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Cohen LE, Hansen CL, Andrew MK, McNeil SA, Vanhems P, Kyncl J, Domingo JD, Zhang T, Dbaibo G, Laguna-Torres VA, Draganescu A, Baumeister E, Gomez D, Raboni SM, Giamberardino HIG, Nunes MC, Burtseva E, Sominina A, Medić S, Coulibaly D, Salah AB, Otieno NA, Koul PA, Unal S, Tanriover MD, Mazur M, Bresee J, Viboud C, Chaves SS. Predictors of Severity of Influenza-Related Hospitalizations: Results From the Global Influenza Hospital Surveillance Network (GIHSN). J Infect Dis 2024; 229:999-1009. [PMID: 37527470 PMCID: PMC11011157 DOI: 10.1093/infdis/jiad303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 07/13/2023] [Accepted: 07/26/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND The Global Influenza Hospital Surveillance Network (GIHSN) has since 2012 provided patient-level data on severe influenza-like-illnesses from >100 participating clinical sites worldwide based on a core protocol and consistent case definitions. METHODS We used multivariable logistic regression to assess the risk of intensive care unit admission, mechanical ventilation, and in-hospital death among hospitalized patients with influenza and explored the role of patient-level covariates and country income level. RESULTS The data set included 73 121 patients hospitalized with respiratory illness in 22 countries, including 15 660 with laboratory-confirmed influenza. After adjusting for patient-level covariates we found a 7-fold increase in the risk of influenza-related intensive care unit admission in lower middle-income countries (LMICs), compared with high-income countries (P = .01). The risk of mechanical ventilation and in-hospital death also increased by 4-fold in LMICs, though these differences were not statistically significant. We also find that influenza mortality increased significantly with older age and number of comorbid conditions. Across all severity outcomes studied and after controlling for patient characteristics, infection with influenza A/H1N1pdm09 was more severe than with A/H3N2. CONCLUSIONS Our study provides new information on influenza severity in underresourced populations, particularly those in LMICs.
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Affiliation(s)
- Lily E Cohen
- Ready2Respond p/o The Task Force for Global Health, Decatur, Georgia, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Chelsea L Hansen
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
- Brotman Baty Institute, University of Washington, Seattle, Washington, USA
- PandemiX Center, Department of Science & Environment, Roskilde University, Denmark
| | - Melissa K Andrew
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shelly A McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Jan Kyncl
- Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czech Republic
- Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Javier Díez Domingo
- Fundación Para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO–Public Health), Valencia, Spain
| | - Tao Zhang
- School of Public Health, Fudan University, Shanghai, China
| | - Ghassan Dbaibo
- Center for Infectious Diseases Research, American University of Beirut, Beirut, Lebanon
| | | | - Anca Draganescu
- National Institute for Infectious Diseases “Prof Dr Matei Bals”, Bucharest, Romania
| | - Elsa Baumeister
- Respiratory Virus Laboratory, Virology Department, INEI-ANLIS, Buenos Aires, Argentina
| | - Doris Gomez
- Grupo de Investigación UNIMOL, Facultad de Medicina, Universidad de Cartagena, Cartagena de Indias, Colombia
| | - Sonia M Raboni
- Virology Laboratory, Infectious Diseases Division, Universidade Federal do Paraná, Hospital Pequeno Principe, Curitiba, Paraná, Brazil
| | - Heloisa I G Giamberardino
- Virology Laboratory, Infectious Diseases Division, Universidade Federal do Paraná, Hospital Pequeno Principe, Curitiba, Paraná, Brazil
| | - Marta C Nunes
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elena Burtseva
- Gamaleya Federal Research Center for Epidemiology and Microbiology, Ministry of Health of Russian Federation, Moscow, Russia
| | - Anna Sominina
- Smorodintsev Research Institute of Influenza, St Petersburg, Russia
| | - Snežana Medić
- Institute for Public Health of Vojvodina, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | | | - Afif Ben Salah
- Institut Pasteur de Tunis, Tunis, Tunisia
- Arabian Gulf University, Manama, Bahrain
| | - Nancy A Otieno
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Parvaiz A Koul
- Sheri Kashmir Institute of Medical Sciences, Srinagar, India
| | - Serhat Unal
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
- Turkish Society of Internal Medicine, Ankara, Turkey
| | - Mine Durusu Tanriover
- Turkish Society of Internal Medicine, Ankara, Turkey
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
| | - Marie Mazur
- Ready2Respond p/o The Task Force for Global Health, Decatur, Georgia, USA
| | - Joseph Bresee
- Ready2Respond p/o The Task Force for Global Health, Decatur, Georgia, USA
| | - Cecile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Sandra S Chaves
- Foundation for Influenza Epidemiology, Fondation de France, Paris, France
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Boussarsar M, Ennouri E, Habbachi N, Bouguezzi N, Meddeb K, Gallas S, Hafdhi M, Zghidi M, Toumi R, Ben Saida I, Abid S, Boutiba-Ben Boubaker I, Maazaoui L, El Ghord H, Gzara A, Yazidi R, Ben Salah A. Epidemiology and burden of Severe Acute Respiratory Infections (SARI) in the aftermath of COVID-19 pandemic: A prospective sentinel surveillance study in a Tunisian Medical ICU, 2022/2023. PLoS One 2023; 18:e0294960. [PMID: 38100529 PMCID: PMC10723666 DOI: 10.1371/journal.pone.0294960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/10/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Severe Acute Respiratory Infections (SARI) caused by influenza and other respiratory viruses pose significant global health challenges, and the COVID-19 pandemic has further strained healthcare systems. As the focus shifts from the pandemic to other respiratory infections, assessing the epidemiology and burden of SARI is crucial for healthcare planning and resource allocation. Aim: to understand the impact of the post-pandemic period on the epidemiology of SARI cases, clinical outcomes, and healthcare resource utilization in Tunisia. METHODS This is a prospective study conducted in a Tunisian MICU part of a national sentinel surveillance system, focusing on enhanced SARI surveillance. SARI cases from week 39/2022, 26 September to week 19/2023, 13 May were included, according to a standardized case definition. Samples were collected for virological RT-PCR testing, and an electronic system ensured standardized and accurate data collection. Descriptive statistics were performed to assess epidemiology, trends, and outcomes of SARI cases, and univariate/multivariate analyses to assess factors associated with mortality. RESULTS Among 312 MICU patients, 164 SARI cases were identified during the study period. 64(39%) RT-PCR were returned positive for at least one pathogen, with influenza A and B strains accounting for 20.7% of cases at the early stages of the influenza season. The MICU experienced a significant peak in admissions during weeks 1-11/2023, leading to resource mobilization and the creation of a surge unit. SARI cases utilized 1664/3120 of the MICU-stay days and required 1157 mechanical ventilation days. The overall mortality rate among SARI cases was 22.6%. Age, non-COPD, and ARDS were identified as independent predictors of mortality. CONCLUSIONS The present study identified a relatively high rate of SARI cases, with 39% positivity for at least one respiratory virus, with influenza A and B strains occurring predominantly during the early stages of the influenza season. The findings shed light on the considerable resource utilization and mortality associated with these infections, underscoring the urgency for proactive management and efficient resource allocation strategies.
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Affiliation(s)
- Mohamed Boussarsar
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, Farhat Hached University Hospital, Sousse, Tunisia
| | - Emna Ennouri
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, Farhat Hached University Hospital, Sousse, Tunisia
| | - Naima Habbachi
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Nabil Bouguezzi
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, Farhat Hached University Hospital, Sousse, Tunisia
| | - Khaoula Meddeb
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, Farhat Hached University Hospital, Sousse, Tunisia
| | - Salma Gallas
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, Farhat Hached University Hospital, Sousse, Tunisia
| | - Malek Hafdhi
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Marwa Zghidi
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, Farhat Hached University Hospital, Sousse, Tunisia
| | - Radhouane Toumi
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, Farhat Hached University Hospital, Sousse, Tunisia
| | - Imen Ben Saida
- University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
- Medical Intensive Care Unit, Research Laboratory “Heart Failure”, Farhat Hached University Hospital, Sousse, Tunisia
| | - Salma Abid
- National Influenza Centre-Tunis, Unit Virology, Microbiology Laboratory, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Ilhem Boutiba-Ben Boubaker
- National Influenza Centre-Tunis, Unit Virology, Microbiology Laboratory, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Faculty of Medicine of Tunis, Tunis, Tunisia
| | | | | | - Ahlem Gzara
- Primary Health Care Directorate, Tunis, Tunisia
| | - Rihab Yazidi
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, Tunis-Belvédère, Tunisia
- Service of Medical Epidemiology, Institut Pasteur de Tunis, Tunis-Belvédère, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections LR16IPT02, Institut Pasteur de Tunis, University of Tunis, El Manar, Tunis, Tunisia
| | - Afif Ben Salah
- Service of Medical Epidemiology, Institut Pasteur de Tunis, Tunis-Belvédère, Tunisia
- Department of Family and Community Medicine, College of Medicine and Medical Sciences (CMMS), Arabian Gulf University (AGU), Manama, Bahrain
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Naouar I, Kammoun Rebai W, Ben Salah A, Bouguerra H, Toumi A, Hamida NB, Louzir H, Meddeb-Garnaoui A. A Prospective cohort study of zoonotic cutaneous leishmaniasis in tunisia: Clinical and Immunological features and immune correlates of protection. PLoS Negl Trop Dis 2023; 17:e0011784. [PMID: 38064516 PMCID: PMC10732404 DOI: 10.1371/journal.pntd.0011784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 12/20/2023] [Accepted: 11/09/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND This study aimed to define immunological markers of exposure to L. major parasites and identify correlates of protection against infection. METHODS We analyzed a cohort of 790 individuals at risk of developing ZCL living in endemic areas with varying L. major infection prevalence. One area had a high infection prevalence indicated by high proportions of leishmanin skin test (LST) positive subjects, while the other areas were recent foci with lower infection prevalence. Blood samples were collected before the transmission season to measure Interferon gamma (IFN-γ), Interleukin 10 (IL-10), and Granzyme B (GrB) levels in response to parasite stimulation in peripheral blood mononuclear cells. A one-year follow-up period involved active detection of new ZCL cases to estimate disease incidence after a transmission season and identify immune correlates of protection. RESULTS The study population showed heterogeneity in parasite contact, evident from specific scars and/or positive LST results, significantly higher in the old focus compared to recent foci. IFN-γ and GrB were markers of parasite exposure and reliable indicators of immunity to L. major. Positive correlations were observed between IFN-γ/IL-10 and GrB/IL-10 ratios and LST results. Unexpectedly, only 29 new ZCL cases (4%) appeared after a transmission season, with 27 cases reported in recent foci and 2 in the oldest focus. Our findings indicate that individuals in L. major endemic areas are likely to develop ZCL regardless of their LST status. We showed that high pre-transmission season levels of IFN-γ and GrB produced by PBMC, along with a high IFN-γ/IL-10 ratio, were associated with protection. CONCLUSION This study on a large cohort at risk of ZCL confirmed IFN-γ and GrB as protective factors against the disease. A high IFN-γ/IL-10 ratio, but not GrB/IL-10 ratio was associated with resistance. These results are valuable for developing and evaluating of a vaccine against human leishmaniasis.
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Affiliation(s)
- Ikbel Naouar
- Laboratory of Transmission Control and Immunobiology of Infection, Pasteur Institute of Tunis, Tunis, Tunisia
- Faculty of Sciences, University of Tunis El Manar, Tunis, Tunisia
- Department of Immunology, University of Toronto, Ontario, Canada
| | - Wafa Kammoun Rebai
- Faculty of Sciences, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Medical Parasitology, Biotechnology and Biomolecular, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Afif Ben Salah
- Laboratory of Transmission Control and Immunobiology of Infection, Pasteur Institute of Tunis, Tunis, Tunisia
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Hind Bouguerra
- National Observatory of New and Emerging Diseases, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Amine Toumi
- Health Information and Intelligence Section, Ministry of Public Health, Doha, Qatar
| | - Nabil Belhadj Hamida
- Laboratory of Transmission Control and Immunobiology of Infection, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Hechmi Louzir
- Laboratory of Transmission Control and Immunobiology of Infection, Pasteur Institute of Tunis, Tunis, Tunisia
- National Observatory of New and Emerging Diseases, Tunis, Tunisia
| | - Amel Meddeb-Garnaoui
- Laboratory of Medical Parasitology, Biotechnology and Biomolecular, Pasteur Institute of Tunis, Tunis, Tunisia
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Ben Khelil J, Yazidi R, Ben Mrad N, Jarraya F, Rachdi E, Ayed S, Jamoussi A, Ben Salah A, Besbes M. Comparison of the clinical features and outcomes of severe seasonal influenza and COVID-19 patients in Tunisia between 2021 and 2022. Influenza Other Respir Viruses 2023; 17:e13215. [PMID: 38131002 PMCID: PMC10733115 DOI: 10.1111/irv.13215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/20/2023] [Accepted: 10/01/2023] [Indexed: 12/23/2023] Open
Abstract
Background We compared patients diagnosed at a SARI (severe acute respiratory infections) surveillance site with COVID-19 and those with seasonal influenza to investigate the clinical differences, common features, and outcomes. Methods We conducted a descriptive, retrospective study in the Medical Intensive Care Unit (ICU) at Abderrahman Mami Hospital between September 2021 and April 2022. Demographic, clinical, and biological data as well as outcomes were recorded for all patients. Results Among 223 SARI patients, 83 were confirmed COVID-19, and 22 were influenza positive. The distribution according to gender was similar; but patients with influenza were younger than those suffering from COVID-19(mean age 60.36 SD 17.28 vs. 61.88 SD 17.91; P = 0.601). In terms of underlying chronic diseases, the frequency was 84.3% in the COVID-19 group and 72.7% in the influenza group. COVID-19 patients had a longer duration of hospitalization (mean [SD], 9.51 days [8.47 days] vs. 7.33 days [8.82 days]; P = 0.003), and a more frequent need for invasive ventilation (80 [97.4%] vs. 20 [92.3]). Case fatality was also higher among this group compared to the latter (39 [47%] vs. 6 [27.3%], P = 0.01). Conclusion This exploratory study suggests higher severity of COVID-19 compared to seasonal influenza among SARI hospitalized patients even during the Omicron wave. Further research on higher sample sizes is required to confirm this conclusion.
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Affiliation(s)
- Jalila Ben Khelil
- Intensive Care DepartmentAbderrahman Mami HospitalArianaTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01Abderrahman Mami HospitalArianaTunisia
| | - Rihab Yazidi
- Service of Medical EpidemiologyInstitut Pasteur de TunisTunis‐BelvédèreTunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LR16IPT02); Institut Pasteur de TunisTunis‐BelvédèreTunisia
| | - Nacef Ben Mrad
- Intensive Care DepartmentAbderrahman Mami HospitalArianaTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01Abderrahman Mami HospitalArianaTunisia
| | - Fatma Jarraya
- Intensive Care DepartmentAbderrahman Mami HospitalArianaTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01Abderrahman Mami HospitalArianaTunisia
| | - Emna Rachdi
- Intensive Care DepartmentAbderrahman Mami HospitalArianaTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01Abderrahman Mami HospitalArianaTunisia
| | - Samia Ayed
- Intensive Care DepartmentAbderrahman Mami HospitalArianaTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01Abderrahman Mami HospitalArianaTunisia
| | - Amira Jamoussi
- Intensive Care DepartmentAbderrahman Mami HospitalArianaTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01Abderrahman Mami HospitalArianaTunisia
| | - Afif Ben Salah
- Laboratory of Transmission, Control and Immunobiology of Infections (LR16IPT02); Institut Pasteur de TunisTunis‐BelvédèreTunisia
- Department of Family and Community Medicine, College of Medicine and Medical Sciences (CMMS)Arabian Gulf University (AGU)ManamaBahrain
| | - Mohamed Besbes
- Intensive Care DepartmentAbderrahman Mami HospitalArianaTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarTunisTunisia
- Research Unit for Respiratory Failure and Mechanical Ventilation UR22SP01Abderrahman Mami HospitalArianaTunisia
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Habbash F, Rabeeah A, Huwaidi Z, Abuobaidah H, Alqabbat J, Hayyan F, Almarabheh A, Al Sindi H, Ben Salah A. Telemedicine in non-communicable chronic diseases care during the COVID-19 pandemic: exploring patients' perspectives. Front Public Health 2023; 11:1270069. [PMID: 37818295 PMCID: PMC10560720 DOI: 10.3389/fpubh.2023.1270069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/07/2023] [Indexed: 10/12/2023] Open
Abstract
Purpose This study aimed to explore challenges facing patients using Telemedicine consultations in non-communicable chronic disease clinics in primary care settings and to evaluate their satisfaction and willingness to use this service in the future. Methods This is an analytical cross-sectional study enrolling participants who were randomly selected from representative primary care centers in Bahrain and providing Telemedicine consultations. A semi-structured questionnaire permitted data collection using telephone interviews. Results A total of 251 individuals participated in the study of whom the majority were Bahraini (90.04%), and the mean age was 54.48 ± 10.78 years. Most of the participants 231 (92.03%) were satisfied with the Telemedicine consultation while only 142 (56.80%) were willing to use this service in the future. The main perceived challenges related to Teleconsultations were the lack of physical examination, inadequate time of TM consultation, fear of medical errors, and lack of privacy. The willingness to use TM consultation in the future was mainly determined by the degree of comfort to tell private information (p < 0.01) and to less extent the ease of the communication tool (p = 0.005) on multivariate analysis. Conclusion TM consultations could be a good complement to conventional consultation formats in the future. The sustainability of this innovative healthcare delivery tool requires addressing acceptability by users, ease of use, patient-centeredness, and technological advances to ensure privacy.
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Affiliation(s)
- Fatema Habbash
- Department of Family and Community Medicine, Arabian Gulf University, Manama, Bahrain
- Department of Family Medicine, University Medical Center King Abdullah Medical City Bahrain, Manama, Bahrain
| | | | | | | | | | | | - Amer Almarabheh
- Department of Family and Community Medicine, Arabian Gulf University, Manama, Bahrain
| | | | - Afif Ben Salah
- Department of Family and Community Medicine, Arabian Gulf University, Manama, Bahrain
- Institute Pasteur de Tunis, Department of Medical Epidemiology, Tunis, Tunisia
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Alsayyad A, Chlif S, Mohamed A, Habbash F, Ayoob Z, Almarabheh A, Al Sayed K, Alsaleh A, Alhajeri M, Alzayani S, Abu Alfatah N, Ahmed J, Ben Salah A. Super-spreading social events for COVID-19 transmission: evidence from the investigation of six early clusters in Bahrain. Front Public Health 2023; 11:1216113. [PMID: 37744496 PMCID: PMC10513455 DOI: 10.3389/fpubh.2023.1216113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/17/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction This study aimed to characterize six early clusters of COVID-19 and derive key transmission parameters from confirmed cases that were traced between April and June 2020 in Bahrain. Methods Pairs of "infector-infectee" allowed us to map the clusters and estimate the incubation period serial interval as the secondary attack rate. The chi-squared test, with a p-value computed using the Monte Carlo test, measured associations between categorical variables. Statistical analysis was performed using R software and the "data.tree, tidyverse" libraries. Results From 9 April to 27 June 2020, we investigated 596 individuals suspected of COVID-19, of whom 127 positive cases were confirmed by PCR and linked in six clusters. The mean age was 30.34 years (S.D. = 17.84 years). The male-to-female ratio was 0.87 (276/318), and most of the contacts were of Bahraini citizenship (511/591 = 86.5%). Exposure occurred within the family in 74.3% (411/553), and 18.9% of clusters' cases were symptomatic (23/122 = 18.9%). Mapped clusters and generations increased after 24 May 2020, corresponding to "Aid El-Fitr." The mean incubation period was 4 days, and the mean serial interval ranged from 3 to 3.31 days. The secondary attack rate was 0.21 (95% C.I.) = [0.17-0.24]. Conclusion COVID-19 transmission was amplified due to the high number of families mixing during "Aid El Fitr" and "Ramadhan," generating important clusters. Estimated serial intervals and incubation periods support asymptomatic transmission.
