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Sáez-Llorens X, Lanata C, Aranguren E, Celis CR, Cornejo R, DeAntonio R, Ecker L, Garrido D, Gil AI, Gonzales M, Hess-Holtz M, Leroux-Roels G, Junker H, Kays SK, Koch SD, Lazzaro S, Mann P, Quintini G, Srivastava B, Vahrenhorst D, von Eisenhart-Rothe P, Wolz OO, Oostvogels L. Corrigendum to "Safety and immunogenicity of mRNA-LNP COVID-19 vaccine CVnCoV in Latin American adults: A phase 2 randomized study" [Vaccine: X 11 (2022) 100189]. Vaccine X 2023; 14:100307. [PMID: 37131960 PMCID: PMC10139920 DOI: 10.1016/j.jvacx.2023.100307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
[This corrects the article DOI: 10.1016/j.jvacx.2022.100189.].
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Affiliation(s)
| | | | | | | | | | | | - Lucie Ecker
- Instituto de Investigación Nutricional, Lima, Peru
| | | | - Ana I Gil
- Instituto de Investigación Nutricional, La Molina, Peru
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2
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Sáez-Llorens X, Lanata C, Aranguren E, Celis CR, Cornejo R, DeAntonio R, Ecker L, Garrido D, I Gil A, Gonzales M, Hess-Holtz M, Leroux-Roels G, Junker H, Kays SK, Koch SD, Lazzaro S, Mann P, Quintini G, Srivastava B, Vahrenhorst D, von Eisenhart-Rothe P, Wolz OO, Oostvogels L. Safety and immunogenicity of mRNA-LNP COVID-19 vaccine CVnCoV in Latin American adults: a phase 2 randomized study. Vaccine X 2022; 11:100189. [PMID: 35791320 PMCID: PMC9247226 DOI: 10.1016/j.jvacx.2022.100189] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/23/2021] [Revised: 05/17/2022] [Accepted: 06/27/2022] [Indexed: 12/02/2022] Open
Abstract
Two 12 µg CVnCoV doses are immunogenic against S-protein in adults. Immune responses were lower in > 60 year-olds than 18–60 year-olds. Distinct neutralizing antibody and CD4 + T cell responses to S-protein were induced. Booster doses increased responses to S-protein showing immune memory was induced. Three 12 µg doses are well tolerated with mainly mild to moderate adverse events.
Background The COVID-19 vaccine candidate CVnCoV comprises sequence-optimized mRNA encoding SARS-CoV-2 S-protein encapsulated in lipid nanoparticles. In this phase 2a study, we assessed reactogenicity and immunogenicity of two or three doses in younger and older adults. Methods Younger (18–60 years) and older (>60 years) adults were enrolled in two sites in Panama and Peru to receive either 6 or 12 µg doses of CVnCoV or licensed control vaccines 28 days apart; subsets received a 12 µg booster dose on Day 57 or Day 180. Solicited adverse events (AE) were reported for 7 days and unsolicited AEs for 4 weeks after each vaccination, and serious AEs (SAE) throughout the study. Humoral immunogenicity was measured as neutralizing and receptor binding domain (RBD) IgG antibodies and cellular immunogenicity was assessed as CD4+/CD8 + T cell responses. Results A total of 668 participants were vaccinated (332 aged 18–60 years and 336 aged > 60 years) including 75 who received homologous booster doses. Vaccination was well tolerated with no vaccine-related SAEs. Solicited and unsolicited AEs were mainly mild to moderate and resolved spontaneously. Both age groups demonstrated robust immune responses as neutralizing antibodies or RBD-binding IgG, after two doses, with lower titers in the older age group than the younger adults. Neither group achieved levels observed in human convalescent sera (HCS), but did equal or surpass HCS levels following homologous booster doses. Following CVnCoV vaccination, robust SARS-CoV-2 S-protein-specific CD4 + T-cell responses were observed in both age groups with CD8 + T-cell responses in some individuals, consistent with observations in convalescing COVID-19 patients after natural infection. Conclusions We confirmed that two 12 µg doses of CVnCoV had an acceptable safety profile, and induced robust immune responses. Marked humoral immune responses to homologous boosters suggest two doses had induced immune memory.
