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Amin AB, Cates JE, Liu Z, Wu J, Ali I, Rodriguez A, Panjwani J, Tate JE, Lopman BA, Parashar UD. Rotavirus genotypes in the post-vaccine era: A systematic review and meta-analysis of global, regional, and temporal trends in settings with and without rotavirus vaccine introduction. J Infect Dis 2023:jiad403. [PMID: 37738554 DOI: 10.1093/infdis/jiad403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/31/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Even moderate differences in rotavirus vaccine effectiveness against non-vaccine genotypes may exert selective pressures on circulating rotaviruses. Whether this vaccine effect or natural temporal fluctuations underlie observed changes in genotype distributions is unclear. METHODS We systematically reviewed studies reporting rotavirus genotypes from children <5 years of age globally between 2005 and 2023. We compared rotavirus genotypes between vaccine-introducing and non-introducing settings globally and by World Health Organization (WHO) region, calendar time, and time since vaccine introduction. RESULTS Crude pooling of genotype data from 361 studies indicated higher G2P[4], a non-vaccine genotype, prevalence in vaccine-introducing settings, both globally and by WHO region. This difference did not emerge when examining genotypes over time in the Americas, the only region with robust longitudinal data. Relative to non-introducing settings, G2P[4] detections were more likely in settings with recent introduction (e.g. 1-2 years post-introduction aOR: 4.39 (95% CI: 2.87-6.72)) but were similarly likely in settings with more time elapsed since introduction, (e.g. 7 or more years aOR (1.62 95% CI: 0.49-5.37)). CONCLUSIONS When accounting for both regional and temporal trends, there was no substantial evidence of long-term vaccine-related selective pressures on circulating genotypes. Increased prevalence of G2P[4] may be transient after rotavirus vaccine introduction.
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Affiliation(s)
- Avnika B Amin
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - Jordan E Cates
- Viral Gastroenteritis Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Zihao Liu
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - Joanne Wu
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - Iman Ali
- CDC Foundation, Atlanta, Georgia, United States
| | - Alexia Rodriguez
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - Junaid Panjwani
- Viral Gastroenteritis Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Jacqueline E Tate
- Viral Gastroenteritis Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Benjamin A Lopman
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - Umesh D Parashar
- Viral Gastroenteritis Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
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Johnson JA, Read TD, Petit RA, Marconi VC, Meagley KL, Rodriguez-Barradas MC, Beenhouwer DO, Brown ST, Holodniy M, Lucero-Obusan CA, Schirmer P, Ingersoll JM, Kraft CS, Neill FH, Atmar RL, Kambhampati AK, Cates JE, Mirza SA, Hall A, Cardemil CV, Lopman BA. Association of Secretor Status and Recent Norovirus Infection With Gut Microbiome Diversity Metrics in a Veterans Affairs Population. Open Forum Infect Dis 2022; 9:ofac125. [PMID: 35434176 PMCID: PMC9007923 DOI: 10.1093/ofid/ofac125] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/08/2022] [Indexed: 11/12/2022] Open
Abstract
Norovirus infection causing acute gastroenteritis could lead to adverse effects on the gut microbiome. We assessed the association of microbiome diversity with norovirus infection and secretor status in patients from Veterans Affairs medical centers. Alpha diversity metrics were lower among patients with acute gastroenteritis but were similar for other comparisons.
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Affiliation(s)
- Jordan A Johnson
- Department of Epidemiology, Emory University Rollins School of Public Health, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Timothy D Read
- Department of Epidemiology, Emory University Rollins School of Public Health, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Robert A Petit
- Department of Epidemiology, Emory University Rollins School of Public Health, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Vincent C Marconi
- Department of Epidemiology, Emory University Rollins School of Public Health, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Kathryn L Meagley
- Department of Epidemiology, Emory University Rollins School of Public Health, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - David O Beenhouwer
- Veterans Affairs Greater Los Angeles Health System, Los Angeles, California, USA
| | - Sheldon T Brown
- James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Mark Holodniy
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Office of Population Health, Public Health Surveillance and Research, Veterans Health Administration, Washington, DC, USA
- Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, California, USA
| | - Cynthia A Lucero-Obusan
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Office of Population Health, Public Health Surveillance and Research, Veterans Health Administration, Washington, DC, USA
| | - Patricia Schirmer
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Office of Population Health, Public Health Surveillance and Research, Veterans Health Administration, Washington, DC, USA
| | - Jessica M Ingersoll
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Colleen S Kraft
- Department of Epidemiology, Emory University Rollins School of Public Health, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Frederick H Neill
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Robert L Atmar
- Office of Population Health, Public Health Surveillance and Research, Veterans Health Administration, Washington, DC, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA
| | - Anita K Kambhampati
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jordan E Cates
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sara A Mirza
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aron J Hall
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cristina V Cardemil
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Benjamin A Lopman
