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Abdelmalek CM, Singh S, Fasil B, Horvath AR, Mulkey SB, Curé C, Campos M, Cavalcanti DP, Tong VT, Mercado M, Daza M, Marcela Benavides M, Acosta J, Gilboa S, Valencia D, Sancken CL, Newton S, Scalabrin DMF, Mussi-Pinhata MM, Vasconcelos Z, Chakhtoura N, Moye J, Leslie EJ, Bulas D, Vezina G, Marques FJP, Leyser M, Del Campo M, Vilain E, DeBiasi RL, Wang T, Nath A, Haydar T, Muenke M, Mansour TA, du Plessis AJ, Murray JC, Cordero JF, Kousa YA. Building a growing genomic data repository for maternal and fetal health through the PING Consortium. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.24.24307899. [PMID: 38826415 PMCID: PMC11142296 DOI: 10.1101/2024.05.24.24307899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Background Prenatally transmitted viruses can cause severe damage to the developing brain. There is unexplained variability in prenatal brain injury and postnatal neurodevelopmental outcomes, suggesting disease modifiers. Discordant outcomes among dizygotic twins could be explained by genetic susceptibly or protection. Among several well-recognized threats to the developing brain, Zika is a mosquito-borne, positive-stranded RNA virus that was originally isolated in Uganda and spread to cause epidemics in Africa, Asia, and the Americas. In the Americas, the virus caused congenital Zika syndrome and a multitude of neurodevelopmental disorders. As of now, there is no preventative treatment or cure for the adverse outcomes caused by prenatal Zika infection. The Prenatal Infection and Neurodevelopmental Genetics (PING) Consortium was initiated in 2016 to identify factors modulating prenatal brain injury and postnatal neurodevelopmental outcomes for Zika and other prenatal viral infections. Methods The Consortium has pooled information from eight multi-site studies conducted at 23 research centers in six countries to build a growing clinical and genomic data repository. This repository is being mined to search for modifiers of virally induced brain injury and developmental outcomes. Multilateral partnerships include commitments with Children's National Hospital (USA), Instituto Nacional de Salud (Colombia), the Natural History of Zika Virus Infection in Gestation program (Brazil), and Zika Instituto Fernandes Figueira (Brazil), in addition to the Centers for Disease Control and Prevention and the National Institutes of Health. Discussion Our goal in bringing together these sets of patient data was to test the hypothesis that personal and populational genetic differences affect the severity of brain injury after a prenatal viral infection and modify neurodevelopmental outcomes. We have enrolled 4,102 mothers and 3,877 infants with 3,063 biological samples and clinical data covering over 80 phenotypic fields and 5,000 variables. There were several notable challenges in bringing together cohorts enrolled in different studies, including variability in the timepoints evaluated and the collected clinical data and biospecimens. Thus far, we have performed whole exome sequencing on 1,226 participants. Here, we present the Consortium's formation and the overarching study design. We began our investigation with prenatal Zika infection with the goal of applying this knowledge to other prenatal infections and exposures that can affect brain development.
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Zaka A, Dehkordi O, Weir R, Oyawusi M, Millis RM. A Case of Guillain-Barré Syndrome With Multiple Causative Factors in a Young Male. Cureus 2023; 15:e49745. [PMID: 38161846 PMCID: PMC10757645 DOI: 10.7759/cureus.49745] [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] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
Guillain-Barré syndrome (GBS), an immune-mediated disease of the peripheral nervous system, is mainly characterized by rapidly progressive ascending weakness of the limbs with reduced or absent deep tendon reflexes. The exact cause of GBS is unknown, but it often occurs after a gastrointestinal or respiratory infection. The present study represents a case of GBS in which multiple antecedent antigenic stimuli may have contributed to the development of GBS. The patient, a 28-year-old immunocompetent man with no significant medical history, presented to the emergency department (ED) with acute ascending flaccid paralysis that persisted for a few days. His initial symptoms included tingling in his legs, which started at his shin and calf and developed into numbness, which extended to his upper limbs and arms. A CT scan of the lumbar and cervical spine indicated minor L4-L5 and L5-S1 disc herniation as well as slight bulging in C5-C6 and C7. The patient was discharged but returned to the ED for urgent treatment the next day after he weakened rapidly, losing the ability to walk or maintain balance. Based on his clinical presentation of ascending weakness and generalized hyporeflexia, he was diagnosed with GBS. Abnormal liver function and positive blood tests for anti-cytomegalovirus (anti-CMV) and anti-Epstein-Barr virus (anti-EBV) IgG and IgM antibodies diagnosed hepatitis, CMV, and EBV, respectively. The patient was treated with intravenous immunoglobulin therapy (IVIG; 27 g/day) and antiviral medicine (ganciclovir; 340 mg IV/day) for five days. His nonexistent deep tendon reflexes began to improve two to three days following treatment. He was able to ambulate longer distances with a walker, and his upper extremities regained full strength. This case highlights the importance of a multiple-treatment approach to the treatment of GBS, wherein multiple antigenic triggering factors may be involved.
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Affiliation(s)
- Ahmed Zaka
- Neurology, Howard University Hospital, Washington D.C., USA
| | - Ozra Dehkordi
- Neurology, Howard University Hospital, Washington D.C., USA
| | - Roger Weir
- Neurology, Howard University Hospital, Washington D.C., USA
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Sootichote R, Puangmanee W, Benjathummarak S, Kowaboot S, Yamanaka A, Boonnak K, Ampawong S, Chatchen S, Ramasoota P, Pitaksajjakul P. Potential Protective Effect of Dengue NS1 Human Monoclonal Antibodies against Dengue and Zika Virus Infections. Biomedicines 2023; 11:biomedicines11010227. [PMID: 36672734 PMCID: PMC9855337 DOI: 10.3390/biomedicines11010227] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/01/2023] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
Due to the lack of an effective therapeutic treatment to flavivirus, dengue virus (DENV) nonstructural protein 1 (NS1) has been considered to develop a vaccine owing to its lack of a role in antibody-dependent enhancement (ADE). However, both NS1 and its antibody have shown cross-reactivity to host molecules and have stimulated anti-DENV NS1 antibody-mediated endothelial damage and platelet dysfunction. To overcome the pathogenic events and reactogenicity, human monoclonal antibodies (HuMAbs) against DENV NS1 were generated from DENV-infected patients. Herein, the four DENV NS1-specific HuMAbs revealed the therapeutic effects in viral neutralization, reduction of viral replication, and enhancement of cell cytolysis of DENV and zika virus (ZIKV) via complement pathway. Furthermore, we demonstrate that DENV and ZIKV NS1 trigger endothelial dysfunction, leading to vascular permeability in vitro. Nevertheless, the pathogenic effects from NS1 were impeded by 2 HuMAbs (D25-4D4C3 and D25-2B11E7) and also protected the massive cytokines stimulation (interleukin [IL-]-1b, IL-1ra, IL-2, IL-4, IL-5, IL-6, IL-8, IL-9, IL-13, IL-17, eotaxin, granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, Inducible protein-10, monocyte chemoattractant protein-1, macrophage inflammatory protein [MIP]-1 α, MIP-1β, tumor necrosis factor-α, platelet-derived growth factor, and RANTES). Collectively, our findings suggest that the novel protective NS1 monoclonal antibodies generated from humans has multiple therapeutic benefits against DENV and ZIKV infections.