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Affiliation(s)
| | | | | | | | | | | | - Lucie Ecker
- Instituto de Investigación Nutricional, Lima, Peru
| | | | - Ana I Gil
- Instituto de Investigación Nutricional, La Molina, Peru
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Khalil I, Walker R, Porter CK, Muhib F, Chilengi R, Cravioto A, Guerrant R, Svennerholm AM, Qadri F, Baqar S, Kosek M, Kang G, Lanata C, Armah G, Wierzba T, Hasso-Agopsowicz M, Giersing B, Louis Bourgeois A. Enterotoxigenic Escherichia coli (ETEC) vaccines: Priority activities to enable product development, licensure, and global access. Vaccine 2021; 39:4266-4277. [PMID: 33965254 PMCID: PMC8273896 DOI: 10.1016/j.vaccine.2021.04.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 02/08/2023]
Abstract
Diarrhoeal disease attributable to enterotoxigenic Escherichia coli (ETEC) causes substantial morbidity and mortality predominantly in paediatric populations in low- and middle-income countries. In addition to acute illness, there is an increasing appreciation of the long-term consequences of enteric infections, including ETEC, on childhood growth and development. Provision of potable water and sanitation and appropriate clinical care for acute illness are critical to reduce the ETEC burden. However, these interventions are not always practical and may not achieve equitable and sustainable coverage. Vaccination may be the most cost-effective and equitable means of primary prevention; however, additional data are needed to accelerate the investment and guide the decision-making process for ETEC vaccines. First, to understand and quantify the ETEC disease burden, additional data are needed on the association between ETEC infection and physical and cognitive stunting as well as delayed educational attainment. Furthermore, the role of inappropriate or inadequate antibiotic treatment of ETEC-attributable diarrhoea may contribute to the development of antimicrobial resistance (AMR) and needs further elucidation. An ETEC vaccine that mitigates acute diarrhoeal illness and minimizes the longer-term disease manifestations could have significant public health impact and be a cost-effective countermeasure. Herein we review the ETEC vaccine pipeline, led by candidates compatible with the general parameters of the Preferred Product Characteristics (PPC) recently developed by the World Health Organization. Additionally, we have developed an ETEC Vaccine Development Strategy to provide a framework to underpin priority activities for researchers, funders and vaccine manufacturers, with the goal of addressing globally unmet data needs in the areas of research, product development, and policy, as well as commercialization and delivery. The strategy also aims to guide prioritization and co-ordination of the priority activities needed to minimize the timeline to licensure and use of ETEC vaccines, especially in in low- and middle-income countries, where they are most urgently needed.
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Affiliation(s)
| | | | | | | | - Roma Chilengi
- Centre for Infectious Disease Research in Zambia, Zambia
| | | | | | | | | | - Shahida Baqar
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, USA
| | | | | | | | - George Armah
- Noguchi Memorial Institute for Medical Research, Ghana
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4
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Howard LM, Zhu Y, Griffin M, Edwards K, Williams JV, Gil A, Vidal JE, Klugman K, Lanata C, Grijalva CG. 2617. Increased Nasopharyngeal Pneumococcal Density During Asymptomatic Respiratory Virus Infection Is Associated with Subsequent Development of Acute Respiratory Illness. Open Forum Infect Dis 2019. [PMCID: PMC6810442 DOI: 10.1093/ofid/ofz360.2295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Increased density of nasopharyngeal (NP) pneumococcal colonization has been associated with invasive pneumococcal disease in children. However, factors that lead to increased pneumococcal density are poorly understood. We sought to determine whether viral detection during asymptomatic periods in young children was associated with increased NP pneumococcal density and the subsequent development of acute respiratory illness (ARI).
Methods
Using NP samples obtained during asymptomatic periods from children less than 3 years of age in the rural Peruvian Andes, we determined NP pneumococcal colonization density by quantitative polymerase chain reaction (qPCR) and identified respiratory viruses by RT–PCR. We examined the association between viral detection and pneumococcal density adjusting for relevant covariates using a multivariable quantile mixed effects regression model. We also assessed the association of pneumococcal density during asymptomatic periods in these children on the time to the next ARI using survival analysis.