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Affiliation(s)
- Adel Alsayyad
- Ministry of Health, Manama, Bahrain
- Family and Community Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Sadok Chlif
- Family and Community Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Institut Pasteur de Tunis, Tunis, Tunisia
| | | | - Fatema Habbash
- Family and Community Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- King Abdullah University Medical Centre, Manama, Bahrain
| | | | - Amer Almarabheh
- Family and Community Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | | | - Aseel Alsaleh
- Family and Community Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | | | - Salman Alzayani
- Family and Community Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | | | - Jamil Ahmed
- Family and Community Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Afif Ben Salah
- Family and Community Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Institut Pasteur de Tunis, Tunis, Tunisia
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Almarabheh A, Salah AB, Alghamdi M, Al Saleh A, Elbarbary A, Al Qashar A, Alserdieh F, Alahmed F, Alhaddar H, Alsada L, Yosri M, Omran M, Khudhair M, Salih M, Fuad N, Chlif S. Validity and reliability of the WHOQOL-BREF in the measurement of the quality of life of Sickle disease patients in Bahrain. Front Psychol 2023; 14:1219576. [PMID: 37720642 PMCID: PMC10503438 DOI: 10.3389/fpsyg.2023.1219576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023] Open
Abstract
Background Limited attention is devoted to the improvement of the quality of life of patients suffering from the negative consequences of Sickle cell disease (SCD). Our study focuses on the evaluation of the performance of the WHOQOL-BREF as a tool to measure the quality of life of SCD Patients in Bahrain. Methods We conducted a cross-sectional study that enrolled 273 SCD patients selected using a simple random sampling technique from primary health-care centers in Bahrain in 2019. A designed questionnaire including the WHOQOL-BREF was filled by the patients in the health centers. The reliability of the WHOQOL-BREF was assessed by standardized Cronbach's alpha coefficient, and the validity was measured by convergent validity, principal component analysis and confirmatory factor analysis. Results The WHOQOL-BREF had good internal consistency as Cronbach's alpha coefficient for the overall scale was 0.91. The convergent validity results indicated that the correlation coefficients values for all scale domains are significantly correlated at α < 0.01. Confirmatory factor analysis found that the four-domain structure produced a robust fit to the data. Conclusion The WHOQOL-BREF tool has high internal consistency and validity in assessing the quality of life of Sickle Disease patients in Bahrain.
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Affiliation(s)
- Amer Almarabheh
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Afif Ben Salah
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Department of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Manal Alghamdi
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Aseel Al Saleh
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Abdulla Elbarbary
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Ahmed Al Qashar
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Faisal Alserdieh
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Fatema Alahmed
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Hasan Alhaddar
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Lulwa Alsada
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Mohamed Yosri
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Mahmood Omran
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Mina Khudhair
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Motasem Salih
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Noora Fuad
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Sadok Chlif
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Department of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
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Boukthir A, Bouguerra H, Ben Salah A, Erber AC, Chaabene S, Moussa H, Guillemette F, Alaya NB, Bettaieb J. Influenza vaccine uptake in Tunisia from two high-risk groups' perception and attitudes: a qualitative study. Front Public Health 2023; 11:1212431. [PMID: 37655288 PMCID: PMC10466396 DOI: 10.3389/fpubh.2023.1212431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/17/2023] [Indexed: 09/02/2023] Open
Abstract
Background Pregnant women (PW) and older adult with chronic diseases (ECD) are priority groups for the influenza vaccination. This study was designed to have a better insight into the influenza perceptions and barriers of the vaccine uptake from these groups' perspectives. Methods This qualitative study consisted of 20 focus group discussions (FGDs) enrolled from five governorates across the country (north, center, and south) between March 18 and July 10, 2019, in urban and rural areas. FGDs were conducted in Arabic (Tunisian dialect) and following the topic guide. Data were transcribed in the local language then translated into English and analyzed using Nvivo12 Software. This permitted the analysis thematic approach, using codes determined by the focus groups. Results A total of 170 individuals participated in the FGDs (84 ECD and 86 PW). Both groups recognized the weakness of the immune system as key determinant for severity. While PW raised the lack of information about the vaccine, the ECD emphasized accessibility problems. Five main barriers to influenza vaccination were identified: cultural barriers and use of traditional medicine, misleading or lack of information about influenza and the vaccine, advice against its uptake, problems of availability and accessibility of the vaccine as well as mistrust towards the vaccine including adverse effects, vaccine composition and effectiveness. Conclusion The study provided refined information from the perspectives of users to orient the policies regarding the promotion of influenza vaccine by decision makers among these two high risk groups.
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Affiliation(s)
- Aicha Boukthir
- Department of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
- Département de communication sociale, Laboratoire Interdisciplinaire de Recherche en Enseignement Supérieur (LIRES), Université du Québec à Trois-Rivières, Québec, QC, Canada
| | - Hind Bouguerra
- Observatoire National des Maladies Nouvelles et Emergentes, Tunis, Tunisia
- Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisia
| | - Afif Ben Salah
- Department of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Astrid C. Erber
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Sana Chaabene
- Department of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Hayet Moussa
- Département de Sociologie et d’Anthropologie, Institut Supérieur des Sciences Humaines de Tunis, Université de Tunis El Manar, Tunis, Tunisia
| | - François Guillemette
- Département des Sciences de l’Education, Laboratoire Interdisciplinaire de Recherche en Enseignement Supérieur (LIRES), Université du Québec à Trois-Rivières, Québec, QC, Canada
| | - Nissaf Ben Alaya
- Observatoire National des Maladies Nouvelles et Emergentes, Tunis, Tunisia
- Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisia
| | - Jihene Bettaieb
- Department of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
- Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisia
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9
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Hechaichi A, Bouguerra H, Letaief H, Safer M, Missaoui L, Cherif A, Farah S, Jabrane H, Atawa T, Yahia H, Hamdouni H, Zitoun K, Chahed K, Laamouri R, Daaboub J, Rabhi M, Salah AB, Chahed MK, Bouafif Ben Alaya N. Outbreak Investigation of Typhoid Fever in the District of Gabes, South of Tunisia. Epidemiologia (Basel) 2023; 4:223-234. [PMID: 37489494 PMCID: PMC10366729 DOI: 10.3390/epidemiologia4030023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/28/2023] [Accepted: 05/08/2023] [Indexed: 07/26/2023] Open
Abstract
Typhoid fever is a significant public health concern in many parts of the world, particularly in developing countries with poor sanitation and hygiene conditions. In July 2016, an outbreak of typhoid fever occurred in Ghannouche, located in the south of Tunisia. This paper reports the results of a field investigation undertaken to identify possible transmission pathways and risk factors in order to propose control and preventive measures. A retrospective cohort study including a passive and active case finding, as well as an environmental and bacteriological investigation was conducted from July to September 2016. A case was defined as a person residing or having stayed in Ghannouche and having presented from the beginning of June clinical signs suggestive of typhoid fever, with, for a confirmed case, laboratory isolation of S.Tyhi, and for a probable case, an epidemiological link with a confirmed case. Attack rates were determined, and risk ratios were estimated with respect to exposures. Unadjusted and adjusted odds ratios were estimated using binary logistic regression. Among the 628 subjects investigated, 102 cases of typhoid fever were identified (74 confirmed and 28 probable) with an overall attack rate of 16.24%. Over 56% of cases were male and those under 10 years old were most affected (38.2%% of cases) with a median age of 12 years (interquartile range 5 to 25 years). The main clinical signs were fever (95%) and diarrhea (57%). Young age (adjusted OR = 0.95 and 95% CI = 0.93-0.97), low level of education (adjusted OR = 4.76 and 95% CI = 1.34-16.81), and the habitat type Arab or rudimentary house (adjusted OR = 4.93 and 95% CI = 2.61-8.27) were the socio-demographic factors independently associated with typhoid fever. Typhoid fever was found to be associated with drinking softened water (adjusted OR = 2.64 and 95% CI = 1.16-4.82), eating raw fruit and vegetables from family gardens (adjusted OR = 6.13 and 95% CI = 3.66-11.06), and using uncontrolled waste disposal (adjusted OR = 3.52 and 95% CI = 2.03-6.94). A total of 110 drinking water samples were analyzed; out of the 38 samples of softened water, 12 were non-compliant and 5 were positive for Salmonella. The screening activity identified two asymptomatic carriers, one of whom was a softened water seller. We concluded that drinking softened water from informal or unauthorized sale units, consuming fruit and vegetables from family gardens, uncontrolled dumping of household waste, and poor socio-economic conditions increase the risk of typhoid fever in this region. Many recommendations were implemented to stop this outbreak and to prevent further episodes.
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Affiliation(s)
- Aicha Hechaichi
- National Observatory of Emerging Diseases, Ministry of Health, Diplomat Building, 5-7 Khartoum Street, Le Belvédère, Tunis 1002, Tunisia
- Preventive Medicine Department, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis 1007, Tunisia
- Preventive Medicine Department, Faculté de Médecine de Tunis, Université de Tunis El Manar, LR01ES04 Epidémiologie et Prévention des Maladies Cardiovasculaires en Tunisie, Tunis 1007, Tunisia
| | - Hind Bouguerra
- National Observatory of Emerging Diseases, Ministry of Health, Diplomat Building, 5-7 Khartoum Street, Le Belvédère, Tunis 1002, Tunisia
- Preventive Medicine Department, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis 1007, Tunisia
- Preventive Medicine Department, Faculté de Médecine de Tunis, Université de Tunis El Manar, LR01ES04 Epidémiologie et Prévention des Maladies Cardiovasculaires en Tunisie, Tunis 1007, Tunisia
| | - Hajer Letaief
- National Observatory of Emerging Diseases, Ministry of Health, Diplomat Building, 5-7 Khartoum Street, Le Belvédère, Tunis 1002, Tunisia
- Preventive Medicine Department, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis 1007, Tunisia
- Preventive Medicine Department, Faculté de Médecine de Tunis, Université de Tunis El Manar, LR01ES04 Epidémiologie et Prévention des Maladies Cardiovasculaires en Tunisie, Tunis 1007, Tunisia
| | - Mouna Safer
- National Observatory of Emerging Diseases, Ministry of Health, Diplomat Building, 5-7 Khartoum Street, Le Belvédère, Tunis 1002, Tunisia
- Preventive Medicine Department, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis 1007, Tunisia
- Preventive Medicine Department, Faculté de Médecine de Tunis, Université de Tunis El Manar, LR01ES04 Epidémiologie et Prévention des Maladies Cardiovasculaires en Tunisie, Tunis 1007, Tunisia
| | - Lamia Missaoui
- National Observatory of Emerging Diseases, Ministry of Health, Diplomat Building, 5-7 Khartoum Street, Le Belvédère, Tunis 1002, Tunisia
| | - Amal Cherif
- National Observatory of Emerging Diseases, Ministry of Health, Diplomat Building, 5-7 Khartoum Street, Le Belvédère, Tunis 1002, Tunisia
| | - Saffar Farah
- National Observatory of Emerging Diseases, Ministry of Health, Diplomat Building, 5-7 Khartoum Street, Le Belvédère, Tunis 1002, Tunisia
| | - Houcine Jabrane
- Direction Régionale de Santé Gabès, Place du Gouvernorat, Gabès 6000, Tunisia
| | - Taoufik Atawa
- Direction des Soins de Santé de Base, Ministry of Health, 31 Khartoum Street, Tunis 1002, Tunisia
| | - Hamdi Yahia
- Direction Régionale de Santé Gabès, Place du Gouvernorat, Gabès 6000, Tunisia
| | - Hayet Hamdouni
- Direction des Soins de Santé de Base, Ministry of Health, 31 Khartoum Street, Tunis 1002, Tunisia
| | - Khadija Zitoun
- Direction Régionale de Santé Tunis, 9 Rue Ibn El Haythem, Tunis 1002, Tunisia
| | - Karim Chahed
- National Observatory of Emerging Diseases, Ministry of Health, Diplomat Building, 5-7 Khartoum Street, Le Belvédère, Tunis 1002, Tunisia
| | - Ramzi Laamouri
- National Observatory of Emerging Diseases, Ministry of Health, Diplomat Building, 5-7 Khartoum Street, Le Belvédère, Tunis 1002, Tunisia
| | - Jaber Daaboub
- Direction de L'hygiène du Milieu et de la Protection de L'environnement, Ministry of Health, Bab Saadoun, Tunis 1006, Tunisia
| | - Mohamed Rabhi
- Direction de L'hygiène du Milieu et de la Protection de L'environnement, Ministry of Health, Bab Saadoun, Tunis 1006, Tunisia
| | - Afif Ben Salah
- Graduate Studies and Research, Arabian Gulf University, Road 2904 Building 293, Manama 329, Bahrain
| | - Mohamed Kouni Chahed
- Preventive Medicine Department, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis 1007, Tunisia
| | - Nissaf Bouafif Ben Alaya
- National Observatory of Emerging Diseases, Ministry of Health, Diplomat Building, 5-7 Khartoum Street, Le Belvédère, Tunis 1002, Tunisia
- Preventive Medicine Department, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis 1007, Tunisia
- Preventive Medicine Department, Faculté de Médecine de Tunis, Université de Tunis El Manar, LR01ES04 Epidémiologie et Prévention des Maladies Cardiovasculaires en Tunisie, Tunis 1007, Tunisia
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Shehata MH, Habbash F, Makarem B, Salah AB. Modified online team-based learning as an alternative to family medicine clinical training. Med Educ 2022; 56:862. [PMID: 35608002 DOI: 10.1111/medu.14836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Ghawar W, Chaouch M, Ben Salah A, Snoussi MA, Salem S, Kharroubi G, Chouchen S, Bouaoun A, Laouini D, Bettaieb J, Ben Abderrazak S. First Report of Two Jaculus Rodents as Potential Reservoir Hosts of Leishmania Parasites in Tunisia. Microorganisms 2022; 10:microorganisms10081502. [PMID: 35893560 PMCID: PMC9332729 DOI: 10.3390/microorganisms10081502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/30/2022] Open
Abstract
This study shows, for the first time, natural Leishmania infection among Jaculus spp. in an endemic region of Tataouine, South Tunisia. To better characterize the transmission cycles in this complex focus of mixed transmission, Leishmania detection and species identification were performed by direct examination, internal transcribed spacer-1 (ITS1)-PCR-restriction fragment length polymorphism (RFLP), and sequencing of Jaculus (J.) jaculus (Linnaeus, 1758) and J. hirtipes (Lichtenstein, 1823) rodent species, which are frequently encountered in this area. Leishmania parasites were observed in 19 (41.3%) smears, while DNA parasites were detected in 28 (60.9%) Jaculus spp. spleens; among them, 12 (54.5%) were from 22 J. jaculus individuals and 16 (66.7%) were from 24 J. hirtipes individuals. Leishmania parasites were confirmed as Leishmania (L.) killicki (syn. L. tropica) in two J. hirtipes individuals (4.3%) and L. major (n = 24; 52.2%) in 10 J. jaculus and 14 J. hirtipes individuals. This finding represents the first evidence of natural infection with Leishmania parasites in rodents belonging to the Jaculus genus, providing the rationale to consider them as potential reservoir hosts of Old World Leishmania parasites in Tunisia and North Africa.
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Affiliation(s)
- Wissem Ghawar
- Department of Medical Epidemiology, Institut Pasteur de Tunis, Tunis 1002, Tunisia; (A.B.S.); (M.A.S.); (S.S.); (G.K.); (J.B.)
- Laboratory of Transmission, Control and Immunobiology of Infections (LR16IPT02), Institut Pasteur de Tunis, Tunis 1002, Tunisia;
- Clinical Investigation Center (CIC), Institut Pasteur de Tunis, Tunis 1002, Tunisia; (S.C.); (A.B.)
- Campus Universitaire Farhat Hached, University Tunis El Manar, Tunis 1068, Tunisia; (M.C.); (S.B.A.)
- Correspondence: or ; Tel.: +216-71-843-755; Fax: +216-71-791-833
| | - Melek Chaouch
- Campus Universitaire Farhat Hached, University Tunis El Manar, Tunis 1068, Tunisia; (M.C.); (S.B.A.)
- Laboratory of Medical Parasitology, Biotechnology and Biomolecules (LR16IPT06), Institut Pasteur de Tunis, Tunis 1002, Tunisia
- Laboratory of Bioinformatics, Biomathematics and Biostatistics (LR16IPT09), Institut Pasteur de Tunis, Tunis 1002, Tunisia
| | - Afif Ben Salah
- Department of Medical Epidemiology, Institut Pasteur de Tunis, Tunis 1002, Tunisia; (A.B.S.); (M.A.S.); (S.S.); (G.K.); (J.B.)
- Laboratory of Transmission, Control and Immunobiology of Infections (LR16IPT02), Institut Pasteur de Tunis, Tunis 1002, Tunisia;
- Clinical Investigation Center (CIC), Institut Pasteur de Tunis, Tunis 1002, Tunisia; (S.C.); (A.B.)
- Campus Universitaire Farhat Hached, University Tunis El Manar, Tunis 1068, Tunisia; (M.C.); (S.B.A.)
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis 1068, Tunisia
- Department of Family and Community Medicine, College of Medicine and Medical Sciences (CMMS), Arabian Gulf University (AGU), Manama 329, Bahrain
| | - Mohamed Ali Snoussi
- Department of Medical Epidemiology, Institut Pasteur de Tunis, Tunis 1002, Tunisia; (A.B.S.); (M.A.S.); (S.S.); (G.K.); (J.B.)
- Laboratory of Transmission, Control and Immunobiology of Infections (LR16IPT02), Institut Pasteur de Tunis, Tunis 1002, Tunisia;
- Clinical Investigation Center (CIC), Institut Pasteur de Tunis, Tunis 1002, Tunisia; (S.C.); (A.B.)
- Campus Universitaire Farhat Hached, University Tunis El Manar, Tunis 1068, Tunisia; (M.C.); (S.B.A.)
| | - Sadok Salem
- Department of Medical Epidemiology, Institut Pasteur de Tunis, Tunis 1002, Tunisia; (A.B.S.); (M.A.S.); (S.S.); (G.K.); (J.B.)
- Laboratory of Transmission, Control and Immunobiology of Infections (LR16IPT02), Institut Pasteur de Tunis, Tunis 1002, Tunisia;
- Clinical Investigation Center (CIC), Institut Pasteur de Tunis, Tunis 1002, Tunisia; (S.C.); (A.B.)
- Campus Universitaire Farhat Hached, University Tunis El Manar, Tunis 1068, Tunisia; (M.C.); (S.B.A.)
| | - Ghassen Kharroubi
- Department of Medical Epidemiology, Institut Pasteur de Tunis, Tunis 1002, Tunisia; (A.B.S.); (M.A.S.); (S.S.); (G.K.); (J.B.)
- Laboratory of Transmission, Control and Immunobiology of Infections (LR16IPT02), Institut Pasteur de Tunis, Tunis 1002, Tunisia;
- Clinical Investigation Center (CIC), Institut Pasteur de Tunis, Tunis 1002, Tunisia; (S.C.); (A.B.)
- Campus Universitaire Farhat Hached, University Tunis El Manar, Tunis 1068, Tunisia; (M.C.); (S.B.A.)
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis 1068, Tunisia
| | - Said Chouchen
- Clinical Investigation Center (CIC), Institut Pasteur de Tunis, Tunis 1002, Tunisia; (S.C.); (A.B.)
- Health Regional Directorate of Tataouine, Administrative City, Tataouine Nouvelle, Tataouine 3263, Tunisia
| | - Amor Bouaoun
- Clinical Investigation Center (CIC), Institut Pasteur de Tunis, Tunis 1002, Tunisia; (S.C.); (A.B.)
- Health Regional Directorate of Tataouine, Administrative City, Tataouine Nouvelle, Tataouine 3263, Tunisia
| | - Dhafer Laouini
- Laboratory of Transmission, Control and Immunobiology of Infections (LR16IPT02), Institut Pasteur de Tunis, Tunis 1002, Tunisia;
- Clinical Investigation Center (CIC), Institut Pasteur de Tunis, Tunis 1002, Tunisia; (S.C.); (A.B.)
- Campus Universitaire Farhat Hached, University Tunis El Manar, Tunis 1068, Tunisia; (M.C.); (S.B.A.)
| | - Jihene Bettaieb
- Department of Medical Epidemiology, Institut Pasteur de Tunis, Tunis 1002, Tunisia; (A.B.S.); (M.A.S.); (S.S.); (G.K.); (J.B.)
- Laboratory of Transmission, Control and Immunobiology of Infections (LR16IPT02), Institut Pasteur de Tunis, Tunis 1002, Tunisia;
- Clinical Investigation Center (CIC), Institut Pasteur de Tunis, Tunis 1002, Tunisia; (S.C.); (A.B.)
- Campus Universitaire Farhat Hached, University Tunis El Manar, Tunis 1068, Tunisia; (M.C.); (S.B.A.)
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis 1068, Tunisia
| | - Souha Ben Abderrazak
- Campus Universitaire Farhat Hached, University Tunis El Manar, Tunis 1068, Tunisia; (M.C.); (S.B.A.)
