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Ximenes D, de Jesus G, de Sousa ASCFC, Soares C, Amaral LC, Oakley T, Alves L, Amaral S, Sarmento N, Guterres H, Cabral JADD, Boavida F, Yan J, Francis JR, Martins N, Arkell P. A pilot study investigating severe community-acquired febrile illness through implementation of an innovative microbiological and nucleic acid amplification testing strategy in Timor-Leste (ISIN-MANAS-TL). IJID Reg 2024; 11:100345. [PMID: 38596819 PMCID: PMC11002651 DOI: 10.1016/j.ijregi.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 04/11/2024]
Abstract
Objectives Acute febrile illness (AFI) causes significant health-seeking, morbidity, and mortality in Southeast Asia. This pilot study aimed to describe presentation, etiology, treatment, and outcomes of patients with AFI at one hospital in Timor-Leste and assessing the feasibility of conducting larger studies in this setting. Methods Patients attending Hospital Nacional Guido Valadares with tympanic or axillary temperature ≥37.5°C in whom a blood culture was taken as part of routine clinical care were eligible. Participants were followed up daily for 10 days and again after 30 days. Whole blood was analyzed using a real-time quantitative polymerase chain reaction assay detecting dengue virus serotypes 1-4 and other arthropod-borne infections. Results A total of 82 participants were recruited. Polymerase chain reaction testing was positive for dengue in 14 of 82 (17.1%) participants and blood culture identified a bacterial pathogen in three of 82 (3.7%) participants. Follow-up was completed by 75 of 82 (91.5%) participants. High rates of hospital admission (58 of 82, 70.7%), broad-spectrum antimicrobial treatment (34 of 82, 41.5%), and mortality (9 of 82, 11.0%) were observed. Conclusions Patients with AFI experience poor clinical outcomes. Prospective observational and interventional studies assessing interventions, such as enhanced diagnostic testing, clinical decision support tools, or antimicrobial stewardship interventions, are required and would be feasible to conduct in this setting.
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Affiliation(s)
- Deolindo Ximenes
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Gustodio de Jesus
- Emergency Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Antonio SCFC de Sousa
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
- Molecular and Serology Department, Laboratorio Nacional da Saúde, Dili, Timor-Leste
| | - Caetano Soares
- Emergency Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Luciana C. Amaral
- Emergency Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Tessa Oakley
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Lucsendar Alves
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Salvador Amaral
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Nevio Sarmento
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Helio Guterres
- Internal Medicine Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | | | - Flavio Boavida
- Emergency Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Joshua R. Francis
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Nelson Martins
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Paul Arkell
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
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Arkell P, Mairiang D, Songjaeng A, Malpartida-Cardenas K, Hill-Cawthorne K, Avirutnan P, Georgiou P, Holmes A, Rodriguez-Manzano J. Analytical and diagnostic performance characteristics of reverse-transcriptase loop-mediated isothermal amplification assays for dengue virus serotypes 1-4: A scoping review to inform potential use in portable molecular diagnostic devices. PLOS Glob Public Health 2023; 3:e0002169. [PMID: 37552632 PMCID: PMC10409275 DOI: 10.1371/journal.pgph.0002169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/20/2023] [Indexed: 08/10/2023]
Abstract
Dengue is a mosquito-borne disease caused by dengue virus (DENV) serotypes 1-4 which affects 100-400 million adults and children each year. Reverse-transcriptase (RT) quantitative polymerase chain reaction (qPCR) assays are the current gold-standard in diagnosis and serotyping of infections, but their use in low-middle income countries (LMICs) has been limited by laboratory infrastructure requirements. Loop-mediated isothermal amplification (LAMP) assays do not require thermocycling equipment and therefore could potentially be deployed outside laboratories and/or miniaturised. This scoping literature review aimed to describe the analytical and diagnostic performance characteristics of previously developed serotype-specific dengue RT-LAMP assays and evaluate potential for use in portable molecular diagnostic devices. A literature search in Medline was conducted. Studies were included if they were listed before 4th May 2022 (no prior time limit set) and described the development of any serotype-specific DENV RT-LAMP assay ('original assays') or described the further evaluation, adaption or implementation of these assays. Technical features, analytical and diagnostic performance characteristics were collected for each assay. Eight original assays were identified. These were heterogenous in design and reporting. Assays' lower limit of detection (LLOD) and linear range of quantification were comparable to RT-qPCR (with lowest reported values 2.2x101 and 1.98x102 copies/ml, respectively, for studies which quantified target RNA copies) and analytical specificity was high. When evaluated, diagnostic performance was also high, though reference diagnostic criteria varied widely, prohibiting comparison between assays. Fourteen studies using previously described assays were identified, including those where reagents were lyophilised or 'printed' into microfluidic channels and where several novel detection methods were used. Serotype-specific DENV RT-LAMP assays are high-performing and have potential to be used in portable molecular diagnostic devices if they can be integrated with sample extraction and detection methods. Standardised reporting of assay validation and diagnostic accuracy studies would be beneficial.
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Affiliation(s)
- Paul Arkell
- Centre for Antimicrobial Optimisation, Department of Infectious Disease, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Dumrong Mairiang
- Siriraj Center of Research Excellence in Dengue and Emerging Pathogens (SiCORE-Dengue), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Molecular Biology of Dengue and Flaviviruses Research Team, Medical Molecular Biotechnology Research Group, National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency (NSTDA), Bangkok, Thailand
| | - Adisak Songjaeng
- Siriraj Center of Research Excellence in Dengue and Emerging Pathogens (SiCORE-Dengue), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Division of Dengue Hemorrhagic Fever Research, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kenny Malpartida-Cardenas
- Centre for Antimicrobial Optimisation, Department of Infectious Disease, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Kerri Hill-Cawthorne
- Centre for Antimicrobial Optimisation, Department of Infectious Disease, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Panisadee Avirutnan
- Siriraj Center of Research Excellence in Dengue and Emerging Pathogens (SiCORE-Dengue), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Molecular Biology of Dengue and Flaviviruses Research Team, Medical Molecular Biotechnology Research Group, National Center for Genetic Engineering and Biotechnology (BIOTEC), National Science and Technology Development Agency (NSTDA), Bangkok, Thailand
- Division of Dengue Hemorrhagic Fever Research, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pantelis Georgiou
- Centre for Antimicrobial Optimisation, Department of Infectious Disease, Imperial College London, Hammersmith Hospital, London, United Kingdom
- Department of Electrical and Electronic Engineering, Imperial College London, London, United Kingdom
| | - Alison Holmes
- Centre for Antimicrobial Optimisation, Department of Infectious Disease, Imperial College London, Hammersmith Hospital, London, United Kingdom
- David Price Evans Global Health and Infectious Disease Research Group, University of Liverpool, Liverpool, United Kingdom
| | - Jesus Rodriguez-Manzano
- Centre for Antimicrobial Optimisation, Department of Infectious Disease, Imperial College London, Hammersmith Hospital, London, United Kingdom
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Le B, Monteiro MAA, Amaral S, Wand H, Matthews A, Hii SF, Clarke NE, Arkell P, Yan J, Engelman D, Fancourt N, Fernandes JL, Steer A, Kaldor J, Traub R, Francis JR, Nery SV. The impact of ivermectin, diethylcarbamazine citrate, and albendazole mass drug administration on the prevalence of scabies and soil-transmitted helminths in school-aged children in three municipalities in Timor-Leste: a before-after assessment. Lancet Glob Health 2023; 11:e924-e932. [PMID: 37202027 DOI: 10.1016/s2214-109x(23)00134-1] [Citation(s) in RCA: 1] [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: 09/19/2022] [Revised: 02/07/2023] [Accepted: 02/27/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Integrated programmes that use combination mass drug administration (MDA) might improve control of multiple neglected tropical diseases simultaneously. We investigated the impact of Timor-Leste's national ivermectin, diethylcarbamazine citrate, and albendazole MDA, for lymphatic filariasis elimination and soil-transmitted helminth (STH) control, on scabies, impetigo, and STH infections. METHODS We did a before-after study in six primary schools across three municipalities in Timor-Leste (urban [Dili], semi-urban [Ermera], and rural [Manufahi]) before (April 23 to May 11, 2019) and 18 months after (Nov 9 to Nov 27, 2020) MDA delivery between May 17 and June 1, 2019. Study participants included schoolchildren, as well as infants, children, and adolescents who were incidentally present at school on study days. All schoolchildren whose parents provided consent were eligible to participate in the study. Infants, children, and adolescents younger than 19 years who were not enrolled in