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Meiring JE, Khanam F, Basnyat B, Charles RC, Crump JA, Debellut F, Holt KE, Kariuki S, Mugisha E, Neuzil KM, Parry CM, Pitzer VE, Pollard AJ, Qadri F, Gordon MA. Typhoid fever. Nat Rev Dis Primers 2023; 9:71. [PMID: 38097589 DOI: 10.1038/s41572-023-00480-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 12/18/2023]
Abstract
Typhoid fever is an invasive bacterial disease associated with bloodstream infection that causes a high burden of disease in Africa and Asia. Typhoid primarily affects individuals ranging from infants through to young adults. The causative organism, Salmonella enterica subsp. enterica serovar Typhi is transmitted via the faecal-oral route, crossing the intestinal epithelium and disseminating to systemic and intracellular sites, causing an undifferentiated febrile illness. Blood culture remains the practical reference standard for diagnosis of typhoid fever, where culture testing is available, but novel diagnostic modalities are an important priority under investigation. Since 2017, remarkable progress has been made in defining the global burden of both typhoid fever and antimicrobial resistance; in understanding disease pathogenesis and immunological protection through the use of controlled human infection; and in advancing effective vaccination programmes through strategic multipartner collaboration and targeted clinical trials in multiple high-incidence priority settings. This Primer thus offers a timely update of progress and perspective on future priorities for the global scientific community.
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Affiliation(s)
- James E Meiring
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi
| | - Farhana Khanam
- International Centre for Diarrhoel Disease Research, Dhaka, Bangladesh
| | - Buddha Basnyat
- Oxford University Clinical Research Unit, Kathmandu, Nepal
| | - Richelle C Charles
- Massachusetts General Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | - Kathryn E Holt
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Samuel Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Emmanuel Mugisha
- Center for Vaccine Innovation and Access, PATH, Seattle, WA, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christopher M Parry
- Department of Clinical Sciences and Education, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases and Public Health Modelling Unit, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Firdausi Qadri
- International Centre for Diarrhoel Disease Research, Dhaka, Bangladesh
| | - Melita A Gordon
- Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
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Martin LB, Khanam F, Qadri F, Khalil I, Sikorski MJ, Baker S. Vaccine value profile for Salmonella enterica serovar Paratyphi A. Vaccine 2023; 41 Suppl 2:S114-S133. [PMID: 37951691 DOI: 10.1016/j.vaccine.2023.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/27/2022] [Accepted: 01/23/2023] [Indexed: 11/14/2023]
Abstract
In Asia, there are an estimated 12 million annual cases of enteric fever, a potentially fatal systemic bacterial infection caused by Salmonella enterica serovars Typhi (STy) and Paratyphi A (SPA). The recent availability of typhoid conjugate vaccines (TCV), an increasing incidence of disease caused by SPA and growing antimicrobial resistance (AMR) across the genus Salmonella makes a bivalent STy/SPA vaccine a useful public health proposition. The uptake of a stand-alone paratyphoid vaccine is likely low thus, there is a pipeline of bivalent STy/SPA candidate vaccines. Several candidates are close to entering clinical trials, which if successful should facilitate a more comprehensive approach for enteric fever control. Additionally, the World Health Organization (WHO) has made advancing the development of vaccines that protect young children and working aged adults against both agents of enteric fever a priority objective. This "Vaccine Value Profile" (VVP) addresses information related predominantly to invasive disease caused by SPA prevalent in Asia. Information is included on stand-alone SPA candidate vaccines and candidate vaccines targeting SPA combined with STy. Out of scope for the first version of this VVP is a wider discussion on the development of a universal Salmonella combination candidate vaccine, addressing both enteric fever and invasive non-typhoidal Salmonella disease, for use globally. This VVP is a detailed, high-level assessment of existing, publicly available information to inform and contextualize the public health, economic, and societal potential of pipeline vaccines and vaccine-like products for SPA. Future versions of this VVP will be updated to reflect ongoing activities such as vaccine development strategies and "Full Vaccine Value Assessment" that will inform the value proposition of an SPA vaccine. This VVP was developed by an expert working group from academia, non-profit organizations, public-private partnerships, and multi-lateral organizations as well as in collaboration with stakeholders from the WHO South-East Asian Region. All contributors have extensive expertise on various elements of the VVP for SPA and collectively aimed to identify current research and knowledge gaps.
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Affiliation(s)
- Laura B Martin
- Independent Consultant (current affiliation US Pharmacopeia Convention), USA.
| | - Farhana Khanam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Bangladesh.
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Bangladesh.
| | | | | | - Stephen Baker
- University of Cambridge School of Clinical Medicine, UK.
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Pokhrel N, Chapagain R, Thakur CK, Basnet A, Amatya I, Singh R, Ghimire R. Salmonella infection among the pediatric population at a tertiary care children's hospital in central Nepal: a retrospective study. Front Microbiol 2023; 14:1218864. [PMID: 37840726 PMCID: PMC10570616 DOI: 10.3389/fmicb.2023.1218864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/10/2023] [Indexed: 10/17/2023] Open
Abstract
Background Typhoid fever, an infective bacterial disease, is capable of causing fatal systemic infection in humans, and in an era of antimicrobial resistance, it has become of public health importance. This study aimed to investigate the laboratory diagnosis of Salmonella bloodstream infection, its serotype, antimicrobial resistance pattern, and seasonal variation at a tertiary care children's hospital. Methods We undertook a retrospective, cross-sectional study by reviewing hospital-based laboratory records of patients whose blood culture samples were submitted from the outpatient department to the laboratory of a tertiary care children's hospital in Kathmandu, Nepal, from January 2017 to January 2019. Results Among the total blood culture samples obtained (n = 39,771), bacterial isolates (n = 1,055, 2.65%) belonged either to the Genus Enterobacteriaceae or Genus Acinetobacter. Altogether (n = 91, 8.63%), isolates were positive for Salmonella spp., which were further identified as Salmonella enterica subsp. enterica ser. Typhi (n = 79, 7.49%), Salmonella enterica subsp. enterica ser. Paratyphi A (n = 11, 1.04%), and Salmonella enterica subsp. enterica ser. Paratyphi B (n = 1, 0.1%). The median age of patients was 6 years (IQR: 4-9), with male and female patients constituting (n = 53, 58.24%; OR, 1.0; 95% CI, 0.60-1.67) and (n = 38, 41.76%; OR, 0.98; 95% CI, 0.49-2.05) cases, respectively. The disease was observed throughout the year, with a high prevalence toward the spring season (March-May). An antibiogram showed resistance more toward nalidixic acid with S. Typhi, comprising half the isolates (n = 52, 65.82%; p = 0.11). Resistance toward β-lactams with β-lactamase inhibitors (amoxicillin/clavulanate; 1.27%) was seen in a single isolate of S. Typhi. The multidrug resistance pattern was not pronounced. The multiple antibiotic resistance (MAR) index was in the range between 0.14 and 0.22 in S. Typhi and 0.22 and 0.23 in S. Paratyphi. Conclusion Salmonella Typhi was the predominant ser. Infection was common among children between 1 and 5 years of age, showing male predominance and with the spring season contributing to a fairly higher number of cases. Antimicrobial susceptibility testing of S. Typhi showed more resistance toward nalidixic acid, with only a single isolate resistant to β-lactamase inhibitors (amoxicillin/clavulanate). Alarming multidrug resistance patterns were not observed. The MAR index in this study indicates the importance of the judicious use of antimicrobials and hospital infection prevention and control practices.
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Affiliation(s)
| | - Ramhari Chapagain
- Department of Pediatrics, Kanti Children’s Hospital, Kathmandu, Nepal
| | | | - Ajaya Basnet
- Shi-Gan International College of Science and Technology, Kathmandu, Nepal
| | - Isha Amatya
- Nepal Health Research Council, Kathmandu, Nepal
| | | | - Raghav Ghimire
- Department of Pediatric Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
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John J, Bavdekar A, Rongsen-Chandola T, Dutta S, Gupta M, Kanungo S, Sinha B, Srinivasan M, Shrivastava A, Bansal A, Singh A, Koshy RM, Jinka DR, Thomas MS, Alexander AP, Thankaraj S, Ebenezer SE, Karthikeyan AS, Kumar D, Njarekkattuvalappil SK, Raju R, Sahai N, Veeraraghavan B, Murhekar MV, Mohan VR, Natarajan SK, Ramanujam K, Samuel P, Lo NC, Andrews J, Grassly NC, Kang G. Burden of Typhoid and Paratyphoid Fever in India. N Engl J Med 2023; 388:1491-1500. [PMID: 37075141 PMCID: PMC10116367 DOI: 10.1056/nejmoa2209449] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND In 2017, more than half the cases of typhoid fever worldwide were projected to have occurred in India. In the absence of contemporary population-based data, it is unclear whether declining trends of hospitalization for typhoid in India reflect increased antibiotic treatment or a true reduction in infection. METHODS From 2017 through 2020, we conducted weekly surveillance for acute febrile illness and measured the incidence of typhoid fever (as confirmed on blood culture) in a prospective cohort of children between the ages of 6 months and 14 years at three urban sites and one rural site in India. At an additional urban site and five rural sites, we combined blood-culture testing of hospitalized patients who had a fever with survey data regarding health care use to estimate incidence in the community. RESULTS A total of 24,062 children who were enrolled in four cohorts contributed 46,959 child-years of observation. Among these children, 299 culture-confirmed typhoid cases were recorded, with an incidence per 100,000 child-years of 576 to 1173 cases in urban sites and 35 in rural Pune. The estimated incidence of typhoid fever from hospital surveillance ranged from 12 to 1622 cases per 100,000 child-years among children between the ages of 6 months and 14 years and from 108 to 970 cases per 100,000 person-years among those who were 15 years of age or older. Salmonella enterica serovar Paratyphi was isolated from 33 children, for an overall incidence of 68 cases per 100,000 child-years after adjustment for age. CONCLUSIONS The incidence of typhoid fever in urban India remains high, with generally lower estimates of incidence in most rural areas. (Funded by the Bill and Melinda Gates Foundation; NSSEFI Clinical Trials Registry of India number, CTRI/2017/09/009719; ISRCTN registry number, ISRCTN72938224.).
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Affiliation(s)
- Jacob John
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Ashish Bavdekar
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Temsunaro Rongsen-Chandola
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Shanta Dutta
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Madhu Gupta
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Suman Kanungo
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Bireshwar Sinha
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Manikandan Srinivasan
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Ankita Shrivastava
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Adarsh Bansal
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Ashita Singh
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Roshine M Koshy
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Dasharatha R Jinka
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Mathew S Thomas
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Anna P Alexander
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Shajin Thankaraj
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Sheena E Ebenezer
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Arun S Karthikeyan
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Dilesh Kumar
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Swathi K Njarekkattuvalappil
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Reshma Raju
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Nikhil Sahai
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Balaji Veeraraghavan
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Manoj V Murhekar
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Venkata R Mohan
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Sindhu K Natarajan
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Karthikeyan Ramanujam
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Prasanna Samuel
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Nathan C Lo
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Jason Andrews
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Nicholas C Grassly
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
| | - Gagandeep Kang
- From Christian Medical College, Vellore (J.J., M.S., A.S.K., D.K., S.K. Njarekkattuvalappil, R.R., N.S., B.V., V.R.M., S.K. Natarajan, K.R., P.S., G.K.), KEM Hospital Research Centre, Pune (A. Bavdekar, A. Shrivastava), Centre for Health Research and Development, Society for Applied Studies, New Delhi (T.R.C., B.S.), Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata (S.D., S.K.), Post Graduate Institute of Medical Education and Research, Chandigarh (M.G., A. Bansal), Chinchpada Christian Hospital, Nandurbar (A. Singh), Makunda Christian Leprosy and General Hospital, Karimganj (R.M.K., S.T.), Rural Development Trust Hospital, Bathalapalli (D.R.J.), Duncan Hospital, Raxaul (M.S.T., S.E.E.), Lady Willingdon Hospital, Manali (A.P.A.), and ICMR-National Institute of Epidemiology, Chennai (M.V.M.) - all in India; University of California, San Francisco, San Francisco (N.C.L.), and Stanford University School of Medicine, Stanford (J.A.) - both in California; and Imperial College London, London (N.C.G.)
