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De Santis O, Bouscaren N, Flahault A. Asymptomatic dengue infection rate: A systematic literature review. Heliyon 2023; 9:e20069. [PMID: 37809992 PMCID: PMC10559824 DOI: 10.1016/j.heliyon.2023.e20069] [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: 12/21/2022] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives Dengue infection is spreading worldwide. The clinical spectrum is broad and includes asymptomatic infections. This review provides an overview of the different proportions of asymptomatic infections described in epidemiological studies according to definitions, study designs, and detection methods. Methods Medline and Embase databases were searched without restriction of date or language. Studies were included if they reported data on the incidence or prevalence of asymptomatic dengue infections. The data were summarized and classified according to the definitions of the term 'asymptomatic'. Results A total of 74 studies were included. The mean proportion of asymptomatic infections among dengue-infected persons was 54% in 50 included studies. The prevalence of dengue infections detected in healthy persons was 0.2% in 24 included studies. The term 'asymptomatic' has been used to refer to 'clinically undetectable infection', but also to 'undiagnosed infection' or 'mild infection'. Only 8% were clinically undetectable laboratory-confirmed dengue infections. Conclusion The proportion of asymptomatic dengue infections varied greatly. Studies proving data on clinically undetectable laboratory-confirmed dengue infections were very few, but provided consistent results of low proportions of asymptomatic infections. These data challenge the assumption that the majority of dengue cases are asymptomatic.
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Affiliation(s)
- Olga De Santis
- Institute of Global Health, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland
- Direction de la recherche, de l'innovation et de la coopération internationale, CHU de La Réunion, 97410, Saint-Pierre, France
| | - Nicolas Bouscaren
- Service de Santé Publique et Soutien à la Recherche, Inserm CIC1410, CHU de La Réunion, 97410 Saint-Pierre, France
| | - Antoine Flahault
- Institute of Global Health, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland
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2
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Man O, Kraay A, Thomas R, Trostle J, Lee GO, Robbins C, Morrison AC, Coloma J, Eisenberg JNS. Characterizing dengue transmission in rural areas: A systematic review. PLoS Negl Trop Dis 2023; 17:e0011333. [PMID: 37289678 PMCID: PMC10249895 DOI: 10.1371/journal.pntd.0011333] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Dengue has historically been considered an urban disease associated with dense human populations and the built environment. Recently, studies suggest increasing dengue virus (DENV) transmission in rural populations. It is unclear whether these reports reflect recent spread into rural areas or ongoing transmission that was previously unnoticed, and what mechanisms are driving this rural transmission. We conducted a systematic review to synthesize research on dengue in rural areas and apply this knowledge to summarize aspects of rurality used in current epidemiological studies of DENV transmission given changing and mixed environments. We described how authors defined rurality and how they defined mechanisms for rural dengue transmission. We systematically searched PubMed, Web of Science, and Embase for articles evaluating dengue prevalence or cumulative incidence in rural areas. A total of 106 articles published between 1958 and 2021 met our inclusion criteria. Overall, 56% (n = 22) of the 48 estimates that compared urban and rural settings reported rural dengue incidence as being as high or higher than in urban locations. In some rural areas, the force of infection appears to be increasing over time, as measured by increasing seroprevalence in children and thus likely decreasing age of first infection, suggesting that rural dengue transmission may be a relatively recent phenomenon. Authors characterized rural locations by many different factors, including population density and size, environmental and land use characteristics, and by comparing their context to urban areas. Hypothesized mechanisms for rural dengue transmission included travel, population size, urban infrastructure, vector and environmental factors, among other mechanisms. Strengthening our understanding of the relationship between rurality and dengue will require a more nuanced definition of rurality from the perspective of DENV transmission. Future studies should focus on characterizing details of study locations based on their environmental features, exposure histories, and movement dynamics to identify characteristics that may influence dengue transmission.
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Affiliation(s)
- Olivia Man
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Alicia Kraay
- Department of Kinesiology and Community Health, University of Illinois, Urbana, Illinois, United States of America
- Institution for Genomic Biology, University of Illinois, Urbana, Illinois, United States of America
| | - Ruth Thomas
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - James Trostle
- Department of Anthropology, Trinity College, Hartford, Connecticut, United States of America
| | - Gwenyth O. Lee
- Rutgers Global Health Institute, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, United States of America
- Rutgers Department of Biostatistics and Epidemiology, School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, United States of America
| | - Charlotte Robbins
- Department of Anthropology, Trinity College, Hartford, Connecticut, United States of America
| | - Amy C. Morrison
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, California, United States of America
| | - Josefina Coloma
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Joseph N. S. Eisenberg
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
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3
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Wegman AD, Fang H, Rothman AL, Thomas SJ, Endy TP, McCracken MK, Currier JR, Friberg H, Gromowski GD, Waickman AT. Monomeric IgA Antagonizes IgG-Mediated Enhancement of DENV Infection. Front Immunol 2021; 12:777672. [PMID: 34899736 PMCID: PMC8654368 DOI: 10.3389/fimmu.2021.777672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/08/2021] [Indexed: 01/05/2023] Open
Abstract
Dengue virus (DENV) is a prevalent human pathogen, infecting approximately 400 million individuals per year and causing symptomatic disease in approximately 100 million. A distinct feature of dengue is the increased risk for severe disease in some individuals with preexisting DENV-specific immunity. One proposed mechanism for this phenomenon is antibody-dependent enhancement (ADE), in which poorly-neutralizing IgG antibodies from a prior infection opsonize DENV to increase infection of Fc gamma receptor-bearing cells. While IgM and IgG are the most commonly studied DENV-reactive antibody isotypes, our group and others have described the induction of DENV-specific serum IgA responses during dengue. We hypothesized that monomeric IgA would be able to neutralize DENV without the possibility of ADE. To test this, we synthesized IgG and IgA versions of two different DENV-reactive monoclonal antibodies. We demonstrate that isotype-switching does not affect the antigen binding and neutralization properties of the two mAbs. We show that DENV-reactive IgG, but not IgA, mediates ADE in Fc gamma receptor-positive K562 cells. Furthermore, we show that IgA potently antagonizes the ADE activity of IgG. These results suggest that levels of DENV-reactive IgA induced by DENV infection might regulate the overall IgG mediated ADE activity of DENV-immune plasma in vivo, and may serve as a predictor of disease risk.
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Affiliation(s)
- Adam D Wegman
- Department of Microbiology and Immunology, State University of New York Upstate Medical University, Syracuse, NY, United States
| | - Hengsheng Fang
- Department of Microbiology and Immunology, State University of New York Upstate Medical University, Syracuse, NY, United States
| | - Alan L Rothman
- Department of Cell and Molecular Biology, Institute for Immunology and Informatics, University of Rhode Island, Providence, RI, United States
| | - Stephen J Thomas
- Department of Microbiology and Immunology, State University of New York Upstate Medical University, Syracuse, NY, United States.,Institute for Global Health and Translational Sciences, State University of New York Upstate Medical University, Syracuse, NY, United States
| | - Timothy P Endy
- Department of Microbiology and Immunology, State University of New York Upstate Medical University, Syracuse, NY, United States
| | - Michael K McCracken
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Jeffrey R Currier
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Heather Friberg
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Gregory D Gromowski
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Adam T Waickman
- Department of Microbiology and Immunology, State University of New York Upstate Medical University, Syracuse, NY, United States.,Institute for Global Health and Translational Sciences, State University of New York Upstate Medical University, Syracuse, NY, United States
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4
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A Cluster of Dengue Cases in Travelers: A Clinical Series from Thailand. Trop Med Infect Dis 2021; 6:tropicalmed6030152. [PMID: 34449752 PMCID: PMC8396219 DOI: 10.3390/tropicalmed6030152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 12/19/2022] Open
Abstract
Dengue is an overlooked tropical disease for which billions of people are at risk. The disease, caused by a Flavivirus with four distinct serotypes, is transmitted primarily by urban Aedes mosquito species. The infection leads to a spectrum of clinical manifestations, with the majority being asymptomatic. Primary dengue fever and, to a greater extent, a subsequent infection with a different serotype is associated with increased severity. Increased global travel and recreational tourism expose individuals naïve to the dengue viruses, the most common arboviral infections among travelers. We describe a cluster of possible primary acute dengue infections in a group of 12 individuals who presented to Bangkok Hospital for Tropical Diseases in 2017. Infection was confirmed by dengue NS1 antigen and multiplex real-time RT-PCR. Nine individuals required hospitalization, and four developed dengue warning signs. Leukocytes, neutrophils, and platelets declined towards defervescence and were negatively correlated with day of illness. Six clinical isolates were identified as dengue serotype-1, with 100% nucleotide identity suggesting that these patients were infected with the same virus.