the school but were incidentally present at schools on study days were also eligible to participate if their parents consented. Ivermectin, diethylcarbamazine citrate, and albendazole MDA was implemented nationally, with single doses of oral ivermectin (200 μg/kg), diethylcarbamazine citrate (6 mg/kg), and albendazole (400 mg) administered by the Ministry of Health. Scabies and impetigo were assessed by clinical skin examinations, and STHs using quantitative PCR. The primary (cluster-level) analysis adjusted for clustering while the secondary (individual-level) analysis adjusted for sex, age, and clustering. The primary outcomes of the study were prevalence ratios for scabies, impetigo, and STHs (Trichuris trichiura, Ascaris lumbricoides, Necator americanus, and moderate-to-heavy A lumbricoides infections) between baseline and 18 months from the cluster-level analysis. FINDINGS At baseline, 1043 (87·7%) of 1190 children registered for the study underwent clinical assessment for scabies and impetigo. The mean age of those who completed skin examinations was 9·4 years (SD 2·4) and 514 (53·8%) of 956 were female (87 participants with missing sex data were excluded from this percentage calculation). Stool samples were received for 541 (45·5%) of 1190 children. The mean age of those for whom stool samples were received was 9·8 years (SD 2·2) and 300 (55·5%) were female. At baseline, 348 (33·4%) of 1043 participants had scabies, and 18 months after MDA, 133 (11·1%) of 1196 participants had scabies (prevalence ratio 0·38, 95% CI 0·18-0·88; p=0·020) in the cluster-level analysis. At baseline, 130 (12·5%) of 1043 participants had impetigo, compared with 27 (2·3%) of 1196 participants at follow-up (prevalence ratio 0·14, 95% CI 0·07-0·27; p<0·0001). There was a significant reduction in T trichiura prevalence from baseline (26 [4·8%] of 541 participants) to 18-month follow-up (four [0·6%] of 623 participants; prevalence ratio 0·16, 95% CI 0·04-0·66; p<0·0001). In the individual-level analysis, moderate-to-heavy A lumbricoides infections reduced from 54 (10·0%; 95% CI 0·7-19·6) of 541 participants to 28 (4·5%, 1·2-8·4) of 623 participants (relative reduction 53·6%; 95% CI 9·1-98·1; p=0·018). INTERPRETATION Ivermectin, diethylcarbamazine citrate, and albendazole MDA was associated with substantial reductions in prevalence of scabies, impetigo, and T trichiura, and of moderate-to-heavy intensity A lumbricoides infections. Combination MDA could be used to support integrated control programmes to target multiple NTDs. FUNDING National Health and Medical Research Council of Australia and the Department of Foreign Affairs and Trade Indo-Pacific Centre for Health Security. TRANSLATION For the Tetum translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Brandon Le
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | | | - Salvador Amaral
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Handan Wand
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Sze Fui Hii
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Naomi E Clarke
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Paul Arkell
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Jennifer Yan
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Daniel Engelman
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Nicholas Fancourt
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | | | - Andrew Steer
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Rebecca Traub
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Joshua R Francis
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Susana Vaz Nery
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Gusmao C, Tanesi MY, Gomes N, Sheridan SL, Sarmento N, Oakley T, David M, Wapling J, Alves L, Amaral S, Draper AD, Cruz B, Coelho D, Guterres H, Fancourt NS, Yan J, Macartney K, Francis JR, Arkell P. Seroprevalence and prevention of hepatitis B, measles and rubella among healthcare workers in Dili, Timor-Leste. Lancet Reg Health Southeast Asia 2023; 13:100133. [PMID: 37383559 PMCID: PMC10305905 DOI: 10.1016/j.lansea.2022.100133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/01/2022] [Accepted: 12/09/2022] [Indexed: 06/30/2023]
Abstract
Introduction The World Health Organisation recommends that healthcare workers (HCWs) are immune to measles and rubella, and those at risk of exposure are offered the hepatitis B vaccine. No formal programme for occupational assessment and provision of vaccinations to HCWs currently exists in Timor-Leste. Methods A cross-sectional study was undertaken to determine the seroprevalence of hepatitis B, measles and rubella among HCWs in Dili, Timor-Leste. All patient-facing employees at three healthcare institutions during April-June 2021 were invited to participate. Epidemiological data were collected by interview-questionnaire and a serum sample was collected by phlebotomy and analysed at the National Health Laboratory. Participants were contacted to discuss their results. Relevant vaccines were offered to seronegative individuals and those with active hepatitis B infection were referred for further assessment and management in a hepatology clinic as per national guidelines. Results Three-hundred-and-twenty-four HCWs were included (representing 51.3% of all eligible HCWs working at the three participating institutions). Sixteen (4.9%; 95% CI: 2.8-7.9%) had active hepatitis B infection, 121 (37.3%; 95% CI: 32.1-42.9%) had evidence of previous (cleared) hepatitis B infection, 134 (41.4%; 95% CI: 35.9-46.9%) were hepatitis B seronegative, and 53 (16.4%; 95% CI: 12.5-20.8%) had been vaccinated. Two-hundred-and-sixty-seven (82.4%; 95% CI: 77.8-86.4%) and 306 (94.4%; 95% CI: 91.4-96.7%) individuals exhibited antibodies to measles and rubella, respectively. Interpretation There are significant immunity gaps and a high prevalence of hepatitis B infection among HCWs in Dili Municipality, Timor-Leste. Routine occupational assessment and targeted vaccination of this group would be beneficial and should include all types of HCWs. This study provided an opportunity to develop a programme for the occupational assessment and vaccination of HCWs and forms the template for a national guideline. Funding This work was supported by the Department of Foreign Affairs and Trade, Australian Government [Complex Grant Agreement Number 75889].
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Affiliation(s)
- Celia Gusmao
- Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Maria Y. Tanesi
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Nelia Gomes
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Sarah L. Sheridan
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - Nevio Sarmento
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Tessa Oakley
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Michael David
- Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council New South Wales, Sydney, NSW, Australia
- School of Medicine & Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - Johanna Wapling
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Lucsendar Alves
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Salvador Amaral
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anthony D.K. Draper
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Northern Territory Centre for Disease Control, Darwin, Northern Territory, Australia
| | | | | | | | - Nicholas S.S. Fancourt
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jennifer Yan
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Joshua R. Francis
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Paul Arkell
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Imperial College, London, United Kingdom
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5
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Arkell P, Sheridan SL, Martins N, Tanesi MY, Gomes N, Amaral S, Oakley T, Solano V, David M, Draper ADK, Sarmento N, da Silva E, Alves L, Freitas C, Machado FDN, Gusmão C, da Costa Barreto I, Fancourt NSS, Macartney K, Yan J, Francis JR. Vaccine Preventable Disease Seroprevalence in a Nationwide Assessment of Timor-Leste (VASINA-TL): study protocol for a population-representative cross-sectional serosurvey. BMJ Open 2023; 13:e071381. [PMID: 37202138 PMCID: PMC10201250 DOI: 10.1136/bmjopen-2022-071381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/25/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Historic disruption in health infrastructure combined with data from a recent vaccine coverage survey suggests there are likely significant immunity gaps to vaccine preventable diseases and high risk of outbreaks in Timor-Leste. Community-based serological surveillance is an important tool to augment understanding of population-level immunity achieved through vaccine coverage and/or derived from prior infection. METHODS AND ANALYSIS This national population-representative serosurvey will take a three-stage cluster sample and aims to include 5600 individuals above 1 year of age. Serum samples will be collected by phlebotomy and analysed for measles IgG, rubella IgG, SARS-CoV-2 antispike protein IgG, hepatitis B surface antibody and hepatitis B core antigen using commercially available chemiluminescent immunoassays or ELISA. In addition to crude prevalence estimates and to account for differences in Timor-Leste's age structure, stratified age-standardised prevalence estimates will be calculated, using Asia in 2013 as the standard population. Additionally, this survey will derive a national asset of serum and dried blood spot samples which can be used for further investigation of infectious disease seroepidemiology and/or validation of existing and novel serological assays for infectious diseases. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Research Ethics and Technical Committee of the Instituto Nacional da Saúde, Timor-Leste and the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research, Australia. Co-designing this study with Timor-Leste's Ministry-of-Health and other relevant partner organisations will allow immediate translation of findings into public health policy, which may include changes to routine immunisation service delivery and/or plans for supplementary immunisation activities.
