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Use of Animal Models in Studying Roles of Antibodies and Their Secretion Cells in Dengue Vaccine Development. Viruses 2020; 12:v12111261. [PMID: 33167518 PMCID: PMC7694450 DOI: 10.3390/v12111261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 11/17/2022] Open
Abstract
The cardinal feature of adaptive immunity is its ability to form memory responses that can be rapidly recalled to contain pathogens upon reencountering. Conferring a robust memory immune response to an infection is a key feature for a successful vaccination program. The plasmablasts are cells that not only can secret non-neutralizing antibodies but also can secrete the specific antibodies essential to neutralize and inactivate the invading pathogens. Dengue has been recognized as one of the most important vector-borne human viral diseases globally. Currently, supportive care with vigilant monitoring is the standard practice since there is as yet no approved therapeutic modality to treat dengue. Even though the approved vaccine has become available, its low efficacy with the potential to cause harm is the major hurdle to promote the widespread usage of the vaccine. Despite the decades of research on dengue, the major challenge in dengue vaccine development is the absence of suitable experimental animal models that reflect the pathological features and clinical symptoms, as seen in humans. Dengue is transmitted by the bite of mosquitoes carrying infectious dengue virus (DENV), which has four distinct serotypes. Recently, cases resulting from unconventional transmission routes, such as blood transfusion, organs as well as stem cells and bone marrow transplantations, and mother-to-infant vertical transmission, have been reported, suggesting an alternate route of DENV transmission exists in nature. This review discusses issues and challenges needing to be resolved to develop an effective dengue vaccine. Development of a robust and reliable dengue animal model that can reflect not only dynamic human clinical symptoms but also can answer around why preexisting neutralizing antibodies do not confer protection upon re-infection and immune protection marker for dengue vaccine efficacy evaluation.
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Cavalcanti LPDG, Arthur Brasil Gadelha Farias L, Kalline de Almeida Barreto F, Siqueira AM, Ribeiro GS, Ricardo Ribas Freitas A, Weaver SC, Kitron U, Brito CAA. Chikungunya Case Classification after the Experience with Dengue Classification: How Much Time Will We Lose? Am J Trop Med Hyg 2020; 102:257-259. [PMID: 31769391 DOI: 10.4269/ajtmh.19-0608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In 2013, cases of chikungunya virus (CHIKV) infection were first detected in the Caribbean. Chikungunya virus rapidly spread through Central and South America, causing explosive outbreaks in naive populations. Since its emergence in 2004, the number of case and series reports describing severe, atypical manifestations seen in chikungunya patients has increased substantially, calling into question whether clinicians and health services are failing to diagnose these atypical cases because of not only insufficient knowledge but also limitations in the case classification. Although this classification based on the duration of the musculoskeletal (acute, subacute, and chronic forms) complaints helped guide therapeutic approaches directed to these manifestations, patients presenting severe or complicated forms, which are less frequent but produce most of the fatal outcomes, were not properly addressed. In Brazil and the Caribbean, a clear temporal and spatial association between excess overall mortality and the occurrence of chikungunya epidemics has been shown, supporting the hypothesis that many of these excess deaths were a consequence of CHIKV infections. Thus, accumulated experience has highlighted that the current chikungunya case classification does not encompass the actual needs presented by certain cases with atypical features nor does it contribute to early detection and management of potentially severe cases. With continued CHIKV circulation in three continents and recent reemergence in Asia and Europe, we need a classification that is prospective and informed both by initial clinical presentation and by progression of signs and symptoms.
