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Avanzi C, Lécorché E, Rakotomalala FA, Benjak A, Rapelanoro Rabenja F, Ramarozatovo LS, Cauchoix B, Rakoto-Andrianarivelo M, Tió-Coma M, Leal-Calvo T, Busso P, Boy-Röttger S, Chauffour A, Rasamoelina T, Andrianarison A, Sendrasoa F, Spencer JS, Singh P, Dashatwar DR, Narang R, Berland JL, Jarlier V, Salgado CG, Moraes MO, Geluk A, Randrianantoandro A, Cambau E, Cole ST. Population Genomics of Mycobacterium leprae Reveals a New Genotype in Madagascar and the Comoros. Front Microbiol 2020; 11:711. [PMID: 32477280 PMCID: PMC7233131 DOI: 10.3389/fmicb.2020.00711] [Citation(s) in RCA: 8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/26/2020] [Indexed: 01/06/2023] Open
Abstract
Human settlement of Madagascar traces back to the beginning of the first millennium with the arrival of Austronesians from Southeast Asia, followed by migrations from Africa and the Middle East. Remains of these different cultural, genetic, and linguistic legacies are still present in Madagascar and other islands of the Indian Ocean. The close relationship between human migration and the introduction and spread of infectious diseases, a well-documented phenomenon, is particularly evident for the causative agent of leprosy, Mycobacterium leprae. In this study, we used whole-genome sequencing (WGS) and molecular dating to characterize the genetic background and retrace the origin of the M. leprae strains circulating in Madagascar (n = 30) and the Comoros (n = 3), two islands where leprosy is still considered a public health problem and monitored as part of a drug resistance surveillance program. Most M. leprae strains (97%) from Madagascar and Comoros belonged to a new genotype as part of branch 1, closely related to single nucleotide polymorphism (SNP) type 1D, named 1D-Malagasy. Other strains belonged to the genotype 1A (3%). We sequenced 39 strains from nine other countries, which, together with previously published genomes, amounted to 242 genomes that were used for molecular dating. Specific SNP markers for the new 1D-Malagasy genotype were used to screen samples from 11 countries and revealed this genotype to be restricted to Madagascar, with the sole exception being a strain from Malawi. The overall analysis thus ruled out a possible introduction of leprosy by the Austronesian settlers and suggests a later origin from East Africa, the Middle East, or South Asia.
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Affiliation(s)
- Charlotte Avanzi
- Global Health Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Department of Microbiology, Immunology and Pathology, Mycobacteria Research Laboratories, Colorado State University, Fort Collins, CO, United States
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Emmanuel Lécorché
- AP-HP, Hôpital Lariboisière, Service de Bactériologie, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux - Laboratoire Associé, Paris, France
- Université de Paris, INSERM, IAME UMR1137, Paris, France
| | | | - Andrej Benjak
- Global Health Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Fahafahantsoa Rapelanoro Rabenja
- Unité de Soin, de Formations et de Recherche de Dermatologie, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - Lala S. Ramarozatovo
- Unité de Soin, de Formations et de Recherche de Dermatologie, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
- Department of Medecine-Interne, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | | | | | - Maria Tió-Coma
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Thyago Leal-Calvo
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Philippe Busso
- Global Health Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Stefanie Boy-Röttger
- Global Health Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Aurélie Chauffour
- Sorbonne Université, INSERM U1135, Centre d’Immunologie et des Maladies Infectieuses, CIMI-Paris, Paris, France
| | | | - Aina Andrianarison
- Unité de Soin, de Formations et de Recherche de Dermatologie, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - Fandresena Sendrasoa
- Unité de Soin, de Formations et de Recherche de Dermatologie, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - John S. Spencer
- Department of Microbiology, Immunology and Pathology, Mycobacteria Research Laboratories, Colorado State University, Fort Collins, CO, United States
| | - Pushpendra Singh
- National Institute of Research in Tribal Health (Indian Council of Medical Research), Jabalpur, India
| | | | - Rahul Narang
- Mahatma Gandhi Institute of Medical Sciences, Wardha, India
| | - Jean-Luc Berland
- Fondation Merieux, Lyon, France
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Lyon, France
| | - Vincent Jarlier
- Sorbonne Université, INSERM U1135, Centre d’Immunologie et des Maladies Infectieuses, CIMI-Paris, Paris, France