- Department of Epidemiology, Emory University Rollins School of Public Health, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, and Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
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Myat TW, Thu HM, Tate JE, Burnett E, Cates JE, Parashar UD, Kyaw YM, Khaing TEE, Moh KM, Win NN, Khine WK, Kham MMZ, Kyaw T, Khine YY, Oo KK, Aung KM. Rotavirus infection among children under five years of age hospitalized with acute gastroenteritis in Myanmar during 2018-2020 - Multicentre surveillance before rotavirus vaccine introduction. Vaccine 2021; 39:6907-6912. [PMID: 34702620 PMCID: PMC10862084 DOI: 10.1016/j.vaccine.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/24/2021] [Accepted: 10/09/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Rotavirus gastroenteritis (RVGE) is a leading cause of severe diarrhea in children under-five worldwide, with the majority of mortality in lower -income countries. This study aimed to provide baseline information on epidemiology of rotavirus and circulating strains before rotavirus vaccine introduction in Myanmar. METHODS Hospital-based, prospective surveillance was conducted from May 2018 to January 2020 at four sentinel sites; two hospitals in Lower Myanmar, one hospital each in Middle Myanmar and East Myanmar. Children under five years of age hospitalized for acute gastroenteritis were enrolled; demographic and clinical data were collected. Stool samples were screened by ELISA (ProSpecT™ Rotavirus, OXOID-UK) for rotavirus antigen and a subset of ELISA positive samples were genotyped by reverse transcription polymerase chain reaction. RESULTS Rotavirus was detected in 45.7% (799/1750) of cases enrolled at three sites in May 2018-April 2019 and 42.5% (521/1227) at four sites in May 2019-January 2020. RVGE cases were predominantly male (58.7%; 775/1320) and 92.6% (1223/1320) of RVGE cases occurred in <2 years old. Rotavirus detection was higher in the cold and dry season (November-April). RVGE compared to non-RVGE cases had more frequent vomiting (78.3% Vs 68.1%, p < 0.01), fever (65.8% Vs 61.3%, p = 0.01), severe dehydration (3.6% Vs 2.1%, p < 0.01) and requirement of treatment by IV fluid (58.3% Vs 53.1%, p < 0.01). The most prevalent genotypes identified were G1P[6] (113/359, 31.5%), G1P[8] (94/359, 26.2%) and G2P[4] (33/359, 9.2%). CONCLUSIONS This study confirms the persistent high prevalence of RVGE among children under-five admitted to hospitals in different parts of Myanmar and the diversity of rotavirus strains over time prior to vaccine introduction. The rotavirus vaccine was introduced nationwide in February 2020 in Myanmar and these data will be important baseline data for post-vaccination monitoring of vaccine impact and circulating strains.
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Affiliation(s)
- Theingi Win Myat
- Department of Medical Research, Ministry of Health and Sports, Myanmar.
| | - Hlaing Myat Thu
- Department of Medical Research, Ministry of Health and Sports, Myanmar
| | | | | | | | | | - Ye Myint Kyaw
- Yangon Children's Hospital, Ministry of Health and Sports, Myanmar
| | - Tin Ei Ei Khaing
- 550 Bedded Children's Hospital, Mandalay, Ministry of Health and Sports, Myanmar
| | - Khin Moh Moh
- Women and Children Hospital (Shan State, Taunggyi), Ministry of Health and Sports, Myanmar
| | - Nwet Nwet Win
- North Okkalapa General and Teaching Hospital, Ministry of Health and Sports, Myanmar
| | - Win Kay Khine
- Department of Medical Research, Ministry of Health and Sports, Myanmar
| | - Myat Mo Zar Kham
- Department of Medical Research, Ministry of Health and Sports, Myanmar
| | - Thida Kyaw
- Department of Medical Research, Ministry of Health and Sports, Myanmar
| | - Yin Yin Khine
- Department of Medical Research, Ministry of Health and Sports, Myanmar
| | - Khin Khin Oo
- Department of Medical Research, Ministry of Health and Sports, Myanmar
| | - Khaing Moe Aung
- Department of Medical Research, Ministry of Health and Sports, Myanmar
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Pacheco O, Newton SM, Daza M, Cates JE, Reales JAM, Burkel VK, Mercado M, Godfred-Cato S, Gonzalez M, Anderson KN, Woodworth KR, Valencia D, Tong VT, Gilboa SM, Osorio MB, Rodríguez DYS, Prieto-Alvarado FE, Moore CA, Honein MA, Ospina Martínez ML. Neurodevelopmental findings in children 20-30 months of age with postnatal Zika infection at 1-12 months of age, Colombia, September-November 2017. Paediatr Perinat Epidemiol 2021; 35:92-97. [PMID: 32488915 PMCID: PMC7708429 DOI: 10.1111/ppe.12690] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/10/2020] [Accepted: 05/01/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Zika virus (ZIKV) infection during pregnancy can cause infant brain and eye abnormalities and has been associated with adverse neurodevelopmental outcomes in exposed infants. Evidence is limited on ZIKV's effects on children infected postnatally within the first year of life. OBJECTIVE To determine whether any adverse neurodevelopmental outcomes occurred in early childhood for children infected postnatally with ZIKV during infancy, given the neurotoxicity of ZIKV infection and the rapid brain development that occurs in infancy and early childhood. METHODS The Colombia Instituto Nacional de Salud (INS) conducted health and developmental screenings between September and November 2017 to evaluate 60 children at ages 20-30 months who had laboratory-confirmed symptomatic postnatal ZIKV infection at ages 1-12 months. We examined the frequency of adverse neurologic, hearing, eye, and developmental outcomes as well as the relationship between age at Zika symptom onset and developmental outcomes. RESULTS Nine of the 60 (15.0%) children had adverse outcomes on the neurologic, hearing, or eye examination. Six of the 47 (12.8%) children without these adverse findings, and who received a valid developmental screening, had an alert score in the hearing-language domain which signals the need for additional developmental evaluation. CONCLUSION Neurologic, hearing, eye, and developmental findings suggest reassuring results. Since the full spectrum of neurodevelopmental outcomes in children postnatally infected with ZIKV remains unknown, routine paediatric care is advised to monitor the development of these children to ensure early identification of any adverse neurodevelopmental outcomes.
