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Britton KJ, Pomat W, Sapura J, Kave J, Nivio B, Ford R, Kirarock W, Moore HC, Kirkham LA, Richmond PC, Chan J, Lehmann D, Russell FM, Blyth CC. Clinical predictors of hypoxic pneumonia in children from the Eastern Highlands Province, Papua New Guinea: secondary analysis of two prospective observational studies. Lancet Reg Health West Pac 2024; 45:101052. [PMID: 38699291 PMCID: PMC11064719 DOI: 10.1016/j.lanwpc.2024.101052] [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] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/15/2024] [Accepted: 03/13/2024] [Indexed: 05/05/2024]
Abstract
Background Pneumonia is the leading cause of death in young children globally and is prevalent in the Papua New Guinea highlands. We investigated clinical predictors of hypoxic pneumonia to inform local treatment guidelines in this resource-limited setting. Methods Between 2013 and 2020, two consecutive prospective observational studies were undertaken enrolling children 0-4 years presenting with pneumonia to health-care facilities in Goroka Town, Eastern Highlands Province. Logistic regression models were developed to identify clinical predictors of hypoxic pneumonia (oxygen saturation <90% on presentation). Model performance was compared against established criteria to identify severe pneumonia. Findings There were 2067 cases of pneumonia; hypoxaemia was detected in 36.1%. The strongest independent predictors of hypoxic pneumonia were central cyanosis on examination (adjusted odds ratio [aOR] 5.14; 95% CI 3.47-7.60), reduced breath sounds (aOR 2.92; 95% CI 2.30-3.71), and nasal flaring or grunting (aOR 2.34; 95% CI 1.62-3.38). While the model developed to predict hypoxic pneumonia outperformed established pneumonia severity criteria, it was not sensitive enough to be clinically useful at this time. Interpretation Given signs and symptoms are unable to accurately detect hypoxia, all health care facilities should be equipped with pulse oximeters. However, for the health care worker without access to pulse oximetry, consideration of central cyanosis, reduced breath sounds, nasal flaring or grunting, age-specific tachycardia, wheezing, parent-reported drowsiness, or bronchial breathing as suggestive of hypoxaemic pneumonia, and thus severe disease, may prove useful in guiding management, hospital referral and use of oxygen therapy. Funding Funded by Pfizer Global and the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Kathryn J. Britton
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Medicine, The University of Western Australia, Nedlands, Western Australia, Australia
| | - William Pomat
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea
| | - Joycelyn Sapura
- Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea
| | - John Kave
- Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea
| | - Birunu Nivio
- Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea
| | - Rebecca Ford
- Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea
| | - Wendy Kirarock
- Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea
| | - Hannah C. Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Lea-Ann Kirkham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- Centre for Child Health Research, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Peter C. Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Medicine, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Jocelyn Chan
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Lehmann
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Fiona M. Russell
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Centre for International Child Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher C. Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Medicine, The University of Western Australia, Nedlands, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Western Australia, Australia
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Orami T, Aho C, Ford RL, Pomat WS, Greenhill A, Kirkham LA, Masiria G, Nivio B, Britton KJ, Jacoby P, Richmond PC, van den Biggelaar AHJ, Lehmann D. Pneumococcal carriage, serotype distribution, and antimicrobial susceptibility in Papua New Guinean children vaccinated with PCV10 or PCV13 in a head-to-head trial. Vaccine 2023; 41:5392-5399. [PMID: 37479616 DOI: 10.1016/j.vaccine.2023.07.026] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Children in Papua New Guinea (PNG) are at high risk of pneumococcal infections. We investigated pneumococcal carriage rates, serotype distribution, and antimicrobial susceptibility in PNG children after vaccination with 10-valent or 13-valent pneumococcal conjugate vaccines (PCV10; PCV13). METHODS Infants (N = 262) were randomized to receive 3 doses of PCV10 or PCV13 at 1-2-3 months of age, followed by pneumococcal polysaccharide vaccination (PPV) or no PPV at 9 months of age. Nasopharyngeal swabs (NPS) collected at ages 1, 4, 9, 10, 23 and 24 months were cultured using standard bacteriological procedures. Morphologically distinct Streptococcus pneumoniae colonies were serotyped by the Quellung reaction. Antimicrobial susceptibility was determined by Kirby-Bauer disc diffusion and minimum inhibitory concentration (MIC). RESULTS S. pneumoniae was isolated from 883/1063 NPS collected at 1-23 months of age, including 820 serotypeable (64 different serotypes) and 144 non-serotypeable isolates. At age 23 months, 93.6% (95%CI 86.6-97.6%) of PCV10 recipients and 88.6% (95%CI 80.1-94.4%) of PCV13 recipients were pneumococcal carriers, with higher carriage of PCV10 serotypes by PCV10 recipients (19.8%, 95%CI 12.2-29.5) than PCV13 recipients (9.3%, 95%CI 4.1-17.3) (p = 0.049). There were no other statistically significant differences between PCV10 and PCV13 recipients and children receiving PPV or no PPV. Nearly half (45.6%) of carried pneumococci were non-susceptible to penicillin based on the meningitis breakpoint (MIC ≥ 0.12 µg/mL), but resistance was rare (1.1%) using the non-meningitis cut-off (MIC ≥ 8 µg/mL). Non-susceptibility to trimethoprim-sulfamethoxazole (SXT) was common: 23.2% of isolates showed intermediate resistance (MIC 1/19-2/38 µg/mL) and 16.9% full resistance (MIC ≥ 4/76 µg/mL). PCV serotypes 14 and 19A were commonly non-susceptible to both penicillin (14, 97%; 19A, 70%) and SXT (14, 97%; 19A, 87%). CONCLUSION Even after PCV10 or PCV13 vaccination, children living in a high-risk setting such as PNG continue to experience high levels of pneumococcal colonization, including carriage of highly antimicrobial-resistant PCV serotypes. The study is registered with ClinicalTrials.gov (CTN NCT01619462).