Results
During asymptomatic periods, the presence of NP pneumococcal colonization was more common when respiratory viruses were detected. In addition, in the multivariable model, log10-transformed pneumococcal densities were significantly higher during asymptomatic periods when viruses were detected [median 4.52 (4.14, 5.01) P < 0.001], specifically human rhinovirus (HRV) [median 4.58 (4.27, 5.12), P < 0.001] and adenovirus (AdV) [median 4.21 (3.79, 4.91), P = 0.014], compared with when no virus was detected [median 3.16 (2.92, 3.73), Figure 1]. Increased pneumococcal density was also significantly associated with a higher rate of subsequent ARI (p = 0.008, Figure 2).
Conclusion
Among young children, detection of respiratory viruses during asymptomatic periods was associated with increased pneumococcal colonization density, which, in turn, was associated with higher rate of subsequent ARI.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Leigh M Howard
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yuwei Zhu
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marie Griffin
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathryn Edwards
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Ana Gil
- Instituto de Investigacion Nutricional, Lima, Peru
| | - Jorge E Vidal
- Rollins School of Public Health Emory University, Atlanta, Georgia
| | - Keith Klugman
- Bill and Melinda Gates Foundation, Seattle, Washington
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5
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Cousens S, Perin J, Christian P, Wu LSF, Soofi S, Bhutta Z, Lanata C, Guerrant RL, Lima AAM, Mølbak K, Valentiner-Branth P, Checkley W, Gilman RH, Sack RB, Black RE, Humphrey J, Walker N. Modelling stunting in LiST: the effect of applying smoothing to linear growth data. BMC Public Health 2017; 17:778. [PMID: 29143649 PMCID: PMC5688407 DOI: 10.1186/s12889-017-4744-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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] [Indexed: 11/11/2022] Open
Abstract
Background The Lives Saved Tool (LiST) is a widely used resource for evidence-based decision-making regarding health program scale-up in low- and middle-income countries. LiST estimates the impact of specified changes in intervention coverage on mortality and stunting among children under 5 years of age. We aimed to improve the estimates of the parameters in LiST that determine the rate at which the effects of interventions to prevent stunting attenuate as children get older. Methods We identified datasets with serial measurements of children’s lengths or heights and used random effects models and restricted cubic splines to model the growth trajectories of children with at least six serial length/height measurements. We applied WHO growth standards to both measured and modelled (smoothed) lengths/heights to determine children’s stunting status at multiple ages (1, 6, 12, 24 months). We then calculated the odds ratios for the association of stunting at one age point with stunting at the next (“stunting-to-stunting ORs”) using both measured and smoothed data points. We ran analyses in LiST to compare the impact on intervention effect attenuation of using smoothed rather than measured stunting-to-stunting ORs. Results A total of 21,786 children with 178,786 length/height measurements between them contributed to our analysis. The odds of stunting at a given age were strongly related to whether a child is stunted at an earlier age, using both measured and smoothed lengths/heights, although the relationship was stronger for smoothed than measured lengths/heights. Using smoothed lengths/heights, we estimated that children stunted at 1 month have 45 times the odds of being stunted at 6 months, with corresponding odds ratios of 362 for the period 6 to 12 months and 175 for the period 12 to 24 months. Using the odds ratios derived from the smoothed data in LiST resulted in a somewhat slower attenuation of intervention effects over time, but substantial attenuation was still observed in the LiST outputs. For example, in Mali the effect of effectively eliminating SGA births reduced prevalence of stunting at age 59 months from 44.4% to 43.7% when using odds ratios derived from measured lengths/heights and from 44.4% to 41.9% when using odds ratios derived from smoothed lengths/heights. Conclusions Smoothing of children’s measured lengths/heights increased the strength of the association between stunting at a given age and stunting at an earlier age. Using odds ratios based on smoothed lengths/heights in LiST resulted in a small reduction in the attenuation of intervention effects with age and thus some increase in the estimated benefits, and may better reflect the true benefits of early nutritional interventions. Electronic supplementary material The online version of this article (10.1186/s12889-017-4744-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simon Cousens
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Lee Shu-Fune Wu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sajid Soofi
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan
| | - Zulfiqar Bhutta
- Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan.,Centre for Global Child Health, the Hospital for Sick Children, Toronto, Canada
| | | | - Richard L Guerrant
- Center for Global Health, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Aldo A M Lima
- Institute of Biomedicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Kåre Mølbak
- Department of Infectious Diseases Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | | | - William Checkley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert H Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - R Bradley Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jean Humphrey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Neff Walker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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6