- AP-HP, Hôpital Pitié-Salpêtrière, Service de Bactériologie, Centre National de Référence des Mycobactéries et de la résistance des Mycobactéries aux Antituberculeux, Paris, France
| | - Claudio G. Salgado
- Laboratório de Dermato-Imunologia Universidade Federal do Pará (UFPA), Marituba, Brazil
| | - Milton O. Moraes
- Laboratório de Hanseníase, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil
| | - Annemieke Geluk
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | | | - Emmanuelle Cambau
- AP-HP, Hôpital Lariboisière, Service de Bactériologie, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux - Laboratoire Associé, Paris, France
- Université de Paris, INSERM, IAME UMR1137, Paris, France
| | - Stewart T. Cole
- Global Health Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Institut Pasteur, Paris, France
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Ortuno-Gutierrez N, Younoussa A, Randrianantoandro A, Braet S, Cauchoix B, Ramboarina S, Baco A, Mzembaba A, Salim Z, Amidy M, Grillone S, Richardus JH, de Jong BC, Hasker E. Protocol, rationale and design of PEOPLE (Post ExpOsure Prophylaxis for LEprosy in the Comoros and Madagascar): a cluster randomized trial on effectiveness of different modalities of implementation of post-exposure prophylaxis of leprosy contacts. BMC Infect Dis 2019; 19:1033. [PMID: 31805862 PMCID: PMC6896699 DOI: 10.1186/s12879-019-4649-0] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/22/2019] [Indexed: 12/25/2022] Open
Abstract
Background Leprosy is an ancient infectious disease with a global annual incidence that has plateaued above 200,000 new cases since over a decade. New strategies are required to overcome this stalemate. Post-exposure prophylaxis (PEP) with a single dose of Rifampicin (SDR) has conditionally been recommended by the World Health Organization (WHO), based on a randomized-controlled-trial in Bangladesh. More evidence is required. The Post ExpOsure Prophylaxis for Leprosy (PEOPLE) trial will assess effectiveness of different modalities of PEP on the Comoros and Madagascar. Methods PEOPLE is a cluster-randomized trial with villages selected on previous leprosy-incidence and randomly allocated to four arms. Four annual door-to-door surveys will be performed in all arms. All consenting permanent residents will be screened for leprosy. Leprosy patients will be treated according to international guidelines and eligible contacts will be provided with SDR-PEP. Arm-1 is the comparator in which no PEP will be provided. In arms 2, 3 and 4, SDR-PEP will be provided at double the regular dose (20 mg/kg) to eligible contacts aged two years and above. In arm 2 all household-members of incident leprosy patients are eligible. In arm 3 not only household-members but also neighbourhood contacts living within 100-m of an incident case are eligible. In arm 4 such neighbourhood contacts are only eligible if they test positive to anti-PGL-I, a serological marker. Incidence rate ratios calculated between the comparator arm 1 and each of the intervention arms will constitute the primary outcome. Discussion Different trials on PEP have yielded varying results. The pivotal COLEP trial in Bangladesh showed a 57% reduction in incidence over a two-year period post-intervention without any rebound in the following years. A study in a high-incidence setting in Indonesia showed no effect of PEP provided to close contacts but a major effect of PEP provided as a blanket measure to an entire island population. High background incidence could be the reason of the lack of effect of PEP provided to individual contacts. The PEOPLE trial will assess effectiveness of PEP in a high incidence setting and will compare three different approaches, to identify who benefits most from PEP. Trial registration Clinicaltrials.Gov. NCT03662022. Initial Protocol Version 1.2, 27-Aug-2018.
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Affiliation(s)
- Nimer Ortuno-Gutierrez
- Projects Department, Damien Foundation, Boulevard Leopold II, 263, PO B-1081, Brussels, Belgium.
| | - Assoumani Younoussa
- National Tuberculosis and Leprosy control Program, Moroni, Union of the Comoros
| | | | - Sofie Braet
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Abdallah Baco
- National Tuberculosis and Leprosy control Program, Moroni, Union of the Comoros
| | - Aboubacar Mzembaba
- National Tuberculosis and Leprosy control Program, Moroni, Union of the Comoros
| | - Zahara Salim
- National Tuberculosis and Leprosy control Program, Moroni, Union of the Comoros
| | - Mohamed Amidy
- National Tuberculosis and Leprosy control Program, Moroni, Union of the Comoros
| | - Saverio Grillone
- National Tuberculosis and Leprosy control Program, Moroni, Union of the Comoros
| | | | | | - Epco Hasker
- Institute of Tropical Medicine, Antwerp, Belgium
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