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Davidson EM, Scoullar MJL, Peach E, Morgan CJ, Melepia P, Opi DH, Supsup H, Hezeri P, Philip W, Kabiu D, Tokmun K, Suruka R, Fidelis R, Elijah A, Siba PM, Pomat W, Kombut B, Robinson LJ, Crabb BS, Kennedy E, Boeuf P, Simpson JA, Beeson JG, Fowkes FJI. Quantifying differences in iron deficiency-attributable anemia during pregnancy and postpartum. Cell Rep Med 2023:101097. [PMID: 37413986 PMCID: PMC10394161 DOI: 10.1016/j.xcrm.2023.101097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/13/2022] [Accepted: 06/08/2023] [Indexed: 07/08/2023]
Abstract
Pregnant women in resource-limited settings are highly susceptible to anemia and iron deficiency, but the etiology of postpartum anemia remains poorly defined. To inform the optimal timing for anemia interventions, changes in iron deficiency-attributable anemia through pregnancy and postpartum need to be understood. In 699 pregnant Papua New Guinean women attending their first antenatal care appointment and following up at birth and 6 and 12 months postpartum, we undertake logistic mixed-effects modeling to determine the effect of iron deficiency on anemia and population attributable fractions, calculated from odds ratios, to quantify the contribution of iron deficiency to anemia. Anemia is highly prevalent during pregnancy and 12 months postpartum, with iron deficiency increasing the odds of anemia during pregnancy and, to a lesser extent, postpartum. Iron deficiency accounts for ≥72% of anemia during pregnancy and 20%-37% postpartum. Early iron supplementation during and between pregnancies could break the cycle of chronic anemia in women of reproductive age.
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Affiliation(s)
- Eliza M Davidson
- Burnet Institute, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Michelle J L Scoullar
- Burnet Institute, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | | | - Christopher J Morgan
- Burnet Institute, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; John Hopkins Program for International Education in Gynecology and Obstetrics, Baltimore, MD, USA
| | - Pele Melepia
- Burnet Institute, Kokopo, East New Britain, Papua New Guinea
| | - D Herbert Opi
- Burnet Institute, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Immunology, Monash University, Wellington Road, Melbourne, VIC, Australia
| | - Hadlee Supsup
- Burnet Institute, Kokopo, East New Britain, Papua New Guinea; East New Britain Provincial Health Authority, Rabaul, East New Britain, Papua New Guinea
| | - Priscah Hezeri
- Burnet Institute, Kokopo, East New Britain, Papua New Guinea
| | - Wilson Philip
- Burnet Institute, Kokopo, East New Britain, Papua New Guinea
| | - Dukduk Kabiu
- Burnet Institute, Kokopo, East New Britain, Papua New Guinea
| | | | - Rose Suruka
- Burnet Institute, Kokopo, East New Britain, Papua New Guinea
| | - Ruth Fidelis
- Burnet Institute, Kokopo, East New Britain, Papua New Guinea
| | - Arthur Elijah
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Peter M Siba
- Centre for Health Research and Diagnostics, Divine Word University, Madang, Papua New Guinea
| | - William Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Benishar Kombut
- Burnet Institute, Kokopo, East New Britain, Papua New Guinea; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Leanne J Robinson
- Burnet Institute, Melbourne, VIC, Australia; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Elissa Kennedy
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - James G Beeson
- Burnet Institute, Melbourne, VIC, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Immunology, Monash University, Wellington Road, Melbourne, VIC, Australia; Department of Microbiology, Monash University, Melbourne, VIC, Australia
| | - Freya J I Fowkes
- Burnet Institute, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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Eghrari D, Scoullar MJL, Wilson AN, Peach E, Elijah A, Melepia P, SupSup H, Vallely LM, Siba PM, Kennedy EC, Vogel JP, Homer CSE, Robinson LJ, Fowkes FJI, Pomat W, Crabb BS, Beeson JG, Morgan CJ. Low knowledge of newborn danger signs among pregnant women in Papua New Guinea and implications for health seeking behaviour in early infancy - findings from a longitudinal study. BMC Pregnancy Childbirth 2023; 23:71. [PMID: 36703135 PMCID: PMC9878757 DOI: 10.1186/s12884-022-05322-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/20/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Globally, 2.5 million babies die in the first 28 days of life each year with most of these deaths occurring in low- and middle-income countries. Early recognition of newborn danger signs is important in prompting timely care seeking behaviour. Little is known about women's knowledge of newborn danger signs in Papua New Guinea. This study aims to assess this knowledge gap among a cohort of women in East New Britain Province. METHODS This study assessed knowledge of newborn danger signs (as defined by the World Health Organization) at three time points from a prospective cohort study of women in East New Britain Province, factors associated with knowledge of danger signs after childbirth were assessed using logistic regression. This study includes quantitative and qualitative interview data from 699 pregnant women enrolled at their first antenatal clinic visit, followed up after childbirth (n = 638) and again at one-month post-partum (n = 599). RESULTS Knowledge of newborn danger signs was very low. Among the 638 women, only 9.4% knew three newborn danger signs after childbirth and only one knew all four essential danger signs defined by Johns Hopkins University 'Birth Preparedness and Complication Readiness' Index. Higher knowledge scores were associated with higher gravidity, income level, partner involvement in antenatal care, and education. CONCLUSION Low levels of knowledge of newborn danger signs among pregnant women are a potential obstacle to timely care-seeking in rural Papua New Guinea. Antenatal and postnatal education, and policies that support enhanced education and decision-making powers for women and their families, are urgently needed.