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Igiri BE, Okoduwa SIR, Munirat SA, Otu-Bassey IB, Bashir A, Onyiyioza OM, Enang IA, Okoduwa UJ. Diversity in Enteric Fever Diagnostic Protocols and Recommendation for Composite Reference Standard. IRANIAN JOURNAL OF MEDICAL MICROBIOLOGY 2023; 17:22-38. [DOI: 10.30699/ijmm.17.1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Yanto TA, Lugito NPH, Hwei LRY, Virliani C, Octavius GS. Prevalence and Determinants of COVID-19 Vaccine Acceptance in South East Asia: A Systematic Review and Meta-Analysis of 1,166,275 Respondents. Trop Med Infect Dis 2022; 7:361. [PMID: 36355903 PMCID: PMC9696885 DOI: 10.3390/tropicalmed7110361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 09/15/2023] Open
Abstract
Despite its importance in guiding public health decisions, studies on COVID-19 vaccination acceptance and its determinants in South East Asia (SEA) are lacking. Therefore, this study aims to determine the prevalence of COVID-19 vaccine acceptance and the variables influencing the vaccine's acceptance. This review is registered under PROSPERO CRD42022352198. We included studies that reported vaccination acceptance from all SEA countries, utilising five academic databases (Pubmed, MEDLINE, Cochrane Library, Science Direct, and Google Scholar), three Indonesian databases (the Indonesian Scientific Journal Database, Neliti, and Indonesia One Search), two pre-print databases (MedRxiv and BioRxiv), and two Thailand databases (ThaiJo and Thai-Journal Citation Index). The analysis was conducted using STATA 17.0 with metaprop commands. The prevalence for COVID-19 vaccination acceptance in SEA was 71% (95%CI 69-74; I2 99.87%, PI: 68.6-73.5). Myanmar achieved the highest COVID-19 vaccination acceptance prevalence, with 86% (95%CI 84-89), followed by Vietnam with 82% (95% CI 79-85; I2 99.04%) and Malaysia with 78% (95%CI 72-84; I2 99.88%). None of the ten determinants studied (age, sex, education, previous COVID-19 infections, smoking and marriage status, health insurance, living together, chronic diseases, and healthcare workers) were significantly associated with acceptance. This result will be useful in guiding vaccination uptake in SEA.
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Affiliation(s)
- Theo Audi Yanto
- Department of Internal Medicine, Universitas Pelita Harapan, Tangerang 15811, Indonesia
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Jiang M, Wang HM, Zhou GL, Chen YS, Deng JK. Invasive Salmonella Infections Among Children in Shenzhen, China: A Five-year Retrospective Review. Pediatr Infect Dis J 2022; 41:684-689. [PMID: 35622427 DOI: 10.1097/inf.0000000000003588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Invasive Salmonella infections are highly prevalent worldwide. Clinical data of childhood invasive Salmonella infections from China are limited. METHODS Data of hospitalized children <18 years old with invasive Salmonella infections from 2016 to 2020 in Shenzhen Children's Hospital in Shenzhen were retrospectively collected. Serotypes and antimicrobial susceptibility tests of the invasive Salmonella isolates were performed. RESULTS Sixty-three cases were enrolled during the 5-year study period including 8 in 2016, 11 in 2017, 16 in 2018, 6 in 2019 and 22 in 2020. The median age was 15 months (interquartile range, 11-22 months), and 79.4% (50 cases) were <2 years of age. Underlying diseases were found in 28.6% (18 cases) of the patients with a great variety, but no cases of malaria or HIV infection were identified. Most of the invasive Salmonella cases were bloodstream infections (84.1%), followed by osteoarthritis (11.1%) and meningitis (4.8%). Gastroenteritis (49.2%) and pneumonia (28.6%) were found to be the major manifestations among the patients. Furthermore, invasive Salmonella infections resulted in the death of 3 children (4.8%). Salmonella enteritis (12 cases; 15.9%) and Salmonella typhimurium (9 cases; 19.0%) as the most common serovars were identified. The resistance rates of Salmonella strains to ceftriaxone, ceftazidime and cefepime were also measured to be 17.5%, 17.5% and 9.5%, respectively. CONCLUSIONS An increasing number of childhood invasive Salmonella infections with a broad range of serotypes was observed in Shenzhen, China. It is critical to pay attention to the antimicrobial resistance of the isolates taken from children with invasive Salmonella infections.
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Affiliation(s)
| | | | - Guang-Lun Zhou
- Department of Urology and Laboratory of Pelvic Floor Muscle Function
| | - Yun-Sheng Chen
- Department of Clinical Laboratory, Shenzhen Children's Hospital, Shenzhen, China
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Nampota-Nkomba N, Nyirenda OM, Khonde L, Mapemba V, Mbewe M, Ndaferankhande JM, Msuku H, Masesa C, Misiri T, Mwakiseghile F, Patel PD, Patel P, Johnson-Mayo I, Pasetti MF, Heyderman RS, Tracy JK, Datta S, Liang Y, Neuzil KM, Gordon MA, Laurens MB. Safety and immunogenicity of a typhoid conjugate vaccine among children aged 9 months to 12 years in Malawi: a nested substudy of a double-blind, randomised controlled trial. Lancet Glob Health 2022; 10:e1326-e1335. [PMID: 35961356 PMCID: PMC9380257 DOI: 10.1016/s2214-109x(22)00275-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 05/24/2022] [Accepted: 06/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Typhoid fever is a substantial public health problem in Africa, yet there are few clinical trials of typhoid conjugate vaccine (TCV). We assessed immunogenicity and safety of Typbar TCV in Malawi. METHODS This substudy was nested within a phase 3, double-blind, parallel design, randomised controlled trial of TCV in children from Ndirande Health Centre in Ndirande township, Blantyre, Malawi. To be eligible, participants had to be aged between 9 months and 12 years with no known immunosuppression or chronic health conditions, including HIV or severe malnutrition; eligible participants were enrolled into three strata of approximately 200 children (9-11 months, 1-5 years, and 6-12 years), randomly assigned (1:1) to receive TCV or control (meningococcal serogroup A conjugate vaccine [MCV-A]) intramuscularly. Serum was collected before vaccination and at 28 days and 730-1035 days after vaccination to measure anti-Vi antibodies by ELISA. Because of COVID-19, day 730 visits were extended up to 1035 days. This nested substudy evaluated reactogenicity, safety, and immunogenicity by age stratum. Safety outcomes, analysed in the intention-to-treat population, included solicited adverse events within 7 days of vaccination (assessed on 3 separate days) and unsolicited adverse events within 28 days of vaccination. This trial is registered with ClinicalTrials.gov, NCT03299426. FINDINGS Between Feb 22 and Sept 6, 2018, 664 participants were screened, and 631 participants were enrolled and randomly assigned (320 to the TCV group and 311 to the MCV-A group). 305 participants in the TCV group and 297 participants in the MCV-A group were vaccinated. Among TCV recipients, anti-Vi IgG geometric mean titres increased more than 500 times from 4·2 ELISA units (EU)/mL (95% CI 4·0-4·4) at baseline to 2383·7 EU/mL (2087·2-2722·3) at day 28, then decreased to 48·0 EU/mL (39·9-57·8) at day 730-1035, remaining more than 11 times higher than baseline. Among MCV-A recipients, anti-Vi IgG titres remained unchanged: 4·3 EU/mL (4·0-4·5) at baseline, 4·4 EU/mL (4·0-4·7) on day 28, and 4·6 EU/mL (4·2-5·0) on day 730-1035. TCV and MCV-A recipients had similar solicited local (eight [3%] of 304, 95% CI 1·3-5·1 and three [1%] of 293, 0·4-3·0) and systemic (27 [9%] of 304, 6·2-12·6 and 27 [9%] of 293, 6·4-13·1) reactogenicity. Related unsolicited adverse events occurred similarly in TCV and MCV-A recipients in eight (3%) of 304 (1·3-5·1) and eight (3%) of 293 (1·4-5·3). INTERPRETATION This study provides evidence of TCV safety, tolerability, and immunogenicity up to 730-1035 days in Malawian children aged 9 months to 12 years. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
| | - Osward M Nyirenda
- Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Lameck Khonde
- Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Victoria Mapemba
- Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Maurice Mbewe
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - John M Ndaferankhande
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Harrison Msuku
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Clemens Masesa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Theresa Misiri
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Felistas Mwakiseghile
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Priyanka D Patel
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Pratiksha Patel
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Ifayet Johnson-Mayo
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marcela F Pasetti
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Robert S Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi; Department of Infection, Division of Infectious Diseases, University College London, London, UK
| | - J Kathleen Tracy
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shrimati Datta
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Yuanyuan Liang
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Melita A Gordon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi; University of Liverpool, Liverpool, UK
| | - Matthew B Laurens
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA.
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Singhal K, Bothra M, Kapoor S, Jhamb U, Mishra D. Metabolic Disorders among Children Presenting with Acute Encephalopathy. Indian J Pediatr 2022; 89:665-672. [PMID: 35254636 DOI: 10.1007/s12098-022-04087-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/27/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To study the clinicoetiological profile of children presenting with acute noninfectious encephalopathy (NIE) and identify the proportion of children having inborn errors of metabolism (IEM). METHOD This descriptive cross sectional study was conducted in a tertiary care centre in Northern India. Consecutive children, aged more than 28 d and less than 12 y, with acute encephalopathy were enrolled after ruling out CNS infection. All children were evaluated on an internally validated structured proforma. A sequential pre-decided battery of tests was applied to determine the cause of encephalopathy. IEM suspects were subjected to TMS/GCMS followed by mutation analysis for confirmation. RESULTS Fifty children with noninfectious encephalopathy (NIE) were recruited and metabolic causes were detected in 9 of these children (18%), aged 3 to 42 mo, with female preponderance. The IEMs included lactic acidosis (4), glutaric aciduria (3), isovaleric academia (1), and hyperhomocysteinemia (1). History of previously affected siblings and consanguinity between the parents were important indicators of IEM. MS/MS and mutation analysis were the mainstay of diagnosis in these patients. IEMs contributed to the most common cause amongst cases of NIE. CONCLUSION IEMs constitute a significant proportion of NIE in India and a high index of suspicion is required to make the diagnosis.
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Affiliation(s)
- Kirti Singhal
- Department of Pediatrics, MAMC and LNJP Hospital, Delhi, 110002, India
| | - Meenakshi Bothra
- Department of Pediatrics, MAMC and LNJP Hospital, Delhi, 110002, India.
| | - Seema Kapoor
- Department of Pediatrics, MAMC and LNJP Hospital, Delhi, 110002, India
| | - Urmila Jhamb
- Department of Pediatrics, MAMC and LNJP Hospital, Delhi, 110002, India
| | - Devendra Mishra
- Department of Pediatrics, MAMC and LNJP Hospital, Delhi, 110002, India
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10
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Garniasih D, Susanah S, Sribudiani Y, Hilmanto D. The incidence and mortality of childhood acute lymphoblastic leukemia in Indonesia: A systematic review and meta-analysis. PLoS One 2022; 17:e0269706. [PMID: 35696384 PMCID: PMC9191700 DOI: 10.1371/journal.pone.0269706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background The incidence of childhood ALL in Indonesia is still largely unknown. The widely mentioned statistics from other countries turn out to be only estimated figures. Other data do not specify the types of leukemia and are not specifically focused on children. Therefore, this study aims to pool incidence and mortality statistics from available studies in Indonesia. Methods We searched five different academic databases, including Pubmed, MEDLINE, Cochrane Library, Science Direct, and Google Scholar. Three Indonesian databases, such as the Indonesian Scientific Journal Database (ISJD), Neliti, and Indonesia One Search, were also utilized. Incidence was expressed as per 100,000 children. We used the Newcastle-Ottawa scale (NOS) to assess the quality of cohort studies. The inclusion criteria are cohort studies published in the languages of English or Indonesian. For this analysis, we define children as 0–18 years old. Findings The incidence rate for childhood ALL was found to be 4.32 per 100,000 children (95% CI 2.65–5.99) with a prediction interval of 1.98 to 9.42 per 100,000 children. The incidence rate is higher in males, with 2.45 per 100,000 children (95% CI 1.98–2.91) and a prediction interval of 1.90 to 3.16 per 100,000 children. As for females, the incidence rate is 2.05 per 100,000 children (95% CI 1.52–2.77) with a prediction interval of 1.52 to 2.77 per 100,000 children. The mortality of childhood ALL ranges from 0.44 to 5.3 deaths per 100,000 children, while the CFR is 3.58% with varying true effect sizes of 2.84% to 4.52%. Interpretation With 79.5 million children living in Indonesia in 2018, this means that there were roughly 3,434 new cases of childhood ALL. An organized effort between multiple sectors is needed to improve the registries of childhood ALL in Indonesia.