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Affiliation(s)
- Rochanawan Sootichote
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Wilarat Puangmanee
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Surachet Benjathummarak
- Center of Excellence for Antibody Research, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Siriporn Kowaboot
- Faculty of Medical Technology, Rangsit University, Pathumthani 12000, Thailand
| | - Atsushi Yamanaka
- Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan
| | - Korbporn Boonnak
- Department of Immunology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Sumate Ampawong
- Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Supawat Chatchen
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Pongrama Ramasoota
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Center of Excellence for Antibody Research, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Pannamthip Pitaksajjakul
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Center of Excellence for Antibody Research, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Correspondence: ; Tel.: +66-023069186 or +66-0899858305
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Reddy MP, Subramaniam A, Chua C, Ling RR, Anstey C, Ramanathan K, Slutsky AS, Shekar K. Respiratory system mechanics, gas exchange, and outcomes in mechanically ventilated patients with COVID-19-related acute respiratory distress syndrome: a systematic review and meta-analysis. THE LANCET. RESPIRATORY MEDICINE 2022; 10:1178-1188. [PMID: 36335956 PMCID: PMC9708089 DOI: 10.1016/s2213-2600(22)00393-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 07/28/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022]
Abstract
The association of respiratory mechanics, particularly respiratory system static compliance (CRS), with severity of hypoxaemia in patients with COVID-19-related acute respiratory distress syndrome (ARDS) has been widely debated, with some studies reporting distinct ARDS phenotypes based on CRS. Ascertaining whether such phenotypes exist is important, because they might indicate the need for ventilation strategies that differ from those used in patients with ARDS due to other causes. In a systematic review and meta-analysis of studies published between Dec 1, 2019, and March 14, 2022, we evaluated respiratory system mechanics, ventilator parameters, gas exchange parameters, and clinical outcomes in patients with COVID-19-related ARDS. Among 11 356 patients in 37 studies, mean reported CRS, measured close to the time of endotracheal intubation, was 35·8 mL/cm H2O (95% CI 33·9-37·8; I2=96·9%, τ2=32·6). Pooled mean CRS was normally distributed. Increasing ARDS severity (assessed by PaO2/FiO2 ratio as mild, moderate, or severe) was associated with decreasing CRS. We found no evidence for distinct CRS-based clinical phenotypes in patients with COVID-19-related ARDS, and we therefore conclude that no change in conventional lung-protective ventilation strategies is warranted. Future studies should explore the personalisation of mechanical ventilation strategies according to factors including respiratory system mechanics and haemodynamic status in patients with ARDS.
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Affiliation(s)
- Mallikarjuna Ponnapa Reddy
- Department of Intensive Care Medicine, Calvary Hospital, Canberra, ACT, Australia,Department of Intensive Care Medicine, Peninsula Health, Frankston, VIC, Australia,Correspondence to: Dr Mallikarjuna Ponnapa Reddy, Department of Intensive Care Medicine, Calvary Hospital, Canberra ACT 2617, Australia
| | - Ashwin Subramaniam
- Department of Intensive Care Medicine, Peninsula Health, Frankston, VIC, Australia,Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, Australia,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia,Peninsula Clinical School, Monash University, Clayton, VIC, Australia
| | - Clara Chua
- Department of Intensive Care Medicine, Peninsula Health, Frankston, VIC, Australia,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Ryan Ruiyang Ling
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Christopher Anstey
- Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine University of Queensland, Brisbane, QLD, Australia,School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - Kollengode Ramanathan
- Department of Surgery, National University of Singapore, Singapore,Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore
| | - Arthur S Slutsky
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada,Department of Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Kiran Shekar
- Prince Charles Hospital Northside Clinical Unit, Faculty of Medicine University of Queensland, Brisbane, QLD, Australia,Department of Intensive Care Medicine, Bond University, Gold Coast, QLD, Australia,Adult Intensive Care Services and Critical Care Research Group, the Prince Charles Hospital, Brisbane, QLD, Australia,Department of Intensive Care Medicine, Queensland University of Technology, Brisbane, QLD, Australia
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Osoro E, Inwani I, Mugo C, Hunsperger E, Verani JR, Omballa V, Wamalwa D, Rhee C, Nduati R, Kinuthia J, Jin H, Okutoyi L, Mwaengo D, Maugo B, Otieno NA, Mirieri H, Shabibi M, Munyua P, Njenga MK, Widdowson MA. Prevalence of microcephaly and Zika virus infection in a pregnancy cohort in Kenya, 2017-2019. BMC Med 2022; 20:291. [PMID: 36100910 PMCID: PMC9470235 DOI: 10.1186/s12916-022-02498-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Zika virus (ZIKV), first discovered in Uganda in 1947, re-emerged globally in 2013 and was later associated with microcephaly and other birth defects. We determined the incidence of ZIKV infection and its association with adverse pregnancy and fetal outcomes in a pregnancy cohort in Kenya. METHODS From October 2017 to July 2019, we recruited and followed up women aged ≥ 15 years and ≤ 28 weeks pregnant in three hospitals in coastal Mombasa. Monthly follow-up included risk factor questions and a blood sample collected for ZIKV serology. We collected anthropometric measures (including head circumference), cord blood, venous blood from newborns, and any evidence of birth defects. Microcephaly was defined as a head circumference (HC) < 2 standard deviations (SD) for sex and gestational age. Severe microcephaly was defined as HC < 3 SD for sex and age. We tested sera for anti-ZIKV IgM antibodies using capture enzyme-linked immunosorbent assay (ELISA) and confirmed positives using the plaque reduction neutralization test (PRNT90) for ZIKV and for dengue (DENV) on the samples that were ZIKV neutralizing antibody positive. We collected blood and urine from participants reporting fever or rash for ZIKV testing. RESULTS Of 2889 pregnant women screened for eligibility, 2312 (80%) were enrolled. Of 1916 recorded deliveries, 1816 (94.6%) were live births and 100 (5.2%) were either stillbirths or spontaneous abortions (< 22 weeks of gestation). Among 1236 newborns with complete anthropometric measures, 11 (0.9%) had microcephaly and 3 (0.2%) had severe microcephaly. A total of 166 (7.2%) participants were positive for anti-ZIKV IgM, 136 of whom became seropositive during follow-up. Among the 166 anti-ZIKV IgM positive, 3 and 18 participants were further seropositive for ZIKV and DENV neutralizing antibodies, respectively. Of these 3 and 18 pregnant women, one and 13 (72.2%) seroconverted with antibodies to ZIKV and DENV, respectively. All 308 samples (serum and urine samples collected during sick visits and samples that were anti-ZIKV IgM positive) tested by RT-PCR were negative for ZIKV. No adverse pregnancy or neonatal outcomes were reported among the three participants with confirmed ZIKV exposure. Among newborns from pregnant women with DENV exposure, four (22.2%) were small for gestational age and one (5.6%) had microcephaly. CONCLUSIONS The prevalence of severe microcephaly among newborns in coastal Kenya was high relative to published estimates from facility-based studies in Europe and Latin America, but little evidence of ZIKV transmission. There is a need for improved surveillance for microcephaly and other congenital malformations in Kenya.