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Affiliation(s)
- Paul Arkell
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
| | - Sarah L Sheridan
- National Centre for Immunisation Research and Surveillance (NCIRS), Westmead, New South Wales, Australia
| | - Nelson Martins
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
| | - Maria Y Tanesi
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
| | - Nelia Gomes
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
| | - Salvador Amaral
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
| | - Tessa Oakley
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
| | - Vanessa Solano
- Faculty of Science and Technology, Research Institute for the Environment and Livelihoods, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Michael David
- The Daffodil Centre, The University of Sydney, Sydney, New South Wales, Australia
- School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
| | - Anthony D K Draper
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
- Centre for Disease Control, Northern Territory Department of Health, Casuarina, Northern Territory, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Northern Territory, Australia
| | - Nevio Sarmento
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
| | - Endang da Silva
- Laboratório Nacional da Saúde, Timor-Leste Ministry of Health, Dili, Timor-Leste
| | - Lucsendar Alves
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Carlito Freitas
- Departemento Vigilancia e Epidemiologia, Timor-Leste Ministry of Health, Dili, Timor-Leste
| | - Filipe de Neri Machado
- Departemento Vigilancia e Epidemiologia, Timor-Leste Ministry of Health, Dili, Timor-Leste
| | - Celia Gusmão
- Department of Internal Medicine, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Ismael da Costa Barreto
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Dili, Timor-Leste
- Health System Strengthening Department, World Health Organisation, Timor-Leste Office, Dili, Timor-Leste
| | - Nicholas S S Fancourt
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance (NCIRS), Westmead, New South Wales, Australia
| | - Jennifer Yan
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Joshua R Francis
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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6
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Sarmento N, Soares da Silva E, Barreto I, Ximenes JC, Angelina JM, Correia DM, Babo SM, Tilman AJP, Salles de Sousa A, Hornay E, Ico LC, Machado FDN, Niha MV, Ballard S, Lin C, Howden B, Baird R, Wapling J, Alves L, Oakley T, Marr I, Draper AD, Arkell P, Smith-Vaughan H, Fancourt NS, Yan J, Francis JR. The COVID-19 laboratory response in Timor-Leste; a story of collaboration. Lancet Reg Health Southeast Asia 2023; 11:100150. [PMID: 36744276 PMCID: PMC9883004 DOI: 10.1016/j.lansea.2023.100150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/18/2022] [Accepted: 01/05/2023] [Indexed: 01/14/2023]
Abstract
Timor-Leste is a small nation of 1.3 million people which shares a land border with Indonesia and is 550 km from Darwin, Australia. It is one of the poorest nations in Asia. The National Health Laboratory (NHL) and its network of smaller laboratories in Timor-Leste had limited capacity to perform molecular diagnostic testing before the coronavirus disease 2019 (COVID-19) pandemic began. With the support of international development partners, the NHL rapidly expanded its molecular testing service. From March 2020 to February 2022, over 200,000 molecular tests were performed; COVID-19 testing sites were established in hospital and community health center laboratories and all 13 municipalities, and the number of scientists and technicians at the molecular diagnostic laboratory at the NHL increased from five to 28 between 2019 and 2022. Molecular diagnostic testing for COVID-19 was successfully established at the NHL and in the municipalities. The molecular diagnostic laboratory at NHL is now equipped to respond to not only large-scale COVID-19 testing but also laboratory detection of other infectious diseases, preparing Timor-Leste for future outbreaks or pandemics.
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Affiliation(s)
- Nevio Sarmento
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste,Molecular Diagnostic Laboratory, National Health Laboratory, Dili, Timor-Leste,Corresponding author. Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | | | - Ismael Barreto
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - João C. Ximenes
- World Health Organization, Timor-Leste Country Office, Dili, Timor-Leste
| | - Julia M. Angelina
- World Health Organization, Timor-Leste Country Office, Dili, Timor-Leste
| | - Dircia M. Correia
- World Health Organization, Timor-Leste Country Office, Dili, Timor-Leste
| | - Silvia M. Babo
- World Health Organization, Timor-Leste Country Office, Dili, Timor-Leste
| | | | - Antonio Salles de Sousa
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Elisabeth Hornay
- Molecular Diagnostic Laboratory, National Health Laboratory, Dili, Timor-Leste
| | - Lourenço C. Ico
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | | | - Maria Varela Niha
- Departamento Vigilância e Epidemiologia, Ministério da Saúde, Dili, Timor-Leste
| | - Susan Ballard
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute of Infection and Immunity, Melbourne, Australia
| | - Chantel Lin
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute of Infection and Immunity, Melbourne, Australia
| | - Benjamin Howden
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute of Infection and Immunity, Melbourne, Australia
| | - Rob Baird
- Territory Pathology, Royal Darwin Hospital, Darwin, Australia
| | - Johanna Wapling
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Lucsendar Alves
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Tessa Oakley
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Ian Marr
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Anthony D.K. Draper
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste,Northern Territory Centre for Disease Control, Darwin, Australia,National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Paul Arkell
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste,Imperial College, London, United Kingdom
| | - Heidi Smith-Vaughan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Nicholas S.S. Fancourt
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Joshua R. Francis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
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7
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Niha MA, Draper AD, Viegas ODS, de Araujo RM, Joao JC, da Silva E, Barreto I, Sarmento N, Oakley T, Machado FDN, Fancourt NS, Marr I, Dos Santos Fernandes LN, Martins N, Arkell P, Tilman AJ, Dingle B, Freitas CC, Bhowmick PS, Sheridan S, Howden BP, Yan J, Francis JR, Martins N. The epidemiology of the COVID-19 pandemic in the small, low-resource country of Timor-Leste, January 2020 - June 2022. Commun Dis Intell (2018) 2023; 47. [PMID: 36654501 DOI: 10.33321/cdi.2023.47.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Abstract Timor-Leste, a small, mountainous half-island nation which shares a land border with Indonesia and which is 550 km from Australia, has a population of 1.3 million and achieved independence for the second time in 2002. It is one of the poorest nations in Asia. In response to the global coronavirus disease 2019 (COVID-19) pandemic, the Timor-Leste Ministry of Health undertook surveillance and contact tracing activities on all notified COVID-19 cases. Between 1 January 2020 and 30 June 2022, there were 22,957 cases of COVID-19 notified which occurred in three waves, the first which was delayed until April 2021 (community transmission of B.1.466.2 variant following major flooding), followed by waves in August 2021 (B.1.617.2 Delta variant transmission) and February 2022 (B.1.1.529 Omicron variant transmission). There were 753 people hospitalised due to COVID-19 and 133 deaths. Of the 133 deaths, 122 (92%) were considered not fully vaccinated (< 2 COVID-19 vaccines) and none had received boosters. Timor-Leste implemented measures to control COVID-19, including: rapid closure of international borders; isolation of cases; quarantining of international arrivals and close contacts; restrictions on internal travel; social and physical distancing; and, finally, a country-wide vaccination program. The health system's capacity was never exceeded.
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Affiliation(s)
- Maria Av Niha
- Ministry of Health, Caicoli, Timor-Leste.,2. World Health Organization, Timor-Leste Office, Caicoli, Timor-Leste
| | - Anthony Dk Draper
- Centre for Disease Control, Public Health Unit, Top End Health Service, Northern Territory Government Department of Health, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | | | - Rui M de Araujo
- Centro Integrado de Gestão de Crise, Timor-Leste Government, Dili, Timor-Leste
| | | | | | - Ismail Barreto
- World Health Organization, Timor-Leste Office, Caicoli, Timor-Leste
| | - Nevio Sarmento
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Tessa Oakley
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | - Nicholas Ss Fancourt
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Ian Marr
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | | | - Paul Arkell
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | - Benjamin Dingle
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | | | - Sarah Sheridan
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, Australia
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia.,Doherty Applied Microbial Genomics, Department of Microbiology & Immunology, University of Melbourne, Victoria, Australia
| | - Jennifer Yan
- Ministry of Health, Caicoli, Timor-Leste.,Paediatric Department, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, Australia
| | - Joshua R Francis
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Paediatric Department, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, Australia
| | - Nelson Martins
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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8
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Sarmento N, Ico LC, Sheridan SL, Tanesi MY, Santos CG, Barreto I, Gomes N, Oakley T, Draper ADK, Fancourt NSS, Yan J, Macartney K, Francis JR, Arkell P. The use of residual serum samples to perform serological surveillance of severe acute respiratory syndrome coronavirus 2 in Dili and regional areas of Timor-Leste. Trans R Soc Trop Med Hyg 2022; 117:313-315. [PMID: 36482768 PMCID: PMC10069296 DOI: 10.1093/trstmh/trac117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 10/17/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
ABSTRACT
Background
Lack of access to diagnostic testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can limit disease surveillance in remote areas. Serological surveillance can indicate the true extent and distribution of infections in such settings.
Methods
This study monitored SARS-CoV-2 seroprevalence in residual serum samples salvaged from laboratories at five healthcare facilities across Timor-Leste from March to October 2021.
Results
Seroprevalence increased from 8.3% to 87.0% during the study period. Potential immunity gaps were identified among children aged 0–15 y (who had not been eligible for vaccination) and individuals aged >60 y.
Conclusions
Efforts to vaccinate vulnerable individuals including older people should be maintained. Residual serum samples can be analysed to give local, contemporary information about the extent and distribution of antibodies to infections, especially SARS-CoV-2, in areas where epidemiological information is limited.