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Affiliation(s)
- Dina Garniasih
- Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
- * E-mail:
| | - Susi Susanah
- Department of Pediatrics, Universitas Padjadjaran, Bandung, Indonesia
- Research Center of Medical Genetics, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Yunia Sribudiani
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Research Center of Medical Genetics, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Dany Hilmanto
- Department of Pediatrics, Universitas Padjadjaran, Bandung, Indonesia
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11
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Singh Y, Saxena A, Singh SP, Verma MK, Kumar A, Kumar A, Mrigesh M, Saxena MK. Calcium phosphate adjuvanted nanoparticles of outer membrane proteins of Salmonella Typhi as a candidate for vaccine development against Typhoid fever. J Med Microbiol 2022; 71. [PMID: 35476604 DOI: 10.1099/jmm.0.001529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. The conventional adjuvants used in vaccines have limitations like induction of an imbalanced Th1 and Th2 immune response. To overcome this limitation, novel adjuvants and newer forms of existing adjuvants like calcium phosphate nanoparticles are being tested.Hypothesis/Gap Statement. Calcium phosphate adjuvanted outer membrane proteins vaccine may work as an efficient, safe and cost effective vaccine against Salmonella Typhi.Aim. Our goals were to evaluate the potential of calcium phosphate nanoparticles as an adjuvant using outer membrane proteins (Omps) of Salmonella Typhi as antigens for immune response, with montanide (commercially available adjuvant) as control, and its toxicity in rats.Methodology. Calcium phosphate adjuvanted outer membrane proteins nanoparticles were synthesized and characterized. The efficacy of vaccine formulation in mice and toxicity assay were carried out in rats.Results. The calcium phosphate nanoparticles varying in size between 20-50 nm had entrapment efficiency of 41.5% and loading capacity of 54%. The calcium phosphate nanoparticle-Omps vaccine formulation (nanoparticle-Omps) induced a strong humoral immune response, which was significantly higher than the control group for the entire period of study. In the montanide-Omps group the initial very high immune response declined steeply and then remained steady. The immune response induced by nanoparticle-Omps did not change appreciably. The cell mediated immune response as measured by lymphocyte proliferation assay and delayed type hypersensitivity test showed a higher response (P<0.01) for the nanoparticles-Omps group as compared to montanide-Omps group. The bacterial clearance assay also showed higher clearance in the nanoparticles-Omps group as compared to montanide-Omps group (approx 1.4%). The toxicity analysis in rats showed no difference in the values of toxicity biomarkers and blood chemistry parameters, revealing vaccine formulation was non-toxic in rats.Conclusion. Calcium phosphate nanoparticles as adjuvant in vaccines is safe, have good encapsulation and loading capacity and induce a strong cell mediated, humoral and protective immune response.
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Affiliation(s)
- Yashpal Singh
- Department of Molecular Biology & Genetic Engineering, College of Basic Sciences & Humanities, Pantnagar, Uttarakhand, India
| | - Anjani Saxena
- Department of Veterinary Pharmacology & Toxicology, College of Veterinary & Animal Sciences, Pantnagar, Uttarakhand, India
| | - S P Singh
- Department of Veterinary Pharmacology & Toxicology, College of Veterinary & Animal Sciences, Pantnagar, Uttarakhand, India
| | - Manish Kumar Verma
- Department of Veterinary Pharmacology & Toxicology, College of Veterinary & Animal Sciences, Pantnagar, Uttarakhand, India
| | - Arun Kumar
- Department of Veterinary Surgery and Radiology, College of Veterinary & Animal Sciences, Pantnagar, Uttarakhand, India
| | - Avadhesh Kumar
- Department of Veterinary & Animal Husbandry Extension Education, College of Veterinary & Animal Sciences, Pantnagar, Uttarakhand, India
| | - Meena Mrigesh
- Department of Veterinary Anatomy, College of Veterinary & Animal Sciences, Pantnagar, Uttarakhand, India
| | - Mumtesh Kumar Saxena
- Department of Animal Genetics & Breeding, College of Veterinary & Animal Sciences G.B. Pant University of Agriculture & Technology, Pantnagar, Uttarakhand, India
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12
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Paediatric enteric fever in Brussels: a case series over 16 years. Eur J Pediatr 2022; 181:1151-1158. [PMID: 34766200 DOI: 10.1007/s00431-021-04309-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/11/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
Enteric fever (EF) is a major public health problem and a witness of the global health disparities. It is caused by Salmonella enterica serovar Typhi (Salmonella ser. Typhi) and Salmonella enterica serovar Paratyphi A, B, C (Salmonella ser. Paratyphi) and is estimated to infect 12-26 million persons yearly. Paediatric data on enteric fever in Europe are scarce. A case series of EF was analysed to describe the clinical presentation, laboratory characteristics and diagnostic challenges identified in a paediatric population in Brussels. We performed a retrospective study of all lab-confirmed cases of enteric fever in children aged 0-15 years at two Brussels teaching hospitals, between January 2005 and December 2020. We reviewed age, gender, travel history, consultations before diagnosis, hospitalisation duration, clinical symptoms and laboratory findings. There were 34 positive isolates of S. typhi and S. paratyphi: 31 patients had positive blood culture, 1 patient had positive bone aspirate and 2 patients had positive stool culture (one was excluded for missing data). There were 20 girls (60%). Median age was 3.5 years (range 5 months to 14 years). Travel to EF endemic areas was present in 55% of patients. Diagnosis was delayed in 80% of children. Eosinopenia was present in 93% of the cohort. The patients had not received any preventive travel education or vaccination. Conlusion: Enteric fever poses diagnostic challenges to clinicians. Eosinopenia in a febrile patient coming from the tropics should raise suspicion of EF. Travellers to endemic areas should be better educated about EF risks, and typhoid fever vaccination must be promoted. What is Known: • Enteric fever is a global public health problem and includes typhoid and paratyphoid fever. • Typhoid fever is vaccine preventable disease. Paratyphoid fever is not vaccine preventable. What is New: • Enteric fever diagnosis is very challenging in non-endemic settings, and a large proportion of patients may develop serious complications if they receive delayed management. Occurrence of small family clusters is possible and mandates education and monitoring of the families of enteric fever affected children. • We report that the widest majority of our enteric fever affected patients (69%) had aneosinophilia (zero eosinophil count), and almost all patients (93%) had eosinopaenia (less than 50 eosinophil count) during their bacteriaemic phase.
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13
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Kim CL, Cruz Espinoza LM, Vannice KS, Tadesse BT, Owusu-Dabo E, Rakotozandrindrainy R, Jani IV, Teferi M, Bassiahi Soura A, Lunguya O, Steele AD, Marks F. The Burden of Typhoid Fever in Sub-Saharan Africa: A Perspective. Res Rep Trop Med 2022; 13:1-9. [PMID: 35308424 PMCID: PMC8932916 DOI: 10.2147/rrtm.s282461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/12/2022] [Indexed: 11/23/2022] Open
Abstract
While typhoid fever has largely been eliminated in high-income regions which have developed modern water, sanitation, and hygiene facilities, it remains a significant public health burden resulting in morbidity and mortality among millions of individuals in resource-constrained settings. Prevention and control efforts are needed that integrate several high-impact interventions targeting facilities and infrastructure, including those addressing improvements in sanitation, access to safe water, and planned urbanization, together with parallel efforts directed at effective strategies for use of typhoid conjugate vaccines (TCV). The use of TCVs is a critical tool with the potential of having a rapid impact on typhoid fever disease burden; their introduction will also serve as an important strategy to combat evolving antimicrobial resistance to currently available typhoid fever treatments. Well-designed epidemiological surveillance studies play a critical role in establishing the need for, and monitoring the impact of, typhoid fever control and prevention strategies implemented by public health authorities. Here, we present a perspective based on a narrative review of the impact of typhoid fever on morbidity and mortality in sub-Saharan Africa and discuss ongoing surveillance activities and the role of vaccination in prevention and control efforts.
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Affiliation(s)
- Cara Lynn Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Kirsten S Vannice
- Enteric and Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Birkneh Tilahun Tadesse
- International Vaccine Institute, Seoul, Republic of Korea
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ellis Owusu-Dabo
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Ilesh V Jani
- Instituto Nacional de Saúde (INS), Maputo Province, Mozambique
| | | | - Abdramane Bassiahi Soura
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-Zerbo de Ouagadougou, Ouagadougou, Burkina Faso
| | - Octavie Lunguya
- Department of Microbiology, Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
- Department of Medical Biology, University Teaching Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - A Duncan Steele
- Enteric and Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- University of Antananarivo, Antananarivo, Madagascar
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Correspondence: Florian Marks, Tel +82-2-881-1133, Email
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Nabarro LE, McCann N, Herdman MT, Dugan C, Ladhani S, Patel D, Morris-Jones S, Balasegaram S, Heyderman RS, Brown M, Parry CM, Godbole G. British Infection Association Guidelines for the Diagnosis and Management of Enteric Fever in England. J Infect 2022; 84:469-489. [PMID: 35038438 DOI: 10.1016/j.jinf.2022.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/10/2021] [Accepted: 01/05/2022] [Indexed: 11/25/2022]
Abstract
Enteric fever (EF) is an infection caused by the bacteria called Salmonella Typhi or Paratyphi. Infection is acquired through swallowing contaminated food or water. Most EF in England occurs in people returning from South Asia and other places where EF is common; catching EF in England is rare. The main symptom is fever, but stomach pain, diarrhoea, muscle aches, rash and other symptoms may occur. EF is diagnosed by culturing the bacteria from blood and/or stool in a microbiology laboratory. EF usually responds well to antibiotic treatment. Depending on how unwell the individual is, antibiotics may be administered by mouth or by injection. Over the past several years, there has been an overall increase in resistance to antibiotics used to treat enteric fever, in all endemic areas. Additionally, since 2016, there has been an ongoing outbreak of drug-resistant EF in Pakistan. This infection is called extensively drug-resistant, or XDR, EF and only responds to a limited number of antibiotics. Occasionally individuals develop complications of EF including confusion, bleeding, a hole in the gut or an infection of the bones or elsewhere. Some people may continue to carry the bacteria in their stool for a longtime following treatment for the initial illness. These people may need treatment with a longer course of antibiotics to eradicate infection. Travellers can reduce their risk of acquiring EF by following safe food and water practices and by receiving the vaccine at least a few weeks before travel. These guidelines aim to help doctors do the correct tests and treat patients for enteric fever in England but may also be useful to doctors and public health professionals in other similar countries.
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Affiliation(s)
- L E Nabarro
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK; United Kingdom Health Security Agency, UK; St George's University Hospitals NHS Foundation Trust, London, UK; British Infection Association, UK
| | - N McCann
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - C Dugan
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | - S Ladhani
- United Kingdom Health Security Agency, UK; Paediatric Infectious Diseases Research Group, St George's University, London, UK
| | - D Patel
- National Travel Health Network and Centre (NaTHNaC), UK
| | - S Morris-Jones
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - R S Heyderman
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK; Research Department of Infection, Division of Infection and Immunity, University College London, London, UK
| | - M Brown
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - C M Parry
- Liverpool School of Tropical Medicine, Liverpool, UK; Alder Hey Hospital and Liverpool University Hospitals, Liverpool, UK; Centre for Tropical Medicine and Global Health, University of Oxford, UK
| | - G Godbole
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK; United Kingdom Health Security Agency, UK; British Infection Association, UK.
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15
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Forster DP, Leder K. Typhoid fever in travellers: estimating the risk of acquisition by country. J Travel Med 2021; 28:6383558. [PMID: 34619766 PMCID: PMC8715417 DOI: 10.1093/jtm/taab150] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Typhoid fever is a notifiable disease within Australia. Although studies in endemic regions give an indication of acquisition risk, many countries lack reliable data, and little is known of the absolute or relative risk in Australian travellers. By combining notified case data with travel statistics provided by the Australian Bureau of Statistics, the aim of this study was to give an indication of risk for typhoid acquisition among Australian travellers. METHODS Australian typhoid notifications between 1st January 2010 and 30th June 2017 were grouped by country of acquisition and age category (<15 or ≥15 years). Australian travel data were used to inform time at risk and incidence rate of Australian typhoid notifications pertaining to country and region of acquisition. Salmonella Paratyphi infections, though notifiable, were excluded as the focus was vaccine preventable illness. Data from New South Wales and Victoria were used to examine the incidence in those acquiring infection in their country of birth (COB) against travellers who did not. RESULTS Nine hundred twenty-three cases of typhoid were notified over the period of review, 96% of which were acquired overseas. The greatest determinant of risk was travel destination, with countries in south Asia associated with highest crude incidence rate (252 per 100 000 person-years), particularly Bangladesh. Younger age and immigrants returning to their COB were generally associated with higher risk of acquisition. CONCLUSIONS The risk of typhoid fever in Australian travellers to endemic regions is considerable. Immigrants returning to their COB appear to be at higher risk and it is likely that this risk extends to their traveling dependents. These findings help clinicians and public health officials to plan and advise pre-travel vaccination strategies with at-risk individuals and groups. Additional sociodemographic data collection with Australian typhoid notifications would enhance the surveillance of differing international travel risk groups leaving Australia.
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Affiliation(s)
- Daniel P Forster
- Public Events, COVID-19 Response, Engagement & Delivery, Department of Health, VIC, Melbourne, Australia.,Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Doherty Institute for Infection and Immunity, VIC, Melbourne, Australia
| | - Karin Leder
- Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Doherty Institute for Infection and Immunity, VIC, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, VIC, Melbourne, Australia
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16
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Saigal K, Gupta D, Saikia D. Clinicoepidemiological Observations of Enteric Fever in Infants: Experiences From a Tertiary Care Pediatric Hospital in North India. J Infect Dis 2021; 224:S568-S572. [PMID: 35238364 PMCID: PMC8892531 DOI: 10.1093/infdis/jiab430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background There is a lack of evident data to explain the true scenario of age-specific enteric fever in India. The current study aimed to evaluate the burden and disease pattern of enteric fever among infants in a tertiary care pediatric hospital. Methods A prospective laboratory-based surveillance was conducted from April 2018 to January 2020 at a children’s hospital in North India, under the Surveillance for Enteric Fever in India study. The study included children <1 year of age in whom Salmonella serovar Typhi/Salmonella serovar Paratyphi grew in cultures from blood or sterile body fluid. The key outcome measures included disease spectrum and clinical presentation. Results Of the 10 737 blood cultures from infants, 26 were positive for S. Typhi or S. Paratyphi. The majority of cases occurred in infants aged 6–12 months, with the youngest being 1 month old. Fever with abdominal pain and diarrhea were the common symptoms, with 46% of infants requiring inpatient care. All of the isolates were susceptible to ceftriaxone. Third-generation cephalosporins were used as the first-line therapy for hospitalized infants. The average duration of fever was 8.6 days. The overall case-fatality rate among infants with enteric fever was 7.4%. Conclusions Enteric fever is a major contributor to disease and death among children. Robust surveillance studies are required to understand the true disease burden.