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Affiliation(s)
- Eric Osoro
- Washington State University Global Health Kenya, One Padmore Place, George Padmore Road, Off Ngong Road, Nairobi, Kenya. .,Paul G. Allen School of Global Health, Washington State University, Pullman, USA.
| | - Irene Inwani
- Department of Pediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Cyrus Mugo
- Department of Pediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Elizabeth Hunsperger
- Division of Global Health Protection, Centers for Disease Control and Prevention, CDC Kenya, Nairobi, Kenya
| | - Jennifer R Verani
- Division of Global Health Protection, Centers for Disease Control and Prevention, CDC Kenya, Nairobi, Kenya
| | - Victor Omballa
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Chulwoo Rhee
- Division of Global Health Protection, CentersforDiseaseControlandPrevention, Atlanta, USA
| | - Ruth Nduati
- Department of Pediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Research and Programs Department, Kenyatta National Hospital/University of Nairobi, Nairobi, Kenya
| | - Hafsa Jin
- Coast General Hospital, Mombasa, Kenya
| | - Lydia Okutoyi
- Department of Obstetrics and Gynecology/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Dufton Mwaengo
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Brian Maugo
- Department of Pediatrics and Child Health/Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Nancy A Otieno
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Harriet Mirieri
- Washington State University Global Health Kenya, One Padmore Place, George Padmore Road, Off Ngong Road, Nairobi, Kenya
| | | | - Peninah Munyua
- Division of Global Health Protection, Centers for Disease Control and Prevention, CDC Kenya, Nairobi, Kenya
| | - M Kariuki Njenga
- Washington State University Global Health Kenya, One Padmore Place, George Padmore Road, Off Ngong Road, Nairobi, Kenya.,Paul G. Allen School of Global Health, Washington State University, Pullman, USA
| | - Marc-Alain Widdowson
- Division of Global Health Protection, Centers for Disease Control and Prevention, CDC Kenya, Nairobi, Kenya.,Institute of Tropical Medicine, Antwerp, Belgium
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Elbers S, Wittink H, Kaiser U, Kleijnen J, Pool J, Köke A, Smeets R. Living systematic reviews in rehabilitation science can improve evidence-based healthcare. Syst Rev 2021; 10:309. [PMID: 34876231 PMCID: PMC8650945 DOI: 10.1186/s13643-021-01857-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022] Open
Abstract
Although systematic reviews are considered as central components in evidence-based practice, they currently face an important challenge to keep up with the exponential publication rate of clinical trials. After initial publication, only a minority of the systematic reviews are updated, and it often takes multiple years before these results become accessible. Consequently, many systematic reviews are not up to date, thereby increasing the time-gap between research findings and clinical practice. A potential solution is offered by a living systematic reviews approach. These types of studies are characterized by a workflow of continuous updates which decreases the time it takes to disseminate new findings. Although living systematic reviews are specifically designed to continuously synthesize new evidence in rapidly emerging topics, they have also considerable potential in slower developing domains, such as rehabilitation science. In this commentary, we outline the rationale and required steps to transition a regular systematic review into a living systematic review. We also propose a workflow that is designed for rehabilitation science.
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Affiliation(s)
- S Elbers
- Research group Lifestyle & Health, Research Centre Healthy and Sustainable Living, University of Applied Sciences Utrecht, P.O. Box 12011, 3508, AA, Utrecht, The Netherlands. .,Department of Rehabilitation Medicine, Research School CAPHRI, Faculty of Health, Life Sciences and Medicine, Maastricht University, Maastricht, The Netherlands.
| | - H Wittink
- Research group Lifestyle & Health, Research Centre Healthy and Sustainable Living, University of Applied Sciences Utrecht, P.O. Box 12011, 3508, AA, Utrecht, The Netherlands
| | - U Kaiser
- Comprehensive Pain Center, Medical Faculty Technical University Dresden, Dresden, Germany.,University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - J Kleijnen
- Department of Family Medicine, Research School CAPHRI, Faculty of Health, Life Sciences and Medicine, Maastricht University, Maastricht, The Netherlands
| | - J Pool
- Research group Lifestyle & Health, Research Centre Healthy and Sustainable Living, University of Applied Sciences Utrecht, P.O. Box 12011, 3508, AA, Utrecht, The Netherlands
| | - A Köke
- Department of Rehabilitation Medicine, Research School CAPHRI, Faculty of Health, Life Sciences and Medicine, Maastricht University, Maastricht, The Netherlands.,Centre of Expertise in Pain and Rehabilitation, Adelante, Maastricht, The Netherlands.,South University of Applied Sciences Heerlen, Heerlen, The Netherlands
| | - R Smeets
- Department of Rehabilitation Medicine, Research School CAPHRI, Faculty of Health, Life Sciences and Medicine, Maastricht University, Maastricht, The Netherlands.,CIR Revalidatie, location Eindhoven, Eindhoven, The Netherlands.,Pain in Motion International Research Group (PiM)
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7
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Anderson TC, Leung JW, Harpaz R, Dooling KL. Risk of Guillain-Barré syndrome following herpes zoster, United States, 2010-2018. Hum Vaccin Immunother 2021; 17:5304-5310. [PMID: 34856864 DOI: 10.1080/21645515.2021.1985890] [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: 01/05/2023] Open
Abstract
Epidemiologic data regarding the risk of Guillain-Barré syndrome (GBS) following herpes zoster (HZ) are limited. We conducted a self-controlled case series analysis using two large national data sources to evaluate the risk of GBS following HZ among U.S. adults. We analyzed medical claims from the IBM® MarketScan® Commercial Claims and Encounters (persons 18-64 years during 2010-2018) and Centers for Medicare and Medicaid Services Medicare (persons ≥65 years during 2014-2018) databases. HZ cases were defined as persons with an outpatient claim with a primary or secondary ICD-9 or ICD-10 diagnostic code for HZ. GBS cases were defined as persons with an inpatient claim with a principle diagnostic code for GBS and an associated procedural code. We compared the rates of GBS following HZ in the 1-42-day risk window versus primary (100-365-day) or secondary (43-99-day) control windows. We identified 489,516 persons 18-64 years of age and 650,229 persons ≥65 years of age with HZ, among whom 11 and 41, respectively, developed GBS 1-365 days following HZ. The risk of GBS following HZ was increased during the risk window as compared to the primary control window for both groups, with a rate ratio of 6.3 (95% CI, 1.8-21.9) for those 18-64 years and 4.1 (95% CI, 1.9-8.7) for those ≥65 years. This study provides new and methodologically rigorous epidemiologic support for an association between HZ and GBS, and useful context regarding the benefits versus potential risks of zoster vaccination.
