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Gruninger S, Rasamoelina T, Rakotoarivelo R, Doumbia CO, Lorenz E, van Dam GJ, Schwarz NG, May J, Rakotozandrindrainy R, Fusco D. Schistosomiasis control in adults: a call for action towards the goal of universal health coverage. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.031] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Schistosomiasis is a high-burden parasitic disease and endemic in tropical climates, such as Madagascar. Recently it is emerging in Europe. Chronic infections lead to disabilities including loss in work productivity. Current control strategies focus on school-aged children, thereby systematically excluding adults. The goal to eliminate the disease as a public health problem is aligned with the Sustainable Development Goals agenda, including Universal Health Coverage (UHC). We aim at assessing the distribution of schistosomiasis among adults in Madagascar, in order to promote more targeted public health initiatives against the disease.
Methods
In a cross-sectional study, 1477 blood samples were collected at three primary health-care centers in Madagascar from 03.21 to 01.22. A semi quantitative PCR assay was used to assess the presence of Schistosoma. Positivity rates with 95% Confidence Intervals (CI) were reported by gender and age groups.
Results
Our study population had a balanced gender distribution with 54.2% [CI: 51.7;56.8] of females and a median age of 37 years (IQR: 24-48). Preliminary results show an overall Schistosome positivity rate of 59.5% [CI: 57.0;62.0]. Positivity was higher in males 62.4% [CI: 58.7;66.1], than in females 57.1% [CI: 53.5;60.5]. Highest positivity was seen in the 18-34 year age group with 66.2% [CI: 62.7;69.6]. Lowest positivity of 46.2% [CI: 39.2;53.2] was observed in adults aged over 55 years.
Conclusions
Our preliminary results provide evidence of high positivity rates of schistosomiasis among adults in a highly endemic country. Differently from many studies, males seem more affected than females. The youngest age group, representing the more active workforce of a population, shows a higher positivity rate. Our data suggests that, in the logic of UHC and health as a human right, public health strategies for schistosomiasis need to be re-addressed towards a universal coverage of affected individuals.
Key messages
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Affiliation(s)
- S Gruninger
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine , Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck- Riems, Germany
| | - T Rasamoelina
- Centre d’Infectiologie Charles Mérieux, University of Antananarivo , Antananarivo, Madagascar
| | - R Rakotoarivelo
- Department of Infectious Diseases, University of Fianarantsoa Andrainjato , Fianarantsoa, Madagascar
| | - C Oumar Doumbia
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine , Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck- Riems, Germany
- University Clinical Research Center, University of Sciences Technics and Technologies of Bamako , Bamako, Mali
| | - E Lorenz
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine , Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck- Riems, Germany
| | - GJ van Dam
- Department of Parasitology, Leiden University Medical Center , Leiden, Netherlands
| | - NG Schwarz
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine , Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck- Riems, Germany
| | - J May
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine , Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck- Riems, Germany
| | - R Rakotozandrindrainy
- Department of Microbiology and Parasitology, University of Antananarivo , Antananarivo, Madagascar
| | - D Fusco
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine , Hamburg, Germany
- German Center for Infection Research, Hamburg-Borstel-Lübeck- Riems, Germany
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Schotte U, Hoffmann T, Schwarz NG, Rojak S, Lusingu J, Minja D, Kaseka J, Mbwana J, Gesase S, May J, Dekker D, Frickmann H. Study of enteric pathogens among children in the tropics and effects of prolonged storage of stool samples. Lett Appl Microbiol 2021; 72:774-782. [PMID: 33544912 DOI: 10.1111/lam.13457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/13/2021] [Accepted: 01/28/2021] [Indexed: 12/11/2022]
Abstract
The study was performed to compare real-time PCR after nucleic acid extraction directly from stool samples as well as from samples stored and transported on Whatman papers or flocked swabs at ambient temperature in the tropics. In addition, the possible suitability for a clear determination of likely aetiological relevance of PCR-based pathogen detections based on cycle threshold (Ct) values was assessed. From 632 Tanzanian children <5 years of age with and without gastrointestinal symptoms, 466 samples were subjected to nucleic acid extraction and real-time PCR for gastrointestinal viral, bacterial and protozoan pathogens. Equal or even higher frequencies of pathogen detections from Whatman papers or flocked swabs were achieved compared with nucleic acid extraction directly from stool samples. Comparison of the Ct values showed no significant difference according to the nucleic acid extraction strategy. Also, the Ct values did not allow a decision whether a detected pathogen was associated with gastrointestinal symptoms.
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Affiliation(s)
- U Schotte
- Department A - Veterinary Medicine, Central Institute of the Bundeswehr Medical Service Kiel, Kronshagen, Germany
| | - T Hoffmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Hamburg, Germany
| | - N G Schwarz
- Infectious Disease Epidemiology Department, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | - S Rojak
- Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
| | - J Lusingu
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - D Minja
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - J Kaseka
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - J Mbwana
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - S Gesase
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - J May
- Infectious Disease Epidemiology Department, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | - D Dekker
- Infectious Disease Epidemiology Department, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | - H Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Hamburg, Germany.,Department of Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
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Hoekstra PT, Schwarz NG, Adegnika AA, Andrianarivelo MR, Corstjens PLAM, Rakotoarivelo RA, Rakotozandrindrainy R, Sicuri E, Kreidenweiss A, van Dam GJ. Fast and reliable easy-to-use diagnostics for eliminating bilharzia in young children and mothers: An introduction to the freeBILy project. Acta Trop 2020; 211:105631. [PMID: 32679109 DOI: 10.1016/j.actatropica.2020.105631] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 02/15/2020] [Revised: 06/24/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
Schistosoma antigen detection tests have a large potential for schistosomiasis control programs due to their ability to detect active and ongoing Schistosoma infections, their much higher sensitivity compared to microscopical methods, and the possibility to use non-invasive urine samples. Pregnant women and young children could especially benefit from affordable and easy-to-use antigen tests as inclusion of these vulnerable groups in mass drug administration campaigns will always require higher justification hurdles, especially in low to middle endemic regions with a higher proportion of individuals who are not infected and thus unnecessarily exposed to praziquantel. The overall objective of the 'fast and reliable easy-to-use diagnostics for eliminating bilharzia in young children and mothers' (freeBILy, www.freeBILy.eu) project is to thoroughly evaluate the point-of-care circulating cathodic antigen (POC-CCA) and the up-converting phosphor reporter particle, lateral flow circulating anodic antigen (UCP-LF CAA) urine strip tests to diagnose Schistosoma infections in pregnant women and young children and to assess their potential as a schistosomiasis control tool in test-and-treat strategies. The freeBILy project will generate valuable, evidence-based findings on improved tools and test-and-treat strategies to reduce the burden of schistosomiasis in pregnant women and young children.
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Affiliation(s)
- Pytsje T Hoekstra
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Norbert G Schwarz
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg, Germany; German Center for Infection Research, Germany
| | - Ayola A Adegnika
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands; German Center for Infection Research, Germany; Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon; Eberhard Karls Universität Tübingen, Tübingen, Germany
| | | | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Elisa Sicuri
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Andrea Kreidenweiss
- German Center for Infection Research, Germany; Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
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Honkpehedji YJ, Adegnika AA, Dejon-Agobe JC, Zinsou JF, Mba RB, Gerstenberg J, Rakotozandrindrainy R, Rakotoarivelo RA, Rasamoelina T, Sicuri E, Schwarz NG, Corstjens PLAM, Hoekstra PT, van Dam GJ, Kreidenweiss A. Prospective, observational study to assess the performance of CAA measurement as a diagnostic tool for the detection of Schistosoma haematobium infections in pregnant women and their child in Lambaréné, Gabon: study protocol of the freeBILy clinical trial in Gabon. BMC Infect Dis 2020; 20:718. [PMID: 32993559 PMCID: PMC7523491 DOI: 10.1186/s12879-020-05445-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Schistosoma antigen detection in urine is a valuable diagnostic approach for schistosomiasis control programmes because of the higher sensitivity compared to parasitological methods and preferred sampling of urine over stool. Highly accurate diagnostics are important in low Schistosoma transmission areas. Pregnant women and young children could particularly benefit from antigen testing as praziquantel (PZQ) can be given to only confirmed Schistosoma cases. This prevents the unborn baby from unnecessary exposure to PZQ. We present here the protocol of a diagnostic study that forms part of the freeBILy project. The aim is to evaluate the accuracy of circulating anodic antigen (CAA) detection for diagnosis of Schistosoma haematobium infections in pregnant women and to validate CAA as an endpoint measure for anti-Schistosoma drug efficacy. The study will also investigate Schistosoma infections in infants. METHODS A set of three interlinked prospective, observational studies is conducted in Gabon. The upconverting phosphor lateral flow (UCP-LF) CAA test is the index diagnostic test that will be evaluated. The core trial, sub-study A, comprehensively evaluates the accuracy of the UCP-LF CAA urine test against a set of other Schistosoma diagnostics in a cross-sectional trial design. Women positive for S. haematobium will proceed with sub-study B and will be randomised to receive PZQ treatment immediately or after delivery followed by weekly sample collection. This approach includes comparative monitoring of CAA levels following PZQ intake and will also contribute further data for safety of PZQ administration during pregnancy. Sub-study C is a longitudinal study to determine the incidence of S. haematobium infection as well as the age for first infection in life-time. DISCUSSION The freeBILy trial in Gabon will generate a comprehensive set of data on the accuracy of the UCP-LF CAA test for the detection of S. haematobium infection in pregnant women and newborn babies and for the use of CAA as a marker to determine PZQ efficacy. Furthermore, incidence of Schistosoma infection in infants will be reported. Using the ultrasensitive diagnostics, this information will be highly relevant for Schistosoma prevalence monitoring by national control programs as well as for the development of medicaments and vaccines. TRIAL REGISTRATION The registration number of this study is NCT03779347 ( clinicaltrials.gov , date of registration: 19 December 2018).
