ellam T, Elliott L, Ellison R, Emberson J, Epp R, Er A, Espino-Obrero M, Estcourt S, Estienne L, Evans G, Evans J, Evans S, Fabbri G, Fajardo-Moser M, Falcone C, Fani F, Faria-Shayler P, Farnia F, Farrugia D, Fechter M, Fellowes D, Feng F, Fernandez J, Ferraro P, Field A, Fikry S, Finch J, Finn H, Fioretto P, Fish R, Fleischer A, Fleming-Brown D, Fletcher L, Flora R, Foellinger C, Foligno N, Forest S, Forghani Z, Forsyth K, Fottrell-Gould D, Fox P, Frankel A, Fraser D, Frazier R, Frederick K, Freking N, French H, Froment A, Fuchs B, Fuessl L, Fujii H, Fujimoto A, Fujita A, Fujita K, Fujita Y, Fukagawa M, Fukao Y, Fukasawa A, Fuller T, Funayama T, Fung E, Furukawa M, Furukawa Y, Furusho M, Gabel S, Gaidu J, Gaiser S, Gallo K, Galloway C, Gambaro G, Gan CC, Gangemi C, Gao M, Garcia K, Garcia M, Garofalo C, Garrity M, Garza A, Gasko S, Gavrila M, Gebeyehu B, Geddes A, Gentile G, George A, George J, Gesualdo L, Ghalli F, Ghanem A, Ghate T, Ghavampour S, Ghazi A, Gherman A, Giebeln-Hudnell U, Gill B, Gillham S, Girakossyan I, Girndt M, Giuffrida A, Glenwright M, Glider T, Gloria R, Glowski D, Goh BL, Goh CB, Gohda T, Goldenberg R, Goldfaden R, Goldsmith C, Golson B, Gonce V, Gong Q, Goodenough B, Goodwin N, Goonasekera M, Gordon A, Gordon J, Gore A, Goto H, Goto S, Goto S, Gowen D, Grace A, Graham J, Grandaliano G, Gray M, Green JB, Greene T, Greenwood G, Grewal B, Grifa R, Griffin D, Griffin S, Grimmer P, Grobovaite E, Grotjahn S, Guerini A, Guest C, Gunda S, Guo B, Guo Q, Haack S, Haase M, Haaser K, Habuki K, Hadley A, Hagan S, Hagge S, Haller H, Ham S, Hamal S, Hamamoto Y, Hamano N, Hamm M, Hanburry A, Haneda M, Hanf C, Hanif W, Hansen J, Hanson L, Hantel S, Haraguchi T, Harding E, Harding T, Hardy C, Hartner C, Harun Z, Harvill L, Hasan A, Hase H, Hasegawa F, Hasegawa T, Hashimoto A, Hashimoto C, Hashimoto M, Hashimoto S, Haskett S, Hauske SJ, Hawfield A, Hayami T, Hayashi M, Hayashi S, Haynes R, Hazara A, Healy C, Hecktman J, Heine G, Henderson H, Henschel R, Hepditch A, Herfurth K, Hernandez G, Hernandez Pena A, Hernandez-Cassis C, Herrington WG, Herzog C, Hewins S, Hewitt D, Hichkad L, Higashi S, Higuchi C, Hill C, Hill L, Hill M, Himeno T, Hing A, Hirakawa Y, Hirata K, Hirota Y, Hisatake T, Hitchcock S, Hodakowski A, Hodge W, Hogan R, Hohenstatt U, Hohenstein B, Hooi L, Hope S, Hopley M, Horikawa S, Hosein D, Hosooka T, Hou L, Hou W, Howie L, Howson A, Hozak M, Htet Z, Hu X, Hu Y, Huang J, Huda N, Hudig L, Hudson A, Hugo C, Hull R, Hume L, Hundei W, Hunt N, Hunter A, Hurley S, Hurst A, Hutchinson C, Hyo T, Ibrahim FH, Ibrahim S, Ihana N, Ikeda T, Imai A, Imamine R, Inamori A, Inazawa H, Ingell J, Inomata K, Inukai Y, Ioka M, Irtiza-Ali A, Isakova T, Isari W, Iselt M, Ishiguro A, Ishihara K, Ishikawa T, Ishimoto T, Ishizuka K, Ismail R, Itano S, Ito H, Ito K, Ito M, Ito Y, Iwagaitsu S, Iwaita Y, Iwakura T, Iwamoto M, Iwasa M, Iwasaki H, Iwasaki S, Izumi K, Izumi K, Izumi T, Jaafar SM, Jackson C, Jackson Y, Jafari G, Jahangiriesmaili M, Jain N, Jansson K, Jasim H, Jeffers L, Jenkins A, Jesky M, Jesus-Silva J, Jeyarajah D, Jiang Y, Jiao X, Jimenez G, Jin B, Jin Q, Jochims J, Johns B, Johnson C, Johnson T, Jolly S, Jones L, Jones L, Jones S, Jones T, Jones V, Joseph M, Joshi S, Judge P, Junejo N, Junus S, Kachele M, Kadowaki T, Kadoya H, Kaga H, Kai H, Kajio H, Kaluza-Schilling W, Kamaruzaman L, Kamarzarian A, Kamimura Y, Kamiya H, Kamundi C, Kan T, Kanaguchi Y, Kanazawa A, Kanda E, Kanegae S, Kaneko K, Kaneko K, Kang HY, Kano T, Karim M, Karounos D, Karsan W, Kasagi R, Kashihara N, Katagiri H, Katanosaka A, Katayama A, Katayama M, Katiman E, Kato K, Kato M, Kato N, Kato S, Kato T, Kato Y, Katsuda Y, Katsuno T, Kaufeld J, Kavak Y, Kawai I, Kawai M, Kawai M, Kawase A, Kawashima S, Kazory A, Kearney J, Keith B, Kellett J, Kelley S, Kershaw M, Ketteler M, Khai Q, Khairullah Q, Khandwala H, Khoo KKL, Khwaja A, Kidokoro K, Kielstein J, Kihara M, Kimber C, Kimura S, Kinashi H, Kingston H, Kinomura M, Kinsella-Perks E, Kitagawa M, Kitajima M, Kitamura S, Kiyosue A, Kiyota M, Klauser F, Klausmann G, Kmietschak W, Knapp K, Knight C, Knoppe A, Knott C, Kobayashi M, Kobayashi R, Kobayashi T, Koch M, Kodama S, Kodani N, Kogure E, Koizumi M, Kojima H, Kojo T, Kolhe N, Komaba H, Komiya T, Komori H, Kon SP, Kondo M, Kondo M, Kong W, Konishi M, Kono K, Koshino M, Kosugi T, Kothapalli B, Kozlowski T, Kraemer B, Kraemer-Guth A, Krappe J, Kraus D, Kriatselis C, Krieger C, Krish P, Kruger B, Ku Md Razi KR, Kuan Y, Kubota S, Kuhn S, Kumar P, Kume S, Kummer I, Kumuji R, Küpper A, Kuramae T, Kurian L, Kuribayashi C, Kurien R, Kuroda E, Kurose T, Kutschat A, Kuwabara N, Kuwata H, La Manna G, Lacey M, Lafferty K, LaFleur P, Lai V, Laity E, Lambert A, Landray MJ, Langlois M, Latif F, Latore E, Laundy E, Laurienti D, Lawson A, Lay M, Leal I, Leal I, Lee AK, Lee J, Lee KQ, Lee R, Lee SA, Lee YY, Lee-Barkey Y, Leonard N, Leoncini G, Leong CM, Lerario S, Leslie A, Levin A, Lewington A, Li J, Li N, Li X, Li Y, Liberti L, Liberti ME, Liew A, Liew YF, Lilavivat U, Lim SK, Lim YS, Limon E, Lin H, Lioudaki E, Liu H, Liu J, Liu L, Liu Q, Liu WJ, Liu X, Liu Z, Loader D, Lochhead H, Loh CL, Lorimer A, Loudermilk L, Loutan J, Low CK, Low CL, Low YM, Lozon Z, Lu Y, Lucci D, Ludwig U, Luker N, Lund D, Lustig R, Lyle S, Macdonald C, MacDougall I, Machicado R, MacLean D, Macleod P, Madera A, Madore F, Maeda K, Maegawa H, Maeno S, Mafham M, Magee J, Maggioni AP, Mah DY, Mahabadi V, Maiguma M, Makita Y, Makos G, Manco L, Mangiacapra R, Manley J, Mann P, Mano S, Marcotte G, Maris J, Mark P, Markau S, Markovic M, Marshall C, Martin M, Martinez C, Martinez S, Martins G, Maruyama K, Maruyama S, Marx K, Maselli A, Masengu A, Maskill A, Masumoto S, Masutani K, Matsumoto M, Matsunaga T, Matsuoka N, Matsushita M, Matthews M, Matthias S, Matvienko E, Maurer M, Maxwell P, Mayne KJ, Mazlan N, Mazlan SA, Mbuyisa A, McCafferty K, McCarroll F, McCarthy T, McClary-Wright C, McCray K, McDermott P, McDonald C, McDougall R, McHaffie E, McIntosh K, McKinley T, McLaughlin S, McLean N, McNeil L, Measor A, Meek J, Mehta A, Mehta R, Melandri M, Mené P, Meng T, Menne J, Merritt K, Merscher S, Meshykhi C, Messa P, Messinger L, Miftari N, Miller R, Miller Y, Miller-Hodges E, Minatoguchi M, Miners M, Minutolo R, Mita T, Miura Y, Miyaji M, Miyamoto S, Miyatsuka T, Miyazaki M, Miyazawa I, Mizumachi R, Mizuno M, Moffat S, Mohamad Nor FS, Mohamad Zaini SN, Mohamed Affandi FA, Mohandas C, Mohd R, Mohd Fauzi NA, Mohd Sharif NH, Mohd Yusoff Y, Moist L, Moncada A, Montasser M, Moon A, Moran C, Morgan N, Moriarty J, Morig G, Morinaga H, Morino K, Morisaki T, Morishita Y, Morlok S, Morris A, Morris F, Mostafa S, Mostefai Y, Motegi M, Motherwell N, Motta D, Mottl A, Moys R, Mozaffari S, Muir J, Mulhern J, Mulligan S, Munakata Y, Murakami C, Murakoshi M, Murawska A, Murphy K, Murphy L, Murray S, Murtagh H, Musa MA, Mushahar L, Mustafa R, Mustafar R, Muto M, Nadar E, Nagano R, Nagasawa T, Nagashima E, Nagasu H, Nagelberg S, Nair H, Nakagawa Y, Nakahara M, Nakamura J, Nakamura R, Nakamura T, Nakaoka M, Nakashima E, Nakata J, Nakata M, Nakatani S, Nakatsuka A, Nakayama Y, Nakhoul G, Nangaku M, Naverrete G, Navivala A, Nazeer I, Negrea L, Nethaji C, Newman E, Ng SYA, Ng TJ, Ngu LLS, Nimbkar T, Nishi H, Nishi M, Nishi S, Nishida Y, Nishiyama A, Niu J, Niu P, Nobili G, Nohara N, Nojima I, Nolan J, Nosseir H, Nozawa M, Nunn M, Nunokawa S, Oda M, Oe M, Oe Y, Ogane K, Ogawa W, Ogihara T, Oguchi G, Ohsugi M, Oishi K, Okada Y, Okajyo J, Okamoto S, Okamura K, Olufuwa O, Oluyombo R, Omata A, Omori Y, Ong LM, Ong YC, Onyema J, Oomatia A, Oommen A, Oremus R, Orimo Y, Ortalda V, Osaki Y, Osawa Y, Osmond Foster J, O'Sullivan A, Otani T, Othman N, Otomo S, O'Toole J, Owen L, Ozawa T, Padiyar A, Page N, Pajak S, Paliege A, Pandey A, Pandey R, Pariani H, Park J, Parrigon M, Passauer J, Patecki M, Patel M, Patel R, Patel T, Patel Z, Paul R, Paul R, Paulsen L, Pavone L, Peixoto A, Peji J, Peng BC, Peng K, Pennino L, Pereira E, Perez E, Pergola P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Mohy A, Page N, Boyce W, Gomez JA. Economic Evaluation of Rotavirus Vaccination in Children Aged Under Five Years in South Africa. Clin Drug Investig 2023; 43:851-863. [PMID: 37831397 PMCID: PMC10632264 DOI: 10.1007/s40261-023-01312-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Evidence on the economic value of rotavirus vaccines in middle-income countries is limited. We aimed to model the implementation of three vaccines (human rotavirus, live, attenuated, oral vaccine [HRV, 2 doses]; rotavirus vaccine, live, oral, pentavalent [HBRV, 3 doses] and rotavirus vaccine, live attenuated oral, freeze-dried [BRV-PV, 3 doses] presented in 1-dose and 2-dose vials) into the South African National Immunisation Programme. METHODS Cost and cost-effectiveness analyses were conducted to compare three rotavirus vaccines using a static, deterministic, population model in children aged <5 years in South Africa from country payer and societal perspectives. Deterministic and probabilistic sensitivity analyses were conducted to assess the impact of uncertainty in model inputs. RESULTS The human rotavirus, live, attenuated, oral vaccine (HRV) was associated with cost savings versus HBRV from both perspectives, and versus BRV-PV 1-dose vial from the societal perspective. In the cost-effectiveness analysis, HRV was estimated to avoid 1,107 home care rotavirus gastroenteritis (RVGE) events, 247 medical visits, 35 hospitalisations, and 4 RVGE-related deaths versus HBRV and BRV-PV. This translated to 73 quality-adjusted life years gained. HRV was associated with lower costs versus HBRV from both payer (-$3.9M) and societal (-$11.5M) perspectives and versus BRV-PV 1-dose vial from the societal perspective (-$3.8M), dominating those options. HRV was associated with higher costs versus BRV-PV 1-dose vial from the payer perspective and versus BRV-PV 2‑dose vial from both payer and societal perspectives (ICERs: $51,834, $121,171, and $16,717, respectively), exceeding the assumed cost-effectiveness threshold of 0.5 GDP per capita. CONCLUSION Vaccination with a 2-dose schedule of HRV may lead to better health outcomes for children in South Africa compared with the 3-dose schedule rotavirus vaccines.