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Affiliation(s)
- Tara C Anderson
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica W Leung
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Kathleen L Dooling
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Ponnapa Reddy M, Subramaniam A, Afroz A, Billah B, Lim ZJ, Zubarev A, Blecher G, Tiruvoipati R, Ramanathan K, Wong SN, Brodie D, Fan E, Shekar K. Prone Positioning of Nonintubated Patients With Coronavirus Disease 2019-A Systematic Review and Meta-Analysis. Crit Care Med 2021; 49:e1001-e1014. [PMID: 33927120 PMCID: PMC8439644 DOI: 10.1097/ccm.0000000000005086] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Several studies have reported prone positioning of nonintubated patients with coronavirus diseases 2019-related hypoxemic respiratory failure. This systematic review and meta-analysis evaluated the impact of prone positioning on oxygenation and clinical outcomes. DESIGN AND SETTING We searched PubMed, Embase, and the coronavirus diseases 2019 living systematic review from December 1, 2019, to November 9, 2020. SUBJECTS AND INTERVENTION Studies reporting prone positioning in hypoxemic, nonintubated adult patients with coronavirus diseases 2019 were included. MEASUREMENTS AND MAIN RESULTS Data on prone positioning location (ICU vs non-ICU), prone positioning dose (total minutes/d), frequency (sessions/d), respiratory supports during prone positioning, relative changes in oxygenation variables (peripheral oxygen saturation, Pao2, and ratio of Pao2 to the Fio2), respiratory rate pre and post prone positioning, intubation rate, and mortality were extracted. Twenty-five observational studies reporting prone positioning in 758 patients were included. There was substantial heterogeneity in prone positioning location, dose and frequency, and respiratory supports provided. Significant improvements were seen in ratio of Pao2 to the Fio2 (mean difference, 39; 95% CI, 25-54), Pao2 (mean difference, 20 mm Hg; 95% CI, 14-25), and peripheral oxygen saturation (mean difference, 4.74%; 95% CI, 3-6%). Respiratory rate decreased post prone positioning (mean difference, -3.2 breaths/min; 95% CI, -4.6 to -1.9). Intubation and mortality rates were 24% (95% CI, 17-32%) and 13% (95% CI, 6-19%), respectively. There was no difference in intubation rate in those receiving prone positioning within and outside ICU (32% [69/214] vs 33% [107/320]; p = 0.84). No major adverse events were recorded in small subset of studies that reported them. CONCLUSIONS Despite the significant variability in frequency and duration of prone positioning and respiratory supports applied, prone positioning was associated with improvement in oxygenation variables without any reported serious adverse events. The results are limited by a lack of controls and adjustments for confounders. Whether this improvement in oxygenation results in meaningful patient-centered outcomes such as reduced intubation or mortality rates requires testing in well-designed randomized clinical trials.
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Affiliation(s)
- Mallikarjuna Ponnapa Reddy
- Department of Intensive Care Medicine, Calvary Hospital, ACT, Australia
- Department of Intensive Care Medicine, Peninsula Health, Frankston, VIC, Australia
| | - Ashwin Subramaniam
- Department of Intensive Care Medicine, Peninsula Health, Frankston, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Afsana Afroz
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Zheng Jie Lim
- Department of Intensive Care Medicine, Ballarat Health Services, Ballarat, VIC, Australia
| | - Alexandr Zubarev
- Department of Intensive Care Medicine, Peninsula Health, Frankston, VIC, Australia
| | - Gabriel Blecher
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
- Department of Emergency, Monash Health, Clayton, VIC, Australia
| | - Ravindranath Tiruvoipati
- Department of Intensive Care Medicine, Peninsula Health, Frankston, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Kollengode Ramanathan
- Department of Intensive Care Medicine, Calvary Hospital, ACT, Australia
- Department of Intensive Care Medicine, Peninsula Health, Frankston, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care Medicine, Ballarat Health Services, Ballarat, VIC, Australia
- Department of Emergency, Monash Health, Clayton, VIC, Australia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National University Hospital, Singapore
- Faculty of Medicine, Bond University, Gold Coast, QLD, Australia
- Department of Medicine, Columbia University College of Physicians and Surgeons, and Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY
- Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Adult Intensive Care Services, the Prince Charles Hospital, Brisbane, QLD, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Suei Nee Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Daniel Brodie
- Department of Medicine, Columbia University College of Physicians and Surgeons, and Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Kiran Shekar
- Faculty of Medicine, Bond University, Gold Coast, QLD, Australia
- Adult Intensive Care Services, the Prince Charles Hospital, Brisbane, QLD, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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9
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Duarte G, Miranda AE, Bermudez XPD, Saraceni V, Martinez-Espinosa FE. Brazilian Protocol for Sexually Transmitted Infections 2020: Zika virus infection. Rev Soc Bras Med Trop 2021; 54:e2020609. [PMID: 34008724 PMCID: PMC8210481 DOI: 10.1590/0037-8682-609-2020] [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] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
This article addresses the vector, sexual and vertical transmissions of the Zika virus, a topic covered in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Although in Brazil Zika virus is transmitted more predominantly by Aedes aegypti, the vertical and sexual transmission routes are of significant importance for reproductive health. Sexual transmission demands specific prophylactic interventions, including the use of male or female condoms, especially among couples in a risk situation and planning pregnancy. Vertical transmission is linked to severe structural abnormalities of the central nervous system, and there is still no vaccine or known pharmacological resources that can prevent it. As the disease is predominantly asymptomatic, failure to comply with the basic principles of care and guidelines associated with the spread of the infection transcends the severity of the disease's symptoms. Although in Brazil Zika virus is predominantly transmitted by the Aedes aegypti mosquito, vertical and sexual transmission routes are important for reproductive health. Vertical transmission causes severe central nervous system structural abnormalities.
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Affiliation(s)
- Geraldo Duarte
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil
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10
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Duarte G, Miranda AE, Bermúdez XPD, Saraceni V, Martínez-Espinosa FE. [Brazilian Protocol for Sexually Transmitted Infections 2020: Zika virus infection]. ACTA ACUST UNITED AC 2021; 30:e2020609. [PMID: 33729407 DOI: 10.1590/s1679-4974202100017.esp1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023]
Abstract
This article addresses vector, sexual and vertical transmission of Zika virus, a topic covered in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Although in Brazil Zika virus is transmitted most predominantly by Aedes aegypti, the vertical and sexual transmission routes are of significant importance for reproductive health. Sexual transmission demands the use of specific prophylactic interventions, including the use of male or female condoms, especially among couples planning pregnancy. Vertical transmission is linked to severe structural abnormalities of the central nervous system and there is still no vaccine or known pharmacological resources that can prevent it. As the disease is predominantly asymptomatic, failure to comply with basic principles of care and guidelines related to the spread of infection transcends the severity of the symptoms of the disease.
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Affiliation(s)
- Geraldo Duarte
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | | | | | - Valeria Saraceni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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11
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Ipekci AM, Buitrago-Garcia D, Meili KW, Krauer F, Prajapati N, Thapa S, Wildisen L, Araujo-Chaveron L, Baumann L, Shah S, Whiteley T, Solís-García G, Tsotra F, Zhelyazkov I, Imeri H, Low N, Counotte MJ. Outbreaks of publications about emerging infectious diseases: the case of SARS-CoV-2 and Zika virus. BMC Med Res Methodol 2021; 21:50. [PMID: 33706715 PMCID: PMC7948668 DOI: 10.1186/s12874-021-01244-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Outbreaks of infectious diseases generate outbreaks of scientific evidence. In 2016 epidemics of Zika virus emerged, and in 2020, a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a pandemic of coronavirus disease 2019 (COVID-19). We compared patterns of scientific publications for the two infections to analyse the evolution of the evidence. METHODS We annotated publications on Zika virus and SARS-CoV-2 that we collected using living evidence databases according to study design. We used descriptive statistics to categorise and compare study designs over time. RESULTS We found 2286 publications about Zika virus in 2016 and 21,990 about SARS-CoV-2 up to 24 May 2020, of which we analysed a random sample of 5294 (24%). For both infections, there were more epidemiological than laboratory science studies. Amongst epidemiological studies for both infections, case reports, case series and cross-sectional studies emerged first, cohort and case-control studies were published later. Trials were the last to emerge. The number of preprints was much higher for SARS-CoV-2 than for Zika virus. CONCLUSIONS Similarities in the overall pattern of publications might be generalizable, whereas differences are compatible with differences in the characteristics of a disease. Understanding how evidence accumulates during disease outbreaks helps us understand which types of public health questions we can answer and when.