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Affiliation(s)
- Nevio Sarmento
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Lourenço C Ico
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Sarah L Sheridan
- National Centre for Immunisation Research and Surveillance , Westmead, NSW 2145 , Australia
| | - Maria Y Tanesi
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Celia G Santos
- Department of Internal Medicine, Hospital Nacional Guido Valadares , Dili , Timor-Leste
| | - Ismael Barreto
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Nelia Gomes
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Tessa Oakley
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Anthony D K Draper
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Nicholas S S Fancourt
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance , Westmead, NSW 2145 , Australia
| | - Joshua R Francis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
| | - Paul Arkell
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT 0810, Australia
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9
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Arkell P, Wilson R, Watkins K, Antcliffe DB, Gilchrist M, Wilson M, Rawson TM, Holmes A. Application of therapeutic drug monitoring to the treatment of bacterial central nervous system infection: a scoping review. J Antimicrob Chemother 2022; 77:3408-3413. [PMID: 36227686 DOI: 10.1093/jac/dkac332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bacterial central nervous system (CNS) infection is challenging to treat and carries high risk of recurrence, morbidity, and mortality. Low CNS penetration of antibiotics may contribute to poor clinical outcomes from bacterial CNS infections. The current application of therapeutic drug monitoring (TDM) to management of bacterial CNS infection was reviewed. METHODS Studies were included if they described adults treated for a suspected/confirmed bacterial CNS infection and had antibiotic drug concentration(s) determined that affected individual treatment. RESULTS One-hundred-and-thirty-six citations were retrieved. Seventeen manuscripts were included describing management of 68 patients. TDM for vancomycin (58/68) and the beta-lactams (29/68) was most common. Timing of clinical sampling varied widely between studies and across different antibiotics. Methods for setting individual PK-PD targets, determining parameters and making treatment changes varied widely and were sometimes unclear. DISCUSSION Despite increasing observational data showing low CNS penetration of various antibiotics, there are few clinical studies describing practical implementation of TDM in management of CNS infection. Lack of consensus around clinically relevant CSF PK-PD targets and protocols for dose-adjustment may contribute. Standardised investigation of TDM as a tool to improve treatment is required, especially as innovative drug concentration-sensing and PK-PD modelling technologies are emerging. Data generated at different centres offering TDM should be open access and aggregated to enrich understanding and optimize application.
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Affiliation(s)
- Paul Arkell
- Department of Infectious Disease, Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, UK
| | - Richard Wilson
- Department of Infectious Disease, Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, UK.,Department of Infectious Disease, National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, UK.,Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 3BX, UK.,Department of Pharmacy, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Killian Watkins
- Department of Infectious Disease, Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, UK
| | - David B Antcliffe
- Department of Infectious Disease, Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, UK.,Department of Anaesthesia and Critical Care, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK.,Division of Anaesthesia, Pain and Critical Care Medicine, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Mark Gilchrist
- Department of Infectious Disease, Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, UK.,Department of Infectious Disease, National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, UK.,Department of Pharmacy, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Mark Wilson
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Timothy M Rawson
- Department of Infectious Disease, Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, UK.,Department of Infectious Disease, National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, UK
| | - Alison Holmes
- Department of Infectious Disease, Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, UK.,Department of Infectious Disease, National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, UK.,Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L69 3BX, UK
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10
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Moser N, Yu LS, Rodriguez Manzano J, Malpartida-Cardenas K, Au A, Arkell P, Cicatiello C, Moniri A, Miglietta L, Wang WH, Wang SF, Holmes A, Chen YH, Georgiou P. Quantitative detection of dengue serotypes using a smartphone-connected handheld lab-on-chip platform. Front Bioeng Biotechnol 2022; 10:892853. [PMID: 36185458 PMCID: PMC9521504 DOI: 10.3389/fbioe.2022.892853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
Dengue is one of the most prevalent infectious diseases in the world. Rapid, accurate and scalable diagnostics are key to patient management and epidemiological surveillance of the dengue virus (DENV), however current technologies do not match required clinical sensitivity and specificity or rely on large laboratory equipment. In this work, we report the translation of our smartphone-connected handheld Lab-on-Chip (LoC) platform for the quantitative detection of two dengue serotypes. At its core, the approach relies on the combination of Complementary Metal-Oxide-Semiconductor (CMOS) microchip technology to integrate an array of 78 × 56 potentiometric sensors, and a label-free reverse-transcriptase loop mediated isothermal amplification (RT-LAMP) assay. The platform communicates to a smartphone app which synchronises results in real time with a secure cloud server hosted by Amazon Web Services (AWS) for epidemiological surveillance. The assay on our LoC platform (RT-eLAMP) was shown to match performance on a gold-standard fluorescence-based real-time instrument (RT-qLAMP) with synthetic DENV-1 and DENV-2 RNA and extracted RNA from 9 DENV-2 clinical isolates, achieving quantitative detection in under 15 min. To validate the portability of the platform and the geo-tagging capabilities, we led our study in the laboratories at Imperial College London, UK, and Kaohsiung Medical Hospital, Taiwan. This approach carries high potential for application in low resource settings at the point of care (PoC).
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Affiliation(s)
- Nicolas Moser
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, United Kingdom
- *Correspondence: Nicolas Moser,
| | - Ling-Shan Yu
- Institute of Biopharmaceutical Sciences, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Jesus Rodriguez Manzano
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, United Kingdom
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Kenny Malpartida-Cardenas
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, United Kingdom
| | - Anselm Au
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, United Kingdom
| | - Paul Arkell
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Chiara Cicatiello
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, United Kingdom
| | - Ahmad Moniri
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, United Kingdom
| | - Luca Miglietta
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, United Kingdom
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Wen-Hung Wang
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
- Center for Tropical Medicine and Infectious Disease, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng Fan Wang
- Center for Tropical Medicine and Infectious Disease, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Alison Holmes
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Yen-Hsu Chen
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
- Center for Tropical Medicine and Infectious Disease, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pantelis Georgiou
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Faculty of Engineering, Imperial College London, London, United Kingdom
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11
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Wilson RC, Arkell P, Riezk A, Gilchrist M, Wheeler G, Hope W, Holmes AH, Rawson TM. Addition of probenecid to oral β-lactam antibiotics: a systematic review and meta-analysis. J Antimicrob Chemother 2022; 77:2364-2372. [PMID: 35726853 DOI: 10.1093/jac/dkac200] [Citation(s) in RCA: 3] [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: 03/18/2022] [Accepted: 05/29/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To explore the literature comparing the pharmacokinetic and clinical outcomes from adding probenecid to oral β-lactams. METHODS Medline and EMBASE were searched from inception to December 2021 for all English language studies comparing the addition of probenecid (intervention) with an oral β-lactam [flucloxacillin, penicillin V, amoxicillin (± clavulanate), cefalexin, cefuroxime axetil] alone (comparator). ROBINS-I and ROB-2 tools were used. Data on antibiotic therapy, infection diagnosis, primary and secondary outcomes relating to pharmacokinetics and clinical outcomes, plus adverse events were extracted and reported descriptively. For a subset of studies comparing treatment failure between probenecid and control groups, meta-analysis was performed. RESULTS Overall, 18/295 (6%) screened abstracts were included. Populations, methodology and outcome data were heterogeneous. Common populations included healthy volunteers (9/18; 50%) and those with gonococcal infection (6/18; 33%). Most studies were crossover trials (11/18; 61%) or parallel-arm randomized trials (4/18; 22%). Where pharmacokinetic analyses were performed, addition of probenecid to oral β-lactams increased total AUC (7/7; 100%), Cmax (5/8; 63%) and serum t½ (6/8; 75%). Probenecid improved PTA (2/2; 100%). Meta-analysis of 3105 (2258 intervention, 847 control) patients treated for gonococcal disease demonstrated a relative risk of treatment failure in the random-effects model of 0.33 (95% CI 0.20-0.55; I2 = 7%), favouring probenecid. CONCLUSIONS Probenecid-boosted β-lactam therapy is associated with improved outcomes in gonococcal disease. Pharmacokinetic data suggest that probenecid-boosted oral β-lactam therapy may have a broader application, but appropriately powered mechanistic and efficacy studies are required.
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Affiliation(s)
- Richard C Wilson
- National Institute for Health and Care Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.,Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, Acton, London W12 0NN, UK.,Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Paul Arkell
- Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, Acton, London W12 0NN, UK.,Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Alaa Riezk
- Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, Acton, London W12 0NN, UK
| | - Mark Gilchrist
- National Institute for Health and Care Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.,Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, Acton, London W12 0NN, UK.,Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Graham Wheeler
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, Wood Lane, London W12 7RH, UK
| | - William Hope
- Centre for Excellence in Infectious Diseases Research (CEIDR), University of Liverpool, Liverpool L7 8TX, UK
| | - Alison H Holmes
- National Institute for Health and Care Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.,Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, Acton, London W12 0NN, UK.,Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Timothy M Rawson
- National Institute for Health and Care Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.,Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, Acton, London W12 0NN, UK.,Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
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12
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Arkell P, Gusmao C, Sheridan SL, Tanesi MY, Gomes N, Oakley T, Wapling J, Alves L, Kopf S, Sarmento N, Barreto IDC, Amaral S, Draper AD, Coelho D, Guterres H, Salles A, Machado F, Fancourt NS, Yan J, Marr I, Macartney K, Francis JR. Serological surveillance of healthcare workers to evaluate natural infection- and vaccine-derived immunity to SARS-CoV-2 during an outbreak in Dili, Timor-Leste. Int J Infect Dis 2022; 119:80-86. [PMID: 35358723 PMCID: PMC8958849 DOI: 10.1016/j.ijid.2022.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 11/30/2022] Open
Abstract
Background Serosurveillance can be used to investigate the extent and distribution of immunity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within a population. Characterisation of humoral immune responses gives insight into whether immunity is infection- or vaccine-derived. Methods A longitudinal study of health care workers (HCWs) in Dili, Timor-Leste, was conducted during vaccine rollout (ChAdOx1) and a concurrent SARS-CoV-2 outbreak. Results A total of 324 HCWs were included at baseline (April-May 2021). Out of those, 32 (9.9%) were seropositive for anti-nucleocapsid protein (anti-N) IgG antibodies, indicating a significant sub-clinical infection among HCWs early in the local outbreak. Follow-up was conducted in 157 (48.5%) participants (July-September 2021), by which time there had been high uptake of vaccination (91.7%), and 86.0% were seropositive for anti-spike protein antibodies. Acquisition of anti-N antibodies was observed in partially vaccinated HCWs (30/76, 39.5%), indicating some post-dose-1 infections. Discussion Serosurveillance of HCWs may provide early warning of SARS-CoV-2 outbreaks and should be considered in non-endemic settings, particularly where there is limited availability/uptake of testing for acute infection. Characterisation of humoral immune responses may be used to assess vaccine impact and coverage. Such studies should be considered in national and international efforts to investigate and mitigate against future emerging pathogens.