- Laboratory of Medical Parasitology, Biotechnology and Biomolecules (LR16IPT06), Institut Pasteur de Tunis, Tunis 1002, Tunisia
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Arekat M, Shehata MH, Deifalla A, Al-Ansari A, Kumar A, Alsenbesy M, Alshenawi H, El-Agroudy A, Husni M, Rizk D, Elamin A, Ben Salah A, Atwa H. Evaluation of the Utility of Online Objective Structured Clinical Examination Conducted During the COVID-19 Pandemic. Adv Med Educ Pract 2022; 13:407-418. [PMID: 35509352 PMCID: PMC9060808 DOI: 10.2147/amep.s357229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/28/2022] [Indexed: 05/05/2023]
Abstract
BACKGROUND The COVID-19 pandemic led to profound restrictions on the face-to-face learning and assessment in all educational institutions, particularly the medical schools. The College of Medicine and Medical Sciences of the Arabian Gulf University (CMMS-AGU) conducted the final exams, both theoretical and clinical components, for its MD students online. This study was conducted to evaluate the utility of online clinical exams held at CMMS-AGU. METHODS This is a cross-sectional, mixed method study that included samples from final year medical students, examiners, and heads of clinical departments. Data were collected through surveys, structured interviews, documents' review, and calculation of online examination's psychometrics. Descriptive statistics were used. Quantitative data were presented in the form of means and standard deviations. Responses of heads of clinical departments in the structured interview were transcribed and analyzed thematically based on three pre-established themes. RESULTS Quantitative and qualitative data on the utility (validity, reliability, acceptability, educational impact, and cost and feasibility) of online objective structured clinical examination (OSCE) were collected. Content validity of the online clinical examination was established through high mean scores of content representativeness, which was confirmed by the heads of clinical departments regarding the proper coverage of clinical skills. Criterion validity was established through a high correlation between clinical and theoretical exam results (r = 0.75). Reliability of the exam was established through an acceptable Cronbach's alpha value (0.70 to 0.78) over the four days of the examinations. The examinations were perceived as highly acceptable by both students and examiners. High educational impact was inferred from students' responses and review of documents. The examination was found to be feasible and of reasonable cost. CONCLUSION Online OSCE might be a good alternative of conventional clinical assessments in times of crises and impossibility of having in-person contact between students, examiners, and patients. An important major drawback is still present in such initiatives, which is the inability to assess students' physical examination skills.
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Affiliation(s)
- Mona Arekat
- Internal Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Mohamed Hany Shehata
- Family and Community Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
- Family Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt
- Correspondence: Mohamed Hany Shehata, Family and Community Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain, Tel +97333918183, Email
| | - Abdelhalim Deifalla
- Anatomy Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Human Anatomy and Embryology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ahmed Al-Ansari
- Medical Education Unit, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Archana Kumar
- Medical Education Unit, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Mohamed Alsenbesy
- Internal Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
- Internal Medicine Department, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Hamdi Alshenawi
- Surgery Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Amgad El-Agroudy
- Internal Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Mariwan Husni
- Psychiatry Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Psychiatry Department, Northern Ontario School of Medicine (NOSM), Ontario, Canada
| | - Diaa Rizk
- Obstetrics and Gynecology Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Abdelaziz Elamin
- Pediatrics Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Afif Ben Salah
- Family and Community Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Hani Atwa
- Medical Education Unit, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Medical Education Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Habbash F, Ben Salah A, Almarabheh A, Jahrami H. Insomnia and Related Factors During the Delta Wave of the COVID-19 Pandemic in the Kingdom of Bahrain: A Cross-Sectional Study. Nat Sci Sleep 2022; 14:1963-1975. [PMID: 36340636 PMCID: PMC9635386 DOI: 10.2147/nss.s380141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE This study aims to estimate the prevalence of insomnia and related risk factors during the Delta wave of the COVID-19 pandemic in the Kingdom of Bahrain. METHODS An analytical cross-sectional study included 646 individuals from the general population aged 18 years and over, living in the Kingdom of Bahrain during the Delta wave of the pandemic. Data were collected by an anonymous online questionnaire using the snowball-sampling technique between June and August 2021. We used the Insomnia Severity Index (ISI) and the generalized anxiety disorder scale (GAD-7) to measure the level of insomnia and anxiety, respectively. RESULTS A total of 646 individuals participated in the study. Most of the participants were females (86%). The mean age was 38.7 ± 12.7 years (age range 18-89) and around half of the participants were 35 years or older. Clinical insomnia was reported by 20% [95% CI, 16.9-20.0] of the participants, and 50.1% [95% CI, 46.2-50.1] had subclinical insomnia according to ISI. The proportion of insomnia was significantly higher among females, healthcare workers, participants with lower educational levels, a lower or decreased monthly income during the pandemic, or participants who reported anxiety symptoms (all P < 0.01). Scales of anxiety and insomnia revealed a high correlation (r2 = 0.347, P< 0.01). The logistic regression model confirmed that factors independently associated with insomnia are female gender (OR=1.94, 95% CI, 1.00-3.76, P < 0.050) as well as presence of anxiety (GAD-7 score ≥ 5) [OR=12.98, 95% CI, 5.61-30.00, P < 0.001]. CONCLUSION The burden of insomnia was significant among the general population in the Kingdom of Bahrain during the Delta wave of the COVID-19 pandemic despite the low severity of this variant. Mental health programs are a high priority during the pandemic and afterward. Detection of insomnia could be used to treat some mental health problems at an early stage.
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Affiliation(s)
- Fatema Habbash
- Family and Community Medicine Department, Arabian Gulf University, Manama, Kingdom of Bahrain.,Family Medicine Department, King Abdullah University Medical Center, Manama, Kingdom of Bahrain
| | - Afif Ben Salah
- Family and Community Medicine Department, Arabian Gulf University, Manama, Kingdom of Bahrain.,Institute Pasteur de Tunis, Department of Medical Epidemiology, 13 Place Pasteur, Belvedere, Tunis, Tunisia
| | - Amer Almarabheh
- Family and Community Medicine Department, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Haitham Jahrami
- Department of Psychiatry, Ministry of Health, Manama, Kingdom of Bahrain.,Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
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14
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Kharroubi G, Cherif I, Bouabid L, Gharbi A, Boukthir A, Ben Alaya N, Ben Salah A, Bettaieb J. Influenza vaccination knowledge, attitudes, and practices among Tunisian elderly with chronic diseases. BMC Geriatr 2021; 21:700. [PMID: 34911475 PMCID: PMC8672335 DOI: 10.1186/s12877-021-02667-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 11/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Generally, seasonal influenza does not cause severe infection in healthy adults, but for the elderly, an infection can pose a serious health concern. Although several measures can help prevent influenza, vaccination is considered the most effective. This study aimed to assess influenza vaccine uptake among elderly with chronic diseases in Tunisia during the 2018-2019 influenza season, and to identify knowledge, attitudes and barriers associated with influenza vaccine uptake. METHODS During influenza season of 2018-2019, we conducted a national cross-sectional study among elderly with chronic disease who were attending primary and secondary health care facilities in Tunisia. We collected data regarding practices, general knowledge and attitudes related to influenza and influenza vaccine, using a standardized questionnaire. A multivariate analysis by logistic regression was performed to assess the factors influencing willingness to receive influenza vaccine. RESULTS Among the 1191 surveyed elderly, 19.4% (95%CI 14.1-21.9) were vaccinated during the 2018-2019 influenza season and 64.7% (61.9-67.3) expressed willingness to be vaccinated in the next season regardless of vaccination status in the 2018-2019 season. Previous vaccination in the 2018-2019 influenza season was the most significantly associated factor with willingness to receive influenza vaccine (adjusted OR = 16.5 [3.7-72.4]). Significant associations were also observed between knowledge of influenza severity for the elderly as well as for those with chronic diseases and willingness to be vaccinated (p < 0.01). Likewise, participants who were convinced by flu vaccine effectiveness and those who were not concerned about vaccine side effects were more likely to be vaccinated (p < 0.001). The main reason that may lead to vaccine acceptance was a doctor's recommendation (41.1%), while the two main reasons that may lead to vaccine refusal were concerns about side effects (71.5%) and a belief that vaccine was ineffective in averting influenza illness (33.9%). Doctors were the most trusted source for information about influenza vaccine (91.5%). CONCLUSION Our study revealed low influenza vaccination coverage among Tunisian elderly with chronic diseases believed to be at higher risk for severe acute respiratory infections and death if infected with influenza. Treating physicians' role in promoting influenza vaccination in this high-risk group seems to be crucial.
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Affiliation(s)
- Ghassen Kharroubi
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, 1002, Belvédère, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia
| | - Ines Cherif
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, 1002, Belvédère, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia
| | - Leila Bouabid
- National Observatory of New and Emerging Diseases, Tunis, Tunisia
| | - Adel Gharbi
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, 1002, Belvédère, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia
| | - Aicha Boukthir
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, 1002, Belvédère, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia
| | - Nissaf Ben Alaya
- National Observatory of New and Emerging Diseases, Tunis, Tunisia
| | - Afif Ben Salah
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, 1002, Belvédère, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia.,Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Jihene Bettaieb
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, 1002, Belvédère, Tunis, Tunisia. .,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia.
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15
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Ayouni K, Kharroubi G, Mallekh R, Hammami W, Marouani R, Mhamdi M, Ben Salah A, Triki H, Bettaieb J. Seroprevalence of hepatitis A virus infection in Central-West of Tunisia. J Med Virol 2021; 93:3666-3671. [PMID: 32986240 DOI: 10.1002/jmv.26563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/28/2020] [Accepted: 09/23/2020] [Indexed: 11/06/2022]
Abstract
Hepatitis A infections still represent a major global health concern. During the past years, a transition pattern of the hepatitis A epidemiology was noted in many parts of the world. In Tunisia, there is not a recent survey on age-specific hepatitis A virus seroprevalence. This study aimed to investigate the seroprevalence of hepatitis A virus infection in Central-West Tunisia, representative of regions with lowest socioeconomic level in the country, before vaccine implementation. Sera obtained from the blood samples of subjects were screened for the detection of hepatitis A virus. The seroprevalence was evaluated by detection of total antibodies to hepatitis A virus using commercially available immunoassay kits. A total of 1379 subjects, aged 5-75 years (mean age: 29.0 ± 17.3 years) were studied. The global anti-hepatitis A virus seroplevalence was 84.7% (95% confidence interval: [82.6-86.5]). A higher hepatitis A virus seroprevalence was showed in subjects aged 10-14 years compared to those aged less than 10 years (50.0% vs. 31.0%). In subjects aged 20-29 years, a rapid increase in the hepatitis A virus prevalence was noted; it reached 97.0%. The seroprevalence of anti-hepatitis A virus differed by zone of residence (81.1% in rural area vs. 72.4% in urban area, p = .005) and increased significantly with lower level of education (p = .019). There was no statistical significant seroprevalence difference between male and female: 84.2% versus 85.2%, respectively. Our study confirm the transition pattern of the hepatitis A virus endemicity in Tunisia from high to intermediate and provide an evaluation of the hepatitis A virus epidemiological situation before vaccine implementation.
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Affiliation(s)
- Kaouther Ayouni
- Laboratory of Clinical Virology, Pasteur Institute of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center, Pasteur Institute of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ghassen Kharroubi
- Clinical Investigation Center, Pasteur Institute of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Epidemiology, Clinical Investigation Center, Pasteur Institute of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Rym Mallekh
- Department of Epidemiology, Clinical Investigation Center, Pasteur Institute of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Walid Hammami
- Laboratory of Clinical Virology, Pasteur Institute of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center, Pasteur Institute of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | | | - Moncef Mhamdi
- Regional Health Direction of Kasserine, Kasserine, Tunisia
| | - Afif Ben Salah
- Clinical Investigation Center, Pasteur Institute of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Epidemiology, Clinical Investigation Center, Pasteur Institute of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Henda Triki
- Laboratory of Clinical Virology, Pasteur Institute of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Clinical Investigation Center, Pasteur Institute of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Jihène Bettaieb
- Clinical Investigation Center, Pasteur Institute of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Epidemiology, Clinical Investigation Center, Pasteur Institute of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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16
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Cherif I, Kharroubi G, Bouabid L, Gharbi A, Boukthir A, Ben Alaya N, Ben Salah A, Bettaieb J. Knowledge, attitudes and uptake related to influenza vaccine among healthcare workers during the 2018-2019 influenza season in Tunisia. BMC Public Health 2021; 21:907. [PMID: 33980192 PMCID: PMC8116062 DOI: 10.1186/s12889-021-10970-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/04/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The influenza vaccine (IV) is considered the most effective strategy to prevent seasonal influenza infection and annual vaccination of healthcare workers (HCWs) is recommended by the World Health Organization given their high mixing with patients. We assessed IV uptake among HCWs in the 2018-2019 season and explored their knowledge and attitudes regarding influenza immunization. METHODS A cross-sectional study was conducted in 150 representative Tunisian health facilities from March to May 2019. We recruited 1231 HCWs with direct patient contact using self-weighted multistage sampling. Univariate and multivariate logistic regression analyses permitted to assess the factors associated with IV uptake in the 2018-2019 influenza season. RESULTS Among 1231 health professionals enrolled in this study, less than half (36.6, 95% confidence interval [CI]: 33.9-39.4) received the IV at least once in their lives and only 15.3% (CI: 13.3-17.4) were vaccinated against influenza in the 2018-2019 influenza season. High confidence regarding IV efficacy, belief about the mandatory character of influenza vaccination for HCWs, and IV uptake in the 4 years preceding the 2018-2019 influenza season were independently associated with higher IV uptake by multivariate analysis. However, participants with high educational level were less likely to receive the IV than those with the lowest educational level. CONCLUSIONS Our study revealed a low vaccination rate among Tunisian HCWs confirming the importance of tailored education programs targeting this population.
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Affiliation(s)
- Ines Cherif
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia
| | - Ghassen Kharroubi
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia
| | - Leila Bouabid
- National Observatory of New and Emerging Diseases, 5-7, Khartoum Street, Diplomat, 13th floor, Le Belvédère, 1002, Tunis, Tunisia
| | - Adel Gharbi
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia
| | - Aicha Boukthir
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia
| | - Nissaf Ben Alaya
- National Observatory of New and Emerging Diseases, 5-7, Khartoum Street, Diplomat, 13th floor, Le Belvédère, 1002, Tunis, Tunisia
| | - Afif Ben Salah
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia.,Arabian Gulf University, Road 2904 Building 293, Manama, 329, Bahrain
| | - Jihene Bettaieb
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia. .,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13, Place Pasteur, B.P.74, Belvédère, 1002, Tunis, Tunisia.
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17
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Boukthir A, Bettaieb J, Erber AC, Bouguerra H, Mallekh R, Naouar I, Gharbi A, Alghamdi M, Plugge E, Olliaro P, Ben Salah A. Psycho-social impacts, experiences and perspectives of patients with Cutaneous Leishmaniasis regarding treatment options and case management: An exploratory qualitative study in Tunisia. PLoS One 2020; 15:e0242494. [PMID: 33259489 PMCID: PMC7707605 DOI: 10.1371/journal.pone.0242494] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/03/2020] [Indexed: 11/19/2022] Open
Abstract
Although non-fatal and mostly self-healing in the case of Leishmania (L.) major, cutaneous leishmaniasis (CL) is mainly treated to reduce lesion healing time. Less attention is paid to the improvement of scars, especially in aesthetically relevant areas of the body, which can dramatically affect patients' wellbeing. We explored patients' perspectives about treatment options and the social and psychological burden of disease (lesion and scar). Individual in-depth interviews were conducted with ten confirmed CL patients at two L. major endemic sites in Southern Tunisia (Sidi Bouzid and Gafsa). Participants were selected using a sampling approach along a spectrum covering e.g. age, sex, and clinical presentation. Patients' experiences, opinions and preferences were explored, and their detailed accounts gave an insight on the impact of CL on their everyday lives. The impact of CL was found to be considerable. Most patients were not satisfied with treatment performance and case management. They expected a shorter healing time and better accessibility of the health system. Tolerance of the burden of disease was variable and ranged from acceptance of hidden scars to suicidal thoughts resulting from the fear to become handicapped, and the stress caused by close relatives. Some believed CL to be a form of skin cancer. Unexpectedly, this finding shows the big gap between the perspectives of patients and assumptions of health professionals regarding this disease. This study provided valuable information for better case management emphasizing the importance of improving communication with patients, and accessibility to treatment. It generated context-specific knowledge to policy makers in Tunisia to implement effective case management in a country where access to treatment remains a challenge due to socio-economic and geographic barriers despite a long tradition in CL control.
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Affiliation(s)
- Aicha Boukthir
- Department of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia
| | - Jihene Bettaieb
- Department of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia
| | - Astrid C. Erber
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Hind Bouguerra
- Observatoire National des Maladies Nouvelles et Emergentes, Tunis, Tunisia
| | - Rym Mallekh
- Department of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Ikbel Naouar
- Department of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Adel Gharbi
- Department of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Manal Alghamdi
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Emma Plugge
- UK Collaborating Centre for the WHO Health in Prisons Programme, Public Health England, Reading, United Kingdom
| | - Piero Olliaro
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Special Program for Research & Training in Tropical Diseases (WHO/TDR), Geneva, Switzerland
| | - Afif Ben Salah
- Department of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- * E-mail:
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18
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Ayouni K, Naffeti B, Ben Aribi W, Bettaieb J, Hammami W, Ben Salah A, Ammar H, Ben Miled S, Triki H. Hepatitis a virus infection in Central-West Tunisia: an age structured model of transmission and vaccination impact. BMC Infect Dis 2020; 20:627. [PMID: 32842988 PMCID: PMC7477833 DOI: 10.1186/s12879-020-05318-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The epidemiological pattern of hepatitis A infection has shown dynamic changes in many parts of the world due to improved socio-economic conditions and the accumulation of seronegative subjects, which leads to possible outbreaks and increased morbidity rate. In Tunisia, the epidemiological status of hepatits A virus is currently unknown. However, over the past years higher numbers of symptomatic hepatitis A virus infection in school attendants and several outbreaks were reported to the Ministry of Health, especially from regions with the lowest socio-economic levels in the country. The aim of this study was to investigate the current seroprevalence of hepatitis A virus antibodies in central-west Tunisia and assess the impact of hepatitis A virus vaccination on hepatitis A epidemiology. METHODS Serum samples from 1379 individuals, aged 5-75 years, were screened for hepatitis A virus antibodies. Adjusted seroprevalence, incidence and force of infection parameters were estimated by a linear age structured SEIR (Susceptible-Exposed-Infectious-Recovered) compartmental model. A vaccine model was then constructed to assess the impact on hepatitis A virus epidemiology of 3 scenarios of vaccination strategies: one dose at 12-months of age, one dose at 6-years and one dose at 12-months and another at 6-years of age during 6 years. RESULTS A rapid increase in anti-hepatitis A virus seroprevalence was noted during infancy and adolescence: 47% of subjects under 10-years-old are infected; the prevalence increases to 77% at 15-years and reaches 97% in subjects aged 30-years. The force of infection is highest between 10 and 30-years of age and the incidence declines with increasing age. The vaccine model showed that the 3-scenarios lead to a significant reduction of the fraction of susceptibles. The two doses scenario gives the best results. Single-dose vaccination at 6-years of age provides more rapid decrease of disease burden in school-aged children, as compared to single-dose vaccination at 12-months, but keeps with a non-negligible fraction of susceptibles among children < 6-years. CONCLUSIONS Our study confirms the epidemiological switch from high to intermediate endemicity of hepatitis A virus in Tunisia and provides models that may help undertake best decisions in terms of vaccinations strategies.