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Affiliation(s)
- Donya Eghrari
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1008.90000 0001 2179 088XUniversity of Melbourne, Melbourne, Australia
| | - Michelle J. L. Scoullar
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1008.90000 0001 2179 088XUniversity of Melbourne, Melbourne, Australia ,Burnet Institute, Kokopo, Papua New Guinea
| | - Alyce N. Wilson
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1008.90000 0001 2179 088XUniversity of Melbourne, Melbourne, Australia
| | - Elizabeth Peach
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia
| | - Arthur Elijah
- grid.412690.80000 0001 0663 0554University of Papua New Guinea, Port Moresby, Papua New Guinea ,grid.415118.80000 0004 8340 8668Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | | | - Hadlee SupSup
- East New Britain Provincial Health Authority, Kokopo, Papua New Guinea
| | - Lisa M. Vallely
- grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea ,grid.1005.40000 0004 4902 0432The Kirby Institute, University of New South Wales, Sydney, Australia ,grid.1011.10000 0004 0474 1797Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Peter M. Siba
- grid.449086.70000 0001 0581 065XCenter for Health Research and Diagnostics, Divine Word University, Madang, Papua New Guinea
| | - Elissa C. Kennedy
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1002.30000 0004 1936 7857Monash University, Melbourne, Australia ,grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, Australia
| | - Joshua P. Vogel
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1008.90000 0001 2179 088XUniversity of Melbourne, Melbourne, Australia
| | - Caroline S. E. Homer
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1008.90000 0001 2179 088XUniversity of Melbourne, Melbourne, Australia
| | - Leanne J. Robinson
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1008.90000 0001 2179 088XUniversity of Melbourne, Melbourne, Australia ,grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea ,grid.1002.30000 0004 1936 7857Monash University, Melbourne, Australia
| | - Freya J. I. Fowkes
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1008.90000 0001 2179 088XUniversity of Melbourne, Melbourne, Australia ,grid.1002.30000 0004 1936 7857Monash University, Melbourne, Australia
| | - William Pomat
- grid.417153.50000 0001 2288 2831Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Brendan S. Crabb
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1008.90000 0001 2179 088XUniversity of Melbourne, Melbourne, Australia ,grid.1002.30000 0004 1936 7857Monash University, Melbourne, Australia
| | - James G. Beeson
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1008.90000 0001 2179 088XUniversity of Melbourne, Melbourne, Australia ,grid.1002.30000 0004 1936 7857Monash University, Melbourne, Australia
| | - Christopher J. Morgan
- grid.1056.20000 0001 2224 8486Burnet Institute, Melbourne, Australia ,grid.1008.90000 0001 2179 088XUniversity of Melbourne, Melbourne, Australia ,grid.21107.350000 0001 2171 9311Jhpiego, a Johns Hopkins University Affiliate, Baltimore, USA
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Batura N, Saweri OP, Vallely A, Pomat W, Homer C, Guy R, Luchters S, Mola G, Vallely LM, Morgan C, Kariwiga G, Wand H, Rogerson S, Tabrizi SN, Whiley DM, Low N, Peeling RW, Siba PM, Riddell M, Laman M, Bolnga J, Robinson LJ, Morewaya J, Badman S, Kelly-Hanku A, Toliman PJ, Peter W, Peach E, Garland S, Kaldor J, Wiseman V. Point-of-care testing and treatment of sexually transmitted and genital infections during pregnancy in Papua New Guinea (WANTAIM trial): protocol for an economic evaluation alongside a cluster-randomised trial. BMJ Open 2021; 11:e046308. [PMID: 34385236 PMCID: PMC8362726 DOI: 10.1136/bmjopen-2020-046308] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Left untreated, sexually transmitted and genital infections (henceforth STIs) in pregnancy can lead to serious adverse outcomes for mother and child. Papua New Guinea (PNG) has among the highest prevalence of curable STIs including syphilis, chlamydia, gonorrhoea, trichomoniasis and bacterial vaginosis, and high neonatal mortality rates. Diagnosis and treatment of these STIs in PNG rely on syndromic management. Advances in STI diagnostics through point-of-care (PoC) testing using GeneXpert technology hold promise for resource-constrained countries such as PNG. This paper describes the planned economic evaluation of a cluster-randomised cross-over trial comparing antenatal PoC testing and immediate treatment of curable STIs with standard antenatal care in two provinces in PNG. METHODS AND ANALYSIS Cost-effectiveness of the PoC intervention compared with standard antenatal care will be assessed prospectively over the trial period (2017-2021) from societal and provider perspectives. Incremental cost-effectiveness ratios will be calculated for the primary health outcome, a composite measure of the proportion of either preterm birth and/or low birth weight; for life years saved; for disability-adjusted life years averted; and for non-health benefits (financial risk protection and improved health equity). Scenario analyses will be conducted to identify scale-up options, and budget impact analysis will be undertaken to understand short-term financial impacts of intervention adoption on the national budget. Deterministic and probabilistic sensitivity analysis will be conducted to account for uncertainty in key model inputs. ETHICS AND DISSEMINATION This study has ethical approval from the Institutional Review Board of the PNG Institute of Medical Research; the Medical Research Advisory Committee of the PNG National Department of Health; the Human Research Ethics Committee of the University of New South Wales; and the Research Ethics Committee of the London School of Hygiene and Tropical Medicine. Findings will be disseminated through national stakeholder meetings, conferences, peer-reviewed publications and policy briefs. TRIAL REGISTRATION NUMBER ISRCTN37134032.
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Affiliation(s)
- Neha Batura
- Institute for Global Health, University College London, London, UK
| | - Olga Pm Saweri
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Andrew Vallely
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - William Pomat
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Caroline Homer
- The Burnet Institute, Melbourne, Victoria, Australia
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Rebecca Guy
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Stanley Luchters
- The Burnet Institute, Melbourne, Victoria, Australia
- Department of Public Health and Preventive Medicine, Ghent University, Ghent, Belgium
- Department of Population Health, Medical College, Aga Khan University, Nairobi, Kenya
- Department of Epidemiology and Preventive Medicine, Monash University, Monash, Victoria, Australia
| | - Glen Mola
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Lisa M Vallely
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | | | - Grace Kariwiga
- Milne Bay Provincial Health Authority, Alotau, Papua New Guinea
| | - Handan Wand
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen Rogerson
- Department of Medicine, The Doherty Institute, University of Melbourne, Melbourne, Victoria, Australia
| | | | - David M Whiley
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Rosanna W Peeling
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter M Siba
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Michaela Riddell
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Moses Laman
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - John Bolnga
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Leanne J Robinson
- The Burnet Institute, Melbourne, Victoria, Australia
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Jacob Morewaya
- Milne Bay Provincial Health Authority, Alotau, Papua New Guinea
| | - Steven Badman
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Angela Kelly-Hanku
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Pamela J Toliman
- The Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Wilfred Peter
- Madang Provincial Health Authority, Madang, Papua New Guinea
| | | | - Suzanne Garland
- Microbiology and Infectious Diseases Department, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Cleary E, Hetzel MW, Siba PM, Lau CL, Clements ACA. Correction to: Spatial prediction of malaria prevalence in Papua New Guinea: a comparison of Bayesian decision network and multivariate regression modelling approaches for improved accuracy in prevalence prediction. Malar J 2021; 20:318. [PMID: 34271929 PMCID: PMC8283970 DOI: 10.1186/s12936-021-03838-4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Eimear Cleary
- Research School of Population Health, Australian National University, Canberra, Australia.