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Affiliation(s)
- Yabo Josiane Honkpehedji
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ayôla Akim Adegnika
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
- German Center for Infection Research (DZIF), Tübingen, Germany
| | - Jean Claude Dejon-Agobe
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
- Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeannot Fréjus Zinsou
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Romuald Beh Mba
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Jacob Gerstenberg
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | | | | | | | - Elisa Sicuri
- Fundación Privada Instituto de Salud Global Barcelona, Barcelona, Spain
| | | | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Pytsje T Hoekstra
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Andrea Kreidenweiss
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany.
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands.
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Hahn A, Loderstädt U, Frickmann H, Schwarz NG. Sparing the control arm using well-characterized diagnostic approaches – the Gart and Buck prevalence estimator for efficacy estimation in single-arm trials. J LAB MED 2019. [DOI: 10.1515/labmed-2019-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Efficacy estimation of medical interventions in clinical trials requires diagnostics to assess the study endpoint. The imperfect nature of diagnostics often leads to biased efficacy estimations, usually underestimation, that could result in failure of clinical trials. Adjustment methods can be used if sensitivity and specificity are known, but they are not regularly applied. Double-arm clinical trials are the standard for demonstrating the superiority of a medical intervention. However, sometimes single-arm trials are the only option: for example, if a parallel group trial design with a control group is regarded as unethical. Based on the Gart and Buck prevalence estimator (aka the Rogan-Gladen estimator), we demonstrate how the concept of diagnostic accuracy-adjusted effect estimation can be used for estimating the efficacy in single-arm trials. The accuracy of the diagnostic measure (sensitivity and specificity) used for endpoint assessment as well as the predictive accuracy of a predictor and its allocation among the study population have to be known to obtain consistent efficacy estimation of a medical intervention. If double-arm trials are not feasible, an approach such as that described here can provide evidence regarding the efficacy of a medical intervention based on a single-arm trial.
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Frickmann H, Wegner C, Ruben S, Behrens C, Kollenda H, Hinz R, Rojak S, Schwarz NG, Hagen RM, Tannich E. Evaluation of the multiplex real-time PCR assays RealStar malaria S&T PCR kit 1.0 and FTD malaria differentiation for the differentiation of Plasmodium species in clinical samples. Travel Med Infect Dis 2019; 31:101442. [PMID: 31255712 DOI: 10.1016/j.tmaid.2019.06.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 01/05/2019] [Revised: 06/20/2019] [Accepted: 06/26/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Two commercial PCR assays were assessed in a retrospective study to determine their reliability as tools for the differentiation of Plasmodium species in human blood. METHODS A total of 1022 blood samples from 817 patients with suspected or confirmed malaria submitted to the German National Reference Centre for Tropical Pathogens were subjected to malaria microscopy using thick and thin blood films as well as to a genus-specific malaria real-time PCR. Parasite-positive samples were analysed by RealStar Malaria S&T PCR Kit 1.0 (altona Diagnostics) and FTD Malaria Differentiation (Fast Track Diagnostics) multiplex real-time PCR assays targeting species-specific Plasmodium DNA. RESULTS Out of the 1022 blood samples, 247 (24.2%) tested positive for Plasmodium spp. The two multiplex assays showed rather similar performance characteristics and provided concordant species information in 98.9% of samples positive by malaria microscopy and in 95.1% (RealStar) and 96.8% (FTD) of samples positive by genus-specific PCR. Compared to FTD, RealStar revealed slightly reduced sensitivity for submicroscopic, low-level P. falciparum infections, while FTD was unable to detect P. knowlesi. CONCLUSIONS The two commercial malaria PCR assays assessed are suitable for discriminating Plasmodium species in clinical samples, and can provide additional information in cases of microscopically uncertain findings.
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Affiliation(s)
- Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, Tropical Microbiology and Entomology Unit, Bundeswehr Hospital Hamburg, Hamburg, Germany; Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany.
| | - Christine Wegner
- National Reference Centre for Tropical Pathogens, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Stefanie Ruben
- National Reference Centre for Tropical Pathogens, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Christoph Behrens
- National Reference Centre for Tropical Pathogens, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Hans Kollenda
- Department of Microbiology and Hospital Hygiene, Tropical Microbiology and Entomology Unit, Bundeswehr Hospital Hamburg, Hamburg, Germany
| | - Rebecca Hinz
- Department of Microbiology and Hospital Hygiene, Tropical Microbiology and Entomology Unit, Bundeswehr Hospital Hamburg, Hamburg, Germany
| | - Sandra Rojak
- Department of Microbiology and Hospital Hygiene, Tropical Microbiology and Entomology Unit, Bundeswehr Hospital Hamburg, Hamburg, Germany; Department of Infectious Diseases and Tropical Medicine, Bundeswehr Hospital Hamburg, Hamburg, Germany
| | - Norbert G Schwarz
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Ralf Matthias Hagen
- Department of Preventive Medicine, Bundeswehr Medical Academy, Munich, Germany
| | - Egbert Tannich
- National Reference Centre for Tropical Pathogens, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
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Frickmann H, Hanke M, Hahn A, Schwarz NG, Landt O, Moter A, Kikhney J, Hinz R, Rojak S, Dekker D, Tannich E, Podbielski A. Detection of Tropheryma whipplei in stool samples by one commercial and two in-house real-time PCR assays. Trop Med Int Health 2018; 24:101-108. [PMID: 30347125 DOI: 10.1111/tmi.13172] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Tropheryma whipplei, the causative agent of Whipple's disease, can also be identified in stool samples of humans without systemic disease. It is much more frequently detected in human stool samples in tropical environments than in industrialized countries. PCR-screening has been applied for point prevalence studies and environmental assessments in tropical settings, but results depend on the applied assay. We compared one commercial qPCR kit with two well-described in-house assays for detection of T. whipplei from stool. METHODS Residual materials from nucleic acid extractions of stool samples from two groups with presumably different prevalences and increased likelihood of being colonized or infected by T. whipplei were tested. One group comprised 300 samples from study participants from western Africa (group 1); the second group was of 300 returnees from tropical deployments (group 2). Each sample was assessed with all three qPCR assays. Cycle threshold (Ct ) values were descriptively compared. RESULTS Based solely on mathematical modeling, the three PCR assays showed considerably different detection rates of T. whipplei DNA in stool samples (kappa 0.67 (95% confidence interval [0.60, 0.73])). Considering the calculated test characteristics, prevalence of 28.3% for group 1 and 5.0% for group 2 was estimated. Discordant test results were associated with later Ct values. The study did not validate the assays for the detection of T. whipplei in Whipple's disease and for diagnostic purposes since clinical specificity and sensitivity were not investigated. CONCLUSIONS In spite of the observed diagnostic uncertainty, PCR-based screening approaches can be used for epidemiological purposes and environmental samples to define the source and reservoir in resource-limited tropical settings if prevalence is calculated using diagnostic accuracy-adjusted methods.
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Affiliation(s)
- Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Hamburg, Germany.,Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Miriam Hanke
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Andreas Hahn
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Norbert G Schwarz
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | | | - Annette Moter
- Institute for Microbiology, Charité - University Medicine Berlin, Berlin, Germany.,Biofilmcenter, German Heart Institute Berlin, Berlin, Germany
| | - Judith Kikhney
- Institute for Microbiology, Charité - University Medicine Berlin, Berlin, Germany.,Biofilmcenter, German Heart Institute Berlin, Berlin, Germany
| | - Rebecca Hinz
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Hamburg, Germany
| | - Sandra Rojak
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Hamburg, Germany.,Department of Tropical Medicine and Infectious Disease, Bundeswehr Hospital Hamburg, Hamburg, Germany
| | - Denise Dekker
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | - Egbert Tannich
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Andreas Podbielski
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
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Hahn A, Schwarz NG, Meyer T, Frickmann H. PCR-based rapid diagnostic tests as a strategy for preventing infections with sexually transmitted diseases-a 'diagnostics-as-prevention' modelling approach. Lett Appl Microbiol 2018; 67:420-424. [PMID: 30074254 DOI: 10.1111/lam.13059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 02/10/2018] [Revised: 07/13/2018] [Accepted: 07/31/2018] [Indexed: 12/18/2022]
Abstract
The potential was modelled of molecular rapid diagnostic tests (RDTs) that target agents of sexually transmitted diseases (STDs) to contribute to a reduction in the exposure risk for sexually active populations who prefer condom-free high-risk contacts. The biostatistical approach is exemplified by considering the use of a PCR-based RDT for Chlamydia trachomatis and Neisseria gonorrhoeae in a population of German men having sex with men. We modelled the exposure risk as risk of sexual contact with individuals infected by a STD in spite of multiple RDTs having been conducted to identify STDs that could lead to avoidance of an infectious sexual contact. The risk for a given specific disease is influenced by the diagnostic accuracy of all diagnostic tests conducted. The simulation showed a reduction in exposure risk through conducting the selected PCR-based RDT as a strategy to prevent infections with C. trachomatis and N. gonorrhoeae in comparison with unprotected sexual contact of >97% for C. trachomatis and ≥96% for N. gonorrhoeae. Reliable knowledge of the performance characteristics of the diagnostic tests applied is essential for a thorough risk assessment based on such diagnostic approaches. SIGNIFICANCE AND IMPACT OF THE STUDY A low-threshold use of molecular rapid diagnostic tests in settings where risky sexual activity is undertaken with deliberate non-use of condoms is modelled. Such an approach might contribute to a considerable reduction in the exposure risk if positively tested individuals are excluded from unprotected sexual intercourse. Protective effects are influenced by the prevalence of the disease and the performance characteristics of the applied tests. Precise knowledge of the performance characteristics of the test assays employed are prerequisites of a reliable risk assessment. The modelling approach is of particular use for preventive health experts.