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5
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Elson WH, Reiner RC, Siles C, Bazan I, Vilcarromero S, Riley-Powell AR, Kawiecki AB, Astete H, Hontz RD, Barker CM, Vazquez-Prokopec GM, Morrison AC, Scott TW, Elder JP, Rothman AL, Paz-Soldan VA. Heterogeneity of Dengue Illness in Community-Based Prospective Study, Iquitos, Peru. Emerg Infect Dis 2021; 26:2077-2086. [PMID: 32818402 PMCID: PMC7454099 DOI: 10.3201/eid2609.191472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Measuring heterogeneity of dengue illness is necessary to define suitable endpoints in dengue vaccine and therapeutic trials and will help clarify behavioral responses to illness. To quantify heterogeneity in dengue illness, including milder cases, we developed the Dengue Illness Perceptions Response (IPR) survey, which captured detailed symptom data, including intensity, duration, and character, and change in routine activities caused by illness. During 2016–2019, we collected IPR data daily during the acute phase of illness for 79 persons with a positive reverse transcription PCR result for dengue virus RNA. Most participants had mild ambulatory disease. However, we measured substantial heterogeneity in illness experience, symptom duration, and maximum reported intensity of individual symptoms. Symptom intensity was a more valuable predicter of major activity change during dengue illness than symptom presence or absence alone. These data suggest that the IPR measures clinically useful heterogeneity in dengue illness experience and its relation to altered human behavior.
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6
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Lim JK, Chanthavanich P, Limkittikul K, Lee JS, Sirivichayakul C, Lee KS, Lim SK, Yoon IK, Hattasingh W. Clinical and epidemiologic characteristics associated with dengue fever in 2011-2016 in Bang Phae district, Ratchaburi province, Thailand. PLoS Negl Trop Dis 2021; 15:e0009513. [PMID: 34191799 PMCID: PMC8244866 DOI: 10.1371/journal.pntd.0009513] [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: 08/03/2020] [Accepted: 05/28/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Dengue is a major public health problem in Thailand, but data are often focused on certain dengue-endemic areas. Methods: To better understand dengue epidemiology and clinical characteristics in Thailand, a fever surveillance study was conducted among patients aged 1-55 years, who presented with non-localized febrile illness at Bang Phae Community Hospital in Ratchaburi province, Thailand from October 2011 to September 2016. RESULTS Among 951 febrile episodes, 130 were dengue-confirmed. Individuals aged 10-14 years were mostly affected, followed by those 15-19 years-of-age, with about 15% of dengue-confirmed cases from adults 25 years and older. There were annual peaks of dengue occurrence between June-November. Most prevalent serotype in circulation was DENV-2 in 2012, DENV-3 in 2014, and DENV-4 & -3 in 2015. Among dengue cases, 65% were accurately detected using the dengue NS1 RDT. Detection rate was similar between secondary and primary dengue cases where 66% of secondary vs. 60% of primary dengue cases had positive results on the NS1 RDT. Among dengue cases, 66% were clinically diagnosed with suspected dengue or DHF, prior to lab confirmation. Dengue was positively associated with rash, headache, hematemesis and alterations to consciousness, when compared to non-dengue. Dengue patients were 10.6 times more likely to be hospitalized, compared to non-dengue cases. Among dengue cases, 95 were secondary and 35 were primary infections. There were 8 suspected DHF cases and all were identified to be secondary dengue. Secondary dengue cases were 3.5 times more likely to be hospitalized compared to primary dengue cases. Although the majority of our dengue-positive patients were secondary dengue cases, with few patients showing manifestations of DHF, our dengue cases were mostly mild disease. Even among children < 10 years-of-age, 61% had secondary infection and the rate of secondary infection increased with age. CONCLUSION While the majority of dengue-confirmed cases were children, almost three-quarters of dengue-confirmed cases in this study were secondary dengue. Our study results consistent with previous data from the country confirm the hyperendemic transmission of DENV in Thailand, even in the non-epidemic years. With various interventions becoming available for dengue prevention and control, including dengue vaccines, decision-making on future implementation strategies should be based on such burden of disease data.
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Affiliation(s)
| | | | | | - Jung-Seok Lee
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Kang Sung Lee
- International Vaccine Institute, Seoul, Republic of Korea
| | - Sl-Ki Lim
- International Vaccine Institute, Seoul, Republic of Korea
| | - In-Kyu Yoon
- Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway
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7
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Waickman AT, Friberg H, Gromowski GD, Rutvisuttinunt W, Li T, Siegfried H, Victor K, McCracken MK, Fernandez S, Srikiatkhachorn A, Ellison D, Jarman RG, Thomas SJ, Rothman AL, Endy T, Currier JR. Temporally integrated single cell RNA sequencing analysis of PBMC from experimental and natural primary human DENV-1 infections. PLoS Pathog 2021; 17:e1009240. [PMID: 33513191 PMCID: PMC7875406 DOI: 10.1371/journal.ppat.1009240] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 02/10/2021] [Accepted: 12/15/2020] [Indexed: 11/25/2022] Open
Abstract
Dengue human infection studies present an opportunity to address many longstanding questions in the field of flavivirus biology. However, limited data are available on how the immunological and transcriptional response elicited by an attenuated challenge virus compares to that associated with a wild-type DENV infection. To determine the kinetic transcriptional signature associated with experimental primary DENV-1 infection and to assess how closely this profile correlates with the transcriptional signature accompanying natural primary DENV-1 infection, we utilized scRNAseq to analyze PBMC from individuals enrolled in a DENV-1 human challenge study and from individuals experiencing a natural primary DENV-1 infection. While both experimental and natural primary DENV-1 infection resulted in overlapping patterns of inflammatory gene upregulation, natural primary DENV-1 infection was accompanied with a more pronounced suppression in gene products associated with protein translation and mitochondrial function, principally in monocytes. This suggests that the immune response elicited by experimental and natural primary DENV infection are similar, but that natural primary DENV-1 infection has a more pronounced impact on basic cellular processes to induce a multi-layered anti-viral state. Dengue Human Challenge Models allow for the analysis of host/virus interactions under highly controlled experimental conditions. However, it is unclear how close the immune response generated by an attenuated challenge virus compares to that generated by a naturally acquired DENV infection. In this study, we utilized single cell RNA sequencing to assess the immune response generated by both experimental and natural primary DENV-1 infections. This analysis suggests that the immune response elicited by experiential and natural primary DENV-1 infections are similar, but that natural DENV-1 infection has a more pronounced impact on basic cellular processes to induce a multi-layered anti-viral state.