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Affiliation(s)
- Karnika Saigal
- Department of Microbiology and Infectious Diseases, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Deepika Gupta
- Department of Microbiology and Infectious Diseases, Chacha Nehru Bal Chikitsalaya, New Delhi, India
| | - Diganta Saikia
- Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, New Delhi, India
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17
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Jones E, Jin C, Stockdale L, Dold C, Pollard AJ, Hill J. A Salmonella Typhi Controlled Human Infection Study for Assessing Correlation between Bactericidal Antibodies and Protection against Infection Induced by Typhoid Vaccination. Microorganisms 2021; 9:microorganisms9071394. [PMID: 34203328 PMCID: PMC8304662 DOI: 10.3390/microorganisms9071394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023] Open
Abstract
Vi-polysaccharide conjugate vaccines are efficacious against typhoid fever in children living in endemic settings, their recent deployment is a promising step in the control of typhoid fever. However, there is currently no accepted correlate of protection. IgG and IgA antibodies generated in response to Vi conjugate or Vi plain polysaccharide vaccination are important but there are no definitive protective titre thresholds. We adapted a luminescence-based serum bactericidal activity (SBA) for use with S. Typhi and assessed whether bactericidal antibodies induced by either Vi tetanus toxoid conjugate (Vi-TT) or Vi plain polysaccharide (Vi-PS) were associated with protection in a controlled human infection model of typhoid fever. Both Vi-PS and Vi-TT induced significant increase in SBA titre after 28 days (Vi-PS; p < 0.0001, Vi-TT; p = 0.003), however higher SBA titre at the point of challenge did not correlate with protection from infection or reduced symptom severity. We cannot eliminate the role of SBA as part of a multifactorial immune response which protects against infection, however, our results do not support a strong role for SBA as a mechanism of Vi vaccine mediated protection in the CHIM setting.
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18
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A Study of Paratyphoid Fever in Bulgarian Children. ACTA MEDICA BULGARICA 2021. [DOI: 10.2478/amb-2021-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective. To study both the molecular discrimination of D-tartrate fermenting and non-fermenting strains of Salmonella enterica subsp. enterica serotype Paratyphi B isolated from patients with paratyphoid fever and the clinical course of this disease.
Materials and methods. The isolates examined were from children aged 3 months to 9 years. A total of 33 Salmonella strains were serotyped as Salmonella Paratyphi B, with an antigenic formula based on O- and H- antigens: 1,4, [5], 12: b: 1,2 by Kauffmann–White classification.
Results. Multiplex PCR analysis confirmed all tested strains as d-tartrate fermenting (dT+), also referred to as variant Java.
Discussion. We found that the most common cause of paratyphoid fever among children in Bulgaria is variant Java Salmonella Paratyphi B. Most children had classic symptoms of acute gastroenteritis – fever, watery diarrhea and vomiting.
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19
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Affiliation(s)
- Buddha Basnyat
- Oxford University Clinical Research Unit-Patan Academy of Health Science Kathmandu, Nepal
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | | | | | - Christopher M Parry
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Alder Hey Children' Hospital and Liverpool University Hospitals. Liverpool, UK
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20
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Khadka P, Thapaliya J, Thapa S. Susceptibility pattern of Salmonella enterica against commonly prescribed antibiotics, to febrile-pediatric cases, in low-income countries. BMC Pediatr 2021; 21:38. [PMID: 33446146 PMCID: PMC7809854 DOI: 10.1186/s12887-021-02497-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In most low-income countries, febrile-pediatric-cases are often treated empirically with accessible antibiotics without periodic epidemiological surveillance, susceptibility testing, or minimal lethal dose calculations. With this backdrop, the study was undertaken to evaluate the susceptibility trend of Salmonella enterica against the commonly prescribed antibiotics. METHODS All isolates of Salmonella enterica were identified by standard protocols of biotyping and serotyping, then tested against antibiotics by the modified Kirby disk-diffusion method. Minimum Inhibitory Concentration (MIC) of isolates was determined by the agar-dilution method and compared with disk diffusion results and on nalidixic-acid sensitive/resistant strains. RESULTS Among 1815 febrile-pediatric patients, 90(4.9%) isolates of Salmonella enterica [serovar: Salmonella Typhi 62(68.8%) and Salmonella Paratyphi A 28(31.1%)] were recovered. The incidence of infection was higher among males, age groups 5 to 9, and patients enrolling in the out-patient department (OPD). On the disk-diffusion test, most isolates were sensitive against first-line drugs i.e.cephalosporins, and macrolides. However, against quinolones, a huge percentile 93.3%, of isolates were resistant [including 58 Typhiand 26 Paratyphiserovar] while nearly 14% were resistant against fluoroquinolones. When MICs breakpoint were adjusted as follows: 4 μg/ml for azithromycin, ≥1 μg/ml for ciprofloxacin, 2 μg/ml for ofloxacin, 8 μg/ml for nalidixic acid, and 1 μg/ml for cefixime, higher sensitivity and specificity achieved. Compared to other tested antibiotics, a low rate of azithromycin resistance was observed. Nevertheless, higher resistance against fluoroquinolones was observed on NARS strain. CONCLUSION Higher susceptibility of Salmonella enterica to the conventional anti-typhoidal drugs (amoxicillin, chloramphenicol, cotrimoxazole, cephotaxime) advocates for its reconsideration. Although, the lower susceptibility against fluoroquinolones among nalidixic-acid-resistant Salmonella (NARS) strain negates its empirical use among the study age group.
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Affiliation(s)
- Priyatam Khadka
- Medical Microbiology, Tri-Chandra Multiple Campus, Kathmandu, Nepal.
| | - Januka Thapaliya
- Medical Microbiology, Tri-Chandra Multiple Campus, Kathmandu, Nepal
| | - Shovana Thapa
- International Friendship Children's Hospital, Kathmandu, Nepal
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21
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Medise BE, Soedjatmiko S, Gunardi H, Sekartini R, Satari HI, Hadinegoro SR, Wirahmadi A, Puspita M, Sari RM, Yang JS, Sil A, Sahastrabuddhe S, Bachtiar NS. A novel Vi-diphtheria toxoid typhoid conjugate vaccine is safe and can induce immunogenicity in healthy Indonesian children 2-11 years: a phase II preliminary report. BMC Pediatr 2020; 20:480. [PMID: 33059607 PMCID: PMC7560054 DOI: 10.1186/s12887-020-02375-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/07/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Typhoid fever caused by Salmonella enteric serovar Typhi (S. Typhi) is a common cause of morbidity in the world. In 2017, 14.3 million cases of Typhoid and paratyphoid fever occurred globally. School age children between 3 to 19 years old are the most affected. Poor sanitation and multi drug resistance have increased the need for vaccines to reduce the global burden of disease. Based on previous trials, typhoid conjugate vaccines have longer- lasting protection, higher efficacy, require fewer doses and are suitable from infancy that allows them to be incorporated into the routine immunization program. Our previous phase I trial proved that a novel Vi-DT typhoid conjugate vaccine is safe and immunogenic in subjects 2-5 and 18-40 years. Our phase II trial consisted of subjects 6 months to 40 years. Our previously published paper on subjects 6 to < 24 months proved that this vaccine is safe and immunogenic for this age group. Therefore, with this paper we aimed to evaluate the safety and immunogenicity in children 2-11 years. METHODS A randomized, observer-blind, superiority design of Vi-DT Typhoid conjugate vaccine compared to Vi-polysaccharide vaccine (Vi-PS) phase II study was conducted from October 2018 to December 2018 where 200 subjects aged 2-11 years were recruited. A blood sample prior to vaccination was taken, followed by administration of a single dose of either test vaccine (Vi-DT) or control vaccine (Vi-PS) and then a second blood sample was collected 28 days post vaccination. Adverse reactions were assessed and antibody increment was evaluated at 28 days post vaccination through collected serum sample. RESULTS Pain was the most common local reaction. Fever and muscle pain were the most common systemic reactions. Both Vi-DT and Vi-PS groups had roughly the same number of adverse reactions. At 28 days post vaccination, 100% of subjects in the Vi-DT group and 93% of subjects in the Vi-PS group produced antibody increment ≥4 times. The Vi-DT group produced a higher GMT as compared to Vi-PS. CONCLUSION Vi-DT vaccine is safe and immunogenic in children 2-11 years old. TRIAL REGISTRATION Trial registration number: NCT03460405 .
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Affiliation(s)
- Bernie Endyarni Medise
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jalan Diponegoro no, Jakarta, 71, Indonesia.
| | - Soedjatmiko Soedjatmiko
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jalan Diponegoro no, Jakarta, 71, Indonesia
| | - Hartono Gunardi
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jalan Diponegoro no, Jakarta, 71, Indonesia
| | - Rini Sekartini
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jalan Diponegoro no, Jakarta, 71, Indonesia
| | - Hindra Irawan Satari
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jalan Diponegoro no, Jakarta, 71, Indonesia
| | - Sri Rezeki Hadinegoro
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jalan Diponegoro no, Jakarta, 71, Indonesia
| | - Angga Wirahmadi
- Department of Child Health, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General National Hospital, Jalan Diponegoro no, Jakarta, 71, Indonesia
| | | | | | - Jae Seung Yang
- International Vaccine Institute, Seoul, Republic of Korea
| | - Arijit Sil
- International Vaccine Institute, Seoul, Republic of Korea
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22
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Cruz Espinoza LM, McCreedy E, Holm M, Im J, Mogeni OD, Parajulee P, Panzner U, Park SE, Toy T, Haselbeck A, Seo HJ, Jeon HJ, Kim JH, Kwon SY, Kim JH, Parry CM, Marks F. Occurrence of Typhoid Fever Complications and Their Relation to Duration of Illness Preceding Hospitalization: A Systematic Literature Review and Meta-analysis. Clin Infect Dis 2020; 69:S435-S448. [PMID: 31665781 PMCID: PMC6821330 DOI: 10.1093/cid/ciz477] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Complications from typhoid fever disease have been estimated to occur in 10%-15% of hospitalized patients, with evidence of a higher risk in children and when delaying the implementation of effective antimicrobial treatment. We estimated the prevalence of complications in hospitalized patients with culture-confirmed typhoid fever and the effects of delaying the implementation of effective antimicrobial treatment and age on the prevalence and risk of complications. METHODS A systematic review and meta-analysis were performed using studies in the PubMed database. We rated risk of bias and conducted random-effects meta-analyses. Days of disease at hospitalization (DDA) was used as a surrogate for delaying the implementation of effective antimicrobial treatment. Analyses were stratified by DDA (DDA <10 versus ≥10 mean/median days of disease) and by age (children versus adults). Differences in risk were assessed using odds ratios (ORs) and 95% confidence intervals (CIs). Heterogeneity and publication bias were evaluated with the I2 value and funnel plot analysis, respectively. RESULTS The pooled prevalence of complications estimated among hospitalized typhoid fever patients was 27% (95% CI, 21%-32%; I2 = 90.9%, P < .0001). Patients with a DDA ≥ 10 days presented higher prevalence (36% [95% CI, 29%-43%]) and three times greater risk of severe disease (OR, 3.00 [95% CI, 2.14-4.17]; P < .0001) than patients arriving earlier (16% [95% CI, 13%- 18%]). Difference in prevalence and risk by age groups were not significant. CONCLUSIONS This meta-analysis identified a higher overall prevalence of complications than previously reported and a strong association between duration of symptoms prior to hospitalization and risk of serious complications.