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Affiliation(s)
| | - Suzanne M. Newton
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA,Eagle Global Scientific, Atlanta, GA, USA
| | | | - Jordan E. Cates
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | | | - Veronica K. Burkel
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA,Eagle Medical Services, LLC, Atlanta, GA, USA
| | | | - Shana Godfred-Cato
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | | | - Kayla N. Anderson
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Kate R. Woodworth
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Diana Valencia
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Van T. Tong
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Suzanne M. Gilboa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | | | | | | | - Cynthia A. Moore
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Margaret A. Honein
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
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5
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Cates JE, Vinjé J, Parashar U, Hall AJ. Recent advances in human norovirus research and implications for candidate vaccines. Expert Rev Vaccines 2020; 19:539-548. [PMID: 32500763 PMCID: PMC10760411 DOI: 10.1080/14760584.2020.1777860] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/01/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Noroviruses are a leading cause of acute gastroenteritis worldwide. An estimated 21 million illnesses in the United States and upwards of 684 million illnesses worldwide are attributed to norovirus infection. There are no licensed vaccines to prevent norovirus, but several candidates are in development. AREAS COVERED We review recent advances in molecular epidemiology of noroviruses, immunology, and in-vitro cultivation of noroviruses using human intestinal enteroids. We also provide an update on the status of norovirus vaccine candidates. EXPERT OPINION Molecular epidemiological studies confirm the tremendous genetic diversity of noroviruses, the continuous emergence of new recombinant strains, and the predominance of GII.4 viruses worldwide. Duration of immunity, extent of cross protection between different genotypes, and differences in strain distribution for young children compared with adults remain key knowledge gaps. Recent discoveries regarding which epitopes are targeted by neutralizing antibodies using the novel in vitro culture of human noroviruses in human intestinal enteroids are enhancing our understanding of mechanisms of protection and providing guidance for vaccine development. A future norovirus vaccine has the potential to substantially reduce the burden of illnesses due to this ubiquitous virus.
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Affiliation(s)
- Jordan E Cates
- Division of Viral Diseases, Centers for Disease Control and Prevention , Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention , Atlanta, GA, USA
| | - Jan Vinjé
- Division of Viral Diseases, Centers for Disease Control and Prevention , Atlanta, GA, USA
| | - Umesh Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention , Atlanta, GA, USA
| | - Aron J Hall
- Division of Viral Diseases, Centers for Disease Control and Prevention , Atlanta, GA, USA
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Siegel DA, Jatlaoui TC, Koumans EH, Kiernan EA, Layer M, Cates JE, Kimball A, Weissman DN, Petersen EE, Reagan‐Steiner S, Godfred‐Cato S, Moulia D, Moritz E, Lehnert JD, Mitchko J, London J, Zaki SR, King BA, Jones CM, Patel A, Meaney Delman D, Koppaka R. Update: Interim guidance for health care providers evaluating and caring for patients with suspected e‐cigarette, or vaping, product use associated lung Injury — United States, October 2019. Am J Transplant 2019. [DOI: 10.1111/ajt.15690] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- David A. Siegel
- National Center for Chronic Disease Prevention and Health Promotion CDC Atlanta Georgia
| | - Tara C. Jatlaoui
- National Center for Chronic Disease Prevention and Health Promotion CDC Atlanta Georgia
| | - Emily H. Koumans
- National Center for Chronic Disease Prevention and Health Promotion CDC Atlanta Georgia
| | - Emily A. Kiernan