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Affiliation(s)
- A Hahn
- Institute for Microbiology, Charité - University Medicine Berlin, Berlin, Germany
| | - N G Schwarz
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | - T Meyer
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Frickmann
- Department of Tropical Medicine at the Bernhard Nocht Institute, Bundeswehr Hospital Hamburg, Hamburg, Germany.,Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
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9
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Frickmann H, Schwarz NG, Hahn A, Ludyga A, Warnke P, Podbielski A. Comparing a single-day swabbing regimen with an established 3-day protocol for MRSA decolonization control. Clin Microbiol Infect 2017; 24:522-527. [PMID: 28870730 DOI: 10.1016/j.cmi.2017.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/20/2017] [Revised: 08/15/2017] [Accepted: 08/24/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Success of methicillin-resistant Staphylococcus aureus (MRSA) decolonization procedures is usually verified by control swabs of the colonized body region. This prospective controlled study compared a single-day regimen with a well-established 3-day scheme for noninferiority and adherence to the testing scheme. METHODS Two sampling schemes for screening MRSA patients of a single study cohort at a German tertiary-care hospital 2 days after decolonization were compared regarding their ability to identify MRSA colonization in throat or nose. In each patient, three nose and three throat swabs were taken at 3- to 4-hour intervals during screening day 1, and in the same patients once daily on days 1, 2 and 3. Swabs were analysed using chromogenic agar and broth enrichment. The study aimed to investigate whether the single-day swabbing scheme is not inferior to the 3-day scheme with a 15% noninferiority margin. RESULTS One hundred sixty patients were included, comprising 105 and 101 patients with results on all three swabs for decolonization screening of the nose and throat, respectively. Noninferiority of the single-day swabbing scheme was confirmed for both pharyngeal and nasal swabs, with 91.8% and 89% agreement, respectively. The absolute difference of positivity rates between the swabbing regimens was 0.025 (-0.082, 0.131) for the nose and 0.006 (-0.102, 0.114) (95% confidence interval) for the pharynx as calculated with McNemar's test for matched or paired data. Compliance with the single-day scheme was better, with 12% lacking second-day swabs and 27% lacking third-day swabs from the nostrils. CONCLUSIONS The better adherence to the single-day screening scheme with noninferiority suggests its implementation as the new gold standard.
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Affiliation(s)
- H Frickmann
- Department of Tropical Medicine at the Bernhard Nocht Institute, Bundeswehr Hospital Hamburg, Germany; Institute for Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany.
| | - N G Schwarz
- Infectious Disease Epidemiology Working Group, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany
| | - A Hahn
- Takeda Pharma Vertrieb GmbH & Co. KG, Berlin, Germany
| | | | - P Warnke
- Institute for Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - A Podbielski
- Institute for Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
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Hinz R, Schwarz NG, Hahn A, Frickmann H. Serological approaches for the diagnosis of schistosomiasis - A review. Mol Cell Probes 2016; 31:2-21. [PMID: 27986555 DOI: 10.1016/j.mcp.2016.12.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 11/28/2016] [Accepted: 12/12/2016] [Indexed: 01/14/2023]
Abstract
Schistosomiasis is a common disease in endemic areas of Sub-Saharan Africa, South America and Asia. It is rare in Europe, mainly imported from endemic countries due to travelling or human migration. Available methods for the diagnosis of schistosomiasis comprise microscopic, molecular and serological approaches, with the latter detecting antigens or antibodies associated with Schistosoma spp. infection. The serological approach is a valuable screening tool in low-endemicity settings and for travel medicine, though the interpretation of any diagnostic results requires knowledge of test characteristics and a patient's history. Specific antibody detection by most currently used assays is only possible in a relatively late stage of infection and does not allow for the differentiation of acute from previous infections for therapeutic control or the discrimination between persisting infection and re-infection. Throughout the last decades, new target antigens have been identified, and assays with improved performance and suitability for use in the field have been developed. For numerous assays, large-scale studies are still required to reliably characterise assay characteristics alone and in association with other available methods for the diagnosis of schistosomiasis. Apart from S. mansoni, S. haematobium and S. japonicum, for which most available tests were developed, other species of Schistosoma that occur less frequently need to be taken into account. This narrative review describes and critically discusses the results of published studies on the evaluation of serological assays that detect antibodies against different Schistosoma species of humans. It provides insights into the diagnostic performance and an overview of available assays and their suitability for large-scale use or individual diagnosis, and thus sets the scene for serological diagnosis of schistosomiasis and the interpretation of results.
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Affiliation(s)
- Rebecca Hinz
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Germany; Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital Hamburg, Germany.
| | | | - Andreas Hahn
- Takeda Pharma Vertrieb GmbH & Co. KG, Berlin, Germany
| | - Hagen Frickmann
- Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital Hamburg, Germany; Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Germany
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Dekker D, Wolters M, Mertens E, Boahen KG, Krumkamp R, Eibach D, Schwarz NG, Adu-Sarkodie Y, Rohde H, Christner M, Marks F, Sarpong N, May J. Antibiotic resistance and clonal diversity of invasive Staphylococcus aureus in the rural Ashanti Region, Ghana. BMC Infect Dis 2016; 16:720. [PMID: 27899074 PMCID: PMC5129674 DOI: 10.1186/s12879-016-2048-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/18/2016] [Indexed: 01/23/2023] Open
Abstract
Background Staphylococcus aureus is among the most common pathogens isolated from blood cultures in Ghana; yet the epidemiology of blood infections in rural settings is poorly described. This study aims to investigate antimicrobial susceptibility and clonal diversity of S. aureus causing bloodstream infections in two hospitals in the Ashanti Region, Ghana. Methods Blood cultures were performed for all febrile patients (≥37.5 °C) on hospital admission. Antibiotic susceptibility testing for S. aureus isolates was carried out by the VITEK 2 system. Multiplex polymerase chain reaction (PCR) was used to detect S. aureus-specific nuc gene, Panton-Valentine leukocidin (PVL), and methicillin-resistant S. aureus (MRSA)-specific mecA and mecC genes. The population structure of S. aureus was assessed by spa typing. Results In total, 9,834 blood samples were cultured, out of which 0.6% (n = 56) were positive for S. aureus. Multidrug resistance (MDR) was detected in 35.7% (n = 20) of the S. aureus strains, of which one was a MRSA. The highest rate of antibiotic resistance was seen for commonly available antibiotics, including penicillin (n = 55; 98.2%), tetracycline (n = 32; 57.1%) and trimethoprim/sulfamethoxazole (n = 26; 46.4%). Of all S. aureus strains, 75.0% (n = 42) carried the PVL-encoding genes. We found 25 different spa types with t355 (n = 11; 19.6%), t314 (n = 8; 14.3%), t084 (n = 8; 14.3%) and t311 (n = 5; 8.9%) being predominant. Conclusion The study exhibited an alarmingly large level of antibiotic resistance to locally available antibiotics. The frequency of genetically diverse and PVL-positive methicillin-sensitive S. aureus (MSSA) was high and could represent a reservoir for the emergence of virulent PVL-positive MRSA clones.
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Affiliation(s)
- Denise Dekker
- Bernhard Nocht Institute for Tropical Medicine (BNITM), Research Group Infectious Disease Epidemiology, Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany. .,German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck, Hamburg, Germany.
| | - Manuel Wolters
- University Medical Centre Hamburg-Eppendorf (UKE), Martinistr.52, D-20246, Hamburg, Germany
| | - Eva Mertens
- Bernhard Nocht Institute for Tropical Medicine (BNITM), Research Group Infectious Disease Epidemiology, Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany.,German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck, Hamburg, Germany
| | - Kennedy Gyau Boahen
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana
| | - Ralf Krumkamp
- Bernhard Nocht Institute for Tropical Medicine (BNITM), Research Group Infectious Disease Epidemiology, Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany.,German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck, Hamburg, Germany
| | - Daniel Eibach
- Bernhard Nocht Institute for Tropical Medicine (BNITM), Research Group Infectious Disease Epidemiology, Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany
| | - Norbert G Schwarz
- Bernhard Nocht Institute for Tropical Medicine (BNITM), Research Group Infectious Disease Epidemiology, Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany
| | - Yaw Adu-Sarkodie
- Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Holger Rohde
- University Medical Centre Hamburg-Eppendorf (UKE), Martinistr.52, D-20246, Hamburg, Germany
| | - Martin Christner
- University Medical Centre Hamburg-Eppendorf (UKE), Martinistr.52, D-20246, Hamburg, Germany
| | - Florian Marks
- International Vaccine Institute (IVI), Seoul, Republic of Korea
| | - Nimako Sarpong
- Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Kumasi, Ghana
| | - Jürgen May
- Bernhard Nocht Institute for Tropical Medicine (BNITM), Research Group Infectious Disease Epidemiology, Bernhard-Nocht-Str. 74, D-20359, Hamburg, Germany.,German Centre for Infection Research (DZIF), Hamburg-Borstel-Lübeck, Hamburg, Germany
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Ehlkes L, Kreuels B, Schwarz NG, May J. [Epidemiology of Ebola virus disease and of other highly contagious, life-threatening diseases with low incidence in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 58:705-13. [PMID: 25997608 PMCID: PMC7080030 DOI: 10.1007/s00103-015-2165-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Das Vorkommen von Ebolafieber, der Marburgvirus-Krankheit sowie von Lassa-Fieber ist – abgesehen von vereinzelten eingeschleppten Fällen – auf den afrikanischen Kontinent beschränkt. Hämorrhagisches Krim-Kongo-Fieber kommt in Südosteuropa, jedoch bisher nicht in Deutschland vor. Weitere hämorrhagische Fiebererkrankungen sind regional auf dem südamerikanischen Kontinent verbreitet. Die Lungenpest ist die bakterielle Infektionskrankheit mit der höchsten Kontagiösität und Letalität und ist vor allem in Madagaskar und Ostafrika, aber auch in vielen anderen Ländern beheimatet, wie z. B. in Indien und in den USA. Affenpocken haben in entlegenen Regionen des Kongobeckens zu Ausbrüchen geführt, die sich in Zukunft aufgrund der nicht mehr durchgeführten Pockenimpfung häufen könnten. Das 2002/2003 neu aufgetretene Severe Acute Respiratory Syndrome (SARS) ist eine weitere Erkrankung mit hohem epidemischen Potenzial. Typisch für diese hochkontagiösen Erreger ist, dass sie meist unerkannt zwischen Reservoirtieren abseits des Menschen zirkulieren. Durch sporadischen Kontakt zwischen infizierten Tieren und dem Menschen können diese übertragen werden. Die dann folgende Mensch-zu-Mensch-Übertragung kann zu ausgedehnten Epidemien, wie dem derzeitigen Ausbruch des Ebolafiebers in Westafrika, führen.