| | - Manuel W Hetzel
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.,Centre for Health Research and Diagnostics, Divine Word University, Madang, Papua New Guinea
| | - Colleen L Lau
- Research School of Population Health, Australian National University, Canberra, Australia.,School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Bentley, Australia.,Telethon Kids Institute, Nedlands, Australia
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Scoullar MJL, Boeuf P, Peach E, Fidelis R, Tokmun K, Melepia P, Elijah A, Bradshaw CS, Fehler G, Siba PM, Erskine S, Mokany E, Kennedy E, Umbers AJ, Luchters S, Robinson LJ, Wong NC, Vallely AJ, Badman SG, Vallely LM, Fowkes FJI, Morgan C, Pomat W, Crabb BS, Beeson JG. Mycoplasma genitalium and Other Reproductive Tract Infections in Pregnant Women, Papua New Guinea, 2015-2017. Emerg Infect Dis 2021; 27:894-904. [PMID: 33622474 PMCID: PMC7920647 DOI: 10.3201/eid2703.201783] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Much about the range of pathogens, frequency of coinfection, and clinical effects of reproductive tract infections (RTIs) among pregnant women remains unknown. We report on RTIs (Mycoplasma genitalium, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Treponema pallidum subspecies pallidum, bacterial vaginosis, and vulvovaginal candidiasis) and other reproductive health indicators in 699 pregnant women in Papua New Guinea during 2015–2017. We found M. genitalium, an emerging pathogen in Papua New Guinea, in 12.5% of participants. These infections showed no evidence of macrolide resistance. In total, 74.1% of pregnant women had >1 RTI; most of these infections were treatable. We detected sexually transmitted infections (excluding syphilis) in 37.7% of women. Our findings showed that syndromic management of infections is greatly inadequate. In total, 98.4% of women had never used barrier contraception. These findings will inform efforts to improve reproductive healthcare in Papua New Guinea.
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Cleary E, Hetzel MW, Siba PM, Lau CL, Clements ACA. Spatial prediction of malaria prevalence in Papua New Guinea: a comparison of Bayesian decision network and multivariate regression modelling approaches for improved accuracy in prevalence prediction. Malar J 2021; 20:269. [PMID: 34120604 PMCID: PMC8201920 DOI: 10.1186/s12936-021-03804-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Considerable progress towards controlling malaria has been made in Papua New Guinea through the national malaria control programme’s free distribution of long-lasting insecticidal nets, improved diagnosis with rapid diagnostic tests and improved access to artemisinin combination therapy. Predictive prevalence maps can help to inform targeted interventions and monitor changes in malaria epidemiology over time as control efforts continue. This study aims to compare the predictive performance of prevalence maps generated using Bayesian decision network (BDN) models and multilevel logistic regression models (a type of generalized linear model, GLM) in terms of malaria spatial risk prediction accuracy. Methods Multilevel logistic regression models and BDN models were developed using 2010/2011 malaria prevalence survey data collected from 77 randomly selected villages to determine associations of Plasmodium falciparum and Plasmodium vivax prevalence with precipitation, temperature, elevation, slope (terrain aspect), enhanced vegetation index and distance to the coast. Predictive performance of multilevel logistic regression and BDN models were compared by cross-validation methods. Results Prevalence of P. falciparum, based on results obtained from GLMs was significantly associated with precipitation during the 3 driest months of the year, June to August (β = 0.015; 95% CI = 0.01–0.03), whereas P. vivax infection was associated with elevation (β = − 0.26; 95% CI = − 0.38 to − 3.04), precipitation during the 3 driest months of the year (β = 0.01; 95% CI = − 0.01–0.02) and slope (β = 0.12; 95% CI = 0.05–0.19). Compared with GLM model performance, BDNs showed improved accuracy in prediction of the prevalence of P. falciparum (AUC = 0.49 versus 0.75, respectively) and P. vivax (AUC = 0.56 versus 0.74, respectively) on cross-validation. Conclusions BDNs provide a more flexible modelling framework than GLMs and may have a better predictive performance when developing malaria prevalence maps due to the multiple interacting factors that drive malaria prevalence in different geographical areas. When developing malaria prevalence maps, BDNs may be particularly useful in predicting prevalence where spatial variation in climate and environmental drivers of malaria transmission exists, as is the case in Papua New Guinea.
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Affiliation(s)
- Eimear Cleary
- Research School of Population Health, Australian National University, Canberra, Australia.
| | - Manuel W Hetzel
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.,Centre for Health Research and Diagnostics, Divine Word University, Madang, Papua New Guinea
| | - Colleen L Lau
- Research School of Population Health, Australian National University, Canberra, Australia.,School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Bentley, Australia.,Telethon Kids Institute, Nedlands, Australia
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7
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Kattenberg JH, Gumal DL, Ome-Kaius M, Kiniboro B, Philip M, Jally S, Kasian B, Sambale N, Siba PM, Karl S, Barry AE, Felger I, Kazura JW, Mueller I, Robinson LJ. The epidemiology of Plasmodium falciparum and Plasmodium vivax in East Sepik Province, Papua New Guinea, pre- and post-implementation of national malaria control efforts. Malar J 2020; 19:198. [PMID: 32503607 PMCID: PMC7275396 DOI: 10.1186/s12936-020-03265-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/20/2020] [Indexed: 02/07/2023] Open
Abstract
Background In the past decade, national malaria control efforts in Papua New Guinea (PNG) have received renewed support, facilitating nationwide distribution of free long-lasting insecticidal nets (LLINs), as well as improvements in access to parasite-confirmed diagnosis and effective artemisinin-combination therapy in 2011–2012. Methods To study the effects of these intensified control efforts on the epidemiology and transmission of Plasmodium falciparum and Plasmodium vivax infections and investigate risk factors at the individual and household level, two cross-sectional surveys were conducted in the East Sepik Province of PNG; one in 2005, before the scale-up of national campaigns and one in late 2012-early 2013, after 2 rounds of LLIN distribution (2008 and 2011–2012). Differences between studies were investigated using Chi square (χ2), Fischer’s exact tests and Student’s t-test. Multivariable logistic regression models were built to investigate factors associated with infection at the individual and household level. Results The prevalence of P. falciparum and P. vivax in surveyed communities decreased from 55% (2005) to 9% (2013) and 36% to 6%, respectively. The mean multiplicity of infection (MOI) decreased from 1.8 to 1.6 for P. falciparum (p = 0.08) and from 2.2 to 1.4 for P. vivax (p < 0.001). Alongside these reductions, a shift towards a more uniform distribution of infections and illness across age groups was observed but there was greater heterogeneity across the study area and within the study villages. Microscopy positive infections and clinical cases in the household were associated with high rate infection households (> 50% of household members with Plasmodium infection). Conclusion After the scale-up of malaria control interventions in PNG between 2008 and 2012, there was a substantial reduction in P. falciparum and P. vivax infection rates in the studies villages in East Sepik Province. Understanding the extent of local heterogeneity in malaria transmission and the driving factors is critical to identify and implement targeted control strategies to ensure the ongoing success of malaria control in PNG and inform the development of tools required to achieve elimination. In household-based interventions, diagnostics with a sensitivity similar to (expert) microscopy could be used to identify and target high rate households.