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Affiliation(s)
| | - Ellen McCreedy
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, Rhode Island
| | - Marianne Holm
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Justin Im
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Ondari D Mogeni
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Prerana Parajulee
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Ursula Panzner
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Se Eun Park
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Trevor Toy
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Andrea Haselbeck
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Hye Jin Seo
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea.,Department of Medicine, University of Cambridge, United Kingdom, United Kingdom
| | - Jong-Hoon Kim
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Soo Young Kwon
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | - Jerome H Kim
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea
| | | | - Florian Marks
- International Vaccine Institute, Seoul National University Research Park, Republic of Korea.,Department of Medicine, University of Cambridge, United Kingdom, United Kingdom
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23
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Britto CD, Mathias S, Bosco A, Dyson ZA, Dougan G, Raveendran S, Abin VL, Jose S, Nagaraj S, Holt KE, Pollard AJ. Pathogen genomic surveillance of typhoidal Salmonella infection in adults and children reveals no association between clinical outcomes and infecting genotypes. Trop Med Health 2020; 48:58. [PMID: 32684794 PMCID: PMC7359007 DOI: 10.1186/s41182-020-00247-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND India is endemic for enteric fever, and it is not known whether the variations in clinical manifestations between patients are due to host, environmental or pathogen factors.Blood culture surveillance was conducted at St. John's Medical College Hospital, Bangalore, between July 2016 and June 2017. Clinical, laboratory and demographic data were collected from each case, and bacterial isolates were subjected to whole genome sequencing. Comparative analysis between adults and paediatric patients was carried out to ascertain differences between adult and paediatric disease. RESULTS Among the 113 cases of blood culture-confirmed enteric fever, young adults (16-30 years) and children < 15 years accounted for 47% and 37% of cases, respectively. Anaemia on presentation was seen in 46% of cases, and 19% had an abnormal leucocyte count on presentation. The majority received treatment as inpatients (70%), and among these, adults had a significantly longer duration of admission when compared with children (p = 0.002). There were atypical presentations including arthritis, acute haemolysis and a case of repeated typhoid infection with two separate S. Typhi genotypes. There was no association between infecting genotype/serovar and treatment status (outpatient vs inpatient), month of isolation, duration of admission, patient age (adult or child), antimicrobial susceptibility, Widal positivity or haematologic parameters. CONCLUSIONS Amidst the many public health concerns of South India, enteric fever continues to contribute substantially to hospital burden with non-specific as well as uncommon clinical features in both paediatric and adult populations likely driven by host and environmental factors. Robust clinical surveillance as well monitoring of pathogen population structure is required to inform treatment and preventive strategies.
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Affiliation(s)
- Carl D. Britto
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE UK
- St. John’s Medical College Hospital and Division of Infectious Disease, St. John’s Research Institute, Bangalore, India
- Division of Infectious Disease, St. John’s Research Institute, Bengaluru, 560034 India
| | - Sitarah Mathias
- St. John’s Medical College Hospital and Division of Infectious Disease, St. John’s Research Institute, Bangalore, India
| | - Ashish Bosco
- St. John’s Medical College Hospital and Division of Infectious Disease, St. John’s Research Institute, Bangalore, India
| | - Zoe A. Dyson
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria 3004 Australia
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT UK
| | - Gordon Dougan
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Savitha Raveendran
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria 3004 Australia
| | - V. L. Abin
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria 3004 Australia
| | - Sanju Jose
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria 3004 Australia
| | - Savitha Nagaraj
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria 3004 Australia
| | - Kathryn E. Holt
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria 3004 Australia
- London School of Hygiene & Tropical Medicine, London, WC1E 7HT UK
| | - Andrew J. Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, OX3 7LE UK
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24
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Minodier P, Imbert P. Conduite à tenir devant un enfant fébrile au retour de voyage ☆. JOURNAL DE PEDIATRIE ET DE PUERICULTURE 2020; 33:118-145. [PMID: 32341631 PMCID: PMC7184019 DOI: 10.1016/j.jpp.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Les pathologies le plus fréquentes au retour de voyage à l’étranger sont les infections gastro-intestinales, les maladies fébriles et les problèmes dermatologiques. L’évaluation d’un enfant fébrile de retour de voyage est clinique : vérification des antécédents et des vaccinations, recherche d’autres cas au contact, signes fonctionnels et physiques, caractéristiques du voyage. Un bilan paraclinique de débrouillage complète souvent l’évaluation pour une orientation syndromique. Si les causes de fièvre sont surtout cosmopolites, la gravité des pathologies exotiques doit les faire rechercher en priorité. Le paludisme doit être évoqué devant toute fièvre en provenance d’Afrique subsaharienne. Le diagnostic repose sur l’association d’un frottis sanguin et d’un test sensible (goutte épaisse, polymerase chain reaction [PCR]) ou d’un test de diagnostic rapide (pour Plasmodium [P ]. falciparum ). Les critères clinicobiologiques de gravité sont essentiels pour orienter et traiter le patient. En cas d’accès non compliqué à P. falciparum , le traitement repose sur une thérapie combinée à base d’artémisinine (ACT), artéméther-luméfantrine ou arténimol-pipéraquine. Les accès graves sont traités par l’artésunate intraveineux, puis un ACT oral. Dengue, chikungunya et infection à virus Zika ont des caractéristiques cliniques communes (association fièvre-éruption-arthralgies, traitement symptomatique). En cas de dengue, il faut surveiller l’apparition de signes d’alerte qui pourraient faire craindre une évolution péjorative. Le chikungunya est grave en cas de transmission per partum, avec un risque d’encéphalite néonatale. Chez l’enfant, le Zika est a- ou peu symptomatique. Mais en cas d’infection pendant une grossesse, le risque est celui d’une embryofœtopathie. Le diagnostic de ces arboviroses repose sur la PCR à la phase aiguë et la sérologie secondairement. La symptomatologie de la typhoïde est peu spécifique, justifiant la pratique d’hémocultures systématiques devant une fièvre du retour. Son traitement repose sur les céphalosporines de troisième génération ou la ciprofloxacine, mais les résistances augmentent. Au total, la diversité des étiologies d’une fièvre de retour et la gravité potentielle des infections importées imposent une réflexion sur le parcours de soins de ces patients, en particulier vis-à-vis du risque de fièvre hémorragique.
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Affiliation(s)
- P. Minodier
- Accueil des urgences pédiatriques, Hôpital Nord, Chemin des Bourrelly, 13920 Marseille cedex 15, France
| | - P. Imbert
- Centre de vaccinations internationales, Hôpital d’instruction des Armées-Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
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25
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Theiss-Nyland K, Shakya M, Colin-Jones R, Voysey M, Smith N, Karkey A, Dongol S, Pant D, Farooq YG, Neuzil KM, Shrestha S, Basnyat B, Pollard AJ. Assessing the Impact of a Vi-polysaccharide Conjugate Vaccine in Preventing Typhoid Infections Among Nepalese Children: A Protocol for a Phase III, Randomized Control Trial. Clin Infect Dis 2020; 68:S67-S73. [PMID: 30845329 PMCID: PMC6405280 DOI: 10.1093/cid/ciy1106] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Enteric fever is estimated to affect 11–20 million people worldwide each year. Morbidity and mortality from enteric fever primarily occur in lower-income countries, with children under 5 years of age experiencing a significant portion of the burden. Over the last few decades, the control of enteric fever has focused primarily on improved water and sanitation, with the available vaccines unsuitable for children and primarily used by travelers. A new typhoid conjugate vaccine (Vi-TCV), prequalified by the World Health Organization (WHO) and highly immunogenic in children under 5, has the potential to reduce the typhoid burden in endemic countries. Methods This study is a double-blinded, randomized, controlled trial with a 2-year follow-up to assess the protective impact of the Vi-TCV vaccine, compared with a control vaccine, in children from 9 months to 16 years of age. The primary outcome of interest is the reduction in the number of culture-confirmed typhoid cases attributable to Vi-TCV. Approximately 20 000 children living in the Lalitpur district, within the Kathmandu valley, will be enrolled in the study and followed to measure both safety and efficacy data, which will include adverse events, hospitalizations, antibiotic use, and fever frequency. Results Both the intervention and control vaccines are WHO prequalified vaccines, which provide a health benefit to all participants. Children have been chosen to participate because they bear a substantial burden of both typhoid morbidity and mortality in this population. The results of this study will be disseminated through a series of published articles. The findings will also be made available to the participants and the broader community, as well as local stakeholders, within Nepal. Conclusions This is the first large-scale, individually randomized, controlled trial of Vi-TCV in children in an endemic setting, and will provide new data on Vi-TCV field efficacy. With Vi-TCV introduction being considered in high-burden countries, this study will support important policy decisions. Clinical Trials Registration The trial is registered on the ISRCTN registry (for details, see https://doi.org/10.1186/ISRCTN43385161; registry number: ISRCTN 43385161).
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Affiliation(s)
| | - Mila Shakya
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - Rachel Colin-Jones
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - Merryn Voysey
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - Nicola Smith
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - Abhilasha Karkey
- Oxford University Clinical Research Unit-Nepal, Patan Hospital, Kathmandu
| | - Sabina Dongol
- Oxford University Clinical Research Unit-Nepal, Patan Hospital, Kathmandu
| | - Dikshya Pant
- Oxford University Clinical Research Unit-Nepal, Patan Hospital, Kathmandu
| | - Yama G Farooq
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health at the University of Maryland, Baltimore, MD
| | | | - Buddha Basnyat
- Oxford University Clinical Research Unit-Nepal, Patan Hospital, Kathmandu
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
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26
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Theiss-Nyland K, Qadri F, Colin-Jones R, Zaman K, Khanam F, Liu X, Voysey M, Khan A, Hasan N, Ashher F, Farooq YG, Pollard AJ, Clemens JD. Assessing the Impact of a Vi-polysaccharide Conjugate Vaccine in Preventing Typhoid Infection Among Bangladeshi Children: A Protocol for a Phase IIIb Trial. Clin Infect Dis 2020; 68:S74-S82. [PMID: 30845333 PMCID: PMC6405281 DOI: 10.1093/cid/ciy1107] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Typhoid fever illnesses are responsible for more than 100 000 deaths worldwide each year. In Bangladesh, typhoid fever is endemic, with incidence rates between 292–395 per 100 000 people annually. While considerable effort has been made to improve access to clean water and sanitation services in the country, there is still a significant annual typhoid burden, which particularly affects children. A typhoid conjugate vaccine (Vi-TCV) was recently prequalified by the World Health Organization and recommended for use, and offers the potential to greatly reduce the typhoid burden in Bangladesh. Methods This study is a double-blind, cluster-randomized, controlled trial of Vi-TCV in a geographically defined area in Dhaka, Bangladesh. At least 32 500 children from 9 months to <16 years of age will be vaccinated and followed for 2 years to assess the effectiveness and safety of Vi-TCV in a real-world setting. All cluster residents will also be followed to measure the indirect effect of Vi-TCV in this community. Ethics and Dissemination This protocol has been approved by the International Centre for Diarrhoeal Disease Research, Bangladesh; a University of Oxford research review; and both ethical review committees. Informed written consent and assent will be obtained before enrollment. Vi-TCV has been shown to be safe and effective in previous, smaller-scale studies. The results of this study will be shared through a series of peer-reviewed journal articles. The findings will also be disseminated to the local government, stakeholders within the community, and the population within which the study was conducted. Conclusions This trial is the largest and only cluster-randomized control trial of Vi-TCV ever conducted, and will describe the effectiveness of Vi-TCV in an endemic population. The results of this trial may provide important evidence to support the introduction of TCVs in countries with a high burden of typhoid. Clinical Trials Registration ISRCTN11643110.
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Affiliation(s)
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka
| | - Rachel Colin-Jones
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - K Zaman
- International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka
| | - Farhana Khanam
- International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka
| | - Xinxue Liu
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - Merryn Voysey
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - Arifuzzaman Khan
- International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka
| | - Nazmul Hasan
- International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka
| | - Fahim Ashher
- International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka
| | - Yama G Farooq
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, United Kingdom
| | - John D Clemens
- International Centre for Diarrhoeal Disease Research-Bangladesh, Dhaka
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O'Reilly PJ, Pant D, Shakya M, Basnyat B, Pollard AJ. Progress in the overall understanding of typhoid fever: implications for vaccine development. Expert Rev Vaccines 2020; 19:367-382. [PMID: 32238006 DOI: 10.1080/14760584.2020.1750375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Typhoid fever continues to have a substantial impact on human health, especially in Asia and sub-Saharan Africa. Access to safe water, and adequate sanitation and hygiene remain the cornerstone of prevention, but these are not widely available in many impoverished settings. The emergence of antibiotic resistance affects typhoid treatment and adds urgency to typhoid control efforts. Vaccines provide opportunities to prevent and control typhoid fever in endemic settings. AREAS COVERED Literature search was performed looking for evidence concerning the global burden of typhoid and strategies for the prevention and treatment of typhoid fever. Cost of illness, available typhoid and paratyphoid vaccines and cost-effectiveness were also reviewed. The objective was to provide a critical overview of typhoid fever, in order to assess the current understanding and potential future directions for typhoid treatment and control. EXPERT COMMENTARY Our understanding of typhoid burden and methods of prevention has grown over recent years. However, typhoid fever still has a significant impact on health in low and middle-income countries. Introduction of typhoid conjugate vaccines to the immunization schedule is expected to make a major contribution to control of typhoid fever in endemic countries, although vaccination alone is unlikely to eliminate the disease.
