1
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Nilles EJ, de St Aubin M, Dumas D, Duke W, Etienne MC, Abdalla G, Jarolim P, Oasan T, Garnier S, Iihoshi N, Lopez B, de la Cruz L, Puello YC, Baldwin M, Roberts KW, Peña F, Durski K, Sanchez IM, Gunter SM, Kneubehl AR, Murray KO, Lino A, Strobel S, Baez AA, Lau CL, Kucharski A, Gutiérrez EZ, Skewes-Ramm R, Vasquez M, Paulino CT. Monitoring Temporal Changes in SARS-CoV-2 Spike Antibody Levels and Variant-Specific Risk for Infection, Dominican Republic, March 2021-August 2022. Emerg Infect Dis 2023; 29:723-733. [PMID: 36848869 PMCID: PMC10045678 DOI: 10.3201/eid2904.221628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
To assess changes in SARS-CoV-2 spike binding antibody prevalence in the Dominican Republic and implications for immunologic protection against variants of concern, we prospectively enrolled 2,300 patients with undifferentiated febrile illnesses in a study during March 2021-August 2022. We tested serum samples for spike antibodies and tested nasopharyngeal samples for acute SARS-CoV-2 infection using a reverse transcription PCR nucleic acid amplification test. Geometric mean spike antibody titers increased from 6.6 (95% CI 5.1-8.7) binding antibody units (BAU)/mL during March-June 2021 to 1,332 (95% CI 1,055-1,682) BAU/mL during May-August 2022. Multivariable binomial odds ratios for acute infection were 0.55 (95% CI 0.40-0.74), 0.38 (95% CI 0.27-0.55), and 0.27 (95% CI 0.18-0.40) for the second, third, and fourth versus the first anti-spike quartile; findings were similar by viral strain. Combining serologic and virologic screening might enable monitoring of discrete population immunologic markers and their implications for emergent variant transmission.
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2
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Yue H, Nowak RP, Overwijn D, Payne NC, Fischinger S, Atyeo C, Lam EC, St. Denis K, Brais LK, Konishi Y, Sklavenitis-Pistofidis R, Baden LR, Nilles EJ, Karlson EW, Yu XG, Li JZ, Woolley AE, Ghobrial IM, Meyerhardt JA, Balazs AB, Alter G, Mazitschek R, Fischer ES. Diagnostic TR-FRET assays for detection of antibodies in patient samples. Cell Rep Methods 2023; 3:100421. [PMID: 37056371 PMCID: PMC10088089 DOI: 10.1016/j.crmeth.2023.100421] [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] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/15/2022] [Accepted: 02/14/2023] [Indexed: 02/22/2023]
Abstract
Serological assays are important diagnostic tools for surveying exposure to the pathogen, monitoring immune response post vaccination, and managing spread of the infectious agent among the population. Current serological laboratory assays are often limited because they require the use of specialized laboratory technology and/or work with a limited number of sample types. Here, we evaluate an alternative by developing time-resolved Förster resonance energy transfer (TR-FRET) homogeneous assays that exhibited exceptional versatility, scalability, and sensitivity and outperformed or matched currently used strategies in terms of sensitivity, specificity, and precision. We validated the performance of the assays measuring total immunoglobulin G (IgG) levels; antibodies against severe acute respiratory syndrome coronavirus (SARS-CoV) or Middle Eastern respiratory syndrome (MERS)-CoV spike (S) protein; and SARS-CoV-2 S and nucleocapsid (N) proteins and applied it to several large sample sets and real-world applications. We further established a TR-FRET-based ACE2-S competition assay to assess the neutralization propensity of the antibodies. Overall, these TR-FRET-based serological assays can be rapidly extended to other antigens and are compatible with commonly used plate readers.
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Affiliation(s)
- Hong Yue
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Radosław P. Nowak
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - Daan Overwijn
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
| | - N. Connor Payne
- Department of Chemistry & Chemical Biology, Harvard University, Cambridge, MA 02138, USA
- Center for Systems Biology, Massachusetts General Hospital (MGH), Boston, MA 02114, USA
| | - Stephanie Fischinger
- Ragon Institute of MGH, Massachusetts Institute of Technology (MIT), and Harvard, Cambridge, MA 02139, USA
| | - Caroline Atyeo
- Ragon Institute of MGH, Massachusetts Institute of Technology (MIT), and Harvard, Cambridge, MA 02139, USA
| | - Evan C. Lam
- Ragon Institute of MGH, Massachusetts Institute of Technology (MIT), and Harvard, Cambridge, MA 02139, USA
| | - Kerri St. Denis
- Ragon Institute of MGH, Massachusetts Institute of Technology (MIT), and Harvard, Cambridge, MA 02139, USA
| | - Lauren K. Brais
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Yoshinobu Konishi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Romanos Sklavenitis-Pistofidis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Lindsey R. Baden
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Eric J. Nilles
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | | | - Xu G. Yu
- Ragon Institute of MGH, Massachusetts Institute of Technology (MIT), and Harvard, Cambridge, MA 02139, USA
| | - Jonathan Z. Li
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Ann E. Woolley
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Irene M. Ghobrial
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | | | - Alejandro B. Balazs
- Ragon Institute of MGH, Massachusetts Institute of Technology (MIT), and Harvard, Cambridge, MA 02139, USA
| | - Galit Alter
- Ragon Institute of MGH, Massachusetts Institute of Technology (MIT), and Harvard, Cambridge, MA 02139, USA
| | - Ralph Mazitschek
- Center for Systems Biology, Massachusetts General Hospital (MGH), Boston, MA 02114, USA
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Eric S. Fischer
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA 02115, USA
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3
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Nilles EJ, Paulino CT, de St Aubin M, Duke W, Jarolim P, Sanchez IM, Murray KO, Lau CL, Gutiérrez EZ, Ramm RS, Vasquez M, Kucharski A. Tracking immune correlates of protection for emerging SARS-CoV-2 variants. Lancet Infect Dis 2023; 23:153-154. [PMID: 36640795 PMCID: PMC9833833 DOI: 10.1016/s1473-3099(23)00001-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Eric J Nilles
- Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard Humanitarian Initiative, Cambridge, MA, USA.
| | | | - Michael de St Aubin
- Brigham and Women's Hospital, Boston, MA, USA; Harvard Humanitarian Initiative, Cambridge, MA, USA
| | - William Duke
- Pedro Henríquez Ureña National University, Santo Domingo, Dominican Republic
| | - Petr Jarolim
- Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Kristy O Murray
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | | | - Emily Zielinski Gutiérrez
- Centers for Disease Control and Prevention, Central America Regional Office, Guatemala City, Guatemala
| | - Ronald Skewes Ramm
- Ministry of Health and Social Assistance, Santo Domingo, Dominican Republic
| | | | - Adam Kucharski
- London School of Hygiene & Tropical Medicine, London, UK
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4
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Nilles EJ, Paulino CT, de St Aubin M, Restrepo AC, Mayfield H, Dumas D, Finch E, Garnier S, Etienne MC, Iselin L, Duke W, Jarolim P, Oasan T, Yu J, Wan H, Peña F, Iihoshi N, Abdalla G, Lopez B, Cruz LDL, Henríquez B, Espinosa-Bode A, Puello YC, Durski K, Baldwin M, Baez AA, Merchant RC, Barouch DH, Skewes-Ramm R, Gutiérrez EZ, Kucharski A, Lau CL. SARS-CoV-2 seroprevalence, cumulative infections, and immunity to symptomatic infection - A multistage national household survey and modelling study, Dominican Republic, June-October 2021. Lancet Reg Health Am 2022; 16:100390. [PMID: 36408529 PMCID: PMC9642112 DOI: 10.1016/j.lana.2022.100390] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/26/2022] [Accepted: 10/19/2022] [Indexed: 11/10/2022]
Abstract
Background Population-level SARS-CoV-2 immunological protection is poorly understood but can guide vaccination and non-pharmaceutical intervention priorities. Our objective was to characterise cumulative infections and immunological protection in the Dominican Republic. Methods Household members ≥5 years were enrolled in a three-stage national household cluster serosurvey in the Dominican Republic. We measured pan-immunoglobulin antibodies against the SARS-CoV-2 spike (anti-S) and nucleocapsid glycoproteins, and pseudovirus neutralising activity against the ancestral and B.1.617.2 (Delta) strains. Seroprevalence and cumulative prior infections were weighted and adjusted for assay performance and seroreversion. Binary classification machine learning methods and pseudovirus neutralising correlates of protection were used to estimate 50% and 80% protection against symptomatic infection. Findings Between 30 Jun and 12 Oct 2021 we enrolled 6683 individuals from 3832 households. We estimate that 85.0% (CI 82.1-88.0) of the ≥5 years population had been immunologically exposed and 77.5% (CI 71.3-83) had been previously infected. Protective immunity sufficient to provide at least 50% protection against symptomatic SARS-CoV-2 infection was estimated in 78.1% (CI 74.3-82) and 66.3% (CI 62.8-70) of the population for the ancestral and Delta strains respectively. Younger (5-14 years, OR 0.47 [CI 0.36-0.61]) and older (≥75-years, 0.40 [CI 0.28-0.56]) age, working outdoors (0.53 [0.39-0.73]), smoking (0.66 [0.52-0.84]), urban setting (1.30 [1.14-1.49]), and three vs no vaccine doses (18.41 [10.69-35.04]) were associated with 50% protection against the ancestral strain. Interpretation Cumulative infections substantially exceeded prior estimates and overall immunological exposure was high. After controlling for confounders, markedly lower immunological protection was observed to the ancestral and Delta strains across certain subgroups, findings that can guide public health interventions and may be generalisable to other settings and viral strains. Funding This study was funded by the US CDC.
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Affiliation(s)
- Eric J Nilles
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Infectious Diseases and Epidemics Program, Harvard Humanitarian Initiative, Cambridge, MA, USA
| | | | - Michael de St Aubin
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA.,Infectious Diseases and Epidemics Program, Harvard Humanitarian Initiative, Cambridge, MA, USA
| | | | - Helen Mayfield
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Devan Dumas
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA.,Infectious Diseases and Epidemics Program, Harvard Humanitarian Initiative, Cambridge, MA, USA
| | - Emilie Finch
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Salome Garnier
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA.,Infectious Diseases and Epidemics Program, Harvard Humanitarian Initiative, Cambridge, MA, USA.,Harvard University, Cambridge, MA, USA
| | - Marie Caroline Etienne
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA
| | | | - William Duke
- Pedro Henríquez Ureña National University, Santo Domingo, Dominican Republic
| | - Petr Jarolim
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Timothy Oasan
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA
| | - Jingyou Yu
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Huahua Wan
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Farah Peña
- Ministry of Health and Social Assistance, Santo Domingo, Dominican Republic
| | - Naomi Iihoshi
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA
| | - Gabriela Abdalla
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA
| | - Beatriz Lopez
- Centers for Disease Control and Prevention, Central America Regional Office, Guatemala City, Guatemala
| | - Lucia de la Cruz
- Ministry of Health and Social Assistance, Santo Domingo, Dominican Republic
| | - Bernarda Henríquez
- Ministry of Health and Social Assistance, Santo Domingo, Dominican Republic
| | - Andres Espinosa-Bode
- Centers for Disease Control and Prevention, Central America Regional Office, Guatemala City, Guatemala
| | | | - Kara Durski
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA
| | - Margaret Baldwin
- Division of Global Emergency Care and Humanitarian Studies, Brigham and Womens Hospital, Boston, MA, USA.,Infectious Diseases and Epidemics Program, Harvard Humanitarian Initiative, Cambridge, MA, USA
| | - Amado Alejandro Baez
- Ministry of Health and Social Assistance, Santo Domingo, Dominican Republic.,Pedro Henríquez Ureña National University, Santo Domingo, Dominican Republic
| | - Roland C Merchant
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dan H Barouch
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Ronald Skewes-Ramm
- Ministry of Health and Social Assistance, Santo Domingo, Dominican Republic
| | - Emily Zielinski Gutiérrez
- Centers for Disease Control and Prevention, Central America Regional Office, Guatemala City, Guatemala
| | - Adam Kucharski
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Colleen L Lau
- School of Public Health, University of Queensland, Brisbane, Australia
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5
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Loesche M, Karlson EW, Talabi O, Zhou G, Boutin N, Atchley R, Loevinsohn G, Chang JBP, Hasdianda MA, Okenla A, Sampson E, Schram H, Magsipoc K, Goodman K, Donahue L, MacGowan M, Novack LA, Jarolim P, Baden LR, Nilles EJ. Longitudinal SARS-CoV-2 Nucleocapsid Antibody Kinetics, Seroreversion, and Implications for Seroepidemiologic Studies. Emerg Infect Dis 2022; 28:1859-1862. [PMID: 35868337 PMCID: PMC9423917 DOI: 10.3201/eid2809.220729] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Given widespread use of spike antibody in generating coronavirus disease vaccines, SARS-CoV-2 nucleocapsid antibodies are increasingly used to indicate previous infection in serologic surveys. However, longitudinal kinetics and seroreversion are poorly defined. We found substantial seroreversion of nucleocapsid total immunoglobulin, underscoring the need to account for seroreversion in seroepidemiologic studies.
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6
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Kaplonek P, Cizmeci D, Fischinger S, Collier AR, Suscovich T, Linde C, Broge T, Mann C, Amanat F, Dayal D, Rhee J, de St. Aubin M, Nilles EJ, Musk ER, Menon AS, Saphire EO, Krammer F, Lauffenburger DA, Barouch DH, Alter G. mRNA-1273 and BNT162b2 COVID-19 vaccines elicit antibodies with differences in Fc-mediated effector functions. Sci Transl Med 2022; 14:eabm2311. [PMID: 35348368 PMCID: PMC8995030 DOI: 10.1126/scitranslmed.abm2311] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [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: 09/03/2021] [Accepted: 03/17/2022] [Indexed: 01/02/2023]
Abstract
The successful development of several coronavirus disease 2019 (COVID-19) vaccines has substantially reduced morbidity and mortality in regions of the world where the vaccines have been deployed. However, in the wake of the emergence of viral variants that are able to evade vaccine-induced neutralizing antibodies, real-world vaccine efficacy has begun to show differences across the two approved mRNA platforms, BNT162b2 and mRNA-1273; these findings suggest that subtle variation in immune responses induced by the BNT162b2 and mRNA-1273 vaccines may confer differential protection. Given our emerging appreciation for the importance of additional antibody functions beyond neutralization, we profiled the postboost binding and functional capacity of humoral immune responses induced by the BNT162b2 and mRNA-1273 vaccines in a cohort of hospital staff. Both vaccines induced robust humoral immune responses to wild-type severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to variants of concern. However, differences emerged across epitope-specific responses, with higher concentrations of receptor binding domain (RBD)- and N-terminal domain-specific IgA observed in recipients of mRNA-1273. Antibodies eliciting neutrophil phagocytosis and natural killer cell activation were also increased in mRNA-1273 vaccine recipients as compared to BNT162b2 recipients. RBD-specific antibody depletion highlighted the different roles of non-RBD-specific antibody effector functions induced across the mRNA vaccines. These data provide insights into potential differences in protective immunity conferred by these vaccines.