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Affiliation(s)
- Johanna H Kattenberg
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea.,Division of Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia.,Department of Biomedical Sciences, Institute of Tropical Medicine, Malariology Unit, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Dulcie L Gumal
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea.,Disease Elimination Program, Vector-borne Diseases and Tropical Public Health Group, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Maria Ome-Kaius
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea.,Division of Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia
| | - Benson Kiniboro
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea
| | - Matthew Philip
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea
| | - Shadrach Jally
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea
| | - Bernadine Kasian
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea
| | - Naomi Sambale
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea
| | - Peter M Siba
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea
| | - Stephan Karl
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea.,Division of Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia
| | - Alyssa E Barry
- Division of Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia.,School of Medicine, Deakin University, Geelong and Burnet Institute, Melbourne, VIC, Australia
| | - Ingrid Felger
- Medical Parasitology and Infection Biology, Swiss Tropical & Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland
| | - James W Kazura
- Center for Global Health and Diseases, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, 44106, USA
| | - Ivo Mueller
- Division of Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia.,Department of Parasites and Insect Vectors, Malaria Parasites and Hosts Unit, Pasteur Institute, 25-28 rue du Docteur-Roux, 75724, Paris Cedex 15, France
| | - Leanne J Robinson
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, PO Box 378, Madang, 511, MP, Papua New Guinea. .,Division of Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, VIC, 3052, Australia. .,Department of Medical Biology, University of Melbourne, Parkville, VIC, 3010, Australia. .,Disease Elimination Program, Vector-borne Diseases and Tropical Public Health Group, Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.
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8
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Rodriguez-Rodriguez D, Maraga S, Lorry L, Robinson LJ, Siba PM, Mueller I, Pulford J, Ross A, Hetzel MW. Repeated mosquito net distributions, improved treatment, and trends in malaria cases in sentinel health facilities in Papua New Guinea. Malar J 2019; 18:364. [PMID: 31718659 PMCID: PMC6852945 DOI: 10.1186/s12936-019-2993-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 11/04/2019] [Indexed: 11/16/2022] Open
Abstract
Background Long-lasting insecticidal nets (LLIN), improved diagnosis and artemisinin-based combination therapy (ACT) have reduced malaria prevalence in Papua New Guinea since 2008. Yet, national incidence trends are inconclusive due to confounding effects of the scale-up of rapid diagnostic tests, and inconsistencies in routine reporting. Methods Malaria trends and their association with LLIN and ACT roll-out between 2010 and 2014 in seven sentinel health facilities were analysed. The analysis included 35,329 fever patients. Intervention effects were estimated using regression models. Results Malaria incidence initially ranged from 20 to 115/1000 population; subsequent trends varied by site. Overall, LLIN distributions had a cumulative effect, reducing the number of malaria cases with each round (incidence rate ratio ranging from 0.12 to 0.53 in five sites). No significant reduction was associated with ACT introduction. Plasmodium falciparum remained the dominant parasite in all sentinel health facilities. Resurgence occurred in one site in which a shift to early and outdoor biting of anophelines had previously been documented. Conclusions LLINs, but not ACT, were associated with reductions of malaria cases in a range of settings, but sustainability of the gains appear to depend on local factors. Malaria programmes covering diverse transmission settings such as Papua New Guinea must consider local heterogeneity when choosing interventions and ensure continuous monitoring of trends.
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Affiliation(s)
- Daniela Rodriguez-Rodriguez
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Seri Maraga
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Lina Lorry
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Leanne J Robinson
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea.,Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.,Institut Pasteur, Paris, France
| | | | - Amanda Ross
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Manuel W Hetzel
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
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9
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Rodríguez-Rodríguez D, Maraga S, Jamea-Maiasa S, Tandrapah A, Makita L, Siba PM, Mueller I, Pulford J, Hetzel M. Mapping routine malaria incidence at village level for targeted control in Papua New Guinea. Geospat Health 2019; 14. [PMID: 31724386 DOI: 10.4081/gh.2019.798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 09/10/2019] [Indexed: 06/10/2023]
Abstract
Malaria surveillance and response-systems are essential for identifying the areas most affected by malaria and for targeting interventions and optimising resources. This study aimed to assess whether the visualisation of routinely collected health facility data linked to village of residence provides evidence for targeting control interventions in four sentinel health facilities in Papua New Guinea. A video format was used to visualise the dynamics in case incidence over time and space alongside photographs illustrating the context of the data collection in the study sites. Incidence changes overtime were illustrated in animated maps. Despite limitations, this approach appeared useful in sites with very few remaining cases or with increasingly marked heterogeneity. Villages that could benefit from targeted interventions or investigations were identified.
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Affiliation(s)
- Daniela Rodríguez-Rodríguez
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Papua New Guinea Institute of Medical Research, Goroka and Madang.
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10
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Pulford J, Saweri OPM, Jeffery C, Siba PM, Mueller I, Hetzel MW. Does test-based prescription of evidence-based treatment for malaria improve treatment seeking and satisfaction? Findings of repeated cross-sectional surveys in Papua New Guinea. BMJ Glob Health 2018; 3:e000915. [PMID: 30498587 PMCID: PMC6254749 DOI: 10.1136/bmjgh-2018-000915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 10/01/2018] [Accepted: 10/06/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction The presumptive treatment of febrile illness with antimalarial medication is becoming less common in low-income and middle-income countries as access to reliable diagnostic tests improves. We explore whether the shift towards test-based antimalarial prescription, and the introduction of highly efficacious artemisinin combination therapies (ACTs), reduces critical delays in seeking treatment for febrile illness or increases patient satisfaction. Methods We conducted countrywide repeat, cross-sectional surveys in 118 randomly selected primary healthcare services in Papua New Guinea. The clinical case management of 1765 consecutively presenting febrile patients was observed and exit interviews were completed at discharge. This was done prior to implementation of test-based ACT prescription (2011) and at 12 (2012) and 60 months (2016) postimplementation. We conducted multiple logistic regressions. Treatment response time was dichotomised as <24 hours from symptom onset vs 24+ hours. Satisfaction was dichotomised as a ‘high’ vs ‘low’ rating based on participant response to a visual, 7-point Likert-type scale. Results 62% (322/517) of febrile patients reported seeking treatment within 24 hours of symptom onset in 2011 compared with 53% (230/434) in 2012 and 42% (339/814) in 2016. Adjusted ORs for reporting a treatment response time <24 hours in the postimplementation surveys were 0.77 (95% CI 0.48 to 1.26) and 0.45 (95% CI 0.31 to 0.65), respectively when compared with the preimplementation period. 53% (230/533) of febrile patients reported ‘high’ satisfaction with the service received in 2011 compared with 32% (143/449) in 2012 and 35% (278/803) in 2016. Adjusted ORs for reporting high satisfaction in the postimplementation surveys were 0.52 (95% CI 0.32 to 0.85) and 0.65 (95% CI 0.39 to 1.10), respectively when compared with the preimplementation period. Conclusion Nationwide implementation of test-based ACT prescription in Papua New Guinea has increased the likelihood of critical treatment seeking delays and decreased patient satisfaction with the service received.