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Clark A, Black R, Tate J, Roose A, Kotloff K, Lam D, Blackwelder W, Parashar U, Lanata C, Kang G, Troeger C, Platts-Mills J, Mokdad A, Sanderson C, Lamberti L, Levine M, Santosham M, Steele D. Estimating global, regional and national rotavirus deaths in children aged <5 years: Current approaches, new analyses and proposed improvements. PLoS One 2017; 12:e0183392. [PMID: 28892480 PMCID: PMC5593200 DOI: 10.1371/journal.pone.0183392] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [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: 04/05/2017] [Accepted: 08/03/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Rotavirus is a leading cause of diarrhoeal mortality in children but there is considerable disagreement about how many deaths occur each year. METHODS AND FINDINGS We compared CHERG, GBD and WHO/CDC estimates of age under 5 years (U5) rotavirus deaths at the global, regional and national level using a standard year (2013) and standard list of 186 countries. The global estimates were 157,398 (CHERG), 122,322 (GBD) and 215,757 (WHO/CDC). The three groups used different methods: (i) to select data points for rotavirus-positive proportions; (ii) to extrapolate data points to individual countries; (iii) to account for rotavirus vaccine coverage; (iv) to convert rotavirus-positive proportions to rotavirus attributable fractions; and (v) to calculate uncertainty ranges. We conducted new analyses to inform future estimates. We found that acute watery diarrhoea was associated with 87% (95% CI 83-90%) of U5 diarrhoea hospitalisations based on data from 84 hospital sites in 9 countries, and 65% (95% CI 57-74%) of U5 diarrhoea deaths based on verbal autopsy reports from 9 country sites. We reanalysed data from the Global Enteric Multicenter Study (GEMS) and found 44% (55% in Asia, and 32% in Africa) rotavirus-positivity among U5 acute watery diarrhoea hospitalisations, and 28% rotavirus-positivity among U5 acute watery diarrhoea deaths. 97% (95% CI 95-98%) of the U5 diarrhoea hospitalisations that tested positive for rotavirus were entirely attributable to rotavirus. For all clinical syndromes combined the rotavirus attributable fraction was 34% (95% CI 31-36%). This increased by a factor of 1.08 (95% CI 1.02-1.14) when the GEMS results were reanalysed using a more sensitive molecular test. CONCLUSIONS We developed consensus on seven proposals for improving the quality and transparency of future rotavirus mortality estimates.
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Affiliation(s)
- Andrew Clark
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robert Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Jacqueline Tate
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna Roose
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Karen Kotloff
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Diana Lam
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - William Blackwelder
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Umesh Parashar
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Claudio Lanata
- Instituto de Investigacion Nutricional, Lima, Peru
- Vanderbilt University, Nashville, Tennessee, United States of America
| | | | - Christopher Troeger
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - James Platts-Mills
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Ali Mokdad
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | | | - Colin Sanderson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Laura Lamberti
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Myron Levine
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Mathuram Santosham
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Duncan Steele
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
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7
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Nelson K, Grijalva CG, Chochua S, Hawkins P, Gil A, Lanata C, Griffin MR, Edwards K, Klugman K, Vidal J. Dynamics of Colonization and Recolonization of Streptococcus pneumoniae Strains in Healthy Peruvian Children. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Carlos G. Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Ana Gil
- Instituto de Investigacion Nutricional, Lima, Peru
| | | | | | - Kathryn Edwards
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Keith Klugman
- Pneumonia, Bill & Melinda Gates Foundation, Seattle, Washington
| | - Jorge Vidal
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia
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8
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Howard L, Grier A, Griffin MR, Edwards K, Williams J, Gil A, Lanata C, Gill S, Grijalva CG. Nasopharyngeal Microbiome Composition During Acute Respiratory Illnesses and Asymptomatic Periods in Young Peruvian Children. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Leigh Howard
- Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alex Grier
- University of Rochester Medical Center, Rochester, New York
| | | | - Kathryn Edwards
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - John Williams
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ana Gil
- Instituto de Investigacion Nutricional, Lima, Peru
| | | | - Steven Gill
- University of Rochester Medical Center, Rochester, New York
| | - Carlos G. Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
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9