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Affiliation(s)
- L Ehlkes
- Arbeitsgruppe Infektionsepidemiologie, Bernhard-Nocht-Institut für Tropenmedizin (BNITM), Bernhard-Nocht-Str. 74, 20359, Hamburg, Deutschland
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Gabor JJ, Schwarz NG, Esen M, Kremsner PG, Grobusch MP. Influenza A and Parvovirus B19 Seropositivity Rates in Gabonese Infants. Am J Trop Med Hyg 2015; 93:407-9. [PMID: 26055747 DOI: 10.4269/ajtmh.14-0558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/19/2014] [Indexed: 12/13/2022] Open
Abstract
Clinical and epidemiological data from Central Africa on influenza A and parvovirus B19 infections are limited. We analyzed 162 blood samples of infants 3, 9, 15, and 30 months of age for IgG antibodies against both pathogens. Antibody responses were 0, 3.7%, 12.3%, and 20.4% against influenza A; and 1.2%, 2.5%, 3.1%, and 9.3% against parvovirus B19, respectively. Seropositivity rates were 89.5 (95% confidence interval [CI]: 59-120.1) and 38.2 (95% CI: 18.9-57.6)/1,000 person-years at risk for influenza A and parvovirus B19, respectively. Our data add to the understanding of the epidemiology of both conditions.
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Affiliation(s)
- Julian J Gabor
- Medical Research Center (CERMEL), Lambaréné, Gabon; Institute for Tropical Medicine, University of Tübingen, Germany; Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Norbert G Schwarz
- Medical Research Center (CERMEL), Lambaréné, Gabon; Institute for Tropical Medicine, University of Tübingen, Germany; Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Meral Esen
- Medical Research Center (CERMEL), Lambaréné, Gabon; Institute for Tropical Medicine, University of Tübingen, Germany; Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Peter G Kremsner
- Medical Research Center (CERMEL), Lambaréné, Gabon; Institute for Tropical Medicine, University of Tübingen, Germany; Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Martin P Grobusch
- Medical Research Center (CERMEL), Lambaréné, Gabon; Institute for Tropical Medicine, University of Tübingen, Germany; Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
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Maïga-Ascofaré O, Rakotozandrindrainy R, Girmann M, Hahn A, Randriamampionona N, Poppert S, May J, Schwarz NG. Molecular epidemiology and seroprevalence in asymptomatic Plasmodium falciparum infections of Malagasy pregnant women in the highlands. Malar J 2015; 14:188. [PMID: 25935753 PMCID: PMC4432997 DOI: 10.1186/s12936-015-0704-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 12/05/2014] [Accepted: 04/22/2015] [Indexed: 11/29/2022] Open
Abstract
Background Malaria epidemiology in Madagascar is classified into four different areas, ranging from unstable seasonal transmission in the highlands to hyperendemic perennial transmission areas in the costal level. Most malaria studies in Madagascar are focused on symptomatic children. However, because of the low transmission in some areas with correspondingly low level of semi-immunity, adults are also at risk, in particular pregnant women. The objective of this study was to gain information on the genetic epidemiology of malarial infections in pregnant women in order to provide information for malaria control and elimination programmes in Madagascar. Methods Between May and August 2010, we carried out cross-sectional surveys targeting healthy pregnant women in six locations, three in the coastal area and three in the highlands at 850–1300 m. 1244 blood samples were screened for anti-Plasmodium falciparum antibodies by immunofluorescence test and for malarial infection by realtime-PCR. The prevalence of chloroquine and sulphadoxine-pyrimethamine resistance markers was also determined in all Plasmodium falciparum samples by PCR-RFLP as well as the multiplicity of infection through genotyping six neutral microsatellites. Results In the highlands, 67.4% of the women presented antibodies against Plasmodium falciparum and 9.2% were carrying parasites, at the coast 95.6% and 14.8%, respectively. In the mean, 1.2 clones were detected in infected pregnant woman in the highlands and 1.5 at the coast. A higher level of monoclonal infections was found in the highlands (85.4%) compared to the coast (61.8%). Resistance markers for sulphadoxine-pyrimethamine were present only in two sites. Conclusion Immunity is triggered in Malagasy highland populations when they are infected with malaria parasites, but these populations could also serve as a reservoir for epidemics. Electronic supplementary material The online version of this article (doi:10.1186/s12936-015-0704-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Mirko Girmann
- Bernhard-Nocht Institute for Tropical Medicine, Hamburg, Germany.
| | - Andreas Hahn
- Bernhard-Nocht Institute for Tropical Medicine, Hamburg, Germany.
| | | | | | - Jürgen May
- Bernhard-Nocht Institute for Tropical Medicine, Hamburg, Germany.
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Frickmann H, Schwarz NG, Rakotozandrindrainy R, May J, Hagen RM. PCR for enteric pathogens in high-prevalence settings. What does a positive signal tell us? Infect Dis (Lond) 2015; 47:491-8. [PMID: 25761823 DOI: 10.3109/23744235.2015.1022212] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Molecular methods, in particular PCR, are increasingly used for the diagnosis of enteric pathogens in stool samples. In high-endemicity settings, however, asymptomatic carriage or residual DNA from previous infections will hamper the interpretation of positive test results. We assessed the quantitative dimension of this problem in schoolchildren in the rural highlands of Madagascar. METHODS Stool samples were collected from 410 apparently healthy Madagascan schoolchildren and analysed by multiplex real-time PCR for enteroinvasive bacteria (Salmonella spp., Shigella spp./enteroinvasive Escherichia coli (EIEC), Campylobacter jejuni, Yersinia spp.), enteric protozoa (Entamoebea histolytica, Giardia duodenalis, Cryptosporidium spp., Cyclospora spp.), and helminths (Ascaris lumbricoides, Ancylostoma spp., Necator americanus, Strongyloides stercoralis). Symptoms of gastrointestinal disease were assessed. RESULTS Among the 410 samples, we detected Giardia duodenalis in 195, Campylobacter jejuni in 91, Ascaris lumbricoides in 72, Cyclospora cayetanenesis in 68, Shigella spp./EIEC in 56, and Strongyloides stercoralis and Cryptosporum spp. in 1 case each. Salmonella spp., Yersinia spp. and hookworms were not observed. Relative risk assessment suggested few and incoherent associations with pathogen detections, indicating asymptomatic carriage or DNA residuals. Only 26.1% of the schoolchildren were tested negative for all analysed pathogens. CONCLUSIONS The very high risk of detecting traces of asymptomatic carriage or residual DNA from previous infections limits the value of highly sensitive PCR for the causal attribution of detected enteric pathogens from stool samples to an infectious gastrointestinal disease in the high-endemicity setting. Evaluated standards for the interpretation of such results are needed both for the diagnostic routine and for epidemiological assessments.
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Affiliation(s)
- Hagen Frickmann
- From the Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg , Hamburg , Germany
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Schwarz NG, Rakotozandrindrainy R, Heriniaina JN, Randriamampionona N, Hahn A, Hogan B, Frickmann H, Dekker D, Poppert S, Razafindrabe T, Rakotondrainiarivelo JP, May J, Hagen RM. Schistosoma mansoni in schoolchildren in a Madagascan highland school assessed by PCR and sedimentation microscopy and Bayesian estimation of sensitivities and specificities. Acta Trop 2014; 134:89-94. [PMID: 24657847 DOI: 10.1016/j.actatropica.2014.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 02/25/2014] [Accepted: 03/08/2014] [Indexed: 11/25/2022]
Abstract
Madagascar is an endemic area for schistosomiasis, but recent prevalence data are scarce. We investigated stool samples of 410 children aged 4-18 years from a combined primary and secondary school in a Madagascan highland village near Ambositra in order to assess the prevalence of Schistosoma mansoni using microscopy and real-time polymerase chain reaction (PCR). A high prevalence of S. mansoni of 77.1% was detected by PCR, while only 15.2% of microscopic examinations of sedimentation-enriched stools were positive. We estimated the sensitivity and specificity of stool sedimentation microscopy (19.7% and 98.8%) and of PCR (98.9% and 89.3%) using a Bayesian approach for two dependant tests in one population without a reference standard. Our Bayesian posterior estimate of the prevalence is 80.2%. Simple sedimentation technique misses about 4/5 of all PCR-confirmed infections and is insufficient to determine the prevalence of S. mansoni. A survey comparing PCR with a classical standard technique (KatoKatz) is desirable.
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Frickmann H, Podbielski A, Essig A, Schwarz NG, Zautner AE. Difficulties in species identification within the genus Haemophilus - A pilot study addressing a significant problem for routine diagnostics. Eur J Microbiol Immunol (Bp) 2014; 4:99-105. [PMID: 24883195 DOI: 10.1556/eujmi.4.2014.2.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 02/06/2014] [Indexed: 11/19/2022] Open
Abstract
Diagnostic misidentifications of commensalic Haemophilus haemolyticus as pathogenic Haemophilus influenzae are frequent. This pilot study evaluates whether isolations of H. haemolyticus are frequent enough in Germany to cause a relevant diagnostic problem, considering the fact that even H. influenzae is a mere colonizer in about 30% of isolations. In microbiological laboratories of two hospitals located in Northern and Southern Germany, the distribution of Haemophilus spp. was analyzed during a six-month-period. Site of infection, sex, and age of the patients was taken into consideration. A total of 77 Haemophilus spp. isolates was acquired and discriminated on species level, comprising: 48 H. influenzae, 25 Haemophilus parainfluenzae, 3 H. haemolyticus, and 1 Haemophilus parahaemolyticus. The proportion of H. haemolyticus was calculated to range between 1.2% and 16.2 % within the 95% confidence limits. Commensalic Haemophilus spp. were isolated from oropharynx-associated sites only. H. influenzae, in contrast, was detected in clinically relevant materials like lower respiratory materials and conjunctiva swabs. Altogether, there was a low proportion of clinical H. haemolyticus isolates. Accordingly, the problem of unnecessary antibiotic therapies due to misidentifications of H. haemolyticus as H. influenzae is quantitatively negligible compared with the risk of confusing H. influenzae colonizations with infections.