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Affiliation(s)
- Peter J O'Reilly
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre , Oxford, UK
| | - Dikshya Pant
- Department of Paediatrics, Patan Academy of Health Sciences, Patan Hospital , Kathmandu, Nepal
| | - Mila Shakya
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences , Kathmandu, Nepal
| | - Buddha Basnyat
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences , Kathmandu, Nepal
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre , Oxford, UK
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28
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Medise BE, Soedjatmiko S, Gunardi H, Sekartini R, Satari HI, Hadinegoro SR, Wirahmadi A, Puspita M, Sari RM, Yang JS, Sil A, Sahastrabuddhe S, Bachtiar NS. One-month follow up of a randomized clinical trial-phase II study in 6 to <24 months old Indonesian subjects: Safety and immunogenicity of Vi-DT Typhoid Conjugate Vaccine. Int J Infect Dis 2020; 93:102-107. [DOI: 10.1016/j.ijid.2020.01.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/23/2020] [Accepted: 01/23/2020] [Indexed: 01/21/2023] Open
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Birabaharan M, Kainth MK, Kessel AD, Hagmann SHF. Case Report: Typhoid Fever Complicated by Acute Respiratory Distress Syndrome in a Pediatric Traveler. Am J Trop Med Hyg 2020; 101:319-322. [PMID: 31264556 DOI: 10.4269/ajtmh.19-0286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) is seldom described as a complication of typhoid fever (TF). Only 13 cases have hitherto been reported in the English and non-English literature since 1990. We report an 8-year-old boy with TF after return from India who developed pediatric ARDS (pARDS) despite adequate antibiotic treatment. Among patients with available information including this case, we noted that most not born or raised in a TF-endemic country (4/6) compared with none (0/6) of the domestic cases in a TF-endemic country developed ARDS within 48 hours of starting the antibiotic treatment. Our case raises important questions regarding the frequency, pathophysiology, and appropriate management of ARDS and pARDS in patients with TF.
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Affiliation(s)
- Morgan Birabaharan
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Mundeep K Kainth
- Feinstein Institute for Medical Research, Manhasset, New York.,Division of Pediatric Infectious Diseases, Steven and Alexandra Cohen Children's Medical Center of New York/Northwell Health, New Hyde Park, New York.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Aaron D Kessel
- Division of Pediatric Critical Care Medicine, Steven and Alexandra Cohen Children's Medical Center of New York/Northwell Health, New Hyde Park, New York.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Stefan H F Hagmann
- Division of Pediatric Infectious Diseases, Steven and Alexandra Cohen Children's Medical Center of New York/Northwell Health, New Hyde Park, New York.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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30
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Bhutta ZA. Integrating Typhoid Fever Within the Sustainable Development Goals: Pragmatism or Utopia? Clin Infect Dis 2020; 68:S34-S41. [PMID: 30767006 PMCID: PMC6376087 DOI: 10.1093/cid/ciy957] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Several decades following the first estimates of the global burden of typhoidal salmonellosis (infections caused by Salmonella Typhi and Salmonella Paratyphi), this disorder remains a major cause of morbidity worldwide with an estimated 17 million cases annually. The risk factors for typhoid include poverty, poor living conditions with unsafe water and lack of adequate sanitation, and unsafe foods-all reasons for the disease burden being highest among such populations including urban slums. A recent review of typhoid trends globally and in specific countries suggests that the relative contributions of these risk factors to disease burden reduction as well as persistence have varied. There is also the risk of periodic outbreaks related to introduction of relatively virulent drug-resistant strains or movements of vulnerable populations, including those in conflict zones. Most countries of the world are now aligning their health and multisectoral strategies to address the Sustainable Development Goals (SDGs) and targets, which were agreed upon by all countries of the world in September 2015. Though neglected so far, there are huge opportunities for mainstreaming typhoid prevention and control strategies within the SDGs. This article reviews some of the approaches that may help elevate typhoid to a higher level of awareness in public health programs and policy and to ensure that investments in major public health preventive measures are made part of the universal health coverage agenda.
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Affiliation(s)
- Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
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31
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Jones C, An SJ, Yoon YK, Kothari S, Sahastrabuddhe S, Carbis R. Spectroscopic characterisation of a series of Salmonella Typhi Vi-diphtheria toxoid glycoconjugate antigens differing in polysaccharide-protein ratio. J Pharm Biomed Anal 2020; 181:113100. [PMID: 31991319 DOI: 10.1016/j.jpba.2020.113100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/28/2019] [Accepted: 01/06/2020] [Indexed: 11/28/2022]
Abstract
Glycoconjugate vaccines consisting of the Salmonella enterica subsp. enterica serovar Typhi (S. Typhi) Vi capsular polysaccharide (PS) covalently attached to a suitable carrier protein have become available to support mass paediatric vaccination campaigns against typhoid. One developmental vaccine from the International Vaccine Institute (IVI) uses diphtheria toxoid (DTx) as the carrier protein. Several investigational conjugates with different PS:protein ratios were prepared, as previously reported by the IVI group, for physicochemical and immunochemical characterisation. We describe here the further spectroscopic characterisation of this series of glycoconjugate immunogen bulks using NMR spectroscopy, circular dichroism and absorption spectroscopy. We have used several mathematical approaches to extract information from the spectroscopic data not previously applied to glycoconjugates. These complementary approaches provide information on (i) the integrity of the carrier protein, (ii) consistency between batches of vaccine components, (iii) the polysaccharide: protein ratio (iv) the O-acetylation of the Vi in the conjugate (v) the stability of the O-acetylation of the Vi, and (vi) the presence of residual process reagents in the bulk. The utility of the data analysis approaches is discussed. Together, these analytical methods provide important characterisation of Vi-DTx conjugates to support development and quality control of commercial products.
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Affiliation(s)
- Christopher Jones
- Laboratory for Molecular Structure, National Institute for Biological Standards and Control, Blanche Lane, South Mimms, Herts EN6 3QG, UK.
| | - So Jung An
- International Vaccine Institute, SNU Research Park, San 4-8, Nakseongdae-dong, Gwanak-gu 151-919, Seoul, Republic of Korea.
| | - Yeon Kyung Yoon
- International Vaccine Institute, SNU Research Park, San 4-8, Nakseongdae-dong, Gwanak-gu 151-919, Seoul, Republic of Korea.
| | - Sudeep Kothari
- International Vaccine Institute, SNU Research Park, San 4-8, Nakseongdae-dong, Gwanak-gu 151-919, Seoul, Republic of Korea.
| | - Sushant Sahastrabuddhe
- International Vaccine Institute, SNU Research Park, San 4-8, Nakseongdae-dong, Gwanak-gu 151-919, Seoul, Republic of Korea.
| | - Rodney Carbis
- International Vaccine Institute, SNU Research Park, San 4-8, Nakseongdae-dong, Gwanak-gu 151-919, Seoul, Republic of Korea.
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Ingle DJ, Nair S, Hartman H, Ashton PM, Dyson ZA, Day M, Freedman J, Chattaway MA, Holt KE, Dallman TJ. Informal genomic surveillance of regional distribution of Salmonella Typhi genotypes and antimicrobial resistance via returning travellers. PLoS Negl Trop Dis 2019; 13:e0007620. [PMID: 31513580 PMCID: PMC6741848 DOI: 10.1371/journal.pntd.0007620] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 07/09/2019] [Indexed: 11/30/2022] Open
Abstract
Salmonella enterica serovar Typhi (S. Typhi) is the causative agent of typhoid fever, a systemic human infection with a burden exceeding 20 million cases each year that occurs disproportionately among children in low and middle income countries. Antimicrobial therapy is the mainstay for treatment, but resistance to multiple agents is common. Here we report genotypes and antimicrobial resistance (AMR) determinants detected from routine whole-genome sequencing (WGS) of 533 S. Typhi isolates referred to Public Health England between April 2014 and March 2017, 488 (92%) of which had accompanying patient travel information obtained via an enhanced surveillance questionnaire. The majority of cases involved S. Typhi 4.3.1 (H58) linked with travel to South Asia (59%). Travel to East and West Africa were associated with genotypes 4.3.1 and 3.3.1, respectively. Point mutations in the quinolone resistance determining region (QRDR), associated with reduced susceptibility to fluoroquinolones, were very common (85% of all cases) but the frequency varied significantly by region of travel: 95% in South Asia, 43% in East Africa, 27% in West Africa. QRDR triple mutants, resistant to ciprofloxacin, were restricted to 4.3.1 lineage II and associated with travel to India, accounting for 23% of cases reporting travel to the country. Overall 24% of isolates were MDR, however the frequency varied significantly by region and country of travel: 27% in West Africa, 52% in East Africa, 55% in Pakistan, 24% in Bangladesh, 3% in India. MDR determinants were plasmid-borne (IncHI1 PST2 plasmids) in S. Typhi 3.1.1 linked to West Africa, but in all other regions MDR was chromosomally integrated in 4.3.1 lineage I. We propose that routine WGS data from travel-associated cases in industrialised countries could serve as informal sentinel AMR genomic surveillance data for countries where WGS is not available or routinely performed. Our data demonstrate how routine WGS data produced by Public Health England can be further mined for informal passive surveillance of Salmonella Typhi circulating in different geographical regions where typhoid is endemic. We have shown the public health utility of a simplified approach to WGS reporting based on the GenoTyphi genotyping framework and nomenclature, which doesn’t require the generation of a phylogenetic tree or other phylogenetic analysis. These approaches yielded results consistent with previously reported antimicrobial resistance (AMR) patterns of S. Typhi, including prevalence of multi-drug resistant (MDR) and fluoroquinolone resistance in different regions in association with different pathogen variants. These data provide a rationale and framework for the extraction and reporting of geographically stratified genotype and AMR data from public health labs in non-endemic countries. Prospective analysis and reporting of such data could potentially detect shifts in regional S. Typhi populations, such as replacement or spread of different subclades and the emergence and dissemination of MDR, fluoroquinolone resistant and/or extensively drug resistant S. Typhi, providing valuable data to inform typhoid control measures in low and middle income countries that are still building their genomics capacity.
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Affiliation(s)
- Danielle J. Ingle
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- * E-mail:
| | - Satheesh Nair
- Gastrointestinal Bacteria Reference Unit, Bacteriology Reference Department, National Infection Service, Public Health England, London, United Kingdom
| | - Hassan Hartman
- Gastrointestinal Bacteria Reference Unit, Bacteriology Reference Department, National Infection Service, Public Health England, London, United Kingdom
| | - Philip M. Ashton
- Gastrointestinal Bacteria Reference Unit, Bacteriology Reference Department, National Infection Service, Public Health England, London, United Kingdom
| | - Zoe A. Dyson
- Department of Medicine, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Parkville, Victoria, Australia
| | - Martin Day
- Gastrointestinal Bacteria Reference Unit, Bacteriology Reference Department, National Infection Service, Public Health England, London, United Kingdom
| | - Joanne Freedman
- Travel Migrant and Health Department, Public Health England, 61 Colindale Avenue, London, United Kingdom
| | - Marie A. Chattaway
- Gastrointestinal Bacteria Reference Unit, Bacteriology Reference Department, National Infection Service, Public Health England, London, United Kingdom
| | - Kathryn E. Holt
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Parkville, Victoria, Australia
- London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Timothy J. Dallman
- Gastrointestinal Bacteria Reference Unit, Bacteriology Reference Department, National Infection Service, Public Health England, London, United Kingdom
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Minodier P, Imbert P. Conducta práctica ante un niño febril al regresar de un viaje. EMC. PEDIATRIA 2019; 54:1-22. [PMID: 32308527 PMCID: PMC7159023 DOI: 10.1016/s1245-1789(19)42593-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Las enfermedades más frecuentes al regresar de un viaje al extranjero son las infecciones gastrointestinales, las enfermedades febriles y los problemas dermatológicos. La evaluación de un niño febril al regreso de un viaje es clínica: verificación de los antecedentes y las vacunaciones, búsqueda de otros casos en contacto, signos funcionales y físicos, y características del viaje. Unas pruebas complementarias de rutina completan a menudo la evaluación para una orientación sindrómica. Si bien las causas de fiebre son, sobre todo, cosmopolitas, la gravedad de la enfermedad exótica obliga a buscarlas prioritariamente. El paludismo debe sospecharse ante una fiebre procedente de África subsahariana. El diagnóstico se basa en la asociación de un frotis sanguíneo y una prueba sensible (gota gruesa, reacción en cadena de la polimerasa [PCR]) o una prueba de diagnóstico rápido (para Plasmodium falciparum ). Los criterios clínico-biológicos de gravedad son esenciales para orientar y tratar al paciente. En caso de acceso no complicado por P. falciparum, el tratamiento se basa en un tratamiento combinado a base de artemisinina (ACT), arteméter-lumefantrina o artenimol-piperaquina. Los accesos graves se tratan con artesunato intravenoso, seguido de ACT oral. Dengue, chikungunya e infección por virus Zika tienen características clínicas comunes (fiebre-erupción-artralgias, tratamiento sintomático). En caso de dengue, conviene controlar la aparición de signos de alerta, que podrían hacer temer una evolución negativa. El chikungunya es grave en caso de transmisión en el parto, con un riesgo de encefalitis neonatal. En el niño, el Zika es asintomático o poco sintomático. Pero, en caso de infección durante el embarazo, el riesgo es el de una embriofetopatía. El diagnóstico de estas arbovirosis se basa en la PCR en la fase aguda y en la serología secundariamente. La sintomatología de la fiebre tifoidea es poco específica, lo cual justifica la práctica de hemocultivos sistemáticos ante una fiebre tras un viaje. Su tratamiento se basa en las cefalosporinas de tercera generación o el ciprofloxacino, pero las resistencias aumentan. En suma, la diversidad de las etiologías de una fiebre al regreso de un viaje y la potencial gravedad de las infecciones importadas imponen una reflexión sobre el proceso de tratamiento de estos pacientes, en especial en lo referente al riesgo de fiebre hemorrágica.