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Affiliation(s)
- Paul Arkell
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Imperial College, London, UK.
| | - Celia Gusmao
- Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Sarah L Sheridan
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - Maria Y Tanesi
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Nelia Gomes
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Tessa Oakley
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Johanna Wapling
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Lucsendar Alves
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Stacey Kopf
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Nevio Sarmento
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | | | - Salvador Amaral
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Anthony Dk Draper
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | | | | | | | | | - Nicholas Ss Fancourt
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Ian Marr
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia
| | - Joshua R Francis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
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13
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Mehta R, Chekmeneva E, Jackson H, Sands C, Mills E, Arancon D, Li HK, Arkell P, Rawson TM, Hammond R, Amran M, Haber A, Cooke GS, Noursadeghi M, Kaforou M, Lewis MR, Takats Z, Sriskandan S. Antiviral metabolite 3'-deoxy-3',4'-didehydro-cytidine is detectable in serum and identifies acute viral infections including COVID-19. Med 2022; 3:204-215.e6. [PMID: 35128501 PMCID: PMC8801973 DOI: 10.1016/j.medj.2022.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/14/2021] [Accepted: 01/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is a critical need for rapid viral infection diagnostics to enable prompt case identification in pandemic settings and support targeted antimicrobial prescribing. METHODS Using untargeted high-resolution liquid chromatography coupled with mass spectrometry, we compared the admission serum metabolome of emergency department patients with viral infections (including COVID-19), bacterial infections, inflammatory conditions, and healthy controls. Sera from an independent cohort of emergency department patients admitted with viral or bacterial infections underwent profiling to validate findings. Associations between whole-blood gene expression and the identified metabolite of interest were examined. FINDINGS 3'-Deoxy-3',4'-didehydro-cytidine (ddhC), a free base of the only known human antiviral small molecule ddhC-triphosphate (ddhCTP), was detected for the first time in serum. When comparing 60 viral with 101 non-viral cases in the discovery cohort, ddhC was the most significantly differentially abundant metabolite, generating an area under the receiver operating characteristic curve (AUC) of 0.954 (95% CI: 0.923-0.986). In the validation cohort, ddhC was again the most significantly differentially abundant metabolite when comparing 40 viral with 40 bacterial cases, generating an AUC of 0.81 (95% CI 0.708-0.915). Transcripts of viperin and CMPK2, enzymes responsible for ddhCTP synthesis, were among the five genes most highly correlated with ddhC abundance. CONCLUSIONS The antiviral precursor molecule ddhC is detectable in serum and an accurate marker for acute viral infection. Interferon-inducible genes viperin and CMPK2 are implicated in ddhC production in vivo. These findings highlight a future diagnostic role for ddhC in viral diagnosis, pandemic preparedness, and acute infection management. FUNDING NIHR Imperial BRC; UKRI.
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Affiliation(s)
- Ravi Mehta
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
| | - Elena Chekmeneva
- National Phenome Centre, Imperial College London, London SW7 2AZ, UK
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK
| | - Heather Jackson
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
| | - Caroline Sands
- National Phenome Centre, Imperial College London, London SW7 2AZ, UK
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK
| | - Ewurabena Mills
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
| | | | - Ho Kwong Li
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
- MRC Centre for Molecular Bacteriology & Infection, Imperial College London, London SW7 2AZ, UK
| | - Paul Arkell
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Timothy M. Rawson
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
- Division of Infection & Immunity, University College London, London WC1 E6BT, UK
| | - Robert Hammond
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Maisarah Amran
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Anna Haber
- Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Graham S. Cooke
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
| | - Mahdad Noursadeghi
- Division of Infection & Immunity, University College London, London WC1 E6BT, UK
| | - Myrsini Kaforou
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
| | - Matthew R. Lewis
- National Phenome Centre, Imperial College London, London SW7 2AZ, UK
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK
| | - Zoltan Takats
- National Phenome Centre, Imperial College London, London SW7 2AZ, UK
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK
| | - Shiranee Sriskandan
- Department of Infectious Disease, Imperial College London, London W12 0NN, UK
- MRC Centre for Molecular Bacteriology & Infection, Imperial College London, London SW7 2AZ, UK
- NIHR Health Protection Research Unit in Healthcare-associated Infection & Antimicrobial Resistance, Imperial College London, London W12 0NN, UK
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14
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Arkell P, Angelina J, do Carmo Vieira A, Wapling J, Marr I, Monteiro M, Matthews A, Amaral S, da Conceicao V, Kim SH, Bailey D, Yan J, Fancourt's NSS, Vaz Nery S, Francis JR. Integrated serological surveillance of acute febrile illness in the context of a lymphatic filariasis survey in Timor-Leste: a pilot study using dried blood spots. Trans R Soc Trop Med Hyg 2021; 116:531-537. [PMID: 34850241 PMCID: PMC9157677 DOI: 10.1093/trstmh/trab164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/04/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Acute febrile illnesses (AFIs), including dengue, scrub typhus and leptospirosis, cause significant morbidity and mortality in Southeast Asia. Serological surveillance can be used to investigate the force and distribution of infections. Dried blood spot (DBS) samples are an attractive alternative to serum because they are easier to collect and transport and require less cold storage. We conducted a pilot study to determine the feasibility of integrating serological surveillance for dengue, scrub typhus and leptospirosis into a population-representative lymphatic filariasis seroprevalence survey in Timor-Leste using DBSs. Methods A total of 272 DBSs were collected from healthy community participants. DBSs were analysed at the National Health Laboratory using commercially available enzyme-linked immunosorbent assays. To validate assays for DBSs, 20 anonymised serum samples of unknown serostatus were used to create dried serum spots (DSSs). These were analysed with optical densities compared with those of serum. Where low variance was observed (dengue assay) the published kit cut-offs for serum were applied to the analysis of DBSs. For the other assays (scrub typhus and leptospirosis), index values (IVs) were calculated and cut-offs were determined to be at 2 standard deviations (SDs) above the mean. Results Of the 272 samples analysed, 19 (7.0% [95% confidence interval {CI} 4.3 to 10.7]) were positive for dengue immunoglobulin G (IgG), 11 (4.0% [95% CI 2.1 to 7.1]) were positive for scrub typhus IgG and 16 (5.9% [95% CI 3.4 to 9.4%]) were positive for leptospira IgG. Conclusions While dengue seroprevalence was lower than in nearby countries, results represent the first evidence of scrub typhus and leptospirosis transmission in Timor-Leste. Integrated programmes of serological surveillance could greatly improve our understanding of infectious disease epidemiology in remote areas and would incur minimal additional fieldwork costs. However, when planning such studies, the choice of assays, their validation for DBSs and the laboratory infrastructure and technical expertise at the proposed location of analysis must be considered.
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Affiliation(s)
- Paul Arkell
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Imperial College London, London, UK
| | | | | | - Johanna Wapling
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Ian Marr
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Merita Monteiro
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Ministry of Health, Dili, Timor-Leste
| | | | - Salvador Amaral
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Virginia da Conceicao
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,National Health Laboratory, Dili, Timor-Leste
| | | | - Daniel Bailey
- Rare and Imported Pathogens Laboratory, Porton Down, UK
| | - Jennifer Yan
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Royal Darwin Hospital, Darwin, NT, Australia
| | | | - Susana Vaz Nery
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Joshua R Francis
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Royal Darwin Hospital, Darwin, NT, Australia
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15
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Bartlett AW, Traub R, Amaral S, Hii SF, Clarke NE, Matthews A, Zendejas-Heredia PA, Arkell P, Monteiro MAA, da Conceicao V, da Costa Maia C, Soares MI, Prisca Guterres JD, Francis JR, Vaz Nery S. Comparison between Quantitative Polymerase Chain Reaction and Sodium Nitrate Flotation Microscopy in Diagnosing Soil-Transmitted Helminth Infections. Am J Trop Med Hyg 2021; 105:1210-1213. [PMCID: PMC8592210 DOI: 10.4269/ajtmh.21-0227] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2023] Open
Abstract
There is evolving interest in alternate microscopy techniques and quantitative polymerase chain reaction (qPCR) to evaluate soil-transmitted helminth (STH) burden. Using data from a cross-sectional survey of 540 schoolchildren across six primary schools in three municipalities of Timor-Leste, we compared the performance of microscopy using sodium nitrate flotation (SNF) and qPCR in determining STH prevalence and infection intensity. Prevalence by qPCR was higher than SNF for Ascaris lumbricoides (17.5% versus 11.2%), hookworm (8.3% versus 1.2%), and Trichuris trichiura (4.7% versus 1.6%). Agreement between SNF and qPCR was fair for hookworm (κ = 0.21) and moderate for A. lumbricoides (κ = 0.59) and T. trichiura (κ = 0.44). Moderate or heavy intensity infections were identified in 15.9% of infections detected by SNF, whereas qPCR identified 36.1% as moderate or heavy infections using cycle threshold to eggs per gram conversion formulas. Quantitative PCR is a promising diagnostic technique, though further studies validating infection intensity correlates are required.