- Agency for Toxic Substances and Disease Registry CDC Atlanta Georgia
- Emory University School of Medicine Atlanta Georgia
| | - Mark Layer
- Emory University School of Medicine Atlanta Georgia
- National Center for Environmental Health CDC Atlanta Georgia
| | - Jordan E. Cates
- National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
- Epidemic Intelligence Service CDC Atlanta Georgia
| | - Anne Kimball
- Epidemic Intelligence Service CDC Atlanta Georgia
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention CDC Atlanta Georgia
| | - David N. Weissman
- National Institute for Occupational Safety and Health CDC Atlanta Georgia
| | - Emily E. Petersen
- National Center for Chronic Disease Prevention and Health Promotion CDC Atlanta Georgia
| | - Sarah Reagan‐Steiner
- National Center for Emerging and Zoonotic Infectious Diseases CDC Atlanta Georgia
| | - Shana Godfred‐Cato
- National Center on Birth Defects and Developmental Disabilities CDC Atlanta Georgia
| | - Danielle Moulia
- National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
- General Dynamics Information Technology Falls Church Virginia
| | - Erin Moritz
- National Center for Environmental Health CDC Atlanta Georgia
| | - Jonathan D. Lehnert
- National Center for Emerging and Zoonotic Infectious Diseases CDC Atlanta Georgia
| | - Jane Mitchko
- National Center for Chronic Disease Prevention and Health Promotion CDC Atlanta Georgia
| | - Joel London
- National Center for Chronic Disease Prevention and Health Promotion CDC Atlanta Georgia
| | - Sherif R. Zaki
- National Center for Emerging and Zoonotic Infectious Diseases CDC Atlanta Georgia
| | - Brian A. King
- National Center for Chronic Disease Prevention and Health Promotion CDC Atlanta Georgia
| | | | - Anita Patel
- National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
| | - Dana Meaney Delman
- National Center on Birth Defects and Developmental Disabilities CDC Atlanta Georgia
| | - Ram Koppaka
- National Center for Immunization and Respiratory Diseases CDC Atlanta Georgia
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Siegel DA, Jatlaoui TC, Koumans EH, Kiernan EA, Layer M, Cates JE, Kimball A, Weissman DN, Petersen EE, Reagan-Steiner S, Godfred-Cato S, Moulia D, Moritz E, Lehnert JD, Mitchko J, London J, Zaki SR, King BA, Jones CM, Patel A, Delman DM, Koppaka R. Update: Interim Guidance for Health Care Providers Evaluating and Caring for Patients with Suspected E-cigarette, or Vaping, Product Use Associated Lung Injury - United States, October 2019. MMWR Morb Mortal Wkly Rep 2019; 68:919-927. [PMID: 31633675 PMCID: PMC6802682 DOI: 10.15585/mmwr.mm6841e3] [Citation(s) in RCA: 166] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cates JE, Westreich D, Unger HW, Bauserman M, Adair L, Cole SR, Meshnick S, Rogerson SJ. Intermittent Preventive Therapy in Pregnancy and Incidence of Low Birth Weight in Malaria-Endemic Countries. Am J Public Health 2018; 108:399-406. [PMID: 29346002 DOI: 10.2105/ajph.2017.304251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To estimate the impact of hypothetical antimalarial and nutritional interventions (which reduce the prevalence of low midupper arm circumference [MUAC]) on the incidence of low birth weight (LBW). METHODS We analyzed data from 14 633 pregnancies from 13 studies conducted across Africa and the Western Pacific from 1996 to 2015. We calculated population intervention effects for increasing intermittent preventive therapy in pregnancy (IPTp), full coverage with bed nets, reduction in malaria infection at delivery, and reductions in the prevalence of low MUAC. RESULTS We estimated that, compared with observed IPTp use, administering 3 or more doses of IPTp to all women would decrease the incidence of LBW from 9.9% to 6.9% (risk difference = 3.0%; 95% confidence interval = 1.7%, 4.0%). The intervention effects for eliminating malaria at delivery, increasing bed net ownership, and decreasing low MUAC prevalence were all modest. CONCLUSIONS Increasing IPTp uptake to at least 3 doses could decrease the incidence of LBW in malaria-endemic countries. The impact of IPTp on LBW was greater than the effect of prevention of malaria, consistent with a nonmalarial effect of IPTp, measurement error, or selection bias.