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Affiliation(s)
- P Minodier
- Accueil des urgences pédiatriques, Hôpital Nord, Chemin des Bourrelly, 13920 Marseille cedex 15, France
| | - P Imbert
- Centre de vaccinations internationales, Hôpital d'instruction des Armées-Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
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Abstract
Purpose of review Enteric fever remains a major global-health concern, estimated to be responsible for between 11.9 and 26.9 million cases annually. Long-term prevention of enteric fever will require improved access to safe drinking water combined with investment in sanitation and hygiene interventions. In the short-to-medium term, new control strategies for typhoid fever have arrived in the form of typhoid Vi-conjugate vaccines (TCVs), offering hope that disease control can be achieved in the near future. Recent findings The diagnosis of enteric fever is complicated by its nonspecific clinical presentation, coupled with the low sensitivity of commonly used diagnostics. Investment in diagnostics has the potential to improve management, to refine estimates of disease burden and to facilitate vaccine impact studies. A new generation of reliable, diagnostic tests is needed that are simultaneously accessible, cost-effective, sensitive, and specific. The emergence and global dissemination of multidrug-resistant, fluoroquinolone-resistant, and extensively drug-resistant (XDR) strains of Salmonella Typhi emphasizes the importance of continued surveillance and appropriate antibiotic stewardship, integrated into a global strategy to address antimicrobial resistance (AMR). Current empirical treatment guidelines are out of date and should be updated to respond to local trends in AMR, so as to guide treatment choices in the absence of robust diagnostics and laboratory facilities. In September 2017, the WHO Strategic Advisory Group of Experts (SAGE) immunization recommended the programmatic use of TCVs in high burden countries. Ongoing and future studies should aim to study the impact of these vaccines in a diverse range of setting and to support the deployment of TCVs in high-burden countries. Summary The advent of new generation TCVs offers us a practical and affordable public-health tool that – for the first time – can be integrated into routine childhood immunization programmes. In this review, we advocate for the deployment of TCVs in line with WHO recommendations, to improve child health and limit the spread of antibiotic-resistant S. Typhi.
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Bilcke J, Antillón M, Pieters Z, Kuylen E, Abboud L, Neuzil KM, Pollard AJ, Paltiel AD, Pitzer VE. Cost-effectiveness of routine and campaign use of typhoid Vi-conjugate vaccine in Gavi-eligible countries: a modelling study. THE LANCET. INFECTIOUS DISEASES 2019; 19:728-739. [PMID: 31130329 PMCID: PMC6595249 DOI: 10.1016/s1473-3099(18)30804-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/10/2018] [Accepted: 12/14/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Typhoid fever is a major cause of morbidity and mortality in low-income and middle-income countries. In 2017, WHO recommended the programmatic use of typhoid Vi-conjugate vaccine (TCV) in endemic settings, and Gavi, The Vaccine Alliance, has pledged support for vaccine introduction in these countries. Country-level health economic evaluations are now needed to inform decision-making. METHODS In this modelling study, we compared four strategies: no vaccination, routine immunisation at 9 months, and routine immunisation at 9 months with catch-up campaigns to either age 5 years or 15 years. For each of the 54 countries eligible for Gavi support, output from an age-structured transmission-dynamic model was combined with country-specific treatment and vaccine-related costs, treatment outcomes, and disability weights to estimate the reduction in typhoid burden, identify the strategy that maximised average net benefit (ie, the optimal strategy) across a range of country-specific willingness-to-pay (WTP) values, estimate and investigate the uncertainties surrounding our findings, and identify the epidemiological conditions under which vaccination is optimal. FINDINGS The optimal strategy was either no vaccination or TCV immunisation including a catch-up campaign. Routine vaccination with a catch-up campaign to 15 years of age was optimal in 38 countries, assuming a WTP value of at least US$200 per disability-adjusted life-year (DALY) averted, or assuming a WTP value of at least 25% of each country's gross domestic product (GDP) per capita per DALY averted, at a vaccine price of $1·50 per dose (but excluding Gavi's contribution according to each country's transition phase). This vaccination strategy was also optimal in 48 countries assuming a WTP of at least $500 per DALY averted, in 51 with assumed WTP values of at least $1000, in 47 countries assuming a WTP value of at least 50% of GDP per capita per DALY averted, and in 49 assuming a minimum of 100%. Vaccination was likely to be cost-effective in countries with 300 or more typhoid cases per 100 000 person-years. Uncertainty about the probability of hospital admission (and typhoid incidence and mortality) had the greatest influence on the optimal strategy. INTERPRETATION Countries should establish their own WTP threshold and consider routine TCV introduction, including a catch-up campaign when vaccination is optimal on the basis of this threshold. Obtaining improved estimates of the probability of hospital admission would be valuable whenever the optimal strategy is uncertain. FUNDING Bill & Melinda Gates Foundation, Research Foundation-Flanders, and the Belgian-American Education Foundation.
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Affiliation(s)
- Joke Bilcke
- Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.
| | - Marina Antillón
- Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Zoë Pieters
- Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Center for Statistics, I-Biostat, Hasselt University, Diepenbeek, Belgium
| | - Elise Kuylen
- Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Linda Abboud
- Centre for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the National Institute for Health Research Oxford Biomedical Research Centre, Oxford, UK
| | - A David Paltiel
- Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA.
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Abstract
Salmonella enterica subspecies enterica serovar Typhi (Salmonella Typhi) is the cause of typhoid fever and a human host-restricted organism. Our understanding of the global burden of typhoid fever has improved in recent decades, with both an increase in the number and geographic representation of high-quality typhoid fever incidence studies, and greater sophistication of modeling approaches. The 2017 World Health Organization Strategic Advisory Group of Experts on Immunization recommendation for the introduction of typhoid conjugate vaccines for infants and children aged >6 months in typhoid-endemic countries is likely to require further improvements in our understanding of typhoid burden at the global and national levels. Furthermore, the recognition of the critical and synergistic role of water and sanitation improvements in concert with vaccine introduction emphasize the importance of improving our understanding of the sources, patterns, and modes of transmission of Salmonella Typhi in diverse settings.
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Affiliation(s)
- John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
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Affiliation(s)
- Felicia A Scaggs Huang
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Elizabeth Schlaudecker
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Balasubramanian S, Shah A, Pemde HK, Chatterjee P, Shivananda S, Guduru VK, Soans S, Shastri D, Kumar R. Indian Academy of Pediatrics (IAP) Advisory Committee on Vaccines and Immunization Practices (ACVIP) Recommended Immunization Schedule (2018-19) and Update on Immunization for Children Aged 0 Through 18 Years. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1444-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bhutta ZA, Zaidi AKM, Pangestu T. Reducing Typhoid Burden within a Generation. Am J Trop Med Hyg 2018; 99:1-3. [PMID: 30047372 PMCID: PMC6128364 DOI: 10.4269/ajtmh.18-0500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 06/12/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Zulfiqar A. Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Anita K. M. Zaidi
- Vaccine Development and Surveillance, Bill & Melinda Gates Foundation, Seattle, Washigton
- Enteric and Diarrheal Diseases, Bill & Melinda Gates Foundation, Seattle, Washigton
| | - Tikki Pangestu
- Visiting Professor, Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore
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Colombo C, Pitirollo O, Lay L. Recent Advances in the Synthesis of Glycoconjugates for Vaccine Development. Molecules 2018; 23:molecules23071712. [PMID: 30011851 PMCID: PMC6099631 DOI: 10.3390/molecules23071712] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/09/2018] [Accepted: 07/11/2018] [Indexed: 12/25/2022] Open
Abstract
During the last decade there has been a growing interest in glycoimmunology, a relatively new research field dealing with the specific interactions of carbohydrates with the immune system. Pathogens’ cell surfaces are covered by a thick layer of oligo- and polysaccharides that are crucial virulence factors, as they mediate receptors binding on host cells for initial adhesion and organism invasion. Since in most cases these saccharide structures are uniquely exposed on the pathogen surface, they represent attractive targets for vaccine design. Polysaccharides isolated from cell walls of microorganisms and chemically conjugated to immunogenic proteins have been used as antigens for vaccine development for a range of infectious diseases. However, several challenges are associated with carbohydrate antigens purified from natural sources, such as their difficult characterization and heterogeneous composition. Consequently, glycoconjugates with chemically well-defined structures, that are able to confer highly reproducible biological properties and a better safety profile, are at the forefront of vaccine development. Following on from our previous review on the subject, in the present account we specifically focus on the most recent advances in the synthesis and preliminary immunological evaluation of next generation glycoconjugate vaccines designed to target bacterial and fungal infections that have been reported in the literature since 2011.
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Affiliation(s)
- Cinzia Colombo
- Dipartimento di Chimica, Universita' degli Studi di Milano, via Golgi 19, 20133 Milano, Italy.
| | - Olimpia Pitirollo
- Dipartimento di Chimica, Universita' degli Studi di Milano, via Golgi 19, 20133 Milano, Italy.
| | - Luigi Lay
- Dipartimento di Chimica, Universita' degli Studi di Milano, via Golgi 19, 20133 Milano, Italy.
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Abstract
BACKGROUND Typhoid fever and paratyphoid fever continue to be important causes of illness and death, particularly among children and adolescents in south-central and southeast Asia. Two typhoid vaccines are widely available, Ty21a (oral) and Vi polysaccharide (parenteral). Newer typhoid conjugate vaccines are at varying stages of development and use. The World Health Organization has recently recommended a Vi tetanus toxoid (Vi-TT) conjugate vaccine, Typbar-TCV, as the preferred vaccine for all ages. OBJECTIVES To assess the effects of vaccines for preventing typhoid fever. SEARCH METHODS In February 2018, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, and mRCT. We also searched the reference lists of all included trials. SELECTION CRITERIA Randomized and quasi-randomized controlled trials (RCTs) comparing typhoid fever vaccines with other typhoid fever vaccines or with an inactive agent (placebo or vaccine for a different disease) in adults and children. Human challenge studies were not eligible. DATA COLLECTION AND ANALYSIS Two review authors independently applied inclusion criteria and extracted data, and assessed the certainty of the evidence using the GRADE approach. We computed vaccine efficacy per year of follow-up and cumulative three-year efficacy, stratifying for vaccine type and dose. The outcome addressed was typhoid fever, defined as isolation of Salmonella enterica serovar Typhi in blood. We calculated risk ratios (RRs) and efficacy (1 - RR as a percentage) with 95% confidence intervals (CIs). MAIN RESULTS In total, 18 RCTs contributed to the quantitative analysis in this review: 13 evaluated efficacy (Ty21a: 5 trials; Vi polysaccharide: 6 trials; Vi-rEPA: 1 trial; Vi-TT: 1 trial), and 9 reported on adverse events. All trials but one took place in typhoid-endemic countries. There was no information on vaccination in adults aged over 55 years of age, pregnant women, or travellers. Only one trial included data on children under two years of age.Ty21a vaccine (oral vaccine, three doses)A three-dose schedule of Ty21a vaccine probably prevents around half of typhoid cases during the first three years after vaccination (cumulative efficacy 2.5 to 3 years: 50%, 95% CI 35% to 61%, 4 trials, 235,239 participants, moderate-certainty evidence). These data include patients aged 3 to 44 years.Compared with placebo, this vaccine probably does not cause more vomiting, diarrhoea, nausea or abdominal pain (2 trials, 2066 participants; moderate-certainty evidence), headache, or rash (1 trial, 1190 participants; moderate-certainty evidence); however, fever (2 trials, 2066 participants; moderate-certainty evidence) is probably more common following vaccination.Vi polysaccharide vaccine (injection, one dose)A single dose of Vi polysaccharide vaccine prevents around two-thirds of typhoid cases in the first year after vaccination (year 1: 69%, 95% CI 63% to 74%; 3 trials, 99,979 participants; high-certainty evidence). In year 2, trial results were more variable, with the vaccine probably preventing between 45% and 69% of typhoid cases (year 2: 59%, 95% CI 45% to 69%; 4 trials, 194,969 participants; moderate-certainty evidence). These data included participants aged 2 to 55 years of age.The three-year cumulative efficacy of the vaccine may be around 55% (95% CI 30% to 70%; 11,384 participants, 1 trial; low-certainty evidence). These data came from a single trial conducted in South Africa in the 1980s in participants aged 5 to 15 years.Compared with placebo, this vaccine probably did not increase the incidence of fever (3 trials, 132,261 participants; moderate-certainty evidence) or erythema (3 trials, 132,261 participants; low-certainty evidence); however, swelling (3 trials, 1767 participants; moderate-certainty evidence) and pain at the injection site (1 trial, 667 participants; moderate-certainty evidence) were more common in the vaccine group.Vi-rEPA vaccine (two doses)Administration of two doses of the Vi-rEPA vaccine probably prevents between 50% and 96% of typhoid cases during the first two years after vaccination (year 1: 94%, 95% CI 75% to 99%; year 2: 87%, 95% CI 56% to 96%, 1 trial, 12,008 participants; moderate-certainty evidence). These data came from a single trial with children two to five years of age conducted in Vietnam.Compared with placebo, both the first and the second dose of this vaccine increased the risk of fever (1 trial, 12,008 and 11,091 participants, low-certainty evidence) and the second dose increase the incidence of swelling at the injection site (one trial, 11,091 participants, moderate-certainty evidence).Vi-TT vaccine (two doses)We are uncertain of the efficacy of administration of two doses of Vi-TT (PedaTyph) in typhoid cases in children during the first year after vaccination (year 1: 94%, 95% CI -1% to 100%, 1 trial, 1625 participants; very low-certainty evidence). These data come from a single cluster-randomized trial in children aged six months to 12 years and conducted in India. For single dose Vi-TT (Typbar-TCV), we found no efficacy trials evaluating the vaccine with natural exposure.There were no reported serious adverse effects in RCTs of any of the vaccines studied. AUTHORS' CONCLUSIONS The licensed Ty21a and Vi polysaccharide vaccines are efficacious in adults and children older than two years in endemic countries. The Vi-rEPA vaccine is just as efficacious, although data is only available for children. The new Vi-TT vaccine (PedaTyph) requires further evaluation to determine if it provides protection against typhoid fever. At the time of writing, there were only efficacy data from a human challenge setting in adults on the Vi-TT vaccine (Tybar), which clearly justify the ongoing field trials to evaluate vaccine efficacy.