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Affiliation(s)
- Paulina Kaplonek
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
| | - Deniz Cizmeci
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
| | | | - Ai-ris Collier
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | | | | | | | - Colin Mann
- Department of Immunology and Microbial Science, The Scripps Research Institute, La Jolla Institute for Immunology, La Jolla, CA 92037, USA
| | - Fatima Amanat
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Diana Dayal
- Space Exploration Technologies Corp, Hawthorne, CA 90250, USA
| | - Justin Rhee
- Space Exploration Technologies Corp, Hawthorne, CA 90250, USA
| | | | | | - Elon R. Musk
- Space Exploration Technologies Corp, Hawthorne, CA 90250, USA
| | - Anil S. Menon
- Space Exploration Technologies Corp, Hawthorne, CA 90250, USA
| | - Erica Ollmann Saphire
- Department of Immunology and Microbial Science, The Scripps Research Institute, La Jolla Institute for Immunology, La Jolla, CA 92037, USA
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Douglas A. Lauffenburger
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Dan H. Barouch
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA
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7
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Siddiqui SM, Bowman KA, Zhu AL, Fischinger S, Beger S, Maron JS, Bartsch YC, Atyeo C, Gorman MJ, Yanis A, Hultquist JF, Lorenzo-Redondo R, Ozer EA, Simons LM, Talj R, Rankin DA, Chapman L, Meade K, Steinhart J, Mullane S, Siebert S, Streeck H, Sabeti P, Halasa N, Musk ER, Barouch DH, Menon AS, Nilles EJ, Lauffenburger DA, Alter G. Serological Markers of SARS-CoV-2 Reinfection. mBio 2022; 13:e0214121. [PMID: 35073738 PMCID: PMC8787477 DOI: 10.1128/mbio.02141-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/13/2021] [Indexed: 01/09/2023] Open
Abstract
As public health guidelines throughout the world have relaxed in response to vaccination campaigns against SARS-CoV-2, it is likely that SARS-CoV-2 will remain endemic, fueled by the rise of more infectious SARS-CoV-2 variants. Moreover, in the setting of waning natural and vaccine immunity, reinfections have emerged across the globe, even among previously infected and vaccinated individuals. As such, the ability to detect reexposure to and reinfection by SARS-CoV-2 is a key component for global protection against this virus and, more importantly, against the potential emergence of vaccine escape mutations. Accordingly, there is a strong and continued need for the development and deployment of simple methods to detect emerging hot spots of reinfection to inform targeted pandemic response and containment, including targeted and specific deployment of vaccine booster campaigns. In this study, we identify simple, rapid immune biomarkers of reinfection in rhesus macaques, including IgG3 antibody levels against nucleocapsid and FcγR2A receptor binding activity of anti-RBD antibodies, that are recapitulated in human reinfection cases. As such, this cross-species analysis underscores the potential utility of simple antibody titers and function as price-effective and scalable markers of reinfection to provide increased resolution and resilience against new outbreaks. IMPORTANCE As public health and social distancing guidelines loosen in the setting of waning global natural and vaccine immunity, a deeper understanding of the immunological response to reexposure and reinfection to this highly contagious pathogen is necessary to maintain public health. Viral sequencing analysis provides a robust but unrealistic means to monitor reinfection globally. The identification of scalable pathogen-specific biomarkers of reexposure and reinfection, however, could significantly accelerate our capacity to monitor the spread of the virus through naive and experienced hosts, providing key insights into mechanisms of disease attenuation. Using a nonhuman primate model of controlled SARS-CoV-2 reexposure, we deeply probed the humoral immune response following rechallenge with various doses of viral inocula. We identified virus-specific humoral biomarkers of reinfection, with significant increases in antibody titer and function upon rechallenge across a range of humoral features, including IgG1 to the receptor binding domain of the spike protein of SARS-CoV-2 (RBD), IgG3 to the nucleocapsid protein (N), and FcγR2A receptor binding to anti-RBD antibodies. These features not only differentiated primary infection from reexposure and reinfection in monkeys but also were recapitulated in a sequencing-confirmed reinfection patient and in a cohort of putatively reinfected humans that evolved a PCR-positive test in spite of preexisting seropositivity. As such, this cross-species analysis using a controlled primate model and human cohorts reveals increases in antibody titers as promising cross-validated serological markers of reinfection and reexposure.
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Affiliation(s)
- Sameed M. Siddiqui
- Computational and Systems Biology Program, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Kathryn A. Bowman
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Alex L. Zhu
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Stephanie Fischinger
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
- PhD Program in Immunology and Virology, University of Duisburg-Essen, Essen, Germany
| | - Samuel Beger
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Jenny S. Maron
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
- PhD Program in Virology, Division of Medical Sciences, Harvard University, Boston, Massachusetts, USA
| | - Yannic C. Bartsch
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Caroline Atyeo
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
- PhD Program in Virology, Division of Medical Sciences, Harvard University, Boston, Massachusetts, USA
| | - Matthew J. Gorman
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Ahmad Yanis
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Judd F. Hultquist
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Pathogen Genomics and Microbial Evolution, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ramon Lorenzo-Redondo
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Pathogen Genomics and Microbial Evolution, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Egon A. Ozer
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Pathogen Genomics and Microbial Evolution, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lacy M. Simons
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center for Pathogen Genomics and Microbial Evolution, Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rana Talj
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Danielle A. Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Lindsay Chapman
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Kyle Meade
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Jordan Steinhart
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Sean Mullane
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Suzanne Siebert
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Hendrik Streeck
- Institute of Virology, University Hospital, University of Bonn, and German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Pardis Sabeti
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA
- Howard Hughes Medical Institute, Chevy Chase, Maryland, USA
- Massachusetts Consortium on Pathogen Readiness, Boston, Massachusetts, USA
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elon R. Musk
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Dan H. Barouch
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Cambridge, Massachusetts, USA
| | - Anil S. Menon
- Space Exploration Technologies Corp., Hawthorne, California, USA
| | - Eric J. Nilles
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Cambridge, Massachusetts, USA
- Harvard Humanitarian Initiative, Boston, Massachusetts, USA
| | - Douglas A. Lauffenburger
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
- Massachusetts Consortium on Pathogen Readiness, Boston, Massachusetts, USA
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8
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Finch E, Lowe R, Fischinger S, de St Aubin M, Siddiqui SM, Dayal D, Loesche MA, Rhee J, Beger S, Hu Y, Gluck MJ, Mormann B, Hasdianda MA, Musk ER, Alter G, Menon AS, Nilles EJ, Kucharski AJ. SARS-CoV-2 antibodies protect against reinfection for at least 6 months in a multicentre seroepidemiological workplace cohort. PLoS Biol 2022; 20:e3001531. [PMID: 35143473 PMCID: PMC8865659 DOI: 10.1371/journal.pbio.3001531] [Citation(s) in RCA: 7] [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: 05/12/2021] [Revised: 02/23/2022] [Accepted: 01/07/2022] [Indexed: 11/28/2022] Open
Abstract
Identifying the potential for SARS-CoV-2 reinfection is crucial for understanding possible long-term epidemic dynamics. We analysed longitudinal PCR and serological testing data from a prospective cohort of 4,411 United States employees in 4 states between April 2020 and February 2021. We conducted a multivariable logistic regression investigating the association between baseline serological status and subsequent PCR test result in order to calculate an odds ratio for reinfection. We estimated an odds ratio for reinfection ranging from 0.14 (95% CI: 0.019 to 0.63) to 0.28 (95% CI: 0.05 to 1.1), implying that the presence of SARS-CoV-2 antibodies at baseline is associated with around 72% to 86% reduced odds of a subsequent PCR positive test based on our point estimates. This suggests that primary infection with SARS-CoV-2 provides protection against reinfection in the majority of individuals, at least over a 6-month time period. We also highlight 2 major sources of bias and uncertainty to be considered when estimating the relative risk of reinfection, confounders and the choice of baseline time point, and show how to account for both in reinfection analysis. Identifying the potential for SARS-CoV-2 reinfection is crucial for understanding possible long-term epidemic dynamics. Analysis of a seroepidemiological cohort suggests that primary infection with SARS-CoV-2 protects against reinfection in the majority of individuals, at least over a six month period.
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Affiliation(s)
- Emilie Finch
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Rachel Lowe
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Barcelona Supercomputing Center (BSC), Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Stephanie Fischinger
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, United States of America
- Institut für HIV Forschung, Universität Duisburg-Essen, Duisburg, Germany
| | - Michael de St Aubin
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, United States of America
| | - Sameed M. Siddiqui
- Computational and Systems Biology Program, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Diana Dayal
- Space Exploration Technologies Corp, Hawthorne, California, United States of America
| | - Michael A. Loesche
- Space Exploration Technologies Corp, Hawthorne, California, United States of America
- Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Justin Rhee
- Space Exploration Technologies Corp, Hawthorne, California, United States of America
| | - Samuel Beger
- Space Exploration Technologies Corp, Hawthorne, California, United States of America
| | - Yiyuan Hu
- Space Exploration Technologies Corp, Hawthorne, California, United States of America
| | - Matthew J. Gluck
- Space Exploration Technologies Corp, Hawthorne, California, United States of America
| | - Benjamin Mormann
- Space Exploration Technologies Corp, Hawthorne, California, United States of America
| | | | - Elon R. Musk
- Space Exploration Technologies Corp, Hawthorne, California, United States of America
| | - Galit Alter
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, United States of America
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Anil S. Menon
- Space Exploration Technologies Corp, Hawthorne, California, United States of America
| | - Eric J. Nilles
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, United States of America
- Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Adam J. Kucharski
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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9
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Kaplonek P, Fischinger S, Cizmeci D, Bartsch YC, Kang J, Burke JS, Shin SA, Dayal D, Martin P, Mann C, Amanat F, Julg B, Nilles EJ, Musk ER, Menon AS, Krammer F, Saphire EO, Andrea Carfi, Alter G. mRNA-1273 vaccine-induced antibodies maintain Fc effector functions across SARS-CoV-2 variants of concern. Immunity 2022; 55:355-365.e4. [PMID: 35090580 PMCID: PMC8733218 DOI: 10.1016/j.immuni.2022.01.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [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] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/16/2021] [Accepted: 01/04/2022] [Indexed: 01/16/2023]
Abstract
SARS-CoV-2 mRNA vaccines confer robust protection against COVID-19, but the emergence of variants has generated concerns regarding the protective efficacy of the currently approved vaccines, which lose neutralizing potency against some variants. Emerging data suggest that antibody functions beyond neutralization may contribute to protection from the disease, but little is known about SARS-CoV-2 antibody effector functions. Here, we profiled the binding and functional capacity of convalescent antibodies and Moderna mRNA-1273 COVID-19 vaccine-induced antibodies across SARS-CoV-2 variants of concern (VOCs). Although the neutralizing responses to VOCs decreased in both groups, the Fc-mediated responses were distinct. In convalescent individuals, although antibodies exhibited robust binding to VOCs, they showed compromised interactions with Fc-receptors. Conversely, vaccine-induced antibodies also bound robustly to VOCs but continued to interact with Fc-receptors and mediate antibody effector functions. These data point to a resilience in the mRNA-vaccine-induced humoral immune response that may continue to offer protection from SARS-CoV-2 VOCs independent of neutralization.
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Affiliation(s)
| | | | - Deniz Cizmeci
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | | | - Jaewon Kang
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - John S Burke
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Sally A Shin
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Diana Dayal
- Space Exploration Technologies Corp, Hawthorne, CA, USA
| | | | - Colin Mann
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Fatima Amanat
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Boris Julg
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | | | - Elon R Musk
- Space Exploration Technologies Corp, Hawthorne, CA, USA
| | - Anil S Menon
- Space Exploration Technologies Corp, Hawthorne, CA, USA
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erica Ollman Saphire
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, La Jolla, CA, USA
| | | | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA.
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10
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Nilles EJ, Siddiqui SM, Fischinger S, Bartsch YC, de St. Aubin M, Zhou G, Gluck MJ, Berger S, Rhee J, Petersen E, Mormann B, Loesche M, Hu Y, Chen Z, Yu J, Gebre M, Atyeo C, Gorman MJ, Zhu AL, Burke J, Slein M, Hasdianda MA, Jambaulikar G, Boyer EW, Sabeti PC, Barouch DH, Julg B, Kucharski AJ, Musk ER, Lauffenburger DA, Alter G, Menon AS. Epidemiological and Immunological Features of Obesity and SARS-CoV-2. Viruses 2021; 13:2235. [PMID: 34835041 PMCID: PMC8624148 DOI: 10.3390/v13112235] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 12/15/2022] Open
Abstract
Obesity is a key correlate of severe SARS-CoV-2 outcomes while the role of obesity on risk of SARS-CoV-2 infection, symptom phenotype, and immune response remain poorly defined. We examined data from a prospective SARS-CoV-2 cohort study to address these questions. Serostatus, body mass index, demographics, comorbidities, and prior COVID-19 compatible symptoms were assessed at baseline and serostatus and symptoms monthly thereafter. SARS-CoV-2 immunoassays included an IgG ELISA targeting the spike RBD, multiarray Luminex targeting 20 viral antigens, pseudovirus neutralization, and T cell ELISPOT assays. Our results from a large prospective SARS-CoV-2 cohort study indicate symptom phenotype is strongly influenced by obesity among younger but not older age groups; we did not identify evidence to suggest obese individuals are at higher risk of SARS-CoV-2 infection; and remarkably homogenous immune activity across BMI categories suggests immune protection across these groups may be similar.
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Affiliation(s)
- Eric J. Nilles
- Brigham and Women’s Hospital, Boston, MA 02115, USA; (G.Z.); (B.M.); (M.L.); (M.A.H.); (G.J.); (E.W.B.)
- Harvard Medical School, Boston, MA 02115, USA
- Harvard Humanitarian Initiative, Boston, MA 02114, USA;
- Massachusetts Consortium on Pathogen Readiness, Boston, MA 02115, USA; (P.C.S.); (G.A.)
| | - Sameed M. Siddiqui
- Computational and Systems Biology Program, Massachusetts Institute of Technology, Cambridge, MA 02139, USA;
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; (D.H.B.); (B.J.)
| | - Stephanie Fischinger
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA; (S.F.); (Y.C.B.); (Z.C.); (J.Y.); (M.G.); (C.A.); (M.J.G.); (A.L.Z.); (J.B.); (M.S.)
| | - Yannic C. Bartsch
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA; (S.F.); (Y.C.B.); (Z.C.); (J.Y.); (M.G.); (C.A.); (M.J.G.); (A.L.Z.); (J.B.); (M.S.)
| | | | - Guohai Zhou
- Brigham and Women’s Hospital, Boston, MA 02115, USA; (G.Z.); (B.M.); (M.L.); (M.A.H.); (G.J.); (E.W.B.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Matthew J. Gluck
- Space Exploration Technologies Corp., Hawthorne, CA 90250, USA; (M.J.G.); (S.B.); (J.R.); (E.P.); (Y.H.); (E.R.M.); (A.S.M.)
| | - Samuel Berger
- Space Exploration Technologies Corp., Hawthorne, CA 90250, USA; (M.J.G.); (S.B.); (J.R.); (E.P.); (Y.H.); (E.R.M.); (A.S.M.)
| | - Justin Rhee
- Space Exploration Technologies Corp., Hawthorne, CA 90250, USA; (M.J.G.); (S.B.); (J.R.); (E.P.); (Y.H.); (E.R.M.); (A.S.M.)
| | - Eric Petersen
- Space Exploration Technologies Corp., Hawthorne, CA 90250, USA; (M.J.G.); (S.B.); (J.R.); (E.P.); (Y.H.); (E.R.M.); (A.S.M.)
| | - Benjamin Mormann
- Brigham and Women’s Hospital, Boston, MA 02115, USA; (G.Z.); (B.M.); (M.L.); (M.A.H.); (G.J.); (E.W.B.)
- Space Exploration Technologies Corp., Hawthorne, CA 90250, USA; (M.J.G.); (S.B.); (J.R.); (E.P.); (Y.H.); (E.R.M.); (A.S.M.)
| | - Michael Loesche
- Brigham and Women’s Hospital, Boston, MA 02115, USA; (G.Z.); (B.M.); (M.L.); (M.A.H.); (G.J.); (E.W.B.)