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Affiliation(s)
- Adam T. Waickman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Institute for Global Health and Translational Sciences, State University of New York Upstate Medical University, Syracuse, New York, United States of America
- Department of Microbiology and Immunology, State University of New York Upstate Medical University, Syracuse, New York, United States of America
- * E-mail:
| | - Heather Friberg
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Gregory D. Gromowski
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Wiriya Rutvisuttinunt
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Tao Li
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Hayden Siegfried
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Kaitlin Victor
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Michael K. McCracken
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Stefan Fernandez
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Anon Srikiatkhachorn
- Department of Cell and Molecular Biology, Institute for Immunology and Informatics, University of Rhode Island, Providence, Rhode Island, United States of America
- Faculty of Medicine, King Mongkut’s Institute of Technology Ladkrabang, Bangkok, Thailand
| | - Damon Ellison
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Richard G. Jarman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Stephen J. Thomas
- Institute for Global Health and Translational Sciences, State University of New York Upstate Medical University, Syracuse, New York, United States of America
| | - Alan L. Rothman
- Department of Cell and Molecular Biology, Institute for Immunology and Informatics, University of Rhode Island, Providence, Rhode Island, United States of America
| | - Timothy Endy
- Department of Microbiology and Immunology, State University of New York Upstate Medical University, Syracuse, New York, United States of America
| | - Jeffrey R. Currier
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
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8
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Christofferson RC, Parker DM, Overgaard HJ, Hii J, Devine G, Wilcox BA, Nam VS, Abubakar S, Boyer S, Boonnak K, Whitehead SS, Huy R, Rithea L, Sochantha T, Wellems TE, Valenzuela JG, Manning JE. Current vector research challenges in the greater Mekong subregion for dengue, Malaria, and Other Vector-Borne Diseases: A report from a multisectoral workshop March 2019. PLoS Negl Trop Dis 2020; 14:e0008302. [PMID: 32730249 PMCID: PMC7392215 DOI: 10.1371/journal.pntd.0008302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Rebecca C. Christofferson
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Daniel M. Parker
- University of California, Irvine, California, United States of America
| | | | | | - Gregor Devine
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Bruce A. Wilcox
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand
| | - Vu Sinh Nam
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Sazaly Abubakar
- Tropical Infectious Diseases Research and Education Center, Kuala Lumpur, Malaysia
| | | | - Kobporn Boonnak
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Stephen S. Whitehead
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Rekol Huy
- National Center for Parasitology Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Leang Rithea
- National Center for Parasitology Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Tho Sochantha
- National Center for Parasitology Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Thomas E. Wellems
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Jesus G. Valenzuela
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Jessica E. Manning
- US National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia
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9
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Sanborn MA, Li T, Victor K, Siegfried H, Fung C, Rothman AL, Srikiatkhachorn A, Fernandez S, Ellison D, Jarman RG, Friberg H, Maljkovic Berry I, Currier JR, Waickman AT. Analysis of cell-associated DENV RNA by oligo(dT) primed 5' capture scRNAseq. Sci Rep 2020; 10:9047. [PMID: 32493997 PMCID: PMC7270085 DOI: 10.1038/s41598-020-65939-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/12/2020] [Indexed: 01/12/2023] Open
Abstract
Dengue is one of the most widespread vector-borne viral diseases in the world. However, the size, heterogeneity, and temporal dynamics of the cell-associated viral reservoir during acute dengue virus (DENV) infection remains unclear. In this study, we analyzed cells infected in vitro with DENV and PBMC from an individual experiencing a natural DENV infection utilizing 5’ capture single cell RNA sequencing (scRNAseq). Both positive- and negative-sense DENV RNA was detected in reactions containing either an oligo(dT) primer alone, or in reactions supplemented with a DENV-specific primer. The addition of a DENV-specific primer did not increase the total amount of DENV RNA captured or the fraction of cells identified as containing DENV RNA. However, inclusion of a DENV-specific cDNA primer did increase the viral genome coverage immediately 5’ to the primer binding site. Furthermore, while the majority of intracellular DENV sequence captured in this analysis mapped to the 5’ end of the viral genome, distinct patterns of enhanced coverage within the DENV polyprotein coding region were observed. The 5’ capture scRNAseq analysis of PBMC not only recapitulated previously published reports by detecting virally infected memory and naïve B cells, but also identified cell-associated genomic variants not observed in contemporaneous serum samples. These results demonstrate that oligo(dT) primed 5’ capture scRNAseq can detect DENV RNA and quantify virus-infected cells in physiologically relevant conditions, and provides insight into viral sequence variability within infected cells.
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Affiliation(s)
- Mark A Sanborn
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Tao Li
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Kaitlin Victor
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Hayden Siegfried
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Christian Fung
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Alan L Rothman
- Department of Cell and Molecular Biology, Institute for Immunology and Informatics, University of Rhode Island, Providence, RI, USA
| | - Anon Srikiatkhachorn
- Department of Cell and Molecular Biology, Institute for Immunology and Informatics, University of Rhode Island, Providence, RI, USA.,Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand
| | - Stefan Fernandez
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Damon Ellison
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Richard G Jarman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Heather Friberg
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Irina Maljkovic Berry
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Jeffrey R Currier
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Adam T Waickman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
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10
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Waickman AT, Gromowski GD, Rutvisuttinunt W, Li T, Siegfried H, Victor K, Kuklis C, Gomootsukavadee M, McCracken MK, Gabriel B, Mathew A, Grinyo I Escuer A, Fouch ME, Liang J, Fernandez S, Davidson E, Doranz BJ, Srikiatkhachorn A, Endy T, Thomas SJ, Ellison D, Rothman AL, Jarman RG, Currier JR, Friberg H. Transcriptional and clonal characterization of B cell plasmablast diversity following primary and secondary natural DENV infection. EBioMedicine 2020; 54:102733. [PMID: 32315970 PMCID: PMC7170960 DOI: 10.1016/j.ebiom.2020.102733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/19/2020] [Accepted: 03/10/2020] [Indexed: 01/06/2023] Open
Abstract
Antibody-mediated humoral immunity is thought to play a central role in mediating the immunopathogenesis of acute DENV infection, but limited data are available on the diversity, specificity, and functionality of the antibody response at the molecular level elicited by primary or secondary DENV infection. In order to close this functional gap in our understanding of DENV-specific humoral immunity, we utilized high-throughput single cell RNA sequencing to investigate B cells circulating in both primary and secondary natural DENV infections. We captured full-length paired immunoglobulin receptor sequence data from 9,027 B cells from a total of 6 subjects, including 2,717 plasmablasts. In addition to IgG and IgM class-switched cells, we unexpectedly found a high proportion of the DENV-elicited plasmablasts expressing IgA, principally in individuals with primary DENV infections. These IgA class-switched cells were extensively hypermutated even in individuals with a serologically confirmed primary DENV infection. Utilizing a combination of conventional biochemical assays and high-throughput shotgun mutagenesis, we determined that DENV-reactive IgA class-switched antibodies represent a significant fraction of DENV-reactive Igs generated in response to DENV infection, and that they exhibit a comparable epitope specificity to DENV-reactive IgG antibodies. These results provide insight into the molecular-level diversity of DENV-elicited humoral immunity and identify a heretofore unappreciated IgA plasmablast response to DENV infection.