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Affiliation(s)
- Kaouther Ayouni
- Laboratory of Clinical Virology - Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia. .,Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, Street 15 Medenine Bardo, Tunis, Tunisia. .,Faculty of Sciences of Tunis, University of Tunis El Manar, Campus Universitaire 2092-El Manar, Tunis, Tunisia.
| | - Bechir Naffeti
- Laboratory of Intelligent Networks and Nanotechnology, LARINA, University of Carthage, Tunis, Tunisia.,Faculty of Sciences of Bizerte, University of Carthage, Avenue de la République, P. O. Box 77-1054, Tunis, Amilcar, Tunisia
| | - Walid Ben Aribi
- Laboratory of Intelligent Networks and Nanotechnology, LARINA, University of Carthage, Tunis, Tunisia.,Faculty of Sciences of Bizerte, University of Carthage, Avenue de la République, P. O. Box 77-1054, Tunis, Amilcar, Tunisia
| | - Jihène Bettaieb
- Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, Street 15 Medenine Bardo, Tunis, Tunisia.,Department of Epidemiology - Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El Manar, 15 Rue Djebel Lakhdhar. La Rabta, 1007, Tunis, Tunisia
| | - Walid Hammami
- Laboratory of Clinical Virology - Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia.,Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, Street 15 Medenine Bardo, Tunis, Tunisia
| | - Afif Ben Salah
- Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, Street 15 Medenine Bardo, Tunis, Tunisia.,Department of Epidemiology - Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El Manar, 15 Rue Djebel Lakhdhar. La Rabta, 1007, Tunis, Tunisia
| | - Hamadi Ammar
- Laboratory of Intelligent Networks and Nanotechnology, LARINA, University of Carthage, Tunis, Tunisia.,Faculty of Economic Sciences and Management of Nabeul, University of Carthage, Avenue de la République, BP 77-1054, Tunis, Amilcar, Tunisia
| | - Slimane Ben Miled
- Laboratory of Bioinformatics, Biomathématics and Biostatistics, Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia
| | - Henda Triki
- Laboratory of Clinical Virology - Pasteur Institute of Tunis, University of Tunis El Manar, 13, Place Pasteur, BP: 74-1002, Tunis, Tunisia.,Clinical Investigation Center - Pasteur Institute of Tunis, University of Tunis El Manar, Street 15 Medenine Bardo, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El Manar, 15 Rue Djebel Lakhdhar. La Rabta, 1007, Tunis, Tunisia
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19
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Bettaieb J, Toumi A, Ghawar W, Chlif S, Nouira M, Belhaj-Hamida N, Gharbi A, Ben-Alaya N, Laouini D, Louzir H, Dellagi K, Ben Salah A. A prospective cohort study of Cutaneous Leishmaniasis due to Leishmania major: Dynamics of the Leishmanin skin test and its predictive value for protection against infection and disease. PLoS Negl Trop Dis 2020; 14:e0008550. [PMID: 32841284 PMCID: PMC7473511 DOI: 10.1371/journal.pntd.0008550] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 09/04/2020] [Accepted: 07/01/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Leishmanin Skin Test (LST) is considered as a useful indicator of past infection by Leishmania parasites. However, the temporal dynamics of a positive LST under different epidemiologic scenarios and whether it relates to the protection against the recurrence of an overt disease are not fully documented. METHODOLOGY/PRINCIPAL FINDINGS We report here on a population based prospective study conducted on 2686 individuals living in two foci located in Central Tunisia, to assess over a one-year epidemiologic season, the incidence of Leishmania (L.) major infection and disease and changes in LST reactivity. The two foci were both endemic for Cutaneous Leishmaniasis (CL) due to L. major, but contrasted in their history for this disease (ie: an old focus versus a recent focus). We found that most infections occurred in the new focus (290/1000; 95% CI: 265-315 person-years) with an incidence rate of CL lesions 2.4 times higher than in the old focus. Likewise, the rates of LST reactivity reversion and loss, in the new focus, were 99/1000[38-116] person-years and 14/1000[8-21] person-years, respectively. Loss of LST reactivity was not noticed in the old focus. Interestingly, the incidence rates of symptomatic infection did not differ significantly according to the LST status at enrolment (negative versus positive) between the combined foci and the new one. CONCLUSIONS/SIGNIFICANCE Our findings confirm LST as a good tool for assessing L. major cryptic infection. However, the instability of the LST positivity in new foci should be considered as an important confounder of the outcome of this infection when developing a research protocol for vaccine trial.
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Affiliation(s)
- Jihène Bettaieb
- Department of Medical Epidemiology, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Amine Toumi
- Department of Medical Epidemiology, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Wissem Ghawar
- Department of Medical Epidemiology, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Sadok Chlif
- Department of Medical Epidemiology, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mariem Nouira
- Department of Medical Epidemiology, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Nabil Belhaj-Hamida
- Department of Medical Epidemiology, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Adel Gharbi
- Department of Medical Epidemiology, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Nissaf Ben-Alaya
- Department of Epidemiology, Observatoire National des Maladies Nouvelles et Emergentes, Tunis, Tunisia
| | - Dhafer Laouini
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Hechmi Louzir
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Koussay Dellagi
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Afif Ben Salah
- Department of Medical Epidemiology, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
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20
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Bouguerra H, Boutouria E, Zorraga M, Cherif A, Yazidi R, Abdeddaiem N, Maazaoui L, ElMoussi A, Abid S, Amine S, Bouabid L, Bougatef S, Kouni Chahed M, Ben Salah A, Bettaieb J, Bouafif Ben Alaya N. Applying the moving epidemic method to determine influenza epidemic and intensity thresholds using influenza-like illness surveillance data 2009-2018 in Tunisia. Influenza Other Respir Viruses 2020; 14:507-514. [PMID: 32390333 PMCID: PMC7431642 DOI: 10.1111/irv.12748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 12/12/2019] [Accepted: 12/15/2019] [Indexed: 01/14/2023] Open
Abstract
Background Defining the start and assessing the intensity of influenza seasons are essential to ensure timely preventive and control measures and to contribute to the pandemic preparedness. The present study aimed to determine the epidemic and intensity thresholds of influenza season in Tunisia using the moving epidemic method. Methods We applied the moving epidemic method (MEM) using the R Language implementation (package “mem”). We have calculated the epidemic and the different intensity thresholds from historical data of the past nine influenza seasons (2009‐2010 to 2017‐2018) and assessed the impact of the 2009‐2010 pandemic year. Data used were the weekly influenza‐like illness (ILI) proportions compared with all outpatient acute consultations. The goodness of the model was assessed using a cross validation procedure. Results The average duration of influenza epidemic during a typical season was 20 weeks and ranged from 11 weeks (2009‐2010 season) to 23 weeks (2015‐2016 season). The epidemic threshold with the exclusion of the pandemic season was 6.25%. It had a very high sensitivity of 85% and a high specificity of 69%. The different levels of intensity were established as follows: low, if ILI proportion is below 9.74%, medium below 12.05%; high below 13.27%; and very high above this last rate. Conclusions This is the first mathematically based study of seasonal threshold of influenza in Tunisia. As in other studies in different countries, the model has shown both good specificity and sensitivity, which allows timely and accurate detection of the start of influenza seasons. The findings will contribute to the development of more efficient measures for influenza prevention and control.
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Affiliation(s)
- Hind Bouguerra
- National Observatory of New and Emerging Diseases, Ministry of Health, Tunis, Tunisia
| | - Elyes Boutouria
- National Observatory of New and Emerging Diseases, Ministry of Health, Tunis, Tunisia
| | | | - Amal Cherif
- National Observatory of New and Emerging Diseases, Ministry of Health, Tunis, Tunisia
| | | | | | | | - Awatef ElMoussi
- Microbiology Laboratory, Virology Unit, Charles Nicolle Hospital, Tunis, Tunisia
| | - Salma Abid
- Microbiology Laboratory, Virology Unit, Charles Nicolle Hospital, Tunis, Tunisia
| | - Slim Amine
- Microbiology Laboratory, Virology Unit, Charles Nicolle Hospital, Tunis, Tunisia
| | - Leila Bouabid
- National Observatory of New and Emerging Diseases, Ministry of Health, Tunis, Tunisia
| | - Souha Bougatef
- National Observatory of New and Emerging Diseases, Ministry of Health, Tunis, Tunisia
| | | | | | | | - Nissaf Bouafif Ben Alaya
- National Observatory of New and Emerging Diseases, Ministry of Health, Tunis, Tunisia.,Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisia.,Faculté de Médecine de Tunis, LR01ES04 Epidémiologie et Prévention des Maladies Cardiovasculaires en Tunisie, Université de Tunis El Manar, Tunis, Tunisia
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21
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Erber AC, Arana B, Ben Salah A, Bennis I, Boukthir A, Castro Noriega MDM, Cissé M, Cota GF, Handjani F, López-Carvajal L, Marsh K, Medina DM, Plugge E, Lang T, Olliaro P. Patients' preferences of cutaneous leishmaniasis treatment outcomes: Findings from an international qualitative study. PLoS Negl Trop Dis 2020; 14:e0007996. [PMID: 32092059 PMCID: PMC7058360 DOI: 10.1371/journal.pntd.0007996] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 03/05/2020] [Accepted: 12/15/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is a disease that often affects exposed skin areas and may heal leaving lifelong scars. Patients' expectations from treatment are rarely considered in drug development for CL. An initiative aiming to address shortcomings in clinical trial design and conduct for CL treatments involving the researchers' community is on-going. This manuscript presents patient-preferred outcomes for CL and an assessment on how to consider these in the conduct of future trials. METHODOLOGY/PRINCIPAL FINDINGS We report preferred treatment outcomes by 74 patients with confirmed CL in endemic regions of Brazil, Burkina Faso, Colombia, Iran, Morocco, Peru and Tunisia during individual in-depth interviews. Beyond outcomes customarily considered in trials (such as lesion appearance and adverse events), patients talked about a large number of outcomes related to quality of life, such as pain, scar formation, and others affecting their work and daily activities. They also reported fears around getting rid of the parasite, disease recurrence, and possible sequelae. CONCLUSIONS/SIGNIFICANCE The study results provide a rich insight into important outcomes for CL treatments, as well as related topics, from the perspective of a diverse patient population. Among the outcomes identified, we argue that those related to quality of life as well as recurrence should be included to a greater extent for assessment in clinical trials, and discuss the suitability of measurement instruments such as the Dermatology Quality of Life Index (DLQI). Interviews also point out the potential need to address concerns related to parasitological cure or scar formation, such as social stigmatization and disability. In addition, patients should be given information in order to clarify reported misconceptions. This study therefore suggests a methodology for consulting CL patients on outcomes as elements of clinical trial design, and how to incorporate these outcomes in trials. It also discusses how reported outcomes could be addressed in clinical care.
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Affiliation(s)
- Astrid C. Erber
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Byron Arana
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - Afif Ben Salah
- Institut Pasteur de Tunis, Tunis, Tunisia
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Issam Bennis
- National School of Public Health, Rabat, Morocco
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - María del Mar Castro Noriega
- Centro Internacional de Entrenamiento de Investigaciones Médicas (CIDEIM), Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | | | | | - Farhad Handjani
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Liliana López-Carvajal
- Programa de Estudio y Control de Enfermedades Tropicales (PECET), Universidad de Antioquia, Medellín, Colombia
| | - Kevin Marsh
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Dalila Martínez Medina
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Perú
- Departamento de Enfermedades Infecciosas, Dermatológicas y Tropicales, Hospital Cayetano Heredia, Lima, Perú
| | - Emma Plugge
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- UK Collaborating Centre for the WHO Health in Prisons Programme, Public Health England, Reading, United Kingdom
| | - Trudie Lang
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Piero Olliaro
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Special Programme for Research & Training in Tropical Diseases (WHO/TDR), Geneva, Switzerland
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22
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Bettaieb J, Chouikha A, Khedhiri M, Kharroubi G, Badreddine M, Bel Hadj Hmida N, Gharbi A, Hammemi W, Sadraoui A, Ben Yahia A, Meddeb Z, Ben Salah A, Triki H. Hepatitis C virus epidemiology in Central-West Tunisia: a population-based cross-sectional study. Arch Virol 2019; 164:2243-2253. [PMID: 31179516 DOI: 10.1007/s00705-019-04308-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/09/2019] [Indexed: 12/18/2022]
Abstract
This study aimed to assess the seroprevalence, viraemia and genotype distribution of hepatitis C virus (HCV) in a region in Central-West Tunisia. A door-to-door cross-sectional study was conducted on a randomly selected sample. A total of 3178 individuals aged 5 to 74 years and members of 935 families were investigated. Seroprevalence of HCV was assessed using ELISA tests. The viral load was determined by real-time RT-PCR, and HCV genotyping was conducted by amplification and sequencing in the NS5b genomic region. The global prevalence of HCV antibodies was 3.32% (95% confidence interval [CI]: 2.72-4.00). It was significantly higher in women: 4.47% vs. 2.16% in men, p = 0.001. Seroprevalence increased with age, and the highest rates were found in the 50- to 59-year-old age group (12.90%, 95% CI: 9.45-16.86), suggesting a cohort effect with very low contribution of intrafamilial transmission. Genotyping showed a predominance of subtype 1b (84.6%), with cocirculation of subtypes 2c (9.6%), 1a (1.9%), 1d (1.9%) and 2k (1.9%), similar to the previously reported genotype distribution in Tunisia and with no genetic clusters specific to the study region. These results indicate a higher endemicity of HCV infection when compared to the previously reported nationwide surveillance data. This study provides valuable data that can contribute to current strategies to eliminate hepatitis C.
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Affiliation(s)
- Jihene Bettaieb
- Department of Medical Epidemiology, Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia.,Research Laboratory: "Transmission, Controle et Immunobiologie des Infections" (LR11-IPT02), Tunis, Tunisia.,Clinical Investigation Center (CIC), Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia.,Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Anissa Chouikha
- Laboratory of Clinical Virology, Pasteur Institute of Tunis, University Tunis El Manar, 13 Place Pasteur BP-74, 1002, Tunis Belvedere, Tunisia. .,Research Laboratory: "Transmission, Controle et Immunobiologie des Infections" (LR11-IPT02), Tunis, Tunisia. .,Clinical Investigation Center (CIC), Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia.
| | - Marwa Khedhiri
- Laboratory of Clinical Virology, Pasteur Institute of Tunis, University Tunis El Manar, 13 Place Pasteur BP-74, 1002, Tunis Belvedere, Tunisia.,Research Laboratory: "Transmission, Controle et Immunobiologie des Infections" (LR11-IPT02), Tunis, Tunisia.,Clinical Investigation Center (CIC), Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Ghassen Kharroubi
- Department of Medical Epidemiology, Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia.,Research Laboratory: "Transmission, Controle et Immunobiologie des Infections" (LR11-IPT02), Tunis, Tunisia.,Clinical Investigation Center (CIC), Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia.,Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Malek Badreddine
- Department of Medical Epidemiology, Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia.,Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Nabil Bel Hadj Hmida
- Department of Medical Epidemiology, Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia.,Research Laboratory: "Transmission, Controle et Immunobiologie des Infections" (LR11-IPT02), Tunis, Tunisia.,Clinical Investigation Center (CIC), Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Adel Gharbi
- Department of Medical Epidemiology, Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia.,Research Laboratory: "Transmission, Controle et Immunobiologie des Infections" (LR11-IPT02), Tunis, Tunisia.,Clinical Investigation Center (CIC), Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Walid Hammemi
- Laboratory of Clinical Virology, Pasteur Institute of Tunis, University Tunis El Manar, 13 Place Pasteur BP-74, 1002, Tunis Belvedere, Tunisia.,Clinical Investigation Center (CIC), Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Amel Sadraoui
- Laboratory of Clinical Virology, Pasteur Institute of Tunis, University Tunis El Manar, 13 Place Pasteur BP-74, 1002, Tunis Belvedere, Tunisia.,Clinical Investigation Center (CIC), Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Ahlem Ben Yahia
- Laboratory of Clinical Virology, Pasteur Institute of Tunis, University Tunis El Manar, 13 Place Pasteur BP-74, 1002, Tunis Belvedere, Tunisia.,Clinical Investigation Center (CIC), Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Zina Meddeb
- Laboratory of Clinical Virology, Pasteur Institute of Tunis, University Tunis El Manar, 13 Place Pasteur BP-74, 1002, Tunis Belvedere, Tunisia.,Clinical Investigation Center (CIC), Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Afif Ben Salah
- Department of Medical Epidemiology, Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia.,Research Laboratory: "Transmission, Controle et Immunobiologie des Infections" (LR11-IPT02), Tunis, Tunisia.,Clinical Investigation Center (CIC), Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia.,Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.,Department of Community and Family Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Henda Triki
- Laboratory of Clinical Virology, Pasteur Institute of Tunis, University Tunis El Manar, 13 Place Pasteur BP-74, 1002, Tunis Belvedere, Tunisia.,Research Laboratory: "Transmission, Controle et Immunobiologie des Infections" (LR11-IPT02), Tunis, Tunisia.,Clinical Investigation Center (CIC), Pasteur Institute of Tunis, University Tunis El Manar, Tunis, Tunisia.,Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
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23
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Yazidi R, Aissi W, Bouguerra H, Nouira M, Kharroubi G, Maazaoui L, Zorraga M, Abdeddaiem N, Chlif S, El Moussi A, Ben Hadj Kacem MA, Snoussi MA, Ghawar W, Koubaa M, Polansky L, McCarron M, Boussarsar M, Menif K, Amine S, Ben Khelil J, Ben Jemaa M, Bettaieb J, Bouafif Ben Alaya N, Ben Salah A. Evaluation of the influenza-like illness surveillance system in Tunisia, 2012-2015. BMC Public Health 2019; 19:694. [PMID: 31170955 PMCID: PMC6555026 DOI: 10.1186/s12889-019-7035-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 05/22/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND This study was initiated to evaluate, for the first time, the performance and quality of the influenza-like illness (ILI) surveillance system in Tunisia. METHODS The evaluation covered the period of 2012-2015 and used different data sources to measure indicators related to data quality and completeness, representativeness, timeliness, simplicity, acceptability, flexibility, stability and utility. RESULTS During the evaluation period, 485.221 ILI cases were reported among 6.386.621 outpatients at 268 ILI sentinel sites. To conserve resources, cases were only enrolled and tested for influenza during times when the number of patients meeting the ILI case definition exceeded 7% (10% after 2014) of the total number of outpatients for the week. When this benchmark was met, five to 10 patients were enrolled and sampled by nasopharyngeal swabs the following week. In total, The National Influenza Center (NIC) received 2476 samples, of which 683 (27.6%) were positive for influenza. The greatest strength of the system was its representativeness and flexibility. The timeliness of the data and the acceptability of the surveillance system performed moderately well; however, the utility of the data and the stability and simplicity of the surveillance system need improvement. Overall, the performance of the Tunisian influenza surveillance system was evaluated as performing moderately well for situational awareness in the country and for collecting representative influenza virologic samples. CONCLUSIONS The influenza surveillance system in Tunisia provided pertinent evidence for public health interventions related to influenza situational awareness. To better monitor influenza, we propose that ILI surveillance should be limited to sites that are currently performing well and the quality of data collected should be closely monitored and improved.
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Affiliation(s)
- Rihab Yazidi
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, 13, Place Pasteur, BP 74, 1002, Tunis-Belvédère, Tunisia. .,University of Carthage, Faculty of Sciences of Bizerte, Jarzouna, 7021, Bizerte, Tunisia.
| | - Wafa Aissi
- National Institute of Public Health, 5-7 rue El-Khartoum, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Hind Bouguerra
- Observatoire National des Maladies Nouvelles et Emergentes de Tunis, Tunis, Tunisia
| | - Mariem Nouira
- Service of Medical Epidemiology, Institut Pasteur de Tunis, 13, Place Pasteur, BP 74, 1002, Tunis-Belvédère, Tunisia
| | - Ghassen Kharroubi
- Service of Medical Epidemiology, Institut Pasteur de Tunis, 13, Place Pasteur, BP 74, 1002, Tunis-Belvédère, Tunisia
| | | | | | | | - Sadok Chlif
- Service of Medical Epidemiology, Institut Pasteur de Tunis, 13, Place Pasteur, BP 74, 1002, Tunis-Belvédère, Tunisia
| | - Awatef El Moussi
- National Influenza Centre-Tunis, Unit Virology, Microbiology Laboratory, Charles Nicolle's Hospital, Tunis, Tunisia
| | - Mohamed Ali Ben Hadj Kacem
- National Influenza Centre-Tunis, Unit Virology, Microbiology Laboratory, Charles Nicolle's Hospital, Tunis, Tunisia
| | - Mohamed Ali Snoussi
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, 13, Place Pasteur, BP 74, 1002, Tunis-Belvédère, Tunisia.,Service of Medical Epidemiology, Institut Pasteur de Tunis, 13, Place Pasteur, BP 74, 1002, Tunis-Belvédère, Tunisia
| | - Wissem Ghawar
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, 13, Place Pasteur, BP 74, 1002, Tunis-Belvédère, Tunisia.,Service of Medical Epidemiology, Institut Pasteur de Tunis, 13, Place Pasteur, BP 74, 1002, Tunis-Belvédère, Tunisia
| | - Makram Koubaa
- Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Lauren Polansky
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop A20, Atlanta, GA, 30329-4027, USA
| | - Margaret McCarron
- Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop A20, Atlanta, GA, 30329-4027, USA
| | - Mohamed Boussarsar
- Medical Intensive Care Unit Farhat Hached University Hospital, 4000, Sousse, Tunisia.,Research Laboratory, Heart Failure, N LR12SP09 Ibn Al Jazzar Faculty of Medicine, 4000, Sousse, Tunisia.,Non Invasive Ventilation Specialized Master Coordinator Ibn Al Jazzar, Faculty of Medicine, 4000, Sousse, Tunisia
| | - Khaled Menif
- Pediatric Intensive Care Unit, Children's Hospital Bechir Hamza of Tunis, Place Bab Saadoun, 1007, Tunis, Tunisia
| | - Slim Amine
- National Influenza Centre-Tunis, Unit Virology, Microbiology Laboratory, Charles Nicolle's Hospital, Tunis, Tunisia
| | - Jalila Ben Khelil
- Intensive care department Abderrahmen Mami Hospital, Ariana, Tunisia
| | - Mounir Ben Jemaa
- Department of Infectious Diseases, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Jihene Bettaieb
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, 13, Place Pasteur, BP 74, 1002, Tunis-Belvédère, Tunisia.,Service of Medical Epidemiology, Institut Pasteur de Tunis, 13, Place Pasteur, BP 74, 1002, Tunis-Belvédère, Tunisia
| | - Nissaf Bouafif Ben Alaya
- Observatoire National des Maladies Nouvelles et Emergentes de Tunis, Tunis, Tunisia.,Primary Health Care Directorate, Tunis, Tunisia
| | - Afif Ben Salah
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, 13, Place Pasteur, BP 74, 1002, Tunis-Belvédère, Tunisia. .,Service of Medical Epidemiology, Institut Pasteur de Tunis, 13, Place Pasteur, BP 74, 1002, Tunis-Belvédère, Tunisia. .,Department of Family and Community Medicine, College of Medicine and Medical Sciences (CMMS), Arabian Gulf University (AGU), Manama, Bahrain.