- Space Exploration Technologies Corp., Hawthorne, CA 90250, USA; (M.J.G.); (S.B.); (J.R.); (E.P.); (Y.H.); (E.R.M.); (A.S.M.)
| | - Yiyuan Hu
- Space Exploration Technologies Corp., Hawthorne, CA 90250, USA; (M.J.G.); (S.B.); (J.R.); (E.P.); (Y.H.); (E.R.M.); (A.S.M.)
| | - Zhilin Chen
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA; (S.F.); (Y.C.B.); (Z.C.); (J.Y.); (M.G.); (C.A.); (M.J.G.); (A.L.Z.); (J.B.); (M.S.)
| | - Jingyou Yu
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA; (S.F.); (Y.C.B.); (Z.C.); (J.Y.); (M.G.); (C.A.); (M.J.G.); (A.L.Z.); (J.B.); (M.S.)
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Makda Gebre
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA; (S.F.); (Y.C.B.); (Z.C.); (J.Y.); (M.G.); (C.A.); (M.J.G.); (A.L.Z.); (J.B.); (M.S.)
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Caroline Atyeo
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA; (S.F.); (Y.C.B.); (Z.C.); (J.Y.); (M.G.); (C.A.); (M.J.G.); (A.L.Z.); (J.B.); (M.S.)
| | - Matthew J. Gorman
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA; (S.F.); (Y.C.B.); (Z.C.); (J.Y.); (M.G.); (C.A.); (M.J.G.); (A.L.Z.); (J.B.); (M.S.)
| | - Alex Lee Zhu
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA; (S.F.); (Y.C.B.); (Z.C.); (J.Y.); (M.G.); (C.A.); (M.J.G.); (A.L.Z.); (J.B.); (M.S.)
| | - John Burke
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA; (S.F.); (Y.C.B.); (Z.C.); (J.Y.); (M.G.); (C.A.); (M.J.G.); (A.L.Z.); (J.B.); (M.S.)
| | - Matthew Slein
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA 02139, USA; (S.F.); (Y.C.B.); (Z.C.); (J.Y.); (M.G.); (C.A.); (M.J.G.); (A.L.Z.); (J.B.); (M.S.)
| | - Mohammad A. Hasdianda
- Brigham and Women’s Hospital, Boston, MA 02115, USA; (G.Z.); (B.M.); (M.L.); (M.A.H.); (G.J.); (E.W.B.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Guruprasad Jambaulikar
- Brigham and Women’s Hospital, Boston, MA 02115, USA; (G.Z.); (B.M.); (M.L.); (M.A.H.); (G.J.); (E.W.B.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Edward W. Boyer
- Brigham and Women’s Hospital, Boston, MA 02115, USA; (G.Z.); (B.M.); (M.L.); (M.A.H.); (G.J.); (E.W.B.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Pardis C. Sabeti
- Massachusetts Consortium on Pathogen Readiness, Boston, MA 02115, USA; (P.C.S.); (G.A.)
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; (D.H.B.); (B.J.)
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Howard Hughes Medical Institute, Chevy Chase, MD 20815, USA
| | - Dan H. Barouch
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; (D.H.B.); (B.J.)
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
| | - Boris Julg
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; (D.H.B.); (B.J.)
| | - Adam J. Kucharski
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Elon R. Musk
- Space Exploration Technologies Corp., Hawthorne, CA 90250, USA; (M.J.G.); (S.B.); (J.R.); (E.P.); (Y.H.); (E.R.M.); (A.S.M.)
| | - Douglas A. Lauffenburger
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA;
| | - Galit Alter
- Massachusetts Consortium on Pathogen Readiness, Boston, MA 02115, USA; (P.C.S.); (G.A.)
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; (D.H.B.); (B.J.)
| | - Anil S. Menon
- Space Exploration Technologies Corp., Hawthorne, CA 90250, USA; (M.J.G.); (S.B.); (J.R.); (E.P.); (Y.H.); (E.R.M.); (A.S.M.)
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11
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Kaplonek P, Wang C, Bartsch Y, Fischinger S, Gorman MJ, Bowman K, Kang J, Dayal D, Martin P, Nowak RP, Villani AC, Hsieh CL, Charland NC, Gonye AL, Gushterova I, Khanna HK, LaSalle TJ, Lavin-Parsons KM, Lilley BM, Lodenstein CL, Manakongtreecheep K, Margolin JD, McKaig BN, Rojas-Lopez M, Russo BC, Sharma N, Tantivit J, Thomas MF, Sade-Feldman M, Feldman J, Julg B, Nilles EJ, Musk ER, Menon AS, Fischer ES, McLellan JS, Schmidt A, Goldberg MB, Filbin MR, Hacohen N, Lauffenburger DA, Alter G. Early cross-coronavirus reactive signatures of humoral immunity against COVID-19. Sci Immunol 2021; 6:eabj2901. [PMID: 34652962 PMCID: PMC8943686 DOI: 10.1126/sciimmunol.abj2901] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [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: 05/05/2021] [Revised: 07/06/2021] [Accepted: 09/01/2021] [Indexed: 12/15/2022]
Abstract
The introduction of vaccines has inspired hope in the battle against SARS-CoV-2. However, the emergence of viral variants, in the absence of potent antivirals, has left the world struggling with the uncertain nature of this disease. Antibodies currently represent the strongest correlate of immunity against SARS-CoV-2, thus we profiled the earliest humoral signatures in a large cohort of acutely ill (survivors and nonsurvivors) and mild or asymptomatic individuals with COVID-19. Although a SARS-CoV-2–specific immune response evolved rapidly in survivors of COVID-19, nonsurvivors exhibited blunted and delayed humoral immune evolution, particularly with respect to S2-specific antibodies. Given the conservation of S2 across β-coronaviruses, we found that the early development of SARS-CoV-2–specific immunity occurred in tandem with preexisting common β-coronavirus OC43 humoral immunity in survivors, which was also selectively expanded in individuals that develop a paucisymptomatic infection. These data point to the importance of cross-coronavirus immunity as a correlate of protection against COVID-19.
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Affiliation(s)
| | - Chuangqi Wang
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Yannic Bartsch
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | | | | | - Kathryn Bowman
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Jaewon Kang
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Diana Dayal
- Space Exploration Technologies Corporation, Hawthorne, CA, USA
| | - Patrick Martin
- Space Exploration Technologies Corporation, Hawthorne, CA, USA
| | - Radoslaw P. Nowak
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, USA
| | - Alexandra-Chloé Villani
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Center for Immunology and Inflammatory Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ching-Lin Hsieh
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX, USA
| | - Nicole C. Charland
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Anna L.K. Gonye
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Irena Gushterova
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Hargun K. Khanna
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas J. LaSalle
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Brendan M. Lilley
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Carl L. Lodenstein
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kasidet Manakongtreecheep
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Center for Immunology and Inflammatory Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Justin D. Margolin
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Brenna N. McKaig
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Maricarmen Rojas-Lopez
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Microbiology, Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Brian C. Russo
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Microbiology, Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Nihaarika Sharma
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jessica Tantivit
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Center for Immunology and Inflammatory Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Molly F. Thomas
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Center for Immunology and Inflammatory Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Moshe Sade-Feldman
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jared Feldman
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Boris Julg
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | | | - Elon R. Musk
- Space Exploration Technologies Corporation, Hawthorne, CA, USA
| | - Anil S. Menon
- Space Exploration Technologies Corporation, Hawthorne, CA, USA
| | - Eric S. Fischer
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jason S. McLellan
- Department of Molecular Biosciences, The University of Texas at Austin, Austin, TX, USA
| | - Aaron Schmidt
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Marcia B. Goldberg
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Microbiology, Harvard Medical School, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Michael R. Filbin
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Nir Hacohen
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
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12
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Kaplonek P, Cizmeci D, Fischinger S, Collier AR, Suscovich T, Linde C, Broge T, Mann C, Amanat F, Dayal D, Rhee J, de St. Aubin M, Nilles EJ, Musk ER, Menon AS, Saphire EO, Krammer F, Lauffenburger DA, Barouch DH, Alter G. Subtle immunological differences in mRNA-1273 and BNT162b2 COVID-19 vaccine induced Fc-functional profiles. bioRxiv 2021:2021.08.31.458247. [PMID: 34494026 PMCID: PMC8423223 DOI: 10.1101/2021.08.31.458247] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The successful development of several COVID-19 vaccines has substantially reduced morbidity and mortality in regions of the world where the vaccines have been deployed. However, in the wake of the emergence of viral variants, able to evade vaccine induced neutralizing antibodies, real world vaccine efficacy has begun to show differences across the mRNA platforms, suggesting that subtle variation in immune responses induced by the BNT162b2 and mRNA1273 vaccines may provide differential protection. Given our emerging appreciation for the importance of additional antibody functions, beyond neutralization, here we profiled the postboost binding and functional capacity of the humoral response induced by the BNT162b2 and mRNA-1273 in a cohort of hospital staff. Both vaccines induced robust humoral immune responses to WT SARS-CoV-2 and VOCs. However, differences emerged across epitopespecific responses, with higher RBD- and NTD-specific IgA, as well as functional antibodies (ADNP and ADNK) in mRNA-1273 vaccine recipients. Additionally, RBD-specific antibody depletion highlighted the different roles of non-RBD-specific antibody effector function induced across the mRNA vaccines, providing novel insights into potential differences in protective immunity generated across these vaccines in the setting of newly emerging VOCs.
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Affiliation(s)
| | - Deniz Cizmeci
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | | | - Ai-ris Collier
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | | | | | | | - Colin Mann
- Department of Immunology and Microbial Science, The Scripps Research Institute, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Fatima Amanat
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Diana Dayal
- Space Exploration Technologies Corp, Hawthorne, CA, USA
| | - Justin Rhee
- Space Exploration Technologies Corp, Hawthorne, CA, USA
| | | | | | - Elon R. Musk
- Space Exploration Technologies Corp, Hawthorne, CA, USA
| | - Anil S. Menon
- Space Exploration Technologies Corp, Hawthorne, CA, USA
| | - Erica Ollmann Saphire
- Department of Immunology and Microbial Science, The Scripps Research Institute, La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Dan H. Barouch
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
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13
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Nilles EJ, Karlson EW, Norman M, Gilboa T, Fischinger S, Atyeo C, Zhou G, Bennett CL, Tolan NV, Oganezova K, Walt DR, Alter G, Simmons DP, Schur P, Jarolim P, Woolley AE, Baden LR. Evaluation of Three Commercial and Two Non-Commercial Immunoassays for the Detection of Prior Infection to SARS-CoV-2. J Appl Lab Med 2021; 6:1561-1570. [PMID: 34196711 PMCID: PMC8420636 DOI: 10.1093/jalm/jfab072] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/15/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Serological testing provides a record of prior infection with SARS-CoV-2, but assay performance requires independent assessment. METHODS We evaluated 3 commercial (Roche Diagnostics pan-IG, and Epitope Diagnostics IgM and IgG) and 2 non-commercial (Simoa and Ragon/MGH IgG) immunoassays against 1083 unique samples that included 251 PCR-positive and 832 prepandemic samples. RESULTS The Roche assay registered the highest specificity 99.6% (3/832 false positives), the Ragon/MGH assay 99.5% (4/832), the primary Simoa assay model 99.0% (8/832), and the Epitope IgG and IgM 99.0% (8/830) and 99.5% (4/830), respectively. Overall sensitivities for the Simoa, Roche pan-IG, Epitope IgG, Ragon/MGH IgG, and Epitope IgM were 92.0%, 82.9%, 82.5%, 64.5% and 47.0%, respectively. The Simoa immunoassay demonstrated the highest sensitivity among samples stratified by days postsymptom onset (PSO), <8 days PSO (57.69%) 8-14 days PSO (93.51%), 15-21 days PSO (100%), and > 21 days PSO (95.18%). CONCLUSIONS All assays demonstrated high to very high specificities while sensitivities were variable across assays.
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Affiliation(s)
- Eric J Nilles
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Elizabeth W Karlson
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA,Address correspondence to this author at: Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115, USA. Fax 508-785-0351; e-mail
| | - Maia Norman
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA,Tufts University School of Medicine, Boston, MA,Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
| | - Tal Gilboa
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA,Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
| | | | | | - Guohai Zhou
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Christopher L Bennett
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA,Massachusetts General Hospital, Boston, MA
| | - Nicole V Tolan
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | | | - David R Walt
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA,Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
| | - Galit Alter
- Harvard Medical School, Boston, MA,Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA,Harvard T.H. Chan School of Public Health, Boston, MA
| | - Daimon P Simmons
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Peter Schur
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Petr Jarolim
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Ann E Woolley
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Lindsey R Baden
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
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14
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Kaplonek P, Wang C, Bartsch Y, Fischinger S, Gorman MJ, Bowman K, Kang J, Dayal D, Martin P, Nowak R, Hsieh CL, Feldman J, Julg B, Nilles EJ, Musk ER, Menon AS, Fischer ES, McLellan JS, Schmidt A, Goldberg MB, Filbin M, Hacohen N, Lauffenburger DA, Alter G. Early cross-coronavirus reactive signatures of protective humoral immunity against COVID-19. bioRxiv 2021:2021.05.11.443609. [PMID: 34013263 PMCID: PMC8132219 DOI: 10.1101/2021.05.11.443609] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The introduction of vaccines has inspired new hope in the battle against SARS-CoV-2. However, the emergence of viral variants, in the absence of potent antivirals, has left the world struggling with the uncertain nature of this disease. Antibodies currently represent the strongest correlate of immunity against COVID-19, thus we profiled the earliest humoral signatures in a large cohort of severe and asymptomatic COVID-19 individuals. While a SARS-CoV-2-specific immune response evolved rapidly in survivors of COVID-19, non-survivors exhibited blunted and delayed humoral immune evolution, particularly with respect to S2-specific antibody evolution. Given the conservation of S2 across β-coronaviruses, we found the early development of SARS-CoV-2-specific immunity occurred in tandem with pre-existing common β-coronavirus OC43 humoral immunity in survivors, which was selectively also expanded in individuals that develop paucisymptomatic infection. These data point to the importance of cross-coronavirus immunity as a correlate of protection against COVID-19.
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Affiliation(s)
| | - Chuangqi Wang
- Department of Biological Engineering, Massachusetts Institute of Technology, MA, USA
| | - Yannic Bartsch
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | | | | | - Kathryn Bowman
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Jaewon Kang
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | | | | | | | - Ching-Lin Hsieh
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
- Department of Biological Engineering, Massachusetts Institute of Technology, MA, USA
- Space Exploration Technologies Corp, USA
- Brigham Women's Hospital, USA
- Massachusetts General Hospital, USA
- Broad Institute, USA
| | - Jared Feldman
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | - Boris Julg
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | | | | | | | | | - Jason S McLellan
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
- Department of Biological Engineering, Massachusetts Institute of Technology, MA, USA
- Space Exploration Technologies Corp, USA
- Brigham Women's Hospital, USA
- Massachusetts General Hospital, USA
- Broad Institute, USA
| | - Aaron Schmidt
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
| | | | | | - Nir Hacohen
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
- Broad Institute, USA
| | | | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA
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15
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Henderson AD, Kama M, Aubry M, Hue S, Teissier A, Naivalu T, Bechu VD, Kailawadoko J, Rabukawaqa I, Sahukhan A, Hibberd ML, Nilles EJ, Funk S, Whitworth J, Watson CH, Lau CL, Edmunds WJ, Cao-Lormeau VM, Kucharski AJ. Interactions between timing and transmissibility explain diverse flavivirus dynamics in Fiji. Nat Commun 2021; 12:1671. [PMID: 33723237 PMCID: PMC7961049 DOI: 10.1038/s41467-021-21788-y] [Citation(s) in RCA: 1] [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: 06/08/2020] [Accepted: 02/10/2021] [Indexed: 12/14/2022] Open
Abstract
Zika virus (ZIKV) has caused large, brief outbreaks in isolated populations, however ZIKV can also persist at low levels over multiple years. The reasons for these diverse transmission dynamics remain poorly understood. In Fiji, which has experienced multiple large single-season dengue epidemics, there was evidence of multi-year transmission of ZIKV between 2013 and 2017. To identify factors that could explain these differences in dynamics between closely related mosquito-borne flaviviruses, we jointly fit a transmission dynamic model to surveillance, serological and molecular data. We estimate that the observed dynamics of ZIKV were the result of two key factors: strong seasonal effects, which created an ecologically optimal time of year for outbreaks; and introduction of ZIKV after this optimal time, which allowed ZIKV transmission to persist over multiple seasons. The ability to jointly fit to multiple data sources could help identify a similar range of possible outbreak dynamics in other settings.