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Affiliation(s)
- Adam T Waickman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States.
| | - Gregory D Gromowski
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Wiriya Rutvisuttinunt
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Tao Li
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Hayden Siegfried
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Kaitlin Victor
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Caitlin Kuklis
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Methee Gomootsukavadee
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Michael K McCracken
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Benjamin Gabriel
- Department of Cell and Molecular Biology, Institute for Immunology and Informatics, University of Rhode Island, Providence, RI, United States
| | - Anuja Mathew
- Department of Cell and Molecular Biology, Institute for Immunology and Informatics, University of Rhode Island, Providence, RI, United States
| | | | | | - Jenny Liang
- Integral Molecular, Philadelphia, PA, United States
| | - Stefan Fernandez
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | | | - Anon Srikiatkhachorn
- Department of Cell and Molecular Biology, Institute for Immunology and Informatics, University of Rhode Island, Providence, RI, United States; Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand
| | - Timothy Endy
- Department of Microbiology and Immunology, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Stephen J Thomas
- Institute for Global Health and Translational Sciences, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Damon Ellison
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Alan L Rothman
- Department of Cell and Molecular Biology, Institute for Immunology and Informatics, University of Rhode Island, Providence, RI, United States
| | - Richard G Jarman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Jeffrey R Currier
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
| | - Heather Friberg
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, United States
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11
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Clinical and epidemiologic characteristics associated with dengue during and outside the 2016 outbreak identified in health facility-based surveillance in Ouagadougou, Burkina Faso. PLoS Negl Trop Dis 2019; 13:e0007882. [PMID: 31809504 PMCID: PMC6897397 DOI: 10.1371/journal.pntd.0007882] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/25/2019] [Indexed: 12/29/2022] Open
Abstract
Background In Africa, the magnitude of dengue virus (DENV) transmission is largely unknown. In Burkina Faso, several outbreaks have been reported and data are often based on findings from outbreak investigations. Methods To better understand dengue epidemiology and clinical characteristics in Burkina Faso, a fever surveillance study was conducted among patients aged 1–55 years, who presented with non-malarial febrile illness at five primary healthcare facilities in Ouagadougou, Burkina Faso from December 2014 to February 2017, encompassing a 3-month dengue outbreak in September-November 2016. Acute and convalescent blood samples were collected within an interval of 10–21 days between visits. Acute samples were tested with dengue rapid diagnostic tests (RDT) and a selected subset with RT-PCR, and all acute/convalescent samples with IgM/IgG ELISA. Results Among 2929 non-malarial febrile patients, 740 (25%) were dengue–positive based on RT-PCR and/or IgM/IgG ELISA; 428 out of 777 patients (55%) and 312 out of 2152 (14%) were dengue-positive during outbreak and non-outbreak periods, respectively. There were 11% (316/2929) and 4% (129/2929) patients showing positive for NS1 and IgM, on the RDT, respectively. DENV 2 predominated during the outbreak, whereas DENV 3 predominated before the outbreak. Only 25% of dengue-positive cases were clinically diagnosed with suspected dengue. The odds of requiring observation for ≤3 days (versus routine outpatient care) were 11 times higher among dengue-positive cases than non-dengue cases. In adjusted analyses, dengue-positivity was associated with rash and retro-orbital pain (OR = 2.6 and 7.4, respectively) during the outbreak and with rash and nausea/vomiting (OR = 1.5 and 1.4, respectively) during the non-outbreak period. Conclusion Dengue virus is an important pathogen in Burkina Faso, accounting for a substantial proportion of non-malarial fevers both during and outside outbreak, but is only infrequently suspected by clinicians. Additional longitudinal data would help to further define characteristics of dengue for improved case detection and surveillance. There is not much evidence on dengue in Africa, relative to the Asia-Pacific and Latin American regions. To estimate the proportion of dengue among patients with fever, and to identify clinical features of dengue during outbreak and non-outbreak periods, we studied 2929 patients with non-malarial fever, aged 1–55 years, who attended five primary healthcare centers in Ouagadougou, Burkina Faso. Patients were tested with a rapid test for dengue, and further tests were carried out on paired blood samples taken 10–21 days apart. Overall, a quarter of non-malarial febrile episodes identified between December 2014 and February 2017 were dengue-positive. Dengue-positive cases were 11 times more likely than non-dengue cases to require observation for ≤3 days. During the study period in 2016, there was a dengue outbreak where more than half of non-malarial febrile patients were identified to be dengue-positive. DENV 2 was the main serotype in circulation during the outbreak, whereas DENV 3 was the main serotype before the outbreak. Rash and retro-orbital pain were more frequently found among dengue-positive cases, compared to non-dengue cases, during the outbreak. During the non-outbreak period, rash and nausea/vomiting were more likely in dengue-positive versus non-dengue cases. There was a low level of clinical suspicion of dengue even during the 2016 outbreak. Therefore, a broader use of rapid diagnostic tests and more epidemiologic data would help to improve dengue case detection and surveillance in Burkina Faso.
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Abstract
This is a selective review of recent publications on dengue clinical features, epidemiology, pathogenesis, and vaccine development placed in a context of observations made over the past half century. Four dengue viruses (DENVs) are transmitted by urban cycle mosquitoes causing diseases whose nature and severity are influenced by interacting factors such as virus, age, immune status of the host, and human genetic variability. A phenomenon that controls the kinetics of DENV infection, antibody-dependent enhancement, best explains the correlation of the vascular permeability syndrome with second heterotypic DENV infections and infection in the presence of passively acquired antibodies. Based on growing evidence in vivo and in vitro, the tissue-damaging DENV non-structural protein 1 (NS1) is responsible for most of the pathophysiological features of severe dengue. This review considers the contribution of hemophagocytic histiocytosis syndrome to cases of severe dengue, the role of movement of humans in dengue epidemiology, and modeling and planning control programs and describes a country-wide survey for dengue infections in Bangladesh and efforts to learn what controls the clinical outcome of dengue infections. Progress and problems with three tetravalent live-attenuated vaccines are reviewed. Several research mysteries remain: why is the risk of severe disease during second heterotypic DENV infection so low, why is the onset of vascular permeability correlated with defervescence, and what are the crucial components of protective immunity?
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Affiliation(s)
- Scott Halstead
- Emeritus Professor, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
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13
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Waickman AT, Friberg H, Gargulak M, Kong A, Polhemus M, Endy T, Thomas SJ, Jarman RG, Currier JR. Assessing the Diversity and Stability of Cellular Immunity Generated in Response to the Candidate Live-Attenuated Dengue Virus Vaccine TAK-003. Front Immunol 2019; 10:1778. [PMID: 31417556 PMCID: PMC6684763 DOI: 10.3389/fimmu.2019.01778] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/15/2019] [Indexed: 11/13/2022] Open
Abstract
The development of an efficacious DENV vaccine has been a long-standing public health priority. However, this effort has been complicated significantly due to the hazard presented by incomplete humoral immunity in mediating immune enhancement of infection and disease severity. Therefore, there is a significant need for DENV vaccine platforms capable of generating broad immune responses including durable cellular immunity, as well as novel analytical tools to assess the magnitude, diversity, and persistence of vaccine-elicited immunity. In this study, we demonstrate that a single dose of the recombinant, tetravalent, live-attenuated DENV vaccine TAK-003 elicits potent and durable cellular immunity against both the structural and non-structural proteins of all four DENV serotypes, which is maintained for at least 4 months post-immunization. Although not contained within the vaccine formulation, significant reactivity against the non-structural (NS) proteins of DENV-1,-3, and-4 is observed following vaccination, to an extent directly proportional to the magnitude of responses to the corresponding vaccine (DENV-2) components. Distinct, quantifiable, and durable patterns of DENV antigen reactivity can be observed in individuals following vaccination. Detailed epitope mapping of T cell reactivity against the DENV-2 proteome using a matrix of overlapping peptide pools demonstrated that TAK-003 elicits a broad response directed across the DENV-2 proteome, with focused reactivity against NS1 and NS3. We conclude that, as measured by an IFN-γ ELISPOT assay, a single dose of TAK-003 generates potent T cell-mediated immunity which is durable in magnitude and breadth through 4 months post-vaccination.