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Affiliation(s)
- Jordan E Cates
- Jordan E. Cates, Daniel Westreich, Stephen R. Cole, and Steven Meshnick are with the Department of Epidemiology, University of North Carolina-Chapel Hill (UNC). Holger W. Unger is with the Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia. Melissa Bauserman is with the Department of Pediatrics, Division of Neonatal-Perinatal Medicine, School of Medicine, UNC. Linda Adair is with the Department of Nutrition, UNC. Stephen J. Rogerson is with the Department of Medicine at the Doherty Institute, The University of Melbourne
| | - Daniel Westreich
- Jordan E. Cates, Daniel Westreich, Stephen R. Cole, and Steven Meshnick are with the Department of Epidemiology, University of North Carolina-Chapel Hill (UNC). Holger W. Unger is with the Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia. Melissa Bauserman is with the Department of Pediatrics, Division of Neonatal-Perinatal Medicine, School of Medicine, UNC. Linda Adair is with the Department of Nutrition, UNC. Stephen J. Rogerson is with the Department of Medicine at the Doherty Institute, The University of Melbourne
| | - Holger W Unger
- Jordan E. Cates, Daniel Westreich, Stephen R. Cole, and Steven Meshnick are with the Department of Epidemiology, University of North Carolina-Chapel Hill (UNC). Holger W. Unger is with the Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia. Melissa Bauserman is with the Department of Pediatrics, Division of Neonatal-Perinatal Medicine, School of Medicine, UNC. Linda Adair is with the Department of Nutrition, UNC. Stephen J. Rogerson is with the Department of Medicine at the Doherty Institute, The University of Melbourne
| | - Melissa Bauserman
- Jordan E. Cates, Daniel Westreich, Stephen R. Cole, and Steven Meshnick are with the Department of Epidemiology, University of North Carolina-Chapel Hill (UNC). Holger W. Unger is with the Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia. Melissa Bauserman is with the Department of Pediatrics, Division of Neonatal-Perinatal Medicine, School of Medicine, UNC. Linda Adair is with the Department of Nutrition, UNC. Stephen J. Rogerson is with the Department of Medicine at the Doherty Institute, The University of Melbourne
| | - Linda Adair
- Jordan E. Cates, Daniel Westreich, Stephen R. Cole, and Steven Meshnick are with the Department of Epidemiology, University of North Carolina-Chapel Hill (UNC). Holger W. Unger is with the Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia. Melissa Bauserman is with the Department of Pediatrics, Division of Neonatal-Perinatal Medicine, School of Medicine, UNC. Linda Adair is with the Department of Nutrition, UNC. Stephen J. Rogerson is with the Department of Medicine at the Doherty Institute, The University of Melbourne
| | - Stephen R Cole
- Jordan E. Cates, Daniel Westreich, Stephen R. Cole, and Steven Meshnick are with the Department of Epidemiology, University of North Carolina-Chapel Hill (UNC). Holger W. Unger is with the Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia. Melissa Bauserman is with the Department of Pediatrics, Division of Neonatal-Perinatal Medicine, School of Medicine, UNC. Linda Adair is with the Department of Nutrition, UNC. Stephen J. Rogerson is with the Department of Medicine at the Doherty Institute, The University of Melbourne
| | - Steven Meshnick
- Jordan E. Cates, Daniel Westreich, Stephen R. Cole, and Steven Meshnick are with the Department of Epidemiology, University of North Carolina-Chapel Hill (UNC). Holger W. Unger is with the Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia. Melissa Bauserman is with the Department of Pediatrics, Division of Neonatal-Perinatal Medicine, School of Medicine, UNC. Linda Adair is with the Department of Nutrition, UNC. Stephen J. Rogerson is with the Department of Medicine at the Doherty Institute, The University of Melbourne
| | - Stephen J Rogerson
- Jordan E. Cates, Daniel Westreich, Stephen R. Cole, and Steven Meshnick are with the Department of Epidemiology, University of North Carolina-Chapel Hill (UNC). Holger W. Unger is with the Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia. Melissa Bauserman is with the Department of Pediatrics, Division of Neonatal-Perinatal Medicine, School of Medicine, UNC. Linda Adair is with the Department of Nutrition, UNC. Stephen J. Rogerson is with the Department of Medicine at the Doherty Institute, The University of Melbourne
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- Jordan E. Cates, Daniel Westreich, Stephen R. Cole, and Steven Meshnick are with the Department of Epidemiology, University of North Carolina-Chapel Hill (UNC). Holger W. Unger is with the Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia. Melissa Bauserman is with the Department of Pediatrics, Division of Neonatal-Perinatal Medicine, School of Medicine, UNC. Linda Adair is with the Department of Nutrition, UNC. Stephen J. Rogerson is with the Department of Medicine at the Doherty Institute, The University of Melbourne
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Cates JE, Unger HW, Briand V, Fievet N, Valea I, Tinto H, D’Alessandro U, Landis SH, Adu-Afarwuah S, Dewey KG, ter Kuile FO, Desai M, Dellicour S, Ouma P, Gutman J, Oneko M, Slutsker L, Terlouw DJ, Kariuki S, Ayisi J, Madanitsa M, Mwapasa V, Ashorn P, Maleta K, Mueller I, Stanisic D, Schmiegelow C, Lusingu JPA, van Eijk AM, Bauserman M, Adair L, Cole SR, Westreich D, Meshnick S, Rogerson S. Malaria, malnutrition, and birthweight: A meta-analysis using individual participant data. PLoS Med 2017; 14:e1002373. [PMID: 28792500 PMCID: PMC5549702 DOI: 10.1371/journal.pmed.1002373] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/11/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Four studies previously indicated that the effect of malaria infection during pregnancy on the risk of low birthweight (LBW; <2,500 g) may depend upon maternal nutritional status. We investigated this dependence further using a large, diverse study population. METHODS AND FINDINGS We evaluated the interaction between maternal malaria infection and maternal anthropometric status on the risk of LBW using pooled data from 14,633 pregnancies from 13 studies (6 cohort studies and 7 randomized controlled trials) conducted in Africa and the Western Pacific from 1996-2015. Studies were identified by the Maternal Malaria and Malnutrition (M3) initiative using a convenience sampling approach and were eligible for pooling given adequate ethical approval and availability of essential variables. Study-specific adjusted effect estimates were calculated using inverse probability of treatment-weighted linear and log-binomial regression models and pooled using