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Affiliation(s)
- Alasdair D Henderson
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
| | - Mike Kama
- Fiji Center for Diseases Control, Suva, Fiji
| | - Maite Aubry
- Institut Louis Malardé, Papeete, Tahiti, French Polynesia
| | - Stephane Hue
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Anita Teissier
- Institut Louis Malardé, Papeete, Tahiti, French Polynesia
| | | | | | | | | | | | - Martin L Hibberd
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Sebastian Funk
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jimmy Whitworth
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Conall H Watson
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Epidemic Diseases Research Group Oxford, University of Oxford, Oxford, UK
| | - Colleen L Lau
- Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - W John Edmunds
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Adam J Kucharski
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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16
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Bartsch YC, Fischinger S, Siddiqui SM, Chen Z, Yu J, Gebre M, Atyeo C, Gorman MJ, Zhu AL, Kang J, Burke JS, Slein M, Gluck MJ, Beger S, Hu Y, Rhee J, Petersen E, Mormann B, Aubin MDS, Hasdianda MA, Jambaulikar G, Boyer EW, Sabeti PC, Barouch DH, Julg BD, Musk ER, Menon AS, Lauffenburger DA, Nilles EJ, Alter G. Discrete SARS-CoV-2 antibody titers track with functional humoral stability. Nat Commun 2021; 12:1018. [PMID: 33589636 PMCID: PMC7884400 DOI: 10.1038/s41467-021-21336-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [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] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/20/2021] [Indexed: 02/03/2023] Open
Abstract
Antibodies serve as biomarkers of infection, but if sustained can confer long-term immunity. Yet, for most clinically approved vaccines, binding antibody titers only serve as a surrogate of protection. Instead, the ability of vaccine induced antibodies to neutralize or mediate Fc-effector functions is mechanistically linked to protection. While evidence has begun to point to persisting antibody responses among SARS-CoV-2 infected individuals, cases of re-infection have begun to emerge, calling the protective nature of humoral immunity against this highly infectious pathogen into question. Using a community-based surveillance study, we aimed to define the relationship between titers and functional antibody activity to SARS-CoV-2 over time. Here we report significant heterogeneity, but limited decay, across antibody titers amongst 120 identified seroconverters, most of whom had asymptomatic infection. Notably, neutralization, Fc-function, and SARS-CoV-2 specific T cell responses were only observed in subjects that elicited RBD-specific antibody titers above a threshold. The findings point to a switch-like relationship between observed antibody titer and function, where a distinct threshold of activity-defined by the level of antibodies-is required to elicit vigorous humoral and cellular response. This response activity level may be essential for durable protection, potentially explaining why re-infections occur with SARS-CoV-2 and other common coronaviruses.
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Affiliation(s)
| | - Stephanie Fischinger
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
- Institut für HIV Forschung, Universität Duisburg-Essen, Duisburg, Germany
| | - Sameed M Siddiqui
- Computational and Systems Biology Program, Massachusetts Institute of Technology, Cambridge, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Zhilin Chen
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Jingyou Yu
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Makda Gebre
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Caroline Atyeo
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | | | - Alex Lee Zhu
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Jaewon Kang
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - John S Burke
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Matthew Slein
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Matthew J Gluck
- Space Exploration Technologies Corp, Hawthorne, CA, USA
- Icahn School of Medicine at Mount Sinai, Nw York, USA
| | - Samuel Beger
- Space Exploration Technologies Corp, Hawthorne, CA, USA
| | - Yiyuan Hu
- Space Exploration Technologies Corp, Hawthorne, CA, USA
| | - Justin Rhee
- Space Exploration Technologies Corp, Hawthorne, CA, USA
| | - Eric Petersen
- Space Exploration Technologies Corp, Hawthorne, CA, USA
| | | | | | | | | | | | - Pardis C Sabeti
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
- Massachusetts Consortium on Pandemic Readiness, Cambridge, MA, USA
| | - Dan H Barouch
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Massachusetts Consortium on Pandemic Readiness, Cambridge, MA, USA
| | - Boris D Julg
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Elon R Musk
- Space Exploration Technologies Corp, Hawthorne, CA, USA
| | - Anil S Menon
- Space Exploration Technologies Corp, Hawthorne, CA, USA.
| | - Douglas A Lauffenburger
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | | | - Galit Alter
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA.
- Massachusetts Consortium on Pandemic Readiness, Cambridge, MA, USA.
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17
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Bartsch YC, Wang C, Zohar T, Fischinger S, Atyeo C, Burke JS, Kang J, Edlow AG, Fasano A, Baden LR, Nilles EJ, Woolley AE, Karlson EW, Hopke AR, Irimia D, Fischer ES, Ryan ET, Charles RC, Julg BD, Lauffenburger DA, Yonker LM, Alter G. Humoral signatures of protective and pathological SARS-CoV-2 infection in children. Nat Med 2021; 27:454-462. [PMID: 33589825 DOI: 10.1038/s41591-021-01263-3] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/25/2021] [Indexed: 01/30/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic continues to spread relentlessly, associated with a high frequency of respiratory failure and mortality. Children experience largely asymptomatic disease, with rare reports of multisystem inflammatory syndrome in children (MIS-C). Identifying immune mechanisms that result in these disparate clinical phenotypes in children could provide critical insights into coronavirus disease 2019 (COVID-19) pathogenesis. Using systems serology, in this study we observed in 25 children with acute mild COVID-19 a functional phagocyte and complement-activating IgG response to SARS-CoV-2, similar to the acute responses generated in adults with mild disease. Conversely, IgA and neutrophil responses were significantly expanded in adults with severe disease. Moreover, weeks after the resolution of SARS-CoV-2 infection, children who develop MIS-C maintained highly inflammatory monocyte-activating SARS-CoV-2 IgG antibodies, distinguishable from acute disease in children but with antibody levels similar to those in convalescent adults. Collectively, these data provide unique insights into the potential mechanisms of IgG and IgA that might underlie differential disease severity as well as unexpected complications in children infected with SARS-CoV-2.
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Affiliation(s)
| | - Chuangqi Wang
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Tomer Zohar
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA.,Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Caroline Atyeo
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - John S Burke
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Jaewon Kang
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Andrea G Edlow
- Massachusetts General Hospital Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Boston, MA, USA
| | - Alessio Fasano
- Massachusetts General Hospital, Mucosal Immunology and Biology Research Center, Boston, MA, USA.,Massachusetts General Hospital, Department of Pediatrics, Boston, MA, USA
| | | | | | | | | | - Alex R Hopke
- Massachusetts General Hospital, BioMEMS Resource Center, Boston, MA, USA
| | - Daniel Irimia
- Massachusetts General Hospital, BioMEMS Resource Center, Boston, MA, USA
| | - Eric S Fischer
- Department of Cancer Biology, Dana Farber Cancer Institute, Boston, MA, USA.,Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, USA
| | - Edward T Ryan
- Massachusetts General Hospital, BioMEMS Resource Center, Boston, MA, USA
| | - Richelle C Charles
- Massachusetts General Hospital, BioMEMS Resource Center, Boston, MA, USA
| | - Boris D Julg
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Douglas A Lauffenburger
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Lael M Yonker
- Massachusetts General Hospital, Mucosal Immunology and Biology Research Center, Boston, MA, USA. .,Massachusetts General Hospital, Department of Pediatrics, Boston, MA, USA.
| | - Galit Alter
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA.
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18
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Nilles EJ, Siddiqui SM, Fischinger S, Bartsch YC, de Saint Aubin M, Zhou G, Gluck MJ, Berger S, Rhee J, Petersen E, Mormann B, Loesche M, Chen Z, Yu J, Gebre M, Atyeo C, Gorman MJ, Lee Zhu A, Burke J, Slein M, Hasdianda MA, Jambaulikar G, Boyer E, Sabeti P, Barouch DH, Julg BD, Kucharski AJ, Musk ER, Lauffenburger DA, Alter G, Menon AS. Epidemiological and immunological features of obesity and SARS-CoV-2. medRxiv 2020:2020.11.11.20229724. [PMID: 33200139 PMCID: PMC7668749 DOI: 10.1101/2020.11.11.20229724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Obesity is a key correlate of severe SARS-CoV-2 outcomes while the role of obesity on risk of SARS-CoV-2 infection, symptom phenotype, and immune response are poorly defined. We examined data from a prospective SARS-CoV-2 cohort study to address these questions. Serostatus, body mass index, demographics, comorbidities, and prior COVID-19 compatible symptoms were assessed at baseline and serostatus and symptoms monthly thereafter. SARS-CoV-2 immunoassays included an IgG ELISA targeting the spike RBD, multiarray Luminex targeting 20 viral antigens, pseudovirus neutralization, and T cell ELISPOT assays. Our results from a large prospective SARS-CoV-2 cohort study indicate symptom phenotype is strongly influenced by obesity among younger but not older age groups; we did not identify evidence to suggest obese individuals are at higher risk of SARS-CoV-2 infection; and, remarkably homogenous immune activity across BMI categories suggests natural- and vaccine-induced protection may be similar across these groups.
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Affiliation(s)
- Eric J Nilles
- Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Harvard Humanitarian Initiative, Boston, MA
- Massachusetts Consortium on Pathogen Readiness, Boston, MA
| | - Sameed M Siddiqui
- Computational and Systems Biology Program, Massachusetts Institute of Technology, Cambridge, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
| | | | | | | | - Guohai Zhou
- Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Matthew J Gluck
- Space Exploration Technologies Corp, Hawthorne, CA
- Icahn School of Medicine- Mount Sinai, New York, NY
| | | | - Justin Rhee
- Space Exploration Technologies Corp, Hawthorne, CA
| | | | - Benjamin Mormann
- Brigham and Women’s Hospital, Boston, MA
- Space Exploration Technologies Corp, Hawthorne, CA
| | - Michael Loesche
- Brigham and Women’s Hospital, Boston, MA
- Space Exploration Technologies Corp, Hawthorne, CA
| | - Zhilin Chen
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
| | - Jingyou Yu
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - Makda Gebre
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
- Harvard T.H. Chan School of Public Health, Boston, MA
| | | | | | - Alex Lee Zhu
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
| | - John Burke
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
| | - Matthew Slein
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
| | | | | | - Edward Boyer
- Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Pardis Sabeti
- Massachusetts Consortium on Pathogen Readiness, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
- Harvard T.H. Chan School of Public Health, Boston, MA
- Howard Hughes Medical Institute, Chevy Chase, MD
| | - Dan H Barouch
- Broad Institute of MIT and Harvard, Cambridge, MA
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Boris D Julg
- Broad Institute of MIT and Harvard, Cambridge, MA
| | | | - Elon R Musk
- Space Exploration Technologies Corp, Hawthorne, CA
| | | | - Galit Alter
- Massachusetts Consortium on Pathogen Readiness, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Anil S Menon
- Space Exploration Technologies Corp, Hawthorne, CA
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19
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Kucharski AJ, Nilles EJ. Using serological data to understand unobserved SARS-CoV-2 risk in health-care settings. Lancet Infect Dis 2020; 20:1351-1352. [PMID: 32758436 PMCID: PMC7398653 DOI: 10.1016/s1473-3099(20)30579-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Adam J Kucharski
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
| | - Eric J Nilles
- Brigham and Women's Hospital, Harvard Medical School, Harvard Humanitarian Initiative, Boston, MA, USA
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20
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Kempen JH, Abashawl A, Suga HK, Nigussie Difabachew M, Kempen CJ, Tesfaye Debele M, Menkir AA, Assefa MT, Asfaw EH, Habtegabriel LB, Sitotaw Addisie Y, Nilles EJ, Longenecker JC. SARS-CoV-2 Serosurvey in Addis Ababa, Ethiopia. Am J Trop Med Hyg 2020; 103:2022-2023. [PMID: 32975182 PMCID: PMC7646781 DOI: 10.4269/ajtmh.20-0816] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 07/07/2020] [Accepted: 09/10/2020] [Indexed: 11/25/2022] Open
Abstract
In a serosurvey of asymptomatic people from the general population recruited from a clinical laboratory in May 2020 in Addis Ababa, Ethiopia, three of 99 persons tested positive for SARS-CoV-2 IgG (3.0%, 95% binomial exact confidence interval: 0.6-8.6%). Taking into account pretest probability and the sampling scheme, the range of plausible population prevalence values was approximately 1.0-8.4%. These results suggest that a larger number of people have been infected than the counts detected by surveillance to date; nevertheless, the results suggest the large majority of the general population in Addis Ababa currently is susceptible to COVID-19.
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Affiliation(s)
- John H. Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear, Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts
- Massachusetts Consortium on Pathogen Readiness (MassCPR), Boston, Massachusetts
- MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital, Addis Ababa, Ethiopia
- MyungSung Medical School, Addis Ababa, Ethiopia
| | - Aida Abashawl
- Berhan Public Health and Eye Care Consultancy, Addis Ababa, Ethiopia
| | | | | | - Christopher J. Kempen
- MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | - Eric J. Nilles
- Massachusetts Consortium on Pathogen Readiness (MassCPR), Boston, Massachusetts
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joseph C. Longenecker
- Department of Epidemiology, Faculty of Public Health, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
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21
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Sikorski MJ, Desai SN, Tupua S, Thomsen RE, Han J, Rambocus S, Nimarota-Brown S, Punimata L, Tusitala S, Sialeipata M, Hoffman SA, Tracy JK, Higginson EE, Tennant SM, Gauld JS, Klein DJ, Ballard SA, Robins-Browne RM, Dougan G, Nilles EJ, Howden BP, Crump JA, Naseri TK, Levine MM. Tenacious Endemic Typhoid Fever in Samoa. Clin Infect Dis 2020; 71:S120-S126. [PMID: 32725232 PMCID: PMC7388710 DOI: 10.1093/cid/ciaa314] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Indexed: 11/23/2022] Open
Abstract
Background Typhoid fever has been endemic on the island nation of Samoa (2016 population, 195 979) since the 1960s and has persisted through 2019, despite economic development and improvements in water supply and sanitation. Methods Salmonella enterica serovar Typhi isolates from the 2 hospitals with blood culture capability and matched patient demographic and clinical data from January 2008 through December 2019 were analyzed. Denominators to calculate incidence by island, region, and district came from 2011 and 2016 censuses and from 2017–2019 projections from Samoa’s Bureau of Statistics. Data were analyzed to describe typhoid case burden and incidence from 2008 to 2019 by time, place, and person. Results In sum, 53–193 blood culture-confirmed typhoid cases occurred annually from 2008 to 2019, without apparent seasonality. Typhoid incidence was low among children age < 48 months (17.6–27.8/105), rose progressively in ages 5–9 years (54.0/105), 10–19 years (60.7–63.4/105), and 20–34 years (61.0–79.3/105), and then tapered off; 93.6% of cases occurred among Samoans < 50 years of age. Most typhoid cases and the highest incidence occurred in Northwest Upolu, but Apia Urban Area (served by treated water supplies) also exhibited moderate incidence. The proportion of cases from short-cycle versus long-cycle transmission is unknown. Samoan S. Typhi are pansusceptible to traditional first-line antibiotics. Nevertheless, enhanced surveillance in 2019 detected 4 (2.9%) deaths among 140 cases. Conclusions Typhoid has been endemic in Samoa in the period 2008–2019. Interventions, including mass vaccination with a Vi-conjugate vaccine coadministered with measles vaccine are planned.