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Affiliation(s)
- Adam T Waickman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MA, United States
| | - Heather Friberg
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MA, United States
| | - Morgan Gargulak
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MA, United States
| | - Amanda Kong
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MA, United States
| | - Mark Polhemus
- Department of Medicine, Upstate Medical University of New York, Syracuse, NY, United States
| | - Timothy Endy
- Department of Medicine, Upstate Medical University of New York, Syracuse, NY, United States
| | - Stephen J Thomas
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MA, United States
| | - Richard G Jarman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MA, United States
| | - Jeffrey R Currier
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MA, United States
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14
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Ly S, Fortas C, Duong V, Benmarhnia T, Sakuntabhai A, Paul R, Huy R, Sorn S, Nguon K, Chan S, Kimsan S, Ong S, Kim KS, Buoy S, Voeung L, Dussart P, Buchy P, Tarantola A. Asymptomatic Dengue Virus Infections, Cambodia, 2012-2013. Emerg Infect Dis 2019; 25:1354-1362. [PMID: 31211672 PMCID: PMC6590774 DOI: 10.3201/eid2507.181794] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
We investigated dengue virus (DENV) and asymptomatic DENV infections in rural villages of Kampong Cham Province, Cambodia, during 2012 and 2013. We conducted perifocal investigations in and around households for 149 DENV index cases identified through hospital and village surveillance. We tested participants 0.5-30 years of age by using nonstructural 1 rapid tests and confirmed DENV infections using quantitative reverse transcription PCR or nonstructural 1-capture ELISA. We used multivariable Poisson regressions to explore links between participants' DENV infection status and household characteristics. Of 7,960 study participants, 346 (4.4%) were infected with DENV, among whom 302 (87.3%) were <15 years of age and 225 (65.0%) were <9 years of age. We identified 26 (7.5%) participants with strictly asymptomatic DENV infection at diagnosis and during follow-up. We linked symptomatic DENV infection status to familial relationships with index cases. During the 2-year study, we saw fewer asymptomatic DENV infections than expected based on the literature.
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Affiliation(s)
| | | | - Veasna Duong
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Tarik Benmarhnia
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Anavaj Sakuntabhai
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Richard Paul
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Rekol Huy
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Sopheak Sorn
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Kunthy Nguon
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Siam Chan
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Souv Kimsan
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Sivuth Ong
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Kim Srorn Kim
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Sowathy Buoy
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Lim Voeung
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
| | - Philippe Dussart
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia (S. Ly, C. Fortas, V. Duong, S. Sorn, K. Nguon, S. Chan, S. Kimsan, S. Ong, P. Dussart, P. Buchy, A. Tarantola)
- University of California, San Diego, California, USA (T. Benmarhnia)
- Institut Pasteur, Paris, France (A. Sakuntabhai, R. Paul)
- Malaria National Center, Phnom Penh (R. Huy)
- Kampong Cham Provincial Hospital, Kampong Cham, Cambodia (K.S. Kim)
- Prey Chhor District Referral Hospital, Kampong Cham (S. Buoy)
- Tboung Khmum District Referral Hospital, Thoung Khmum, Cambodia (L. Voeung)
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15
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Gordon A, Gresh L, Ojeda S, Chowell G, Gonzalez K, Sanchez N, Saborio S, Mercado JC, Kuan G, Balmaseda A, Harris E. Differences in Transmission and Disease Severity Between 2 Successive Waves of Chikungunya. Clin Infect Dis 2018; 67:1760-1767. [PMID: 29697796 PMCID: PMC6233685 DOI: 10.1093/cid/ciy356] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/20/2018] [Indexed: 11/13/2022] Open
Abstract
Background Chikungunya, an arboviral disease, caused massive epidemics in Central and South America in 2014-2016. In a prospective pediatric cohort study, we examined the introduction of chikungunya in a naive population and investigated transmission and clinical characteristics. Methods Children presenting to the study health center with a chikungunya-like illness or undifferentiated fever were tested for chikungunya virus (CHIKV) infection by reverse transcriptase-polymerase chain reaction (RT-PCR) and serological assays. Inapparent CHIKV infections in the intervening year were determined by seroconversion in healthy blood samples collected annually. Results A total of 4353 children participated in the cohort study from March 2014 to February 2016 during the 2 epidemic waves of chikungunya. A total of 539 cases of chikungunya were documented, for an incidence rate of 80.2 cases per 1000 person-years (95% confidence interval [CI]: 73.7, 87.2); and a total of 893 CHIKV infections were documented, for an incidence rate of 137.1 infections per 1000 person-years (95% CI: 128.4, 146.4). The seroprevalence of anti-CHIKV antibodies increased linearly with age, with seroprevalence of >45% in 14-year-old children at the end of Epidemic 2. Symptom presentation varied between the epidemics, with Epidemic 2 exhibiting both a higher symptomatic-to-inapparent ratio (1:1.20 in Epidemic 1 vs. 1:0.65 in Epidemic 2) and more severe clinical presentation among cases. The mean reproduction number was also greater in Epidemic 2 than in Epidemic 1. Conclusions The intensity of transmission and severity of clinical presentation varied between the 2 epidemics, with higher transmission intensity associated with greater disease severity.
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Affiliation(s)
- Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | - Lionel Gresh
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Sergio Ojeda
- Sustainable Sciences Institute, Managua, Nicaragua
| | | | - Karla Gonzalez
- Sustainable Sciences Institute, Managua, Nicaragua
- Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia
| | - Nery Sanchez
- Sustainable Sciences Institute, Managua, Nicaragua
| | - Saira Saborio
- Sustainable Sciences Institute, Managua, Nicaragua
- Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia
| | - Juan Carlos Mercado
- Sustainable Sciences Institute, Managua, Nicaragua
- Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia
| | - Guillermina Kuan
- Sustainable Sciences Institute, Managua, Nicaragua
- Centro de Salud Sócrates Flores Vivas, Ministerio de Salud, Managua, Nicaragua
| | - Angel Balmaseda
- Sustainable Sciences Institute, Managua, Nicaragua
- Laboratorio Nacional de Virología, Centro Nacional de Diagnóstico y Referencia
| | - Eva Harris
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley
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16
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Katzelnick LC, Harris E. The use of longitudinal cohorts for studies of dengue viral pathogenesis and protection. Curr Opin Virol 2018; 29:51-61. [PMID: 29597086 PMCID: PMC5996389 DOI: 10.1016/j.coviro.2018.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/12/2018] [Indexed: 12/31/2022]
Abstract
In this review, we describe how longitudinal prospective community-based, school-based, and household-based cohort studies contribute to improving our knowledge of viral disease, focusing specifically on contributions to understanding and preventing dengue. We describe how longitudinal cohorts enable measurement of essential disease parameters and risk factors; provide insights into biological correlates of protection and disease risk; enable rapid application of novel biological and statistical technologies; lead to development of new interventions and inform vaccine trial design; serve as sentinels in outbreak conditions and facilitate development of critical diagnostic assays; enable holistic studies on disease in the context of other infections, comorbidities, and environmental risk factors; and build research capacity that strengthens national and global public health response and disease surveillance.