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Affiliation(s)
- Tilda Orami
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Celestine Aho
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Rebecca L Ford
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - William S Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Andrew Greenhill
- School of Science, Psychology and Sport, Federation University, Churchill, Australia
| | - Lea-Ann Kirkham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Geraldine Masiria
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Birunu Nivio
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Kathryn J Britton
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia; Discipline of Paediatrics, School of Medicine, University of Western Australia, Perth, Australia
| | - Peter Jacoby
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia; Discipline of Paediatrics, School of Medicine, University of Western Australia, Perth, Australia
| | - Anita H J van den Biggelaar
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Deborah Lehmann
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia.
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Middleton BF, Danchin M, Cunliffe NA, Jones MA, Boniface K, Kirkwood CD, Gallagher S, Kirkham LA, Granland C, McNeal M, Donato C, Bogdanovic-Sakran N, Handley A, Bines JE, Snelling TL. Histo-blood group antigen profile of Australian Aboriginal children and seropositivity following oral rotavirus vaccination. Vaccine 2023:S0264-410X(23)00525-X. [PMID: 37179162 DOI: 10.1016/j.vaccine.2023.05.007] [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: 03/07/2023] [Revised: 04/23/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Histo-blood group antigens (HBGAs) may influence immune responses to rotavirus vaccination. METHODS HBGA phenotyping was determined by detection of antigens A, B, H and Lewis a and b in saliva using enzyme-linked immunosorbent assay. Secretor status was confirmed by lectin antigen assay if A, B and H antigens were negative or borderline (OD ± 0.1 of threshold of detection). PCR-RFLP analysis was used to identify the FUT2 'G428A' mutation in a subset. Rotavirus seropositivity was defined as serum anti-rotavirus IgA ≥ 20 AU/mL. RESULTS Of 156 children, 119 (76 %) were secretors, 129 (83 %) were Lewis antigen positive, and 105 (67 %) were rotavirus IgA seropositive. Eighty-seven of 119 (73 %) secretors were rotavirus seropositive, versus 4/9 (44 %) weak secretors and 13/27 (48 %) non-secretors. CONCLUSIONS Most Australian Aboriginal children were secretor and Lewis antigen positive. Non-secretor children were less likely to be seropositive to rotavirus antibodies following vaccination, but this phenotype was less common. HBGA status is unlikely to fully explain underperformance of rotavirus vaccines among Australian Aboriginal children.