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Affiliation(s)
- Rachael Milligan
- Liverpool School of Tropical MedicineCochrane Infectious Diseases GroupPembroke PlaceLiverpoolUKL3 5QA
| | - Mical Paul
- Rambam Health Care CampusDivision of Infectious DiseasesHa‐aliya 8 StHaifaIsrael33705
| | - Marty Richardson
- Liverpool School of Tropical MedicineCochrane Infectious Diseases GroupPembroke PlaceLiverpoolUKL3 5QA
| | - Ami Neuberger
- Rambam Health Care Campus and The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of TechnologyDivision of Infectious DiseasesTel AvivIsrael
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Britto CD, Dyson ZA, Duchene S, Carter MJ, Gurung M, Kelly DF, Murdoch DR, Ansari I, Thorson S, Shrestha S, Adhikari N, Dougan G, Holt KE, Pollard AJ. Laboratory and molecular surveillance of paediatric typhoidal Salmonella in Nepal: Antimicrobial resistance and implications for vaccine policy. PLoS Negl Trop Dis 2018; 12:e0006408. [PMID: 29684021 PMCID: PMC5933809 DOI: 10.1371/journal.pntd.0006408] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/03/2018] [Accepted: 03/25/2018] [Indexed: 11/20/2022] Open
Abstract
Background Children are substantially affected by enteric fever in most settings with a high burden of the disease, including Nepal. However pathogen population structure and transmission dynamics are poorly delineated in young children, the proposed target group for immunization programs. Here we present whole genome sequencing and antimicrobial susceptibility data on 198 S. Typhi and 66 S. Paratyphi A isolated from children aged 2 months to 15 years of age during blood culture surveillance at Patan Hospital, Nepal, 2008–2016. Principal findings S. Typhi was the dominant agent and comprised several distinct genotypes, dominated by 4.3.1 (H58). The heterogeneity of genotypes in children under five was reduced compared to data from 2005–2006, attributable to ongoing clonal expansion of H58. Most isolates (86%) were non-susceptible to fluoroquinolones, associated mainly with S. Typhi H58 lineage II and S. Paratyphi A harbouring mutations in the quinolone resistance-determining region (QRDR); non-susceptible strains from these groups accounted for 50% and 25% of all isolates. Multi-drug resistance (MDR) was rare (3.5% of S. Typhi, 0 S. Paratyphi A) and restricted to chromosomal insertions of resistance genes in H58 lineage I strains. Temporal analyses revealed a shift in dominance from H58 Lineage I to H58 Lineage II, with the latter being significantly more common after 2010. Comparison to global data sets showed the local S. Typhi and S. Paratyphi A strains had close genetic relatives in other South Asian countries, indicating regional strain circulation. Multiple imports from India of ciprofloxacin-resistant H58 lineage II strains were identified, but these were rare and showed no evidence of clonal replacement of local S. Typhi. Significance These data indicate that enteric fever in Nepal continues to be a major public health issue with ongoing inter- and intra-country transmission, and highlights the need for regional coordination of intervention strategies. The absence of a S. Paratyphi A vaccine is cause for concern, given its prevalence as a fluoroquinolone resistant enteric fever agent in this setting.
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Affiliation(s)
- Carl D. Britto
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
- * E-mail:
| | - Zoe A. Dyson
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Parkville, Victoria, Australia
| | - Sebastian Duchene
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Parkville, Victoria, Australia
| | - Michael J. Carter
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Meeru Gurung
- Oxford University Clinical Research Unit-Patan Academy of Health Sciences, Patan, Nepal
| | - Dominic F. Kelly
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | | | - Imran Ansari
- Oxford University Clinical Research Unit-Patan Academy of Health Sciences, Patan, Nepal
| | - Stephen Thorson
- Oxford University Clinical Research Unit-Patan Academy of Health Sciences, Patan, Nepal
| | - Shrijana Shrestha
- Oxford University Clinical Research Unit-Patan Academy of Health Sciences, Patan, Nepal
| | - Neelam Adhikari
- Oxford University Clinical Research Unit-Patan Academy of Health Sciences, Patan, Nepal
| | - Gordon Dougan
- Wellcome Trust Sanger Institute and the Department of Medicine, Cambridge University, Cambridge, United Kingdom
| | - Kathryn E. Holt
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Parkville, Victoria, Australia
| | - Andrew J. Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
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Pommelet V, Mariani P, Basmaci R, Tourdjman M, Morin L, Gaschignard J, de Lauzanne A, Lemaitre C, Bonacorsi S, Faye A. Enteric fever among children: 50 cases in a French tertiary care centre. J Travel Med 2018; 25:5061326. [PMID: 30060197 DOI: 10.1093/jtm/tay059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 07/27/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND Enteric fever in France is primarily travel-associated. Characteristics of paediatric cases are scarce and information from field studies in endemic countries might not be generalizable to non-endemic countries. METHODS In this retrospective study, we reviewed all cases of typhoid and paratyphoid fever treated in a French paediatric tertiary care centre from 1993 to 2015. RESULTS Fifty cases of enteric fever due to Salmonella enterica serovar Typhi (n = 44) and Paratyphi (n = 6) were identified. Sixty-one percent of the children had travelled to Africa and 34% to the Indian subcontinent. Among travel-associated cases, 85% were visiting friends and relatives (VFR). Ninety-six percent had high fever associated with gastrointestinal symptoms. Anaemia (66%), elevated C-reactive protein (80%), transaminitis (87%) and mild hyponatremia (50%) were the main biological findings. Blood cultures were positive in 90% of cases. Twelve strains (24%) were resistant at least to one antibiotic, and all of them had been isolated since 2003, increasing the resistance rate during this last period to 43% (12/28). Ceftriaxone was administered to 71 patients for a median duration of 6 days (interquartile range (IQR): 4-8). The median time to apyrexia after the onset of treatment was 4 days (IQR: 2-5 days). Complications occurred in nine children with five (10%) presenting neurologic disorders. All 50 patients recovered. CONCLUSION In France, paediatric enteric fever is mainly a travel-associated disease and occurs in patients returning from a prolonged stay in an endemic area. Children VFR are at high risk and should be a priority target group for pre-travel preventive measures. The increase in antibiotic resistance reflects the situation in endemic countries and is a major concern.
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Affiliation(s)
- Virginie Pommelet
- Assistance Publique des Hôpitaux de Paris, Service de Pédiatrie Générale, Hôpital Robert-Debré, Paris, France
| | - Patricia Mariani
- Assistance Publique des Hôpitaux de Paris, Laboratoire de microbiologie, Hôpital Robert-Debré, Paris, France.,IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité Paris, France
| | - Romain Basmaci
- Assistance Publique des Hôpitaux de Paris, Service de Pédiatrie Générale, Hôpital Robert-Debré, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, UMRS 1123 ECEVE, Paris, France
| | - Mathieu Tourdjman
- Département des maladies infectieuses, unité des infections alimentaires, zoonotiques et vectorielles, Santé publique France, the French Public Health Agency, France
| | - Laurence Morin
- Assistance publique - Hôpitaux de Paris, Service d'Accueil des Urgences, Hôpital Robert-Debré, Paris, France
| | - Jean Gaschignard
- Assistance Publique des Hôpitaux de Paris, Service de Pédiatrie Générale, Hôpital Robert-Debré, Paris, France
| | - Agathe de Lauzanne
- Assistance Publique des Hôpitaux de Paris, Service de Pédiatrie Générale, Hôpital Robert-Debré, Paris, France
| | - Chloé Lemaitre
- Assistance Publique des Hôpitaux de Paris, Service de Pédiatrie Générale, Hôpital Robert-Debré, Paris, France
| | - Stéphane Bonacorsi
- Assistance Publique des Hôpitaux de Paris, Laboratoire de microbiologie, Hôpital Robert-Debré, Paris, France.,IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité Paris, France
| | - Albert Faye
- Assistance Publique des Hôpitaux de Paris, Service de Pédiatrie Générale, Hôpital Robert-Debré, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, UMRS 1123 ECEVE, Paris, France
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44
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Jin C, Gibani MM, Moore M, Juel HB, Jones E, Meiring J, Harris V, Gardner J, Nebykova A, Kerridge SA, Hill J, Thomaides-Brears H, Blohmke CJ, Yu LM, Angus B, Pollard AJ. Efficacy and immunogenicity of a Vi-tetanus toxoid conjugate vaccine in the prevention of typhoid fever using a controlled human infection model of Salmonella Typhi: a randomised controlled, phase 2b trial. Lancet 2017; 390:2472-2480. [PMID: 28965718 PMCID: PMC5720597 DOI: 10.1016/s0140-6736(17)32149-9] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/20/2017] [Accepted: 07/26/2017] [Indexed: 12/03/2022]
Abstract
BACKGROUND Salmonella enterica serovar Typhi (S Typhi) is responsible for an estimated 20 million infections and 200 000 deaths each year in resource poor regions of the world. Capsular Vi-polysaccharide-protein conjugate vaccines (Vi-conjugate vaccines) are immunogenic and can be used from infancy but there are no efficacy data for the leading candidate vaccine being considered for widespread use. To address this knowledge gap, we assessed the efficacy of a Vi-tetanus toxoid conjugate vaccine using an established human infection model of S Typhi. METHODS In this single-centre, randomised controlled, phase 2b study, using an established outpatient-based human typhoid infection model, we recruited healthy adult volunteers aged between 18 and 60 years, with no previous history of typhoid vaccination, infection, or prolonged residency in a typhoid-endemic region. Participants were randomly assigned (1:1:1) to receive a single dose of Vi-conjugate (Vi-TT), Vi-polysaccharide (Vi-PS), or control meningococcal vaccine with a computer-generated randomisation schedule (block size 6). Investigators and participants were masked to treatment allocation, and an unmasked team of nurses administered the vaccines. Following oral ingestion of S Typhi, participants were assessed with daily blood culture over a 2-week period and diagnosed with typhoid infection when meeting pre-defined criteria. The primary endpoint was the proportion of participants diagnosed with typhoid infection (ie, attack rate), defined as persistent fever of 38°C or higher for 12 h or longer or S Typhi bacteraemia, following oral challenge administered 1 month after Vi-vaccination (Vi-TT or Vi-PS) compared with control vaccination. Analysis was per protocol. This trial is registered with ClinicalTrials.gov, number NCT02324751, and is ongoing. FINDINGS Between Aug 18, 2015, and Nov 4, 2016, 112 participants were enrolled and randomly assigned; 34 to the control group, 37 to the Vi-PS group, and 41 to the Vi-TT group. 103 participants completed challenge (31 in the control group, 35 in the Vi-PS group, and 37 in the Vi-TT group) and were included in the per-protocol population. The composite criteria for typhoid diagnosis was met in 24 (77%) of 31 participants in the control group, 13 (35%) of 37 participants in the Vi-TT group, and 13 (35%) of 35 participants in the Vi-PS group to give vaccine efficacies of 54·6% (95% CI 26·8-71·8) for Vi-TT and 52·0% (23·2-70·0) for Vi-PS. Seroconversion was 100% in Vi-TT and 88·6% in Vi-PS participants, with significantly higher geometric mean titres detected 1-month post-vaccination in Vi-TT vaccinees. Four serious adverse events were reported during the conduct of the study, none of which were related to vaccination (one in the Vi-TT group and three in the Vi-PS group). INTERPRETATION Vi-TT is a highly immunogenic vaccine that significantly reduces typhoid fever cases when assessed using a stringent controlled model of typhoid infection. Vi-TT use has the potential to reduce both the burden of typhoid fever and associated health inequality. FUNDING The Bill & Melinda Gates Foundation and the European Commission FP7 grant, Advanced Immunization Technologies (ADITEC).
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Affiliation(s)
- Celina Jin
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK.
| | - Malick M Gibani
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Maria Moore
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Helene B Juel
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Elizabeth Jones
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - James Meiring
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Victoria Harris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Jonathan Gardner
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Anna Nebykova
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Simon A Kerridge
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Jennifer Hill
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Helena Thomaides-Brears
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Christoph J Blohmke
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Brian Angus
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
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