a random-effects model. The adjusted risk of delivering a baby with LBW was 8.8% among women with malaria infection at antenatal enrollment compared to 7.7% among uninfected women (adjusted risk ratio [aRR] 1.14 [95% confidence interval (CI): 0.91, 1.42]; N = 13,613), 10.5% among women with malaria infection at delivery compared to 7.9% among uninfected women (aRR 1.32 [95% CI: 1.08, 1.62]; N = 11,826), and 15.3% among women with low mid-upper arm circumference (MUAC <23 cm) at enrollment compared to 9.5% among women with MUAC ≥ 23 cm (aRR 1.60 [95% CI: 1.36, 1.87]; N = 9,008). The risk of delivering a baby with LBW was 17.8% among women with both malaria infection and low MUAC at enrollment compared to 8.4% among uninfected women with MUAC ≥ 23 cm (joint aRR 2.13 [95% CI: 1.21, 3.73]; N = 8,152). There was no evidence of synergism (i.e., excess risk due to interaction) between malaria infection and MUAC on the multiplicative (p = 0.5) or additive scale (p = 0.9). Results were similar using body mass index (BMI) as an anthropometric indicator of nutritional status. Meta-regression results indicated that there may be multiplicative interaction between malaria infection at enrollment and low MUAC within studies conducted in Africa; however, this finding was not consistent on the additive scale, when accounting for multiple comparisons, or when using other definitions of malaria and malnutrition. The major limitations of the study included availability of only 2 cross-sectional measurements of malaria and the limited availability of ultrasound-based pregnancy dating to assess impacts on preterm birth and fetal growth in all studies. CONCLUSIONS Pregnant women with malnutrition and malaria infection are at increased risk of LBW compared to women with only 1 risk factor or none, but malaria and malnutrition do not act synergistically.
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Affiliation(s)
- Jordan E. Cates
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Holger W. Unger
- Department of Obstetrics and Gynaecology, Edinburgh Royal Infirmary, Edinburgh, United Kingdom
- Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia
| | - Valerie Briand
- UMR216-MERIT, French National Research Institute for Sustainable Development (IRD), Paris Descartes University, Paris, France
| | - Nadine Fievet
- UMR216-MERIT, French National Research Institute for Sustainable Development (IRD), Paris Descartes University, Paris, France
| | - Innocent Valea
- Unite de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé-DRO, Bobo-Dioulasso, Burkina Faso
- Departement de Recherche Clinique, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Halidou Tinto
- Unite de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé-DRO, Bobo-Dioulasso, Burkina Faso
- Departement de Recherche Clinique, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Umberto D’Alessandro
- Medical Research Council Unit, The Gambia; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah H. Landis
- Worldwide Epidemiology, GlaxoSmithKline, Uxbridge, United Kingdom
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Kathryn G. Dewey
- Department of Nutrition, University of California, Davis, California, United States of America
| | - Feiko O. ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Meghna Desai
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Stephanie Dellicour
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Peter Ouma
- Kenya Medical Research Institute (KEMRI)/ Centre for Global Health Research, Kisumu, Kenya
| | - Julie Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Martina Oneko
- Kenya Medical Research Institute (KEMRI)/ Centre for Global Health Research, Kisumu, Kenya
| | - Laurence Slutsker
- Malaria and Neglected Tropical Diseases, Center for Malaria Control and Elimination, PATH, Seattle, Washington, United States of America
| | - Dianne J. Terlouw
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Simon Kariuki
- Kenya Medical Research Institute (KEMRI)/ Centre for Global Health Research, Kisumu, Kenya
| | - John Ayisi
- Kenya Medical Research Institute (KEMRI)/ Centre for Global Health Research, Kisumu, Kenya
| | - Mwayiwawo Madanitsa
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Victor Mwapasa
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Per Ashorn
- Center for Child Health Research University of Tampere School of Medicine and Tampere University Hospital, Tampere, Finland
| | - Kenneth Maleta
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Ivo Mueller
- Walter and Eliza Hall Institute, Parkville, Victoria, Australia
| | - Danielle Stanisic
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Depart. Of Immunology and Microbiology, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - John P. A. Lusingu
- Centre for Medical Parasitology, Depart. Of Immunology and Microbiology, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Anna Maria van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Melissa Bauserman
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, School of Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Linda Adair
- Department of Nutrition, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Stephen R. Cole
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Daniel Westreich
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Steven Meshnick
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Stephen Rogerson
- Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia
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Unger HW, Cates JE, Gutman J, Briand V, Fievet N, Valea I, Tinto H, d'Alessandro U, Landis SH, Adu-Afarwuah S, Dewey KG, Ter Kuile F, Dellicour S, Ouma P, Slutsker L, Terlouw DJ, Kariuki S, Ayisi J, Nahlen B, Desai M, Madanitsa M, Kalilani-Phiri L, Ashorn P, Maleta K, Mueller I, Stanisic D, Schmiegelow C, Lusingu J, Westreich D, van Eijk AM, Meshnick S, Rogerson S. Maternal Malaria and Malnutrition (M3) initiative, a pooled birth cohort of 13 pregnancy studies in Africa and the Western Pacific. BMJ Open 2016; 6:e012697. [PMID: 28003287 PMCID: PMC5223676 DOI: 10.1136/bmjopen-2016-012697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The Maternal Malaria and Malnutrition (M3) initiative has pooled together 13 studies with the hope of improving understanding of malaria-nutrition interactions during pregnancy and to foster collaboration between nutritionists and malariologists. PARTICIPANTS Data were pooled on 14 635 singleton, live birth pregnancies from women who had participated in 1 of 13 pregnancy studies. The 13 studies cover 8 countries in Africa and Papua New Guinea in the Western Pacific conducted from 1996 to 2015. FINDINGS TO DATE Data are available at the time of antenatal enrolment