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24
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Boussoffara T, Boubaker MS, Ben Ahmed M, Mokni M, Feriani S, Ben Salah A, Louzir H. Activated cytotoxic T cells within zoonotic cutaneous leishmaniasis lesions. Immun Inflamm Dis 2019; 7:95-104. [PMID: 30997749 PMCID: PMC6688079 DOI: 10.1002/iid3.240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 11/23/2018] [Indexed: 01/10/2023]
Abstract
Introduction Zoonotic cutaneous leishmaniasis (ZCL), due to infection by Leishmania (L). major, is characterized by polymorphic clinical manifestations which could be attributed to the host's immune response. In this study we investigated the involvement of cytotoxic cells on the outcome of the disease. Methods Expression of granzyme B (GrB), granulysine (Grly), and interferon (IFN)‐γ was evaluated within ZCL lesion specimens using the technique of real‐time quantitative polymerase chain reaction (RT‐qPCR). Immunohistochemical staining was performed using anti‐CD3, CD4, CD8, CD56, GrB, and IFN‐γ antibodies to identify the phenotype of GrB and IFN‐γ‐producing cells. Results GrB and Grly mRNA was detected within 75% and 80% of ZCL lesions, respectively. Statistical analysis demonstrated a significant correlation between levels of GrB and Grly. Interestingly, expression of these molecules correlates negatively with the lesion's age. The highest levels were measured in early lesions (E‐ZCL) (lesion age ≤1 month) comparing to late lesions (L‐ZCL) (lesion age >1 month). Otherwise, IFN‐γ mRNA was detected only within 56% and a positive correlation was found between levels of this cytokine and those of GrB. Immunohistochemical analysis showed that GrB is produced essentially by CD8+T cells whereas IFN‐γ is produced by both CD4+ and CD8+T cells. Conclusion Together our results demonstrate the presence of cytotoxic cells producing GrB and Grly within leishmaniasis cutaneous lesions.
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Affiliation(s)
- Thouraya Boussoffara
- Laboratory of Transmission, Control and Immunobiology of Infections, Pasteur Institute of Tunis, Tunis, Tunisia.,Université de Tunis El Manar, Tunis, Tunisia
| | - Mohamed Samir Boubaker
- Université de Tunis El Manar, Tunis, Tunisia.,Laboratory of Human and Experimental Pathology, Pasteur Institute of Tunis, Tunis, Tunisia.,Faculté de Médecine de Tunis, Tunis, Tunisia
| | - Melika Ben Ahmed
- Laboratory of Transmission, Control and Immunobiology of Infections, Pasteur Institute of Tunis, Tunis, Tunisia.,Université de Tunis El Manar, Tunis, Tunisia
| | - Mourad Mokni
- Faculté de Médecine de Tunis, Tunis, Tunisia.,Department of Dermatology, Hospital La Rabta, Tunis, Tunisia
| | - Salma Feriani
- Laboratory of Human and Experimental Pathology, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Afif Ben Salah
- Laboratory of Transmission, Control and Immunobiology of Infections, Pasteur Institute of Tunis, Tunis, Tunisia.,Université de Tunis El Manar, Tunis, Tunisia.,Department of Family and Community Medicine, College of Medecine and Medical Sciences, Arabian Gulf University (AGU), Manama, Bahrain
| | - Hechmi Louzir
- Laboratory of Transmission, Control and Immunobiology of Infections, Pasteur Institute of Tunis, Tunis, Tunisia.,Université de Tunis El Manar, Tunis, Tunisia
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25
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Boussoffara T, Boubaker MS, Ben Ahmed M, Mokni M, Guizani I, Ben Salah A, Louzir H. Histological and immunological differences between zoonotic cutaneous leishmaniasis due to Leishmania major and sporadic cutaneous leishmaniasis due to Leishmania infantum. ACTA ACUST UNITED AC 2019; 26:9. [PMID: 30810524 PMCID: PMC6391896 DOI: 10.1051/parasite/2019007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 02/11/2019] [Indexed: 01/19/2023]
Abstract
Lesion features in cutaneous leishmaniasis (CL) depend on the infecting Leishmania species as well as on host immune reponse. In this study, we evaluated the histological and immunological differences between two forms of CL described in Tunisia: zoonotic cutaneous leishmaniasis (ZCL) caused by L. major and sporadic cutaneous leishmaniasis (SCL) caused by L. infantum. Histological analysis showed a mild to moderate infiltrate within ZCL lesions. In contrast, massive infiltration of the dermis was observed within SCL lesions. Contrary to ZCL, infiltrates within SCL lesions were organized and showed granuloma composed of macrophages and lymphocytes. In addition, immunohistochemical analysis showed a predominance of CD4+ T cells within both CL forms. Furthermore, expression of interferon-γ, interleukin (IL)-10, IL-8, IL-13 and monocyte chemotactic protein (MCP)-1 was evaluated using real-time quantitative polymerase chain reaction (RT-qPCR). MCP-1 and IL-10 were expressed at comparable levels in ZCL and SCL lesions. Interestingly, IL-8 mRNA levels were significantly higher in ZCL lesions compared to SCL lesions, but interferon-γ was significantly higher in SCL lesions than in ZCL lesions.
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Affiliation(s)
- Thouraya Boussoffara
- Laboratory of Transmission, Control, and Immunobiology of Infections, Pasteur Institute of Tunis, Tunis, Tunisia - University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Samir Boubaker
- Laboratory of Human and Experimental Pathology, Pasteur Institute of Tunis, Tunis, Tunisia - University of Tunis El Manar, Tunis, Tunisia - Faculté de Médecine de Tunis, Tunis, Tunisia
| | - Melika Ben Ahmed
- Laboratory of Transmission, Control, and Immunobiology of Infections, Pasteur Institute of Tunis, Tunis, Tunisia - University of Tunis El Manar, Tunis, Tunisia
| | - Mourad Mokni
- Department of Dermatology, Hospital La Rabta, Tunis, Tunisia - Faculté de Médecine de Tunis, Tunis, Tunisia
| | - Ikram Guizani
- Laboratory of Molecular Epidemiology and Experimental Pathology Applied to Infectious Diseases, Pasteur Institute of Tunis, Tunis, Tunisia - University of Tunis El Manar, Tunis, Tunisia
| | - Afif Ben Salah
- Laboratory of Transmission, Control, and Immunobiology of Infections, Pasteur Institute of Tunis, Tunis, Tunisia - University of Tunis El Manar, Tunis, Tunisia - Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University (AGU), Manama, Bahrain
| | - Hechmi Louzir
- Laboratory of Transmission, Control, and Immunobiology of Infections, Pasteur Institute of Tunis, Tunis, Tunisia - University of Tunis El Manar, Tunis, Tunisia - Faculté de Médecine de Tunis, Tunis, Tunisia
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Chemkhi J, Guerbouj S, Saadawi W, Shaibi T, Faris S, Ghawar W, Boukthir A, Guizani I, Annajar BB, Ben Salah A. Presence of Sergentomyia (Parrotomyia) lewisi (Diptera: Psychodidae) in Tunisia. J Med Entomol 2019; 56:560-564. [PMID: 30407526 DOI: 10.1093/jme/tjy192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Indexed: 06/08/2023]
Abstract
In Tunisia, 17 phlebotomine sand fly species are reported, belonging to genera Phlebotomus and Sergentomyia. However, subsequent to faunal studies and outbreaks of leishmaniasis in different regions of the country, unrecognized sand fly species could exist. Indeed, we report in this study the presence of Sergentomyia (Parrotomyia) lewisiParrot 1948. A brief collection of phlebotomine sand flies was undertaken in August 2016 in Khbina locality, in Sidi Bouzid governorate situated in Central Tunisia, which constitutes an old focus of Zoonotic Cutaneous Leishmaniasis. Sand flies were collected, using CDC light traps that were placed overnight, in different biotopes (inside habitations, outdoors, and within animal shelters). Specimens were collected and morphologically identified. Measurements were taken with an ocular micrometer. Two female specimens of the species Se. (Parrotomyia) lewisi were collected. One specimen is here described and measured. A comparison of its taxonomic characters to the holotype from Sudan and a specimen from Algeria is also presented. This species was until now only reported from Sudan, Ethiopia, Algeria, and Morocco. It is here described for the first time in Tunisia, which raises the Tunisian sand fly fauna to seven subgenera and 18 species.
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Affiliation(s)
- Jomaa Chemkhi
- Laboratoire d'épidémiologie moléculaire et pathologies appliquées aux maladies infectieuses (LR16IPT04), Institut Pasteur de Tunis, Université de Tunis el Manar, Tunis, Tunisia
| | - Souheila Guerbouj
- Laboratoire d'épidémiologie moléculaire et pathologies appliquées aux maladies infectieuses (LR16IPT04), Institut Pasteur de Tunis, Université de Tunis el Manar, Tunis, Tunisia
| | - Walid Saadawi
- Libyan National Center for Disease Control (NCDC), Tripoli, Libya
| | - Taher Shaibi
- Libyan National Center for Disease Control (NCDC), Tripoli, Libya
| | - Sara Faris
- Libyan National Center for Disease Control (NCDC), Tripoli, Libya
| | - Wissem Ghawar
- Laboratoire d'Epidémiologie Médicale, Institut Pasteur de Tunis, Université de Tunis el Manar, Tunis, Tunisia
| | - Aicha Boukthir
- Laboratoire d'Epidémiologie Médicale, Institut Pasteur de Tunis, Université de Tunis el Manar, Tunis, Tunisia
| | - Ikram Guizani
- Laboratoire d'épidémiologie moléculaire et pathologies appliquées aux maladies infectieuses (LR16IPT04), Institut Pasteur de Tunis, Université de Tunis el Manar, Tunis, Tunisia
| | | | - Afif Ben Salah
- Laboratoire d'Epidémiologie Médicale, Institut Pasteur de Tunis, Université de Tunis el Manar, Tunis, Tunisia
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Boussoffara T, Chelif S, Ben Ahmed M, Mokni M, Ben Salah A, Dellagi K, Louzir H. Immunity Against Leishmania major Infection: Parasite-Specific Granzyme B Induction as a Correlate of Protection. Front Cell Infect Microbiol 2018; 8:397. [PMID: 30483482 PMCID: PMC6243638 DOI: 10.3389/fcimb.2018.00397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/22/2018] [Indexed: 11/13/2022] Open
Abstract
Zoonotic cutaneous leishmaniasis (ZCL) caused by Leishmania (L.) major infection is characterized by different clinical presentations which depend in part on the host factors. In attempt to investigate the impact of the host's immune response in the outcome of the disease, we conducted a prospective study of 453 individuals living in endemic foci of L. major transmission in Central Tunisia. Several factors were assessed at the baseline including (i) the presence of typical scars of ZCL, (ii) in vivo hypersensitivity reaction to leishmanin, and (iii) the in vitro release of granzyme B (Grz B) by peripheral blood mononuclear cells (PBMC) in response to stimulation with live L. major promastigotes. After one season of parasite's transmission, repeated clinical examinations allowed us to diagnose the new emerging ZCL cases. Heterogeneity was observed in terms of number of lesions developed by each individual as well as their size and spontaneous outcome, which led us to establish the parameter “severity of the disease.” The efficacy of the presence of typical ZCL scar, the leishmanin skin test (LST) positive reactivity and the high levels of Grz B (≥2 ng/ml), in the protection against the development of ZCL were 29, 15, and 22%, respectively. However, these factors were more efficient against development of intermediate or severe forms of ZCL. Levels of Grz B >2 ng/ml showed the best efficacy of protection (equals to 72.8%) against development of these forms of ZCL. The association of such parameter with the positivity of the LST exhibited a better efficacy (equals to 83.6%). In conclusion, our results support the involvement of Leishmania-specific cytotoxic cellular immune response in host protection against Leishmania-infection. This factor could be of great interest in monitoring the success of vaccination against human leishmaniasis.
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Affiliation(s)
- Thouraya Boussoffara
- Laboratory of Transmission, Control and Immunobiology of Infections, Pasteur Institute of Tunis, Tunis, Tunisia.,Université de Tunis El Manar, Tunis, Tunisia
| | - Sadok Chelif
- Laboratory of Transmission, Control and Immunobiology of Infections, Pasteur Institute of Tunis, Tunis, Tunisia.,Université de Tunis El Manar, Tunis, Tunisia
| | - Melika Ben Ahmed
- Laboratory of Transmission, Control and Immunobiology of Infections, Pasteur Institute of Tunis, Tunis, Tunisia.,Université de Tunis El Manar, Tunis, Tunisia
| | - Mourad Mokni
- Department of Dermatology, Hospital La Rabta, Tunis, Tunisia
| | - Afif Ben Salah
- Laboratory of Transmission, Control and Immunobiology of Infections, Pasteur Institute of Tunis, Tunis, Tunisia.,Université de Tunis El Manar, Tunis, Tunisia
| | - Koussay Dellagi
- Laboratory of Transmission, Control and Immunobiology of Infections, Pasteur Institute of Tunis, Tunis, Tunisia.,Université de Tunis El Manar, Tunis, Tunisia
| | - Hechmi Louzir
- Laboratory of Transmission, Control and Immunobiology of Infections, Pasteur Institute of Tunis, Tunis, Tunisia.,Université de Tunis El Manar, Tunis, Tunisia
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Chalghaf B, Chemkhi J, Mayala B, Harrabi M, Benie GB, Michael E, Ben Salah A. Ecological niche modeling predicting the potential distribution of Leishmania vectors in the Mediterranean basin: impact of climate change. Parasit Vectors 2018; 11:461. [PMID: 30092826 PMCID: PMC6085715 DOI: 10.1186/s13071-018-3019-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 07/16/2018] [Indexed: 11/10/2022] Open
Abstract
Background Due to climate change, the geographical distribution of sand flies during the last decades has shifted northward from latitudes below 45°N in southern Europe to latitudes just above 50○N. Recent studies show that some phlebotomine sand flies were recorded in several parts of Germany and Belgium. In central Europe, some autochthone leishmaniasis cases are being recorded in regions traditionally regarded as leishmaniasis-free. An important challenge is to predict the geographical distribution of leishmaniasis vectors under new climatic conditions. In this study, we attempted to predict the current distribution of six leishmaniasis vectors in the Mediterranean basin and forecast species’ geographical shift under future climate scenarios using an ensemble ecological niche modeling approach. Species records were obtained from scientific surveys published in the research literature between 2006 and 2016. A series of climate metrics describing temperature and precipitation in the study area under two climatic scenarios were obtained from WorldClim database. A consensus model was derived from six varieties of modeling approaches (regression, machine learning and classification techniques) in order to ensure valid prediction of distribution of vectors under different climate scenarios. Results Model performance was generally high for the included species with a specificity (true negative rate) ranging from 81.03 to 96.52% (mean = 86.94%) and a sensitivity (true positive rate) ranging from 87.93 to 100% (mean = 96.98%). Our work evidenced the hypothesis of the widespread of Leishmania vectors under climate change scenarios. All of the studied species are prospected to gain new areas that are actually not suitable for vectors’ survival. Phlebotomine sand flies are prospected to invade extra-Mediterranean regions, especially western and central Europe. Conclusions Our study confirmed the importance of environmental and climate factors on the distribution of leishmaniasis vectors and demonstrated the performance of ecological niche modeling in the prediction of the geographical spread of vector-borne diseases. Ecological niche modeling should be considered in the future as a valuable tool in addition to experimental laboratory studies for a better understanding of the biology of vector species.
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Affiliation(s)
- Bilel Chalghaf
- Pasteur Institute of Tunis, Tunis, Tunisia. .,Le Centre d'Enseignement et de Recherche en Foresterie de Ste-Foy, Québec, Canada. .,The Centre for Research and Applications in Remote Sensing, Department of Applied Geomatics, Sherbrooke University, Sherbrooke, Quebec, Canada.
| | | | | | | | - Goze Bertin Benie
- The Centre for Research and Applications in Remote Sensing, Department of Applied Geomatics, Sherbrooke University, Sherbrooke, Quebec, Canada
| | | | - Afif Ben Salah
- Pasteur Institute of Tunis, Tunis, Tunisia.,Department of Family and Community Medicine, Arabian Gulf University, Manama, Bahrain
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Erber AC, Arana B, Bennis I, Ben Salah A, Boukthir A, Castro Noriega MDM, Cissé M, Cota GF, Handjani F, Kebede MG, Lang T, López Carvajal L, Marsh K, Martinez Medina D, Plugge E, Olliaro P. An international qualitative study exploring patients' experiences of cutaneous leishmaniasis: study set-up and protocol. BMJ Open 2018; 8:e021372. [PMID: 29909372 PMCID: PMC6009565 DOI: 10.1136/bmjopen-2017-021372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Lack of investments in drug development, lack of standardisation of clinical trials and the complexity of disease presentations contribute to the current lack of effective, safe and adapted treatments for cutaneous leishmaniasis (CL). One aspect concerns outcomes affecting patients' quality of life (QoL): these are hardly assessed in trials, despite potential functional and/or aesthetic impairment caused by CL, which typically affects disadvantaged and vulnerable people living in rural areas. Here, we describe the approach used to bring perspectives of patients with CL into designing and assessing treatments. METHODS AND ANALYSIS This international qualitative study uses interviews with patients to explore their experiences with CL to (1) elicit outcomes and eligibility criteria for clinical trials important to them and (2) to better understand their needs and views about the disease and their requirements and expectations from treatment. Here, we describe the set-up of this collaborative study and the protocol. Data collection is ongoing.The protocol includes study design, preparation, conduct and analysis of individual interviews with approximately 80 patients in seven countries (Burkina Faso, Brazil, two sites in Colombia, Iran, Morocco, Peru and Tunisia) where CL is prevalent. Principal investigators and sites were selected through an open call, and two workshops were organised for protocol development and training in conduct and analysis of qualitative health research. Patient recruitment aims at covering a maximum variation of experiences. Transcripts will be analysed to identify outcomes and eligibility criteria as well as further topics that are expected to emerge from the interviews, such as direct and indirect costs related to CL, its psychological impact, preferred modes of drug administration and traditional treatments. ETHICS AND DISSEMINATION The study received ethical approval by the responsible committees of each of the participating institutions. Findings will be disseminated through publication in peer-reviewed journals, scientific meetings and to participants and their communities.
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Affiliation(s)
- Astrid Christine Erber
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Byron Arana
- Drugs for Neglected Diseases Initiative (DNDi), Geneva, Switzerland
| | - Issam Bennis
- National School of Public Health, Rabat, Morocco
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Afif Ben Salah
- Institut Pasteur de Tunis, Tunis, Tunisia
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University (AGU), Manama, Bahrain
| | | | - Maria del Mar Castro Noriega
- Centro Internacional de Entrenamiento de Investigaciones Médicas (CIDEIM), Cali, Colombia
- EDCTP/TDR Fellow, European Vaccine Initiative (EVI), Heidelberg, Germany
| | | | - Gláucia Fernandes Cota
- Centro de Pesquisa René Rachou (CPqRR), Fundação Oswaldo Cruz (FIOCRUZ), Minas Gerais, Brazil
| | - Farhad Handjani
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mairie Guizaw Kebede
- Ayder Referral Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Trudie Lang
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Liliana López Carvajal
- Programa de Estudio y Control de Enfermedades Tropicales (PECET), Universidad de Antioquia, Medellín, Colombia
| | - Kevin Marsh
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Dalila Martinez Medina
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Enfermedades Infecciosas, Dermatológicas y Tropicales, Hospital Cayetano Heredia, Lima, Peru
| | - Emma Plugge
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Piero Olliaro
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Special Programme for Research & Training in Tropical Diseases (WHO/TDR), Geneva, Switzerland
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Dokhan MR, Jaouadi K, Salem S, Zenbil O, Gonzalez JP, Ben Salah A, Annajar BB. Natural Infection of Phlebotomus sergenti by Leishmania tropica in Libya. Am J Trop Med Hyg 2018. [PMID: 29532769 DOI: 10.4269/ajtmh.17-0814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Cutaneous Leishmaniasis (CL) is a public health concern caused by Leishmania (L.) major and L.tropica in Libya. Information on sandfly vectors, as well as their associated Leishmania species, is of paramount importance because vector dispersion is one of the major factors responsible for pathogen dissemination. A number of 515 sandflies (275 males and 240 females) were collected during June-November 2012 using the Centers for Disease Control miniature light traps from Al Rabta, northwest of Libya. Two hundred and forty unfed females were identified; Phlebotomus (Ph.) papatasi (N = 97), Ph. sergenti (N = 27), Ph. longicuspis (N = 32), Sergentomyia (Se.) minuta (N = 38), and Se. fallax (N = 46). These flies were screened for Leishmania DNA using the polymerase chain reaction-restriction fragment length polymorphism analysis of the internal transcribed spacer 1 and sequencing. Two Ph. sergenti were found positive to L. tropica DNA. This finding should be considered for any further vector surveillance and epidemiological studies of CL in endemic areas across Libya.