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Affiliation(s)
- Adam W. Bartlett
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Rebecca Traub
- University of Melbourne, Parkville, Victoria, Australia
| | - Salvador Amaral
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Sze Fui Hii
- University of Melbourne, Parkville, Victoria, Australia
| | - Naomi E. Clarke
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | | | - Paul Arkell
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | | | | | | | | | | | - Joshua R. Francis
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Royal Darwin Hospital, Darwin, Australia
| | - Susana Vaz Nery
- Kirby Institute, University of New South Wales, Sydney, Australia
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16
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Arkell P, Florindo TE, Baird R, Babua C. Chronic suppurative skin lesions in a young woman. BMJ 2021; 373:n797. [PMID: 33883148 DOI: 10.1136/bmj.n797] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Paul Arkell
- Department of Internal Medicine, Hospital Nacional Guido Valadares, Dili, Timor Leste
- Department of Infectious Diseases, Imperial College London, London, UK
| | - Tanizio E Florindo
- Department of Internal Medicine, Hospital Nacional Guido Valadares, Dili, Timor Leste
| | - Rob Baird
- Territory Pathology, Darwin, Australia
| | - Christopher Babua
- Department of Internal Medicine, Hospital Nacional Guido Valadares, Dili, Timor Leste
- Royal Australasian College of Surgeons, Melbourne, Australia
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17
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Matthews A, Le B, Amaral S, Arkell P, Monteiro M, Clarke N, Barros T, de Jesus Mendonça J, Gusmão SME, Dos Reis Seixas LM, da Piedade JHA, Engelman D, Steer AC, Fancourt NSS, Yan J, Kaldor J, Francis JR, Nery SV. Prevalence of scabies and impetigo in school-age children in Timor-Leste. Parasit Vectors 2021; 14:156. [PMID: 33722285 PMCID: PMC7962383 DOI: 10.1186/s13071-021-04645-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background Scabies and impetigo are endemic in many tropical, low- and middle-income countries. Mass drug administration (MDA) with ivermectin has emerged as a control strategy for these conditions. In 2019, Timor-Leste Ministry of Health planned to implement MDA including ivermectin for the control of lymphatic filariasis, so we undertook a baseline assessment of scabies and impetigo to better understand local epidemiology and contribute to future surveys assessing the impact of MDA. Methods A cross-sectional school survey was conducted in April–May 2019 at six primary schools in a semi-urban (Dili) and two rural (Ermera and Manufahi) settings. Children under 19 years of age present at school on survey days were eligible to participate, of whom we enrolled 1183. Trained health workers interviewed and examined 1043 participants to clinically diagnose scabies using the 2020 International Alliance for the Control of Scabies (IACS) diagnostic criteria, as well as impetigo. Prevalence was adjusted for age and sex. Mixed-effects logistic regression models were used to analyse odds of scabies and impetigo infection. All models accounted for clustering at the school level through the use of random effect terms. Population attributable risk of scabies as a cause of impetigo was also estimated. Results The overall weighted prevalence of scabies was 30.6%. Children in rural Manufahi were more likely to have scabies than those in semi-urban Dili (53.6% vs 28.2%, adjusted odds ratio [AOR] 3.5). Most cases of scabies were mild (3 to 10 lesions), and lesions were usually distributed on more than one body region. Scabies prevalence was lower among 10 to 14 year olds compared to 5 to 9 year olds. Overall weighted prevalence of impetigo was 11.3%. Relative to Dili, children in rural Ermera and Manufahi were twice as likely to have impetigo. Impetigo was twice as common in children with scabies than in those without, corresponding to an attributable risk of scabies as a cause of impetigo of 22.7%. Conclusions Scabies and impetigo prevalence in Timor-Leste is among the highest reported globally, particularly in rural areas. Scabies infestation was strongly associated with impetigo. Comprehensive control strategies are urgently needed in Timor-Leste.![]()
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Affiliation(s)
| | - Brandon Le
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Salvador Amaral
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Paul Arkell
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | | | - Naomi Clarke
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | | | | | | | | | | | - Daniel Engelman
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Australia
| | - Andrew C Steer
- Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Australia
| | - Nicholas S S Fancourt
- Royal Darwin Hospital, Darwin, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Jennifer Yan
- Royal Darwin Hospital, Darwin, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Joshua R Francis
- Royal Darwin Hospital, Darwin, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Susana Vaz Nery
- The Kirby Institute, University of New South Wales, Sydney, Australia
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18
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Arkell P, Mahboobani S, Wilson R, Fatania N, Coleman M, Borman AM, Johnson EM, Armstrong-James DPH, Abdolrasouli A. Bronchoalveolar lavage fluid IMMY Sona Aspergillus lateral-flow assay for the diagnosis of invasive pulmonary aspergillosis: a prospective, real life evaluation. Med Mycol 2021; 59:404-408. [PMID: 33479770 DOI: 10.1093/mmy/myaa113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/30/2020] [Accepted: 12/28/2020] [Indexed: 12/15/2022] Open
Abstract
Prompt and reliable diagnosis of invasive pulmonary aspergillosis (IPA) is essential for early initiation of antifungal therapy. We evaluated bronchoalveolar lavage (BAL) fluid IMMY Sona Aspergillus lateral-flow assay (IMMY LFA) in 92 individuals with suspected pulmonary infection. Sensitivity and specificity (vs. host factor but no IPA) of BAL IMMY LFA for diagnosis of IPA in individuals with any European Organisation for Research and Treatment of Cancer-defied "host factor" were 67% and 85%, respectively. Performance appeared better in individuals with renal transplantation (100%, 100%), compared to those with hematological malignancy and/or allogenic stem cell transplantation (70%, 78%). We found BAL IMMY LFA to be a convenient and useful addition to our diagnostic armory for IPA. LAY ABSTRACT We evaluated a new test for diagnosing invasive pulmonary aspergillosis from bronchoscopy samples. We tested 92 people and found that it was 67% sensitive and 85% specific (compared to diagnosis according to a set of internationally recognised criteria). We found this test convenient and useful.
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Affiliation(s)
- P Arkell
- Department of Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom.,Department of Infectious Disease, Imperial College London, London, United Kingdom.,Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, W12 0NN, United Kingdom
| | - S Mahboobani
- Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - R Wilson
- Department of Infectious Disease, Imperial College London, London, United Kingdom.,Centre for Antimicrobial Optimisation, Imperial College London, Hammersmith Hospital, Du Cane Road, W12 0NN, United Kingdom.,National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London. W12 0NN. United Kingdom.,Pharmacy Department, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - N Fatania
- Department of Medical Microbiology, North West London Pathology (NWLP), Imperial College Healthcare NHS Trust, London, United Kingdom
| | - M Coleman
- Department of Respiratory Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - A M Borman
- National Mycology Reference Laboratory, National Infections Service, Public Health England, Bristol BS10 5NB, United Kingdom.,Medical Research Council Centre for Medical Mycology (MRC CMM), University of Exeter, Exeter EX4 4QD, United Kingdom
| | - E M Johnson
- National Mycology Reference Laboratory, National Infections Service, Public Health England, Bristol BS10 5NB, United Kingdom.,Medical Research Council Centre for Medical Mycology (MRC CMM), University of Exeter, Exeter EX4 4QD, United Kingdom
| | - D P H Armstrong-James
- Department of Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom.,Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - A Abdolrasouli
- Department of Infectious Disease, Imperial College London, London, United Kingdom
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19
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Arkell P, Pan D, Riley P, Cooper P, MacPhee I, Cosgrove C, Brincat S. Should prospective renal transplant recipients be screened for Strongyloides stercoralis? Clin Kidney J 2020; 14:725-727. [PMID: 33623698 PMCID: PMC7886550 DOI: 10.1093/ckj/sfaa047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 03/16/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Paul Arkell
- Infection Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Daniel Pan
- Infection Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Peter Riley
- Infection Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Philip Cooper
- Institute for Infection and Immunity, St George's, University of London, Cranmer Terrace, London, UK
| | - Ian MacPhee
- Institute of Medical and Biomedical Education, St George's, University of London, Cranmer Terrace, London, UK
| | - Catherine Cosgrove
- Infection Department, St George's University Hospitals NHS Foundation Trust, London, UK.,Institute for Infection and Immunity, St George's, University of London, Cranmer Terrace, London, UK
| | - Stephan Brincat
- Department of Nephrology and Transplantation, St George's University Hospitals NHS Foundation Trust, London, UK
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20
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Arkell P, Cosgrove C, Riley P. Persistent eosinophilia among 21 historic cases of Strongyloides stercoralis infection: a case for routine follow-up and repeat treatment. Trans R Soc Trop Med Hyg 2019; 114:137-139. [DOI: 10.1093/trstmh/trz085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Strongyloidasis affects more than 100 million people worldwide and causes persisting infection.
