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Prudden HJ, Hasso-Agopsowicz M, Black RE, Troeger C, Reiner RC, Breiman RF, Jit M, Kang G, Lamberti L, Lanata CF, Lopman BA, Ndifon W, Pitzer VE, Platts-Mills JA, Riddle MS, Smith PG, Hutubessy R, Giersing B. Meeting Report: WHO Workshop on modelling global mortality and aetiology estimates of enteric pathogens in children under five. Cape Town, 28-29th November 2018. Vaccine 2020; 38:4792-4800. [PMID: 32253097 PMCID: PMC7306158 DOI: 10.1016/j.vaccine.2020.01.054] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/15/2020] [Indexed: 12/22/2022]
Abstract
Investment in vaccine product development should be guided by up-to-date and transparent global burden of disease estimates, which are also fundamental to policy recommendation and vaccine introduction decisions. For low- and middle-income countries (LMICs), vaccine prioritization is primarily driven by the number of deaths caused by different pathogens. Enteric diseases are known to be a major cause of death in LMICs. The two main modelling groups providing mortality estimates for enteric diseases are the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle and the Maternal Child Epidemiology Estimation (MCEE) group, led by Johns Hopkins Bloomberg School of Public Health. Whilst previous global diarrhoea mortality estimates for under five-year-olds from these two groups were closely aligned, more recent estimates for 2016 have diverged, particularly with respect to numbers of deaths attributable to different enteric pathogens. This has impacted prioritization and investment decisions for vaccines in the development pipeline. The mission of the Product Development for Vaccines Advisory Committee (PDVAC) at the World Health Organisation (WHO) is to accelerate product development of vaccines and technologies that are urgently needed and ensure they are appropriately targeted for use in LMICs. At their 2018 meeting, PDVAC recommended the formation of an independent working group of subject matter experts to explore the reasons for the difference between the IHME and MCEE estimates, and to assess the respective strengths and limitations of the estimation approaches adopted, including a review of the data on which the estimates are based. Here, we report on the proceedings and recommendations from a consultation with the working group of experts, the IHME and MCEE modelling groups, and other key stakeholders. We briefly review the methodological approaches of both groups and provide a series of proposals for investigating the drivers for the differences in enteric disease burden estimates.
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Affiliation(s)
- H J Prudden
- Initiative for Vaccine Research, World Health Organisation, CH-1211 Geneva, Switzerland
| | - M Hasso-Agopsowicz
- Initiative for Vaccine Research, World Health Organisation, CH-1211 Geneva, Switzerland
| | - R E Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - C Troeger
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA
| | - R C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA
| | - R F Breiman
- Global Health Institute, Emory University, Atlanta, GA, USA
| | - M Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom; Modelling and Economics Unit, National Infections Service, Public Health England, United Kingdom; School of Public Health, University of Hong Kong, Hong Kong
| | - G Kang
- Translational Health Science and Technology Institute, Faridabad, India
| | - L Lamberti
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - C F Lanata
- Instituto de Investigacion Nutricional, Lima, Peru; Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, TN 37027, USA
| | - B A Lopman
- Global Health Institute, Emory University, Atlanta, GA, USA
| | - W Ndifon
- African Institute for Mathematical Sciences, Cape Town, South Africa
| | - V E Pitzer
- Department of Epidemiology and Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - J A Platts-Mills
- Division of Infectious Diseases & International Health, University of Virginia, Charlottesville, VA 22908, USA
| | - M S Riddle
- Uniformed Services University, Bethesda, MD 120814, USA
| | - P G Smith
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom
| | - R Hutubessy
- Initiative for Vaccine Research, World Health Organisation, CH-1211 Geneva, Switzerland
| | - B Giersing
- Initiative for Vaccine Research, World Health Organisation, CH-1211 Geneva, Switzerland.
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Kulasegaram R, Giersing B, Page CJ, Blower PJ, Williamson RA, Peters BS, O'Doherty MJ. In vivo evaluation of 111In-DTPA-N-TIMP-2 in Kaposi sarcoma associated with HIV infection. Eur J Nucl Med 2001; 28:756-61. [PMID: 11440037] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Matrix metalloproteinases are the major agents responsible for the degradation of extracellular matrix and are produced at high levels by transformed and tumour cells, where they participate in the metastatic process by allowing local invasion. They are also more active at sites of new normal growth and angiogenesis. In the early stages of Kaposi sarcoma (KS), in vitro studies have demonstrated that vascular invasion can be inhibited by inhibitors of matrix metalloproteinases. Imaging of visceral and cutaneous KS presents a problem and therefore the potential use of a labelled inhibitor of metalloproteinases, N-TIMP-2, with indium-111 was thought to present a possible imaging tool. The biokinetics, dosimetry and potential for imaging with 111In-DTPA-N-TIMP-2 were assessed in five patients with HIV infection and KS. Between 103.1 and 108.0 MBq of this agent was injected into each patient, and the dynamic uptake over the kidneys was assessed, whole body scans were performed and blood samples were obtained. The clearance from the blood was rapid, with a first component half-time of 16.6+/-3.4 min and a second component half-time of 9.68+/-2.68 h. Two out of five patients experienced minor shivering but one of these patients was generally unwell before the study. The last three patients had no such problems. The tracer distributed predominantly to the kidneys and did not localise in other tissues. No KS lesions were clearly identified. 111In-DTPA-N-TIMP-2 can be successfully prepared and administered to patients safely, with a biodistribution and dosimetry which would allow its use as an imaging tracer. It is unlikely to be of use for imaging KS, but may have a role in other tumours that produce matrix metalloproteinases.
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Affiliation(s)
- R Kulasegaram
- Biosciences Department, University of Kent, Canterbury, UK
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