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Affiliation(s)
- Bianca F Middleton
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
| | - Margie Danchin
- Vaccine Uptake Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of General Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Nigel A Cunliffe
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Mark A Jones
- Health and Clinical Analytics, School of Public Health, University of Sydney, Sydney, Australia
| | - Karen Boniface
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia
| | - Carl D Kirkwood
- Enteric and Diarrheal Diseases, Bill and Melinda Gates Foundation, Seattle, USA
| | - Sarah Gallagher
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Lea-Ann Kirkham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia; Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Caitlyn Granland
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Monica McNeal
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA; Division of Infectious Disease, Cincinnati Children's Hospital Medical Centre, Cincinnati, USA
| | - Celeste Donato
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Amanda Handley
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia
| | - Julie E Bines
- Department of Paediatrics, University of Melbourne, Melbourne, Australia; Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia; Department of Gastroenterology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Thomas L Snelling
- Health and Clinical Analytics, School of Public Health, University of Sydney, Sydney, Australia; Division of Infectious Disease, Cincinnati Children's Hospital Medical Centre, Cincinnati, USA; School of Public Health, Curtin University, Perth, Australia
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Wu Y, Mascaro S, Bhuiyan M, Fathima P, Mace AO, Nicol MP, Richmond PC, Kirkham LA, Dymock M, Foley DA, McLeod C, Borland ML, Martin A, Williams PCM, Marsh JA, Snelling TL, Blyth CC. Predicting the causative pathogen among children with pneumonia using a causal Bayesian network. PLoS Comput Biol 2023; 19:e1010967. [PMID: 36913404 PMCID: PMC10035934 DOI: 10.1371/journal.pcbi.1010967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 03/23/2023] [Accepted: 02/22/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Pneumonia remains a leading cause of hospitalization and death among young children worldwide, and the diagnostic challenge of differentiating bacterial from non-bacterial pneumonia is the main driver of antibiotic use for treating pneumonia in children. Causal Bayesian networks (BNs) serve as powerful tools for this problem as they provide clear maps of probabilistic relationships between variables and produce results in an explainable way by incorporating both domain expert knowledge and numerical data. METHODS We used domain expert knowledge and data in combination and iteratively, to construct, parameterise and validate a causal BN to predict causative pathogens for childhood pneumonia. Expert knowledge elicitation occurred through a series of group workshops, surveys and one-on-one meetings involving 6-8 experts from diverse domain areas. The model performance was evaluated based on both quantitative metrics and qualitative expert validation. Sensitivity analyses were conducted to investigate how the target output is influenced by varying key assumptions of a particularly high degree of uncertainty around data or domain expert knowledge. RESULTS Designed to apply to a cohort of children with X-ray confirmed pneumonia who presented to a tertiary paediatric hospital in Australia, the resulting BN offers explainable and quantitative predictions on a range of variables of interest, including the diagnosis of bacterial pneumonia, detection of respiratory pathogens in the nasopharynx, and the clinical phenotype of a pneumonia episode. Satisfactory numeric performance has been achieved including an area under the receiver operating characteristic curve of 0.8 in predicting clinically-confirmed bacterial pneumonia with sensitivity 88% and specificity 66% given certain input scenarios (i.e., information that is available and entered into the model) and trade-off preferences (i.e., relative weightings of the consequences of false positive versus false negative predictions). We specifically highlight that a desirable model output threshold for practical use is very dependent upon different input scenarios and trade-off preferences. Three commonly encountered scenarios were presented to demonstrate the potential usefulness of the BN outputs in various clinical pictures. CONCLUSIONS To our knowledge, this is the first causal model developed to help determine the causative pathogen for paediatric pneumonia. We have shown how the method works and how it would help decision making on the use of antibiotics, providing insight into how computational model predictions may be translated to actionable decisions in practice. We discussed key next steps including external validation, adaptation and implementation. Our model framework and the methodological approach can be adapted beyond our context to broad respiratory infections and geographical and healthcare settings.
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Affiliation(s)
- Yue Wu
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Steven Mascaro
- Bayesian Intelligence Pty Ltd, Upwey, Victoria, Australia
- Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
| | - Mejbah Bhuiyan
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Parveen Fathima
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Ariel O Mace
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- Department of General Paediaitrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Department of Paediatrics, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Mark P Nicol
- School of Biomedical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- Department of General Paediaitrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Lea-Ann Kirkham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Michael Dymock
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - David A Foley
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- Microbiology, PathWest Laboratory Medicine QEII Medical Centre, Nedlands, Western Australia, Australia
| | - Charlie McLeod
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Meredith L Borland
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
- Emergency Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Andrew Martin
- Department of General Paediaitrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Phoebe C M Williams
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
- Sydney Children's Hospitals Network, New South Wales, Australia
- School of Women's and Children's Health, The University of New South Wales, Kensington, New South Wales, Australia
| | - Julie A Marsh
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Thomas L Snelling
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- Sydney Children's Hospitals Network, New South Wales, Australia
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
- Microbiology, PathWest Laboratory Medicine QEII Medical Centre, Nedlands, Western Australia, Australia
- Infectious Diseases Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
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Middleton BF, Danchin M, Jones MA, Leach AJ, Cunliffe N, Kirkwood CD, Carapetis J, Gallagher S, Kirkham LA, Granland C, McNeal M, Marsh JA, Waddington CS, Snelling TL. OUP accepted manuscript. J Infect Dis 2022; 226:1537-1544. [PMID: 35134951 PMCID: PMC9624458 DOI: 10.1093/infdis/jiac038] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background Rotarix (GlaxoSmithKline) oral rotavirus vaccine is licensed as 2 doses in the first 6 months of life. In settings with high child mortality rates, clinical protection conferred by 2 doses of Rotarix is reduced. We assessed vaccine immune response when an additional dose of Rotarix was given to Australian Aboriginal children 6 to <12 months old. Methods ORVAC is a 2-stage, double-blind, randomized, placebo-controlled trial. Australian Aboriginal children 6 to <12 months old who had received 1 or 2 prior doses of Rotarix rotavirus vaccine were randomized 1:1 to receive an additional dose of Rotarix or matched placebo. The primary immunological end point was seroresponse defined as an anti-rotavirus immunoglobulin A level ≥20 AU/mL, 28–56 days after the additional dose of Rotarix or placebo. Results Between March 2018 and August 2020, a total of 253 infants were enrolled. Of these, 178 infants (70%) had analyzable serological results after follow-up; 89 were randomized to receive Rotarix, and 89 to receive placebo. The proportion with seroresponse was 85% after Rotarix compared with 72% after placebo. There were no occurrences of intussusception or any serious adverse events. Conclusions An additional dose of Rotarix administered to Australian Aboriginal infants 6 to <12 months old increased the proportion with a vaccine seroresponse. Clinical Trials Registration NCT02941107.