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Affiliation(s)
- Justin Pulford
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Olga P M Saweri
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Caroline Jeffery
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,Institut Pasteur, Paris, France
| | - Manuel W Hetzel
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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11
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King CL, Suamani J, Sanuku N, Cheng YC, Satofan S, Mancuso B, Goss CW, Robinson LJ, Siba PM, Weil GJ, Kazura JW. A Trial of a Triple-Drug Treatment for Lymphatic Filariasis. N Engl J Med 2018; 379:1801-1810. [PMID: 30403937 PMCID: PMC6194477 DOI: 10.1056/nejmoa1706854] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The World Health Organization has targeted lymphatic filariasis for global elimination by 2020 with a strategy of mass drug administration. This trial tested whether a single dose of a three-drug regimen of ivermectin plus diethylcarbamazine plus albendazole results in a greater sustained clearance of microfilariae than a single dose of a two-drug regimen of diethylcarbamazine plus albendazole and is noninferior to the two-drug regimen administered once a year for 3 years. METHODS In a randomized, controlled trial involving adults from Papua New Guinea with Wuchereria bancrofti microfilaremia, we assigned 182 participants to receive a single dose of the three-drug regimen (60 participants), a single dose of the two-drug regimen (61 participants), or the two-drug regimen once a year for 3 years (61 participants). Clearance of microfilariae from the blood was measured at 12, 24, and 36 months after trial initiation. RESULTS The three-drug regimen cleared microfilaremia in 55 of 57 participants (96%) at 12 months, in 52 of 54 participants (96%) at 24 months, and in 55 of 57 participants (96%) at 36 months. A single dose of the two-drug regimen cleared microfilaremia in 18 of 56 participants (32%) at 12 months, in 31 of 55 participants (56%) at 24 months, and in 43 of 52 participants (83%) at 36 months (P=0.02 for the three-drug regimen vs. a single dose of the two-drug regimen at 36 months). The two-drug regimen administered once a year for 3 years cleared microfilaremia in 20 of 59 participants (34%) at 12 months, in 42 of 56 participants (75%) at 24 months, and in 51 of 52 participants (98%) at 36 months (P=0.004 for noninferiority of the three-drug regimen vs. the two-drug regimen administered once a year for 3 years at 36 months). Moderate adverse events were more common in the group that received the three-drug regimen than in the combined two-drug-regimen groups (27% vs. 5%, P<0.001). There were no serious adverse events. CONCLUSIONS The three-drug regimen induced clearance of microfilariae from the blood for 3 years in almost all participants who received the treatment and was superior to the two-drug regimen administered once and noninferior to the two-drug regimen administered once a year for 3 years. (Funded by the Bill and Melinda Gates Foundation; ClinicalTrials.gov number, NCT01975441 .).
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Affiliation(s)
- Christopher L King
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
| | - James Suamani
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
| | - Nelly Sanuku
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
| | - Yao-Chieh Cheng
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
| | - Samson Satofan
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
| | - Brooke Mancuso
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
| | - Charles W Goss
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
| | - Leanne J Robinson
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
| | - Peter M Siba
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
| | - Gary J Weil
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
| | - James W Kazura
- From the Center for Global Health and Diseases, Case Western Reserve University School of Medicine (C.L.K., Y.-C.C., B.M., J.W.K.), and the Veterans Affairs Medical Center (C.L.K.), Cleveland; Papua New Guinea Institute of Medical Research, Goroka (J.S., N.S., S.S., L.J.R., P.M.S.); and the Division of Biostatistics (C.W.G.) and Department of Medicine, Infectious Diseases Division (G.J.W.), Washington University School of Medicine, St. Louis
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12
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Tavul L, Hetzel MW, Teliki A, Walsh D, Kiniboro B, Rare L, Pulford J, Siba PM, Karl S, Makita L, Robinson L, Kattenberg JH, Laman M, Oswyn G, Mueller I. Efficacy of artemether-lumefantrine and dihydroartemisinin-piperaquine for the treatment of uncomplicated malaria in Papua New Guinea. Malar J 2018; 17:350. [PMID: 30290825 PMCID: PMC6173938 DOI: 10.1186/s12936-018-2494-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/27/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In 2009, the Papua New Guinea (PNG) Department of Health adopted artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DHA-PPQ) as the first- and second-line treatments for uncomplicated malaria, respectively. This study was conducted to assess the efficacy of both drugs following adoption of the new policy. METHODS Between June 2012 and September 2014, a therapeutic efficacy study was conducted in East Sepik and Milne Bay Provinces of PNG in accordance with the standard World Health Organization (WHO) protocol for surveillance of anti-malarial drug efficacy. Patients ≥ 6 months of age with microscopy confirmed Plasmodium falciparum or Plasmodium vivax mono-infections were enrolled, treated with AL or DHA-PPQ, and followed up for 42 days. Study endpoints were adequate clinical and parasitological response (ACPR) on days 28 and 42. The in vitro efficacy of anti-malarials and the prevalence of selected molecular markers of resistance were also determined. RESULTS A total of 274 P. falciparum and 70 P. vivax cases were enrolled. The day-42 PCR-corrected ACPR for P. falciparum was 98.1% (104/106) for AL and 100% (135/135) for DHA-PPQ. The day-42 PCR-corrected ACPR for P. vivax was 79.0% (15/19) for AL and 92.3% (36/39) for DHA-PPQ. Day 3 parasite clearance of P. falciparum was 99.2% with AL and 100% with DHA-PPQ. In vitro testing of 96 samples revealed low susceptibility to chloroquine (34% of samples above IC50 threshold) but not to lumefantrine (0%). Molecular markers assessed in a sub-set of the study population indicated high rates of chloroquine resistance in P. falciparum (pfcrt SVMNT: 94.2%, n = 104) and in P. vivax (pvmdr1 Y976F: 64.8%, n = 54). CONCLUSIONS AL and DHA-PPQ were efficacious as first- and second-line treatments for uncomplicated malaria in PNG. Continued in vivo efficacy monitoring is warranted considering the threat of resistance to artemisinin and partner drugs in the region and scale-up of artemisinin-based combination therapy in PNG.