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Howard L, Johnson M, Williams J, Gil A, Lanata C, Griffin M, Edwards K, Grijalva CG. Molecular Epidemiology of Rhinovirus Detections in Children in the Peruvian Andes. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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Rosa G, Huaylinos ML, Gil A, Lanata C, Clasen T. Assessing the consistency and microbiological effectiveness of household water treatment practices by urban and rural populations claiming to treat their water at home: a case study in Peru. PLoS One 2014; 9:e114997. [PMID: 25522371 PMCID: PMC4270781 DOI: 10.1371/journal.pone.0114997] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [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: 06/09/2014] [Accepted: 11/17/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Household water treatment (HWT) can improve drinking water quality and prevent disease if used correctly and consistently by vulnerable populations. Over 1.1 billion people report treating their water prior to drinking it. These estimates, however, are based on responses to household surveys that may exaggerate the consistency and microbiological performance of the practice-key factors for reducing pathogen exposure and achieving health benefits. The objective of this study was to examine how HWT practices are actually performed by households identified as HWT users, according to international monitoring standards. METHODS AND FINDINGS We conducted a 6-month case study in urban (n = 117 households) and rural (n = 115 households) Peru, a country in which 82.8% of households report treating their water at home. We used direct observation, in-depth interviews, surveys, spot-checks, and water sampling to assess water treatment practices among households that claimed to treat their drinking water at home. While consistency of reported practices was high in both urban (94.8%) and rural (85.3%) settings, availability of treated water (based on self-report) at time of collection was low, with 67.1% and 23.0% of urban and rural households having treated water at all three sampling visits. Self-reported consumption of untreated water in the home among adults and children <5 was common and this was corroborated during home observations. Drinking water of self-reported users was significantly better than source water in the urban setting and negligible but significantly better in the rural setting. However, only 46.3% and 31.6% of households had drinking water <1 CFU/100 mL at all follow-up visits. CONCLUSIONS Our results raise questions about the usefulness of current international monitoring of HWT practices and their usefulness as a proxy indicator for drinking water quality. The lack of consistency and sub-optimal microbiological effectiveness also raises questions about the potential of HWT to prevent waterborne diseases.
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Affiliation(s)
- Ghislaine Rosa
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | | | - Ana Gil
- Instituto de Investigación Nutricional, Lima, Peru
| | | | - Thomas Clasen
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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11
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Lanata C, Zambrano B, Ecker L. Immunogenicity and Safety of a Fully Liquid DTaP-IPV-Hep B-PRP-T Vaccine at 2-4-6 Months of Age in Peru. ACTA ACUST UNITED AC 2012. [DOI: 10.4172/2157-7560.1000128] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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12
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Money NN, Maves RC, Sebeny P, Kasper MR, Riddle MS, Wu M, Lee JE, Schnabel D, Bowden R, Oaks EV, Ocaña V, Acosta L, Gotuzzo E, Lanata C, Ochoa T, Aguayo N, Bernal M, Meza R, Canal E, Gregory M, Cepeda D, Listiyaningsih E, Putnam SD, Young S, Mansour A, Nakhla I, Moustafa M, Hassan K, Klena J, Bruton J, Shaheen H, Farid S, Fouad S, El-Mohamady H, Styles T, Shiau LCDRD, Espinosa B, McMullen K, Reed E, Neil D, Searles D, Nevin R, Von Thun A, Sessions C. Enteric disease surveillance under the AFHSC-GEIS: current efforts, landscape analysis and vision forward. BMC Public Health 2011; 11 Suppl 2:S7. [PMID: 21388567 PMCID: PMC3092417 DOI: 10.1186/1471-2458-11-s2-s7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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] [Indexed: 11/10/2022] Open
Abstract
The mission of the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) is to support global public health and to counter infectious disease threats to the United States Armed Forces, including newly identified agents or those increasing in incidence. Enteric diseases are a growing threat to U.S. forces, which must be ready to deploy to austere environments where the risk of exposure to enteropathogens may be significant and where routine prevention efforts may be impractical. In this report, the authors review the recent activities of AFHSC-GEIS partner laboratories in regards to enteric disease surveillance, prevention and response. Each partner identified recent accomplishments, including support for regional networks. AFHSC/GEIS partners also completed a Strengths, Weaknesses, Opportunities and Threats (SWOT) survey as part of a landscape analysis of global enteric surveillance efforts. The current strengths of this network include excellent laboratory infrastructure, equipment and personnel that provide the opportunity for high-quality epidemiological studies and test platforms for point-of-care diagnostics. Weaknesses include inconsistent guidance and a splintered reporting system that hampers the comparison of data across regions or longitudinally. The newly chartered Enterics Surveillance Steering Committee (ESSC) is intended to provide clear mission guidance, a structured project review process, and central data management and analysis in support of rationally directed enteric disease surveillance efforts.