of women into their respective parent study and at delivery. The data set comprises essential data such as malaria infection status, anthropometric assessments of maternal nutritional status, presence of anaemia and birth weight, as well as additional variables such gestational age at delivery for a subset of women. Participating studies are described in detail with regard to setting and primary outcome measures, and summarised data are available from each contributing cohort. FUTURE PLANS This pooled birth cohort is the largest pregnancy data set to date to permit a more definite evaluation of the impact of plausible interactions between poor nutritional status and malaria infection in pregnant women on fetal growth and gestational length. Given the current comparative lack of large pregnancy cohorts in malaria-endemic settings, compilation of suitable pregnancy cohorts is likely to provide adequate statistical power to assess malaria-nutrition interactions, and could point towards settings where such interactions are most relevant. The M3 cohort may thus help to identify pregnant women at high risk of adverse outcomes who may benefit from tailored intensive antenatal care including nutritional supplements and alternative or intensified malaria prevention regimens, and the settings in which these interventions would be most effective.
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Affiliation(s)
- Holger W Unger
- Department of Obstetrics and Gynaecology, Edinburgh Royal Infirmary, Edinburgh, UK
- Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia
| | - Jordan E Cates
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Julie Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Valerie Briand
- Institut de Recherche pour le Développement (IRD), Mère et enfant face aux infections tropicales (UMR216), Paris, France
- COMUE Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Nadine Fievet
- Institut de Recherche pour le Développement (IRD), Mère et enfant face aux infections tropicales (UMR216), Paris, France
- COMUE Sorbonne Paris Cité, Faculté de Pharmacie, Université Paris Descartes, Paris, France
| | - Innocent Valea
- Unite de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé-DRO, Bobo-Dioulasso, Burkina Faso
- Departement de Recherche Clinique, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Halidou Tinto
- Unite de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé-DRO, Bobo-Dioulasso, Burkina Faso
- Departement de Recherche Clinique, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Umberto d'Alessandro
- Medical Research Council Unit, The Gambia
- London School of Hygiene and Tropical Medicine, UK
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, California, USA
| | - Feiko Ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Stephanie Dellicour
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Peter Ouma
- Kenya Medical Research Institute (KEMRI)/Center for Global Health Research, Kisumu, Kenya
| | - Laurence Slutsker
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dianne J Terlouw
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme Liverpool School of Tropical Medicine, Liverpool, UK
| | - Simon Kariuki
- Kenya Medical Research Institute (KEMRI)/Center for Global Health Research, Kisumu, Kenya
| | - John Ayisi
- Kenya Medical Research Institute (KEMRI)/Center for Global Health Research, Kisumu, Kenya
| | | | - Meghna Desai
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mwayi Madanitsa
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Linda Kalilani-Phiri
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Per Ashorn
- Tampere Center for Child Health Research, Tampere, Finland
- Department for Pediatrics, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Kenneth Maleta
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Ivo Mueller
- Walter and Eliza Hall Institute, Parkville, Victoria, Australia
| | - Danielle Stanisic
- Institute for Glycomics, Griffith University, Gold Coast, Queensland, Australia
| | - Christentze Schmiegelow
- Faculty of Health Science, Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - John Lusingu
- Faculty of Health Science, Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Daniel Westreich
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anna Maria van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Steven Meshnick
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephen Rogerson
- Department of Medicine at the Doherty Institute, The University of Melbourne, Parkville, Victoria, Australia
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Abstract
BACKGROUND In low-resource settings, malaria and macronutrient undernutrition are major health problems in pregnancy, contributing significantly to adverse pregnancy outcomes such as preterm birth and fetal growth restriction. Affected pregnancies may result in stillbirth and neonatal death, and surviving children are at risk of poor growth and infection in infancy, and of non-communicable diseases in adulthood. Populations exposed to macronutrient undernutrition frequently reside in malaria-endemic areas, and seasonal peaks of low food supply and malaria transmission tend to coincide. Despite these geographic and temporal overlaps, integrated approaches to these twin challenges are infrequent. DISCUSSION This opinion article examines the current evidence for malaria-macronutrition interactions and discusses possible mechanisms whereby macronutrient undernutrition and malaria may interact to worsen pregnancy outcomes. Macronutrient undernutrition dysregulates the immune response. In pregnant women, undernutrition may worsen the already increased susceptibility to malarial infection and could impair development of protective immunity to malaria, and is likely to exacerbate the impact of placental malaria on fetal growth. Malarial infection, in turn, can drive nutritional depletion; poor gestational weight gain and weight loss in pregnancy increases the risk of adverse pregnancy outcomes. Despite a commendable number of studies and trials that, in isolation, attempt to address the challenges of malaria and undernutrition in pregnancy, few dare to venture beyond the 'single disease - single solution' paradigm. We believe that this may be a lost opportunity: researching malaria-nutrition interactions, and designing and implementing integrated interventions to prevent and treat these commonly co-existing and intertwining conditions, may markedly reduce the high burden of preterm birth and fetal growth restriction in affected areas. CONCLUSION We call for more collaboration between researchers studying malaria and nutrition in pregnancy, and propose a research agenda to address this important twin health problem.