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Affiliation(s)
- Ahmed Mohy
- GSK, Value Evidence and Outcomes, Emerging Markets, GSK Vaccines, Wavre, Belgium.
| | - Nicola Page
- Center for Enteric Diseases, National Institute for Communicable Diseases (NICD), A Division of the National Health Laboratory Service, Johannesburg, South Africa
- Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Jorge A Gomez
- GSK, Value Evidence and Outcomes, Emerging Markets, Buenos Aires, Argentina
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Fellows T, Page N, Fix A, Flores J, Cryz S, McNeal M, Iturriza-Gomara M, Groome MJ. Association between Immunogenicity of a Monovalent Parenteral P2-VP8 Subunit Rotavirus Vaccine and Fecal Shedding of Rotavirus following Rotarix Challenge during a Randomized, Double-Blind, Placebo-Controlled Trial. Viruses 2023; 15:1809. [PMID: 37766217 PMCID: PMC10536230 DOI: 10.3390/v15091809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
A correlate of protection for rotavirus (RV) has not been consistently identified. Shedding of RV following an oral rotavirus vaccine (ORV) challenge has been investigated as a potential model to assess protection of parenteral RV vaccines. We previously showed that shedding of a challenge ORV dose was significantly reduced among recipients of a parenteral monovalent RV subunit vaccine (P2-VP8-P[8]) compared to placebo recipients. This secondary data analysis assessed the association between fecal shedding of RV, as determined by ELISA one week after receipt of a Rotarix challenge dose at 18 weeks of age, and serum RV-specific antibody responses, one and six months after vaccination with the third dose of the P2-VP8-P[8] vaccine or placebo. We did not find any association between serum RV-specific immune responses measured one month post-P2-VP8-P[8] vaccination and fecal shedding of RV post-challenge. At nine months of age, six months after the third P2-VP8-P[8] or placebo injection and having received three doses of Rotarix, infants shedding RV demonstrated higher immune responses than non-shedders, showing that RV shedding is reflective of vaccine response following ORV. Further evaluation is needed in a larger sample before fecal shedding of an ORV challenge can be used as a measure of field efficacy in RV vaccine trials.
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Affiliation(s)
- Tamika Fellows
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2001, South Africa;
| | - Nicola Page
- National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Sandringham 2192, South Africa;
- Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Alan Fix
- PATH, Seattle, WA 98121, USA (S.C.)
| | | | | | - Monica McNeal
- Department of Pediatrics, University of Cincinnati Medical School, Cincinnati, OH 45229, USA
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | | | - Michelle J. Groome
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2001, South Africa
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Badr HS, Colston JM, Nguyen NLH, Chen YT, Burnett E, Ali SA, Rayamajhi A, Satter SM, Van Trang N, Eibach D, Krumkamp R, May J, Adegnika AA, Manouana GP, Kremsner PG, Chilengi R, Hatyoka L, Debes AK, Ateudjieu J, Faruque ASG, Hossain MJ, Kanungo S, Kotloff KL, Mandomando I, Nisar MI, Omore R, Sow SO, Zaidi AKM, Lambrecht N, Adu B, Page N, Platts-Mills JA, Mavacala Freitas C, Pelkonen T, Ashorn P, Maleta K, Ahmed T, Bessong P, Bhutta ZA, Mason C, Mduma E, Olortegui MP, Peñataro Yori P, Lima AAM, Kang G, Humphrey J, Ntozini R, Prendergast AJ, Okada K, Wongboot W, Langeland N, Moyo SJ, Gaensbauer J, Melgar M, Freeman M, Chard AN, Thongpaseuth V, Houpt E, Zaitchik BF, Kosek MN. Spatiotemporal variation in risk of Shigella infection in childhood: a global risk mapping and prediction model using individual participant data. Lancet Glob Health 2023; 11:e373-e384. [PMID: 36796984 PMCID: PMC10020138 DOI: 10.1016/s2214-109x(22)00549-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/18/2022] [Accepted: 12/14/2022] [Indexed: 02/16/2023]
Abstract
BACKGROUND Diarrhoeal disease is a leading cause of childhood illness and death globally, and Shigella is a major aetiological contributor for which a vaccine might soon be available. The primary objective of this study was to model the spatiotemporal variation in paediatric Shigella infection and map its predicted prevalence across low-income and middle-income countries (LMICs). METHODS Individual participant data for Shigella positivity in stool samples were sourced from multiple LMIC-based studies of children aged 59 months or younger. Covariates included household-level and participant-level factors ascertained by study investigators and environmental and hydrometeorological variables extracted from various data products at georeferenced child locations. Multivariate models were fitted and prevalence predictions obtained by syndrome and age stratum. FINDINGS 20 studies from 23 countries (including locations in Central America and South America, sub-Saharan Africa, and south and southeast Asia) contributed 66 563 sample results. Age, symptom status, and study design contributed most to model performance followed by temperature, wind speed, relative humidity, and soil moisture. Probability of Shigella infection exceeded 20% when both precipitation and soil moisture were above average and had a 43% peak in uncomplicated diarrhoea cases at 33°C temperatures, above which it decreased. Compared with unimproved sanitation, improved sanitation decreased the odds of Shigella infection by 19% (odds ratio [OR]=0·81 [95% CI 0·76-0·86]) and open defecation decreased them by 18% (OR=0·82 [0·76-0·88]). INTERPRETATION The distribution of Shigella is more sensitive to climatological factors, such as temperature, than previously recognised. Conditions in much of sub-Saharan Africa are particularly propitious for Shigella transmission, although hotspots also occur in South America and Central America, the Ganges-Brahmaputra Delta, and the island of New Guinea. These findings can inform prioritisation of populations for future vaccine trials and campaigns. FUNDING NASA, National Institutes of Health-The National Institute of Allergy and Infectious Diseases, and Bill & Melinda Gates Foundation.
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Affiliation(s)
- Hamada S Badr
- Department of Earth and Planetary Sciences, Johns Hopkins Krieger School of Arts and Sciences, Baltimore, MA, USA
| | - Josh M Colston
- Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Yen Ting Chen
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Eleanor Burnett
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Syed Asad Ali
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ajit Rayamajhi
- Department of Pediatrics, National Academy of Medical Sciences, Kanti Children's Hospital, Kathmandu, Nepal
| | - Syed M Satter
- Programme for Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Daniel Eibach
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
| | - Ralf Krumkamp
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
| | - Jürgen May
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
| | - Ayola Akim Adegnika
- Institute of Tropical Medicine, Universitätsklinikum Tübingen, Tübingen, Germany
| | | | | | - Roma Chilengi
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Luiza Hatyoka
- Enteric diseases and Vaccines Unit, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Amanda K Debes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jerome Ateudjieu
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon; Department of Health Research, M A SANTE (Meileur Acces aux Soins en Santé), Yaoundé, Cameroon; Division of Health Operations Research, Cameroon Ministry of Public Health, Yaoundé, Cameroon
| | - Abu S G Faruque
- Centre for Nutrition & Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M Jahangir Hossain
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Suman Kanungo
- National Institute of Cholera and Enteric Diseases, Kolkota, India
| | - Karen L Kotloff
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - M Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Nyanza, Kenya
| | - Samba O Sow
- Centre pour le Développement des Vaccins, Mali, Bamako, Mali
| | - Anita K M Zaidi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Nathalie Lambrecht
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Research Department 2, Potsdam Institute for Climate Impact Research (PIK), Member of the Leibniz Association, Potsdam, Germany
| | - Bright Adu
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Nicola Page
- Centre for Enteric Diseases, National Institute for Communicable Diseases, Pretoria, South Africa
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | - Tuula Pelkonen
- New Children's Hospital, Pediatric Research Center and Helsinki University Hospital, Helsinki, Finland
| | - Per Ashorn
- Centre for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Kenneth Maleta
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Pascal Bessong
- HIV/AIDS & Global Health Research Programme, University of Venda, Thohoyandou, Limpopo, South Africa
| | - Zulfiqar A Bhutta
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Carl Mason
- Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | | | | | - Pablo Peñataro Yori
- Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Aldo A M Lima
- Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Gagandeep Kang
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Jean Humphrey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | - Kazuhisa Okada
- Research Institute for Microbial Diseases, Osaka University, Osaka, Japan
| | - Warawan Wongboot
- Department of Medical Sciences, National Institute of Health, Nonthaburi, Thailand
| | - Nina Langeland
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Sabrina J Moyo
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - James Gaensbauer
- Center for Global Health, Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Mario Melgar
- Pediatric Infectious Diseases, Hospital Roosevelt, Guatemala City, Guatemala
| | - Matthew Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, 30322, GA, USA
| | - Anna N Chard
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, 30322, GA, USA
| | - Vonethalom Thongpaseuth
- Laboratory and Treatment Unit, Center for Malariology, Parasitology, and Entomology, Ministry of Health, Vientiane, Lao PDR
| | - Eric Houpt
- Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Benjamin F Zaitchik
- Department of Earth and Planetary Sciences, Johns Hopkins Krieger School of Arts and Sciences, Baltimore, MA, USA.
| | - Margaret N Kosek
- Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA, USA
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Veeser J, Hanak C, Rogiers A, Devos M, Page N. Mindfulness based relapse prevention (MBRP, Marlatt) in a naturalistic setting for patients with substance use disorder (SUD). Eur Psychiatry 2022. [PMCID: PMC9567496 DOI: 10.1192/j.eurpsy.2022.2115] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
MBRP has become an established treatment in the field of addiction, but implementing the program in an outpatient setting remains a challenge.
Objectives
We investigated the feasibility of MBRP in an naturalistic outpatient setting and the effect of mindfulness on underlying factors of addiction.
Methods
All patients treated between 2015 and 2019 in the MBRP program at Brugmann University Hospital and Addiction Center Enaden were eligible to participate. Patients were asked to fill in a questionnaire about underlying factors of SUD in the domains of pleasure, emotion regulation, stress, relationship with others and relationship with oneself as well as the effect of the completed training on these factors.
Results
Of the 147(74 F) recruited patients; 32 patients completed the questionnaire. The study population differed in terms of substance (mainly alcohol but also cocaine, cannabis, heroine) as well in their aims towards the substance (reduce, stop or maintaining abstinence). Participation of at least 4 of the 8 sessions was 63 % and overall satisfaction of patients was high. We found a positive effect of mindfulness on all of the underlying factors for SUD. Underlying factors of SUD, as well as the effect of mindfulness on these factors showed strong individual variation. The most frequently observed negative effect was acute craving; 1 patient became acute suicidal.
Conclusions
MBRP is feasible and has a clinical relevant impact on underlying factors of SUD. Negative effects were also observed and should be carefully monitored.
Disclosure
No significant relationships.
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Guga G, Elwood S, Kimathi C, Kang G, Kosek MN, Lima AA, Bessong PO, Samie A, Haque R, Leite JP, Bodhidatta L, Iqbal N, Page N, Kiwelu I, Bhutta ZA, Ahmed T, Liu J, Rogawski McQuade ET, Houpt E, Platts-Mills JA, Mduma ER. Burden, clinical characteristics, risk factors, and seasonality of adenovirus 40/41 diarrhea in children in eight low-resource settings. Open Forum Infect Dis 2022; 9:ofac241. [PMID: 35854993 PMCID: PMC9277636 DOI: 10.1093/ofid/ofac241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background The application of molecular diagnostics has identified enteric group adenovirus serotypes 40 and 41 as important causes of diarrhea in children. However, many aspects of the epidemiology of adenovirus 40/41 diarrhea have not been described. Methods We used data from the 8-site Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project birth cohort study to describe site- and age-specific incidence, risk factors, clinical characteristics, and seasonality. Results The incidence of adenovirus 40/41 diarrhea was substantially higher by quantitative polymerase chain reaction than enzyme immunoassay and peaked at ∼30 episodes per 100 child-years in children aged 7–15 months, with substantial variation in incidence between sites. A significant burden was also seen in children 0–6 months of age, higher than other viral etiologies with the exception of rotavirus. Children with adenovirus 40/41 diarrhea were more likely to have a fever than children with norovirus, sapovirus, and astrovirus (adjusted odds ratio [aOR], 1.62; 95% CI, 1.16–2.26) but less likely than children with rotavirus (aOR, 0.66; 95% CI, 0.49–0.91). Exclusive breastfeeding was strongly protective against adenovirus 40/41 diarrhea (hazard ratio, 0.64; 95% CI, 0.48–0.85), but no other risk factors were identified. The seasonality of adenovirus 40/41 diarrhea varied substantially between sites and did not have clear associations with seasonal variations in temperature or rainfall. Conclusions This study supports the situation of adenovirus 40/41 as a pathogen of substantial importance, especially in infants. Fever was a distinguishing characteristic in comparison to other nonrotavirus viral etiologies, and promotion of exclusive breastfeeding may reduce the high observed burden in the first 6 months of life.