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Affiliation(s)
- Nisha N Money
- Armed Forces Health Surveillance Center, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA
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Parashar UD, Burton A, Lanata C, Boschi-Pinto C, Shibuya K, Steele D, Birmingham M, Glass RI. Global mortality associated with rotavirus disease among children in 2004. J Infect Dis 2009; 200 Suppl 1:S9-S15. [PMID: 19817620 DOI: 10.1086/605025] [Citation(s) in RCA: 390] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND As new rotavirus vaccines are being introduced in immunization programs, global and national estimates of disease burden, especially rotavirus-associated mortality, are needed to assess the potential health benefits of vaccination and to monitor vaccine impact. METHODS We identified 76 studies that were initiated after 1990, lasted at least 1 full year, and examined rotavirus among >100 children hospitalized with diarrhea. The studies were assigned to 5 groups (A-E) with use of World Health Organization classification of countries by child mortality and geography. For each group, the mean rotavirus detection rate was multiplied by diarrhea-related mortality figures from 2004 for countries in that group to yield estimates of rotavirus-associated mortality. RESULTS Overall, rotavirus accounted for 527,000 deaths (95% confidence interval, 475,000-580,000 deaths) annually or 29% of all deaths due to diarrhea among children <5 years of age. Twenty-three percent of deaths due to rotavirus disease occurred in India, and 6 countries (India, Nigeria, Congo, Ethiopia, China, and Pakistan) accounted for more than one-half of deaths due to rotavirus disease. CONCLUSIONS The high mortality associated with rotavirus disease underscores the need for targeted interventions, such as vaccines. To realize the full life-saving potential of vaccines, it will be vital to ensure that they reach children in countries with high mortality. These baseline figures will allow future assessment of vaccine impact on rotavirus-associated mortality.
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Affiliation(s)
- Umesh D Parashar
- Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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14
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Abstract
Under-five mortality varies widely between countries, ranging from four to over 300 deaths/1000 live births. The World Summit for Children established the aim of a two-thirds reduction in worldwide child mortality by 2015. Progress toward this goal during 1990-2000 was variable between world regions. In 2000, 70% of the 1.89 million deaths of children under the age of 5 years due to acute respiratory infections occurred in developing countries. Among Latin American countries, Chile and Uruguay had the lowest percentage of deaths (5-10%), while Bolivia, Peru and Guyana had the highest (15-20%). Mortality rates due to lower respiratory infections have declined in most countries, increased in some and remained unacceptably high in others. To reach the 2015 goal of reducing mortality in the under-fives, effective interventions, such as breastfeeding and complementary feeding, Haemophilus influenzae type B vaccine, zinc supplementation and the use of antibiotics to treat pneumonia need to be implemented in all Latin American countries.
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Affiliation(s)
- Sandra C Fuchs
- Department of Social Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, R. Ramiro Barcelos 2350 s. 415, CEP 90035003 Porto Alegre, RS, Brazil.