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Affiliation(s)
- Mostafa Ramadhan Dokhan
- Department of Zoology, Faculty of Science, University of Sabratha, Sabratha, Libya.,Libyan National Centre for Disease Control (NCDC), Tripoli, Libya
| | - Kaouther Jaouadi
- Laboratory of Medical Epidemiology, Institut Pasteur de Tunis, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, Tunis, Tunisia
| | - Sadok Salem
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, Tunis, Tunisia.,Laboratory of Medical Epidemiology, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Osama Zenbil
- Libyan National Centre for Disease Control (NCDC), Tripoli, Libya
| | - Jean Paul Gonzalez
- Center of Excellence for Emerging and Zoonotic Animal Disease, Kansas State University, Manhattan, Kansas
| | - Afif Ben Salah
- Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, Tunis, Tunisia.,Department of Family and Community Medicine, College of Medicine and Medical Sciences (CMMS), Arabian Gulf University (AGU), Manama, Bahrain.,Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.,Laboratory of Medical Epidemiology, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Badreddin Bashir Annajar
- Public Health Department, Faculty of Medical Technology, University of Tripoli, Tripoli, Libya.,Libyan National Centre for Disease Control (NCDC), Tripoli, Libya
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Ben Othman S, Ghawar W, Chaouch M, Ayari C, Chemkhi J, Cancino-Faure B, Tomás-Pérez M, Alcover MM, Riera C, Ben Salah A, Fisa R, Ben Ismail R, Ben Abderrazak S. First detection of Leishmania DNA in Psammomys obesus and Psammomys vexillaris: Their potential involvement in the epidemiology of leishmaniasis in Tunisia. Infect Genet Evol 2018; 59:7-15. [PMID: 29413886 DOI: 10.1016/j.meegid.2018.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 12/12/2022]
Abstract
Leishmaniasis, a public health problem in Tunisia, are diseases caused by different Leishmania species. Cutaneous leishmaniasis is present from the North to the South under different forms, due to Leishmania (L.) major, L. infantum or L. tropica. Whereas, Psammomys (P.) obesus is the confirmed reservoir host of L. major, those of L. tropica and dermotropic L. infantum wait to be identified. Importantly, P. vexillaris species have been recently highlighted; however, no studies have been carried out to explore its potential role in leishmaniasis epidemiology. Seventy two rodents were collected from Central and South-West of Tunisia between 2007 and 2010. Using several methods, 43 animals were identified as P. obesus and 29 as P. vexillaris. Leishmania kinetoplast DNA was detected in liver samples by real-time PCR in 18 P. obesus and in 8 P. vexillaris. Then, the direct sequencing of the amplified internal transcribed spacer 1, allowed the identification of L. infantum DNA in five P. obesus and in three P. vexillaris, as well as L. tropica DNA in three other P. vexillaris. Whereas, PCR fluorescent fragment length analysis of the 7 spliced leaders, allowed identifying L. major among infected P. obesus and P. vexillaris, and interestingly co-infection (L. major/L. infantum) among two P. obesus. We report here for the first time, the infection of P. obesus, from Central Tunisia, by L. infantum. Suggesting that P. obesus the known reservoir host of L. major, may also serve as reservoir host for L. infantum and thus play a role in the spread of sporadic cutaneous or visceral leishmaniasis in this region. Of equal importance, this work establish for the first time, the natural infection of P. vexillaris by different Leishmania species, suggesting its potential epidemiological role as reservoir host.
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Affiliation(s)
- Souad Ben Othman
- Laboratory of Medical Parasitology, Biotechnology and Biomolecules, Pasteur Institute of Tunis, Tunis, Tunisia; Faculty of Sciences of Bizerte, Carthage University, Tunis, Tunisia
| | - Wissem Ghawar
- Service of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia
| | - Melek Chaouch
- Laboratory of Medical Parasitology, Biotechnology and Biomolecules, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Chiraz Ayari
- Laboratory of Medical Parasitology, Biotechnology and Biomolecules, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Jomaa Chemkhi
- Laboratory of Molecular Epidemiology and Experimental Pathology Applied to Infectious Diseases, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Beatriz Cancino-Faure
- Department of Biology, Health and Environment, Faculty of Pharmacy, University of Barcelona, Barcelona, Spain; Department of Preclinical Sciences, Laboratory of Microbiology, Faculty of Medicine, Catholic University of Maule, Talca, Chile
| | - Miriam Tomás-Pérez
- Department of Biology, Health and Environment, Faculty of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Maria Magdalena Alcover
- Department of Biology, Health and Environment, Faculty of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Cristina Riera
- Department of Biology, Health and Environment, Faculty of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Afif Ben Salah
- Service of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, Tunis, Tunisia
| | - Roser Fisa
- Department of Biology, Health and Environment, Faculty of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Riadh Ben Ismail
- Laboratory of Molecular Epidemiology and Experimental Pathology Applied to Infectious Diseases, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Souha Ben Abderrazak
- Laboratory of Medical Parasitology, Biotechnology and Biomolecules, Pasteur Institute of Tunis, Tunis, Tunisia.
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Olliaro P, Grogl M, Boni M, Carvalho EM, Chebli H, Cisse M, Diro E, Fernandes Cota G, Erber AC, Gadisa E, Handjani F, Khamesipour A, Llanos-Cuentas A, López Carvajal L, Grout L, Lmimouni BE, Mokni M, Nahzat MS, Ben Salah A, Ozbel Y, Pascale JM, Rizzo Molina N, Rode J, Romero G, Ruiz-Postigo JA, Gore Saravia N, Soto J, Uzun S, Mashayekhi V, Vélez ID, Vogt F, Zerpa O, Arana B. Harmonized clinical trial methodologies for localized cutaneous leishmaniasis and potential for extensive network with capacities for clinical evaluation. PLoS Negl Trop Dis 2018; 12:e0006141. [PMID: 29329311 PMCID: PMC5785032 DOI: 10.1371/journal.pntd.0006141] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 01/25/2018] [Accepted: 11/29/2017] [Indexed: 11/27/2022] Open
Abstract
Introduction Progress with the treatment of cutaneous leishmaniasis (CL) has been hampered by inconsistent methodologies used to assess treatment effects. A sizable number of trials conducted over the years has generated only weak evidence backing current treatment recommendations, as shown by systematic reviews on old-world and new-world CL (OWCL and NWCL). Materials and methods Using a previously published guidance paper on CL treatment trial methodology as the reference, consensus was sought on key parameters including core eligibility and outcome measures, among OWCL (7 countries, 10 trial sites) and NWCL (7 countries, 11 trial sites) during two separate meetings. Results Findings and level of consensus within and between OWCL and NWCL sites are presented and discussed. In addition, CL trial site characteristics and capacities are summarized. Conclusions The consensus reached allows standardization of future clinical research across OWCL and NWCL sites. We encourage CL researchers to adopt and adapt as required the proposed parameters and outcomes in their future trials and provide feedback on their experience. The expertise afforded between the two sets of clinical sites provides the basis for a powerful consortium with potential for extensive, standardized assessment of interventions for CL and faster approval of candidate treatments. The term ‘cutaneous leishmaniasis’ (CL) includes a range of manifestations affecting the skin caused by Leishmania parasites across several continents. While not life-threatening, CL can be invalidating and disfiguring, or become complicated. Today, there is no satisfactory treatment for CL that is effective and safe. Faced with no investments into developing drugs for CL, clinical researchers have tried many treatments over the years, but little progress has been made. One of the reasons is the lack of standardized methodologies in conducting these trials which makes it difficult to collate and compare results. Clinical researchers now realize that their efforts can be brought to fruition if common methodologies are available and applied. This paper summarizes the principles and parameters agreed upon by researchers of how to identify patients and how to measure treatment effects in a way that will make it possible to gather convincing evidence of whether a treatment works or not. Adhering to these principles will allow faster progress towards offering better care to patients with this neglected disease.
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Affiliation(s)
- Piero Olliaro
- Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization (WHO), Geneva, Switzerland
- Centre for Tropical Medicine and Vaccinology, Nuffield Department of Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom
- * E-mail:
| | - Max Grogl
- U.S. Naval Medical Unit No.6 Peru, Lima, Peru
| | - Marina Boni
- Drugs for Neglected Diseases initiative (DNDi) Latin America, Rio de Janeiro, Brazil
| | | | - Houda Chebli
- Direction de l’Épidémiologie et de Lutte contre les Maladies, Division des Maladies Transmissibles, Service des Maladies Parasitaires, Rabat, Morocco
| | - Mamoudou Cisse
- Université Polytechnique de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Ermias Diro
- Department of Internal Medicine, University of Gondar, Ethiopia
| | | | - Astrid C. Erber
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Farhad Handjani
- Molecular Dermatology Research Center, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Khamesipour
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Alejandro Llanos-Cuentas
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Liliana López Carvajal
- Programa de Estudio y Control de Enfermedades Tropicales (PECET), Universidad de Antioquia, Medellin, Colombia
| | - Lise Grout
- Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | | | - Mourad Mokni
- Dermatology Department, La Rabta Hospital, Tunis, Tunisia
| | | | - Afif Ben Salah
- Service d'épidémiologie médicale, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Yusuf Ozbel
- Department of Parasitology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Juan Miguel Pascale
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá, República de Panamá
| | - Nidia Rizzo Molina
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Joelle Rode
- Drugs for Neglected Diseases initiative (DNDi) Latin America, Rio de Janeiro, Brazil
| | - Gustavo Romero
- Núcleo de Medicina Tropical, Universidade de Brasília, Campus Universitário Darcy Ribeiro, Brasília, Brazil
| | | | - Nancy Gore Saravia
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia
| | - Jaime Soto
- Fundación Nacional de Dermatología (FUNDERMA), Santa Cruz de la Sierra, Santa Cruz, Bolivia
| | - Soner Uzun
- Department of Dermatology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | | | - Ivan Dario Vélez
- Programa de Estudio y Control de Enfermedades Tropicales (PECET), Universidad de Antioquia, Medellin, Colombia
| | - Florian Vogt
- Unit of HIV and Neglected Tropical Diseases, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Olga Zerpa
- Instituto Medico la Floresta, Caracas, Venezuela
| | - Byron Arana
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
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Jaouadi K, Bettaieb J, Bennour A, Salem S, Ghawar W, Rjeibi MR, Khabouchi N, Gonzalez JP, Diouani MF, Ben Salah A. Blood Meal Analysis of Phlebotomine Sandflies (Diptera: Psychodidae: Phlebotominae) for Leishmania spp. Identification and Vertebrate Blood Origin, Central Tunisia, 2015-2016. Am J Trop Med Hyg 2018; 98:146-149. [PMID: 29165234 DOI: 10.4269/ajtmh.17-0313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
During the time periods of June 2015 and from July to August 2016, sandflies were collected among seven collection sites of the three leishmaniasis endemic villages of Sidi Bouzid, Tunisia. A total of 690 sandflies were captured and identified (380 males and 310 females). Four species belonging to genus Phlebotomus (Ph.) and two species belonging to genus Sergentomyia were identified. Leishmania DNA was detected in four out of 310 females (one Ph. sergenti and three Ph. papatasi). The overall sensitivity of the Prepronociceptin gene detection reached 76%. The concurrent presence of Ph. papatasi and Ph. sergenti vectors, the analysis of blood-meals, together with the detection of L. major in Ph. papatasi, confirms the ultimate conditions for the transmission of the disease in center Tunisia. These results expand the known epidemiological area of distrubtion of leishmaniasis and its vectors in this part of Tunisia, highlighting the need for ongoing entomological and parasitological surveillance.
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Affiliation(s)
- Kaouther Jaouadi
- Laboratory of Medical Epidemiology, Institut Pasteur de Tunis, Tunis-Belvedere, Tunisia; Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, Tunis-Belvedere, Tunisia
| | - Jihene Bettaieb
- Faculty of Medicine of Tunis, Tunis, Tunisia.,Laboratory of Medical Epidemiology, Institut Pasteur de Tunis, Tunis-Belvedere, Tunisia; Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, Tunis-Belvedere, Tunisia
| | - Amira Bennour
- Laboratory of Medical Epidemiology, Institut Pasteur de Tunis, Tunis-Belvedere, Tunisia; Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, Tunis-Belvedere, Tunisia
| | - Sadok Salem
- Laboratory of Medical Epidemiology, Institut Pasteur de Tunis, Tunis-Belvedere, Tunisia; Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, Tunis-Belvedere, Tunisia
| | - Wissem Ghawar
- Laboratory of Medical Epidemiology, Institut Pasteur de Tunis, Tunis-Belvedere, Tunisia; Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, Tunis-Belvedere, Tunisia
| | - Mohamed Ridha Rjeibi
- Laboratoire de Parasitologie, École Nationale de Médecine Vétérinaire de Sidi Thabet, Sidi Thabet, Tunisia
| | - Neila Khabouchi
- Pôle Génomique-Plateforme Technique Institut Pasteur de Tunis, Tunis-Belvedere, Tunisia
| | - Jean-Paul Gonzalez
- Center of Excellence for Emerging and Zoonotic Animal Diseases, Kansas State University, Manhattan, Kansas
| | - Mohamed Fethi Diouani
- Institut Pasteur de Tunis, LR11IPT03, Laboratory of Epidemiology and Veterinary Microbiology (LEMV), Tunis-Belvédère, Tunisia
| | - Afif Ben Salah
- Department of Family and Community Medicine, College of Medicine and Medical Sciences (CMMS), Arabian Gulf University (AGU), Manama, Bahraïn.,Faculty of Medicine of Tunis, Tunis, Tunisia.,Laboratory of Medical Epidemiology, Institut Pasteur de Tunis, Tunis-Belvedere, Tunisia; Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, Tunis-Belvedere, Tunisia
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Kammoun-Rebai W, Bahi-Jaber N, Naouar I, Toumi A, Ben Salah A, Louzir H, Meddeb-Garnaoui A. Human cellular and humoral immune responses to Phlebotomus papatasi salivary gland antigens in endemic areas differing in prevalence of Leishmania major infection. PLoS Negl Trop Dis 2017; 11:e0005905. [PMID: 29023574 PMCID: PMC5638224 DOI: 10.1371/journal.pntd.0005905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/24/2017] [Indexed: 01/22/2023] Open
Abstract
Background Sand fly saliva compounds are able to elicit specific immune responses that have a significant role in Leishmania parasite establishment and disease outcome. Characterizing anti-saliva immune responses in individuals living in well defined leishmaniasis endemic areas would provide valuable insights regarding their effect on parasite transmission and establishment in humans. Methodology/Principal findings We explored the cellular and humoral immune responses to Phlebotomus (P.) papatasi salivary gland extracts (SGE) in individuals living in cutaneous leishmaniasis (CL) old or emerging foci (OF, EF). OF was characterized by a higher infection prevalence as assessed by higher proportions of leishmanin skin test (LST) positive individuals compared to EF. Subjects were further subdivided into healed, asymptomatic or naïve groups. We showed anti-SGE proliferation in less than 30% of the individuals, regardless of the immune status, in both foci. IFN-γ production was higher in OF and only observed in immune individuals from OF and naïve subjects from EF. Although IL-10 was not detected, addition of anti-human IL-10 antibodies revealed an increase in proliferation and IFN-γ production only in individuals from OF. The percentage of seropositive individuals was similar in immune and naïves groups but was significantly higher in OF. No correlation was observed between anti-saliva immune responses and LST response. High anti-SGE-IgG responses were associated with an increased risk of developing ZCL. No differences were observed for anti-SGE humoral or cellular responses among naïve individuals who converted or not their LST response or developed or not ZCL after the transmission season. Conclusions/Significance These data suggest that individuals living in an old focus characterized by a frequent exposure to sand fly bites and a high prevalence of infection, develop higher anti-saliva IgG responses and IFN-γ levels and a skew towards a Th2-type cellular response, probably in favor of parasite establishment, compared to those living in an emerging focus. During murine experimental leishmaniasis sand fly saliva components modulate the host immune response and facilitate infection while pre-exposition to uninfected sand fly bites is associated with a protective cellular response against subsequent infection. Human anti-saliva immune responses are not well defined in leishmaniasis endemic areas. Here, we report an analysis of anti P. papatasi saliva cellular and humoral responses in individuals residing in endemic foci showing different prevalence rates of L. major infection. Individuals were further subdivided based on LST response and presence of typical CL scars. We showed higher anti-saliva cellular and humoral responses and a skew towards a Th2 response in the old focus characterized by the highest prevalence of infection. No correlation was observed between LST and anti-saliva cellular or humoral response. We showed that high anti-saliva IgG responses constituted a risk factor for the development of CL. Our findings suggest that the anti-P. papatasi saliva cellular and humoral response profiles vary with the level of sand fly exposure and the prevalence of infection in CL endemic areas. Such studies in humans from highly endemic areas could contribute to a better understanding of the immune response to sand fly saliva and its role in leishmaniasis outcome.
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Affiliation(s)
- Wafa Kammoun-Rebai
- Laboratory of Medical Parasitology, Biotechnologies and Biomolecules, Institut Pasteur de Tunis, Tunis, Tunisia
- Département de Biologie, Université Tunis El Manar, Tunis, Tunisia
| | - Narges Bahi-Jaber
- UPSP EGEAL Institut Polytechnique LaSalle Beauvais, Beauvais, France
| | - Ikbel Naouar
- Département de Biologie, Université Tunis El Manar, Tunis, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infection, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Amine Toumi
- Laboratory of Transmission, Control and Immunobiology of Infection, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Afif Ben Salah
- Laboratory of Transmission, Control and Immunobiology of Infection, Institut Pasteur de Tunis, Tunis, Tunisia
- Arabian Gulf University, College of Medicine and Medical Sciences, Manama, Bahrain
| | - Hechmi Louzir
- Laboratory of Transmission, Control and Immunobiology of Infection, Institut Pasteur de Tunis, Tunis, Tunisia
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis, Tunisia
| | - Amel Meddeb-Garnaoui
- Laboratory of Medical Parasitology, Biotechnologies and Biomolecules, Institut Pasteur de Tunis, Tunis, Tunisia
- * E-mail:
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Jaouadi K, Bettaieb J, Bennour A, Salem S, Rjeibi MR, Chaabane S, Yazidi R, Khabouchi N, Gharbi A, Salah AB. First Report on Natural Infection of Phlebotomus sergenti with Leishmania tropica in a Classical Focus of Leishmania major in Tunisia. Am J Trop Med Hyg 2017; 97:291-294. [PMID: 28719307 PMCID: PMC5508899 DOI: 10.4269/ajtmh.16-0849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/31/2017] [Indexed: 11/07/2022] Open
Abstract
In Tunisia, chronic cutaneous leishmaniasis due to Leishmania tropica is an important health problem. Its spreading has not been fully elucidated. Information on sandfly vectors, as well as their associated Leishmania species, is of paramount importance since vector dispersion is one of the major factors responsible for pathogen dissemination. Ninety-seven unfed females belonging to the genera Sergentomyia and Phlebotomus were collected between June and August 2015 using sticky paper traps. Polymerase chain reaction-restriction fragment length polymorphism analysis of the internal transcribed spacer 1and sequencing were used for Leishmania detection and identification. In total, 650 sandflies were captured and identified (380 males and 270 females). Ninety-seven unfed females were tested for the presence of Leishmania parasite DNA. Six Phlebotomus sergenti were found positive for L. tropica. This novel finding enhances the understanding of the cycle extension of L. tropica outside its original focus of Tataouine.