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Affiliation(s)
- Godfrey Guga
- Haydom Global Health Research Centre, Haydom, Tanzania
| | - Sarah Elwood
- Haydom Global Health Research Centre, Haydom, Tanzania
| | | | | | - Margaret N. Kosek
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
- Asociación Benéfica PRISMA, Iquitos, Peru
| | | | | | | | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Ladaporn Bodhidatta
- Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | | | - Nicola Page
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Ireen Kiwelu
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jie Liu
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
- School of Public Health, Qingdao University, Shandong, China
| | | | - Eric Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - James A. Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
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Colston JM, Zaitchik BF, Badr HS, Burnett E, Ali SA, Rayamajhi A, Satter SM, Eibach D, Krumkamp R, May J, Chilengi R, Howard LM, Sow SO, Jahangir Hossain M, Saha D, Imran Nisar M, Zaidi AKM, Kanungo S, Mandomando I, Faruque ASG, Kotloff KL, Levine MM, Breiman RF, Omore R, Page N, Platts‐Mills JA, Ashorn U, Fan Y, Shrestha PS, Ahmed T, Mduma E, Yori PP, Bhutta Z, Bessong P, Olortegui MP, Lima AAM, Kang G, Humphrey J, Prendergast AJ, Ntozini R, Okada K, Wongboot W, Gaensbauer J, Melgar MT, Pelkonen T, Freitas CM, Kosek MN. Associations Between Eight Earth Observation-Derived Climate Variables and Enteropathogen Infection: An Independent Participant Data Meta-Analysis of Surveillance Studies With Broad Spectrum Nucleic Acid Diagnostics. Geohealth 2022; 6:e2021GH000452. [PMID: 35024531 PMCID: PMC8729196 DOI: 10.1029/2021gh000452] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/12/2021] [Accepted: 11/18/2021] [Indexed: 05/10/2023]
Abstract
Diarrheal disease, still a major cause of childhood illness, is caused by numerous, diverse infectious microorganisms, which are differentially sensitive to environmental conditions. Enteropathogen-specific impacts of climate remain underexplored. Results from 15 studies that diagnosed enteropathogens in 64,788 stool samples from 20,760 children in 19 countries were combined. Infection status for 10 common enteropathogens-adenovirus, astrovirus, norovirus, rotavirus, sapovirus, Campylobacter, ETEC, Shigella, Cryptosporidium and Giardia-was matched by date with hydrometeorological variables from a global Earth observation dataset-precipitation and runoff volume, humidity, soil moisture, solar radiation, air pressure, temperature, and wind speed. Models were fitted for each pathogen, accounting for lags, nonlinearity, confounders, and threshold effects. Different variables showed complex, non-linear associations with infection risk varying in magnitude and direction depending on pathogen species. Rotavirus infection decreased markedly following increasing 7-day average temperatures-a relative risk of 0.76 (95% confidence interval: 0.69-0.85) above 28°C-while ETEC risk increased by almost half, 1.43 (1.36-1.50), in the 20-35°C range. Risk for all pathogens was highest following soil moistures in the upper range. Humidity was associated with increases in bacterial infections and decreases in most viral infections. Several virus species' risk increased following lower-than-average rainfall, while rotavirus and ETEC increased with heavier runoff. Temperature, soil moisture, and humidity are particularly influential parameters across all enteropathogens, likely impacting pathogen survival outside the host. Precipitation and runoff have divergent associations with different enteric viruses. These effects may engender shifts in the relative burden of diarrhea-causing agents as the global climate changes.
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12
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Ntshoe G, Shonhiwa AM, Govender N, Page N. A systematic review on mobile health applications for foodborne disease outbreak management. BMC Public Health 2021; 21:2228. [PMID: 34876067 PMCID: PMC8653522 DOI: 10.1186/s12889-021-12283-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background Foodborne disease outbreaks are common and notifiable in South Africa; however, they are rarely reported and poorly investigated. Surveillance data from the notification system is suboptimal and limited, and does not provide adequate information to guide public health action and inform policy. We performed a systematic review of published literature to identify mobile application-based outbreak response systems for managing foodborne disease outbreaks and to determine the elements that the system requires to generate foodborne disease data needed for public action. Methods Studies were identified through literature searches using online databases on PubMed/Medline, CINAHL, Academic Search Complete, Greenfile, Library, Information Science & Technology. Search was limited to studies published in English during the period January 1990 to November 2020. Search strategy included various terms in varying combinations with Boolean phrases “OR” and “AND”. Data were collected following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. A standardised data collection tool was used to extract and summarise information from identified studies. We assessed qualities of mobile applications by looking at the operating system, system type, basic features and functionalities they offer for foodborne disease outbreak management. Results Five hundred and twenty-eight (528) publications were identified, of which 48 were duplicates. Of the remaining 480 studies, 2.9% (14/480) were assessed for eligibility. Only one of the 14 studies met the inclusion criteria and reported on one mobile health application named MyMAFI (My Mobile Apps for Field Investigation). There was lack of detailed information on the application characteristics. However, based on minimal information available, MyMAFI demonstrated the ability to generate line lists, reports and offered functionalities for outbreak verification and epidemiological investigation. Availability of other key components such as environmental and laboratory investigations were unknown. Conclusions There is limited use of mobile applications on management of foodborne disease outbreaks. Efforts should be made to set up systems and develop applications that can improve data collection and quality of foodborne disease outbreak investigations. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12283-6.
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Affiliation(s)
- Genevie Ntshoe
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa. .,School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
| | - Andronica Moipone Shonhiwa
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Nevashan Govender
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Nicola Page
- Centre for Enteric Diseases, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa.,Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Page N, Chia K, Brazier D, Manisty C, Kozor R. Assessing access to mri in patients with cardiac implantable electronic devices in australia. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
"Legacy" cardiac implantable electronic devices (CIEDs) have historically been considered non-MRI-conditional. However, a number of recent studies indicate that if certain protocols are followed, patients with such devices may undergo MRI without significant adverse outcomes. Nowadays, industry standards dictate that "modern" CIEDs are MRI compatible. Despite these developments, some patients with CIEDs are denied MRI. Paucity of access to this vital service has been shown to increase expense, lead to more invasive imaging and later diagnosis, and poorer patient outcomes.
This study aims to identify if Australian public hospitals provide MRI services for patients with modern and legacy CIEDs, the characteristics of the services, and the barriers to implementing such a service.
Methods
This study surveyed all Australian Tertiary Referral Public Hospitals (n = 38), with a mixed qualitative and quantitative questionnaire.
Results
35 of the 38 sites completed the survey. Figure 1A shows that the majority of hospitals (30/35, 85.7%) offer MRIs for modern MRI-conditional CIEDs. In contrast, Figure 1B shows that only a minority of hospitals (3/35, 8.6%) offer MRIs for legacy CIEDs.
Protocols governing patient eligibility vary greatly among hospitals that scan modern devices. Locations either allow all CIEDs to be scanned, only non-dependent CIEDs, or only pacemaker CIEDs. 1.5 Tesla is the preferred strength to scan Modern CIEDs (59%), however a sizeable proportion scan at only 3.0 Tesla (10%) or both strengths (31%). A majority (80%) of staff in attendance of the scan were ACLS-trained (Advanced Cardiac Life Support), with no correlation to strength of MRI used. A range of different personnel attend the scan with varied patient monitoring strategies, and a majority (79%) offer thoracic as well as extra-thoracic scanning.
The few hospitals that scan legacy devices only scan at 1.5 tesla, and follow individualised protocols. These sites offer more personnel in attendance for the scan than for modern CIED scans, with all staff ACLS-trained including a physician who can direct CIED programming of required. These sites have more involved patient monitoring, and all also offer thoracic and extra-thoracic MRI scanning.
The predominant barrier identified was an absence of National Guidelines, followed by a lack of formal training or logistical device support.
Conclusions
The majority (85.7%) of Australian Tertiary Referral Public Hospitals have a MRI service for patients with modern CIEDs, but only 8.6% offer this service to patients with legacy CIEDs.
This highlights the need for a national effort to guide the provision of MRI services for patients with CIEDs, and address the identified barriers.
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Affiliation(s)
- N Page
- University of Sydney, Sydney, Australia
| | - K Chia
- Royal North Shore Hospital, Sydney, Australia
| | - D Brazier
- Royal North Shore Hospital, Sydney, Australia
| | - C Manisty
- University College of London, London, United Kingdom of Great Britain & Northern Ireland
| | - R Kozor
- University of Sydney, Sydney, Australia
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McMurry TL, McQuade ETR, Liu J, Kang G, Kosek MN, Lima AAM, Bessong PO, Samie A, Haque R, Mduma ER, Leite JP, Bodhidatta L, Iqbal NT, Page N, Kiwelu I, Bhutta ZA, Ahmed T, Houpt ER, Platts-Mills JA. Duration of Postdiarrheal Enteric Pathogen Carriage in Young Children in Low-resource Settings. Clin Infect Dis 2021; 72:e806-e814. [PMID: 33033835 PMCID: PMC8315229 DOI: 10.1093/cid/ciaa1528] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Indexed: 02/07/2023] Open
Abstract
Background Prolonged enteropathogen shedding after diarrhea complicates the identification of etiology in subsequent episodes and is an important driver of pathogen transmission. A standardized approach has not been applied to estimate the duration of shedding for a wide range of pathogens. Methods We used a multisite birth cohort of children 0–24 months of age from whom diarrheal and monthly nondiarrheal stools were previously tested by quantitative polymerase chain reaction for 29 enteropathogens. We modeled the probability of detection of the etiologic pathogen before and after diarrhea using a log-normal accelerated failure time survival model and estimated the median duration of pathogen carriage as well as differences in subclinical pathogen carriage 60 days after diarrhea onset in comparison to a prediarrhea baseline. Results We analyzed 3247 etiologic episodes of diarrhea for the 9 pathogens with the highest attributable burdens of diarrhea. The median duration of postdiarrheal carriage varied widely by pathogen, from about 1 week for rotavirus (median, 8.1 days [95% confidence interval {CI}, 6.2–9.6]) to >1 month for Cryptosporidium (39.5 days [95% CI, 30.6–49.0]). The largest increases in subclinical pathogen carriage before and after diarrhea were seen for Cryptosporidium (prevalence difference between 30 days prior and 60 days after diarrhea onset, 0.30 [95% CI, .23–.39]) and Shigella (prevalence difference, 0.21 [95% CI, .16–.27]). Conclusions Postdiarrheal shedding was widely variable between pathogens, with strikingly prolonged shedding seen for Cryptosporidium and Shigella. Targeted antimicrobial therapy and vaccination for these pathogens may have a relatively large impact on transmission.
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Affiliation(s)
- Timothy L McMurry
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Elizabeth T Rogawski McQuade
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA.,Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Jie Liu
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | | | - Margaret N Kosek
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA.,Asociación Benéfica PRISMA, Iquitos, Peru
| | | | | | | | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | | | | | | | - Nicola Page
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Ireen Kiwelu
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
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Schubert G, Achi V, Ahuka S, Belarbi E, Bourhaima O, Eckmanns T, Johnstone S, Kabore F, Kra O, Mendes A, Ouedraogo AS, Poda A, Some AS, Tomczyk S, Couacy-Hymann E, Kayembe JM, Meda N, Muyembe Tamfum JJ, Ouangraoua S, Page N, Venter M, Leendertz FH, Akoua-Koffi C. The African Network for Improved Diagnostics, Epidemiology and Management of common infectious Agents. BMC Infect Dis 2021; 21:539. [PMID: 34098893 PMCID: PMC8184052 DOI: 10.1186/s12879-021-06238-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background In sub-Saharan Africa, acute respiratory infections (ARI), acute gastrointestinal infections (GI) and acute febrile disease of unknown cause (AFDUC) have a large disease burden, especially among children, while respective aetiologies often remain unresolved. The need for robust infectious disease surveillance to detect emerging pathogens along with common human pathogens has been highlighted by the ongoing novel coronavirus disease 2019 (COVID-19) pandemic. The African Network for Improved Diagnostics, Epidemiology and Management of Common Infectious Agents (ANDEMIA) is a sentinel surveillance study on the aetiology and clinical characteristics of ARI, GI and AFDUC in sub-Saharan Africa. Methods ANDEMIA includes 12 urban and rural health care facilities in four African countries (Côte d’Ivoire, Burkina Faso, Democratic Republic of the Congo and Republic of South Africa). It was piloted in 2018 in Côte d’Ivoire and the initial phase will run from 2019 to 2021. Case definitions for ARI, GI and AFDUC were established, as well as syndrome-specific sampling algorithms including the collection of blood, naso- and oropharyngeal swabs and stool. Samples are tested using comprehensive diagnostic protocols, ranging from classic bacteriology and antimicrobial resistance screening to multiplex real-time polymerase chain reaction (PCR) systems and High Throughput Sequencing. In March 2020, PCR testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and analysis of full genomic information was included in the study. Standardised questionnaires collect relevant clinical, demographic, socio-economic and behavioural data for epidemiologic analyses. Controls are enrolled over a 12-month period for a nested case-control study. Data will be assessed descriptively and aetiologies will be evaluated using a latent class analysis among cases. Among cases and controls, an integrated analytic approach using logistic regression and Bayesian estimation will be employed to improve the assessment of aetiology and associated risk factors. Discussion ANDEMIA aims to expand our understanding of ARI, GI and AFDUC aetiologies in sub-Saharan Africa using a comprehensive laboratory diagnostics strategy. It will foster early detection of emerging threats and continued monitoring of important common pathogens. The network collaboration will be strengthened and site diagnostic capacities will be reinforced to improve quality management and patient care.