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Affiliation(s)
- Michael J Sikorski
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Ministry of Health, Government of Samoa, Apia, Samoa
| | - Sachin N Desai
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Ministry of Health, Government of Samoa, Apia, Samoa
| | - Siaosi Tupua
- Ministry of Health, Government of Samoa, Apia, Samoa
| | | | - Jane Han
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Ministry of Health, Government of Samoa, Apia, Samoa
| | - Savitra Rambocus
- Ministry of Health, Government of Samoa, Apia, Samoa.,Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | | | | | | | | | - Seth A Hoffman
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - J Kathleen Tracy
- Clinical Translational Research and Informatics Center, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ellen E Higginson
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sharon M Tennant
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Daniel J Klein
- Institute for Disease Modeling, Bellevue, Washington, USA
| | - Susan A Ballard
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Roy M Robins-Browne
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Gordon Dougan
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Eric J Nilles
- World Health Organization, Division of Pacific Technical Support, Suva, Fiji
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - John A Crump
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Take K Naseri
- Ministry of Health, Government of Samoa, Apia, Samoa
| | - Myron M Levine
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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22
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Togami E, Gyawali N, Ong O, Kama M, Cao-Lormeau VM, Aubry M, Ko AI, Nilles EJ, Collins-Emerson JM, Devine GJ, Weinstein P, Lau CL. First evidence of concurrent enzootic and endemic transmission of Ross River virus in the absence of marsupial reservoirs in Fiji. Int J Infect Dis 2020; 96:94-96. [PMID: 32114197 DOI: 10.1016/j.ijid.2020.02.048] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Ross River virus (RRV) is a zoonotic alphavirus transmitted by several mosquito species. Until recently, endemic transmission was only considered possible in the presence of marsupial reservoirs. METHODS RRV seroprevalence was investigated in placental mammals (including horses, cows, goats, pigs, dogs, rats, and mice) in Fiji, where there are no marsupials. A total of 302 vertebrate serum samples were collected from 86 households from 10 communities in Western Fiji. RESULTS Neutralizing antibodies against RRV were detected in 28% to 100% of sera depending on the species, and neutralization was strong even at high dilutions. CONCLUSIONS These results are unlikely to be due to cross-reactions. Chikungunya is the only other alphavirus known to be present in the Pacific Islands, but it rarely spills over into non-humans, even during epidemics. The study findings, together with a recent report of high RRV seroprevalence in humans, strongly suggest that RRV is circulating in Fiji in the absence of marsupial reservoirs. Considering that all non-human vertebrates present in Fiji are pan-global in distribution, RRV has the potential to further expand its geographic range. Further surveillance of RRV and access to RRV diagnostics will be critical for the early detection of emergence and outbreaks.
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Affiliation(s)
- Eri Togami
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, 60 College Street, New Haven, CT 06510, USA.
| | - Narayan Gyawali
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane City, Queensland 4006, Australia
| | - Oselyne Ong
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane City, Queensland 4006, Australia
| | - Mike Kama
- Centre for Communicable Disease Control, Ministry of Health, 88 Amy Street, Toorak P.O. Box 2223, Government Buildings Suva, Fiji
| | - Van-Mai Cao-Lormeau
- Institut Louis Malardé, P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia
| | - Maite Aubry
- Institut Louis Malardé, P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia
| | - Albert I Ko
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, 60 College Street, New Haven, CT 06510, USA; Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Rua Waldemar Falcão, 121, 40296-710 Salvador, Bahia, Brazil
| | - Eric J Nilles
- Harvard Humanitarian Initiative, 14 Story Street, Fl Second, Cambridge, MA 02138, USA; Harvard Medical School, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Julie M Collins-Emerson
- Hopkirk Research Institute, Massey University School of Veterinary Science, Palmerston North 4410, New Zealand
| | - Gregor J Devine
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Brisbane City, Queensland 4006, Australia
| | - Philip Weinstein
- The University of Adelaide, School of Public Health, North Terrace Campus, 5005 South Australia, Australia
| | - Colleen L Lau
- Research School of Population Health, College of Health & Medicine, Australian National University, Canberra ACT 0200, Australia
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23
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Nilles EJ, Karlson EW, Norman M, Gilboa T, Fischinger S, Atyeo C, Zhou G, Bennett CL, Tolan NV, Oganezova K, Walt DR, Alter G, Simmons DP, Schur P, Jarolim P, Baden LR. Evaluation of two commercial and two non-commercial immunoassays for the detection of prior infection to SARS-CoV-2. medRxiv 2020:2020.06.24.20139006. [PMID: 32607518 PMCID: PMC7325183 DOI: 10.1101/2020.06.24.20139006] [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] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Seroepidemiology is an important tool to characterize the epidemiology and immunobiology of SARS-CoV-2 but many immunoassays have not been externally validated raising questions about reliability of study findings. To ensure meaningful data, particularly in a low seroprevalence population, assays need to be rigorously characterized with high specificity. Methods We evaluated two commercial (Roche Diagnostics and Epitope Diagnostics IgM/IgG) and two non-commercial (Simoa and Ragon/MGH IgG) immunoassays against 68 confirmed positive and 232 pre-pandemic negative controls. Sensitivity was stratified by time from symptom onset. The Simoa multiplex assay applied three pre-defined algorithm models to determine sample result. Results The Roche and Ragon/MGH IgG assays each registered 1/232 false positive, the primary Simoa model registered 2/232 false positives, and the Epitope registered 2/230 and 3/230 false positives for the IgG and IgM assays respectively. Sensitivity >21 days post symptom-onset was 100% for all assays except Epitope IgM, but lower and/or with greater variability between assays for samples collected 9-14 days (67-100%) and 15-21 days (69-100%) post-symptom onset. The Simoa and Epitope IgG assays demonstrated excellent sensitivity earlier in the disease course. The Roche and Ragon/MGH IgG assays were less sensitive during early disease, particularly among immunosuppressed individuals. Conclusions The Epitope IgG demonstrated good sensitivity and specificity. The Roche and Ragon/MGH IgG assays registered rare false positives with lower early sensitivity. The Simoa assay primary model had excellent sensitivity and few false positives.
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Affiliation(s)
- Eric J Nilles
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Maia Norman
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Tufts University School of Medicine, Boston, MA
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, MA
| | - Tal Gilboa
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, MA
| | | | | | - Guohai Zhou
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Christopher L Bennett
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Massachusetts General Hospital, Boston, MA
| | - Nicole V Tolan
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - David R Walt
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, MA
| | - Galit Alter
- Harvard Medical School, Boston, MA
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
- Harvard T.H. Chan School of Public Health
| | - Daimon P Simmons
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Peter Schur
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Petr Jarolim
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Lindsey R Baden
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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24
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Kraemer MUG, Pigott DM, Hill SC, Vanderslott S, Reiner RC, Stasse S, Brownstein JS, Gutierrez B, Dennig F, Hay SI, Wint GRW, Pybus OG, Castro MC, Vinck P, Pham PN, Nilles EJ, Cauchemez S. Dynamics of conflict during the Ebola outbreak in the Democratic Republic of the Congo 2018-2019. BMC Med 2020; 18:113. [PMID: 32336281 PMCID: PMC7184697 DOI: 10.1186/s12916-020-01574-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/24/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The 2018-2019 Ebola virus disease (EVD) outbreak in North Kivu and Ituri provinces in the Democratic Republic of the Congo (DRC) is the largest ever recorded in the DRC. It has been declared a Public Health Emergency of International Concern. The outbreak emerged in a region of chronic conflict and insecurity, and directed attacks against health care workers may have interfered with disease response activities. Our study characterizes and quantifies the broader conflict dynamics over the course of the outbreak by pairing epidemiological and all available spatial conflict data. METHODS We build a set of conflict variables by mapping the spatial locations of all conflict events and their associated deaths in each of the affected health zones in North Kivu and Ituri, eastern DRC, before and during the outbreak. Using these data, we compare patterns of conflict before and during the outbreak in affected health zones and those not affected. We then test whether conflict is correlated with increased EVD transmission at the health zone level. FINDINGS The incidence of conflict events per capita is ~ 600 times more likely in Ituri and North Kivu than for the rest of the DRC. We identified 15 time periods of substantial uninterrupted transmission across 11 health zones and a total of 120 bi-weeks. We do not find significant short-term associations between the bi-week reproduction numbers and the number of conflicts. However, we do find that the incidence of conflict per capita was correlated with the incidence of EVD per capita at the health zone level for the entire outbreak (Pearson's r = 0.33, 95% CI 0.05-0.57). In the two provinces, the monthly number of conflict events also increased by a factor of 2.7 in Ebola-affected health zones (p value < 0.05) compared to 2.0 where no transmission was reported and 1.3 in the rest of the DRC, in the period between February 2019 and July 2019. CONCLUSION We characterized the association between variables documenting broad conflict levels and EVD transmission. Such assessment is important to understand if and how such conflict variables could be used to inform the outbreak response. We found that while these variables can help characterize long-term challenges and susceptibilities of the different regions they provide little insight on the short-term dynamics of EVD transmission.
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Affiliation(s)
- Moritz U G Kraemer
- Department of Zoology, University of Oxford, Oxford, UK. .,Harvard Medical School, Harvard University, Boston, USA. .,Computational Epidemiology Group, Boston Children's Hospital, Boston, USA.
| | - David M Pigott
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.,Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Sarah C Hill
- Department of Zoology, University of Oxford, Oxford, UK
| | | | - Robert C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.,Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Stephanie Stasse
- European Union Delegation to the Democratic Republic of the Congo, Kinshasa, Democratic Republic of the Congo
| | - John S Brownstein
- Harvard Medical School, Harvard University, Boston, USA.,Computational Epidemiology Group, Boston Children's Hospital, Boston, USA
| | - Bernardo Gutierrez
- Department of Zoology, University of Oxford, Oxford, UK.,School of Biological and Environmental Sciences, Universidad San Francisco de Quito USFQ, Quito, Ecuador
| | | | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA.,Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - G R William Wint
- Environmental Research Group Oxford, Department of Zoology, University of Oxford, Oxford, UK
| | | | - Marcia C Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Patrick Vinck
- Harvard Medical School, Harvard University, Boston, USA.,Program on Infectious Diseases and Emergencies, Harvard Humanitarian Initiative, Harvard University, Cambridge, USA.,Brigham and Women's Hospital, Boston, USA
| | - Phuong N Pham
- Harvard Medical School, Harvard University, Boston, USA.,Program on Infectious Diseases and Emergencies, Harvard Humanitarian Initiative, Harvard University, Cambridge, USA.,Brigham and Women's Hospital, Boston, USA
| | - Eric J Nilles
- Harvard Medical School, Harvard University, Boston, USA.,Program on Infectious Diseases and Emergencies, Harvard Humanitarian Initiative, Harvard University, Cambridge, USA.,Brigham and Women's Hospital, Boston, USA
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, CNRS, UMR2000, Paris, France.
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25
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Aubry M, Kama M, Vanhomwegen J, Teissier A, Mariteragi-Helle T, Hue S, Hibberd ML, Manuguerra JC, Christi K, Watson CH, Nilles EJ, Lau CL, Aaskov J, Musso D, Kucharski AJ, Cao-Lormeau VM. Ross River Virus Antibody Prevalence, Fiji Islands, 2013-2015. Emerg Infect Dis 2019; 25:827-830. [PMID: 30882332 PMCID: PMC6433005 DOI: 10.3201/eid2504.180694] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A unique outbreak of Ross River virus (RRV) infection was reported in Fiji in 1979. In 2013, RRV seroprevalence among residents was 46.5% (362/778). Of the residents who were seronegative in 2013 and retested in 2015, 10.9% (21/192) had seroconverted to RRV, suggesting ongoing endemic circulation of RRV in Fiji.
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26
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Kama M, Aubry M, Naivalu T, Vanhomwegen J, Mariteragi-Helle T, Teissier A, Paoaafaite T, Hué S, Hibberd ML, Manuguerra JC, Christi K, Watson CH, Nilles EJ, Aaskov J, Lau CL, Musso D, Kucharski AJ, Cao-Lormeau VM. Sustained Low-Level Transmission of Zika and Chikungunya Viruses after Emergence in the Fiji Islands. Emerg Infect Dis 2019; 25:1535-1538. [PMID: 31310218 PMCID: PMC6649350 DOI: 10.3201/eid2508.180524] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Zika and chikungunya viruses were first detected in Fiji in 2015. Examining surveillance and phylogenetic and serologic data, we found evidence of low-level transmission of Zika and chikungunya viruses during 2013–2017, in contrast to the major outbreaks caused by closely related virus strains in other Pacific Island countries.
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27
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Togami E, Kama M, Goarant C, Craig SB, Lau C, Ritter JM, Imrie A, Ko AI, Nilles EJ. A Large Leptospirosis Outbreak following Successive Severe Floods in Fiji, 2012. Am J Trop Med Hyg 2019; 99:849-851. [PMID: 30141390 DOI: 10.4269/ajtmh.18-0335] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Severe flooding has been linked to outbreaks of leptospirosis. Two sequential extreme flood events in Western Fiji caused the largest outbreak of leptospirosis recorded in the South Pacific, with 1,217 total suspected cases, of which 314 were probable and confirmed. Most (83%) cases occurred within 6 weeks of the flood events, displaying a biphasic epidemic curve associated with the floods. Given the temporal proximity of cases to flooding events, most of the transmission appeared to occur during or immediately after the floods; therefore, prevention of exposure to contaminated environments is a priority in the immediate flood and post-flood period. In addition, genotyping studies suggest that multiple animal reservoirs were implicated in the outbreak, reaffirming the importance of integrated human and animal health strategies for leptospirosis control.
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Affiliation(s)
- Eri Togami
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Mike Kama
- Center for Communicable Disease Control, Ministry of Health, Suva, Fiji
| | - Cyrille Goarant
- Leptospirosis Unit, Institut Pasteur in New Caledonia, Noumea, New Caledonia
| | - Scott B Craig
- Forensic and Scientific Service, WHO Leptospirosis Laboratory, Brisbane, Australia.,School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Colleen Lau
- Research School of Population Health, Australia National University, Canberra, Australia
| | - Jana M Ritter
- Infectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Allison Imrie
- School of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Albert I Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Eric J Nilles
- Division of Pacific Technical Support, World Health Organization, Suva, Fiji
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28
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Erickson TB, Brooks J, Nilles EJ, Pham PN, Vinck P. Environmental health effects attributed to toxic and infectious agents following hurricanes, cyclones, flash floods and major hydrometeorological events. J Toxicol Environ Health B Crit Rev 2019; 22:157-171. [PMID: 31437111 DOI: 10.1080/10937404.2019.1654422] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Extreme hydrometeorological events such as hurricanes and cyclones are increasing in frequency and intensity due to climate change and often associated with flash floods in coastal, urbanized and industrial areas. Preparedness and response measures need to concentrate on toxicological and infectious hazards, the potential impact on environmental health, and threat to human lives. The recognition of the danger of flood water after hurricanes is critical. Effective health management needs to consider the likelihood and specific risks of toxic agents present in waters contaminated by chemical spills, bio-toxins, waste, sewage, and water-borne pathogens. Despite significant progress in the ability to rapidly detect and test water for a wide range of chemicals and pathogens, there has been a lack of implementation to adapt toxicity measurements in the context of flash and hurricane-induced flooding. The aim of this review was to highlight the need to collect and analyze data on toxicity of flood waters to understand the risks and prepare vulnerable communities and first responders. It is proposed that new and routinely used technologies be employed during disaster response to rapidly assess toxicity and infectious disease threats, and subsequently take necessary remedial actions.