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Affiliation(s)
- Leah C Katzelnick
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, 185 Li Ka Shing Center, 1951 Oxford Street, Berkeley, CA 94720-3370, United States
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, 185 Li Ka Shing Center, 1951 Oxford Street, Berkeley, CA 94720-3370, United States.
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17
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Waggoner JJ, Gresh L, Mohamed-Hadley A, Balmaseda A, Soda KJ, Abeynayake J, Sahoo MK, Liu Y, Kuan G, Harris E, Pinsky BA. Characterization of Dengue Virus Infections Among Febrile Children Clinically Diagnosed With a Non-Dengue Illness, Managua, Nicaragua. J Infect Dis 2017; 215:1816-1823. [PMID: 28863466 PMCID: PMC5853235 DOI: 10.1093/infdis/jix195] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/21/2017] [Indexed: 01/25/2023] Open
Abstract
Background We sought to characterize dengue virus (DENV) infections among febrile children enrolled in a pediatric cohort study who were clinically diagnosed with a non-dengue illness ("C cases"). Methods DENV infections were detected and viral load quantitated by real-time reverse transcription-polymerase chain reaction in C cases presenting between January 2007 and January 2013. Results One hundred forty-one of 2892 C cases (4.88%) tested positive for DENV. Of all febrile cases in the study, DENV-positive C cases accounted for an estimated 52.0% of patients with DENV viremia at presentation. Compared with previously detected, symptomatic dengue cases, DENV-positive C cases were significantly less likely to develop long-lasting humoral immune responses to DENV, as measured in healthy annual serum samples (79.7% vs 47.8%; P < .001). Humoral immunity was associated with viral load at presentation: 40 of 43 patients (93.0%) with a viral load ≥7.0 log10 copies/mL serum developed the expected rise in anti-DENV antibodies in annual samples versus 13 of 68 (19.1%) patients with a viral load below this level (P < .001). Conclusions Antibody responses to DENV-positive C cases differ from responses to classic symptomatic dengue. These findings have important implications for DENV transmission modeling, immunology, and epidemiologic surveillance.
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Affiliation(s)
- Jesse J Waggoner
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine
| | | | - Alisha Mohamed-Hadley
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Angel Balmaseda
- National Virology Laboratory, Centro Nacional de Diagnóstico y Referencia, Ministry of Health
| | - K James Soda
- Department of Scientific Computing, Florida State University, Tallahassee
| | - Janaki Abeynayake
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Malaya K Sahoo
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Yuanyuan Liu
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Guillermina Kuan
- Centro de Salud Sócrates Flores Vivas, Ministry of Health, Managua, Nicaragua
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley
| | - Benjamin A Pinsky
- Department of Medicine, Division of Infectious Diseases and Geographic Medicine
- Department of Pathology, Stanford University School of Medicine, Stanford, California
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Sharp TM, Tomashek KM, Read JS, Margolis HS, Waterman SH. A New Look at an Old Disease: Recent Insights into the Global Epidemiology of Dengue. CURR EPIDEMIOL REP 2017; 4:11-21. [PMID: 28251039 PMCID: PMC5306284 DOI: 10.1007/s40471-017-0095-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW By all measures, the morbidity and mortality due to dengue are continuing to worsen worldwide. Although both early and recent studies have demonstrated regional differences in how dengue affects local populations, these findings were to varying extents related to disparate surveillance approaches. RECENT FINDINGS Recent studies have broadened the recognized spectrum of disease resulting from DENV infection, particularly in adults, and have also demonstrated new mechanisms of DENV spread both within and between populations. New results regarding the frequency and duration of homo- and heterotypic anti-DENV antibodies have provided important insights relevant to vaccine design and implementation. SUMMARY These observations and findings as well as difficulties in comparing the epidemiology of dengue within and between regions of the world underscore the need for population-based dengue surveillance worldwide. Enhanced surveillance should be implemented to complement passive surveillance in countries in the tropics to establish baseline data in order to define affected populations and evaluate the impact of dengue vaccines and novel vector control interventions.
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Affiliation(s)
- Tyler M. Sharp
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 1324 Calle Cañada, San Juan, PR 00920-3860 USA
| | - Kay M. Tomashek
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 1324 Calle Cañada, San Juan, PR 00920-3860 USA
| | - Jennifer S. Read
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 1324 Calle Cañada, San Juan, PR 00920-3860 USA
| | - Harold S. Margolis
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 1324 Calle Cañada, San Juan, PR 00920-3860 USA
| | - Stephen H. Waterman
- Dengue Branch, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, 1324 Calle Cañada, San Juan, PR 00920-3860 USA
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Ratanawong P, Kittayapong P, Olanratmanee P, Wilder-Smith A, Byass P, Tozan Y, Dambach P, Quiñonez CAM, Louis VR. Spatial Variations in Dengue Transmission in Schools in Thailand. PLoS One 2016; 11:e0161895. [PMID: 27669170 PMCID: PMC5036884 DOI: 10.1371/journal.pone.0161895] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/12/2016] [Indexed: 12/03/2022] Open
Abstract
Background Dengue is an important neglected tropical disease, with more than half of the world’s population living in dengue endemic areas. Good understanding of dengue transmission sites is a critical factor to implement effective vector control measures. Methods A cohort of 1,811 students from 10 schools in rural, semi-rural and semi-urban Thailand participated in this study. Seroconversion data and location of participants’ residences and schools were recorded to determine spatial patterns of dengue infections. Blood samples were taken to confirm dengue infections in participants at the beginning and the end of school term. Entomological factors included a survey of adult mosquito density using a portable vacuum aspirator during the school term and a follow up survey of breeding sites of Aedes vectors in schools after the school term. Clustering analyses were performed to detect spatial aggregation of dengue infections among participants. Results A total of 57 dengue seroconversions were detected among the 1,655 participants who provided paired blood samples. Of the 57 confirmed dengue infections, 23 (40.0%) occurred in students from 6 (6.8%) of the 88 classrooms in 10 schools. Dengue infections did not show significant clustering by residential location in the study area. During the school term, a total of 66 Aedes aegypti mosquitoes were identified from the 278 mosquitoes caught in 50 classrooms of the 10 schools. In a follow-up survey of breeding sites, 484 out of 2,399 water containers surveyed (20.2%) were identified as active mosquito breeding sites. Discussion and Conclusion Our findings suggest that dengue infections were clustered among schools and among classrooms within schools. The schools studied were found to contain a large number of different types of breeding sites. Aedes vector densities in schools were correlated with dengue infections and breeding sites in those schools. Given that only a small proportion of breeding sites in the schools were subjected to vector control measures (11%), this study emphasizes the urgent need to implement vector control strategies at schools, while maintaining efforts at the household level.