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Affiliation(s)
- Kaouther Jaouadi
- Laboratory of Medical Epidemiology, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunisia; University Tunis El Manar, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LTCII), LR11IPT02, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunisia
| | - Jihene Bettaieb
- Laboratory of Medical Epidemiology, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunisia; University Tunis El Manar, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LTCII), LR11IPT02, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunisia
| | - Amira Bennour
- Laboratory of Medical Epidemiology, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunisia; University Tunis El Manar, Tunisia
| | - Sadok Salem
- Laboratory of Medical Epidemiology, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunisia; University Tunis El Manar, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LTCII), LR11IPT02, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunisia
| | - Mohamed Ridha Rjeibi
- Laboratoire de Parasitologie, Ecole Nationale de Médecine Vétérinaire de Sidi Thabet, Sidi Thabet, Tunisia
| | - Sana Chaabane
- Laboratory of Medical Epidemiology, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunisia; University Tunis El Manar, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LTCII), LR11IPT02, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunisia
| | - Rihab Yazidi
- Laboratory of Medical Epidemiology, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunisia; University Tunis El Manar, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LTCII), LR11IPT02, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunisia
| | - Neila Khabouchi
- Pole Génomique-Plateforme Technique Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunisia
| | - Adel Gharbi
- Laboratory of Medical Epidemiology, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunisia; University Tunis El Manar, Tunisia
| | - Afif Ben Salah
- Laboratory of Medical Epidemiology, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunisia; University Tunis El Manar, Tunisia
- Laboratory of Transmission, Control and Immunobiology of Infections (LTCII), LR11IPT02, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunisia
- Department of Family and Community Medicine, College of Medicine and Medical Sciences (CMMS), Arabian Gulf University (AGU), Manama, Bahraïn
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Ghawar W, Pascalis H, Bettaieb J, Mélade J, Gharbi A, Snoussi MA, Laouini D, Goodman SM, Ben Salah A, Dellagi K. Insight into the global evolution of Rodentia associated Morbilli-related paramyxoviruses. Sci Rep 2017; 7:1974. [PMID: 28512347 PMCID: PMC5434063 DOI: 10.1038/s41598-017-02206-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 04/07/2017] [Indexed: 11/11/2022] Open
Abstract
One portion of the family Paramyxoviridae is a group of Unclassified Morbilli-Related Viruses (UMRV) recently recognized in wild small mammals. At a global level, the evolutionary history of these viruses is not properly understood and the relationships between UMRV and their hosts still remain largely unstudied. The present study revealed, for the first time, that Rodentia associated UMRV emerged from a common ancestor in southern Africa more than 4000 years ago. Sequenced UMRV originating from different regions in the world, clustered into four well-supported viral lineages, which suggest that strain diversification occurred during host dispersal and associated exchanges, with purifying selection pressure as the principal evolutionary force. In addition, multi-introductions on different continents and islands of Rodentia associated UMRV and spillover between rodent species, most probably Rattus rattus, were detected and indicate that these animals are implicated in the vectoring and in the worldwide emergence of this virus group. The natural history and the evolution dynamics of these zoonotic viruses, originating from and hosted by wild animals, are most likely shaped by commensalism related to human activities.
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Affiliation(s)
- Wissem Ghawar
- Centre de Recherche et de Veille sur les maladies émergentes dans l'Océan Indien (CRVOI), Plateforme de Recherche CYROI, Sainte Clotilde, La Réunion, France. .,Laboratory of Medical Epidemiology, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunis, Tunisia. .,Laboratory of Transmission, Control and Immunobiology of Infections (LTCII), LR11IPT02, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunis, Tunisia. .,Université Tunis El Manar, Tunis, Tunisia.
| | - Hervé Pascalis
- Centre de Recherche et de Veille sur les maladies émergentes dans l'Océan Indien (CRVOI), Plateforme de Recherche CYROI, Sainte Clotilde, La Réunion, France. .,Université de La Réunion, UMR PIMIT "Processus Infectieux en Milieu Insulaire Tropical", INSERM U1187, CNRS 9192, IRD 249, Plateforme de Recherche CYROI, Saint Denis, La Réunion, France.
| | - Jihéne Bettaieb
- Laboratory of Medical Epidemiology, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LTCII), LR11IPT02, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunis, Tunisia.,Université Tunis El Manar, Tunis, Tunisia
| | - Julien Mélade
- Centre de Recherche et de Veille sur les maladies émergentes dans l'Océan Indien (CRVOI), Plateforme de Recherche CYROI, Sainte Clotilde, La Réunion, France.,Université de La Réunion, UMR PIMIT "Processus Infectieux en Milieu Insulaire Tropical", INSERM U1187, CNRS 9192, IRD 249, Plateforme de Recherche CYROI, Saint Denis, La Réunion, France
| | - Adel Gharbi
- Laboratory of Medical Epidemiology, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LTCII), LR11IPT02, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunis, Tunisia.,Université Tunis El Manar, Tunis, Tunisia
| | - Mohamed Ali Snoussi
- Laboratory of Medical Epidemiology, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LTCII), LR11IPT02, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunis, Tunisia.,Université Tunis El Manar, Tunis, Tunisia
| | - Dhafer Laouini
- Laboratory of Transmission, Control and Immunobiology of Infections (LTCII), LR11IPT02, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunis, Tunisia.,Université Tunis El Manar, Tunis, Tunisia
| | - Steven M Goodman
- Field Museum of Natural History, 1400 S. Lake Shore Dr, Chicago, IL, 60605-2496, USA.,Association Vahatra, BP 3972, Antananarivo, 101, Madagascar
| | - Afif Ben Salah
- Laboratory of Medical Epidemiology, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunis, Tunisia.,Laboratory of Transmission, Control and Immunobiology of Infections (LTCII), LR11IPT02, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunis, Tunisia.,Université Tunis El Manar, Tunis, Tunisia
| | - Koussay Dellagi
- Centre de Recherche et de Veille sur les maladies émergentes dans l'Océan Indien (CRVOI), Plateforme de Recherche CYROI, Sainte Clotilde, La Réunion, France.,Laboratory of Transmission, Control and Immunobiology of Infections (LTCII), LR11IPT02, Institut Pasteur de Tunis (IPT), Tunis-Belvédère, Tunis, Tunisia.,Université de La Réunion, UMR PIMIT "Processus Infectieux en Milieu Insulaire Tropical", INSERM U1187, CNRS 9192, IRD 249, Plateforme de Recherche CYROI, Saint Denis, La Réunion, France
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Chlif S, Aissi W, Bettaieb J, Kharroubi G, Nouira M, Yazidi R, El Moussi A, Maazaoui L, Slim A, Ben Salah A, Influenza Surveillance Group in Tunisia. Modelling of seasonal influenza and estimation of the burden in Tunisia. East Mediterr Health J 2016. [DOI: 10.26719/2016.22.7.459] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Chalghaf B, Chlif S, Mayala B, Ghawar W, Bettaieb J, Harrabi M, Benie GB, Michael E, Salah AB. Ecological Niche Modeling for the Prediction of the Geographic Distribution of Cutaneous Leishmaniasis in Tunisia. Am J Trop Med Hyg 2016; 94:844-851. [PMID: 26856914 PMCID: PMC4824228 DOI: 10.4269/ajtmh.15-0345] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 12/02/2015] [Indexed: 11/25/2022] Open
Abstract
Cutaneous leishmaniasis is a very complex disease involving multiple factors that limit its emergence and spatial distribution. Prediction of cutaneous leishmaniasis epidemics in Tunisia remains difficult because most of the epidemiological tools used so far are descriptive in nature and mainly focus on a time dimension. The purpose of this work is to predict the potential geographic distribution of Phlebotomus papatasi and zoonotic cutaneous leishmaniasis caused by Leishmania major in Tunisia using Grinnellian ecological niche modeling. We attempted to assess the importance of environmental factors influencing the potential distribution of P. papatasi and cutaneous leishmaniasis caused by L. major. Vectors were trapped in central Tunisia during the transmission season using CDC light traps (John W. Hock Co., Gainesville, FL). A global positioning system was used to record the geographical coordinates of vector occurrence points and households tested positive for cutaneous leishmaniasis caused by L. major. Nine environmental layers were used as predictor variables to model the P. papatasi geographical distribution and five variables were used to model the L. major potential distribution. Ecological niche modeling was used to relate known species' occurrence points to values of environmental factors for these same points to predict the presence of the species in unsampled regions based on the value of the predictor variables. Rainfall and temperature contributed the most as predictors for sand flies and human case distributions. Ecological niche modeling anticipated the current distribution of P. papatasi with the highest suitability for species occurrence in the central and southeastern part of Tunisian. Furthermore, our study demonstrated that governorates of Gafsa, Sidi Bouzid, and Kairouan are at highest epidemic risk.
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Affiliation(s)
- Bilel Chalghaf
- *Address correspondence to Bilel Chalghaf, Département de Géomatique Appliquée, Université de Sherbrooke, 2500 boul. de l'Université, Quebec, Canada J1K 2R1. E-mail:
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Naouar I, Boussoffara T, Chenik M, Gritli S, Ben Ahmed M, Belhadj Hmida N, Bahi-Jaber N, Bardi R, Gorgi Y, Ben Salah A, Louzir H. Prediction of T Cell Epitopes from Leishmania major Potentially Excreted/Secreted Proteins Inducing Granzyme B Production. PLoS One 2016; 11:e0147076. [PMID: 26771180 PMCID: PMC4714855 DOI: 10.1371/journal.pone.0147076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 12/27/2015] [Indexed: 01/05/2023] Open
Abstract
Leishmania-specific cytotoxic T cell response is part of the acquired immune response developed against the parasite and contributes to resistance to reinfection. Herein, we have used an immune-informatic approach for the identification, among Leishmania major potentially excreted/secreted proteins previously described, those generating peptides that could be targeted by the cytotoxic immune response. Seventy-eight nonameric peptides that are predicted to be loaded by HLA-A*0201 molecule were generated and their binding capacity to HLA-A2 was evaluated. These peptides were grouped into 20 pools and their immunogenicity was evaluated by in vitro stimulation of peripheral blood mononuclear cells from HLA-A2+-immune individuals with a history of zoonotic cutaneous leishmaniasis. Six peptides were identified according to their ability to elicit production of granzyme B. Furthermore, among these peptides 3 showed highest affinity to HLA-A*0201, one derived from an elongation factor 1-alpha and two from an unknown protein. These proteins could constitute potential vaccine candidates against leishmaniasis.
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Affiliation(s)
- Ikbel Naouar
- Laboratory of Transmission, Control, and Immunobiology of Infections-LR11IPT02, Pasteur Institute of Tunis, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
| | - Thouraya Boussoffara
- Laboratory of Transmission, Control, and Immunobiology of Infections-LR11IPT02, Pasteur Institute of Tunis, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
- * E-mail:
| | - Mehdi Chenik
- University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Medical Parasitology, Biotechnology and Biomolecules, LR11-IPT-06, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Sami Gritli
- Department of Pathology, Charles Nicolle Hospital and Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Melika Ben Ahmed
- Laboratory of Transmission, Control, and Immunobiology of Infections-LR11IPT02, Pasteur Institute of Tunis, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
| | - Nabil Belhadj Hmida
- Laboratory of Transmission, Control, and Immunobiology of Infections-LR11IPT02, Pasteur Institute of Tunis, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
| | - Narges Bahi-Jaber
- Laboratory of Transmission, Control, and Immunobiology of Infections-LR11IPT02, Pasteur Institute of Tunis, Tunis, Tunisia
- UPSP EGEAL Institut Polytechnique LaSalle Beauvais, Beauvais, France
| | - Rafika Bardi
- Laboratory of Immunology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Yousr Gorgi
- Laboratory of Immunology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Afif Ben Salah
- Laboratory of Transmission, Control, and Immunobiology of Infections-LR11IPT02, Pasteur Institute of Tunis, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
| | - Hechmi Louzir
- Laboratory of Transmission, Control, and Immunobiology of Infections-LR11IPT02, Pasteur Institute of Tunis, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
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Jaouadi K, Ghawar W, Salem S, Gharbi M, Bettaieb J, Yazidi R, Harrabi M, Hamarsheh O, Ben Salah A. First report of naturally infected Sergentomyia minuta with Leishmania major in Tunisia. Parasit Vectors 2015; 8:649. [PMID: 26692017 PMCID: PMC4687309 DOI: 10.1186/s13071-015-1269-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 12/14/2015] [Indexed: 12/04/2022] Open
Abstract
Background Many sand fly species are implicated in the transmission cycle of Leishmania parasites around the world. Incriminating new sand flies species, as vectors of Leishmania is crucial to understanding the parasite–vector transmission cycle in different areas in Tunisia and surrounding countries. Findings Seventy-four unfed females belonging to the genera Sergentomyia and Phlebotomus were collected in South Tunisia between June and November 2014, using sticky papers. PCR-RFLP (Restriction Fragment Length Polymorphism) analysis of the internal transcribed spacer 1 (ITS1) was used for Leishmania parasites detection and identification. Leishmania (L.) major (Yakimoff & Shokkor, 1914) was identified within two Sergentomyia (S.) minuta (Rondani, 1843) and one Phlebotomus papatasi (Scopoli, 1786). Conclusion This is the first report of L. major identified from S. minuta in Tunisia. This novel finding enhances the understanding of the transmission cycle of L. major parasites of cutaneous leishmaniasis in an endemic area in South Tunisia.
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Affiliation(s)
- Kaouther Jaouadi
- Department of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, 13 Place Pasteur BP-74, Tunis-Belvedere, 1002, Tunisia.
| | - Wissem Ghawar
- Department of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, 13 Place Pasteur BP-74, Tunis-Belvedere, 1002, Tunisia.
| | - Sadok Salem
- Department of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, 13 Place Pasteur BP-74, Tunis-Belvedere, 1002, Tunisia.
| | - Mohamed Gharbi
- Laboratory of Parasitology, National School of Veterinary Medicine, University of Manouba, 2020, Sidi Thabet, Tunisia.
| | - Jihene Bettaieb
- Department of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, 13 Place Pasteur BP-74, Tunis-Belvedere, 1002, Tunisia.
| | - Rihab Yazidi
- Department of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, 13 Place Pasteur BP-74, Tunis-Belvedere, 1002, Tunisia.
| | - Mariem Harrabi
- Department of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, 13 Place Pasteur BP-74, Tunis-Belvedere, 1002, Tunisia.
| | - Omar Hamarsheh
- Department of Biological Sciences, Faculty of Science & Technology, Al-Quds University, Jerusalem, Palestine.
| | - Afif Ben Salah
- Department of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Institut Pasteur de Tunis, 13 Place Pasteur BP-74, Tunis-Belvedere, 1002, Tunisia.
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Ayari C, Ben Othman S, Chemkhi J, Tabbabi A, Fisa R, Ben Salah A, BenAbderrazak S. First detection of Leishmania major DNA in Sergentomyia (Sintonius) clydei (Sinton, 1928, Psychodidae: Phlebotominae), from an outbreak area of cutaneous leishmaniasis in Tunisia. Infect Genet Evol 2015; 39:241-248. [PMID: 26538476 DOI: 10.1016/j.meegid.2015.10.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 11/18/2022]
Abstract
In recent years there has been growing interest in Sergentomyia species. Their role in the spread of mammalian leishmaniasis appears repeatedly in the literature and the possibility of its implication in Leishmania transmission to humans remains controversial. Sergentomyia (Sintonius) clydei is one of several cryptic species sharing therefore common morphologic criteria with others species of the subgenera Sintonius. Little is known about this specie in Tunisia. We sampled and identified different specimens including four specimens of S. clydei collected from Sidi Bouzid and Kairouan areas (center of Tunisia) using morphological tools. Male Sergentomyia clydei and Sergentomyia christophersi are known to share several morphological characters and can be mistaken for. Consequently we took advantage of 5 male S. christophersi available in our collection (Tataouin, South of Tunisia). In our study morphological tools were completed by molecular study of cytochrome b gene to identify S. clydei. For the detection of Leishmania spp. that might infect our specimens, Leishmania DNA was analyzed by amplification of kinetoplast minicircle DNA using real-time PCR and nested-PCR. Obtained result was confirmed by restriction analysis of the amplified ribosomal internal transcribed spacer 1 (ITS1). We provide in our study, the first molecular identification of S. clydei, in Tunisia. Our Neighbor Joining tree based on mitochondrial cytochrome b gene shows two different clusters. The first includes the Tunisians S. clydei and other specimens from Africa, Middle East and the Arabic peninsula, and the second cluster containing the specimens from Seychelle. Unexpectedly, we also demonstrate the infection of one anthropophilic female S. clydei by Leishmania major DNA. This finding shows that more attention should be paid when identifying parasites by molecular tools within sandfly vector.
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Affiliation(s)
- Chiraz Ayari
- Laboratoire de Parasitologie Médiale, Biotechnologies et Biomolécules (LR11IPT06), Institut Pasteur de Tunis, 13, Place Pasteur-BP74, 1002 Tunis, Tunisia; Faculté des Sciences de Bizerte, Université de Carthage, Tunis, Tunisia
| | - Souad Ben Othman
- Laboratoire de Parasitologie Médiale, Biotechnologies et Biomolécules (LR11IPT06), Institut Pasteur de Tunis, 13, Place Pasteur-BP74, 1002 Tunis, Tunisia
| | - Jomaa Chemkhi
- Laboratoire d'Epidémiologie Moléculaire et Pathologie Expérimentale Appliquée aux Maladies Infectieuses (LR11IPT04), Institut Pasteur de Tunis, 13, Place Pasteur-BP74, 1002 Tunis, Tunisia
| | - Ahmed Tabbabi
- Laboratoire de Parasitologie Médiale, Biotechnologies et Biomolécules (LR11IPT06), Institut Pasteur de Tunis, 13, Place Pasteur-BP74, 1002 Tunis, Tunisia
| | - Roser Fisa
- Laboratoire de Parasitologie, Faculté de Pharmacie, Université de Barcelone, Av. Joan XXIII s/n, 08028 Barcelone, Spain
| | - Afif Ben Salah
- Laboratoire de Transmission, Contrôle et Immunologie des Infections (LR11IPT02), Institut Pasteur de Tunis, 13, Place Pasteur-BP74, 1002 Tunis, Tunisia
| | - Souha BenAbderrazak
- Laboratoire de Parasitologie Médiale, Biotechnologies et Biomolécules (LR11IPT06), Institut Pasteur de Tunis, 13, Place Pasteur-BP74, 1002 Tunis, Tunisia.
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Marzouki S, Kammoun-Rebai W, Bettaieb J, Abdeladhim M, Hadj Kacem S, Abdelkader R, Gritli S, Chemkhi J, Aslan H, Kamhawi S, Ben Salah A, Louzir H, Valenzuela JG, Ben Ahmed M. Validation of Recombinant Salivary Protein PpSP32 as a Suitable Marker of Human Exposure to Phlebotomus papatasi, the Vector of Leishmania major in Tunisia. PLoS Negl Trop Dis 2015; 9:e0003991. [PMID: 26368935 PMCID: PMC4569422 DOI: 10.1371/journal.pntd.0003991] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 07/15/2015] [Indexed: 01/08/2023] Open
Abstract
Background During a blood meal, female sand flies, vectors of Leishmania parasites, inject saliva into the host skin. Sand fly saliva is composed of a large variety of components that exert different pharmacological activities facilitating the acquisition of blood by the insect. Importantly, proteins present in saliva are able to elicit the production of specific anti-saliva antibodies, which can be used as markers for exposure to vector bites. Serological tests using total sand fly salivary gland extracts are challenging due to the difficulty of obtaining reproducible salivary gland preparations. Previously, we demonstrated that PpSP32 is the immunodominant salivary antigen in humans exposed to Phlebotomus papatasi bites and established that humans exposed to P. perniciosus bites do not recognize it. Methodology/Principal Findings Herein, we have validated, in a large cohort of 522 individuals, the use of the Phlebotomus papatasi recombinant salivary protein PpSP32 (rPpSP32) as an alternative method for testing exposure to the bite of this sand fly. We also demonstrated that screening for total anti-rPpSP32 IgG antibodies is sufficient, being comparable in efficacy to the screening for IgG2, IgG4 and IgE antibodies against rPpSP32. Additionally, sera obtained from dogs immunized with saliva of P. perniciosus, a sympatric and widely distributed sand fly in Tunisia, did not recognize rPpSP32 demonstrating its suitability as a marker of exposure to P. papatasi saliva. Conclusions/Significance Our data indicate that rPpSP32 constitutes a useful epidemiological tool to monitor the spatial distribution of P. papatasi in a particular region, to direct control measures against zoonotic cutaneous leishmaniasis, to assess the efficiency of vector control interventions and perhaps to assess the risk of contracting the disease. Leishmaniasis results from an infection by Leishmania parasites that are transmitted through the bites of infected sand flies. This disease affects millions of people worldwide. Zoonotic cutaneous leishmaniasis is widespread in Central Tunisia and constitutes an actual public health problem. Leishmania major, the etiological agent, is transmitted by the sand fly vector Phlebotomus papatasi. Saliva of sand flies contains several pharmacologically active components that play a key role in the acquisition of the blood meal and the establishment of the parasites, thus enhancing the infection. Some of these molecules are able to elicit the production of specific antibodies, which can be used as markers of exposure to the vector’s bite. Herein, using a large cohort of individuals, we have validated the use of P. papatasi recombinant salivary protein PpSP32 (rPpSP32) as an alternative method to standard entomological studies for testing exposure to the bite of this sand fly in humans. rPpSP32 represents a promising epidemiological tool to monitor the spatial distribution of P. papatasi, direct control measures against zoonotic cutaneous leishmaniasis, evaluate the efficiency of vector control interventions and potentially assess the risk of contracting the disease.