Methods
We retrospectively reviewed 21 cases of parasitologically confirmed Strongyloides stercoralis infection at our centre.
Results
We found four individuals who had eosinophilia (>0.5x109/litre) more than 6 mo after treatment.
Conclusions
This may represent ongoing or relapsed infection. Our data support the need for continued follow-up of treated individuals, particularly those with abnormal host defences who are at risk of severe forms of the disease.
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Affiliation(s)
- Paul Arkell
- Infection Department, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT ,UK
| | - Catherine Cosgrove
- Infection Department, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT ,UK
| | - Peter Riley
- Infection Department, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT ,UK
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21
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Pan D, Arkell P, Stone NRH, Parkinson B, Tinwell B, Cosgrove CA. Delayed Strongyloides stercoralis hyperinfection syndrome in a renal transplant patient with Pneumocystis jirovecii pneumonia receiving high-dose corticosteroids. Lancet 2019; 393:1536. [PMID: 30983588 DOI: 10.1016/s0140-6736(19)30708-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/14/2018] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Daniel Pan
- Clinical Infection Unit, St George's Hospital, London, UK.
| | - Paul Arkell
- Clinical Infection Unit, St George's Hospital, London, UK
| | - Neil R H Stone
- Clinical Infection Unit, St George's Hospital, London, UK
| | | | - Brendan Tinwell
- London Southwest Pathology, St George's Hospital, London, UK
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22
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Arkell P, Macallan D, Rees A, Finer N. Severe intraocular herpes simplex virus type-1 infection after 46 years of latency. Lancet Infect Dis 2018; 18:1046. [PMID: 30152347 DOI: 10.1016/s1473-3099(18)30114-2] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Paul Arkell
- St George's University Hospital NHS Trust, London, UK.
| | | | - Angela Rees
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Neil Finer
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
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23
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Davis R, Higgens C, Cosgrove C, Shur J, Arkell P. Tuberculous arthritis: negative Xpert MTB/RIF assay does not rule out infection! BMJ Case Rep 2018; 2018:bcr-2018-224288. [PMID: 29959172 DOI: 10.1136/bcr-2018-224288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present a case of a 31-year-old man of Indian origin with no previous medical history who presented with an inflamed knee. Treatment for bacterial infection was unsuccessful, and needle aspiration of the left knee effusion/collection was smear and culture positive for tuberculosis (TB), despite Xpert MTB/RIF being falsely negative. The patient was commenced on quadruple therapy for TB and within 2 months had improved significantly with no clinical evidence of ongoing inflammation.
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Affiliation(s)
- Rebecca Davis
- Infectious Diseases, St George's University Hospital NHS Foundation Trust, London, UK
| | - Clare Higgens
- Infectious Diseases, St George's University Hospital NHS Foundation Trust, London, UK
| | - Catherine Cosgrove
- Infectious Diseases, St George's University Hospital NHS Foundation Trust, London, UK
| | - Joshua Shur
- Radiology, St Mark's Hospital, Harrow, London
| | - Paul Arkell
- Radiology, St Mark's Hospital, Harrow, London
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24
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Packham J, Arkell P, Sheeran T, Brownfield A, Cadwgan A, Ryan S. Patient experiences, attitudes and expectations towards receiving information about anti-TNF medication: a quantitative study. Clin Rheumatol 2017; 36:2595-2600. [PMID: 28526972 PMCID: PMC5640737 DOI: 10.1007/s10067-017-3642-5] [Citation(s) in RCA: 14] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 03/23/2017] [Accepted: 04/17/2017] [Indexed: 01/28/2023]
Abstract
The objective of the study was to measure patient attitudes and experience of information received during drug counselling for rheumatoid arthritis (RA) medications. This is a cross-sectional UK postal questionnaire study. Three RA patient groups-disease-modifying antirheumatic drugs (DMARDs) only, first anti-tumour necrosis factor (anti-TNF) and failed anti-TNF-were sent postal questionnaires. Data on patient history/demographics, drug counselling experience, knowledge of drug side effects, attitudes to vaccinations, cancer screening and blood borne virus testing was collected; 264/679 (39%) patients responded (median age 65 years, 66% female, median disease duration 15 years). Drug information from rheumatology nurses, rheumatology doctors and information leaflets was most useful. Thirty-eight percent of respondents felt reassured by information received, but 37% felt more worried. Forty percent of participants were aware of important drug side effects. Although 42-65% of patients understood they should temporarily halt anti-TNF therapy with concurrent infection, 75% of patients recalled continuing therapy despite infection. Thirteen percent believed that all vaccinations (including travel vaccinations) were safe while taking anti-TNF. Uptake of UK cancer screening programmes was between 87 and 94%, except prostate screening (47%). Most participants were not aware that they may need to discontinue their anti-TNF if they developed cancer. The majority of participants felt neutral/reassured by the prospect of viral hepatitis (95%) and HIV (91%) testing. Although drug counselling is a well-established part of clinical care, there is potential for further improvement to ensure that patients' knowledge empowers them to act safely. Particular areas for improvement included the following: patients halting DMARDs/anti-TNF therapy during infections, knowledge regarding vaccinations and prostate cancer screening uptake.
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Affiliation(s)
- Jon Packham
- Haywood Academic Rheumatology Centre, Stoke-on-Trent, UK. .,Institute of Applied Clinical Science, Keele University, Keele, UK.
| | - Paul Arkell
- Haywood Academic Rheumatology Centre, Stoke-on-Trent, UK
| | | | - Ann Brownfield
- Haywood Academic Rheumatology Centre, Stoke-on-Trent, UK
| | - Anthony Cadwgan
- University Hospital of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Sarah Ryan
- Haywood Academic Rheumatology Centre, Stoke-on-Trent, UK
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Arkell P, Youkee D, Brown CS, Kamara A, Kamara TB, Johnson O, Lado M, George V, Koroma F, King MB, Parker BE, Baker P. Quantifying the risk of nosocomial infection within Ebola Holding Units: a retrospective cohort study of negative patients discharged from five Ebola Holding Units in Western Area, Sierra Leone. Trop Med Int Health 2016; 22:32-40. [PMID: 27782349 DOI: 10.1111/tmi.12802] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A central pillar in the response to the 2014 Ebola virus disease (EVD) epidemic in Sierra Leone was the role of Ebola Holding Units (EHUs). These units isolated patients meeting a suspect case definition, tested them for EVD, initiated appropriate early treatment and discharged negative patients to onward inpatient care or home. Positive patients were referred to Ebola Treatment Centres. We aimed to estimate the risk of nosocomial transmission within these EHUs. METHODS We followed up a cohort of 543 patients discharged with a negative EVD test from five EHUs in the Western Area, Sierra Leone, and examined all line-listed subsequent EVD tests from any facility in the Western Area to see whether the patient was retested within 30 days, matching by name, age and address. We defined possible readmissions as having the same name and age but uncertain address, and confirmed readmissions where name, age and address matched. RESULTS We found a positive readmission rate of 3.3% (18 cases), which included 1.5% confirmed readmissions (8 cases) and 1.8% possible readmissions (10 cases). This is lower than rates previously reported. We cannot ascertain whether EVD was acquired within the EHUs or from re-exposure in the community. No demographic or clinical variables were identified as risk factors for positive readmission, likely due to our small sample size. CONCLUSIONS These findings support the EHU model as a safe method for isolation of suspect EVD patients and their role in limiting the spread of EVD.
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Affiliation(s)
- Paul Arkell
- King's Sierra Leone Partnership, King's College London, London, UK
| | - Daniel Youkee
- King's Sierra Leone Partnership, King's College London, London, UK
| | - Colin S Brown
- King's Sierra Leone Partnership, King's College London, London, UK.,Hospital for Tropical Diseases, University College Hospital London, London, UK
| | - Abdul Kamara
- Republic of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Oliver Johnson
- King's Sierra Leone Partnership, King's College London, London, UK
| | - Marta Lado
- King's Sierra Leone Partnership, King's College London, London, UK
| | | | | | | | | | - Peter Baker
- King's Sierra Leone Partnership, King's College London, London, UK.,Department of Primary Care and Public Health, Imperial College London, London, UK
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Fowler N, Arkell P, Abouyannis M, James C, Roberts L. Attitudes of serodiscordant couples towards antiretroviral-based HIV prevention strategies in Kenya: a qualitative study. AIDS Patient Care STDS 2015; 29:33-42. [PMID: 25375792 DOI: 10.1089/apc.2014.0210] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This qualitative study aims to gain in-depth information about the attitudes of HIV-serodiscordant couples towards two new methods of HIV prevention; Pre-Exposure Prophylaxis and Treatment as Prevention, both of which have been recently recommended by the World Health Organisation. Semi-structured interviews were conducted with 38 individuals in a serodiscordant relationship in Western Kenya. Topic guides were used to elicit information on perceived benefits, concerns, and preferences towards Treatment as Prevention and Pre-Exposure Prophylaxis. Data evaluation and thematic generation were developed using framework analysis. Results suggest that the majority of participants, irrespective of gender and HIV status, found Treatment as Prevention the more acceptable strategy. Key factors influencing this decision were HIV-negative participants' limited motivation to take prophylactic antiretrovirals and the likely health improvements Treatment as Prevention offers HIV-positive partners. However, issues were raised concerning the likelihood of low concurrent condom use and poor medication adherence when using these preventative approaches. It was concluded that the adoption of Treatment as Prevention as a method of HIV control in Kenya is likely to be more readily accepted by serodiscordant couples than Pre-exposure Prophylaxis. However, future implementation of either strategy would require measures to address the possibility of risk compensation and poor adherence.