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Schwarz NG, Kreuels B, Stark K, Frank C, Schmidt-Chanasit J. Authors reply: Diagnosis of a single imported dengue case who had travelled to Japan – how serious is it for travellers? Euro Surveill 2014; 19:20716. [DOI: 10.2807/1560-7917.es2014.19.8.20716] [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: 11/20/2022] Open
Affiliation(s)
- N G Schwarz
- Bernhard Nocht Institute for Tropical Medicine, Infectious Disease Epidemiology, Hamburg, Germany
- These authors contributed equally to this work
| | - B Kreuels
- These authors contributed equally to this work
- German Centre for Infection Research (DZIF), partner site Hamburg-Luebeck-Borstel, Hamburg, Germany
- Division of Tropical Medicine, 1. Department of Internal Medicine, University Medical Centre Hamburg Eppendorf, Hamburg, Germany
- Bernhard Nocht Institute for Tropical Medicine, Infectious Disease Epidemiology, Hamburg, Germany
| | - K Stark
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Division of Gastrointestinal Infections, Zoonoses and Tropical Infections, Berlin, Germany
| | - C Frank
- Robert Koch Institute, Department for Infectious Disease Epidemiology, Division of Gastrointestinal Infections, Zoonoses and Tropical Infections, Berlin, Germany
| | - J Schmidt-Chanasit
- Bernhard Nocht Institute for Tropical Medicine, WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research, Hamburg, Germany
- German Centre for Infection Research (DZIF), partner site Hamburg-Luebeck-Borstel, Hamburg, Germany
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Hagen RM, Wulff B, Loderstaedt U, Fengler I, Frickmann H, Schwarz NG, Polywka S. Is rapid hepatitis C virus testing from corpses a screening option for index persons who have died after mass-casualty incidents in high-prevalence settings in the field? J ROY ARMY MED CORPS 2013; 160:226-31. [PMID: 24113204 DOI: 10.1136/jramc-2013-000133] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION We tested a commercially available rapid hepatitis C virus (HCV) test assay for its potential use for analyses of corpses as a screening option for index persons who have died after mass-casualty incidents in high-prevalence settings in the field. MATERIALS AND METHODS 50 blood samples were drawn from 16 recently deceased confirmed HCV-positive patients whose corpses were stored at 4°C in the mortuary and were analysed at admission and up to 48 h post mortem by rapid serological testing using the ImmunoFlow HCV test (Core Diagnostics, Birmingham, UK) in comparison with automated serological assays and PCR. Samples from 50 HCV-negative corpses were also analysed. RESULTS The blood of only four of the 16 HCV-positive corpses reacted clearly with the ImmunoFlow HCV test, while in five cases the result was only weakly reactive and three cases showed very weak reactivity. Four of the infected corpses showed initially negative results, three of which became very weakly reactive 48 h post mortem. 49 out of 50 samples (98%) from HCV-negative corpses tested negative. DISCUSSION The rapid test system we investigated showed insufficient sensitivity regarding the identification of HCV positivity. Automated serological testing or PCR should be preferred if it is realistically available in the deployed military setting.
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Affiliation(s)
- Ralf M Hagen
- Department of Tropical Medicine at the Bernhard, Nocht Institute, German Armed Forces Hospital Hamburg, Hamburg, Germany
| | - B Wulff
- Institue for Forensic Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - U Loderstaedt
- Department of Clinical Chemistry, University Medical Center Goettingen, Goettingen, Germany
| | - I Fengler
- Laboratory Department 1, Central Institute of the German Armed Forces Medical Services, Koblenz, Germany
| | - H Frickmann
- Department of Tropical Medicine at the Bernhard, Nocht Institute, German Armed Forces Hospital Hamburg, Hamburg, Germany Institute for Medical Microbiology, Virology and Hygiene, University Hospital of Rostock, Rostock, Germany
| | - N G Schwarz
- Department of Infectious Disease Epidemiology, Bernard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - S Polywka
- Institute for Medical Microbiology, Virology and Hygiene, University Hospital Eppendorf, Hamburg, Germany
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Frickmann H, Hänle A, Essig A, Dekker D, Boahen K, Acquah S, Sarpong N, Adu-Sarkodie Y, Schwarz NG, May J, Marks F, Hagen RM, Poppert S. Fluorescence in situ hybridization (FISH) for rapid identification of Salmonella spp. from agar and blood culture broth--an option for the tropics? Int J Med Microbiol 2013; 303:277-84. [PMID: 23642903 DOI: 10.1016/j.ijmm.2013.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 04/02/2013] [Accepted: 04/07/2013] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Salmonella enterica is an important cause of diarrhea with the potential to cause systemic infection including sepsis, particularly in the tropics. Sepsis in particular requires quick and reliable identification to allow a rapid optimization of antibiotic therapy. We describe the establishment and evaluation of fluorescence in situ hybridization (FISH) as a rapid and easy-to-perform molecular identification procedure from agar and blood culture broths. METHODS Two newly developed FISH probes with specificity for Salmonella spp. were evaluated with 10 reference strains, 448 clinical isolates of Gram-negative bacteria from Germany and Ghana including 316 Salmonella spp. strains, and 39 environmental Salmonella spp. isolates from rivers and streams in Ghana. One FISH probe was further tested with 207 pre-incubated blood culture broths from Germany with Gram-negative rod-shaped bacteria in Gram stain. RESULTS Evaluation of the newly designed FISH probes demonstrated sensitivity of 99.2% and specificity of 98.4% for clinical isolates, sensitivity of 97.4% for environmental Salmonella spp. isolates, and sensitivity of 100% and specificity of 99.5% for blood culture materials. CONCLUSIONS FISH proved to be highly reliable for a rapid identification of Salmonella spp. directly from pre-incubated blood culture broths as well as after growth on agar. The inexpensive and easy-to-perform procedure is particularly suitable for resource-limited areas where more sophisticated procedures are not available.
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Affiliation(s)
- Hagen Frickmann
- Department of Tropical Medicine at the Bernhard-Nocht Institute, German Armed Forces Hospital of Hamburg, Germany.
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Schwarz NG, Girmann M, Randriamampionona N, Bialonski A, Maus D, Krefis AC, Njarasoa C, Rajanalison JF, Ramandrisoa HD, Randriarison ML, May J, Schmidt-Chanasit J, Rakotozandrindrainy R. Seroprevalence of antibodies against Chikungunya, Dengue, and Rift Valley fever viruses after febrile illness outbreak, Madagascar. Emerg Infect Dis 2013; 18:1780-6. [PMID: 23092548 PMCID: PMC3559170 DOI: 10.3201/eid1811.111036] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In October 2009, two-3 months after an outbreak of a febrile disease with joint pain on the eastern coast of Madagascar, we assessed serologic markers for chikungunya virus (CHIKV), dengue virus (DENV), and Rift Valley fever virus (RVFV) in 1,244 pregnant women at 6 locations. In 2 eastern coast towns, IgG seroprevalence against CHIKV was 45% and 23%; IgM seroprevalence was 28% and 5%. IgG seroprevalence against DENV was 17% and 11%. No anti-DENV IgM was detected. At 4 locations, 450-1,300 m high, IgG seroprevalence against CHIKV was 0%-3%, suggesting CHIKV had not spread to higher inland-altitudes. Four women had IgG against RVFV, probably antibodies from a 2008 epidemic. Most (78%) women from coastal locations with CHIKV-specific IgG reported joint pain and stiffness; 21% reported no symptoms. CHIKV infection was significantly associated with high bodyweight. The outbreak was an isolated CHIKV epidemic without relevant DENV co-transmission.
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Frickmann H, Dekker D, Boahen K, Acquah S, Sarpong N, Adu-Sarkodie Y, Schwarz NG, May J, Marks F, Poppert S, Wiemer DF, Hagen RM. Increased detection of invasive enteropathogenic bacteria in pre-incubated blood culture materials by real-time PCR in comparison with automated incubation in Sub-Saharan Africa. ACTA ACUST UNITED AC 2013; 45:616-22. [DOI: 10.3109/00365548.2013.777777] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Frickmann H, Schwarz NG, Wiemer DF, Fischer M, Tannich E, Scheid PL, Müller M, Schotte U, Bock W, Hagen RM. Food and drinking water hygiene and intestinal protozoa in deployed German soldiers. Eur J Microbiol Immunol (Bp) 2013; 3:53-60. [PMID: 24265919 DOI: 10.1556/eujmi.3.2013.1.8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 10/23/2012] [Indexed: 11/19/2022] Open
Abstract
This report analyzes the occurrence of Cryptosporidium spp., E. histolytica, and G. intestinalis in stool of returnees from military deployments and the impact of hygiene precautions. Between 2007 and 2010, stool samples of 830 returnees that were obtained 8-12 weeks after military deployments in Afghanistan, Uzbekistan, the Balkans, Democratic Republic of the Congo/Gabonese Republic, and Sudan and 292 control samples from non-deployed soldiers were analyzed by PCR for Cryptosporidium spp., E. histolytica, G. intestinalis, and the commensal indicator of fecal contamination E. dispar. Data on hygiene precautions were available. The soldiers were questioned regarding gastrointestinal and general symptoms. Among 1122 stool samples, 18 were positive for G. intestinalis, 10 for E. dispar, and no-one for Cryptosporidium spp. and E. histolytica. An increased risk of acquiring chronic parasitic infections in comparison with non-deployed controls was demonstrated only for G. intestinalis in Sudan, where standardized food and drinking water hygiene precautions could not be implemented. Standard food and drinking water hygiene precautions in the context of screened military field camps proved to be highly reliable in preventing food-borne and water-borne chronic infections and colonization by intestinal protozoa, leading to detection proportions similar to those in non-deployed controls.