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Affiliation(s)
- Luciano Pamplona de Góes Cavalcanti
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.,Faculty of Medicine, Unichristus University Center, Fortaleza, Brazil
| | | | | | - André Machado Siqueira
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Guilherme Sousa Ribeiro
- School of Medicine, Federal University of Bahia, Salvador, Brazil.,Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
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Tchuandom SB, Tchadji JC, Tchouangueu TF, Biloa MZ, Atabonkeng EP, Fumba MIM, Massom ES, Nchinda G, Kuiate JR. A cross-sectional study of acute dengue infection in paediatric clinics in Cameroon. BMC Public Health 2019; 19:958. [PMID: 31319834 PMCID: PMC6637490 DOI: 10.1186/s12889-019-7252-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/28/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Dengue fever is the world's fastest spreading mosquito borne viral infection. It is prevalent throughout both subtropical and tropical region, and affects over 128 countries. Dengue virus (DENV) infection poses a serious global public health challenge to three billion people, resulting in approximately 200 million cases of morbidity and 50,000 cases of mortality annually. In Cameroon like in most sub-Saharan African countries, DENV infection occur concurrently with other infectious diseases whose symptoms often overlap, rendering differential diagnosis challenging. This study aims at determining the frequency of acute dengue among febrile children under 15 years attending hospitals in some areas of Cameroon. METHODS A total of 961 children under the age of 15 were recruited in a cross-sectional study using systematic sampling technique and by selecting each subject out of the three. The study was conducted in 10 public health centers in Cameroon. Demographic data and risk factors of the subjects were obtained using well-structured questionnaires. Dengue virus NS1 antigen, IgM and IgG were analysed using a Tell me fast® Combo Dengue NS1-IgG/IgM Rapid Test. An in-house ELISA test for dengue specific IgM antibody was equally performed for confirmation. Descriptive statistical analysis was performed using Graph pad version 6.0. RESULTS A prevalence of 6.14% acute dengue virus infection was observed among children with febrile illness with a significant difference (p = 0.0488) between males (4.7%) and females (7.7%). In addition, children who reportedly were unprotected from vectors, showed a comparatively higher prevalence of the disease seropositivity than those practicing protective measures. CONCLUSION DENV infection therefore is an important cause of fever among children in Cameroon. Thus, there is a need to include differential screening for DENV infections as a tool in the management of fever in children in the country.
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Affiliation(s)
- Salomon Bonsi Tchuandom
- Department of Biochemistry, University of Dschang, Dschang, Cameroon.,Public School of Medical Laboratory Technicians, Yaoundé, Cameroon
| | - Jules Colince Tchadji
- Laboratory of Vaccinology/Biobanking, CIRCB, Melen Yaoundé, Cameroon.,Department of Animal Biology and Physiology, University of Yaoundé 1, Yaoundé, Cameroon
| | - Thibau Flaurant Tchouangueu
- Department of Biochemistry, University of Dschang, Dschang, Cameroon.,Laboratory of Vaccinology/Biobanking, CIRCB, Melen Yaoundé, Cameroon
| | | | | | | | | | - Godwin Nchinda
- Laboratory of Vaccinology/Biobanking, CIRCB, Melen Yaoundé, Cameroon
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Abstract
Dengue is widespread throughout the tropics and local spatial variation in dengue virus transmission is strongly influenced by rainfall, temperature, urbanization and distribution of the principal mosquito vector Aedes aegypti. Currently, endemic dengue virus transmission is reported in the Eastern Mediterranean, American, South-East Asian, Western Pacific and African regions, whereas sporadic local transmission has been reported in Europe and the United States as the result of virus introduction to areas where Ae. aegypti and Aedes albopictus, a secondary vector, occur. The global burden of the disease is not well known, but its epidemiological patterns are alarming for both human health and the global economy. Dengue has been identified as a disease of the future owing to trends toward increased urbanization, scarce water supplies and, possibly, environmental change. According to the WHO, dengue control is technically feasible with coordinated international technical and financial support for national programmes. This Primer provides a general overview on dengue, covering epidemiology, control, disease mechanisms, diagnosis, treatment and research priorities.