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Affiliation(s)
| | - Vincent Achi
- Centre Hospitalier Universitaire Bouaké, Bouaké, Côte d'Ivoire.,Université Alassane Ouattara de Bouaké, Bouaké, Côte d'Ivoire
| | - Steve Ahuka
- Institut National de la Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | | | - Ouattara Bourhaima
- Centre Hospitalier Universitaire Bouaké, Bouaké, Côte d'Ivoire.,Université Alassane Ouattara de Bouaké, Bouaké, Côte d'Ivoire
| | | | - Siobhan Johnstone
- National Institute for Communicable Diseases, Johannesburg, Republic of South Africa
| | | | - Ouffoue Kra
- Centre Hospitalier Universitaire Bouaké, Bouaké, Côte d'Ivoire.,Université Alassane Ouattara de Bouaké, Bouaké, Côte d'Ivoire
| | - Adriano Mendes
- University of Pretoria, Pretoria, Republic of South Africa
| | - Abdoul-Salam Ouedraogo
- Centre Hospitalier Universitaire Sourô Sanou de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Armel Poda
- Centre Hospitalier Universitaire Sourô Sanou de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | | | | | - Emmanuel Couacy-Hymann
- Laboratoire National d'Appui au Développement Agricole / Laboratoire Central de Pathologie Animale, Bingerville, Côte d'Ivoire
| | - Jean-Marie Kayembe
- Hôpital Universitaire/Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Jean-Jacques Muyembe Tamfum
- Institut National de la Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo.,Hôpital Universitaire/Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Nicola Page
- National Institute for Communicable Diseases, Johannesburg, Republic of South Africa.,University of Pretoria, Pretoria, Republic of South Africa
| | | | | | - Chantal Akoua-Koffi
- Centre Hospitalier Universitaire Bouaké, Bouaké, Côte d'Ivoire. .,Université Alassane Ouattara de Bouaké, Bouaké, Côte d'Ivoire.
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16
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Rogawski McQuade ET, Liu J, Kang G, Kosek MN, Lima AAM, Bessong PO, Samie A, Haque R, Mduma ER, Shrestha S, Leite JP, Bodhidatta L, Iqbal N, Page N, Kiwelu I, Bhutta Z, Ahmed T, Houpt ER, Platts-Mills JA. Protection From Natural Immunity Against Enteric Infections and Etiology-Specific Diarrhea in a Longitudinal Birth Cohort. J Infect Dis 2021; 222:1858-1868. [PMID: 31984416 PMCID: PMC7653087 DOI: 10.1093/infdis/jiaa031] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/22/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The degree of protection conferred by natural immunity is unknown for many enteropathogens, but it is important to support the development of enteric vaccines. METHODS We used the Andersen-Gill extension of the Cox model to estimate the effects of previous infections on the incidence of subsequent subclinical infections and diarrhea in children under 2 using quantitative molecular diagnostics in the MAL-ED cohort. We used cross-pathogen negative control associations to correct bias due to confounding by unmeasured heterogeneity of exposure and susceptibility. RESULTS Prior rotavirus infection was associated with a 50% lower hazard (calibrated hazard ratio [cHR], 0.50; 95% confidence interval [CI], 0.41-0.62) of subsequent rotavirus diarrhea. Strong protection was evident against Cryptosporidium diarrhea (cHR, 0.32; 95% CI, 0.20-0.51). There was also protection due to prior infections for norovirus GII (cHR against diarrhea, 0.67; 95% CI, 0.49-0.91), astrovirus (cHR, 0.62; 95% CI, 0.48-0.81), and Shigella (cHR, 0.79; 95% CI, 0.65-0.95). Minimal protection was observed for other bacteria, adenovirus 40/41, and sapovirus. CONCLUSIONS Natural immunity was generally stronger for the enteric viruses than bacteria, potentially due to less antigenic diversity. Vaccines against major causes of diarrhea may be feasible but likely need to be more immunogenic than natural infection.
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Affiliation(s)
- Elizabeth T Rogawski McQuade
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virgina, USA.,Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, Virgina, USA
| | - Jie Liu
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, Virgina, USA
| | | | - Margaret N Kosek
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, Virgina, USA.,Asociación Benéfica PRISMA, Iquitos, Peru
| | | | | | | | - Rashidul Haque
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | | | | | | | - Ladaporn Bodhidatta
- Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | | | - Nicola Page
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Ireen Kiwelu
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Tahmeed Ahmed
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Eric R Houpt
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, Virgina, USA
| | - James A Platts-Mills
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, Virgina, USA
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17
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Page N, Hallingberg B, Brown R, Lowthian E, Hewitt G, Murphy S, Moore G. Change over time in adolescent smoking, cannabis use and their association: findings from the School Health Research Network in Wales. J Public Health (Oxf) 2020; 43:e620-e628. [PMID: 32989453 PMCID: PMC8677436 DOI: 10.1093/pubmed/fdaa174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/29/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 11/13/2022] Open
Abstract
Background While tobacco smoking has declined among UK youth in recent decades, cannabis use has begun to show some growth. Given their interrelationship, growth in cannabis use may act as a barrier to continued reduction in youth smoking. This paper assesses recent tobacco and cannabis use trends in Wales, and their association, to explore whether change in cannabis use might have impacted youth tobacco smoking prevalence. Methods Repeat cross-sectional data on tobacco and cannabis use were obtained from biennial Welsh Student Health and Wellbeing surveys between 2013 and 2019. Data were pooled and analysed using logistic regression with adjustment for school-level clustering. Results No change in regular youth tobacco smoking was observed between 2013 and 2019. In contrast, current cannabis use increased during this time, and cannabis users had significantly greater odds of regular tobacco smoking. After adjusting for change in cannabis use, a significant decline in youth tobacco smoking was observed (OR 0.95; 95% confidence intervals: 0.92, 0.97). Conclusion Recent growth in cannabis use among young people in Wales may have offset prospective declines in regular tobacco smoking. Further reductions in youth smoking may require more integrated policy approaches to address the co-use of tobacco and cannabis among adolescents.
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Affiliation(s)
- N Page
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, CF10 3BD, UK
| | - B Hallingberg
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, CF5 2YB, UK
| | - R Brown
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, CF10 3BD, UK
| | - E Lowthian
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, CF10 3BD, UK
| | - G Hewitt
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, CF10 3BD, UK
| | - S Murphy
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, CF10 3BD, UK
| | - G Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, School of Social Sciences, Cardiff University, Cardiff, CF10 3BD, UK.,SPECTRUM Consortium, UK
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18
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Rogawski McQuade ET, Shaheen F, Kabir F, Rizvi A, Platts-Mills JA, Aziz F, Kalam A, Qureshi S, Elwood S, Liu J, Lima AAM, Kang G, Bessong P, Samie A, Haque R, Mduma ER, Kosek MN, Shrestha S, Leite JP, Bodhidatta L, Page N, Kiwelu I, Shakoor S, Turab A, Soofi SB, Ahmed T, Houpt ER, Bhutta Z, Iqbal NT. Epidemiology of Shigella infections and diarrhea in the first two years of life using culture-independent diagnostics in 8 low-resource settings. PLoS Negl Trop Dis 2020; 14:e0008536. [PMID: 32804926 PMCID: PMC7451981 DOI: 10.1371/journal.pntd.0008536] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [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: 12/18/2019] [Revised: 08/27/2020] [Accepted: 06/29/2020] [Indexed: 02/06/2023] Open
Abstract
Culture-independent diagnostics have revealed a larger burden of Shigella among children in low-resource settings than previously recognized. We further characterized the epidemiology of Shigella in the first two years of life in a multisite birth cohort. We tested 41,405 diarrheal and monthly non-diarrheal stools from 1,715 children for Shigella by quantitative PCR. To assess risk factors, clinical factors related to age and culture positivity, and associations with inflammatory biomarkers, we used log-binomial regression with generalized estimating equations. The prevalence of Shigella varied from 4.9%-17.8% in non-diarrheal stools across sites, and the incidence of Shigella-attributable diarrhea was 31.8 cases (95% CI: 29.6, 34.2) per 100 child-years. The sensitivity of culture compared to qPCR was 6.6% and increased to 27.8% in Shigella-attributable dysentery. Shigella diarrhea episodes were more likely to be severe and less likely to be culture positive in younger children. Older age (RR: 1.75, 95% CI: 1.70, 1.81 per 6-month increase in age), unimproved sanitation (RR: 1.15, 95% CI: 1.03, 1.29), low maternal education (<10 years, RR: 1.14, 95% CI: 1.03, 1.26), initiating complementary foods before 3 months (RR: 1.10, 95% CI: 1.01, 1.20), and malnutrition (RR: 0.91, 95% CI: 0.88, 0.95 per unit increase in weight-for-age z-score) were risk factors for Shigella. There was a linear dose-response between Shigella quantity and myeloperoxidase concentrations. The burden of Shigella varied widely across sites, but uniformly increased through the second year of life and was associated with intestinal inflammation. Culture missed most clinically relevant cases of severe diarrhea and dysentery. Shigella is the second leading cause of diarrhea morbidity and mortality among children in low and middle-income countries. We characterized the epidemiology of Shigella using highly sensitive diagnostic methods in 41,405 diarrheal and monthly non-diarrheal stools from the first two years of life in a multisite birth cohort. The prevalence of Shigella varied from 4.9%-17.8% across sites, and the incidence of Shigella-attributable diarrhea was 31.8 cases (95% CI: 29.6, 34.2) per 100 child-years. Shigella diarrhea episodes were more likely to be severe and less likely to be culture positive in younger children. Older age, unimproved sanitation, low maternal education, initiating complementary foods before 3 months, and malnutrition were risk factors for Shigella. There was a linear dose-response between Shigella quantity and myeloperoxidase, a marker of intestinal inflammation, which suggests a potential mechanism for the impact of Shigella on child growth. Because culture missed most clinically relevant cases of severe diarrhea and dysentery, molecular diagnostics may be important tools in upcoming Shigella vaccine trials.