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Affiliation(s)
- Soumaya Marzouki
- Laboratory of Transmission, Control and Immunobiology of Infection, LR11IPT02, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Wafa Kammoun-Rebai
- Laboratory of Medical Parasitology, Biotechnologies and Biomolecules, LR11IPT06, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Jihene Bettaieb
- Laboratory of Transmission, Control and Immunobiology of Infection, LR11IPT02, Institut Pasteur de Tunis, Tunis, Tunisia
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis, Tunisia
| | - Maha Abdeladhim
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, United States of America
| | - Saoussen Hadj Kacem
- Laboratory of Transmission, Control and Immunobiology of Infection, LR11IPT02, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Rania Abdelkader
- Laboratory of Transmission, Control and Immunobiology of Infection, LR11IPT02, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Sami Gritli
- Department of Pathology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Jomaa Chemkhi
- Laboratory of Molecular Epidemiology and Experimental Pathology, LR11IPT04, Institut Pasteur de Tunis, Tunis, Tunisia
| | - Hamide Aslan
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, United States of America
| | - Shaden Kamhawi
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, United States of America
| | - Afif Ben Salah
- Laboratory of Transmission, Control and Immunobiology of Infection, LR11IPT02, Institut Pasteur de Tunis, Tunis, Tunisia
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis, Tunisia
| | - Hechmi Louzir
- Laboratory of Transmission, Control and Immunobiology of Infection, LR11IPT02, Institut Pasteur de Tunis, Tunis, Tunisia
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis, Tunisia
| | - Jesus G. Valenzuela
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, United States of America
| | - Melika Ben Ahmed
- Laboratory of Transmission, Control and Immunobiology of Infection, LR11IPT02, Institut Pasteur de Tunis, Tunis, Tunisia
- Faculté de Médecine de Tunis, Université Tunis El Manar, Tunis, Tunisia
- * E-mail:
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Harrabi M, Bettaieb J, Ghawar W, Toumi A, Zaâtour A, Yazidi R, Chaâbane S, Chalghaf B, Hide M, Bañuls AL, Ben Salah A. Spatio-temporal Genetic Structuring of Leishmania major in Tunisia by Microsatellite Analysis. PLoS Negl Trop Dis 2015; 9:e0004017. [PMID: 26302440 PMCID: PMC4547700 DOI: 10.1371/journal.pntd.0004017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/30/2015] [Indexed: 01/06/2023] Open
Abstract
In Tunisia, cases of zoonotic cutaneous leishmaniasis caused by Leishmania major are increasing and spreading from the south-west to new areas in the center. To improve the current knowledge on L. major evolution and population dynamics, we performed multi-locus microsatellite typing of human isolates from Tunisian governorates where the disease is endemic (Gafsa, Kairouan and Sidi Bouzid governorates) and collected during two periods: 1991–1992 and 2008–2012. Analysis (F-statistics and Bayesian model-based approach) of the genotyping results of isolates collected in Sidi Bouzid in 1991–1992 and 2008–2012 shows that, over two decades, in the same area, Leishmania parasites evolved by generating genetically differentiated populations. The genetic patterns of 2008–2012 isolates from the three governorates indicate that L. major populations did not spread gradually from the south to the center of Tunisia, according to a geographical gradient, suggesting that human activities might be the source of the disease expansion. The genotype analysis also suggests previous (Bayesian model-based approach) and current (F-statistics) flows of genotypes between governorates and districts. Human activities as well as reservoir dynamics and the effects of environmental changes could explain how the disease progresses. This study provides new insights into the evolution and spread of L. major in Tunisia that might improve our understanding of the parasite flow between geographically and temporally distinct populations. In Tunisia, zoonotic cutaneous leishmaniasis (ZCL) constitutes a significant public health problem. Since 1884, the Gafsa, Kairouan and Sidi Bouzid governorates are the most endemic areas of ZCL. This study used a multi-locus microsatellite typing approach to study the evolution and the population dynamics of Leishmania major in Tunisia. Within the same area, in twenty years, parasite populations evolved by producing a genetically differentiated population, probably better adapted to the ecosystem. In agreement with the reported human cases of ZCL, the genetic data on samples from the three governorates shows that the disease did not spread according to a geographical gradient. Furthermore, L. major flows seem to still occur between governorates and neighboring districts. This study suggests that environmental changes, human activities and reservoir systems have influenced the spread and evolution of L. major populations. Our findings provide important knowledge on the epidemiology of L. major in Tunisia and might help understanding why the disease is still spreading from the south to the center, despite the control measures that have been put into place.
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Affiliation(s)
- Myriam Harrabi
- Institut Pasteur, Tunis, Tunisia
- Faculté des Sciences de Bizerte-Université de Carthage, Tunis, Tunisia
- * E-mail:
| | | | | | | | | | | | | | | | - Mallorie Hide
- UMR MIVEGEC (IRD 224-CNRS5290-Universités Montpellier 1 et 2), Centre IRD, Montpellier, France
| | - Anne-Laure Bañuls
- UMR MIVEGEC (IRD 224-CNRS5290-Universités Montpellier 1 et 2), Centre IRD, Montpellier, France
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Gzara Zargouni A, Tej Dellagi R, Ben Alaya N, Ben Jemaa N, Gamara D, Ben Salah A, Triki H, Kallel K, Chaker E, Rachdi MT. [Indigenous malaria in Tunisia: 4 cases registered in 2013 in Tunisia]. Tunis Med 2015; 93:543-547. [PMID: 26815521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Malaria has been eliminated in Tunisia since 1979, but the country remains, like all other countries harboring the vector, exposed to the potential risk of resurgence. OBJECTIVES Describe the clinical and epidemiological investigation of 4 cases of autochthonous malaria in July 2013 and report the main actions of regional and national response. METHODS Retrospective descriptive survey of the 4 clinical observations as well as the study of the regional report data of basic health care for the region of Tunis in 2013. RESULTS Febrile table concomitant for 4 Tunisian male patients, aged from 21 to 27 years old ; fortuitous discovery of Plasmodium falciparum when checking thrombocytopenia of patient 1 ; diagnosis in cascade of other cases following the epidemiological investigation and field consultation with clinicians ; 3 simple forms and a neuromalaria of favorable evolution ; negative entomological survey for anopheles ; elimination of imported malaria and blood-borne ; airport malaria highly probable. The response included the establishment of a regional and national monitoring unit, an information program aimed at health professionals concerned and public opinion, the involvement of health and entomology teams for the detection and census of potential larval habitats and the implementation of local mosquito eradication measures. CONCLUSION The clinical vigilance and competent biologist's eye is necessary to prevent the resurgence of this disease. The epidemiological surveillance system should be maintained and kept as well as the food safety standards monitoring at the borders.
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Yazidi R, Bettaieb J, Ghawar W, Jaouadi K, Châabane S, Zaatour A, Ben Salah A. RAPD-PCR reveals genetic polymorphism among Leishmania major strains from Tunisian patients. BMC Infect Dis 2015; 15:269. [PMID: 26170197 PMCID: PMC4501292 DOI: 10.1186/s12879-015-1010-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 07/06/2015] [Indexed: 11/17/2022] Open
Abstract
Background Zoonotic cutaneous leishmaniasis caused by Leishmania (L.) major is endemoepidemic in the Center and South of Tunisia. The clinical course of the disease varies widely among different patients and geographic regions. Although genetic diversity in L. major parasites has been suggested as a potential factor influencing their pathogenic variability, little information on genetic polymorphism among L. major strains is available in the literature. This work aimed to estimate the genetic variability within different isolates of L. major. Methods Our sample comprised 39 isolates (confirmed as L. major by restriction fragment length polymorphism typing) from patients experiencing the same clinical manifestations but living in different regions of Tunisia where L. major is endemic. Random amplified polymorphic DNA (RAPD) PCR marker polymorphism was estimated by calculating Nei and Li’s genetic distances and by an analysis of molecular variance (AMOVA). Results Analysis of the genetic diversity among the isolates revealed a high level of polymorphism (43 %) among them. AMOVA indicated that the highest variability (99 %) existed within the study regions. Conclusions Our results revealed a heterogeneous genetic profile for L. major with similar clinical manifestations occurring within the different geographical regions. Additional L. major isolates from patients, insect vectors, and reservoir hosts from different endemic foci should be collected for further analysis.
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Affiliation(s)
- Rihab Yazidi
- Department of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13 Place Pasteur BP-74, Tunis, Belvedere, 1002, Tunisia.
| | - Jihene Bettaieb
- Department of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13 Place Pasteur BP-74, Tunis, Belvedere, 1002, Tunisia.
| | - Wissem Ghawar
- Department of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13 Place Pasteur BP-74, Tunis, Belvedere, 1002, Tunisia.
| | - Kaouther Jaouadi
- Department of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13 Place Pasteur BP-74, Tunis, Belvedere, 1002, Tunisia.
| | - Sana Châabane
- Department of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13 Place Pasteur BP-74, Tunis, Belvedere, 1002, Tunisia.
| | - Amor Zaatour
- Department of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13 Place Pasteur BP-74, Tunis, Belvedere, 1002, Tunisia.
| | - Afif Ben Salah
- Department of Medical Epidemiology, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), Pasteur Institute of Tunis, 13 Place Pasteur BP-74, Tunis, Belvedere, 1002, Tunisia.
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Rezig D, Ben Farhat E, Touzi H, Meddeb Z, Ben Salah A, Triki H. Prevalence of human cosaviruses in Tunisia, North Africa. J Med Virol 2015; 87:940-3. [PMID: 25649285 DOI: 10.1002/jmv.24076] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2014] [Indexed: 12/22/2022]
Abstract
A new picornavirus, named human Cosavirus (HCoSV) was isolated recently from stools of children with acute flaccid paralysis (AFP) and healthy children in Pakistan and Afghanistan. Since then, it was also isolated from patients from other countries. Five species are presently identified forming a new genus in the Picornaviridae family. This study reports the detection of HCoSV in stool specimens collected as part of the National Poliovirus surveillance Program in Tunisia, between 2011 and 2012, from patients with AFP and healthy individuals among their contacts. One hundred and ninety four stool samples were investigated by RT-PCR in the 5' non-coding region of the genome. A total of 64 specimens (33%) tested positive for HCoSV. HCoSV positive specimens were found in 36 cases with neurological syndromes and 28 of their healthy contacts. The highest rate of HCoSV infection (62.5%) occurred in children younger than 6 years of age. The sampling date of stool specimens suggested that HCoSV infection occurred regularly over time. Also, the sampling origin of stool specimen showed that HCoSV infection was detected in almost all the governorates of Tunisia from the North to the South of the country. This study is the first report of HCoSV prevalence in the North African region. It contributes to a better knowledge on the geographic distribution and the epidemiology of these viruses.
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Affiliation(s)
- Dorra Rezig
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles, Institut Pasteur de Tunis, Tunis-Belvédère, Tunisia
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Ghawar W, Attia H, Bettaieb J, Yazidi R, Laouini D, Salah AB. Genotype profile of Leishmania major strains isolated from tunisian rodent reservoir hosts revealed by multilocus microsatellite typing. PLoS One 2014; 9:e107043. [PMID: 25203305 PMCID: PMC4159323 DOI: 10.1371/journal.pone.0107043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 08/13/2014] [Indexed: 11/19/2022] Open
Abstract
Zoonotic cutaneous leishmaniasis (ZCL) caused by Leishmania (L.) major parasites represents a major health problem with a large spectrum of clinical manifestations. Psammomys (P.) obesus and Meriones (M.) shawi represent the most important host reservoirs of these parasites in Tunisia. We already reported that infection prevalence is different between these two rodent species. We aimed in this work to evaluate the importance of genetic diversity in L. major parasites isolated from different proven and suspected reservoirs for ZCL. Using the multilocus microsatellites typing (MLMT), we analyzed the genetic diversity among strains isolated from (i) P. obesus (n = 31), (ii) M. shawi (n = 8) and (iii) Mustela nivalis (n = 1), captured in Sidi Bouzid, an endemic region for ZCL located in the Center of Tunisia. Studied strains present a new homogeneous genotype profile so far as all tested markers and showed no polymorphism regardless of the parasite host-reservoir origin. This lack of genetic diversity among these L. major isolates is the first genetic information on strains isolated from Leishmania reservoirs hosts in Tunisia. This result indicates that rodent hosts are unlikely to exert a selective pressure on parasites and stresses on the similarity of geographic and ecological features in this study area. Overall, these results increase our knowledge among rodent reservoir hosts and L. major parasites interaction.
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Affiliation(s)
- Wissem Ghawar
- Institut Pasteur de Tunis, Service of Medical Epidemiology, Tunis-Belvédère, Tunisia
- Institut Pasteur de Tunis, LR11IPT02, Laboratory of Transmission, Control and Immunobiology of Infections (LTCII), Tunis-Belvédère, Tunisia
- Université Tunis El Manar, Tunis, Tunisia
| | - Hanène Attia
- Institut Pasteur de Tunis, LR11IPT02, Laboratory of Transmission, Control and Immunobiology of Infections (LTCII), Tunis-Belvédère, Tunisia
- Université Tunis El Manar, Tunis, Tunisia
| | - Jihene Bettaieb
- Institut Pasteur de Tunis, Service of Medical Epidemiology, Tunis-Belvédère, Tunisia
- Institut Pasteur de Tunis, LR11IPT02, Laboratory of Transmission, Control and Immunobiology of Infections (LTCII), Tunis-Belvédère, Tunisia
- Université Tunis El Manar, Tunis, Tunisia
| | - Rihab Yazidi
- Institut Pasteur de Tunis, Service of Medical Epidemiology, Tunis-Belvédère, Tunisia
- Institut Pasteur de Tunis, LR11IPT02, Laboratory of Transmission, Control and Immunobiology of Infections (LTCII), Tunis-Belvédère, Tunisia
- Université Tunis El Manar, Tunis, Tunisia
| | - Dhafer Laouini
- Institut Pasteur de Tunis, LR11IPT02, Laboratory of Transmission, Control and Immunobiology of Infections (LTCII), Tunis-Belvédère, Tunisia
- Université Tunis El Manar, Tunis, Tunisia
- * E-mail: (DL); (AB)
| | - Afif Ben Salah
- Institut Pasteur de Tunis, Service of Medical Epidemiology, Tunis-Belvédère, Tunisia
- Institut Pasteur de Tunis, LR11IPT02, Laboratory of Transmission, Control and Immunobiology of Infections (LTCII), Tunis-Belvédère, Tunisia
- Université Tunis El Manar, Tunis, Tunisia
- * E-mail: (DL); (AB)
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Guerbouj S, Djilani F, Bettaieb J, Lambson B, Diouani MF, Ben Salah A, Ben Ismail R, Guizani I. Evaluation of a gp63-PCR based assay as a molecular diagnosis tool in canine leishmaniasis in Tunisia. PLoS One 2014; 9:e105419. [PMID: 25153833 PMCID: PMC4143256 DOI: 10.1371/journal.pone.0105419] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 07/12/2014] [Indexed: 01/27/2023] Open
Abstract
A gp63PCR method was evaluated for the detection and characterization of Leishmania (Leishmania) (L.) parasites in canine lymph node aspirates. This tool was tested and compared to other PCRs based on the amplification of 18S ribosomal genes, a L. infantum specific repetitive sequence and kinetoplastic DNA minicircles, and to classical parasitological (smear examination and/or culture) or serological (IFAT) techniques on a sample of 40 dogs, originating from different L. infantum endemic regions in Tunisia. Sensitivity and specificity of all the PCR assays were evaluated on parasitologically confirmed dogs within this sample (N = 18) and control dogs (N = 45) originating from non–endemic countries in northern Europe and Australia. The gp63 PCR had 83.5% sensitivity and 100% specificity, a performance comparable to the kinetoplast PCR assay and better than the other assays. These assays had comparable results when the gels were southern transferred and hybridized with a radioactive probe. As different infection rates were found according to the technique, concordance of the results was estimated by (κ) test. Best concordance values were between the gp63PCR and parasitological methods (74.6%, 95% confidence intervals CI: 58.8–95.4%) or serology IFAT technique (47.4%, 95% CI: 23.5–71.3%). However, taken together Gp63 and Rib assays covered most of the samples found positive making of them a good alternative for determination of infection rates. Potential of the gp63PCR-RFLP assay for analysis of parasite genetic diversity within samples was also evaluated using 5 restriction enzymes. RFLP analysis confirmed assignment of the parasites infecting the dogs to L. infantum species and illustrated occurrence of multiple variants in the different endemic foci. Gp63 PCR assay thus constitutes a useful tool in molecular diagnosis of L. infantum infections in dogs in Tunisia.
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Affiliation(s)
- Souheila Guerbouj
- Laboratory of Molecular Epidemiology and Experimental Pathology, Pasteur Institute of Tunis, Université de Tunis el Manar, Tunis, Tunisia
- Laboratory of Epidemiology and Ecology of Parasitic Diseases, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Fattouma Djilani
- Laboratory of Epidemiology and Ecology of Parasitic Diseases, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Jihene Bettaieb
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Bronwen Lambson
- Molteno Institute for Parasitology, Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - Mohamed Fethi Diouani
- Laboratory of Epidemiology and Ecology of Parasitic Diseases, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Afif Ben Salah
- Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Riadh Ben Ismail
- Laboratory of Epidemiology and Ecology of Parasitic Diseases, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Ikram Guizani
- Laboratory of Molecular Epidemiology and Experimental Pathology, Pasteur Institute of Tunis, Université de Tunis el Manar, Tunis, Tunisia
- Laboratory of Epidemiology and Ecology of Parasitic Diseases, Pasteur Institute of Tunis, Tunis, Tunisia
- * E-mail:
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Bettaieb J, Toumi A, Chlif S, Chelghaf B, Boukthir A, Gharbi A, Ben Salah A. Prevalence and determinants of Leishmania major infection in emerging and old foci in Tunisia. Parasit Vectors 2014; 7:386. [PMID: 25142220 PMCID: PMC4262385 DOI: 10.1186/1756-3305-7-386] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 08/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Zoonotic Cutaneous Leishmaniasis (ZCL) due to Leishmania major (L. major) is still a serious public health problem in Tunisia. This study aimed to compare the prevalence and risk factors associated with L. major infection in old and new foci using leishmanin skin test (LST) in central Tunisia. METHODS A cross sectional household survey was carried out between January and May 2009 on a sample of 2686 healthy individuals aged between 5 and 65 years. We determined the prevalence of L. major infection using the LST. Risk factors of LST positivity were assessed using a logistic regression model. RESULTS The overall prevalence of LST positivity was 57% (95% CI: 53-59). The prevalence of L. major infection was significantly higher in the old focus (99%; 95% CI: 98-100) than in the emerging foci (43%; 95% CI: 39-46) (p = <0.001). Multivariate analysis of LST positivity risk factors showed that age, the nature of the foci (old/emerging), personal and family history of ZCL are determinants of positive LST results. CONCLUSION The results updated the current epidemiologic profile of ZLC in central Tunisia. Past history of transmission in a population should be considered as a potential confounder in future clinical trials for drugs and vaccines against L. major cutaneous leishmaniasis.
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Affiliation(s)
- Jihene Bettaieb
- Department of Medical Epidemiology, Pasteur Institute of Tunis, Laboratory of Transmission, Control and Immunobiology of Infections (LR11IPT02), 13 Place Pasteur BP-74, 1002 Tunis Belvedere, Tunisia.
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Salah AB, Zaâtour A, Ben Messaoud N, Kidar A, Smith PL, Kopydlowski KM, Kreishman-Deitrick M, Nielsen CJ, Novitt-Moreno A, Ransom JH, Morizot G, Grogl M, Buffet PA. Parasite load decrease during application of a safe and easily applied antileishmanial aminoglycoside cream. PLoS Negl Trop Dis 2014; 8:e2749. [PMID: 24853096 PMCID: PMC4031053 DOI: 10.1371/journal.pntd.0002749] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
| | | | | | | | - Philip L. Smith
- United States Army Medical Materiel Development Activity, Fort Detrick, Maryland, United States of America
| | - Karen M. Kopydlowski
- United States Army Medical Materiel Development Activity, Fort Detrick, Maryland, United States of America
| | - Mara Kreishman-Deitrick
- United States Army Medical Materiel Development Activity, Fort Detrick, Maryland, United States of America
| | - Carl J. Nielsen
- United States Army Medical Materiel Development Activity, Fort Detrick, Maryland, United States of America
| | - Anne Novitt-Moreno
- Fast-Track Drugs & Biologics, LLC, North Potomac, Maryland, United States of America
| | - Janet H. Ransom
- Fast-Track Drugs & Biologics, LLC, North Potomac, Maryland, United States of America
| | | | - Max Grogl
- Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- * E-mail:
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