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Affiliation(s)
- Livingstone Tavul
- Papua New Guinea Institute of Medical Research, PO Box 378, Madang, Papua New Guinea.
| | - Manuel W Hetzel
- Swiss Tropical and Public Health Institute, PO Box, 4002, Basel, Switzerland.,University of Basel, Petersplatz 1, 4003, Basel, Switzerland
| | - Albina Teliki
- Papua New Guinea Institute of Medical Research, PO Box 378, Madang, Papua New Guinea
| | - Dorish Walsh
- Papua New Guinea Institute of Medical Research, PO Box 378, Madang, Papua New Guinea
| | - Benson Kiniboro
- Papua New Guinea Institute of Medical Research, PO Box 378, Madang, Papua New Guinea
| | - Lawrence Rare
- Papua New Guinea Institute of Medical Research, PO Box 378, Madang, Papua New Guinea
| | - Justin Pulford
- Papua New Guinea Institute of Medical Research, PO Box 378, Madang, Papua New Guinea.,Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L35QA, UK
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, PO Box 378, Madang, Papua New Guinea
| | - Stephan Karl
- Papua New Guinea Institute of Medical Research, PO Box 378, Madang, Papua New Guinea.,Infection and Immunity Division, Walter and Eliza Hall Institute, Melbourne, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Leo Makita
- National Department of Health, PO Box 807, Waigani, NCD, Papua New Guinea
| | - Leanne Robinson
- Papua New Guinea Institute of Medical Research, PO Box 378, Madang, Papua New Guinea.,Infection and Immunity Division, Walter and Eliza Hall Institute, Melbourne, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Johanna H Kattenberg
- Papua New Guinea Institute of Medical Research, PO Box 378, Madang, Papua New Guinea.,Institute of Tropical Medicine in Antwerp, Kronenburgstraat 43, 2000, Antwerp, Belgium
| | - Moses Laman
- Papua New Guinea Institute of Medical Research, PO Box 378, Madang, Papua New Guinea
| | - Gilchrist Oswyn
- Milne Bay Provincial Health Authority, Lock Bag 402, Alotau, Papua New Guinea
| | - Ivo Mueller
- Infection and Immunity Division, Walter and Eliza Hall Institute, Melbourne, Australia.,Department of Medical Biology, University of Melbourne, Melbourne, Australia.,Institut Pasteur, 25-28, rue du Docteur-Roux, Cedex 15, 75724, Paris, France
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13
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Pulford J, Kurumop S, Mueller I, Siba PM, Hetzel MW. The impact of the scale-up of malaria rapid diagnostic tests on the routine clinical diagnosis procedures for febrile illness: a series of repeated cross-sectional studies in Papua New Guinea. Malar J 2018; 17:202. [PMID: 29769128 PMCID: PMC5956836 DOI: 10.1186/s12936-018-2351-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper examines the impact of the scale-up of malaria rapid diagnostic tests (RDT) on routine clinical diagnosis procedures for febrile illness in primary healthcare settings in Papua New Guinea. METHODS Repeat, cross-sectional surveys in randomly selected primary healthcare services were conducted. Surveys included passive observation of consecutive febrile case management cases and were completed immediately prior to RDT scale-up (2011) and at 12- (2012) and 60-months (2016) post scale-up. The frequency with which specified diagnostic questions and procedures were observed to occur, with corresponding 95% CIs, was calculated for febrile patients prescribed anti-malarials pre- and post-RDT scale-up and between febrile patients who tested either negative or positive for malaria infection by RDT (post scale-up only). RESULTS A total of 1809 observations from 120 health facilities were completed across the three survey periods of which 915 (51%) were prescribed an anti-malarial. The mean number of diagnostic questions and procedures asked or performed, leading to anti-malarial prescription, remained consistent pre- and post-RDT scale-up (range 7.4-7.7). However, alterations in diagnostic content were evident with the RDT replacing body temperature as the primary diagnostic procedure performed (observed in 5.3 and 84.4% of cases, respectively, in 2011 vs. 77.9 and 58.2% of cases in 2016). Verbal questioning, especially experience of fever, cough and duration of symptoms, remained the most common feature of a diagnostic examination leading to anti-malarial prescription irrespective of RDT use (observed in 96.1, 86.8 and 84.8% of cases, respectively, in 2011 vs. 97.5, 76.6 and 85.7% of cases in 2016). Diagnostic content did not vary substantially by RDT result. CONCLUSIONS Rapid diagnostic tests scale-up has led to a reduction in body temperature measurement. Investigations are very limited when malaria infection is ruled out as a cause of febrile illness by RDT.
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Affiliation(s)
- Justin Pulford
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. .,Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Serah Kurumop
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.,Barcelona Centre for International Health Research, Barcelona, Spain
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Manuel W Hetzel
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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14
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Vallely LM, Toliman P, Ryan C, Rai G, Wapling J, Gabuzzi J, Allen J, Opa C, Munnull G, Kaima P, Kombuk B, Kumbia A, Kombati Z, Law G, Kelly-Hanku A, Wand H, Siba PM, Mola GDL, Kaldor JM, Vallely AJ. Performance of syndromic management for the detection and treatment of genital Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis among women attending antenatal, well woman and sexual health clinics in Papua New Guinea: a cross-sectional study. BMJ Open 2017; 7:e018630. [PMID: 29288183 PMCID: PMC5778337 DOI: 10.1136/bmjopen-2017-018630] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Papua New Guinea (PNG) has among the highest estimated prevalences of genital Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) of any country in the Asia-Pacific region. Diagnosis and treatment of these infections have relied on the WHO-endorsed syndromic management strategy that uses clinical presentation without laboratory confirmation to make treatment decisions. We evaluated the performance of this strategy in clinical settings in PNG. DESIGN Women attending antenatal (ANC), well woman (WWC) and sexual health (SHC) clinics in four provinces were invited to participate, completed a face-to-face interview and clinical examination, and provided genital specimens for laboratory testing. We estimated the performance characteristics of syndromic diagnoses against combined laboratory diagnoses. RESULTS 1764 women were enrolled (ANC=765; WWC=614; SHC=385). The prevalences of CT, NG and TV were highest among women attending ANC and SHC. Among antenatal women, syndromic diagnosis of sexually transmitted infection had low sensitivity (9%-21%) and positive predictive value (PPV) (7%-37%), but high specificity (76%-89%) and moderate negative predictive value (NPV) (55%-86%) for the combined endpoint of laboratory-confirmed CT, NG or TV. Among women attending WWC and SHC, 'vaginal discharge syndrome' had moderate to high sensitivity (72%-78%) and NPV (62%-94%), but low specificity (26%-33%) and PPV (8%-38%). 'Lower abdominal pain syndrome' had low sensitivity (26%-41%) and PPV (8%-23%) but moderate specificity (66%-68%) and high NPV (74%-93%) among women attending WWC, and moderate-high sensitivity (67%-79%) and NPV (62%-86%) but low specificity (26%-28%) and PPV (14%-33%) among SHC attendees. CONCLUSION The performance of syndromic management for the detection and treatment of genital chlamydia, gonorrhoea and trichomonas was poor among women in different clinical settings in PNG. New diagnostic strategies are needed to control these infections and to prevent their adverse health outcomes in PNG and other high-burden countries.