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Affiliation(s)
- Maria G Guzman
- Institute of Tropical Medicine 'Pedro Kouri', PAHO/WHO Collaborating Center for the Study of Dengue and its Vector, Autopista Novia del Mediodia, Km 6 1/2, Havana 11400, Cuba
| | - Duane J Gubler
- Program in Emerging Infectious Diseases, Duke-NUS Graduate Medical School, Singapore
| | - Alienys Izquierdo
- Institute of Tropical Medicine 'Pedro Kouri', PAHO/WHO Collaborating Center for the Study of Dengue and its Vector, Autopista Novia del Mediodia, Km 6 1/2, Havana 11400, Cuba
| | - Eric Martinez
- Institute of Tropical Medicine 'Pedro Kouri', PAHO/WHO Collaborating Center for the Study of Dengue and its Vector, Autopista Novia del Mediodia, Km 6 1/2, Havana 11400, Cuba
| | - Scott B Halstead
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Cavalcanti LPDG, Mota LAM, Lustosa GP, Fortes MC, Mota DAM, Lima AAB, Coelho ICB, Mourão MPG. Evaluation of the WHO classification of dengue disease severity during an epidemic in 2011 in the state of Ceará, Brazil. Mem Inst Oswaldo Cruz 2015; 109:93-8. [PMID: 24626308 PMCID: PMC4005528 DOI: 10.1590/0074-0276140384] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 10/18/2013] [Indexed: 11/22/2022] Open
Abstract
In 2009, the World Health Organization (WHO) issued a new guideline that stratifies dengue-affected patients into severe (SD) and non-severe dengue (NSD) (with or without warning signs). To evaluate the new recommendations, we completed a retrospective cross-sectional study of the dengue haemorrhagic fever (DHF) cases reported during an outbreak in 2011 in northeastern Brazil. We investigated 84 suspected DHF patients, including 45 (53.6%) males and 39 (46.4%) females. The ages of the patients ranged from five-83 years and the median age was 29. According to the DHF/dengue shock syndrome classification, 53 (63.1%) patients were classified as having dengue fever and 31 (36.9%) as having DHF. According to the 2009 WHO classification, 32 (38.1%) patients were grouped as having NSD [4 (4.8%) without warning signs and 28 (33.3%) with warning signs] and 52 (61.9%) as having SD. A better performance of the revised classification in the detection of severe clinical manifestations allows for an improved detection of patients with SD and may reduce deaths. The revised classification will not only facilitate effective screening and patient management, but will also enable the collection of standardised surveillance data for future epidemiological and clinical studies.
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Affiliation(s)
- Luciano Pamplona de Góes Cavalcanti
- Departamento de Saúde Comunitária, Universidade Federal do Ceará, FortalezaCE, Brasil, Departamento de Saúde Comunitária , Universidade Federal do Ceará , Fortaleza , CE , Brasil
| | - Lia Alves Martins Mota
- Faculdade de Medicina, Centro Universitário Christus, FortalezaCE, Brasil, Faculdade de Medicina , Centro Universitário Christus , Fortaleza , CE , Brasil
| | - Gustavo Porto Lustosa
- Faculdade de Medicina, Centro Universitário Christus, FortalezaCE, Brasil, Faculdade de Medicina , Centro Universitário Christus , Fortaleza , CE , Brasil
| | - Mayara Carvalho Fortes
- Faculdade de Medicina, Centro Universitário Christus, FortalezaCE, Brasil, Faculdade de Medicina , Centro Universitário Christus , Fortaleza , CE , Brasil
| | - Davi Alves Martins Mota
- Faculdade de Medicina, Universidade Federal do Ceará, FortalezaCE, Brasil, Faculdade de Medicina , Universidade Federal do Ceará , Fortaleza , CE , Brasil
| | - Antônio Afonso Bezerra Lima
- Hospital São José de Doenças Infecciosas, FortalezaCE, Brasil, Hospital São José de Doenças Infecciosas , Fortaleza , CE , Brasil
| | - Ivo Castelo Branco Coelho
- Núcleo de Medicina Tropical Prof JE Alencar, Universidade Federal do Ceará, FortalezaCE, Brasil, Núcleo de Medicina Tropical Prof JE Alencar , Universidade Federal do Ceará , Fortaleza , CE , Brasil
| | - Maria Paula Gomes Mourão
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, ManausAM, Brasil, Fundação de Medicina Tropical Dr Heitor Vieira Dourado , Manaus , AM , Brasil
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Horstick O, Jaenisch T, Martinez E, Kroeger A, See LLC, Farrar J, Ranzinger SR. Comparing the usefulness of the 1997 and 2009 WHO dengue case classification: a systematic literature review. Am J Trop Med Hyg 2014; 91:621-634. [PMID: 24957540 PMCID: PMC4155569 DOI: 10.4269/ajtmh.13-0676] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 02/19/2014] [Indexed: 11/23/2022] Open
Abstract
The 1997 and 2009 WHO dengue case classifications were compared in a systematic review with 12 eligible studies (4 prospective). Ten expert opinion articles were used for discussion. For the 2009 WHO classification studies show: when determining severe dengue sensitivity ranges between 59-98% (88%/98%: prospective studies), specificity between 41-99% (99%: prospective study) - comparing the 1997 WHO classification: sensitivity 24.8-89.9% (24.8%/74%: prospective studies), specificity: 25%/100% (100%: prospective study). The application of the 2009 WHO classification is easy, however for (non-severe) dengue there may be a risk of monitoring increased case numbers. Warning signs validation studies are needed. For epidemiological/pathogenesis research use of the 2009 WHO classification, opinion papers show that ease of application, increased sensitivity (severe dengue) and international comparability are advantageous; 3 severe dengue criteria (severe plasma leakage, severe bleeding, severe organ manifestation) are useful research endpoints. The 2009 WHO classification has clear advantages for clinical use, use in epidemiology is promising and research use may at least not be a disadvantage.