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Affiliation(s)
- Bianca F Middleton
- Correspondence: Bianca F. Middleton, Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia ()
| | - Margie Danchin
- Vaccine Uptake Group, Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Department of General Medicine, Royal Children’s Hospital, Melbourne, Australia
| | - Mark A Jones
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- School of Public Health, University of Sydney, Sydney, Australia
| | - Amanda J Leach
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Nigel Cunliffe
- Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| | - Carl D Kirkwood
- Enteric and Diarrheal Diseases, Bill and Melinda Gates Foundation, Seattle, USA
| | - Jonathan Carapetis
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Sarah Gallagher
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Lea-Ann Kirkham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Caitlyn Granland
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Monica McNeal
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
- Division of Infectious Disease, Cincinnati Children’s Hospital Medical Centre, Cincinnati, USA
| | - Julie A Marsh
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Claire S Waddington
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Thomas L Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- School of Public Health, University of Sydney, Sydney, Australia
- School of Public Health, Curtin University, Perth, Australia
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Orami T, Ford R, Kirkham LA, Thornton R, Corscadden K, Richmond PC, Pomat WS, van den Biggelaar AHJ, Lehmann D. Pneumococcal conjugate vaccine primes mucosal immune responses to pneumococcal polysaccharide vaccine booster in Papua New Guinean children. Vaccine 2020; 38:7977-7988. [PMID: 33121845 PMCID: PMC7684155 DOI: 10.1016/j.vaccine.2020.10.042] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/30/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023]
Abstract
Introduction Invasive pneumococcal disease remains a major cause of hospitalization and death in Papua New Guinean (PNG) children. We assessed mucosal IgA and IgG responses in PNG infants vaccinated with pneumococcal conjugate vaccine (PCV) followed by a pneumococcal polysaccharide vaccine (PPV) booster. Methods Infants received 7-valent PCV (7vPCV) in a 0–1–2 (neonatal) or 1–2-3-month (infant) schedule, or no 7vPCV (control). At age 9 months all children received 23-valent PPV (23vPPV). IgA and IgG to 7vPCV and non-7vPCV (1, 5, 7F, 19A) serotypes were measured in saliva collected at ages 1, 2, 3, 4, 9, 10 and 18 months (131 children, 917 samples). Correlations were studied between salivary and serum IgG at 4, 10 and 18 months. Results Salivary IgA and IgG responses overall declined in the first 9 months. Compared to non-7vPCV recipients, salivary IgA remained higher in 7vPCV recipients for serotypes 4 at 3 months, 6B at 3 months (neonatal), and 14 at 3 (neonatal), 4 and 9 months (infant); and for salivary IgG for serotypes 4 at 3, 4 and 9 months, 6B at 9 months, 14 at 4 (neonatal) and 9 months, 18C at 3, 4, and 9 (infant) months, and 23F at 4 months. Following 23vPPV, salivary 7vPCV-specific IgA and IgG increased in 7vPCV-vaccinated children but not in controls; and salivary IgA against non-PCV serotypes 5 and 7F increased in 7vPCV recipients and non-recipients. Salivary and serum IgG against 7vPCV-serotypes correlated in 7vPCV-vaccinated children at 4 and 10 months of age. Conclusions PCV may protect high-risk children against pneumococcal colonization and mucosal disease by inducing mucosal antibody responses and priming for mucosal immune memory that results in mucosal immune responses after booster PPV. Saliva can be a convenient alternative sample to serum to study PCV-induced systemic IgG responses.