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Affiliation(s)
- Pitcha Ratanawong
- Institute of Public Health, Heidelberg University Medical School, Heidelberg, Germany
- Center of Excellence for Vectors and Vector-Borne Diseases, Faculty of Science, Mahidol University at Salaya, Nakhon Pathom, Thailand
- * E-mail: (PK); (PR)
| | - Pattamaporn Kittayapong
- Center of Excellence for Vectors and Vector-Borne Diseases, Faculty of Science, Mahidol University at Salaya, Nakhon Pathom, Thailand
- * E-mail: (PK); (PR)
| | - Phanthip Olanratmanee
- Faculty of Science and Technology, Rajabhat Rajanagarindra University, Chachoengsao, Thailand
| | - Annelies Wilder-Smith
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå 90187, Sweden
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Peter Byass
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå 90187, Sweden
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Yesim Tozan
- Institute of Public Health, Heidelberg University Medical School, Heidelberg, Germany
- College of Global Public Health, New York University, New York, New York, United States of America
| | - Peter Dambach
- Institute of Public Health, Heidelberg University Medical School, Heidelberg, Germany
| | | | - Valérie R. Louis
- Institute of Public Health, Heidelberg University Medical School, Heidelberg, Germany
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Coudeville L, Baurin N, L'Azou M, Guy B. Potential impact of dengue vaccination: Insights from two large-scale phase III trials with a tetravalent dengue vaccine. Vaccine 2016; 34:6426-6435. [PMID: 27601343 DOI: 10.1016/j.vaccine.2016.08.050] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 08/11/2016] [Accepted: 08/16/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND A tetravalent dengue vaccine demonstrated its protective efficacy in two phase III efficacy studies. Results from these studies were used to derive vaccination impact in the five Asian (Indonesia, Malaysia, Philippines, Thailand, Vietnam) and the five Latin American countries (Brazil, Colombia, Honduras, Mexico and Puerto Rico) participating in these trials. METHODS Vaccination impact was investigated with an age-structured, host-vector, serotype-specific compartmental model. Parameters related to vaccine efficacy and levels of dengue transmission were estimated using data collected during the phase III efficacy studies. Several vaccination programs, including routine vaccination at different ages with and without large catch-up campaigns, were investigated. RESULTS All vaccination programs explored translated into significant reductions in dengue cases at the population level over the first 10years following vaccine introduction and beyond. The most efficient age for vaccination varied according to transmission intensity and 9years was close to the most efficient age across all settings. The combination of routine vaccination and large catch-up campaigns was found to enable a rapid reduction of dengue burden after vaccine introduction. CONCLUSION Our analysis suggests that dengue vaccination can significantly reduce the public health impact of dengue in countries where the disease is endemic.
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Affiliation(s)
| | - Nicolas Baurin
- Vaccination Value Modeling, Sanofi Pasteur, Lyon, France
| | - Maïna L'Azou
- Global Epidemiology, Sanofi Pasteur, Lyon, France
| | - Bruno Guy
- Research & Development, Sanofi Pasteur, Lyon, France
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Olivera-Botello G, Coudeville L, Fanouillere K, Guy B, Chambonneau L, Noriega F, Jackson N. Tetravalent Dengue Vaccine Reduces Symptomatic and Asymptomatic Dengue Virus Infections in Healthy Children and Adolescents Aged 2-16 Years in Asia and Latin America. J Infect Dis 2016; 214:994-1000. [PMID: 27418050 PMCID: PMC5021228 DOI: 10.1093/infdis/jiw297] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/11/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Asymptomatic dengue virus-infected individuals are thought to play a major role in dengue virus transmission. The efficacy of the recently approved quadrivalent CYD-TDV dengue vaccine against asymptomatic dengue virus infection has not been previously assessed. METHODS We pooled data for 3 736 individuals who received either CYD-TDV or placebo at 0, 6, and 12 months in the immunogenicity subsets of 2 phase 3 trials (clinical trials registration NCT01373281 and NCT01374516). We defined a seroconversion algorithm (ie, a ≥4-fold increase in the neutralizing antibody titer and a titer of ≥40 from month 13 to month 25) as a surrogate marker of asymptomatic infection in the vaccine and placebo groups. RESULTS The algorithm detected seroconversion in 94% of individuals with a diagnosis of virologically confirmed dengue between months 13 and 25, validating its discriminatory power. Among those without virologically confirmed dengue (n = 3 669), 219 of 2 485 in the vaccine group and 157 of 1 184 in the placebo group seroconverted between months 13 and 25, giving a vaccine efficacy of 33.5% (95% confidence interval [CI], 17.9%-46.1%) against asymptomatic infection. Vaccine efficacy was marginally higher in subjects aged 9-16 years (38.6%; 95% CI, 22.1%-51.5%). The annual incidence of asymptomatic dengue virus infection in this age group was 14.8%, which was 4.4 times higher than the incidence for symptomatic dengue (3.4%). CONCLUSIONS The observed vaccine efficacy against asymptomatic dengue virus infections is expected to translate into reduced dengue virus transmission if sufficient individuals are vaccinated in dengue-endemic areas.
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Valerio L, Roure S, Fernández-Rivas G, Ballesteros AL, Ruiz J, Moreno N, Bocanegra C, Sabrià M, Pérez-Quilez O, de Ory F, Molina I. Arboviral infections diagnosed in a European area colonized by Aedes albopictus (2009-2013, Catalonia, Spain). Travel Med Infect Dis 2015; 13:415-21. [PMID: 26169583 DOI: 10.1016/j.tmaid.2015.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 06/18/2015] [Accepted: 06/19/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND The invasive mosquito Aedes albopictus, with proven vectorial ability to transmit European autochthonous cycles of dengue and chikungunya virus, has currently colonized every coastal department of Eastern Spain. The main objective of the study was to define the epidemiological and clinical characteristics as well as the trends of these two arboviral diseases in a European area heavily colonized by Ae. albopictus. METHOD A voluntarily-based, prospective and multicenter surveillance study was performed in all medical units of the North Metropolitan area of Barcelona (406,000 inhabitants, Catalonia; Spain) with diagnostic capability from 2009 to 2013. Since any possible increase in arboviral cases could be justified by changes in traveling behaviors along the study period (especially longer trips) the trend showed by these two arboviral diseases was compared with that displayed by malaria cases during the same period. RESULTS 38 out of 52 (73.1%) suspected cases could be serologically confirmed (IgM+): dengue 34/38 (89.5%) and chikungunya 4/38 (11.5%). No autochthonous cases were identified. The overall incidence of both arboviruses was 0.19 cases/10,000 inhabitants-year (95% CI: 0.07-0.3); dengue = 0.17 cases/10,000 inhabitants-year (95% CI: 0.05-0.3), and chikungunya = 0.02 cases/10,000 inhabitants-year (95% CI: 0.001-0.03). The Incidence Relative Risk of arboviral disease between 2009 and 2013 shown a significant trend (IRR = 1.27. IC 95%: 1.01-1.59; p = 0.043) when compared with that displayed by malaria (IRR = 1.04. IC 95%: 0.924-1.192). If no unexpected circumstances concur, the arboviral disease incidence tax would equal that of malaria about 2021-2022. CONCLUSIONS The incidence of dengue and chikungunya is steadily increasing in the North Metropolitan area of Barcelona, a region densely colonized by Ae. albopictus, at the entire expense of imported cases (especially Visiting Friends and Relatives travelers). To date, no secondary autochthonous cases have been identified and, thus, they have not taken part in this rise.
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Affiliation(s)
- Lluís Valerio
- North Metropolitan International Health Unit, Universitat Autònoma de Barcelona, PROSICS - Institut Català de la Salut, Spain.
| | - Sílvia Roure
- Infectious Diseases Unit, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, PROSICS - Institut Català de la Salut, Spain.
| | - Gema Fernández-Rivas
- Microbiology Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Institut Català de la Salut, Spain.
| | - Angel-Luis Ballesteros
- Internal Medicine Department, Hospital Municipal de Badalona, Badalona Serveis Assistencials, Spain.
| | - Jessica Ruiz
- Internal Medicine Department, Hospital de l'Esperit Sant, Spain.
| | - Nemesio Moreno
- Epidemiology Department, Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Spain.
| | - Cristina Bocanegra
- North Metropolitan International Health Unit, Universitat Autònoma de Barcelona, PROSICS - Institut Català de la Salut, Spain.
| | - Miquel Sabrià
- Infectious Diseases Unit, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, PROSICS - Institut Català de la Salut, Spain.
| | - Olga Pérez-Quilez
- North Metropolitan International Health Unit, Universitat Autònoma de Barcelona, PROSICS - Institut Català de la Salut, Spain.
| | - Fernando de Ory
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.
| | - Israel Molina
- Infectious Diseases Department, Hospital Universitari de la Vall d'Hebron, Universitat Autònoma de Barcelona, PROSICS - Institut Català de la Salut, Spain.