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15
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Zavaleta N, Lanata C, Butron B, Peerson JM, Brown KH, Lönnerdal B. Effect of acute maternal infection on quantity and composition of breast milk. Am J Clin Nutr 1995; 62:559-63. [PMID: 7661117 DOI: 10.1093/ajcn/62.3.559] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
To investigate the potential effects of maternal infection during lactation on breast-milk quantity and composition, we examined low-income Peruvian women who had an acute febrile infection and were exclusively breast-feeding a child from 1 to 6 mo of age (n = 36). Women who were not ill (n = 38) served as controls; all women had body mass indexes (in kg/m2) > 19.5. Blood and milk samples were collected on days 1, 7, and 14 after identification of the episode of illness. C-reactive protein in maternal serum was significantly elevated by infection, whereas two other acute-phase reactants, ceruloplasmin and alpha 2-macroglobulin, showed no change. Serum zinc concentrations were significantly lower in ill women than in women who were not ill, whereas serum copper concentrations were elevated initially in ill women. Serum iron concentrations increased significantly with time, but there was no significant difference between groups. Milk intake, as assessed by 12-h test-weighing, was not affected by the infection. Concentrations of milk total protein, casein, and whey proteins were similar in the two groups and there was no significant effect of illness on milk trace element concentrations. Thus, acute maternal infections during established lactation did not affect milk volume, milk protein, or trace element concentrations, despite expected changes in serum protein and trace element concentrations.
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Affiliation(s)
- N Zavaleta
- Instituto de Investigación Nutricional, Lima, Peru
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16
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Vidal MF, Gilman RH, Ungar BL, Verástegui MR, Benel AC, Marquis G, Penny M, Lanata C, Miranda E. Detection of Giardia lamblia antigen in children living in a Peruvian periurban shantytown (Pueblo Joven). J Clin Microbiol 1991; 29:636-7. [PMID: 2037685 PMCID: PMC269834 DOI: 10.1128/jcm.29.3.636-637.1991] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Stool microscopy and an enzyme-linked immunosorbent assay (ELISA) for Giardia lamblia antigen detection were compared for detecting G. lamblia in 30 Peruvian infants. Of 1,131 fecal specimens, G. lamblia was detected by ELISA alone in 44, by microscopy alone in 17, and by both methods in 91. In another group of 17 children negative for G. lamblia by stool microscopy, 6 had G. lamblia detected by ELISA or duodenal aspiration: 2 only by ELISA, 1 only by duodenal aspirate examination, and 3 by both examinations. The ELISA is useful for the detection of G. lamblia in fecal specimens but compared to stool microscopy does not significantly increase the detection of cases.
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Affiliation(s)
- M F Vidal
- Department of Microbiology, Universidad Peruana Cayetano Heredia, Lima
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17
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Affiliation(s)
- S Berman
- Department of Pediatrics, University of Colorado Health Sciences Center, Denver 80262
| | - E A Simoes
- Department of Pediatrics, University of Colorado Health Sciences Center, Denver 80262
| | - C Lanata
- Department of Pediatrics, University of Colorado Health Sciences Center, Denver 80262
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Flores J, Sears J, Schael IP, White L, Garcia D, Lanata C, Kapikian AZ. Identification of human rotavirus serotype by hybridization to polymerase chain reaction-generated probes derived from a hyperdivergent region of the gene encoding outer capsid protein VP7. J Virol 1990; 64:4021-4. [PMID: 2164610 PMCID: PMC249704 DOI: 10.1128/jvi.64.8.4021-4024.1990] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We have synthesized 32P-labeled hybridization probes from a hyperdivergent region (nucleotides 51 to 392) of the rotavirus gene encoding the VP7 glycoprotein by using the polymerase chain reaction method. Both RNA (after an initial reverse transcription step) and cloned cDNA from human rotavirus serotypes 1 through 4 could be used as templates to amplify this region. High-stringency hybridization of each of the four probes to rotavirus RNAs dotted on nylon membranes allowed the specific detection of corresponding sequences and thus permitted identification of the serotype of the strains dotted. The procedure was useful when applied to rotaviruses isolated from field studies.