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Affiliation(s)
- Tilda Orami
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Rebecca Ford
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Lea-Ann Kirkham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia; Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Ruth Thornton
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia; School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Karli Corscadden
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia; Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia; Division of Pediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - William S Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Anita H J van den Biggelaar
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.
| | - Deborah Lehmann
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia; Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
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Pomat WS, van den Biggelaar AHJ, Wana S, Francis JP, Solomon V, Greenhill AR, Ford R, Orami T, Passey M, Jacoby P, Kirkham LA, Lehmann D, Richmond PC. Safety and Immunogenicity of Pneumococcal Conjugate Vaccines in a High-risk Population: A Randomized Controlled Trial of 10-Valent and 13-Valent Pneumococcal Conjugate Vaccine in Papua New Guinean Infants. Clin Infect Dis 2020; 68:1472-1481. [PMID: 30184183 PMCID: PMC6481999 DOI: 10.1093/cid/ciy743] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/31/2018] [Indexed: 12/31/2022] Open
Abstract
Background There are little data on the immunogenicity of PCV10 and PCV13 in the same high-risk population. Methods PCV10 and PCV13 were studied head-to-head in a randomized controlled trial in Papua New Guinea in which 262 infants received 3 doses of PCV10 or PCV13 at 1, 2, and 3 months of age. Serotype-specific immunoglobulin G (IgG) concentrations, and pneumococcal and nontypeable Haemophilus influenzae (NTHi) carriage were assessed prevaccination and at 4 and 9 months of age. Infants were followed up for safety until 9 months of age. Results One month after the third dose of PCV10 or PCV13, ˃80% of infants had IgG concentrations ≥0.35µg/mL for vaccine serotypes, and 6 months postvaccination IgG concentrations ≥0.35 µg/mL were maintained for 8/10 shared PCV serotypes in > 75% of children vaccinated with either PCV10 or PCV13. Children carried a total of 65 different pneumococcal serotypes (plus nonserotypeable). At 4 months of age, 92% (95% confidence interval [CI] 85–96) of children vaccinated with PCV10 and 81% (95% CI 72–88) vaccinated with PCV13 were pneumococcal carriers (P = .023), whereas no differences were seen at 9 months of age, or for NTHi carriage. Both vaccines were well tolerated and not associated with serious adverse events. Conclusions Infant vaccination with 3 doses of PCV10 or PCV13 is safe and immunogenic in a highly endemic setting; however, to significantly reduce pneumococcal disease in these settings, PCVs with broader serotype coverage and potency to reduce pneumococcal carriage are needed. Clinical Trials Registration NCT01619462.
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Affiliation(s)
| | - Anita H J van den Biggelaar
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and Centre for Child Health Research, University of Western Australia, Perth
| | - Sandra Wana
- Papua New Guinea Institute of Medical Research, Goroka
| | | | - Vela Solomon
- Papua New Guinea Institute of Medical Research, Goroka
| | - Andrew R Greenhill
- Papua New Guinea Institute of Medical Research, Goroka.,School of Health and Life Sciences, Federation University, Churchill, Victoria
| | - Rebecca Ford
- Papua New Guinea Institute of Medical Research, Goroka
| | - Tilda Orami
- Papua New Guinea Institute of Medical Research, Goroka
| | - Megan Passey
- The University of Sydney, University Centre for Rural Health, School of Public Health, Lismore, New South Wales
| | - Peter Jacoby
- Department of Biostatistics, Telethon Kids Institute and Centre for Child Health Research, University of Western Australia, Perth
| | - Lea-Ann Kirkham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and Centre for Child Health Research, University of Western Australia, Perth.,School of Biomedical Sciences, University of Western Australia, Perth
| | - Deborah Lehmann
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and Centre for Child Health Research, University of Western Australia, Perth
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and Centre for Child Health Research, University of Western Australia, Perth.,Division of Paediatrics and Child Health, School of Medicine, University of Western Australia, Perth
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Abudulai LN, Fernandez S, Corscadden K, Kirkham LA, Hunter M, Post JJ, French MA. Production of IgG2 Antibodies to Pneumococcal Polysaccharides After Vaccination of Treated HIV Patients May Be Augmented by IL-7Rα Signaling in ICOS + Circulating T Follicular-Helper Cells. Front Immunol 2019; 10:839. [PMID: 31068934 PMCID: PMC6491457 DOI: 10.3389/fimmu.2019.00839] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/01/2019] [Indexed: 11/13/2022] Open
Abstract
Greater understanding of factors influencing the maturation of antibody responses against pneumococcal polysaccharides (PcPs) may improve pneumococcal vaccination strategies. Although PcPs are type 2 T cell-independent antigens thought not to induce follicular immune responses, we have previously shown that IgG2 antibody responses against antigens in the 23-valent unconjugated PcP vaccine (PPV23) are associated with expansion of ICOS+ circulating T follicular helper (cTFH) cells in HIV seronegative subjects but not HIV patients. As IL-7Rα signaling in CD4+ T cells may affect TFH cell function and is adversely affected by HIV-1 infection, we have examined the relationship of IL-7Rα expression on ICOS+ cTFH cells with PcP-specific IgG2 antibody responses. PPV23 vaccination was undertaken in HIV patients receiving antiretroviral therapy (n = 25) and HIV seronegative subjects (n = 20). IL-7Rα expression on ICOS+ and ICOS− cTFH cells was assessed at day(D) 0, 7, and 28. Fold increase between D0 and D28 in serum IgG1 and IgG2 antibodies to PcP serotypes 4, 6B, 9V, and 14 and the frequency of IgG1+ and IgG2+ antibody secreting cells (ASCs) at D7 were also assessed. Decline in IL-7Rα expression on ICOS+ cTFH cells between D0 and D7 occurred in 75% of HIV seronegative subjects and 60% of HIV patients (Group A), with changes in IL-7Rα expression being more pronounced in HIV patients. Group A patients exhibited abnormally high IL-7Rα expression pre-vaccination, an association of serum IgG2, but not IgG1, antibody responses with a decline of IL-7Rα expression on ICOS+ cTFH cells between D0 and D7, and an association of higher IgG2+ ASCs with lower IL-7Rα expression on ICOS+ cTFH cells at D7. As decline of IL-7Rα expression on CD4+ T cells is an indicator of IL-7Rα signaling, our findings suggest that utilization of IL-7 by cTFH cells affects production of IgG2 antibodies to PPV23 antigens in some HIV patients.