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Affiliation(s)
- Elizabeth T. Rogawski McQuade
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, Virginia, United States of America
- * E-mail: (ETRM); (NTI)
| | - Fariha Shaheen
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Furqan Kabir
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Arjumand Rizvi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - James A. Platts-Mills
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, Virginia, United States of America
| | - Fatima Aziz
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Adil Kalam
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shahida Qureshi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sarah Elwood
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, Virginia, United States of America
| | - Jie Liu
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, Virginia, United States of America
| | | | | | | | | | - Rashidul Haque
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Margaret N. Kosek
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, Virginia, United States of America
- Asociación Benéfica PRISMA, Iquitos, Peru
| | | | | | - Ladaporn Bodhidatta
- Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Nicola Page
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Ireen Kiwelu
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Sadia Shakoor
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Ali Turab
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid Bashir Soofi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Tahmeed Ahmed
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Eric R. Houpt
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, Virginia, United States of America
| | - Zulfiqar Bhutta
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Najeeha Talat Iqbal
- Department of Pediatrics and Child Health and Biological & Biomedical Sciences, Aga Khan University, Karachi, Pakistan
- * E-mail: (ETRM); (NTI)
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19
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Groome MJ, Fairlie L, Morrison J, Fix A, Koen A, Masenya M, Jose L, Madhi SA, Page N, McNeal M, Dally L, Cho I, Power M, Flores J, Cryz S. Safety and immunogenicity of a parenteral trivalent P2-VP8 subunit rotavirus vaccine: a multisite, randomised, double-blind, placebo-controlled trial. Lancet Infect Dis 2020; 20:851-863. [PMID: 32251641 PMCID: PMC7322558 DOI: 10.1016/s1473-3099(20)30001-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/25/2019] [Accepted: 01/02/2020] [Indexed: 12/16/2022]
Abstract
Background A monovalent, parenteral, subunit rotavirus vaccine was well tolerated and immunogenic in adults in the USA and in toddlers and infants in South Africa, but elicited poor responses against heterotypic rotavirus strains. We aimed to evaluate safety and immunogenicity of a trivalent vaccine formulation (P2-VP8-P[4],[6],[8]). Methods A double-blind, randomised, placebo-controlled, dose-escalation, phase 1/2 study was done at three South African research sites. Healthy adults (aged 18–45 years), toddlers (aged 2–3 years), and infants (aged 6–8 weeks, ≥37 weeks' gestation, and without previous receipt of rotavirus vaccination), all without HIV infection, were eligible for enrolment. In the dose-escalation phase, adults and toddlers were randomly assigned in blocks (block size of five) to receive 30 μg or 90 μg of vaccine, or placebo, and infants were randomly assigned in blocks (block size of four) to receive 15 μg, 30 μg, or 90 μg of vaccine, or placebo. In the expanded phase, infants were randomly assigned in a 1:1:1:1 ratio to receive 15 μg, 30 μg, or 90 μg of vaccine, or placebo, in block sizes of four. Participants, parents of participants, and clinical, data, and laboratory staff were masked to treatment assignment. Adults received an intramuscular injection of vaccine or placebo in the deltoid muscle on the day of randomisation (day 0), day 28, and day 56; toddlers received a single injection of vaccine or placebo in the anterolateral thigh on day 0. Infants in both phases received an injection of vaccine or placebo in the anterolateral thigh on days 0, 28, and 56, at approximately 6, 10, and 14 weeks of age. Primary safety endpoints were local and systemic reactions (grade 2 or worse) within 7 days and adverse events and serious adverse events within 28 days after each injection in all participants who received at least one injection. Primary immunogenicity endpoints were analysed in infants in either phase who received all planned injections, had blood samples analysed at the relevant timepoints, and presented no major protocol violations considered to have an effect on the immunogenicity results of the study, and included serum anti-P2-VP8 IgA, IgG, and neutralising antibody geometric mean titres and responses measured 4 weeks after the final injection in vaccine compared with placebo groups. This trial is registered with ClinicalTrials.gov, NCT02646891. Findings Between Feb 15, 2016, and Dec 22, 2017, 30 adults (12 each in the 30 μg and 90 μg groups and six in the placebo group), 30 toddlers (12 each in the 30 μg and 90 μg groups and six in the placebo group), and 557 infants (139 in the 15 μg group, 140 in the 30 μg group, 139 in the 90 μg group, and 139 in the placebo group) were randomly assigned, received at least one dose, and were assessed for safety. There were no significant differences in local or systemic adverse events, or unsolicited adverse events, between vaccine and placebo groups. There were no serious adverse events within 28 days of injection in adults, whereas one serious adverse event occurred in a toddler (febrile convulsion in the 30 μg group) and 23 serious adverse events (four in placebo, ten in 15 μg, four in 30 μg, and five in 90 μg groups) occurred among 20 infants, most commonly respiratory tract infections. One death occurred in an infant within 28 days of injection due to pneumococcal meningitis. In 528 infants (130 in placebo, 132 in 15 μg, 132 in 30 μg, and 134 in 90 μg groups), adjusted anti-P2-VP8 IgG seroresponses (≥4-fold increase from baseline) to P[4], P[6], and P[8] antigens were significantly higher in the 15 μg, 30 μg, and 90 μg groups (99–100%) than in the placebo group (10–29%; p<0·0001). Although significantly higher than in placebo recipients (9–10%), anti-P2-VP8 IgA seroresponses (≥4-fold increase from baseline) to each individual antigen were modest (20–34%) across the 15 μg, 30 μg, and 90 μg groups. Adjusted neutralising antibody seroresponses in infants (≥2·7-fold increase from baseline) to DS-1 (P[4]), 1076 (P[6]), and Wa (P[8]) were higher in vaccine recipients than in placebo recipients: p<0·0001 for all comparisons. Interpretation The trivalent P2-VP8 vaccine was well tolerated, with promising anti-P2-VP8 IgG and neutralising antibody responses across the three vaccine P types. Our findings support advancing the vaccine to efficacy testing. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- Michelle J Groome
- South African Medical Research Council (SAMRC): Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation (DST/NRF): Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Lee Fairlie
- Wits Reproductive Health and HIV Institute, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Julie Morrison
- Family Clinical Research Unit, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | | | - Anthonet Koen
- South African Medical Research Council (SAMRC): Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation (DST/NRF): Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maysseb Masenya
- Wits Reproductive Health and HIV Institute, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa Jose
- South African Medical Research Council (SAMRC): Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation (DST/NRF): Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- South African Medical Research Council (SAMRC): Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation (DST/NRF): Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicola Page
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Monica McNeal
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Len Dally
- The Emmes Corporation, Rockville, MD, USA
| | - Iksung Cho
- PATH, Washington, DC, USA; Novavax, Gaithersburg, MD, USA
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Moore G, Brown R, Page N, Hallingberg B, Gray L, Maynard O, McKell J, Bauld L. Use of e-cigarettes by young people in Great Britain before and after Tobacco Products Directive. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Young people’s experimentation with e-cigarettes has increased in recent years, although regular use remains rare. In May 2016, the EU Tobacco Products Directive (TPD) introduced regulations aimed in part at preventing use by young people. It imposed warnings on e-cigarette packets, banned many forms of advertising, and restricted nicotine strength. This paper examines change in young people’s e-cigarette use after TPD, as well as complementary and alternative causal explanations for change, from young people’s perspectives.
Methods
Quantitative data sources were 2013, 2015 and 2017 School Health Research Network/Health Behaviour in School-aged Children surveys in Wales and 2014 and 2016 Smoking Drinking and Drug Use surveys in England. Data were analysed using segmented binary logistic regression in Wales, with simpler before and after analyses in England. Results were considered alongside qualitative interview data from young people aged 14-15 years in England, Wales and Scotland, collected in 2017 and 2018.
Results
Ever-use of e-cigarettes almost doubled from 2013-15, though subsequent increases were smaller. In Wales, where pre-legislation time series data were available, under a range of assumptions, prior growth in e-cigarette ever-use did not continue post-TPD. Change in trend post-TPD did not reach significance (OR = 0.96; 95%CI=0.91 to 1.01), but became significant after adjusting for change in smoking rates across the time-series (OR = 0.93; 95%CI=0.88 to 0.98). Regular use did not increase significantly from 2015 to 2017 in Wales, although ever and regular use in England both increased from 2014 to 2016. Young people described limited interactions with core components of TPD, while commonly describing e-cigarette use as a fad which was beginning to run its course.
Conclusions
Growth in youth experimentation with e-cigarettes may be slowing. Qualitative data from young people provide a range of explanations which appear largely unrelated to TPD itself.
Key messages
Survey data provide preliminary evidence that use of e-cigarettes may be plateauing among young people in the UK after a rapid initial increase in experimentation. Explanations position e-cigarettes as a passing fad which is beginning to lose its appeal in UK youth. Longer term monitoring of trends and perceptions remain vital.
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Affiliation(s)
- G Moore
- DECIPHer, Cardiff University, Cardiff, UK
| | - R Brown
- DECIPHer, Cardiff University, Cardiff, UK
| | - N Page
- DECIPHer, Cardiff University, Cardiff, UK
| | | | - L Gray
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - O Maynard
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, UK
| | - J McKell
- Institute for Social Marketing, University of Stirling and UK Centre for Tobacco and Alcohol Studies, Stirling, UK
| | - L Bauld
- Usher Institute of Population Health Sciences & Informatics, University of Edinburgh., Edinburgh, UK
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21
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Flanagan S, Anthony J, Dyson L, Page N, Williams M, Brady P. VETERAN-CENTRIC VD-HCBS: HOW VETERANS USE FLEXIBLE SPENDING BUDGETS TO MEET INDEPENDENT LIVING GOALS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.704] [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: 11/13/2022] Open
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Platts-Mills JA, Liu J, Rogawski ET, Kabir F, Lertsethtakarn P, Siguas M, Khan SS, Praharaj I, Murei A, Nshama R, Mujaga B, Havt A, Maciel IA, McMurry TL, Operario DJ, Taniuchi M, Gratz J, Stroup SE, Roberts JH, Kalam A, Aziz F, Qureshi S, Islam MO, Sakpaisal P, Silapong S, Yori PP, Rajendiran R, Benny B, McGrath M, McCormick BJJ, Seidman JC, Lang D, Gottlieb M, Guerrant RL, Lima AAM, Leite JP, Samie A, Bessong PO, Page N, Bodhidatta L, Mason C, Shrestha S, Kiwelu I, Mduma ER, Iqbal NT, Bhutta ZA, Ahmed T, Haque R, Kang G, Kosek MN, Houpt ER. Use of quantitative molecular diagnostic methods to assess the aetiology, burden, and clinical characteristics of diarrhoea in children in low-resource settings: a reanalysis of the MAL-ED cohort study. Lancet Glob Health 2018; 6:e1309-e1318. [PMID: 30287127 PMCID: PMC6227251 DOI: 10.1016/s2214-109x(18)30349-8] [Citation(s) in RCA: 215] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/28/2018] [Accepted: 07/11/2018] [Indexed: 12/17/2022]
Abstract
Background Optimum management of childhood diarrhoea in low-resource settings has been hampered by insufficient data on aetiology, burden, and associated clinical characteristics. We used quantitative diagnostic methods to reassess and refine estimates of diarrhoea aetiology from the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort study. Methods We re-analysed stool specimens from the multisite MAL-ED cohort study of children aged 0–2 years done at eight locations (Dhaka, Bangladesh; Vellore, India; Bhaktapur, Nepal; Naushero Feroze, Pakistan; Venda, South Africa; Haydom, Tanzania; Fortaleza, Brazil; and Loreto, Peru), which included active surveillance for diarrhoea and routine non-diarrhoeal stool collection. We used quantitative PCR to test for 29 enteropathogens, calculated population-level pathogen-specific attributable burdens, derived stringent quantitative cutoffs to identify aetiology for individual episodes, and created aetiology prediction scores using clinical characteristics. Findings We analysed 6625 diarrhoeal and 30 968 non-diarrhoeal surveillance stools from 1715 children. Overall, 64·9% of diarrhoea episodes (95% CI 62·6–71·2) could be attributed to an aetiology by quantitative PCR compared with 32·8% (30·8–38·7) using the original study microbiology. Viral diarrhoea (36·4% of overall incidence, 95% CI 33·6–39·5) was more common than bacterial (25·0%, 23·4–28·4) and parasitic diarrhoea (3·5%, 3·0–5·2). Ten pathogens accounted for 95·7% of attributable diarrhoea: Shigella (26·1 attributable episodes per 100 child-years, 95% CI 23·8–29·9), sapovirus (22·8, 18·9–27·5), rotavirus (20·7, 18·8–23·0), adenovirus 40/41 (19·0, 16·8–23·0), enterotoxigenic Escherichia coli (18·8, 16·5–23·8), norovirus (15·4, 13·5–20·1), astrovirus (15·0, 12·0–19·5), Campylobacter jejuni or C coli (12·1, 8·5–17·2), Cryptosporidium (5·8, 4·3–8·3), and typical enteropathogenic E coli (5·4, 2·8–9·3). 86·2% of the attributable incidence for Shigella was non-dysenteric. A prediction score for shigellosis was more accurate (sensitivity 50·4% [95% CI 46·7–54·1], specificity 84·0% [83·0–84·9]) than current guidelines, which recommend treatment only of bloody diarrhoea to cover Shigella (sensitivity 14·5% [95% CI 12·1–17·3], specificity 96·5% [96·0–97·0]). Interpretation Quantitative molecular diagnostics improved estimates of pathogen-specific burdens of childhood diarrhoea in the community setting. Viral causes predominated, including a substantial burden of sapovirus; however, Shigella had the highest overall burden with a high incidence in the second year of life. These data could improve the management of diarrhoea in these low-resource settings. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
| | - Jie Liu
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Elizabeth T Rogawski
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA; Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | | | | | | | - Shaila S Khan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | | | - Buliga Mujaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | | | - Timothy L McMurry
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Darwin J Operario
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Mami Taniuchi
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Jean Gratz
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Suzanne E Stroup
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - James H Roberts
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | | | | | | | - M Ohedul Islam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Pimmada Sakpaisal
- Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Sasikorn Silapong
- Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Pablo P Yori
- Asociación Benéfica PRISMA, Iquitos, Peru; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Monica McGrath
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | | | - Jessica C Seidman
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Dennis Lang
- Foundation for the National Institutes of Health, Bethesda, MD, USA
| | - Michael Gottlieb
- Foundation for the National Institutes of Health, Bethesda, MD, USA
| | - Richard L Guerrant
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | | | | | | | | | - Nicola Page
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Ladaporn Bodhidatta
- Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Carl Mason
- Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Sanjaya Shrestha
- Walter Reed/AFRIMS Research Unit, Nepal, Kathmandu, Nepal; University of Bergen, Bergen, Norway
| | - Ireen Kiwelu
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | | | | | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Margaret N Kosek
- Asociación Benéfica PRISMA, Iquitos, Peru; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
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Rogawski ET, Liu J, Platts-Mills JA, Kabir F, Lertsethtakarn P, Siguas M, Khan SS, Praharaj I, Murei A, Nshama R, Mujaga B, Havt A, Maciel IA, Operario DJ, Taniuchi M, Gratz J, Stroup SE, Roberts JH, Kalam A, Aziz F, Qureshi S, Islam MO, Sakpaisal P, Silapong S, Yori PP, Rajendiran R, Benny B, McGrath M, Seidman JC, Lang D, Gottlieb M, Guerrant RL, Lima AAM, Leite JP, Samie A, Bessong PO, Page N, Bodhidatta L, Mason C, Shrestha S, Kiwelu I, Mduma ER, Iqbal NT, Bhutta ZA, Ahmed T, Haque R, Kang G, Kosek MN, Houpt ER. Use of quantitative molecular diagnostic methods to investigate the effect of enteropathogen infections on linear growth in children in low-resource settings: longitudinal analysis of results from the MAL-ED cohort study. Lancet Glob Health 2018; 6:e1319-e1328. [PMID: 30287125 PMCID: PMC6227248 DOI: 10.1016/s2214-109x(18)30351-6] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/28/2018] [Accepted: 07/11/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Enteropathogen infections in early childhood not only cause diarrhoea but contribute to poor growth. We used molecular diagnostics to assess whether particular enteropathogens were associated with linear growth across seven low-resource settings. METHODS We used quantitative PCR to detect 29 enteropathogens in diarrhoeal and non-diarrhoeal stools collected from children in the first 2 years of life obtained during the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) multisite cohort study. Length was measured monthly. We estimated associations between aetiology-specific diarrhoea and subclinical enteropathogen infection and quantity and attained length in 3 month intervals, at age 2 and 5 years, and used a longitudinal model to account for temporality and time-dependent confounding. FINDINGS Among 1469 children who completed 2 year follow-up, 35 622 stool samples were tested and yielded valid results. Diarrhoeal episodes attributed to bacteria and parasites, but not viruses, were associated with small decreases in length after 3 months and at age 2 years. Substantial decrements in length at 2 years were associated with subclinical, non-diarrhoeal, infection with Shigella (length-for-age Z score [LAZ] reduction -0·14, 95% CI -0·27 to -0·01), enteroaggregative Escherichia coli (-0·21, -0·37 to -0·05), Campylobacter (-0·17, -0·32 to -0·01), and Giardia (-0·17, -0·30 to -0·05). Norovirus, Cryptosporidium, typical enteropathogenic E coli, and Enterocytozoon bieneusi were also associated with small decrements in LAZ. Shigella and E bieneusi were associated with the largest decreases in LAZ per log increase in quantity per g of stool (-0·13 LAZ, 95% CI -0·22 to -0·03 for Shigella; -0·14, -0·26 to -0·02 for E bieneusi). Based on these models, interventions that successfully decrease exposure to Shigella, enteroaggregative E coli, Campylobacter, and Giardia could increase mean length of children by 0·12-0·37 LAZ (0·4-1·2 cm) at the MAL-ED sites. INTERPRETATION Subclinical infection and quantity of pathogens, particularly Shigella, enteroaggregative E coli, Campylobacter, and Giardia, had a substantial negative association with linear growth, which was sustained during the first 2 years of life, and in some cases, to 5 years. Successfully reducing exposure to certain pathogens might reduce global stunting. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Elizabeth T Rogawski
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA; Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Jie Liu
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | | | | | | | - Shaila S Khan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | | | - Buliga Mujaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | | | - Darwin J Operario
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Mami Taniuchi
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Jean Gratz
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Suzanne E Stroup
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - James H Roberts
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | | | | | | | - M Ohedul Islam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Pimmada Sakpaisal
- Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Sasikorn Silapong
- Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Pablo P Yori
- Asociación Benéfica PRISMA, Iquitos, Peru; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Monica McGrath
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Jessica C Seidman
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Dennis Lang
- Foundation for the National Institutes of Health, Bethesda, MD, USA
| | - Michael Gottlieb
- Foundation for the National Institutes of Health, Bethesda, MD, USA
| | - Richard L Guerrant
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | | | | | | | | | - Nicola Page
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Ladaporn Bodhidatta
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Carl Mason
- Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Sanjaya Shrestha
- Walter Reed/AFRIMS Research Unit, Nepal, Kathmandu, Nepal; University of Bergen, Bergen, Norway
| | - Ireen Kiwelu
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | | | | | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Margaret N Kosek
- Asociación Benéfica PRISMA, Iquitos, Peru; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA.