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Affiliation(s)
- Timothy B Erickson
- Department of Emergency Medicine, Brigham & Women's Hospital, Harvard Medical School, Harvard Humanitarian Initiative , Boston , MA , USA
| | - Julia Brooks
- Department of Emergency Medicine, Brigham & Women's Hospital, Harvard Medical School, Harvard Humanitarian Initiative , Boston , MA , USA
| | - Eric J Nilles
- Department of Emergency Medicine, Brigham & Women's Hospital, Harvard Medical School, Harvard Humanitarian Initiative , Boston , MA , USA
| | - Phuong N Pham
- Department of Emergency Medicine, Brigham & Women's Hospital, Harvard Medical School, Harvard Humanitarian Initiative , Boston , MA , USA
| | - Patrick Vinck
- Department of Emergency Medicine, Brigham & Women's Hospital, Harvard Medical School, Harvard Humanitarian Initiative , Boston , MA , USA
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29
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Subissi L, Dub T, Besnard M, Mariteragi-Helle T, Nhan T, Lutringer-Magnin D, Barboza P, Gurry C, Brindel P, Nilles EJ, Baud D, Merianos A, Musso D, Glynn JR, Dupuis G, Cao-Lormeau VM, Giard M, Mallet HP. Zika Virus Infection during Pregnancy and Effects on Early Childhood Development, French Polynesia, 2013-2016. Emerg Infect Dis 2019; 24:1850-1858. [PMID: 30226164 PMCID: PMC6154169 DOI: 10.3201/eid2410.172079] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Congenital Zika virus syndrome consists of a large spectrum of neurologic abnormalities seen in infants infected with Zika virus in utero. However, little is known about the effects of Zika virus intrauterine infection on the neurocognitive development of children born without birth defects. Using a case-control study design, we investigated the temporal association of a cluster of congenital defects with Zika virus infection. In a nested study, we also assessed the early childhood development of children recruited in the initial study as controls who were born without known birth defects,. We found evidence for an association of congenital defects with both maternal Zika virus seropositivity (time of infection unknown) and symptomatic Zika virus infection during pregnancy. Although the early childhood development assessment found no excess burden of developmental delay associated with maternal Zika virus infection, larger, longer-term studies are needed.
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Vinck P, Pham PN, Bindu KK, Bedford J, Nilles EJ. Institutional trust and misinformation in the response to the 2018-19 Ebola outbreak in North Kivu, DR Congo: a population-based survey. Lancet Infect Dis 2019; 19:529-536. [PMID: 30928435 DOI: 10.1016/s1473-3099(19)30063-5] [Citation(s) in RCA: 250] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/21/2018] [Accepted: 01/15/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The current outbreak of Ebola in eastern DR Congo, beginning in 2018, emerged in a complex and violent political and security environment. Community-level prevention and outbreak control measures appear to be dependent on public trust in relevant authorities and information, but little scholarship has explored these issues. We aimed to investigate the role of trust and misinformation on individual preventive behaviours during an outbreak of Ebola virus disease (EVD). METHODS We surveyed 961 adults between Sept 1 and Sept 16, 2018. We used a multistage sampling design in Beni and Butembo in North Kivu, DR Congo. Of 412 avenues and cells (the lowest administrative structures; 99 in Beni and 313 in Butembo), we randomly selected 30 in each city. In each avenue or cell, 16 households were selected using the WHO Expanded Programme on Immunization's random walk approach. In each household, one adult (aged ≥18 years) was randomly selected for interview. Standardised questionnaires were administered by experienced interviewers. We used multivariate models to examine the intermediate variables of interest, including institutional trust and belief in selected misinformation, with outcomes of interest related to EVD prevention behaviours. FINDINGS Among 961 respondents, 349 (31·9%, 95% CI 27·4-36·9) trusted that local authorities represent their interest. Belief in misinformation was widespread, with 230 (25·5%, 21·7-29·6) respondents believing that the Ebola outbreak was not real. Low institutional trust and belief in misinformation were associated with a decreased likelihood of adopting preventive behaviours, including acceptance of Ebola vaccines (odds ratio 0·22, 95% CI 0·21-0·22, and 1·40, 1·39-1·42) and seeking formal health care (0·06, 0·05-0·06, and 1·16, 1·15-1·17). INTERPRETATION The findings underscore the practical implications of mistrust and misinformation for outbreak control. These factors are associated with low compliance with messages of social and behavioural change and refusal to seek formal medical care or accept vaccines, which in turn increases the risk of spread of EVD. FUNDING The Harvard Humanitarian Initiative Innovation Fund.
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Affiliation(s)
- Patrick Vinck
- Harvard Medical School, Harvard University, Cambridge, MA, USA.
| | - Phuong N Pham
- Harvard Medical School, Harvard University, Cambridge, MA, USA
| | - Kenedy K Bindu
- Center for Research on Democracy and Development in Arica, Free University of the Great Lakes Countries in the Democratic Republic of the Congo, Goma, DR Congo
| | | | - Eric J Nilles
- Harvard Medical School, Harvard University, Cambridge, MA, USA
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de Alwis R, Watson C, Nikolay B, Lowry JH, Thieu NTV, Van TT, Ngoc DTT, Rawalai K, Taufa M, Coriakula J, Lau CL, Nilles EJ, Edmunds WJ, Kama M, Baker S, Cano J. Role of Environmental Factors in Shaping Spatial Distribution of Salmonella enterica Serovar Typhi, Fiji. Emerg Infect Dis 2019; 24:284-293. [PMID: 29350150 PMCID: PMC5782885 DOI: 10.3201/eid2402.170704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Fiji recently experienced a sharp increase in reported typhoid fever cases. To investigate geographic distribution and environmental risk factors associated with Salmonella enterica serovar Typhi infection, we conducted a cross-sectional cluster survey with associated serologic testing for Vi capsular antigen–specific antibodies (a marker for exposure to Salmonella Typhi in Fiji in 2013. Hotspots with high seroprevalence of Vi-specific antibodies were identified in northeastern mainland Fiji. Risk for Vi seropositivity increased with increased annual rainfall (odds ratio [OR] 1.26/quintile increase, 95% CI 1.12–1.42), and decreased with increased distance from major rivers and creeks (OR 0.89/km increase, 95% CI 0.80–0.99) and distance to modeled flood-risk areas (OR 0.80/quintile increase, 95% CI 0.69–0.92) after being adjusted for age, typhoid fever vaccination, and home toilet type. Risk for exposure to Salmonella Typhi and its spatial distribution in Fiji are driven by environmental factors. Our findings can directly affect typhoid fever control efforts in Fiji.
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Mayfield HJ, Smith CS, Lowry JH, Watson CH, Baker MG, Kama M, Nilles EJ, Lau CL. Predictive risk mapping of an environmentally-driven infectious disease using spatial Bayesian networks: A case study of leptospirosis in Fiji. PLoS Negl Trop Dis 2018; 12:e0006857. [PMID: 30307936 PMCID: PMC6198991 DOI: 10.1371/journal.pntd.0006857] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 04/19/2018] [Revised: 10/23/2018] [Accepted: 09/19/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction Leptospirosis is a zoonotic disease responsible for over 1 million severe cases and 60,000 deaths annually. The wide range of animal hosts and complex environmental drivers of transmission make targeted interventions challenging, particularly when restricted to regression-based analyses which have limited ability to deal with complexity. In Fiji, important environmental and socio-demographic factors include living in rural areas, poverty, and livestock exposure. This study aims to examine drivers of transmission under different scenarios of environmental and livestock exposures. Methods Spatial Bayesian networks (SBN) were used to analyse the influence of livestock and poverty on the risk of leptospirosis infection in urban compared to rural areas. The SBN models used a combination of spatially-explicit field data from previous work and publically available census information. Predictive risk maps were produced for overall risk, and for scenarios related to poverty, livestock, and urban/rural setting. Results While high, rather than low, commercial dairy farm density similarly increased the risk of infection in both urban (12% to 18%) and rural areas (70% to 79%), the presence of pigs in a village had different impact in rural (43% to 84%) compared with urban areas (4% to 24%). Areas with high poverty rates were predicted to have 26.6% and 18.0% higher probability of above average seroprevalence in rural and urban areas, respectively. In urban areas, this represents >300% difference between areas of low and high poverty, compared to 43% difference in rural areas. Conclusions Our study demonstrates the use of SBN to provide valuable insights into the drivers of leptospirosis transmission under complex scenarios. By estimating the risk of leptospirosis infection under different scenarios, such as urban versus rural areas, these subgroups or areas can be targeted with more precise interventions that focus on the most relevant key drivers of infection. Leptospirosis is a zoonotic disease responsible for over 60,000 deaths annually and is transmitted from mammal hosts to humans through contact with infected urine. The range of possible hosts and complex environmental factors related to transmission make targeted interventions challenging. We used spatial Bayesian Networks applied to a case study in Fiji to show that livestock exposure and poverty affect the probability of infection differently in rural compared to urban areas. This work illustrates the complexity of leptospirosis transmission drivers in Fiji, and shows how they are affected by the interactions between livestock exposure and other environmental and socio-demographic factors. In doing so, we support previous findings linking the risk of leptospirosis to poverty.
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Affiliation(s)
- Helen J. Mayfield
- Research School of Population Health, The Australian National University, Canberra, Australia
- * E-mail:
| | - Carl S. Smith
- School of Business, University of Queensland, Brisbane, Australia
| | - John H. Lowry
- School of People, Environment and Planning, Massey University, Palmerston North, New Zealand
| | - Conall H. Watson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Michael G. Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Mike Kama
- Fiji Ministry of Health and Medical Services, Suva, Fiji
| | - Eric J. Nilles
- Division of Pacific Technical Support, World Health Organization, Suva, Fiji
- Program on Infectious Diseases and Humanitarian Emergencies Harvard Humanitarian Institute, Boston, MA, United States of America
| | - Colleen L. Lau
- Research School of Population Health, The Australian National University, Canberra, Australia
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Al Jalaf M, Fadali H, Alanee R, Najjar F, Al Deesi Z, Seliem RM, Nilles EJ. Methicillin resistant Staphylococcus Aureus in emergency department patients in the United Arab Emirates. BMC Emerg Med 2018; 18:12. [PMID: 29764376 PMCID: PMC5952421 DOI: 10.1186/s12873-018-0164-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 01/24/2018] [Accepted: 05/02/2018] [Indexed: 12/21/2022] Open
Abstract
Background Since the 1990s, community-associated methicillin resistant staphylococcus aureus (CA-MRSA) has emerged as an important global cause of skin and soft tissue infections. Little is known about the epidemiology of this pathogen in the Middle East. Methods We conducted a prospective observational study in a single large teaching hospital in Dubai to identify the incidence of community-acquired methicillin resistant staphylococcus aureus (MRSA) among ambulatory patients presenting with purulent skin and soft tissue infections. We performed wound cultures and administered standard questionnaires to 100 cases presenting to the emergency department. Bivariate and multivariate analyses were performed to identify risk factors for MSRA versus other pathogens. Results The prevalence of MRSA was 23% (18/78) among 78 culture-positive isolates and 29% (18/62) among Staphylococcus-positive isolates. 74% received antibiotics of which 4/74 (5%) received antibiotics appropriate for CA-MRSA infections. Multivariate adjusted analysis identified playing contact sports (OR 5.9 [95% CI 1.3–27.1]) and female sex (OR 6.3 [95% CI 1.6–24.8]) as independent risks for MRSA infection. Conclusions This is the first study to describe the epidemiology of CA-MRSA in the ambulatory setting in the Middle East and demonstrates a substantial proportion of cases presenting with skin and soft tissue infections were CA-MRSA. Although most skin and soft tissue infections are abscesses for which the cornerstone of treatment is high quality incision and drainage, if adjunct antibiotics are prescribed in this setting, CA-MRSA-active antibiotics should be considered.
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Affiliation(s)
- Muna Al Jalaf
- Department of Emergency Medicine, Rashid Hospital and Trauma Centre, Dubai Health Authority, Dubai, UAE
| | - Hanan Fadali
- Department of Emergency Medicine, Rashid Hospital and Trauma Centre, Dubai Health Authority, Dubai, UAE
| | - Rasha Alanee
- Department of Emergency Medicine, Rashid Hospital and Trauma Centre, Dubai Health Authority, Dubai, UAE
| | - Firas Najjar
- Department of Emergency Medicine, Rashid Hospital and Trauma Centre, Dubai Health Authority, Dubai, UAE
| | - Zulfa Al Deesi
- Laboratory Medicine Department, Rashid Hospital and Trauma Centre, Dubai Health Authority, Dubai, UAE
| | - Rania M Seliem
- Laboratory Medicine Department, Rashid Hospital and Trauma Centre, Dubai Health Authority, Dubai, UAE
| | - Eric J Nilles
- Department of Emergency Medicine, Brigham & Women's Hospital, Boston, USA. .,Harvard Medical School, Boston, USA.
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Mayfield HJ, Lowry JH, Watson CH, Kama M, Nilles EJ, Lau CL. Use of geographically weighted logistic regression to quantify spatial variation in the environmental and sociodemographic drivers of leptospirosis in Fiji: a modelling study. Lancet Planet Health 2018; 2:e223-e232. [PMID: 29709286 PMCID: PMC5924768 DOI: 10.1016/s2542-5196(18)30066-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 04/03/2018] [Accepted: 04/16/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Leptospirosis is a globally important zoonotic disease, with complex exposure pathways that depend on interactions between human beings, animals, and the environment. Major drivers of outbreaks include flooding, urbanisation, poverty, and agricultural intensification. The intensity of these drivers and their relative importance vary between geographical areas; however, non-spatial regression methods are incapable of capturing the spatial variations. This study aimed to explore the use of geographically weighted logistic regression (GWLR) to provide insights into the ecoepidemiology of human leptospirosis in Fiji. METHODS We obtained field data from a cross-sectional community survey done in 2013 in the three main islands of Fiji. A blood sample obtained from each participant (aged 1-90 years) was tested for anti-Leptospira antibodies and household locations were recorded using GPS receivers. We used GWLR to quantify the spatial variation in the relative importance of five environmental and sociodemographic covariates (cattle density, distance to river, poverty rate, residential setting [urban or rural], and maximum rainfall in the wettest month) on leptospirosis transmission in Fiji. We developed two models, one using GWLR and one with standard logistic regression; for each model, the dependent variable was the presence or absence of anti-Leptospira antibodies. GWLR results were compared with results obtained with standard logistic regression, and used to produce a predictive risk map and maps showing the spatial variation in odds ratios (OR) for each covariate. FINDINGS The dataset contained location information for 2046 participants from 1922 households representing 81 communities. The Aikaike information criterion value of the GWLR model was 1935·2 compared with 1254·2 for the standard logistic regression model, indicating that the GWLR model was more efficient. Both models produced similar OR for the covariates, but GWLR also detected spatial variation in the effect of each covariate. Maximum rainfall had the least variation across space (median OR 1·30, IQR 1·27-1·35), and distance to river varied the most (1·45, 1·35-2·05). The predictive risk map indicated that the highest risk was in the interior of Viti Levu, and the agricultural region and southern end of Vanua Levu. INTERPRETATION GWLR provided a valuable method for modelling spatial heterogeneity of covariates for leptospirosis infection and their relative importance over space. Results of GWLR could be used to inform more place-specific interventions, particularly for diseases with strong environmental or sociodemographic drivers of transmission. FUNDING WHO, Australian National Health & Medical Research Council, University of Queensland, UK Medical Research Council, Chadwick Trust.