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Affiliation(s)
- Laila N Abudulai
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia.,Centre for Microscopy, Characterisation and Analysis, The University of Western Australia, Perth, WA, Australia
| | - Sonia Fernandez
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Karli Corscadden
- Wesfarmers Centre for Vaccine and Infectious Disease Research, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Lea-Ann Kirkham
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia.,Wesfarmers Centre for Vaccine and Infectious Disease Research, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Michael Hunter
- Department of Infectious Diseases, Royal Victoria Hospital, Belfast, United Kingdom
| | - Jeffrey J Post
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, NSW, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Martyn A French
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia.,UWA Medical School, The University of Western Australia, Perth, WA, Australia
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van den Biggelaar AHJ, Pomat WS, Masiria G, Wana S, Nivio B, Francis J, Ford R, Passey M, Kirkham LA, Jacoby P, Lehmann D, Richmond P. Immunogenicity and Immune Memory after a Pneumococcal Polysaccharide Vaccine Booster in a High-Risk Population Primed with 10-Valent or 13-Valent Pneumococcal Conjugate Vaccine: A Randomized Controlled Trial in Papua New Guinean Children. Vaccines (Basel) 2019; 7:vaccines7010017. [PMID: 30720721 PMCID: PMC6466212 DOI: 10.3390/vaccines7010017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 11/16/2022] Open
Abstract
We investigated the immunogenicity, seroprotection rates and persistence of immune memory in young children at high risk of pneumococcal disease in Papua New Guinea (PNG). Children were primed with 10-valent (PCV10) or 13-valent pneumococcal conjugate vaccines (PCV13) at 1, 2 and 3 months of age and randomized at 9 months to receive PPV (PCV10/PPV-vaccinated, n = 51; PCV13/PPV-vaccinated, n = 52) or no PPV (PCV10/PPV-naive, n = 57; PCV13/PPV-naive, n = 48). All children received a micro-dose of PPV at 23 months of age to study the capacity to respond to a pneumococcal challenge. PPV vaccination resulted in significantly increased IgG responses (1.4 to 10.5-fold change) at 10 months of age for all PPV-serotypes tested. Both PPV-vaccinated and PPV-naive children responded to the 23-month challenge and post-challenge seroprotection rates (IgG ≥ 0.35 μg/mL) were similar in the two groups (80⁻100% for 12 of 14 tested vaccine serotypes). These findings show that PPV is immunogenic in 9-month-old children at high risk of pneumococcal infections and does not affect the capacity to produce protective immune responses. Priming with currently available PCVs followed by a PPV booster in later infancy could offer improved protection to young children at high risk of severe pneumococcal infections caused by a broad range of serotypes.
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Affiliation(s)
- Anita H J van den Biggelaar
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia.
- Division of Paediatrics, School of Medicine, University of Western Australia, Crawley, WA 6009, Australia.
| | - William S Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea.
| | - Geraldine Masiria
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea.
| | - Sandra Wana
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea.
| | - Birunu Nivio
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea.
| | - Jacinta Francis
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea.
| | - Rebecca Ford
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea.
| | - Megan Passey
- School of Public Health, University Centre for Rural Health (USRH), The University of Sydney, Lismore, NSW 2480, Australia.
| | - Lea-Ann Kirkham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia.
- School of Biomedical Sciences, University of Western Australia, Crawley, WA 6009, Australia.
| | - Peter Jacoby
- Centre for Biostatistics, Telethon Kids Institute, Nedlands, WA 6009, Australia.
| | - Deborah Lehmann
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia.
| | - Peter Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia.
- Division of Paediatrics, School of Medicine, University of Western Australia, Crawley, WA 6009, Australia.