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Affiliation(s)
- Olaf Horstick
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Department of Infectious Diseases, Section Clinical Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany; Instituto de Medicina Tropical, Pedro Kuori, La Habana, Cuba; Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland; Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Wellcome Trust, Oxford, United Kingdom; Consultant in Public Health, Ludwigsburg, Germany
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NS1 antigen detecting assays for diagnosing acute dengue infection in people living in or returning from endemic countries. Hippokratia 2014. [DOI: 10.1002/14651858.cd011155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Rodriguez-Roche R, Gould EA. Understanding the dengue viruses and progress towards their control. BIOMED RESEARCH INTERNATIONAL 2013; 2013:690835. [PMID: 23936833 PMCID: PMC3722981 DOI: 10.1155/2013/690835] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 05/08/2013] [Indexed: 01/12/2023]
Abstract
Traditionally, the four dengue virus serotypes have been associated with fever, rash, and the more severe forms, haemorrhagic fever and shock syndrome. As our knowledge as well as understanding of these viruses increases, we now recognise not only that they are causing increasing numbers of human infections but also that they may cause neurological and other clinical complications, with sequelae or fatal consequences. In this review we attempt to highlight some of these features in the context of dengue virus pathogenesis. We also examine some of the efforts currently underway to control this "scourge" of the tropical and subtropical world.
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Affiliation(s)
- Rosmari Rodriguez-Roche
- Pedro Kouri Tropical Medicine Institute, WHO/PAHO Collaborating Centre for the Study of Dengue and Its Vector, Havana, Cuba.
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Ho TS, Huang MC, Wang SM, Hsu HC, Liu CC. Knowledge, attitude, and practice of dengue disease among healthcare professionals in southern Taiwan. J Formos Med Assoc 2012; 112:18-23. [PMID: 23332425 DOI: 10.1016/j.jfma.2012.11.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 11/05/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND/PURPOSE Primary physicians and nurses serve as the first-line health care providers of dengue virus infection diagnosis, notification, and treatment. Knowledge, attitude, and practice (KAP) among primary healthcare professionals (HCPs) regarding dengue diseases may pace alarm and improve the outcome of dengue control. METHODS A cross-sectional survey using a structured quiz in 264 HCPs (response rate, 76%) was conducted in Tainan City in southern Taiwan. The quiz consisted of 10 questions regarding the control measures, notification, and clinical practices of dengue diseases. Scores of KAP and demographic characteristics of HCPs were analyzed. RESULTS One hundred thirty-four physicians and 130 nurses comprise the 264 HCP responders. Forty-three physicians (32%) and 80 nurses (61.5%) were practicing in medical centers, and they scored higher than nonmedical center peers on quizzes on notification (1.18 vs. 0.93 points, p < 0.01) but lower on control measures (3.52 vs. 3.22 points, p < 0.01). Fifty-seven physicians (42.5%) were experienced in reporting suspected dengue cases, and 13.1% of nurses had reported dengue cases. Three-fourths of HCPs failed to respond to the timing of dengue case notification, whereas nurses scored higher than physicians (0.34 vs. 0.16, p < 0.01). In addition, 57.2% of the HCPs failed to respond correctly to the timing of typical skin rashes occurring in the patients with dengue. More than half of the HCPs considered Taiwan an endemic area of dengue diseases. CONCLUSION This pilot study showed a lack of acquaintance with notification timing and important clinical features of dengue among HCPs in southern Taiwan. Future continued medical/nursing education should place more emphasis on these factors to improve dengue control in this demographic area.
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Affiliation(s)
- Tzong-Shiann Ho
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan City, Taiwan
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