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Frickmann H, Schwarz NG, Holtherm HU, Maassen W, Vorderwülbecke F, Erkens K, Fischer M, Morwinsky T, Hagen RM. Compliance with antimalarial chemoprophylaxis in German soldiers: a 6-year survey. Infection 2013; 41:311-20. [PMID: 23371855 DOI: 10.1007/s15010-013-0411-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Since 1992, German soldiers have been deployed in areas where malaria is endemic. Antimalarial chemoprophylaxis (CP) is directed according to the assessed risk and is provided free of charge. Compliance is crucial if its effect is to be reliable. This study analysed compliance with directed CP in German soldiers as well as its determinants. METHODS Between 2003 and 2009, standardized questionnaire-based interviews were performed with 2,149 out of approximately 100,000 German soldiers who were deployed during this period in areas where malaria is endemic. The questionnaires dealt with information that the soldiers had received about malaria prior to their missions, with their adherence to mosquito-protective and antimalarial chemoprophylactic procedures, and their estimations of their individual level of exposure. RESULTS About 1,308 out of 2,149 interviewed soldiers had been ordered to take CP, allowing for an assessment of the outcome parameter "CP-compliance". About 76.9 % out of 1,308 soldiers to whom regular CP was directed took it regularly. The exposure variables "age", "satisfaction with malaria counselling", "perceived threat due to insects or mosquitoes" and "use of insect repellents" were positively associated with compliance with directed antimalarial CP. CONCLUSIONS The study confirms the findings of the French and US armies that even free-of-charge access to antimalarial medication will not lead to 100 % acceptance. The compliance problem is aggravated by the generally low age of deployed soldiers. Adequate counselling is crucial to increase adherence to antimalarial CP.
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Affiliation(s)
- H Frickmann
- Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Bernhard Nocht Street 74, 20359, Hamburg, Germany.
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Frickmann H, Schwarz NG, Girmann M, Hagen RM, Poppert S, Crusius S, Podbielski A, Heriniaina JN, Razafindrabe T, Rakotondrainiarivelo JP, May J, Rakotozandrindrainy R. Serological survey of HIV and syphilis in pregnant women in Madagascar. Trop Med Int Health 2012; 18:35-9. [DOI: 10.1111/tmi.12007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Krumkamp R, Schwarz NG, Sarpong N, Loag W, Zeeb H, Adu-Sarkodie Y, May J. Extrapolating respiratory tract infection incidences to a rural area of Ghana using a probability model for hospital attendance. Int J Infect Dis 2012; 16:e429-35. [PMID: 22484157 DOI: 10.1016/j.ijid.2012.02.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 02/02/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE The aim of the current study was to extrapolate incidences for respiratory tract infections (RTI) using referral data from a local hospital in Ghana weighted by the individual likelihood of a hospital visit. METHODS Diagnoses from children visiting a rural hospital in Ghana during August 2007 to September 2008 were recorded. A logistic regression model, based on a population study conducted within the hospital catchment area, was used to calculate the individual probability of clinic attendance and to extrapolate the number of recorded cases. Cumulative incidences for children living in the hospital catchment area were estimated. RESULTS Upper RTI was the most common respiratory diagnosis, with an extrapolated incidence of 17481 cases per 100000 per year, followed by pneumonia with an incidence of 2496 per 100 000 per year. All diseases analyzed were most common in the first year of life. CONCLUSIONS In general the study results are in line with comparable studies. Several methodological issues biasing the results in different directions were identified. For example, opportunistic infections that are more often observed in hospital attendees are likely to be overestimated. However, the applied approach presents a tool for areas where disease monitoring systems are not established.
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Affiliation(s)
- R Krumkamp
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
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Adegnika AA, Luty AJF, Grobusch MP, Ramharter M, Yazdanbakhsh M, Kremsner PG, Schwarz NG. ABO blood group and the risk of placental malaria in sub-Saharan Africa. Malar J 2011; 10:101. [PMID: 21513504 PMCID: PMC3098819 DOI: 10.1186/1475-2875-10-101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [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: 01/07/2011] [Accepted: 04/22/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In malarious areas of the world, a higher proportion of the population has blood group O than in non-malarious areas. This is probably due to a survival advantage conferred either by an attenuating effect on the course of or reduction in the risk of infection by plasmodial parasites. Here, the association between ABO blood group and incidence of placental malaria was assessed in order to determine the possible influence of the former on the latter. METHODS Data from a study in Lambaréné, Gabon, and data from three previously published reports of studies in The Gambia, Malawi and Sudan, were compiled and compared. ABO blood groups were cross-tabulated with placental malaria stratified by parity. Odds ratios (OR), stratified by parity, were calculated for the outcome, placental parasitaemia, and compared between blood group O vs. non-O mothers in all four studies. Random effects meta-analysis of data from individual studies from areas with perennial hyper/holoendemic transmission was performed. RESULTS In Gabon, the odds ratio (OR) for active placental parasitaemia in mothers with group O was 0.3 (95% CI 0.05-1.8) for primiparae and 0.7 (95% CI 0.3-1.8) for multiparae. The OR for primiparae in the published study from The Gambia was 3.0 (95% CI 1.2-7.3) and, in Malawi, 2.2 (95% CI 1.1-4.3). In the Sudanese study, no OR for primiparae could be calculated. The OR for placental parasitaemia in group O multiparae was 0.8 (95% CI 0.3-1.7) in the Gambia, 0.6 (95% CI 0.4-1.0) in Malawi and 0.4 (95% CI 0.1-1.8) in Sudan. Combining data from the three studies conducted in hyper-/holo-endemic settings (Gambia, Malawi, Gabon) the OR for placental malaria in blood group O multiparae was 0.65 (95% CI 0.44-0.96) and for primiparae 1.70 (95% CI 0.67-4.33). CONCLUSION Studies conducted in The Gambia and Malawi suggest that blood group O confers a higher risk of active placental infection in primiparae, but a significantly lower risk in multiparae. These findings were not confirmed by the study from Gabon, in which statistically non-significant trends for reduced risk of placental parasitaemia in those with blood group O, regardless of parity, were observed.
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Affiliation(s)
- Ayola A Adegnika
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon
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Marks F, Adu-Sarkodie Y, Hünger F, Sarpong N, Ekuban S, Agyekum A, Nkrumah B, Schwarz NG, Favorov MO, Meyer CG, May J. Typhoid fever among children, Ghana. Emerg Infect Dis 2011; 16:1796-7. [PMID: 21029549 PMCID: PMC3294512 DOI: 10.3201/eid1611.100388] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Schwarz NG, Sarpong N, Hünger F, Marks F, Acquah SE, Agyekum A, Nkrumah B, Loag W, Hagen RM, Evans JA, Dekker D, Fobil JN, Meyer CG, May J, Adu-Sarkodie Y. Systemic bacteraemia in children presenting with clinical pneumonia and the impact of non-typhoid salmonella (NTS). BMC Infect Dis 2010; 10:319. [PMID: 21050455 PMCID: PMC2991321 DOI: 10.1186/1471-2334-10-319] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 11/04/2010] [Indexed: 11/25/2022] Open
Abstract
Background The diagnosis and antimicrobial treatment of pneumonia in African children in the absence of diagnostic means such as x-ray facilities or microbiological laboratories relies primarily on clinical symptoms presented by the patients. In order to assess the spectrum of bacterial pathogens, blood cultures were performed in children fulfilling the clinical criteria of pneumonia. Methods In total, 1032 blood cultures were taken from children between 2 months and 5 years of age who were admitted to a rural hospital in Ghana between September 2007 and July 2009. Pneumonia was diagnosed clinically and according to WHO criteria classified as "non-severe pneumonia" and "severe pneumonia" ("severe pneumonia" includes the WHO categories "severe pneumonia" and "very severe pneumonia"). Results The proportion of bacteriaemia with non-typhoid salmonella (NTS) was similar in children with pneumonia (16/173, 9.2%) compared to children hospitalized for other reasons (112/859, 13%). NTS were the predominant organisms isolated from children with clinical pneumonia and significantly more frequent than Streptococcus pneumoniae (8/173, 4.6%). Nine percent (9/101) of children presenting with severe pneumonia and 10% (7/72) of children with non-severe pneumonia were infected with NTS. Nineteen out of 123 NTS isolates (15%) were susceptible to aminopenicillins (amoxycillin/ampicillin), 23/127 (18%) to chlorampenicol, and 23/98 (23%) to co-trimoxazole. All NTS isolates were sensitive to ceftriaxone and ciprofloxacin. Conclusion In Sub-saharan Africa, sepsis with NTS should be considered in children with symptoms of pneumonia and aminopenicillins might often not be the adequate drugs for treatment.
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Grobusch MP, Gabor JJ, Aponte JJ, Schwarz NG, Poetschke M, Doernemann J, Schuster K, Koester KB, Profanter K, Borchert LB, Kurth F, Pongratz P, Issifou S, Lell B, Kremsner PG. No rebound of morbidity following intermittent preventive sulfadoxine-pyrimethamine treatment of malaria in infants in Gabon. J Infect Dis 2009; 200:1658-61. [PMID: 19848610 DOI: 10.1086/647990] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In the context of a trial studying intermittent preventive sulfadoxine-pyrimethamine treatment of malaria in infants in Lambaréné, Gabon, children aged 18-30 months were followed up after having received their last dose at an age of 15 months. In the intention-to-treat population, the protective efficacy against all malaria episodes was -18.0 (95% confidence interval, -97.4 to 29.5; P = .529). The protective efficacy against first or only anemia episode was -45.3 (95% confidence interval, -234.5 to 36.3; P=.375). The protective efficacies were negative and were not statistically significant. These results do not appear to support the concept of a rebound effect after intermittent preventive sulfadoxine-pyrimethamine treatment of malaria in infants. Clinical trials registration. NCT00167843.
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Affiliation(s)
- Martin P Grobusch
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon.
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Sarpong N, Loag W, Fobil J, Meyer CG, Adu-Sarkodie Y, May J, Schwarz NG. National health insurance coverage and socio-economic status in a rural district of Ghana. Trop Med Int Health 2009; 15:191-7. [PMID: 19961565 DOI: 10.1111/j.1365-3156.2009.02439.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the association between socio-economic status (SES) and health insurance subscription to the Ghanaian National Health Insurance Scheme (NHIS) of residents of the Asante Akim North district of the Ashanti Region, Ghana. METHODS In the course of a community survey, data on asset variables (e.g. electricity, housing conditions and other variables) and on NHIS subscription were collected on the household level in 99 villages. Using principal components analysis, households were classified into three categories of SES (20% high, 40% middle and 40% low SES). Odds ratios of NHIS subscription were calculated for all SES categories, using the low category as the reference group and adjusting for travelling time to health facilities by public transport. RESULTS Of the 7223 households surveyed, 38% subscribed to the NHIS, of these 21% were low, 43% middle and 60% high SES households. SES was significantly associated with NHIS subscription (high SES: OR 4.9, 95% CI 4.3-5.7; middle SES: OR 2.5, 95% CI 2.2-2.9; low SES: OR 1, reference group). CONCLUSION Four years after its introduction, the NHIS has reached subscription rates of 38% in the district surveyed. However, to achieve the aim of assuring universal access to health care facilities for all residents of Ghana, in particular for individuals living under socio-economic constraints, increasing subscription rates are necessary.