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Affiliation(s)
- Aziz Mert Ipekci
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Diana Buitrago-Garcia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | | | - Fabienne Krauer
- Centre for Ecological and Evolutionary Synthesis (CEES), University of Oslo, Oslo, Norway
| | - Nirmala Prajapati
- École des Hautes Études en Santé Publique (EHESP), Saint Denis, France
| | - Shabnam Thapa
- Institute of Public Health, Jagiellonian University Medical College, Kraków, Poland
| | - Lea Wildisen
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Lukas Baumann
- Department of Internal Medicine, Kantonsspital Olten, Olten, Switzerland
| | - Sanam Shah
- École des Hautes Études en Santé Publique (EHESP), Saint Denis, France
| | - Tessa Whiteley
- École des Hautes Études en Santé Publique (EHESP), Saint Denis, France
| | - Gonzalo Solís-García
- Pediatrics Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Foteini Tsotra
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ivan Zhelyazkov
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Hira Imeri
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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12
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Abstract
The extrinsic and autonomic nervous system intricately controls the major functions of the gastrointestinal tract through the enteric nervous system; these include motor, secretory, sensory, storage, and excretory functions. Disorders of the nervous system affecting gastrointestinal tract function manifest primarily as abnormalities in motor (rather than secretory) functions. Common gastrointestinal symptoms in neurologic disorders include sialorrhea, dysphagia, gastroparesis, intestinal pseudo-obstruction, constipation, diarrhea, and fecal incontinence. Diseases of the entire neural axis ranging from the cerebral hemispheres to the peripheral autonomic nerves can result in gastrointestinal motility disorders. The most common neurologic diseases affecting gastrointestinal function are stroke, parkinsonism, multiple sclerosis, and diabetic neuropathy. Diagnosis involves identification of the neurologic disease and its distribution, and documentation of segmental gut dysfunction, typically using noninvasive imaging, transit measurements, or intraluminal measurements of pressure activity and coordination of motility. Apart from treatment of the underlying neurologic disease, management focuses on restoration of normal hydration and nutrition and pharmacologic treatment of the gut neuromuscular disorder.
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13
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Lim ZJ, Subramaniam A, Ponnapa Reddy M, Blecher G, Kadam U, Afroz A, Billah B, Ashwin S, Kubicki M, Bilotta F, Curtis JR, Rubulotta F. Case Fatality Rates for Patients with COVID-19 Requiring Invasive Mechanical Ventilation. A Meta-analysis. Am J Respir Crit Care Med 2021; 203:54-66. [PMID: 33119402 PMCID: PMC7781141 DOI: 10.1164/rccm.202006-2405oc] [Citation(s) in RCA: 218] [Impact Index Per Article: 72.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Rationale: Initial reports of case fatality rates (CFRs) among adults with coronavirus disease (COVID-19) receiving invasive mechanical ventilation (IMV) are highly variable.Objectives: To examine the CFR of patients with COVID-19 receiving IMV.Methods: Two authors independently searched PubMed, Embase, medRxiv, bioRxiv, the COVID-19 living systematic review, and national registry databases. The primary outcome was the "reported CFR" for patients with confirmed COVID-19 requiring IMV. "Definitive hospital CFR" for patients with outcomes at hospital discharge was also investigated. Finally, CFR was analyzed by patient age, geographic region, and study quality on the basis of the Newcastle-Ottawa Scale.Measurements and Results: Sixty-nine studies were included, describing 57,420 adult patients with COVID-19 who received IMV. Overall reported CFR was estimated as 45% (95% confidence interval [CI], 39-52%). Fifty-four of 69 studies stated whether hospital outcomes were available but provided a definitive hospital outcome on only 13,120 (22.8%) of the total IMV patient population. Among studies in which age-stratified CFR was available, pooled CFR estimates ranged from 47.9% (95% CI, 46.4-49.4%) in younger patients (age ≤40 yr) to 84.4% (95% CI, 83.3-85.4%) in older patients (age >80 yr). CFR was also higher in early COVID-19 epicenters. Overall heterogeneity is high (I2 >90%), with nonsignificant Egger's regression test suggesting no publication bias.Conclusions: Almost half of patients with COVID-19 receiving IMV died based on the reported CFR, but variable CFR reporting methods resulted in a wide range of CFRs between studies. The reported CFR was higher in older patients and in early pandemic epicenters, which may be influenced by limited ICU resources. Reporting of definitive outcomes on all patients would facilitate comparisons between studies.Systematic review registered with PROSPERO (CRD42020186997).
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Affiliation(s)
- Zheng Jie Lim
- Department of Intensive Care Medicine, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Ashwin Subramaniam
- Department of Intensive Care Medicine, Peninsula Health, Frankston, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences
| | - Mallikarjuna Ponnapa Reddy
- Department of Intensive Care Medicine, Peninsula Health, Frankston, Victoria, Australia
- School of Clinical Sciences at Monash Health, and
| | - Gabriel Blecher
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Intensive Care Medicine, Calvary Hospital Canberra, Canberra, Australia
| | - Umesh Kadam
- Emergency Department, Monash Health, Clayton, Victoria, Australia
- Department of Intensive Care Medicine, Monash Health Casey Hospital, Casey, Victoria, Australia
| | - Afsana Afroz
- Department of Intensive Care Medicine, Werribee Mercy Hospital, Werribee, Victoria, Australia
- Center for Integrated Critical Care, Department of Medicine and Radiology, Melbourne Medical School, Melbourne, Victoria, Australia
| | - Baki Billah
- Department of Intensive Care Medicine, Werribee Mercy Hospital, Werribee, Victoria, Australia
| | - Sushma Ashwin
- Department of Health Economics, School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia
| | - Mark Kubicki
- Department of Intensive Care Medicine, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Federico Bilotta
- Department of Neuroanaesthesia and Neurocritical Care, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - J. Randall Curtis
- Cambia Palliative Care Center of Excellence and
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington; and
| | - Francesca Rubulotta
- Department of Intensive Care Medicine, Charing Cross Hospital Imperial College National Health Service Trust, London, United Kingdom
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14
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Freitas DA, Souza-Santos R, Carvalho LMA, Barros WB, Neves LM, Brasil P, Wakimoto MD. Congenital Zika syndrome: A systematic review. PLoS One 2020; 15:e0242367. [PMID: 33320867 PMCID: PMC7737899 DOI: 10.1371/journal.pone.0242367] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The signs and symptoms of Zika virus infection are usually mild and self-limited. However, the disease has been linked to neurological complications such as Guillain-Barré syndrome and peripheral nerve involvement, and also to abortion and fetal deaths due to vertical transmission, resulting in various congenital malformations in newborns, including microcephaly. This review aimed to describe the o signs and symptoms that characterize the congenital Zika syndrome. METHODS AND FINDINGS A systematic review was performed with a protocol and described according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search strategy yielded 2,048 studies. After the exclusion of duplicates and application of inclusion criteria, 46 studies were included. The main signs and symptoms associated with the congenital Zika syndrome were microcephaly, parenchymal or cerebellar calcifications, ventriculomegaly, central nervous system hypoplasia or atrophy, arthrogryposis, ocular findings in the posterior and anterior segments, abnormal visual function and low birthweight for gestational age. CONCLUSIONS Zika virus infection during pregnancy can cause a series of changes in the growth and development of children, while impacting the healthcare system due to the severity of cases. Our findings outline the disease profile in newborns and infants and may contribute to the development and updating of more specific clinical protocols.