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Page N, Sivarajasingam V, Jones S, Shepherd J. Links between deprivation and risk of violence-related injury: a qualitative study to identify potential causal mechanisms. J Public Health (Oxf) 2018; 40:e59-e65. [PMID: 28977487 DOI: 10.1093/pubmed/fdx073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 06/13/2017] [Indexed: 11/14/2022] Open
Abstract
Background Deprivation has been shown to have a greater effect on risk of violent injury among adolescent girls than boys, but the mechanisms underlying this association have not been identified. Methods In this qualitative study designed to identify causal mechanisms, focus groups involving girls aged 14-16 years attending secondary schools in South Wales, UK, were convened. Schools were recruited based on a measure of area-level deprivation. Discussions were audio-recorded and transcripts analysed thematically. Results Girls from more deprived areas tended not to participate in organized activities, obtained alcohol from multiple sources, consumed alcoholic drinks of varying strengths in both supervised and unsupervised settings, and tended not to feel trusted by their parents; this led to poor adolescent-parent communication. Girls from less deprived areas tended to participate in organized activities, obtain alcohol from parents, consume low strength alcohol in supervised settings, and have a trusting and communicative relationship with their parents. Conclusion Deprivation may increase risk of adolescent girls sustaining violence-related injury by increasing their time spent in unsupervised environments, with alcohol and without parental knowledge.
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Affiliation(s)
- N Page
- Wales Institute of Social and Economic Research, Data and Methods (WISERD), Faculty of Computing, Engineering and Science, University of South Wales, Pontypridd, UK
| | - V Sivarajasingam
- Violence Research Group, School of Dentistry, Cardiff University, Heath Park, Cardiff, UK
| | - S Jones
- Public Health Wales, Capital Quarter 2, Tyndall Street, Cardiff, UK
| | - J Shepherd
- Violence Research Group, School of Dentistry, Cardiff University, Heath Park, Cardiff, UK
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Deus ND, João E, Cuamba A, Cassocera M, Luís L, Acácio S, Mandomando I, Augusto O, Page N. Epidemiology of Rotavirus Infection in Children from a Rural and Urban Area, in Maputo, Southern Mozambique, before Vaccine Introduction. J Trop Pediatr 2018; 64:141-145. [PMID: 28582541 DOI: 10.1093/tropej/fmx032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study aimed to describe the epidemiology of rotavirus infections in Mozambique before vaccine introduction. Between February 2012 and September 2013, stool specimens, demographic and clinical data were collected from 384 children <5 years old hospitalized with acute diarrhea in Mavalane General Hospital and Manhiça District Hospital, southern Mozambique. The samples were tested for rotavirus A using enzyme-linked immunosorbent assay. The overall prevalence of rotavirus infection was 42.4% [95% confidence interval (95CI): 37.4-47.6%], and was similar in Manhiça (44.3%; 95CI: 36.2-52.7%) and Mavalane (41.3%; 95CI: 34.9-47.9%). The highest prevalence of rotavirus infection was observed in children between 6 and 11 months old. It was also observed that 162 (43.7%) of the children were underweight (weight-for-age z-score < -2), of which 61 were infected by rotavirus.
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Affiliation(s)
- Nilsa de Deus
- Instituto Nacional de Saúde (INS), Maputo, Mozambique, P O Box 264.,Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique, P O Box 1929
| | - Eva João
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique, P O Box 1929.,Institute of Hygiene and Tropical Medicine, Lisboa, Portugal, P O Box 1349-008
| | - Assa Cuamba
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique, P O Box 257
| | - Marta Cassocera
- Instituto Nacional de Saúde (INS), Maputo, Mozambique, P O Box 264
| | - Leopoldina Luís
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique, P O Box 1929
| | - Sozinho Acácio
- Instituto Nacional de Saúde (INS), Maputo, Mozambique, P O Box 264.,Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique, P O Box 1929
| | - Inácio Mandomando
- Instituto Nacional de Saúde (INS), Maputo, Mozambique, P O Box 264.,Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique, P O Box 1929
| | - Orvalho Augusto
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique, P O Box 257
| | - Nicola Page
- Centre for Enteric Diseases, National Institute for Communicable Disease (NICD), Johannesburg, South Africa, P O Box 2131
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Operario DJ, Platts-Mills JA, Nadan S, Page N, Seheri M, Mphahlele J, Praharaj I, Kang G, Araujo IT, Leite JPG, Cowley D, Thomas S, Kirkwood CD, Dennis F, Armah G, Mwenda JM, Wijesinghe PR, Rey G, Grabovac V, Berejena C, Simwaka CJ, Uwimana J, Sherchand JB, Thu HM, Galagoda G, Bonkoungou IJO, Jagne S, Tsolenyanu E, Diop A, Enweronu-Laryea C, Borbor SA, Liu J, McMurry T, Lopman B, Parashar U, Gentsch J, Steele AD, Cohen A, Serhan F, Houpt ER. Etiology of Severe Acute Watery Diarrhea in Children in the Global Rotavirus Surveillance Network Using Quantitative Polymerase Chain Reaction. J Infect Dis 2017; 216:220-227. [PMID: 28838152 PMCID: PMC5853801 DOI: 10.1093/infdis/jix294] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 06/20/2017] [Indexed: 12/26/2022] Open
Abstract
Background The etiology of acute watery diarrhea remains poorly characterized, particularly after rotavirus vaccine introduction. Methods We performed quantitative polymerase chain reaction for multiple enteropathogens on 878 acute watery diarrheal stools sampled from 14643 episodes captured by surveillance of children <5 years of age during 2013-2014 from 16 countries. We used previously developed models of the association between pathogen quantity and diarrhea to calculate pathogen-specific weighted attributable fractions (AFs). Results Rotavirus remained the leading etiology (overall weighted AF, 40.3% [95% confidence interval {CI}, 37.6%-44.3%]), though the AF was substantially lower in the Americas (AF, 12.2 [95% CI, 8.9-15.6]), based on samples from a country with universal rotavirus vaccination. Norovirus GII (AF, 6.2 [95% CI, 2.8-9.2]), Cryptosporidium (AF, 5.8 [95% CI, 4.0-7.6]), Shigella (AF, 4.7 [95% CI, 2.8-6.9]), heat-stable enterotoxin-producing Escherichia coli (ST-ETEC) (AF, 4.2 [95% CI, 2.0-6.1]), and adenovirus 40/41 (AF, 4.2 [95% CI, 2.9-5.5]) were also important. In the Africa Region, the rotavirus AF declined from 54.8% (95% CI, 48.3%-61.5%) in rotavirus vaccine age-ineligible children to 20.0% (95% CI, 12.4%-30.4%) in age-eligible children. Conclusions Rotavirus remained the leading etiology of acute watery diarrhea despite a clear impact of rotavirus vaccine introduction. Norovirus GII, Cryptosporidium, Shigella, ST-ETEC, and adenovirus 40/41 were also important. Prospective surveillance can help identify priorities for further reducing the burden of diarrhea.