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Affiliation(s)
- Lisa M Vallely
- Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Pamela Toliman
- Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Claire Ryan
- The Macfarlane Burnet Institute for Medical Research and Public Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Glennis Rai
- School of Medicine and Health Sciences, University of Papua New Guinea, Boroko, Papua New Guinea
| | - Johanna Wapling
- The Macfarlane Burnet Institute for Medical Research and Public Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Josephine Gabuzzi
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea
| | - Joyce Allen
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea
| | - Christine Opa
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea
| | - Gloria Munnull
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea
| | - Petronia Kaima
- Tininga clinic, Mt Hagen General Hospital, Mount Hagen, Papua New Guinea
| | - Benny Kombuk
- Obstetrics and Gynaecology, Mt Hagen General Hospital, Mount Hagen, Papua New Guinea
| | - Antonia Kumbia
- Obstetrics and Gynaecology, Eastern Highlands Provincial Hospital, Goroka, Papua New Guinea
| | - Zure Kombati
- Department of Pathology, Mt Hagen General Hospital, Mt Hagen, Papua New Guinea
| | - Greg Law
- Sexual Health and Disease Control Branch, National Department of Health, Poert Moresby, Papua New Guinea
| | - Angela Kelly-Hanku
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea
| | - Handan Wand
- Biostatistics and Database Program, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Peter M Siba
- Former Director, Papua New Guinea Institute of Medical Research, Port Moresby, Papua New Guinea
| | - Glen D L Mola
- School of Medicine and Health Sciences, University of Papua New Guinea, Boroko, Papua New Guinea
| | - John M Kaldor
- Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrew J Vallely
- Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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15
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Horwood PF, Soli KW, Maure T, Naito YI, Morita A, Natsuhara K, Tadokoro K, Baba J, Odani S, Tomitsuka E, Igai K, Larkins JA, Siba PM, Pomat W, McBryde ES, Umezaki M, Greenhill AR. A High Burden of Asymptomatic Gastrointestinal Infections in Traditional Communities in Papua New Guinea. Am J Trop Med Hyg 2017; 97:1872-1875. [PMID: 29016338 PMCID: PMC5805050 DOI: 10.4269/ajtmh.17-0282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Stool samples were collected from 148 healthy adults living a traditional subsistence lifestyle in Papua New Guinea and screened for enteric pathogens using real-time RT-PCR/PCR assays. Enteric pathogens were detected in a high proportion (41%) of individuals. Clear differences were observed in the detection of pathogens between highland and lowland communities. In particular, there was a marked difference in detection rates of norovirus GII (20% and 0%, respectively) and Shigella sp. (15% and 0%, respectively). Analysis of the relationship between enteric pathogen carriage and microbial community composition of participants, using box plots to compare specific normal flora population numbers, did not suggest that gut microbial composition was directly associated with pathogen carriage. This study suggests that enteric pathogens are common in healthy individuals in Papua New Guinean highland communities, presumably acting as a reservoir of infection and thus contributing to a high burden of gastrointestinal illnesses.
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Affiliation(s)
- Paul F Horwood
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.,Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Kevin W Soli
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Tobias Maure
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Yuichi I Naito
- Department of Biogeochemistry, Japan Agency for Marine-Earth Science and Technology, Kanagawa, Japan
| | - Ayako Morita
- Department of Human Ecology, The University of Tokyo, Tokyo, Japan
| | - Kazumi Natsuhara
- Faculty of Nursing, The Japanese Red Cross Akita College of Nursing, Akita, Japan
| | - Kiyoshi Tadokoro
- Department of Human Ecology, The University of Tokyo, Tokyo, Japan
| | - Jun Baba
- Research Institute for Languages and Cultures of Asia and Africa, Tokyo, Japan
| | - Shingo Odani
- Faculty of Letter, Chiba University, Chiba, Japan
| | - Eriko Tomitsuka
- Department of Health Chemistry, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Sciences, Niigata City, Japan.,Department of Human Ecology, The University of Tokyo, Tokyo, Japan
| | - Katsura Igai
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.,Department of Human Ecology, The University of Tokyo, Tokyo, Japan
| | - Jo-Ann Larkins
- School of Applied and Biomedical Sciences, Federation University Australia, Victoria, Australia
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - William Pomat
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Emma S McBryde
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Masahiro Umezaki
- Department of Human Ecology, The University of Tokyo, Tokyo, Japan
| | - Andrew R Greenhill
- School of Applied and Biomedical Sciences, Federation University Australia, Victoria, Australia.,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
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16
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Chan JA, Stanisic DI, Duffy MF, Robinson LJ, Lin E, Kazura JW, King CL, Siba PM, Fowkes FJ, Mueller I, Beeson JG. Patterns of protective associations differ for antibodies to P. falciparum-infected erythrocytes and merozoites in immunity against malaria in children. Eur J Immunol 2017; 47:2124-2136. [PMID: 28833064 DOI: 10.1002/eji.201747032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/09/2017] [Accepted: 08/16/2017] [Indexed: 11/10/2022]
Abstract
Acquired antibodies play an important role in immunity to P. falciparum malaria and are typically directed towards surface antigens expressed by merozoites and infected erythrocytes (IEs). The importance of specific IE surface antigens as immune targets remains unclear. We evaluated antibodies and protective associations in two cohorts of children in Papua New Guinea. We used genetically-modified P. falciparum to evaluate the importance of PfEMP1 and a P. falciparum isolate with a virulent phenotype. Our findings suggested that PfEMP1 was the dominant target of antibodies to the IE surface, including functional antibodies that promoted opsonic phagocytosis by monocytes. Antibodies were associated with increasing age and concurrent parasitemia, and were higher among children exposed to a higher force-of-infection as determined using molecular detection. Antibodies to IE surface antigens were consistently associated with reduced risk of malaria in both younger and older children. However, protective associations for antibodies to merozoite surface antigens were only observed in older children. This suggests that antibodies to IE surface antigens, particularly PfEMP1, play an earlier role in acquired immunity to malaria, whereas greater exposure is required for protective antibodies to merozoite antigens. These findings have implications for vaccine design and serosurveillance of malaria transmission and immunity.