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Affiliation(s)
- Danielle A. Freitas
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Reinaldo Souza-Santos
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Liege M. A. Carvalho
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Wagner B. Barros
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Luiza M. Neves
- Fernandes Figueira Institute, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Patrícia Brasil
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Mayumi D. Wakimoto
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
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15
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Martinez SS, Pardo‐Hernandez H, Palacios C. Feeding modifications and additional primary caregiver support for infants exposed to Zika virus or diagnosed with congenital Zika syndrome: a rapid review of the evidence. Trop Med Int Health 2020; 25:1353-1361. [PMID: 32881216 PMCID: PMC7756506 DOI: 10.1111/tmi.13482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Infants exposed to Zika virus (ZIKV) or diagnosed with congenital Zika syndrome (CZVS) may present dysphagia, regurgitation and other feeding difficulties. They may require special feeding practices to minimise the risk of mortality, morbidity and developmental problems. Improving knowledge, skills and behaviours of caregivers may preserve health, maximise development and promote quality of life among affected infants. We reviewed intervention studies of modified feeding practices and additional primary caregiver support to improve outcomes among infants 0 to 12 months of age exposed to ZIKV or diagnosed with CZVS. METHODS Rapid review and meta-analysis. We searched PubMed/MEDLINE and contacted experts. The search is current to 18 July 2020. We planned a meta-analysis using fixed-effect models; if unfeasible, we intended to summarise studies narratively. We planned to assess risk of bias of included studies and quality of evidence using Cochrane guidance. RESULTS We identified 42 records for title and abstract screening; 14 were eligible for full-text assessment. Among these, no intervention studies were found. Eight observational studies reported on the nutritional status, feeding practices and outcomes among infants affected by ZIKV or diagnosed with CZVS. They are presented and discussed to provide a basis for future research. CONCLUSIONS While no intervention studies were found, evidence from eight observational studies highlights the need for early nutrition interventions and caregiver support among infants affected by ZIKV or diagnosed with CZSV. More research is needed to assess whether modifications of feeding practices and provision of additional primary caregiver support will impact outcomes of interest.
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Affiliation(s)
| | | | - Cristina Palacios
- Department of Dietetics and NutritionFlorida International UniversityMiamiFLUSA
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16
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Diosa-Toro M, Prasanth KR, Bradrick SS, Garcia Blanco MA. Role of RNA-binding proteins during the late stages of Flavivirus replication cycle. Virol J 2020; 17:60. [PMID: 32334603 PMCID: PMC7183730 DOI: 10.1186/s12985-020-01329-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/11/2020] [Indexed: 12/21/2022] Open
Abstract
The genus Flavivirus encompasses several worldwide-distributed arthropod-borne viruses including, dengue virus, Japanese encephalitis virus, West Nile virus, yellow fever virus, Zika virus, and tick-borne encephalitis virus. Infection with these viruses manifest with symptoms ranging from febrile illness to life- threatening hypotensive shock and encephalitis. Therefore, flaviviruses pose a great risk to public health. Currently, preventive measures are falling short to control epidemics and there are no antivirals against any Flavivirus.Flaviviruses carry a single stranded positive-sense RNA genome that plays multiple roles in infected cells: it is translated into viral proteins, used as template for genome replication, it is the precursor of the subgenomic flaviviral RNA and it is assembled into new virions. Furthermore, viral RNA genomes are also packaged into extracellular vesicles, e.g. exosomes, which represent an alternate mode of virus dissemination.Because RNA molecules are at the center of Flavivirus replication cycle, viral and host RNA-binding proteins (RBPs) are critical determinants of infection. Numerous studies have revealed the function of RBPs during Flavivirus infection, particularly at the level of RNA translation and replication. These proteins, however, are also critical participants at the late stages of the replication cycle. Here we revise the function of host RBPs and the viral proteins capsid, NS2A and NS3, during the packaging of viral RNA and the assembly of new virus particles. Furthermore, we go through the evidence pointing towards the importance of host RBPs in mediating cellular RNA export with the idea that the biogenesis of exosomes harboring Flavivirus RNA would follow an analogous pathway.
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Affiliation(s)
- Mayra Diosa-Toro
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore.
| | - K Reddisiva Prasanth
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX, USA
| | - Shelton S Bradrick
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX, USA
- Global Health, Surveillance & Diagnostics Group, MRIGlobal, Kansas City, MO, USA
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, USA
| | - Mariano A Garcia Blanco
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore.
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX, USA.
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, USA.
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17
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Guillain-Barré syndrome and antecedent cytomegalovirus infection, USA 2009-2015. Neurol Sci 2019; 41:885-891. [PMID: 31828680 DOI: 10.1007/s10072-019-04156-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/14/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe incidence and clinical characteristics of cases of Guillain-Barré syndrome (GBS) in the USA during 2009-2015, and characteristics of GBS cases with antecedent cytomegalovirus (CMV) infection among persons with employer-sponsored insurance. METHODS We analyzed medical claims from IBM Watson MarketScan® databases. GBS patients were defined as enrollees with an inpatient claim with GBS as the principal diagnosis code, based on ICD-9 or ICD-10, and ≥ 1 claim for lumbar puncture or EMG/nerve conduction study. We assessed intensive care unit (ICU) hospitalization, intubation, dysautonomia, and death. We also assessed selected infectious illness within 60 days prior to the first GBS-coded inpatient claim. RESULTS We identified 3486 GBS patients; annual incidence was 1.0-1.2/100,000 persons during 2009-2015. GBS incidence was higher in males (1.2/100,000) than in females (0.9/100,000) (p = 0.006) and increased with age, from 0.4/100,000 in persons 0-17 years old to 2.1/100,000 in persons ≥ 65 years old (p < 0.001). Half of GBS patients were hospitalized in the ICU, 8% were intubated, 2% developed dysautonomia, and 1% died. Half had a claim for antecedent illness, but only 125 (3.5%) had a claim for specific infectious pathogens. The mean age among 18 GBS patients with antecedent CMV infection was 39 years versus 47 years among those without antecedent CMV infection (p = 0.038). CONCLUSIONS Incidence of GBS using a large national claims database was comparable to that reported in the literature, but cases appeared to be less severe. Half of GBS patients reported prior infectious illness, but only a minority had a specific pathogen identified.