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Affiliation(s)
- N Sarpong
- Agogo Presbyterian Hospital, Agogo, Ghana
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Schwarz NG, Gysels M, Pell C, Gabor J, Schlie M, Issifou S, Lell B, Kremsner PG, Grobusch MP, Pool R. Reasons for non-adherence to vaccination at mother and child care clinics (MCCs) in Lambaréné, Gabon. Vaccine 2009; 27:5371-5. [PMID: 19616497 DOI: 10.1016/j.vaccine.2009.06.100] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 06/17/2009] [Accepted: 06/22/2009] [Indexed: 11/28/2022]
Abstract
The aim of this paper is to explore attitudes of mothers towards childhood vaccinations and reasons for non-attendance and non-adherence to mother-child clinics (MCCs). Forty in-depth interviews with mothers of children under 5 years of age revealed positive attitudes towards vaccination that seem at odds with the region's observed low vaccination coverage. Important reasons for MCC non-attendance included distance to the MCC, transport costs, negative experiences at MCCs (such as interactions with unfriendly staff) and mothers' feeling of shame provoked by different, often poverty-associated reasons such as attending the clinic with a dirty or poorly clothed child.
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Schwarz NG, Adegnika AA, Breitling LP, Gabor J, Agnandji ST, Newman RD, Lell B, Issifou S, Yazdanbakhsh M, Luty AJF, Kremsner PG, Grobusch MP. Placental malaria increases malaria risk in the first 30 months of life. Clin Infect Dis 2008; 47:1017-25. [PMID: 18781874 DOI: 10.1086/591968] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Plasmodium falciparum infection during pregnancy is associated with stillbirth, fetal growth restriction, and low birth weight. An additional consequence may be increased risk of malaria in early life, although the epidemiological evidence of this consequence is limited. METHODS A cohort of 527 children were observed actively every month for 30 months after delivery. Offspring of mothers with microscopically detectable placental P. falciparum infection at the time of delivery were defined as exposed. The outcome measure was malaria (parasitemia and fever). Analyses were performed using Cox proportional hazard models and were stratified by gravidity. RESULTS Overall, offspring of mothers with placental P. falciparum infection had a significantly higher risk of clinical malaria during the first 30 months of life (adjusted hazard ratio, 2.1; 95% confidence interval [CI], 1.2-3.7). The adjusted hazard ratio for offspring of multigravidae was 2.6 (95% CI, 1.3-5.3), and that for primigravidae was 1.5 (95% CI, 0.6-3.8). The offspring of placenta-infected primigravidae had no episodes of malaria during the first year of life. CONCLUSIONS Our findings show that active placental P. falciparum infection detected at delivery is associated with an approximately 2-fold greater risk of malaria during early life, compared with noninfection. The fact that persons born to infected multigravidae rather than primigravidae appear to be at greater risk emphasizes the importance of preventing malaria in mothers of all gravidities.
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Affiliation(s)
- Norbert G Schwarz
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon, South Africa
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May J, Adjei S, Busch W, Gabor JJ, Issifou S, Kobbe R, Kreuels B, Lell B, Schwarz NG, Adjei O, Kremsner PG, Grobusch MP. Therapeutic and prophylactic effect of intermittent preventive anti-malarial treatment in infants (IPTi) from Ghana and Gabon. Malar J 2008; 7:198. [PMID: 18828899 PMCID: PMC2586636 DOI: 10.1186/1475-2875-7-198] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Accepted: 10/01/2008] [Indexed: 11/10/2022] Open
Abstract
Background Intermittent preventive treatment in infants (IPTi) with sulphadoxine-pyrimethamine (SP) reduces the incidence of malaria episodes in young children. The exact mechanism by which the protective effect is mediated needs to be defined. This study aimed to investigate therapeutic, prophylactic, and possible exceeding effects of SP-based IPTi in two clinical trials. Methods Protective efficacies from two IPTi trials performed in Kumasi, Ghana, and Lambaréné, Gabon, were assessed for overlapping time series of 61 days. For six-months periods after each of three IPTi doses a multivariate Poisson regression model with the respective cohort as co-variate was generated and effect modification of protective efficacy with time strata was evaluated by log-likelihood tests. Results Protective efficacies were not significantly different between the two study cohorts. Study-cohort corrected protective efficacy was highest for the first 61 days after each IPTi application and decreased continuously. For the first 61 days after IPTi-1, IPTi-2, and IPTi-3 the protective efficacy was 71%, 44%, and 43%, respectively. A reduction of the malaria incidence rate was detectable for the first 60, 30 and 40 days after IPTi-1, IPTi-2 and IPTi-3 drug application, respectively. After IPTi-3 a higher risk for malaria could be seen after day 60. This effect was mainly based on the overwhelming influence of the Kumasi cohort. Conclusion The results suggest that SP-based IPTi mainly works through a therapeutic and prophylactic effect over 30 to 60 days after drug application and that a sustained effect beyond post-treatment prophylaxis might be very low. Trial registration Data analysis from clinical trials NCT ID # 00206739 (Kumasi Trial) and NCT ID # 00167843 (Lambaréné Trial), .
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Affiliation(s)
- Jürgen May
- Research Group Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht Strasse 74, D-20359 Hamburg, Germany.
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Schwarz NG, Revillion M, Roque-Afonso AM, Dussaix E, Giraud M, Liberpre C, Couturier E, Delarocque Astagneau E. A food-borne outbreak of hepatitis A virus (HAV) infection in a secondary school in Upper Normandy, France, in November 2006. Euro Surveill 2008. [DOI: 10.2807/ese.13.22.18885-en] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In November 2006, six symptomatic cases of hepatitis A in pupils of a secondary school in Upper Normandy, France, were reported to the district health service. This paper describes the outbreak investigation undertaken with the aim to identify the vehicle and source of infection, implement control measures and estimate the size of the outbreak. A primary case at the secondary school was defined as a pupil or a member of the staff with IgM anti-HAV detected in the serum and with onset of symptoms between 12 and 21 November 2006; a secondary case was defined as a contact to a primary case and who developed symptoms and had IgM anti-HAV two to seven weeks later. We performed a case control study of primary cases, controls being pupils visiting the same school (cases/controls 1:4) and inspected the canteen facilities. All 13 canteen employees were examined for anti-HAV IgM antibodies. A phylogenetic analysis of HAV of cases was performed. We identified 10 primary and 5 secondary cases. Among primary cases 90% reported eating liver pate at the canteen compared to 62% among controls (OR 5.5, 95% CI 0.62-256.9).One liver pate sample contained markers of faecal contamination. HAV genotypes were of one identical type. All 13 canteen employees were negative for IgM anti-HAV while four had anti-HAV total antibodies. We found deficiencies regarding food preparing procedures and insufficient hand washing facilities. The vehicle of the outbreak was believed to be the liver pate but the source of HAV could not be identified. Insufficient facilities in the canteen hindered staff from maintaining a high hygiene standard and were subsequently improved.
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Affiliation(s)
- N G Schwarz
- European Programme for Intervention Epidemiology Training (EPIET)
- Institut de Veille Sanitaire (InVS), Département des Maladies Infectieuses, Saint-Maurice, France
| | - M Revillion
- Cellule Interrégionale d’Epidémiologie (Cire) de Haute Normandie, Rouen, France
| | - A M Roque-Afonso
- Centre National de Référence (CNR) d’hépatite A, Hôpital Paul Brousse, Villejuif, France
| | - E Dussaix
- Centre National de Référence (CNR) d’hépatite A, Hôpital Paul Brousse, Villejuif, France
| | - M Giraud
- Direction Départementale des Affaires Sanitaires est Sociales, Evreux, France
| | - C Liberpre
- Direction Départementale des Services Vétérinaires, Evreux, France
| | - E Couturier
- Institut de Veille Sanitaire (InVS), Département des Maladies Infectieuses, Saint-Maurice, France
| | - E Delarocque Astagneau
- Institut de Veille Sanitaire (InVS), Département des Maladies Infectieuses, Saint-Maurice, France
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Schwarz NG, Revillion M, Roque-Afonso AM, Dussaix E, Giraud M, Liberpre C, Couturier E, Delarocque Astagneau E. A food-borne outbreak of hepatitis A virus (HAV) infection in a secondary school in Upper Normandy, France, in November 2006. Euro Surveill 2008; 13:18885. [PMID: 18761959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
In November 2006, six symptomatic cases of hepatitis A in pupils of a secondary school in Upper Normandy, France, were reported to the district health service. This paper describes the outbreak investigation undertaken with the aim to identify the vehicle and source of infection, implement control measures and estimate the size of the outbreak. A primary case at the secondary school was defined as a pupil or a member of the staff with IgM anti-HAV detected in the serum and with onset of symptoms between 12 and 21 November 2006; a secondary case was defined as a contact to a primary case and who developed symptoms and had IgM anti-HAV two to seven weeks later. We performed a case control study of primary cases, controls being pupils visiting the same school (cases/controls 1:4) and inspected the canteen facilities. All 13 canteen employees were examined for anti-HAV IgM antibodies. A phylogenetic analysis of HAV of cases was performed. We identified 10 primary and 5 secondary cases. Among primary cases 90% reported eating liver pate at the canteen compared to 62% among controls (OR 5.5, 95% CI 0.62-256.9). One liver pate sample contained markers of faecal contamination. HAV genotypes were of one identical type. All 13 canteen employees were negative for IgM anti-HAV while four had anti-HAV total antibodies. We found deficiencies regarding food preparing procedures and insufficient hand washing facilities. The vehicle of the outbreak was believed to be the liver pate but the source of HAV could not be identified. Insufficient facilities in the canteen hindered staff from maintaining a high hygiene standard and were subsequently improved.
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Affiliation(s)
- N G Schwarz
- Institut de Veille Sanitaire, Departement des Maladies Infectieuses, Saint-Maurice, France.