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Bhuiyan MU, Snelling TL, West R, Lang J, Rahman T, Borland ML, Thornton R, Kirkham LA, Sikazwe C, Martin AC, Richmond PC, Smith DW, Jaffe A, Blyth CC. Role of viral and bacterial pathogens in causing pneumonia among Western Australian children: a case-control study protocol. BMJ Open 2018; 8:e020646. [PMID: 29549211 PMCID: PMC5857668 DOI: 10.1136/bmjopen-2017-020646] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/27/2017] [Accepted: 02/12/2018] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Pneumonia is the leading cause of childhood morbidity and mortality globally. Introduction of the conjugate Haemophilus influenzae B and multivalent pneumococcal vaccines in developed countries including Australia has significantly reduced the overall burden of bacterial pneumonia. With the availability of molecular diagnostics, viruses are frequently detected in children with pneumonia either as primary pathogens or predispose to secondary bacterial infection. Many respiratory pathogens that are known to cause pneumonia are also identified in asymptomatic children, so the true contribution of these pathogens to childhood community-acquired pneumonia (CAP) remains unclear. Since the introduction of pneumococcal vaccines, very few comprehensive studies from developed countries have attempted to determine the bacterial and viral aetiology of pneumonia. We aim to determine the contribution of bacteria and viruses to childhood CAP to inform further development of effective diagnosis, treatment and preventive strategies. METHODS AND ANALYSIS We are conducting a prospective case-control study (PneumoWA) where cases are children with radiologically confirmed pneumonia admitted to Princess Margaret Hospital for Children (PMH) and controls are healthy children identified from PMH outpatient clinics and from local community immunisation clinics. The case-control ratio is 1:1 with 250 children to be recruited in each arm. Nasopharyngeal swabs are collected from both cases and controls to detect the presence of viruses and bacteria by PCR; pathogen load will be assessed by quantitative PCR. The prevalence of pathogens detected in cases and controls will be compared, the OR of detection and population attributable fraction to CAP for each pathogen will be determined; relationships between pathogen load and disease status and severity will be explored. ETHICS AND DISSEMINATION This study has been approved by the human research ethics committees of PMH, Perth, Australia (PMH HREC REF 2014117EP). Findings will be disseminated at research conferences and in peer-reviewed journals.
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Affiliation(s)
- Mejbah Uddin Bhuiyan
- Division of Paediatrics, Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Thomas L Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Australia
| | - Rachel West
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Jurissa Lang
- PathWest Laboratory Medicine WA, Perth, Australia
| | - Tasmina Rahman
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- Faculty of Health and Medical Sciences, School of Biomedical Science, The University of Western Australia, Perth, Australia
| | - Meredith L Borland
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Australia
| | - Ruth Thornton
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- Faculty of Health and Medical Sciences, School of Biomedical Science, The University of Western Australia, Perth, Australia
| | - Lea-Ann Kirkham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- Faculty of Health and Medical Sciences, School of Biomedical Science, The University of Western Australia, Perth, Australia
| | | | - Andrew C Martin
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Australia
| | - Peter C Richmond
- Division of Paediatrics, Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Australia
| | | | - Adam Jaffe
- Faculty of Medicine, School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Christopher C Blyth
- Division of Paediatrics, Faculty of Health and Medical Sciences, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Australia
- PathWest Laboratory Medicine WA, Perth, Australia
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11
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Lehmann D, Kirarock W, van den Biggelaar AHJ, Passey M, Jacoby P, Saleu G, Masiria G, Nivio B, Greenhill A, Orami T, Francis J, Ford R, Kirkham LA, Solomon V, Richmond PC, Pomat WS. Rationale and methods of a randomized controlled trial of immunogenicity, safety and impact on carriage of pneumococcal conjugate and polysaccharide vaccines in infants in Papua New Guinea. Pneumonia (Nathan) 2017; 9:20. [PMID: 29299402 PMCID: PMC5742486 DOI: 10.1186/s41479-017-0044-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 07/14/2017] [Accepted: 11/16/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Children in third-world settings including Papua New Guinea (PNG) experience early onset of carriage with a broad range of pneumococcal serotypes, resulting in a high incidence of severe pneumococcal disease and deaths in the first 2 years of life. Vaccination trials in high endemicity settings are needed to provide evidence and guidance on optimal strategies to protect children in these settings against pneumococcal infections. METHODS This report describes the rationale, objectives, methods, study population, follow-up and specimen collection for a vaccination trial conducted in an endemic and logistically challenging setting in PNG. The trial aimed to determine whether currently available pneumococcal conjugate vaccines (PCV) are suitable for use under PNG's accelerated immunization schedule, and that a schedule including pneumococcal polysaccharide vaccine (PPV) in later infancy is safe and immunogenic in this high-risk population. RESULTS This open randomized-controlled trial was conducted between November 2011 and March 2016, enrolling 262 children aged 1 month between November 2011 and April 2014. The participants were randomly allocated (1:1) to receive 10-valent PCV (10vPCV) or 13-valent PCV (13vPCV) in a 1-2-3-month schedule, with further randomization to receive PPV or no PPV at age 9 months, followed by a 1/5th PPV challenge at age 23 months. A total of 1229 blood samples were collected to measure humoral and cellular immune responses and 1238 nasopharyngeal swabs to assess upper respiratory tract colonization and carriage load. Serious adverse events were monitored throughout the study. Of the 262 children enrolled, 87% received 3 doses of PCV, 79% were randomized to receive PPV or no PPV at age 9 months, and 67% completed the study at 24 months of age with appropriate immunization and challenge. CONCLUSION Laboratory testing of the many samples collected during this trial will determine the impact of the different vaccine schedules and formulations on nasopharyngeal carriage, antibody production and function, and immune memory. The final data will inform policy on pneumococcal vaccine schedules in countries with children at high risk of pneumococcal disease by providing direct comparison of an accelerated schedule of 10vPCV and 13vPCV and the potential advantages of PPV following PCV immunization. TRIAL REGISTRATION ClinicalTrials.gov CTN NCT01619462, retrospectively registered on May 28, 2012.