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Affiliation(s)
- J Flores
- Laboratory of Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892
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Black RE, Levine MM, Ferreccio C, Clements ML, Lanata C, Rooney J, Germanier R. Efficacy of one or two doses of Ty21a Salmonella typhi vaccine in enteric-coated capsules in a controlled field trial. Chilean Typhoid Committee. Vaccine 1990; 8:81-4. [PMID: 2180234 DOI: 10.1016/0264-410x(90)90183-m] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Typhoid fever remains an important public health problem in many areas of the world and an effective, non-reactogenic vaccine would be useful to control this disease. An attenuated Salmonella typhi strain (Ty21a), which has shown promise in previous trials, was evaluated in a controlled field trial in Santiago, Chile. In this trial, 82,543 schoolchildren were randomly assigned to receive one or two doses of Ty21a vaccine in enteric-coated capsules or placebo. The enteric-coated vaccine formulation was well tolerated and practical for mass oral immunization. In the first two years of surveillance, 213 cases of bacteriologically-confirmed typhoid fever were found in schoolchildren participating in the trial; annual rates in the placebo group were 139 and 227 per 100,000. Vaccine efficacy in the first two years after vaccination was 59% for two doses and 29% for one dose; no efficacy was found 3-5 years after vaccination. These results indicate that it will be necessary to identify a vaccine formulation and schedule for Ty21a S. typhi that is practical and provides high level protection for greater than 2 years.
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Affiliation(s)
- R E Black
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore
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20
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Black RE, Lanata C. Development of rotavirus vaccines. Indian J Pediatr 1988; 55:234-9. [PMID: 2841241 DOI: 10.1007/bf02722188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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22
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Avendano A, Herrera P, Horwitz I, Duarte E, Prenzel I, Lanata C, Levine ML. Duodenal string cultures: practicality and sensitivity for diagnosing enteric fever in children. J Infect Dis 1986; 153:359-62. [PMID: 3080533 DOI: 10.1093/infdis/153.2.358] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Levine MM, Black RE, Clements ML, Lanata C, Sears S, Honda T, Young CR, Finkelstein RA. Evaluation in humans of attenuated Vibrio cholerae El Tor Ogawa strain Texas Star-SR as a live oral vaccine. Infect Immun 1984; 43:515-22. [PMID: 6693169 PMCID: PMC264327 DOI: 10.1128/iai.43.2.515-522.1984] [Citation(s) in RCA: 84] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Texas Star-SR, an A- B+ mutant derived by nitrosoguanidine treatment from Vibrio cholerae El Tor Ogawa strain 3083, was fed to 68 volunteers as an oral vaccine in doses of 10(5) to 5 X 10(10) organisms with NaHCO3. Sixteen (24%) vaccinees experienced some loose stools (unrelated to vaccine dose), but in only one did the total stool volume exceed 1.0 liter. The vaccine strain was cultured from duodenal fluid of 35 of 46 (76%) persons who ingested doses of 10(8) organisms or greater. No A+ B+ toxinogenic revertants were found among 456 clinical isolates tested. Sixty-three vaccinees (93%) manifested seroconversions of vibriocidal antibody, whereas only 20 (29%) had significant rises in serum antitoxin titers. Paired intestinal fluids from 41 volunteers showed significant rises of secretory immunoglobulin A against lipopolysaccharide (29%), Ogawa outer membrane preparation (29%), and toxin (12%) antigens. In challenge studies with pathogenic V. cholerae El Tor Ogawa and El Tor Inaba, the attack rate in vaccinees (7 of 25) was significantly lower than in controls (18 of 25) (vaccine efficacy, 61%); furthermore, the diarrheal stool volume in vaccinees was significantly less than that in controls (P less than 0.01). Texas Star-SR served as a prototype to investigate the concept of immunoprophylaxis by means of attenuated strains as oral vaccines. These observations provide an invaluable background for planning future studies with newly developed attenuated strains prepared by recombinant DNA techniques.
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Levine MM, Black RE, Lanata C. Precise estimation of the numbers of chronic carriers of Salmonella typhi in Santiago, Chile, an endemic area. J Infect Dis 1982; 146:724-6. [PMID: 7142746 DOI: 10.1093/infdis/146.6.724] [Citation(s) in RCA: 131] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
As part of a program to control endemic typhoid fever in Santiago, Chile, an assessment was made of the magnitude of the reservoir of chronic carriers of Salmonella typhi. The availability of an accurate census and reliable data on the prevalence of biliary disease and of S. typhi carriage among persons with cholecystitis allowed an unusually precise estimate of the number of carriers. In 1980 there existed 25,019 female and 4,575 male carries in a population of 4,264,514, yielding a crude prevalence of 694 carriers per 10(5) population. Because of the magnitude of this human reservoir, which includes many females of greater than 40 years of age, it is recommended that a typhoid control program include the identification of carriers followed by health education and therapeutic interventions.
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