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Goesch JN, Schwarz NG, Decker ML, Oyakhirome S, Borchert LB, Kombila UD, Poetschke M, Lell B, Issifou S, Kremsner PG, Grobusch MP. Socio-economic status is inversely related to bed net use in Gabon. Malar J 2008; 7:60. [PMID: 18423025 PMCID: PMC2358918 DOI: 10.1186/1475-2875-7-60] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 04/18/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Insecticide-treated bed nets (ITNs) range among the most effective measures of malaria prophylaxis, yet their implementation level in sub-Saharan Africa is still low. The goal of this study was to investigate the influence of socio-economic factors on the use of bed nets by mothers in Gabon. METHODS A cross-sectional study was conducted completing pre-tested, interviewer-administered questionnaires exploring socioeconomic proxy measures with 397 mothers or guardians of young children. Respondents were grouped according to their socio-economic situation, using scores. The condition of the bed nets was evaluated during a home visit. RESULTS Socio-economic factors of wellbeing were negatively associated with bed net use, such as living in a stone house (OR 0.26, 95% CI 0.14-0.48), running water in the house (OR 0.44, 95% CI 0.21-0.92), shower/flush toilet in the house (OR 0.39/0.34, 95% CI 0.21-0.75/0.16-0.73), ownership of a freezer (OR 0.50, 95% CI 0.26-0.96) and belonging to the highest group in the economic score (OR 0.32, 95% CI 0.15-0.67). In contrast, similar factors were positively associated with a good maintenance condition of the bed nets: higher monthly income (OR 5.64, 95% CI 2.41-13.19) and belonging to the highest group in the economic score (OR 2.55, 95% CI 1.19 - 5.45). CONCLUSION Among the poorest families in Lambaréné the coverage with untreated nets (UTNs) is the highest, but the condition of these UTNs is the worst. To achieve a broad implementation of ITNs in Lambaréné, there is an urgent need for educational programmes as well as need-tailored marketing strategies for ITNs.
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Affiliation(s)
- Julia N Goesch
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon.
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Bernard H, Schwarz NG, Melnic A, Bucov V, Caterinciuc N, Pebody RG, Mulders M, Aidyralieva C, Hahné S. Mumps outbreak ongoing since October 2007 in the Republic of Moldova. Euro Surveill 2008; 13:8079. [PMID: 18445432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- H Bernard
- Robert Koch Institut (RKI), Berlin, Oberschleissheim, Germany.
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Bernard H, Schwarz NG, Melnic A, Bucov V, Caterinciuc N, Pebody RG, Mulders M, Aidyralieva C, Hahné S. Mumps outbreak ongoing since October 2007 in the Republic of Moldova. Euro Surveill 2008. [DOI: 10.2807/ese.13.13.08079-en] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Republic of Moldova is experiencing a nationwide mumps outbreak, with a total of 19,550 notified cases as of 23 March 2008. The outbreak started in October 2007, with 105 cases notified in that month compared to an average number of 24 cases per month notified between January and September 2007. Between 1 October and 31 December 2007, 1,524 cases were notified.
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Affiliation(s)
- H Bernard
- Postgraduate Training for Applied Epidemiology (PAE, German Field Epidemiology Training Program, FETP), Germany
- Robert Koch Institut (RKI), Berlin, delegated to Bavarian Health and Food Safety Authority (LGL), Oberschleissheim, Germany
| | - N G Schwarz
- European Training Programme for Intervention Epidemiology (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Institut de Veille Sanitaire (French National Institute of Health, InVS), Paris, France
| | - A Melnic
- National Scientific and Practical Centre of Preventive Medicine (NSPCPM), Chisinau, Republic of Moldova
| | - V Bucov
- National Scientific and Practical Centre of Preventive Medicine (NSPCPM), Chisinau, Republic of Moldova
| | - N Caterinciuc
- National Scientific and Practical Centre of Preventive Medicine (NSPCPM), Chisinau, Republic of Moldova
| | - R G Pebody
- Health Protection Agency (HPA), London, United Kingdom
- European Training Programme for Intervention Epidemiology (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - M Mulders
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - C Aidyralieva
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - S Hahné
- Rijksinstituut voor Volksgezondheid en Milieu (National Institute for Public Health and the Environment, RIVM), Bilthoven, the Netherlands
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
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Grobusch MP, Lell B, Schwarz NG, Gabor J, Dornemann J, Potschke M, Oyakhirome S, Kiessling GC, Necek M, Langin MU, Klein Klouwenberg P, Klopfer A, Naumann B, Altun H, Agnandji ST, Goesch J, Decker M, Salazar CLO, Supan C, Kombila DU, Borchert L, Koster KB, Pongratz P, Adegnika AA, Glasenapp IV, Issifou S, Kremsner PG. Intermittent preventive treatment against malaria in infants in Gabon--a randomized, double-blind, placebo-controlled trial. J Infect Dis 2007; 196:1595-602. [PMID: 18008242 DOI: 10.1086/522160] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Accepted: 05/30/2007] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Intermittent preventive treatment aims to maximize the protective effects of malaria chemoprophylaxis while minimizing the deleterious effects. METHODS In Gabon, 1189 infants received either sulfadoxine-pyrimethamine (SP; 250 and 12.5 mg, respectively) or placebo at 3, 9, and 15 months of age. Children were actively followed-up until 18 months of age. RESULTS In the intention-to-treat population at 18 months of follow-up, 84 children (17%) in the SP group had > or =1 episode of anemia, versus 108 (21%) in the placebo group (protective efficacy, 22% [95% confidence interval {CI}, -1% to 40%]; P=.06). In the intervention group, there were 66 episodes during 485 person-years at risk, compared with 79 episodes during 497 years in the placebo group (protective efficacy, 17% [95% CI, -24% to 45%; P=.36). The effects were similar at 12 months of follow-up. The study drug was safe and well tolerated. CONCLUSIONS The intervention was efficacious, producing a reduction in risk for anemia but a smaller effect against malaria. It is a valuable additional tool to control malaria in a highly vulnerable age group. Remaining important questions are currently being addressed in further studies. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00167843.
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Affiliation(s)
- Martin P Grobusch
- Medical Research Unit, Albert Schweitzer Hospital, Lambarene, Gabon.
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Schwarz NG, Oyakhirome S, Pötschke M, Gläser B, Klein Klouwenberg P, Altun H, Adegnika AA, Issifou S, Kun JFJ, Kremsner PG, Grobusch MP. 5-day nonobserved artesunate monotherapy for treating uncomplicated Falciparum malaria in young Gabonese children. Am J Trop Med Hyg 2005; 73:705-9. [PMID: 16222013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Despite different recommendations from WHO and national authorities, artesunate monotherapy is increasingly used for treating African children with malaria. A 5-day course of oral artesunate (first day: 4 mg/kg body weight, observed intake; and 2 mg/kg body weight on the following days with nonobserved drug intake) yielded a PCR-corrected Day 28 cure rate of 90% (45 of 50 patients; CI 78-97%) in Gabonese children aged between 2 and 18 months. Artesunate was well tolerated, and no severe adverse events were reported.
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Adegnika AA, Breitling LP, Agnandji ST, Chai SK, Schütte D, Oyakhirome S, Schwarz NG, Grobusch MP, Missinou MA, Ramharter M, Issifou S, Kremsner PG. Effectiveness of quinine monotherapy for the treatment of Plasmodium falciparum infection in pregnant women in Lambaréné, Gabon. Am J Trop Med Hyg 2005; 73:263-6. [PMID: 16103585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Pregnant women participating in a longitudinal immuno-epidemiologic survey in Lambaréné, Gabon, and presenting with Plasmodium falciparum parasitemia at monthly blood smear examinations were offered treatment with oral 7-day quinine monotherapy according to national health guidelines. A total of 50 pregnant women were offered 7-day oral quinine sulfate 10 mg/kg thrice daily. Clinical examinations and laboratory tests were performed on Days 28 and 56 to assess the effectiveness of this standard regimen. By Day 28, the effectiveness of the 7-day quinine regimen was 60% (95% confidence interval: 46-72%). We conclude that a 7-day course of quinine has a poor effectiveness and that alternative treatment regimens for malaria in pregnant women should be assessed.
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Affiliation(s)
- Ayôla A Adegnika
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon.
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Klein Klouwenberg PMC, Oyakhirome S, Schwarz NG, Gläser B, Issifou S, Kiessling G, Klöpfer A, Kremsner PG, Längin M, Lassmann B, Necek M, Pötschke M, Ritz A, Grobusch MP. Malaria and asymptomatic parasitaemia in Gabonese infants under the age of 3 months. Acta Trop 2005; 95:81-5. [PMID: 15950165 DOI: 10.1016/j.actatropica.2005.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [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: 01/13/2005] [Revised: 04/15/2005] [Accepted: 05/01/2005] [Indexed: 11/29/2022]
Abstract
We determined the incidence of both malaria and asymptomatic parasitaemia in infants under the age of 3 months within the framework of a longitudinal cohort study in Lambaréné, Gabon, between December 2002 and July 2004. Of 878 infants who were included at birth, we identified malaria in three infants and, additionally, asymptomatic parasitaemia in six infants. The malaria incidence density was 1.1/1000 person-months or 0.1% of observations. Our findings underpin the notion that the incidence of malaria and parasitaemia in infants below the age of 3 months is very low.
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Ramharter M, Chai SK, Adegnika AA, Klöpfer A, Längin M, Agnandji ST, Oyakhirome S, Schwarz NG, Grobusch MP, Issifou S, Kremsner PG. Shared breastfeeding in central Africa. AIDS 2004; 18:1847-9. [PMID: 15316347 DOI: 10.1097/00002030-200409030-00015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/26/2022]
Abstract
In this study, shared breastfeeding is described asa novel risk factor for vertical HIV transmission. This cross-sectional survey conducted in the central African country Gabon found that 40% of lactating mothers also breastfed other children than their own, and as many children were additionally breastfed by other women. Shared breastfeeding is increasing the exposure to potentially infectious individuals and has therefore to be considered in breastfeeding recommendations.
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Affiliation(s)
- Michael Ramharter
- Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon, Germany
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