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Buddhari D, Aldstadt J, Endy TP, Srikiatkhachorn A, Thaisomboonsuk B, Klungthong C, Nisalak A, Khuntirat B, Jarman RG, Fernandez S, Thomas SJ, Scott TW, Rothman AL, Yoon IK. Dengue virus neutralizing antibody levels associated with protection from infection in thai cluster studies. PLoS Negl Trop Dis 2014; 8:e3230. [PMID: 25329173 PMCID: PMC4199527 DOI: 10.1371/journal.pntd.0003230] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/29/2014] [Indexed: 11/18/2022] Open
Abstract
Background Long-term homologous and temporary heterologous protection from dengue virus (DENV) infection may be mediated by neutralizing antibodies. However, neutralizing antibody titers (NTs) have not been clearly associated with protection from infection. Methodology/Principal Findings Data from two geographic cluster studies conducted in Kamphaeng Phet, Thailand were used for this analysis. In the first study (2004–2007), cluster investigations of 100-meter radius were triggered by DENV-infected index cases from a concurrent prospective cohort. Subjects between 6 months and 15 years old were evaluated for DENV infection at days 0 and 15 by DENV PCR and IgM ELISA. In the second study (2009–2012), clusters of 200-meter radius were triggered by DENV-infected index cases admitted to the provincial hospital. Subjects of any age ≥6 months were evaluated for DENV infection at days 0 and 14. In both studies, subjects who were DENV PCR positive at day 14/15 were considered to have been “susceptible” on day 0. Comparison subjects from houses in which someone had documented DENV infection, but the subject remained DENV negative at days 0 and 14/15, were considered “non-susceptible.” Day 0 samples were presumed to be from just before virus exposure, and underwent plaque reduction neutralization testing (PRNT). Seventeen “susceptible” (six DENV-1, five DENV-2, and six DENV-4), and 32 “non-susceptible” (13 exposed to DENV-1, 10 DENV-2, and 9 DENV-4) subjects were evaluated. Comparing subjects exposed to the same serotype, receiver operating characteristic (ROC) curves identified homotypic PRNT titers of 11, 323 and 16 for DENV-1, -2 and -4, respectively, to differentiate “susceptible” from “non-susceptible” subjects. Conclusions/Significance PRNT titers were associated with protection from infection by DENV-1, -2 and -4. Protective NTs appeared to be serotype-dependent and may be higher for DENV-2 than other serotypes. These findings are relevant for both dengue epidemiology studies and vaccine development efforts. Dengue is caused by four different dengue virus serotypes (DENV-1, -2, -3, -4). Infection induces long-term protection against the same serotype, but only short-term protection, and possible enhancement, from different serotypes. DENV neutralizing antibody titers (NTs) are thought to mediate protection or modify disease. Association of NTs with protection from infection has not, however, been clearly demonstrated. We analyzed data from two geographic clusters studies conducted in Kamphaeng Phet, Thailand, in which DENV NTs just before virus exposure were compared between DENV-infected “susceptible” and non-infected “non-susceptible” subjects. NTs appeared to be associated with protection against DENV-1, -2, and -4, but at different NT cutoff levels, with the cutoff for DENV-2 appearing to be the highest. These findings are relevant for ongoing efforts to investigate dengue epidemiology and develop dengue vaccine candidates.
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Affiliation(s)
- Darunee Buddhari
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
- * E-mail:
| | - Jared Aldstadt
- Department of Geography, University at Buffalo, Buffalo, New York, United States of America
| | - Timothy P. Endy
- Department of Infectious Diseases, State University of New York at Syracuse, Syracuse, New York, United States of America
| | - Anon Srikiatkhachorn
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Butsaya Thaisomboonsuk
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Chonticha Klungthong
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Ananda Nisalak
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Benjawan Khuntirat
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Richard G. Jarman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Stefan Fernandez
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Stephen J. Thomas
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
| | - Thomas W. Scott
- Department of Entomology and Nematology, University of California at Davis, Davis, California, United States of America
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Alan L. Rothman
- Institute for Immunology and Informatics, University of Rhode Island, Providence, Rhode Island, United States of America
| | - In-Kyu Yoon
- Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
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Grange L, Simon-Loriere E, Sakuntabhai A, Gresh L, Paul R, Harris E. Epidemiological risk factors associated with high global frequency of inapparent dengue virus infections. Front Immunol 2014; 5:280. [PMID: 24966859 PMCID: PMC4052743 DOI: 10.3389/fimmu.2014.00280] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 05/28/2014] [Indexed: 02/04/2023] Open
Abstract
Dengue is a major international public health concern, and the number of outbreaks has escalated greatly. Human migration and international trade and travel are constantly introducing new vectors and pathogens into novel geographic areas. Of particular interest is the extent to which dengue virus (DENV) infections are subclinical or inapparent. Not only may such infections contribute to the global spread of DENV by human migration, but also seroprevalence rates in naïve populations may be initially high despite minimal numbers of detectable clinical cases. As the probability of severe disease is increased in secondary infections, populations may thus be primed, with serious public health consequences following introduction of a new serotype. In addition, pre-existing immunity from inapparent infections may affect vaccine uptake, and the ratio of clinically apparent to inapparent infection could affect the interpretation of vaccine trials. We performed a literature search for inapparent DENV infections and provide an analytical review of their frequency and associated risk factors. Inapparent rates were highly variable, but “inapparent” was the major outcome of infection in all prospective studies. Differences in the epidemiological context and type of surveillance account for much of the variability in inapparent infection rates. However, one particular epidemiological pattern was shared by four longitudinal cohort studies: the rate of inapparent DENV infections was positively correlated with the incidence of disease the previous year, strongly supporting an important role for short-term heterotypic immunity in determining the outcome of infection. Primary and secondary infections were equally likely to be inapparent. Knowledge of the extent to which viruses from inapparent infections are transmissible to mosquitoes is urgently needed. Inapparent infections need to be considered for their impact on disease severity, transmission dynamics, and vaccine efficacy and uptake.
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Affiliation(s)
- Laura Grange
- Unité de la Génétique Fonctionnelle des Maladies Infectieuses, Institut Pasteur , Paris , France ; URA3012, Centre National de la Recherche Scientifique , Paris , France
| | - Etienne Simon-Loriere
- Unité de la Génétique Fonctionnelle des Maladies Infectieuses, Institut Pasteur , Paris , France ; URA3012, Centre National de la Recherche Scientifique , Paris , France
| | - Anavaj Sakuntabhai
- Unité de la Génétique Fonctionnelle des Maladies Infectieuses, Institut Pasteur , Paris , France ; URA3012, Centre National de la Recherche Scientifique , Paris , France
| | - Lionel Gresh
- Sustainable Sciences Institute , Managua , Nicaragua
| | - Richard Paul
- Unité de la Génétique Fonctionnelle des Maladies Infectieuses, Institut Pasteur , Paris , France ; URA3012, Centre National de la Recherche Scientifique , Paris , France
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California , Berkeley, CA , USA
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