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18
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Counotte MJ, Althaus CL, Low N, Riou J. Impact of age-specific immunity on the timing and burden of the next Zika virus outbreak. PLoS Negl Trop Dis 2019; 13:e0007978. [PMID: 31877200 PMCID: PMC6948816 DOI: 10.1371/journal.pntd.0007978] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/08/2020] [Accepted: 12/08/2019] [Indexed: 01/27/2023] Open
Abstract
The 2015-2017 epidemics of Zika virus (ZIKV) in the Americas caused widespread infection, followed by protective immunity. The timing and burden of the next Zika virus outbreak remains unclear. We used an agent-based model to simulate the dynamics of age-specific immunity to ZIKV, and predict the future age-specific risk using data from Managua, Nicaragua. We also investigated the potential impact of a ZIKV vaccine. Assuming lifelong immunity, the risk of a ZIKV outbreak will remain low until 2035 and rise above 50% in 2047. The imbalance in age-specific immunity implies that people in the 15-29 age range will be at highest risk of infection during the next ZIKV outbreak, increasing the expected number of congenital abnormalities. ZIKV vaccine development and licensure are urgent to attain the maximum benefit in reducing the population-level risk of infection and the risk of adverse congenital outcomes. This urgency increases if immunity is not lifelong.
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Affiliation(s)
- Michel J. Counotte
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Christian L. Althaus
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Julien Riou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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19
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Ximenes R, Ramsay LC, Miranda RN, Morris SK, Murphy K, Sander B. Health outcomes associated with Zika virus infection in humans: a systematic review of systematic reviews. BMJ Open 2019; 9:e032275. [PMID: 31685512 PMCID: PMC6858219 DOI: 10.1136/bmjopen-2019-032275] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE With the emergence of Zika virus (ZIKV) disease in Central and South America in the mid-2010s and recognition of the teratogenic effects of congenital exposure to ZIKV, there has been a substantial increase in new research published on ZIKV. Our objective is to synthesise the literature on health outcomes associated with ZIKV infection in humans. METHODS We conducted a systematic review (SR) of SRs following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE, Embase, Cochrane and LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) databases from inception to 22 July 2019, and included SRs that reported ZIKV-associated health outcomes. Three independent reviewers selected eligible studies, extracted data and assessed the quality of included SRs using the AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews 2) tool. Conflicts were resolved by consensus or consultation with a third reviewer. RESULTS The search yielded 1382 unique articles, of which 21 SRs met our inclusion criteria. The 21 SRs ranged from descriptive to quantitative data synthesis, including four meta-analyses. The most commonly reported ZIKV-associated manifestations and health outcomes were microcephaly, congenital abnormalities, brain abnormalities, neonatal death and Guillain-Barré syndrome. The included reviews were highly heterogeneous. The overall quality of the SRs was critically low with all studies having more than one critical weakness. CONCLUSION The evolving nature of the literature on ZIKV-associated health outcomes, together with the critically low quality of existing SRs, demonstrates the need for high-quality SRs to guide patient care and inform policy decision making. PROSPERO REGISTRATION NUMBER CRD42018091087.
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Affiliation(s)
- Raphael Ximenes
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Lauren C Ramsay
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rafael Neves Miranda
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Shaun K Morris
- Division of Infectious Diseases and Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kellie Murphy
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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20
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Counotte MJ, Meili KW, Taghavi K, Calvet G, Sejvar J, Low N. Zika virus infection as a cause of congenital brain abnormalities and Guillain-Barré syndrome: A living systematic review. F1000Res 2019; 8:1433. [PMID: 31754425 PMCID: PMC6852328 DOI: 10.12688/f1000research.19918.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 01/10/2023] Open
Abstract
Background: The Zika virus (ZIKV) caused a large outbreak in the Americas leading to the declaration of a Public Health Emergency of International Concern in February 2016. A causal relation between infection and adverse congenital outcomes such as microcephaly was declared by the World Health Organization (WHO) informed by a systematic review structured according to a framework of ten dimensions of causality, based on the work of Bradford Hill. Subsequently, the evidence has continued to accumulate, which we incorporate in regular updates of the original work, rendering it a living systematic review. Methods: We present an update of our living systematic review on the causal relation between ZIKV infection and adverse congenital outcomes and between ZIKV and GBS for four dimensions of causality: strength of association, dose-response, specificity, and consistency. We assess the evidence published between January 18, 2017 and July 1, 2019. Results: We found that the strength of association between ZIKV infection and adverse outcomes from case-control studies differs according to whether exposure to ZIKV is assessed in the mother (OR 3.8, 95% CI: 1.7-8.7, I
2=19.8%) or the foetus/infant (OR 37.4, 95% CI: 11.0-127.1, I
2=0%). In cohort studies, the risk of congenital abnormalities was 3.5 times higher after ZIKV infection (95% CI: 0.9-13.5, I
2=0%). The strength of association between ZIKV infection and GBS was higher in studies that enrolled controls from hospital (OR: 55.8, 95% CI: 17.2-181.7, I
2=0%) than in studies that enrolled controls at random from the same community or household (OR: 2.0, 95% CI: 0.8-5.4, I
2=74.6%). In case-control studies, selection of controls from hospitals could have biased results. Conclusions: The conclusions that ZIKV infection causes adverse congenital outcomes and GBS are reinforced with the evidence published between January 18, 2017 and July 1, 2019.
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Affiliation(s)
| | - Kaspar Walter Meili
- Institute of Social and Preventive Medicine, University Bern, Bern, Switzerland
| | - Katayoun Taghavi
- Institute of Social and Preventive Medicine, University Bern, Bern, Switzerland
| | - Guilherme Calvet
- Acute Febrile Illnesses Laboratory, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - James Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicola Low
- Institute of Social and Preventive Medicine, University Bern, Bern, Switzerland
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21
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Wilder-Smith A, Wei Y, de Araújo TVB, VanKerkhove M, Turchi Martelli CM, Turchi MD, Teixeira M, Tami A, Souza J, Sousa P, Soriano-Arandes A, Soria-Segarra C, Sanchez Clemente N, Rosenberger KD, Reveiz L, Prata-Barbosa A, Pomar L, Pelá Rosado LE, Perez F, Passos SD, Nogueira M, Noel TP, Moura da Silva A, Moreira ME, Morales I, Miranda Montoya MC, Miranda-Filho DDB, Maxwell L, Macpherson CNL, Low N, Lan Z, LaBeaud AD, Koopmans M, Kim C, João E, Jaenisch T, Hofer CB, Gustafson P, Gérardin P, Ganz JS, Dias ACF, Elias V, Duarte G, Debray TPA, Cafferata ML, Buekens P, Broutet N, Brickley EB, Brasil P, Brant F, Bethencourt S, Benedetti A, Avelino-Silva VL, Ximenes RADA, Alves da Cunha A, Alger J. Understanding the relation between Zika virus infection during pregnancy and adverse fetal, infant and child outcomes: a protocol for a systematic review and individual participant data meta-analysis of longitudinal studies of pregnant women and their infants and children. BMJ Open 2019; 9:e026092. [PMID: 31217315 PMCID: PMC6588966 DOI: 10.1136/bmjopen-2018-026092] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Zika virus (ZIKV) infection during pregnancy is a known cause of microcephaly and other congenital and developmental anomalies. In the absence of a ZIKV vaccine or prophylactics, principal investigators (PIs) and international leaders in ZIKV research have formed the ZIKV Individual Participant Data (IPD) Consortium to identify, collect and synthesise IPD from longitudinal studies of pregnant women that measure ZIKV infection during pregnancy and fetal, infant or child outcomes. METHODS AND ANALYSIS We will identify eligible studies through the ZIKV IPD Consortium membership and a systematic review and invite study PIs to participate in the IPD meta-analysis (IPD-MA). We will use the combined dataset to estimate the relative and absolute risk of congenital Zika syndrome (CZS), including microcephaly and late symptomatic congenital infections; identify and explore sources of heterogeneity in those estimates and develop and validate a risk prediction model to identify the pregnancies at the highest risk of CZS or adverse developmental outcomes. The variable accuracy of diagnostic assays and differences in exposure and outcome definitions means that included studies will have a higher level of systematic variability, a component of measurement error, than an IPD-MA of studies of an established pathogen. We will use expert testimony, existing internal and external diagnostic accuracy validation studies and laboratory external quality assessments to inform the distribution of measurement error in our models. We will apply both Bayesian and frequentist methods to directly account for these and other sources of uncertainty. ETHICS AND DISSEMINATION The IPD-MA was deemed exempt from ethical review. We will convene a group of patient advocates to evaluate the ethical implications and utility of the risk stratification tool. Findings from these analyses will be shared via national and international conferences and through publication in open access, peer-reviewed journals. TRIAL REGISTRATION NUMBER PROSPERO International prospective register of systematic reviews (CRD42017068915).