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Affiliation(s)
- Nikola Fowler
- University of Birmingham, Medical School, Birmingham, United Kingdom
| | - Paul Arkell
- St. George's Hospital, London, United Kingdom
| | | | - Catherine James
- University of Birmingham, Medical School, Birmingham, United Kingdom
| | - Lesley Roberts
- University of Warwick, Warwick Medical School, Coventry, United Kingdom
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Affiliation(s)
- Colin Brown
- Colin Brown, BSc MSc MBChB MRCP FRCPath, King's Centre for Global Health, Denmark Hill, London
| | - Paul Arkell
- Paul Arkell, BMedSc MBChB DTMH, King's Centre for Global Health, Denmark Hill, London
| | - Sakib Rokadiya
- Sakib Rokadiya, BSc MBChB DTMH, King's Centre for Global Health, Denmark Hill, London
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Edwards F, Arkell P, Fong AYY, Roberts LM, Gendy D, Wong CSH, Ngu JCY, Tiong LL, Bibi FMS, Lai LYH, Ong TK, Abouyannis M. Bleeding events and associated factors in a cohort of adult patients taking warfarin in Sarawak, Malaysia. J Thromb Thrombolysis 2013; 38:226-34. [DOI: 10.1007/s11239-013-1017-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Arkell P, Ryan S, Brownfield A, Cadwgan A, Packham J. Patient experiences, attitudes and expectations towards receiving information about anti-TNF medication--"It could give me two heads and I'd still try it!". BMC Musculoskelet Disord 2013; 14:165. [PMID: 23663548 PMCID: PMC3653728 DOI: 10.1186/1471-2474-14-165] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 04/25/2013] [Indexed: 01/24/2023] Open
Abstract
Background Anti-tumour necrosis factor (anti-TNF) therapies are an important recent development in the treatment of autoimmune disease. Despite important side effects relating to immune suppression, there is lack of research into patient experiences, attitudes and expectations about the information they receive prior to starting anti-TNF therapy. Methods In May 2011 participants were purposively sampled to form two focus groups varying in age, anti-TNF agent and pre-therapy disease activity. A semi-structured topic guide was used to explore patients’ experiences regarding the information they received prior to commencing anti-TNF therapy. The focus groups were audio-taped and transcribed verbatim. Data were analysed using content analysis. Results Four key themes were identified. Firstly, weighing the risks and benefits of anti-TNF therapy. However, most participants attached limited importance to side effects, saying their strong desire for RA symptom control was overriding. Two reported deliberately concealing illness in order to continue their medication. Secondly, the desire for information. They suggested that counselling should occur at an early stage and not during a severe RA flare-up. Thirdly, the process of starting anti-TNF. Many identified that their biggest worry was whether they would be eligible for the new medication. They remembered little about the investigations they underwent, and none said they would have objected to being tested for blood borne viruses. Finally, the experience of being on anti-TNF. Most were positive, describing effects on quality of life as well as symptoms. Conclusions The use of qualitative methodology in this study has enabled an understanding of patients’ attitudes towards receiving information about anti-TNF therapy. The results may be useful to health professionals in terms of the timing and content of the information given to patients prior to commencing anti-TNF therapy.
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Affiliation(s)
- Paul Arkell
- The Haywood Rheumatology Centre, High Lane, Burslem, Stoke-on-Trent ST6 7AG, UK.
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Hammond C, Velard F, Ah Kioon MD, Come D, Hafsia N, Lin H, Ea HK, Liote F, Dudek M, Wallis GA, Paton K, Harris J, Kendall DA, Kelly S, Mercer L, Galloway J, Low A, Watson K, Lunt M, Dixon W, Symmons D, Hyrich K, Ntatsaki E, Watts RA, Mooney J, Scott DGI, Humphreys J, Verstappen SM, Marshall T, Lunt M, Hyrich K, Symmons DP, Khan A, Scott DL, Abraham A, Pearce MS, Mann KD, Francis RM, Birrell F, Moinzadeh P, Fonseca C, Hellmich M, Shah A, Chighizola C, Denton CP, Ong V, Croia C, Bombardieri M, Francesca A, Serafini B, Humby F, Kelly S, Migliorini P, Pitzalis C, Miles K, Heaney J, Sibinska Z, Salter D, Savill J, Gray D, Gray M, Jones GW, Greenhill CJ, Williams AS, Nowell MA, Jenkins BJ, Jones SA, McGovern J, Nguyen DX, Notley CA, Mauri C, Isenberg D, Ehrenstein M, Jacklin C, Bosworth AM, Bateman J, Allen M, Samani D, Davies D, Harris HE, Brannan S, Venters G, McQuillian A, Lovegrove F, Gibson J, Chinn D, Mclaren JS, Gordhan C, Stack RJ, Kumar K, Awad I, Raza K, Bacon P, Arkell P, Ryan S, Brownfield A, Packham J, Jacklin C, Bosworth AM, Wilkinson K, Roberts KJ, Moots RJ, Edwards SW, Headland SE, Perretti M, Norling L, Dalli J, Flower R, Serhan C, Perretti M, Naylor A, Azzam E, Smith S, Croft A, Duffield J, Huso D, Gay S, Ospelt C, Cooper M, Isacke C, Goodyear S, Rogers M, Buckley C, Greenhill CJ, Williams AS, Jones GW, Nowell MA, Moideen AN, Rosas M, Taylor PR, Humphreys IR, Jones SA, Vattakuzhi Y, Horwood NJ, Clark AR, Mueller AJ, Laird EG, Tew SR, Clegg PD, Orozco G, Eyre S, Bowes J, Flynn E, Barton A, Worthington J, Eyre S, Bowes J, Barton A, Amos C, Diogo D, Lee A, Padyukov L, Stahl EA, Martin J, Rantapaa-Dahlqvist S, Raychaudhuri S, Plenge R, Klareskog L, Gregersen P, Worthington J, Jani M, Chinoy H, Lamb J, Hazel P, Wedderburn L, Vencovsky J, Danko K, Lundberg I, O'Callaghan AS, Radstake T, Ollier WER, Cooper RG, Cobb J, Hinks A, Bowes J, Steel K, Sudman M, Marion MC, Keddache M, Wedderburn LR, Haas JP, Glass DN, Langefeld CD, Thomson W, Thompson SD, Cobb J, Hinks A, Flynn E, Hirani S, Patrick F, Kassoumeri L, Ursu S, Moncrieffe H, Bulatovic M, Bohm M, van Zelst B, Dolezalova P, de Jonge R, Wulffraat N, Newman S, Thomson W, Wedderburn L. Oral abstracts 7: Molecular mechanisms of disease--osteoarthritis * S1. Identification of novel osteoarthritis genes using zebrafish. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Arkell P, Abouyannis M, Manavi K. Can emergency departments fulfil BASHH recommendations for 24-hour access to HIV postexposure prophylaxis following sexual exposure? Int J STD AIDS 2012; 23:75-6. [DOI: 10.1258/ijsa.2011.011259] [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: 11/18/2022]
Affiliation(s)
- P Arkell
- The University of Birmingham, Birmingham, UK
| | | | - K Manavi
- The University of Birmingham, Birmingham, UK
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Abstract
Four similar-looking preparations containing 4% chlorhexidine ('Hibiscrub', Surgiscrub', 'Uniscrub', 'Macrocide') were compared in a single-blind, randomized study in a group of 73 volunteers. The volunteers washed their hands with each preparation ten times over 9 h, one preparation day-1 on each of four days over two weeks. The acceptability of the agents was assessed using visual analogue scales which were analysed by paired t-test. There were marked differences between the products. 'Uniscrub' smelled worse (P less than 0.003) and felt worse than the others (P less than 0.003). 'Hibiscrub' lathered well but 'Macrocide' was found easiest to rinse off. 'Hibiscrub' and 'Surgiscrub' were the least irritant and had the best visual appearance. Despite apparent similarities, these chlorhexidine formulations varied in acceptability to users.
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Affiliation(s)
- D Scott
- The Pharmacy, Dudley Road Hospital, Birmingham, UK
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