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Affiliation(s)
- Deborah Lehmann
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008 Australia
| | - Wendy Kirarock
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | | | - Megan Passey
- The University of Sydney, University Centre for Rural Health, School of Public Health, 61 Uralba Street, Lismore, NSW 2480 Australia
| | - Peter Jacoby
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008 Australia
| | - Gerard Saleu
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | - Geraldine Masiria
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | - Birunu Nivio
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | - Andrew Greenhill
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008 Australia
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
- School of Applied and Biomedical Sciences, Federation University, Northways Road, Churchill, VIC 3842 Australia
| | - Tilda Orami
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | - Jacinta Francis
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | - Rebecca Ford
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | - Lea-Ann Kirkham
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008 Australia
- School of Paediatrics and Child Health, University of Western Australia, Roberts Road, Subiaco, WA 6008 Australia
| | - Vela Solomon
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
| | - Peter C. Richmond
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008 Australia
- School of Paediatrics and Child Health, University of Western Australia, Roberts Road, Subiaco, WA 6008 Australia
| | - William S. Pomat
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008 Australia
- Papua New Guinea Institute of Medical Research, Homate Street, Goroka, Eastern Highlands Province 441 Papua New Guinea
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Jefferies J, Nieminen L, Kirkham LA, Johnston C, Smith A, Mitchell TJ. Identification of a secreted cholesterol-dependent cytolysin (mitilysin) from Streptococcus mitis. J Bacteriol 2006; 189:627-32. [PMID: 17071760 PMCID: PMC1797409 DOI: 10.1128/jb.01092-06] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We have detected a cholesterol-dependent cytolysin, which we have named mitilysin, in a small number of Streptococcus mitis isolates. We have sequenced the mitilysin gene from seven isolates of S. mitis. Comparisons with the pneumococcal pneumolysin gene show 15 amino acid substitutions. S. mitis appear to release mitilysin extracellularly. Certain alleles of mitilysin are not recognized by a monoclonal antibody raised to the related toxin pneumolysin. Based on enzyme-linked immunosorbent assay and neutralization assay results, one isolate of S. mitis may produce a further hemolytic toxin in addition to mitilysin. As genetic exchange is known to occur between S. mitis and Streptococcus pneumoniae, this finding may have implications for the development of vaccines or therapies for pneumococcal disease that are based on pneumolysin.
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Affiliation(s)
- Johanna Jefferies
- Division of Infection and Immunity, Institute of Biomedical and Life Sciences, Glasgow Biomedical Research Centre, University of Glasgow, Glasgow G12 8TA, UK
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Connelly JC, Kirkham LA, Leach DR. The SbcCD nuclease of Escherichia coli is a structural maintenance of chromosomes (SMC) family protein that cleaves hairpin DNA. Proc Natl Acad Sci U S A 1998; 95:7969-74. [PMID: 9653124 PMCID: PMC20913 DOI: 10.1073/pnas.95.14.7969] [Citation(s) in RCA: 185] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Hairpin structures can inhibit DNA replication and are intermediates in certain recombination reactions. We have shown that the purified SbcCD protein of Escherichia coli cleaves a DNA hairpin. This cleavage does not require the presence of a free (3' or 5') DNA end and generates products with 3'-hydroxyl and 5'-phosphate termini. Electron microscopy of SbcCD has revealed the "head-rod-tail" structure predicted for the SMC (structural maintenance of chromosomes) family of proteins, of which SbcC is a member. This work provides evidence consistent with the proposal that SbcCD cleaves hairpin structures that halt the progress of the replication fork, allowing homologous recombination to restore DNA replication.
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Affiliation(s)
- J C Connelly
- Institute of Cell and Molecular Biology, University of Edinburgh, Kings Buildings, Edinburgh EH9 3JR, United Kingdom
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