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Affiliation(s)
- Holger W. Unger
- Department of Medicine at the Doherty Institute, The University of Melbourne, Melbourne, Victoria Australia
- Simpson Centre for Reproductive Health, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Per Ashorn
- Department of Paediatrics, University of Tampere School of Medicine, Tampere, Finland
- Department for International Health, University of Tampere School of Medicine, Tampere, Finland
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Jordan E. Cates
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC USA
| | - Kathryn G. Dewey
- Program in International and Community Nutrition and Department of Nutrition, University of California, Davis, CA USA
| | - Stephen J. Rogerson
- Department of Medicine at the Doherty Institute, The University of Melbourne, Melbourne, Victoria Australia
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Cates JE, Mitrani-Gold FS, Li G, Mundy LM. Systematic Review and Meta-Analysis To Estimate Antibacterial Treatment Effect in Acute Bacterial Skin and Skin Structure Infection. Antimicrob Agents Chemother 2015; 59:4510-20. [PMID: 25987628 PMCID: PMC4505279 DOI: 10.1128/aac.00679-15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 05/09/2015] [Indexed: 11/20/2022] Open
Abstract
A systematic literature review and meta-analysis were conducted to estimate the antibacterial treatment effect for linezolid and ceftaroline to inform on the design of acute bacterial skin and skin structure infection (ABSSSI) noninferiority trials. The primary endpoints included an early clinical treatment response (ECTR) defined as cessation of lesion spread at 48 to 72 h postrandomization and the test-of-cure (TOC) response defined as total resolution of the infection at 7 to 14 days posttreatment. The systematic review identified no placebo-controlled trials in ABSSSI, 4 placebo-controlled trials in uncomplicated skin and soft tissue infection as a proxy for placebo in ABSSSI, 12 linezolid trials in ABSSSI, 3 ceftaroline trials in ABSSSI, and 2 trials for nonantibacterial treatment. The ECTR rates at 48 to 72 h and corresponding 95% confidence intervals (CI) were 78.7% (95% CI, 61.1 to 96.3%) for linezolid, 74.0% (95% CI, 69.7 to 78.3%) for ceftaroline, and 59.0% (95% CI, 52.8 to 65.3%) for nonantibacterial treatment. The early clinical treatment effect could not be estimated, given no available placebo or proxy for placebo data for this endpoint. Clinical, methodological, and statistical heterogeneity influenced the selection of trials for the meta-analysis of the TOC treatment effect estimation. The pooled estimates of the TOC treatment response were 31.0% (95% CI, 6.2 to 55.9%) for the proxy for placebo, 88.1% (95% CI, 81.0 to 95.1%) for linezolid, and 86.1% (95% CI, 83.7 to 88.6%) for ceftaroline. The TOC clinical treatment effect estimation was 25.1% for linezolid and 27.8% for ceftaroline. The antibacterial treatment effect estimation at TOC will inform on the design and analysis of future noninferiority ABSSSI clinical trials.
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Affiliation(s)
- Jordan E Cates
- University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Gang Li
- GSK, Collegeville, Pennsylvania, USA
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Affiliation(s)
- J E Cates
- Emeritus Consultant Physician Avon Area Health Authority
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Cates JE. Book Review: Treatment of Infective Endocarditis. Med Chir Trans 1982. [DOI: 10.1177/014107688207501016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- J E Cates
- Emeritus Consultant Physician Bristol
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Cates JE. Postgraduate medical education in the south west. Bristol Med Chir J 1979; 94:3-11. [PMID: 262447 PMCID: PMC5117379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Harrold BP, Gough KR, Tulloh CG, Cates JE, James JA. Use of trans-sphenoidal hypophysectomy in diabetic retinopathy: preliminary assessment. Br Med J 1965; 2:727-31. [PMID: 4283893 PMCID: PMC1846155 DOI: 10.1136/bmj.2.5464.727] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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