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Affiliation(s)
- Helen J Mayfield
- Department of Global Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - John H Lowry
- School of People, Environment and Planning, Massey University, Palmerston North, New Zealand; School of Geography, Earth Science and Environment, The University of the South Pacific, Suva, Fiji
| | - Conall H Watson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Mike Kama
- Fiji Centre for Communicable Disease Control, Ministry of Health and Medical Services, Suva, Fiji
| | - Eric J Nilles
- Division of Pacific Technical Support, World Health Organization, Suva, Fiji
| | - Colleen L Lau
- Department of Global Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia; Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.
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Affiliation(s)
- Andrés M Patiño
- From the Department of Emergency Medicine, Brigham and Women's Hospital (A.M.P., R.H.M., E.J.N., C.W.B., S.A.R., S.K.), the Department of Emergency Medicine, Massachusetts General Hospital (A.M.P.), and Partners in Health (R.H.M., S.A.R.) - all in Boston; and the Harvard Humanitarian Initiative, Cambridge (E.J.N., S.K.) - all in Massachusetts
| | - Regan H Marsh
- From the Department of Emergency Medicine, Brigham and Women's Hospital (A.M.P., R.H.M., E.J.N., C.W.B., S.A.R., S.K.), the Department of Emergency Medicine, Massachusetts General Hospital (A.M.P.), and Partners in Health (R.H.M., S.A.R.) - all in Boston; and the Harvard Humanitarian Initiative, Cambridge (E.J.N., S.K.) - all in Massachusetts
| | - Eric J Nilles
- From the Department of Emergency Medicine, Brigham and Women's Hospital (A.M.P., R.H.M., E.J.N., C.W.B., S.A.R., S.K.), the Department of Emergency Medicine, Massachusetts General Hospital (A.M.P.), and Partners in Health (R.H.M., S.A.R.) - all in Boston; and the Harvard Humanitarian Initiative, Cambridge (E.J.N., S.K.) - all in Massachusetts
| | - Christopher W Baugh
- From the Department of Emergency Medicine, Brigham and Women's Hospital (A.M.P., R.H.M., E.J.N., C.W.B., S.A.R., S.K.), the Department of Emergency Medicine, Massachusetts General Hospital (A.M.P.), and Partners in Health (R.H.M., S.A.R.) - all in Boston; and the Harvard Humanitarian Initiative, Cambridge (E.J.N., S.K.) - all in Massachusetts
| | - Shada A Rouhani
- From the Department of Emergency Medicine, Brigham and Women's Hospital (A.M.P., R.H.M., E.J.N., C.W.B., S.A.R., S.K.), the Department of Emergency Medicine, Massachusetts General Hospital (A.M.P.), and Partners in Health (R.H.M., S.A.R.) - all in Boston; and the Harvard Humanitarian Initiative, Cambridge (E.J.N., S.K.) - all in Massachusetts
| | - Stephanie Kayden
- From the Department of Emergency Medicine, Brigham and Women's Hospital (A.M.P., R.H.M., E.J.N., C.W.B., S.A.R., S.K.), the Department of Emergency Medicine, Massachusetts General Hospital (A.M.P.), and Partners in Health (R.H.M., S.A.R.) - all in Boston; and the Harvard Humanitarian Initiative, Cambridge (E.J.N., S.K.) - all in Massachusetts
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Emont JP, Ko AI, Homasi-Paelate A, Ituaso-Conway N, Nilles EJ. Epidemiological Investigation of a Diarrhea Outbreak in the South Pacific Island Nation of Tuvalu During a Severe La Niña-Associated Drought Emergency in 2011. Am J Trop Med Hyg 2017; 96:576-582. [PMID: 28138046 DOI: 10.4269/ajtmh.16-0812] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The association between heavy rainfall and an increased risk of diarrhea has been well established but less is known about the effect of drought on diarrhea transmission. In 2011, the Pacific island nation of Tuvalu experienced a concurrent severe La Niña-associated drought and large diarrhea outbreak. We conducted a field investigation in Tuvalu to identify factors that contributed to epidemic transmission in the context of a drought emergency. Peak case numbers coincided with the nadir of recorded monthly rainfall, the lowest recorded since 1930. Independent factors associated with increased risk of diarrhea were households with water tank levels below 20% (odds ratio [OR] = 2.31; 95% confidence interval = 1.16-4.60) and decreased handwashing frequency (OR = 3.00 [1.48-6.08]). The resolution of the outbreak occurred after implementation of a hygiene promotion campaign, despite persistent drought and limited water access. These findings are potentially important given projections that future climate change will cause more frequent and severe droughts.
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Affiliation(s)
- Jordan P Emont
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Albert I Ko
- Fundação Oswaldo Cruz, Salvador, Brazil.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
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Watson CH, Coriakula J, Ngoc DTT, Flasche S, Kucharski AJ, Lau CL, Thieu NTV, le Polain de Waroux O, Rawalai K, Van TT, Taufa M, Baker S, Nilles EJ, Kama M, Edmunds WJ. Social mixing in Fiji: Who-eats-with-whom contact patterns and the implications of age and ethnic heterogeneity for disease dynamics in the Pacific Islands. PLoS One 2017; 12:e0186911. [PMID: 29211731 PMCID: PMC5718486 DOI: 10.1371/journal.pone.0186911] [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: 04/09/2017] [Accepted: 10/10/2017] [Indexed: 11/17/2022] Open
Abstract
Empirical data on contact patterns can inform dynamic models of infectious disease transmission. Such information has not been widely reported from Pacific islands, nor strongly multi-ethnic settings, and few attempts have been made to quantify contact patterns relevant for the spread of gastrointestinal infections. As part of enteric fever investigations, we conducted a cross-sectional survey of the general public in Fiji, finding that within the 9,650 mealtime contacts reported by 1,814 participants, there was strong like-with-like mixing by age and ethnicity, with higher contact rates amongst iTaukei than non-iTaukei Fijians. Extra-domiciliary lunchtime contacts follow these mixing patterns, indicating the overall data do not simply reflect household structures. Inter-ethnic mixing was most common amongst school-age children. Serological responses indicative of recent Salmonella Typhi infection were found to be associated, after adjusting for age, with increased contact rates between meal-sharing iTaukei, with no association observed for other contact groups. Animal ownership and travel within the geographical division were common. These are novel data that identify ethnicity as an important social mixing variable, and use retrospective mealtime contacts as a socially acceptable metric of relevance to enteric, contact and respiratory diseases that can be collected in a single visit to participants. Application of these data to other island settings will enable communicable disease models to incorporate locally relevant mixing patterns in parameterisation.
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Affiliation(s)
- Conall H Watson
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Dung Tran Thi Ngoc
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit-Vietnam, Ho Chi Minh City, Vietnam
| | - Stefan Flasche
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Adam J Kucharski
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Colleen L Lau
- Department of Global Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Nga Tran Vu Thieu
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit-Vietnam, Ho Chi Minh City, Vietnam
| | - Olivier le Polain de Waroux
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Tan Trinh Van
- School of Medicine, Fiji National University, Suva, Fiji
| | - Mere Taufa
- Fiji Centre for Communicable Disease Control, Ministry of Health and Medical Services, Suva, Fiji
| | - Stephen Baker
- The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit-Vietnam, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Eric J Nilles
- Division of Pacific Technical Support, World Health Organization-Western Pacific Region, Suva, Fiji
| | - Mike Kama
- Fiji Centre for Communicable Disease Control, Ministry of Health and Medical Services, Suva, Fiji
| | - W John Edmunds
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Jones FK, Ko AI, Becha C, Joshua C, Musto J, Thomas S, Ronsse A, Kirkwood CD, Sio A, Aumua A, Nilles EJ. Increased Rotavirus Prevalence in Diarrheal Outbreak Precipitated by Localized Flooding, Solomon Islands, 2014. Emerg Infect Dis 2016; 22:875-9. [PMID: 27088272 PMCID: PMC4861519 DOI: 10.3201/eid2205.151743] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Flooding on 1 of the Solomon Islands precipitated a nationwide epidemic of diarrhea that spread to regions unaffected by flooding and caused >6,000 cases and 27 deaths. Rotavirus was identified in 38% of case-patients tested in the city with the most flooding. Outbreak potential related to weather reinforces the need for global rotavirus vaccination.
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Pastula DM, Khan AS, Sharp TM, Biaukula VL, Naivalu TK, Rafai E, Ermias Belay, Staples JE, Fischer M, Kosoy OI, Laven JJ, Bennett EJ, Jenney AWJ, Naidu RN, Lanciotti RS, Galloway RL, Nilles EJ, Sejvar JJ, Kama M. Investigation of a Guillain-Barré syndrome cluster in the Republic of Fiji. J Neurol Sci 2016; 372:350-355. [PMID: 27842986 DOI: 10.1016/j.jns.2016.08.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/05/2016] [Accepted: 08/31/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND In 2014, we investigated a cluster of Guillain-Barre syndrome (GBS) in Fiji that occurred during a dengue epidemic. We designed a case-control study to determine the etiology. METHODS Cases were patients meeting Brighton Collaboration criteria for GBS with onset from February 2014 to May 2014. Controls were persons without symptoms of GBS who were matched by age group and location. We collected information on demographics and potential exposures. Serum samples were tested for evidence of recent arboviral or Leptospira spp. infections. RESULTS Nine cases of GBS were identified for an incidence of five cases per 100,000 population/year. Median age of cases was 27years (range: 0.8-52); five (56%) were male. Six (67%) reported an acute illness prior to GBS onset. Among the 9 cases and 28 controls enrolled, odds ratios for reported exposures or antibodies against various arboviruses or Leptospira spp. were not statistically significant. CONCLUSIONS No clear etiologies were identified for this unusual GBS cluster. There was a temporal association between the GBS cluster and a dengue epidemic, but we were unable to substantiate an epidemiologic or laboratory association. Further study is needed to explore potential associations between arboviral infections and GBS.
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Affiliation(s)
- Daniel M Pastula
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, United States; Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States; Department of Neurology, University of Colorado Denver, Aurora, CO, United States
| | | | - Tyler M Sharp
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States
| | | | | | - Eric Rafai
- Fiji Ministry of Health and Medical Services, Suva, Fiji
| | - Ermias Belay
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - J Erin Staples
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States
| | - Marc Fischer
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States
| | - Olga I Kosoy
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States
| | - Janeen J Laven
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States
| | | | | | | | - Robert S Lanciotti
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, United States
| | - Renee L Galloway
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Eric J Nilles
- Western Pacific Region, World Health Organization, Suva, Fiji
| | - James J Sejvar
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Mike Kama
- Fiji Ministry of Health and Medical Services, Suva, Fiji
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Craig AT, Kama M, Samo M, Vaai S, Matanaicake J, Joshua C, Kolbe A, Durrheim DN, Paterson BJ, Biaukula V, Nilles EJ. Early warning epidemic surveillance in the Pacific island nations: an evaluation of the Pacific syndromic surveillance system. Trop Med Int Health 2016; 21:917-27. [PMID: 27118150 DOI: 10.1111/tmi.12711] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The Pacific Syndromic Surveillance System (PSSS), launched in 2010, provides a simple mechanism by which 121 sentinel surveillance sites in 21 Pacific island countries and areas perform routine indicator- and event-based surveillance for the early detection of infectious disease outbreaks. This evaluation aims to assess whether the PSSS is meeting its objectives, what progress has been made since a formative evaluation of the system was conducted in 2011, and provides recommendations to enhance the PSSS's performance in the future. METHODS Twenty-one informant interviews were conducted with national operators of the system and regional public health agencies that use information generated by it. Historic PSSS data were analysed to assess timeliness and completeness of reporting. RESULTS The system is simple, acceptable and useful for public health decision-makers. The PSSS has greatly enhanced Pacific island countries' ability to undertake early warning surveillance and has contributed to efforts to meet national surveillance-related International Health Regulation (2005) capacity development obligations. Despite this, issues with timeliness and completeness of reporting, data quality and system stability persist. CONCLUSION A balance between maintaining the system's simplicity and technical advances will need to be found to ensure its long-term sustainability, given the low-resource context for which it is designed.
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Affiliation(s)
- Adam T Craig
- University of Newcastle, Callaghan, NSW, Australia
| | - Mike Kama
- National Advisor Communicable Disease, Fiji Centre for Communicable Disease Control, Ministry of Health, Suva, Fiji
| | - Marcus Samo
- Deputy Director Public Health, Ministry of Health, Phonpei, Federated States of Micronesia
| | - Saine Vaai
- National Disease Surveillance and the international Health Regulation (2005), Ministry of Health, Apia, Samoa
| | - Jane Matanaicake
- National Early Warning Surveillance Focal Point, Ministry of Health, Suva, Fiji
| | - Cynthia Joshua
- National Early Warning Surveillance Focal Point, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | | | - David N Durrheim
- University of Newcastle, Callaghan, NSW, Australia.,Hunter New England Population Health, Wallsend, NSW, Australia
| | | | - Viema Biaukula
- Emerging Disease Surveillance and Response, Division of Pacific Technical Support, World Health Organization, Suva, Fiji
| | - Eric J Nilles
- Emerging Disease Surveillance and Response, Division of Pacific Technical Support, World Health Organization, Suva, Fiji
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Kucharski AJ, Funk S, Eggo RM, Mallet HP, Edmunds WJ, Nilles EJ. Transmission Dynamics of Zika Virus in Island Populations: A Modelling Analysis of the 2013-14 French Polynesia Outbreak. PLoS Negl Trop Dis 2016; 10:e0004726. [PMID: 27186984 PMCID: PMC4871342 DOI: 10.1371/journal.pntd.0004726] [Citation(s) in RCA: 195] [Impact Index Per Article: 24.4] [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: 02/05/2016] [Accepted: 05/02/2016] [Indexed: 12/25/2022] Open
Abstract
Between October 2013 and April 2014, more than 30,000 cases of Zika virus (ZIKV) disease were estimated to have attended healthcare facilities in French Polynesia. ZIKV has also been reported in Africa and Asia, and in 2015 the virus spread to South America and the Caribbean. Infection with ZIKV has been associated with neurological complications including Guillain-Barré Syndrome (GBS) and microcephaly, which led the World Health Organization to declare a Public Health Emergency of International Concern in February 2015. To better understand the transmission dynamics of ZIKV, we used a mathematical model to examine the 2013-14 outbreak on the six major archipelagos of French Polynesia. Our median estimates for the basic reproduction number ranged from 2.6-4.8, with an estimated 11.5% (95% CI: 7.32-17.9%) of total infections reported. As a result, we estimated that 94% (95% CI: 91-97%) of the total population of the six archipelagos were infected during the outbreak. Based on the demography of French Polynesia, our results imply that if ZIKV infection provides complete protection against future infection, it would take 12-20 years before there are a sufficient number of susceptible individuals for ZIKV to re-emerge, which is on the same timescale as the circulation of dengue virus serotypes in the region. Our analysis suggests that ZIKV may exhibit similar dynamics to dengue virus in island populations, with transmission characterized by large, sporadic outbreaks with a high proportion of asymptomatic or unreported cases.