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Affiliation(s)
| | | | - Sandrama Nadan
- National Institute for Communicable Diseases, Johannesburg
| | - Nicola Page
- National Institute for Communicable Diseases, Johannesburg
| | - Mapaseka Seheri
- South African Medical Research Council/Diarrhoeal Pathogens Research Unit, Department of Virology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Jeffrey Mphahlele
- South African Medical Research Council/Diarrhoeal Pathogens Research Unit, Department of Virology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | | | | | | | - Daniel Cowley
- Murdoch Childrens Research Institute, Melbourne, Australia
| | - Sarah Thomas
- Murdoch Childrens Research Institute, Melbourne, Australia
| | | | - Francis Dennis
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - George Armah
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Jason M Mwenda
- World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of the Congo
| | | | - Gloria Rey
- WHO Regional Office for the Americas, District of Columbia
| | - Varja Grabovac
- WHO Regional Office for the Western Pacific, Manila, the Philippines
| | | | | | | | | | | | | | | | | | | | - Amadou Diop
- Albert Royer National Paediatric Hospital Laboratory, Dakar, Senegal
| | | | | | - Jie Liu
- University of Virginia, Charlottesville
| | | | | | - Umesh Parashar
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John Gentsch
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Adam Cohen
- World Health Organization, Geneva, Switzerland
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Cornish-Bowden A, Cornish-Bowden A, Rasnick D, Heng HH, Horne S, Abdallah B, Liu G, Ye CJ, Bloomfield M, Vincent MD, Aldaz CM, Karlsson J, Valind A, Jansson C, Gisselsson D, Graves JAM, Stepanenko AA, Andreieva SV, Korets KV, Mykytenko DO, Huleyuk NL, Baklaushev VP, Kovaleva OA, Chekhonin VP, Vassetzky YS, Avdieiev SS, Bakker B, Taudt AS, Belderbos ME, Porubsky D, Spierings DCJ, de Jong TV, Halsema N, Kazemier HG, Hoekstra-Wakker K, Bradley A, de Bont ESJM, van den Berg A, Guryev V, Lansdorp PM, Tatché MC, Foijer F, Liehr T, Baudoin NC, Nicholson JM, Soto K, Quintanilla I, Camps J, Cimini D, Dürrbaum M, Donnelly N, Passerini V, Kruse C, Habermann B, Storchová Z, Mandrioli D, Belpoggi F, Silbergeld EK, Perry MJ, Skotheim RI, Løvf M, Johannessen B, Hoff AM, Zhao S, SveeStrømme JM, Sveen A, Lothe RA, Hehlmann R, Voskanyan A, Fabarius A, Böcking A, Biesterfeld S, Berynskyy L, Börgermann C, Engers R, Dietz J, Fritz A, Sehgal N, Vecerova J, Stojkovicz B, Ding H, Page N, Tye C, Bhattacharya S, Xu J, Stein G, Stein J, Berezney R, Gong X, Grasedieck S, Swoboda J, Rücker FG, Bullinger L, Pollack JR, Roumelioti FM, Chiourea M, Raftopoulou C, Gagos S, Duesberg P, Bloomfield M, Hwang S, Gustafsson HT, O’Sullivan C, Acevedo-Colina A, Huang X, Klose C, Schevchenko A, Dickson RC, Cavaliere P, Dephoure N, Torres EM, Stampfer MR, Vrba L, LaBarge MA, Futscher B, Garbe JC, Zhou YH, Trinh AL, Zhou YH, Digman M. Abstracts from the 3rd Conference on Aneuploidy and Cancer: Clinical and Experimental Aspects. Mol Cytogenet 2017. [PMCID: PMC5499067 DOI: 10.1186/s13039-017-0320-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Sivarajasingam V, Page N, Shepherd J, Moore S. TRENDS IN VIOLENCE IN ENGLAND AND WALES 2010–2014. Arch Emerg Med 2016. [DOI: 10.1136/emermed-2016-206402.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Manana P, Page N, Maupye G, Rakgantso A, Mkhencele T, Hottie G, Dokubo K, Mc Carthy K. Investigation of a suspected diarrhoeal illness outbreak in Upington – ZF Mgcawu District, Northern Cape, South Africa, March – July 2015. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.666] [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: 10/22/2022] Open
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Page N, Groome MJ, Murray T, Nadan S, Netshikweta R, Keddy KH, Poonsamy B, Moyes J, Walaza S, Kahn K, Kuonza L, Taylor MB, Madhi SA, Cohen C. Sapovirus prevalence in children less than five years of age hospitalised for diarrhoeal disease in South Africa, 2009-2013. J Clin Virol 2016; 78:82-8. [PMID: 27002709 DOI: 10.1016/j.jcv.2016.03.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/08/2016] [Accepted: 03/12/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although sapovirus (SaV) has been detected in 2.2-12.7% of gastroenteritis cases globally, there are limited data on SaV epidemiology. OBJECTIVES Describe the epidemiology, clinical characteristics and factors associated with SaV gastroenteritis in hospitalised children <5 years of age in South Africa. STUDY DESIGN Between 2009 and 2013 during prospective diarrhoeal surveillance, stool specimens were collected from four sites and screened for SaVs and associated enteric pathogens using ELISA, microscopy, conventional and real-time PCR. Epidemiological and clinical data were compared in patients with or without SaV. Odds ratios were assessed by bivariate and stepwise multivariable logistic regression analysis. RESULTS Sapoviruses were detected in 7.7% (238/3103) of children admitted to hospital and 11.4% (9/79) of deaths. Sapovirus was detected more commonly in children 19-24 months compared to<6months (aOR=2.3; p=0.018) and in males (aOR=2.0; p=0.001). Additional factors associated with SaV detection included residing with≥7 inhabitants compared to ≤3 (aOR=2.2; p=0.011) and concomitant norovirus infections (aOR=3.0; p=0.003). HIV-infected children with SaV were more likely to have bloody stools (aOR=16.8; p<0.001), low birth weight (<2.5kg; aOR=5.8; p=0.007) and live in environments without flush toilets (aOR=8.1; p=0.003) compared to HIV-uninfected children. CONCLUSIONS Sapoviruses, which are perceived to cause mild diarrhoea, were detected in hospitalised children and diarrhoeal deaths in South Africa. Determinants increasing the odds of SaV included overcrowding and concomitant infections while HIV-infected children with SaV displayed bloody stools, low birth weight and reduced access to proper sanitation. Mitigation strategies against SaV infections include improved sanitation.
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Affiliation(s)
- Nicola Page
- National Institute for Communicable Diseases, Private Bag x4, Sandringham, 2131, South Africa; School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Private Bag x20, Hatfield, 0028, South Africa; Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia, Pretoria, 0007, South Africa.
| | - Michelle J Groome
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of Witwatersrand, Johannesburg, South Africa
| | - Tanya Murray
- Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia, Pretoria, 0007, South Africa
| | - Sandrama Nadan
- National Institute for Communicable Diseases, Private Bag x4, Sandringham, 2131, South Africa; Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia, Pretoria, 0007, South Africa
| | - Rembuluwani Netshikweta
- National Institute for Communicable Diseases, Private Bag x4, Sandringham, 2131, South Africa; Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia, Pretoria, 0007, South Africa
| | - Karen H Keddy
- National Institute for Communicable Diseases, Private Bag x4, Sandringham, 2131, South Africa; Clinical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Bhavani Poonsamy
- National Institute for Communicable Diseases, Private Bag x4, Sandringham, 2131, South Africa
| | - Jocelyn Moyes
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Sibongile Walaza
- National Institute for Communicable Diseases, Private Bag x4, Sandringham, 2131, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Lazarus Kuonza
- National Institute for Communicable Diseases, Private Bag x4, Sandringham, 2131, South Africa; School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Private Bag x20, Hatfield, 0028, South Africa
| | - Maureen B Taylor
- Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia, Pretoria, 0007, South Africa
| | - Shabir A Madhi
- National Institute for Communicable Diseases, Private Bag x4, Sandringham, 2131, South Africa; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- National Institute for Communicable Diseases, Private Bag x4, Sandringham, 2131, South Africa
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Groome MJ, Page N, Cortese MM, Moyes J, Zar HJ, Kapongo CN, Mulligan C, Diedericks R, Cohen C, Fleming JA, Seheri M, Mphahlele J, Walaza S, Kahn K, Chhagan M, Steele AD, Parashar UD, Zell ER, Madhi SA. Effectiveness of monovalent human rotavirus vaccine against admission to hospital for acute rotavirus diarrhoea in South African children: a case-control study. The Lancet Infectious Diseases 2014; 14:1096-1104. [DOI: 10.1016/s1473-3099(14)70940-5] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Seheri L, Mwenda J, Page N. Report of the 7th African Rotavirus Symposium, Cape Town, South Africa, 8th November 2012. Vaccine 2014; 32:6336-41. [DOI: 10.1016/j.vaccine.2014.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 04/29/2014] [Accepted: 05/01/2014] [Indexed: 11/30/2022]
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Caudrelier JM, Malone S, Alhussain H, Gertler S, Nguyen T, Woulfe J, Nicholas G, Page N. Tomothérapie hypofractionnée accélérée avec boost simultané (ARTOSIB) et témozolomide dans le traitement du glioblastome. Cancer Radiother 2013. [DOI: 10.1016/j.canrad.2013.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Esona MD, Mijatovic-Rustempasic S, Foytich K, Roy S, Banyai K, Armah GE, Steele AD, Volotão EM, Gomez MM, Silva MFM, Gautam R, Quaye O, Tam KI, Forbi JC, Seheri M, Page N, Nyangao J, Ndze VN, Aminu M, Bowen MD, Gentsch JR. Human G9P[8] rotavirus strains circulating in Cameroon, 1999-2000: Genetic relationships with other G9 strains and detection of a new G9 subtype. Infect Genet Evol 2013; 18:315-24. [PMID: 23770141 DOI: 10.1016/j.meegid.2013.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/17/2013] [Accepted: 06/03/2013] [Indexed: 11/27/2022]
Abstract
Group A rotaviruses (RV-A) are the leading cause of viral gastroenteritis in children worldwide and genotype G9P[8] is one of the five most common genotypes detected in humans. In order to gain insight into the degree of genetic variability of G9P[8] strains circulating in Cameroon, stool samples were collected during the 1999-2000 rotavirus season in two different geographic regions in Cameroon (Southwest and Western Regions). By RT-PCR, 15 G9P[8] strains (15/89=16.8%) were identified whose genomic configurations was subsequently determined by complete or partial gene sequencing. In general, all Cameroonian G9 strains clustered into current globally-spread sublineages of the VP7 gene and displayed 86.6-100% nucleotide identity amongst themselves and 81.2-99.5% nucleotide identity with global G9 strains. The full genome classification of all Cameroonian strains was G9-P[8]-I1-R1-C1-M1-A1-N1-T1-E1-H1 but phylogenetic analysis of each gene revealed that the strains were spread across 4 or more distinct lineages. An unusual strain, RVA/Human-wt/CMR/6788/1999/G9P[8], which shared the genomic constellation of other Cameroonian G9P[8] strains, contained a novel G9 subtype which diverged significantly (18.8% nucleotide and 19% amino acid distance) from previously described G9 strains. Nucleotide and amino acid alignments revealed that the 3' end of this gene is highly divergent from other G9 VP7 genes suggesting that it arose through extensive accumulation of point mutations. The results of this study demonstrate that diverse G9 strains circulated in Cameroon during 1999-2000.
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Affiliation(s)
- M D Esona
- Gastroenteritis and Respiratory Viruses Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, USA.
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Karanam V, Anim-Nyame N, Page N. PP011. Increased placental expression of angiogenin inhibitor (Ribonuclease inhibitor), a novel gene in pre-eclampsia. Pregnancy Hypertens 2012; 2:245-6. [DOI: 10.1016/j.preghy.2012.04.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bloemhof EE, An X, Kuan G, Moore D, O'Shay B, Page N, Tang H. Telescope alignment from sparsely sampled wavefront measurements over pupil subapertures. Appl Opt 2012; 51:394-400. [PMID: 22270669 DOI: 10.1364/ao.51.000394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 09/13/2011] [Indexed: 05/31/2023]
Abstract
We present a simple formalism that has proven useful in on-axis alignment of two-element telescopes when wavefront information is available from only a limited region (here two noncontiguous subapertures) of the pupil. Misalignments cause predictable full-aperture aberrations, which in turn cause predictable tip/tilt modes in the subapertures. For the most useful case in which secondary mirror tilts are independently constrained by optical monitoring, the four subaperture tip/tilt modes provide enough information to solve for the state of misalignment uniquely. A practically important and intuitively appealing simplification of this inversion occurs if the tip/tilts of the two subapertures are first transformed into a new basis consisting of differential and common-mode tilts in each of the x and y directions. Then the matrices interpreting subaperture modes as full-aperture aberrations and those in turn as mechanical misalignments become diagonal, so the mechanical adjustment required to align each degree of freedom is just a constant sensitivity multiplying one of the measured differential or common-mode tilt basis modes. Knowing that this simplification occurs allows rapid empirical calibration of sensitivities in the lab and then deterministic alignment, simply and transparently, with no need for ray tracing to model the optical effects of the adjustments at each step of the alignment.
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Affiliation(s)
- E E Bloemhof
- National Science Foundation, Arlington, Virginia 22230, USA.
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AlHussain H, Malone S, Gertler S, Nguyen T, Nicholas G, Page N, Woulfe J, Agboola O, Montgomery L, Caudrelier J. Results of a Prospective Trial Evaluating Accelerated Radiation Therapy using Tomotherapy Simultaneous Integrated Boost (ARTOSIB) with Concurrent and Adjuvant Temozolomide (TMZ) Chemotherapy in the Treatment of Glioblastoma Multiforme (GBM). Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Bennett P, Williams Y, Page N, Hood K, Woollard M, Vetter N. Associations between organizational and incident factors and emotional distress in emergency ambulance personnel. British Journal of Clinical Psychology 2011; 44:215-26. [PMID: 16004656 DOI: 10.1348/014466505x29639] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [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: 11/12/2022]
Abstract
OBJECTIVES This study examined the prevalence and correlates of post-traumatic stress disorder (PTSD), anxiety and depression among emergency ambulance personnel. DESIGN AND METHOD A questionnaire and reminder were sent anonymously to 1029 emergency ambulance personnel in a large ambulance service. RESULTS Among the 617 respondents, levels of PTSD symptoms did not differ according to grade, but men had a higher prevalence rate than women. Key predictors of the severity of symptoms were organizational stress, the frequency of experiencing potentially traumatic incidents, length of service, and dissociation in response to an index incident. The degree of organizational, but not incident-related, stress discriminated between 'cases' and 'non-cases'. Nine and 23% of recorded scores indicated clinical levels of depression and anxiety respectively. Several work factors were associated with these emotions, explaining 38% of anxiety and 31% of depression scores. CONCLUSION Both organizational and individually based interventions may be necessary to minimize PTSD and other emotional disorders among ambulance personnel.
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Affiliation(s)
- Paul Bennett
- Department of Psychology, University of Wales, Swansea, UK.
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Page N, Esona M, Seheri M, Nyangao J, Bos P, Mwenda J, Steele D. Characterization of genotype G8 strains from Malawi, Kenya, and South Africa. J Med Virol 2010; 82:2073-81. [DOI: 10.1002/jmv.21912] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Seheri LM, Page N, Dewar JB, Geyer A, Nemarude AL, Bos P, Esona M, Steele AD. Characterization and molecular epidemiology of rotavirus strains recovered in Northern Pretoria, South Africa during 2003-2006. J Infect Dis 2010; 202 Suppl:S139-47. [PMID: 20684694 DOI: 10.1086/653559] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Rotavirus infection is the most common cause of severe dehydrating gastroenteritis in infants and young children and remains a significant clinical problem worldwide. The severity and the burden of rotavirus disease could be reduced through the implementation of an effective vaccine. The aim of this study was to characterize rotavirus strains circulating in the local community as part of an ongoing hospital burden of disease study when a G1P[8] rotavirus vaccine candidate was being evaluated in the same community. From 2003 through 2006, 729 rotavirus-positive stool specimens were collected from children <5 years of age who were treated for diarrhea at Dr George Mukhari Hospital, Ga-Rankuwa, South Africa. Molecular characterization of the strains was performed by polyacrylamide gel electrophoresis and genotyping of the VP4 and VP7 alleles using well-established seminested multiplex reverse-transcription polymerase chain reaction methods. In 2003, 62% of strains exhibited the short rotavirus electropherotype, and the most common rotavirus strain was G2P[4]. In subsequent years, predominant rotavirus strains included G1P[8] and G1P[6] in 2004, G3P[8] and G3P[6] in 2005, and G1P[8] in 2006. For the 4 years of the study, rotavirus strains with P[6] genotype were detected in 25% of all rotavirus-positive specimens. In addition, unusual G12P[6] and G8 strains were detected at a low frequency. These results reflect the diversity of rotavirus strains circulating in South African communities.