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Affiliation(s)
- Annelies Wilder-Smith
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Yinghui Wei
- Centre for Mathematical Sciences, University of Plymouth, Plymouth, UK
| | | | - Maria VanKerkhove
- Health Emergencies Programme, Organisation mondiale de la Sante, Geneve, Switzerland
| | | | - Marília Dalva Turchi
- Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiânia, Brazil
| | - Mauro Teixeira
- Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Adriana Tami
- Department of Medical Microbiology, University Medical Center Groningen, Groningen, The Netherlands
| | - João Souza
- Department of Social Medicine, University of São Paulo, São Paulo, Brazil
| | - Patricia Sousa
- Reference Center for Neurodevelopment, Assistance, and Rehabilitation of Children, State Department of Health of Maranhão, Sao Luís, Brazil
| | | | | | | | - Kerstin Daniela Rosenberger
- Department of Infectious Diseases, Section Clinical Tropical Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Ludovic Reveiz
- Evidence and Intelligence for Action in Health, Pan American Health Organization, Washington, District of Columbia, USA
| | - Arnaldo Prata-Barbosa
- Department of Pediatrics, D’Or Institute for Research & Education, Rio de Janeiro, Brazil
| | - Léo Pomar
- Department of Obstetrics and Gynecology, Centre Hospitalier de l’Ouest Guyanais, Saint-Laurent du Maroni, French Guiana
| | | | - Freddy Perez
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization, Washington, District of Columbia, USA
| | | | - Mauricio Nogueira
- Faculdade de Medicina de Sao Jose do Rio Preto, Department of Dermatologic Diseases, São José do Rio Preto, Brazil
| | - Trevor P. Noel
- Windward Islands Research and Education Foundation, St. George’s University, True Blue Point, Grenada
| | - Antônio Moura da Silva
- Department of Public Health, Universidade Federal do Maranhão – São Luís, São Luís, Brazil
| | | | - Ivonne Morales
- Department of Infectious Diseases, Section Clinical Tropical Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | | | | | - Lauren Maxwell
- Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
| | - Calum N. L. Macpherson
- Windward Islands Research and Education Foundation, St. George’s University, True Blue Point, Grenada
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Zhiyi Lan
- McGill University Health Centre, McGill University, Montréal, Canada
| | | | - Marion Koopmans
- Department of Virology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Caron Kim
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Esaú João
- Department of Infectious Diseases, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Thomas Jaenisch
- Department of Infectious Diseases, Section Clinical Tropical Medicine, UniversitatsKlinikum Heidelberg, Heidelberg, Germany
| | - Cristina Barroso Hofer
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paul Gustafson
- Statistics, University of British Columbia, British Columbia, Vancouver, Canada
| | - Patrick Gérardin
- INSERM CIC1410 Clinical Epidemiology, CHU La Réunion, Saint Pierre, Réunion
- UM 134 PIMIT (CNRS 9192, INSERM U1187, IRD 249, Université de la Réunion), Universite de la Reunion, Sainte Clotilde, Réunion
| | | | - Ana Carolina Fialho Dias
- Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Vanessa Elias
- Sustainable Development and Environmental Health, Pan American Health Organization, Washington, District of Columbia, USA
| | - Geraldo Duarte
- Department of Gynecology and Obstetrics, University of São Paulo, São Paulo, Brazil
| | - Thomas Paul Alfons Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - María Luisa Cafferata
- Mother and Children Health Research Department, Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
| | - Pierre Buekens
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Elizabeth B. Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Patrícia Brasil
- Instituto de pesquisa Clínica Evandro Chagas, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Fátima Brant
- Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sarah Bethencourt
- Facultad de Ciencias de la Salud, Universidad de Carabobo, Valencia, Carabobo, Bolivarian Republic of Venezuela
| | - Andrea Benedetti
- Departments of Medicine and of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Vivian Lida Avelino-Silva
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | | | | | - Jackeline Alger
- Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
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22
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Nelson EJ, Luetke MC, Kianersi S, Willis E, Rosenberg M. Knowledge and perceptions of Zika virus transmission in the community of Puerto Plata, Dominican Republic. BMC Infect Dis 2019; 19:339. [PMID: 31014275 PMCID: PMC6480501 DOI: 10.1186/s12879-019-3952-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Zika virus is associated with increased cases of both microcephaly and Guillain-Barré syndrome. Community knowledge, perceptions and practices to prevent infection with the Zika virus are not well understood, particularly among high risk populations living in resource-poor and Zika-endemic areas. Our objective was to assess knowledge of symptoms, health effects and prevention practices associated with Zika virus in rural communities on the northern coast of the Dominican Republic. Methods Study participants were contacted while attending community events such as free medical clinics and invited to be interviewed regarding their knowledge, attitudes, and perceptions of Zika virus using the World Health Organization’s Zika survey tool. Results Of the 75 Dominicans that participated, 33% did not know who could become infected with Zika. In addition, only 40% of respondents were able to identify mosquitoes or sexual transmission as the primary routes of infection though 51% of respondents thought that Zika was an important issue in their community. Conclusions This study found that general knowledge regarding the basic risks and transmission of Zika were not well understood among a sample of rural Dominicans. Our findings highlight disparities in knowledge and perception of risk from Zika in rural areas compared to previous studies conducted in the Dominican Republic. Education about the basic risks and transmission of Zika are critically needed in these remote populations to reduce Zika transmission.
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Affiliation(s)
- Erik J Nelson
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health - Bloomington, 1025 E. 7th Street, Room C03, Bloomington, IN, 47405, USA.
| | - Maya C Luetke
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health - Bloomington, 1025 E. 7th Street, Room C03, Bloomington, IN, 47405, USA
| | - Sina Kianersi
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health - Bloomington, 1025 E. 7th Street, Room C03, Bloomington, IN, 47405, USA
| | - Erik Willis
- Department of Spanish and Portuguese, Indiana University -Bloomington, Bloomington, Indiana, USA
| | - Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health - Bloomington, 1025 E. 7th Street, Room C03, Bloomington, IN, 47405, USA
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