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Affiliation(s)
- Adam J. Kucharski
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sebastian Funk
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rosalind M. Eggo
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - W. John Edmunds
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Wong VK, Baker S, Pickard DJ, Parkhill J, Page AJ, Feasey NA, Kingsley RA, Thomson NR, Keane JA, Weill FX, Edwards DJ, Hawkey J, Harris SR, Mather AE, Cain AK, Hadfield J, Hart PJ, Thieu NTV, Klemm EJ, Glinos DA, Breiman RF, Watson CH, Kariuki S, Gordon MA, Heyderman RS, Okoro C, Jacobs J, Lunguya O, Edmunds WJ, Msefula C, Chabalgoity JA, Kama M, Jenkins K, Dutta S, Marks F, Campos J, Thompson C, Obaro S, MacLennan CA, Dolecek C, Keddy KH, Smith AM, Parry CM, Karkey A, Mulholland EK, Campbell JI, Dongol S, Basnyat B, Dufour M, Bandaranayake D, Naseri TT, Singh SP, Hatta M, Newton P, Onsare RS, Isaia L, Dance D, Davong V, Thwaites G, Wijedoru L, Crump JA, De Pinna E, Nair S, Nilles EJ, Thanh DP, Turner P, Soeng S, Valcanis M, Powling J, Dimovski K, Hogg G, Farrar J, Holt KE, Dougan G. Phylogeographical analysis of the dominant multidrug-resistant H58 clade of Salmonella Typhi identifies inter- and intracontinental transmission events. Nat Genet 2015; 47:632-9. [PMID: 25961941 PMCID: PMC4921243 DOI: 10.1038/ng.3281] [Citation(s) in RCA: 298] [Impact Index Per Article: 33.1] [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: 12/21/2014] [Accepted: 03/23/2015] [Indexed: 11/09/2022]
Abstract
The emergence of multidrug-resistant (MDR) typhoid is a major global health threat affecting many countries where the disease is endemic. Here whole-genome sequence analysis of 1,832 Salmonella enterica serovar Typhi (S. Typhi) identifies a single dominant MDR lineage, H58, that has emerged and spread throughout Asia and Africa over the last 30 years. Our analysis identifies numerous transmissions of H58, including multiple transfers from Asia to Africa and an ongoing, unrecognized MDR epidemic within Africa itself. Notably, our analysis indicates that H58 lineages are displacing antibiotic-sensitive isolates, transforming the global population structure of this pathogen. H58 isolates can harbor a complex MDR element residing either on transmissible IncHI1 plasmids or within multiple chromosomal integration sites. We also identify new mutations that define the H58 lineage. This phylogeographical analysis provides a framework to facilitate global management of MDR typhoid and is applicable to similar MDR lineages emerging in other bacterial species.
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Affiliation(s)
- Vanessa K Wong
- 1] Wellcome Trust Sanger Institute, Hinxton, UK. [2] Department of Microbiology, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, UK
| | - Stephen Baker
- 1] Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam. [2] Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK. [3] Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Robert A Kingsley
- 1] Wellcome Trust Sanger Institute, Hinxton, UK. [2] Institute of Food Research, Norwich Research Park, Norwich, UK
| | - Nicholas R Thomson
- 1] Wellcome Trust Sanger Institute, Hinxton, UK. [2] Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - David J Edwards
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Hawkey
- 1] Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, Victoria, Australia. [2] Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Amy K Cain
- Wellcome Trust Sanger Institute, Hinxton, UK
| | | | - Peter J Hart
- Institute of Biomedical Research, School of Immunity and Infection, College of Medicine and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Nga Tran Vu Thieu
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Robert F Breiman
- 1] Kenya Medical Research Institute (KEMRI), Nairobi, Kenya. [2] Centers for Disease Control and Prevention, Atlanta, Georgia, USA. [3] Emory Global Health Institute, Atlanta, Georgia, USA
| | - Conall H Watson
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Samuel Kariuki
- 1] Wellcome Trust Sanger Institute, Hinxton, UK. [2] Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Melita A Gordon
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Robert S Heyderman
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Jan Jacobs
- 1] Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium. [2] Department of Microbiology and Immunology, Katholieke Universiteit (KU) Leuven, University of Leuven, Leuven, Belgium
| | - Octavie Lunguya
- 1] National Institute for Biomedical Research, Kinshasa, Democratic Republic of the Congo. [2] University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - W John Edmunds
- Centre for the Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Chisomo Msefula
- 1] Malawi-Liverpool Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi. [2] Microbiology Department, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Jose A Chabalgoity
- Departamento de Desarrollo Biotecnológico, Instituto de Higiene, Facultad de Medicina, Montevideo, Uruguay
| | | | | | - Shanta Dutta
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Florian Marks
- International Vaccine Institute, Department of Epidemiology, Seoul, Republic of Korea
| | - Josefina Campos
- Enteropathogen Division, Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) Carlos G. Malbran Institute, Buenos Aires, Argentina
| | - Corinne Thompson
- 1] Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam. [2] Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Stephen Obaro
- 1] Division of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA. [2] University of Abuja Teaching Hospital, Abuja, Nigeria. [3] Bingham University, Karu, Nigeria
| | - Calman A MacLennan
- 1] Wellcome Trust Sanger Institute, Hinxton, UK. [2] Institute of Biomedical Research, School of Immunity and Infection, College of Medicine and Dental Sciences, University of Birmingham, Birmingham, UK. [3] Novartis Vaccines Institute for Global Health, Siena, Italy
| | - Christiane Dolecek
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Karen H Keddy
- Centre for Enteric Diseases, National Institute for Communicable Diseases, Division in the National Health Laboratory Service, University of the Witwatersrand, Johannesburg, South Africa
| | - Anthony M Smith
- Centre for Enteric Diseases, National Institute for Communicable Diseases, Division in the National Health Laboratory Service, University of the Witwatersrand, Johannesburg, South Africa
| | - Christopher M Parry
- 1] Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK. [2] Graduate School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Abhilasha Karkey
- Patan Academy of Health Sciences, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Kathmandu, Nepal
| | - E Kim Mulholland
- 1] Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. [2] Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - James I Campbell
- 1] Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam. [2] Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Sabina Dongol
- Patan Academy of Health Sciences, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Kathmandu, Nepal
| | - Buddha Basnyat
- Patan Academy of Health Sciences, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Kathmandu, Nepal
| | - Muriel Dufour
- Enteric and Leptospira Reference Laboratory, Institute of Environmental Science and Research, Ltd. (ESR), Porirua, New Zealand
| | - Don Bandaranayake
- National Centre for Biosecurity and Infectious Disease, Institute of Environmental Science and Research, Porirua, New Zealand
| | | | - Shalini Pravin Singh
- National Influenza Center, World Health Organization, Center for Communicable Disease Control, Suva, Fiji
| | - Mochammad Hatta
- Department of Microbiology, Hasanuddin University, Makassar, Indonesia
| | - Paul Newton
- 1] Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK. [2] Lao Oxford Mahosot Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | | | | | - David Dance
- 1] Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK. [2] Lao Oxford Mahosot Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Viengmon Davong
- Lao Oxford Mahosot Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Guy Thwaites
- 1] Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam. [2] Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Lalith Wijedoru
- 1] Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. [2] Paediatric Emergency Medicine, Chelsea and Westminster Hospital, London, UK
| | - John A Crump
- Centre for International Health and Otago International Health Research Network, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Elizabeth De Pinna
- Salmonella Reference Service, Public Health England, Colindale, London, UK
| | - Satheesh Nair
- Salmonella Reference Service, Public Health England, Colindale, London, UK
| | - Eric J Nilles
- Emerging Disease Surveillance and Response, Division of Pacific Technical Support, World Health Organization, Suva, Fiji
| | - Duy Pham Thanh
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Paul Turner
- 1] Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK. [2] Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. [3] Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Sona Soeng
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Mary Valcanis
- Microbiological Diagnostic Unit-Public Health Laboratory, Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Joan Powling
- Microbiological Diagnostic Unit-Public Health Laboratory, Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Karolina Dimovski
- Microbiological Diagnostic Unit-Public Health Laboratory, Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Geoff Hogg
- Microbiological Diagnostic Unit-Public Health Laboratory, Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Jeremy Farrar
- 1] Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam. [2] Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Kathryn E Holt
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, Victoria, Australia
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Craig AT, Ronsse A, Hardie K, Pavlin BI, Biaukula V, Nilles EJ. Risk posed by the Ebola epidemic to the Pacific islands: findings of a recent World Health Organization assessment. Western Pac Surveill Response J 2015; 6:45-50. [PMID: 26306216 PMCID: PMC4542486 DOI: 10.5365/wpsar.2015.6.1.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To assess the public health risk posed by the ongoing Ebola virus disease (EVD) epidemic in West Africa to Pacific island countries and areas and to highlight priority risk management actions for preparedness and response. METHOD The likelihood of EVD importation and the magnitude of public health impact in Pacific island countries and areas were assessed to determine overall risk. Literature about the hazard, epidemiology, exposure and contextual factors associated with EVD was collected and reviewed. Epidemiological information from the current EVD outbreak was assessed. RESULTS As of 11 March 2015, there have been more than 24,200 reported cases of EVD and at least 9976 deaths in six West African countries. Three EVD cases have been infected outside of the West African region, and all have epidemiological links to the outbreak in West Africa. Pacific island countries' and areas' relative geographic isolation and lack of travel or trade links between countries with transmission means that EVD importation is very unlikely. However, should a case be imported, the health and non-health consequences would be major. The capacity of Pacific island countries and areas to respond adequately varies greatly between (and within) states but in general is limited. DISCUSSION This risk assessment highlights the needs to enhance preparedness for EVD in the Pacific by strengthening the capacities outlined in the World Health Organization Framework for Action on Ebola. Priority areas include the ability to detect and respond to suspected EVD cases quickly, isolation and management of cases in appropriately resourced facilities and the prevention of further cases through infection prevention and control. These efforts for Ebola should enhance all-hazards public health preparedness in line with the International Health Regulations (2005).
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Affiliation(s)
- Adam T Craig
- Emerging Disease Surveillance and Response Unit, Division of Pacific Technical Support, World Health Organization, Suva, Fiji
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Axelle Ronsse
- Emerging Disease Surveillance and Response Unit, Division of Pacific Technical Support, World Health Organization, Suva, Fiji
| | - Kate Hardie
- Emerging Disease Surveillance and Response Unit, Division of Pacific Technical Support, World Health Organization, Suva, Fiji
| | - Boris I Pavlin
- Office of the WHO Representative, Papua New Guinea Country Office, Port Moresby, Papua New Guinea
| | - Viema Biaukula
- Emerging Disease Surveillance and Response Unit, Division of Pacific Technical Support, World Health Organization, Suva, Fiji
| | - Eric J Nilles
- Emerging Disease Surveillance and Response Unit, Division of Pacific Technical Support, World Health Organization, Suva, Fiji
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Cao-Lormeau VM, Roche C, Musso D, Mallet HP, Dalipanda T, Dofai A, Nogareda F, Nilles EJ, Aaskov J. Dengue virus type 3, South Pacific Islands, 2013. Emerg Infect Dis 2015; 20:1034-6. [PMID: 24856252 PMCID: PMC4036764 DOI: 10.3201/eid2006.131413] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
After an 18-year absence, dengue virus serotype 3 reemerged in the South Pacific Islands in 2013. Outbreaks in western (Solomon Islands) and eastern (French Polynesia) regions were caused by different genotypes. This finding suggested that immunity against dengue virus serotype, rather than virus genotype, was the principal determinant of reemergence.
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Affiliation(s)
- D Musso
- Institut Louis Malardé, Papeete, Tahiti, Polynésie française.
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Nilles EJ, Alosert M, Mohtasham MA, Saif M, Sulaiman L, Seliem RM, Kotlyar S, Dziura JD, Al-Najjar FJK. Epidemiological and clinical characteristics of imported malaria in the United Arab Emirates. J Travel Med 2014; 21:201-6. [PMID: 24628958 DOI: 10.1111/jtm.12110] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 10/02/2013] [Accepted: 10/03/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The United Arab Emirates (UAE) was certified by the World Health Organization to be free of endemic malaria transmission in 2007. There continued to be, however, a substantial number of imported malaria cases. METHODS A retrospective laboratory and chart review was performed to describe the epidemiological, clinical, and laboratory characteristics of imported malaria in Dubai, UAE. Laboratory records were reviewed at the largest public hospital in Dubai to identify cases of peripheral blood smear-positive malaria from January 1, 2008 to December 31, 2010. Predefined demographic, clinical, and laboratory information was extracted from the electronic medical record system. RESULTS A total of 629 cases of malaria were identified including 493, 122, and 14 cases of Plasmodium vivax, Plasmodium falciparum, and mixed P. vivax/P. falciparum infections, respectively. Of these, 567 (90.1%) cases were either from India or Pakistan and 7% from sub-Saharan Africa. There were no cases among the local Emirati population. There were 162 hospitalizations, including 8 requiring intensive care support and 1 death. More than 10% of P. vivax infections required hospitalization. The interval between arrival in the UAE and diagnosis was 3 months or longer for 25% of P. vivax cases. CONCLUSIONS Imported malaria remains an important cause of morbidity in the UAE. Clinicians need to be aware that P. vivax is not benign and can cause severe disease and that malaria cases may present to health facilities several months after arrival from malaria-endemic regions.
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Affiliation(s)
- Eric J Nilles
- Department of Emergency Medicine, Rashid Hospital and Trauma Centre, Dubai Health Authority, Dubai, UAE
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Musso D, Roche C, Marfel M, Bel M, Nilles EJ, Cao-Lormeau VM. Improvement of leptospirosis surveillance in remote Pacific islands using serum spotted on filter paper. Int J Infect Dis 2013; 20:74-6. [PMID: 24384412 DOI: 10.1016/j.ijid.2013.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 10/08/2013] [Revised: 11/19/2013] [Accepted: 11/18/2013] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Leptospirosis is a serious neglected disease in the Pacific. Because sensitive and specific laboratory tests are largely unavailable, the burden of disease and epidemiological data are often unreliable and do not allow informed disease prioritization and efficient control. We report the use of serum spotted on filter paper to improve the surveillance of leptospirosis in remote and resource-limited settings. METHODS A total of 172 acute-phase serum samples collected from patients with suspected dengue at Yap State Hospital, Federated States of Micronesia, were spotted on filter paper and sent by regular mail to the Institut Louis Malardé, French Polynesia. Real-time PCR protocols for dengue and leptospirosis confirmation were performed on all specimens. RESULTS A total of five leptospirosis infections were detected amongst the patients with suspected dengue. CONCLUSIONS This study confirms the use of filter paper as a convenient tool to improve leptospirosis surveillance capacity in remote areas. New surveillance strategies, notably based on the regular use of this type of tool, are essential to more adequately describe the epidemiology and burden of neglected diseases.
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Affiliation(s)
- Didier Musso
- Institut Louis Malardé, Tahiti, French Polynesia.
| | | | - Maria Marfel
- Yap State Hospital, Yap State, Federated States of Micronesia
| | - Martin Bel
- Waab Community Health Centers, Yap State, Federated States of Micronesia
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Abstract
Evidence suggests that imported malaria is a diagnostic challenge with initial misdiagnosis rates of 40% or greater. Given that prompt diagnosis and appropriate treatment are the only intervention proven to prevent progression to severe malaria and death, these figures are concerning. The purpose of this clinical review is to provide the most up-to-date and practical information on the diagnosis and treatment of imported malaria for the emergency health care provider. We highlight common pitfalls, errors, and mistakes in arriving at the correct diagnosis. We also emphasize the 3 key aspects to avoid progression to severe disease: rapid diagnosis, prompt initiation of treatment, and appropriate choice of antimalarial treatment.
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Affiliation(s)
- Eric J Nilles
- Department of Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
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