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Affiliation(s)
- L M Seheri
- University of Limpopo, Pretoria, South Africa
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Nokes DJ, Peenze I, Netshifhefhe L, Abwao J, De Beer MC, Seheri M, Williams TN, Page N, Steele D. Rotavirus genetic diversity, disease association, and temporal change in hospitalized rural Kenyan children. J Infect Dis 2010; 202 Suppl:S180-6. [PMID: 20684700 DOI: 10.1086/653566] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The effectiveness of rotavirus vaccines will be dependent on the immunity conferred against prevalent and emergent variants causing severe diarrheal disease. Longitudinal surveillance of disease-causing strains is a prerequisite to intervention. METHODS Molecular characterization was conducted on rotavirus-positive stool samples from children admitted with diarrhea to a rural district hospital during 2002-2004. Extracted viral RNA was separated by polyacrylamide gel electrophoresis, and rotavirus VP4 (P types) and VP7 (G types) specificities were determined. RESULTS Among 558 investigated cases, the predominant genotype was P[8]G1 (42%), followed by P[8]G9 (15%), P[4]G8 (7%), P[6]G8 (6%), and P[8]G8 (4%), with 10% mixed strains. Overall, there were 6 different P types and 7 G types. No association was identified between genotype and child age, sex, or severity of diarrhea. The P and G genotypes and polyacrylamide gel electropherotypes showed significant temporal variation in frequency: P[8]G1 decreased from 51% (95% confidence interval [CI], 43%-58%) in 2002 to 30% (95% CI, 24%-37%) in 2004, and P[4]G8 increased from 2% (95% CI, 0%-5%) in 2002 to 13% (95% CI, 9%-19%). Quarterly data revealed seasonally endemic and emergence and/or decay patterns. CONCLUSIONS Our study of rotavirus strains causing severe diarrhea in rural Kenyan children showed a predominance of P[8]G1 and confirms the importance of G8 and G9 strains in sub-Saharan Africa. Considerable genetic diversity of rotavirus strains was observed, including substantial mixed and unusual types, coupled with significant temporal strain variation and emergence. These results warn of variable vaccine efficacy and the need for long-term surveillance of circulating rotavirus genotypes.
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Affiliation(s)
- D James Nokes
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
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Mwenda JM, Ntoto KM, Abebe A, Enweronu-Laryea C, Amina I, Mchomvu J, Kisakye A, Mpabalwani EM, Pazvakavambwa I, Armah GE, Seheri LM, Kiulia NM, Page N, Widdowson MA, Steele AD. Burden and epidemiology of rotavirus diarrhea in selected African countries: preliminary results from the African Rotavirus Surveillance Network. J Infect Dis 2010; 202 Suppl:S5-S11. [PMID: 20684718 DOI: 10.1086/653557] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Severe rotavirus diarrhea in children <5 years of age is a major public health problem; however, limited regional and country specific data on rotavirus disease burden are available from sub-Saharan Africa. In June 2006, the World Health Organization Regional Office for Africa initiated rotavirus surveillance in selected African countries. With use of standardized methodology developed by the World Health Organization, children <5 years of age who were hospitalized with severe diarrhea were enrolled, and stool specimens were collected for detection of rotavirus strains with use of a commercial enzyme immunoassay. Rotavirus strains were further characterized for G and P types with use of a reverse-transcriptase polymerase chain reaction. From June 2006 through December 2008, rotavirus surveillance was established at 14 sites in 11 African countries. Of 5461 stool samples collected from children enrolled in 8 countries with 1 or 2 complete years of data, 2200 (40%) were positive for rotavirus. Ninety percent of all rotavirus hospitalizations occurred among children aged 3-12 months. Predominant types included G1P[8] (21%), G2P[4] (7%), and P [8] (29%); however, unusual types were also detected, including G8P[6] (5%), G8P[8] (1%), G12P[6] (1%), and G12P[6] (1%). A high percentage of mixed rotavirus infections was also detected. These preliminary results indicate that rotavirus is a major cause of severe diarrheal disease in African children.
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Affiliation(s)
- Jason M Mwenda
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo.
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Steele AD, Page N, de Beer M, Sawadogo S. Antigenic and molecular characterization of unusual rotavirus strains in Burkina Faso in 1999. J Infect Dis 2010; 202 Suppl:S225-30. [PMID: 20684707 DOI: 10.1086/653574] [Citation(s) in RCA: 6] [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] [Indexed: 11/03/2022] Open
Abstract
Thirty-six of 37 rotavirus strains recovered from the diarrheal stools of 166 children <3 years of age in Burkina Faso were characterized at both the antigenic and molecular levels. The rotavirus strains were confirmed by polyacrylamide gel electrophoresis; 30 displayed predominantly short electropherotype patterns, and 6 had a long RNA pattern. The strains were subgrouped by monoclonal antibody enzyme immunoassay for VP6 and were typed as subgroup I (29 of 30 short rotavirus strains) and subgroup II (5 of 6 long strains). The VP7 serotyping and genotyping showed that all 6 viruses with long electropherotype patterns were G1. The short strains were determined to be VP7 serotype G2 by reverse-transcription polymerase chain reaction (PCR) in 27 strains and nucleic acid sequencing of selected strains, although only 1 reacted with the G2-specific monoclonal antibodies. Finally, the short patterns were shown by the PCR genotyping method to be VP4 genotype P[6], and the long patterns were shown to be P[8]. The predominant strain found in Burkina Faso in this small study was an unusual G2P[6] strain that showed a short RNA electropherotype and VP6 subgroup I specificity and failed to react with a panel of G2-specific monoclonal antibodies.
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Page N, Esona M, Armah G, Nyangao J, Mwenda J, Sebunya T, Basu G, Pyndiah N, Potgieter N, Geyer A, Steele AD. Emergence and characterization of serotype G9 rotavirus strains from Africa. J Infect Dis 2010; 202 Suppl:S55-63. [PMID: 20684719 DOI: 10.1086/653551] [Citation(s) in RCA: 17] [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: 11/04/2022] Open
Abstract
Serotype G9 strains have been detected sporadically and in localized outbreaks in various African countries, including South Africa, Botswana, Malawi, Kenya, Cameroon, Nigeria, Ghana, Guinea-Bissau, Libya, and Mauritius. Serotype G9 strains were analyzed to investigate genogroup characteristics, including subgroup specificity, electropherotype, and P and G genotypes. In addition, the antigenic composition of the South African G9 strains was assessed. African G9 strains were associated with both DS-1-like characteristics and Wa-like characteristics, indicating the predisposition of G9 strains to frequently reassort. Despite these reassortment events, serotype G9 strains appear to maintain antigenic character in the outer capsid protein, as evident with the reaction of the South African G9 strains with the G9-specific monoclonal antibody F45:1. Phylogenetic analysis clustered African G9 strains geographically, regardless of genogroup characteristics, into 1 lineage (IIId). Two groups of G9 strains, originating in India and Japan, were identified in this lineage. Continuous surveillance of circulating rotavirus strains in Africa is vital to prepare for future vaccine implementation on a continent that clearly needs such preventative medicines.
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Affiliation(s)
- Nicola Page
- National Institute for Communicable Diseases, Sandringham, South Africa.
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Abstract
BACKGROUND Namibia, located on the southwestern coast of southern Africa, is characterized by vast deserts, limited fresh water, and low population density. Mortality estimates among children <5 of age are 63 deaths per 1000 live-births, with diarrheal diseases contributing to 3% of these deaths. Data on the burden of rotavirus disease and circulating serotypes in Namibia are currently not available. MATERIALS AND METHODS From May 1998 through December 1999, 815 stool specimens were collected from children <5 years of age who attended the Windhoek State Hospital, Windhoek, Namibia, for diarrhea. Specimens were screened for the presence of rotavirus antigens. Rotavirus-positive specimens were further analyzed to determine electropherotype, subgroup (SG) specificity, and G and P genotypes. RESULTS Rotavirus was detected in 113 (13.8%) of 815 specimens, with the majority of infections occurring in children <18 months of age. Strains bearing 1 long electropherotype, SGII, and G1P[8] or G1P[6] specificity predominated during the 20-month study period. In addition to the typical winter rotavirus season, a peak in rotavirus infection was also observed during the summer. CONCLUSIONS Serotypes G1P[8], G1P[6], G1P[4], and G2P[4] were found throughout the study period, predominantly in children <18 months of age. The observed summer rotavirus peak coincided with increased rainfall in Namibia and an increase in the diversity of detected serotypes. During the October to December 1999 peak, 2 G9P[6] strains and 1 G8P[4] strain were identified. Expanded and updated information on prevalence of rotavirus infection, circulating serotypes, and burden of disease will be required to enable local government to make decisions on the implementation of rotavirus vaccination in Namibia.
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Affiliation(s)
- Nicola Page
- National Institute for Communicable Diseases, Johannesburg, South Africa.
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Nyangao J, Page N, Esona M, Peenze I, Gatheru Z, Tukei P, Steele A. Characterization of Human Rotavirus Strains from Children with Diarrhea in Nairobi and Kisumu, Kenya, between 2000 and 2002. J Infect Dis 2010; 202 Suppl:S187-92. [DOI: 10.1086/653564] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Esona M, Steele D, Kerin T, Armah G, Peenze I, Geyer A, Page N, Nyangao J, Agbaya V, Trabelsi A, Tsion B, Aminu M, Sebunya T, Dewar J, Glass R, Gentsch J. Determination of the G and P Types of Previously Nontypeable Rotavirus Strains from the African Rotavirus Network, 1996–2004: Identification of Unusual G Types. J Infect Dis 2010; 202 Suppl:S49-54. [DOI: 10.1086/653552] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Esona M, Geyer A, Page N, Trabelsi A, Fodha I, Aminu M, Agbaya V, Tsion B, Kerin T, Armah G, Steele A, Glass R, Gentsch J. Genomic characterization of human rotavirus G8 strains from the African rotavirus network: Relationship to animal rotaviruses. J Med Virol 2009; 81:937-51. [DOI: 10.1002/jmv.21468] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Esona MD, Geyer A, Banyai K, Page N, Aminu M, Armah GE, Hull J, Steele DA, Glass RI, Gentsch JR. Novel human rotavirus genotype G5P[7] from child with diarrhea, Cameroon. Emerg Infect Dis 2009; 15:83-6. [PMID: 19116059 PMCID: PMC2662634 DOI: 10.3201/eid1501.080899] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
We report characterization of a genotype G5P[7] human rotavirus (HRV) from a child in Cameroon who had diarrhea. Sequencing of all 11 gene segments showed similarities to >5 genes each from porcine and human rotaviruses. This G5P[7] strain exemplifies the importance of heterologous animal rotaviruses in generating HRV genetic diversity through reassortment.
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Affiliation(s)
- Mathew D Esona
- Gastroenteritis and Respiratory Viruses Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Simmonds MK, Armah G, Asmah R, Banerjee I, Damanka S, Esona M, Gentsch JR, Gray JJ, Kirkwood C, Page N, Iturriza-Gómara M. New oligonucleotide primers for P-typing of rotavirus strains: Strategies for typing previously untypeable strains. J Clin Virol 2008; 42:368-73. [PMID: 18378188 DOI: 10.1016/j.jcv.2008.02.011] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 02/08/2008] [Accepted: 02/18/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND The use of molecular methods for rotavirus characterisation provides increased sensitivity for typing, and allows the identification of putative reassortant strains. However, due to the constant accumulation of point mutations through genetic drift; and to the emergence of novel genotypes; and possibly zoonotic transmission and subsequent reassortment, the reagents and methods used for genotyping require close monitoring and updating. OBJECTIVES To design and evaluate a new VP4 consensus oligonucleotide primer pair that provides increased sensitivity and allows typing of strains that were untypeable using available methods. STUDY DESIGN A total of 489 rotavirus-positive faecal specimens from studies conducted between 1996 and 2006 were used for the evaluation of the new VP4 primers which was performed in the WHO Rotavirus Collaborating and Reference centres in the US, Australia, South Africa and the UK. RESULTS The new primer pair allowed P-typing of rotavirus strains and provided increased sensitivity, allowing typing of a significant number of strains that previously could not be P-typed. CONCLUSIONS This study highlights the importance of a constant reconsideration of primer sequences employed for the molecular typing of rotaviruses.
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Affiliation(s)
- Mirjam Kühne Simmonds
- Enteric Virus Unit, Virus Reference Department, Centre for Infections, Health Protection Agency, London NW9 5EQ, UK
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