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Affiliation(s)
- Jo-Anne Chan
- Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia.,Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia
| | - Danielle I Stanisic
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Institute for Glycomics, Griffith University, Southport, Queensland, Australia
| | - Michael F Duffy
- Department of Medicine and Melbourne School of Public Health, University of Melbourne, Parkville, Victoria, Australia
| | - Leanne J Robinson
- Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia.,Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Enmoore Lin
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - James W Kazura
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
| | - Christopher L King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Freya Ji Fowkes
- Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia.,Melbourne School of Public Health, University of Melbourne, Parkville, Victoria, Australia.,Department of Epidemiology and Preventive Medicine and Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - James G Beeson
- Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia.,Department of Medicine and Melbourne School of Public Health, University of Melbourne, Parkville, Victoria, Australia.,Department of Microbiology, Monash University, Melbourne, Victoria, Australia
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17
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Hetzel MW, Pulford J, Ura Y, Jamea-Maiasa S, Tandrapah A, Tarongka N, Lorry L, Robinson LJ, Lilley K, Makita L, Siba PM, Mueller I. Insecticide-treated nets and malaria prevalence, Papua New Guinea, 2008-2014. Bull World Health Organ 2017; 95:695-705B. [PMID: 29147042 PMCID: PMC5689189 DOI: 10.2471/blt.16.189902] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 12/21/2022] Open
Abstract
Objective To investigate changes in malaria prevalence in Papua New Guinea after the distribution of long-lasting Insecticide-treated nets, starting in 2004, and the introduction of artemisinin-based combination therapy in 2011. Methods Two malaria surveys were conducted in 2010–2011 and 2013–2014. They included 77 and 92 randomly selected villages, respectively. In each village, all members of 30 randomly selected households gave blood samples and were assessed for malaria infection by light microscopy. In addition, data were obtained from a malaria survey performed in 2008–2009. Results The prevalence of malaria below 1600 m in altitude decreased from 11.1% (95% confidence interval, CI: 8.5–14.3) in 2008–2009 to 5.1% (95% CI 3.6–7.4) in 2010–2011 and 0.9% (95% CI 0.6–1.5) in 2013–2014. Prevalence decreased with altitude. Plasmodium falciparum was more common than P. vivax overall, but not everywhere, and initially the prevalence of P. vivax infection decreased more slowly than P. falciparum infection. Malaria infections were clustered in households. In contrast to findings in 2008–2009, no significant association between net use and prevalence was found in the later two surveys. The prevalence of both fever and splenomegaly also decreased but their association with malaria infection became stronger. Conclusion Large-scale insecticide-treated net distribution was associated with an unprecedented decline in malaria prevalence throughout Papua New Guinea, including epidemic-prone highland areas. The decline was accompanied by broader health benefits, such as decreased morbidity. Better clinical management of nonmalarial fever and research into residual malaria transmission are required.
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Affiliation(s)
- Manuel W Hetzel
- Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel, 4002, Switzerland
| | - Justin Pulford
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Yangta Ura
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Sharon Jamea-Maiasa
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Anthony Tandrapah
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Nandao Tarongka
- Deceased, formerly, Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Lina Lorry
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Leanne J Robinson
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Ken Lilley
- Australian Army Malaria Institute, Enoggera, Australia
| | - Leo Makita
- National Department of Health, Waigani, Papua New Guinea
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Ivo Mueller
- Division of Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
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18
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Salman S, Baiwog F, Page-Sharp M, Kose K, Karunajeewa HA, Mueller I, Rogerson SJ, Siba PM, Ilett KF, Davis TME. Optimal antimalarial dose regimens for chloroquine in pregnancy based on population pharmacokinetic modelling. Int J Antimicrob Agents 2017; 50:542-551. [PMID: 28669839 DOI: 10.1016/j.ijantimicag.2017.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/22/2017] [Accepted: 05/25/2017] [Indexed: 12/25/2022]
Abstract
Despite extensive use and accumulated evidence of safety, there have been few pharmacokinetic studies from which appropriate chloroquine (CQ) dosing regimens could be developed specifically for pregnant women. Such optimised CQ-based regimens, used as treatment for acute malaria or as intermittent preventive treatment in pregnancy (IPTp), may have a valuable role if parasite CQ sensitivity returns following reduced drug pressure. In this study, population pharmacokinetic/pharmacodynamic modelling was used to simultaneously analyse plasma concentration-time data for CQ and its active metabolite desethylchloroquine (DCQ) in 44 non-pregnant and 45 pregnant Papua New Guinean women treated with CQ and sulfadoxine/pyrimethamine or azithromycin (AZM). Pregnancy was associated with 16% and 49% increases in CQ and DCQ clearance, respectively, as well as a 24% reduction in CQ relative bioavailability. Clearance of DCQ was 22% lower in those who received AZM in both groups. Simulations based on the final multicompartmental model demonstrated that a 33% CQ dose increase may be suitable for acute treatment for malaria in pregnancy as it resulted in equivalent exposure to that in non-pregnant women receiving recommended doses, whilst a double dose would likely be required for an effective duration of post-treatment prophylaxis when used as IPTp especially in areas of CQ resistance. The impact of co-administered AZM was clinically insignificant in simulations. The results of past/ongoing trials employing recommended adult doses of CQ-based regimens in pregnant women should be interpreted in light of these findings, and consideration should be given to using increased doses in future trials.
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Affiliation(s)
- Sam Salman
- School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia
| | - Francesca Baiwog
- Papua New Guinea Institute of Medical Research, P.O. Box 378, Madang, Madang Province, Papua New Guinea
| | - Madhu Page-Sharp
- School of Pharmacy, Curtin University of Technology, Kent Street, Bentley, WA 6102, Australia
| | - Kay Kose
- Papua New Guinea Institute of Medical Research, P.O. Box 378, Madang, Madang Province, Papua New Guinea
| | - Harin A Karunajeewa
- Population Health and Immunity, Walter and Eliza Hall Institute, 1G Royal Parade, Parkville, VIC 3052, Australia
| | - Ivo Mueller
- Population Health and Immunity, Walter and Eliza Hall Institute, 1G Royal Parade, Parkville, VIC 3052, Australia; Barcelona Institute for Global Health (ISGlobal), Carrer del Rosselló 132, 08036 Barcelona, Spain
| | - Stephen J Rogerson
- Department of Medicine (RMH), The University of Melbourne, 300 Grattan Street, Parkville, VIC 3050, Australia
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, P.O. Box 378, Madang, Madang Province, Papua New Guinea
| | - Kenneth F Ilett
- School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia
| | - Timothy M E Davis
- School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia.
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19
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Schofield L, Ioannidis LJ, Karl S, Robinson LJ, Tan QY, Poole DP, Betuela I, Hill DL, Siba PM, Hansen DS, Mueller I, Eriksson EM. Synergistic effect of IL-12 and IL-18 induces TIM3 regulation of γδ T cell function and decreases the risk of clinical malaria in children living in Papua New Guinea. BMC Med 2017; 15:114. [PMID: 28615061 PMCID: PMC5471992 DOI: 10.1186/s12916-017-0883-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 05/22/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND γδ T cells are important for both protective immunity and immunopathogenesis during malaria infection. However, the immunological processes determining beneficial or detrimental effects on disease outcome remain elusive. The aim of this study was to examine expression and regulatory effect of the inhibitory receptor T-cell immunoglobulin domain and mucin domain 3 (TIM3) on γδ T cells. While TIM3 expression and function on conventional αβ T cells have been clearly defined, the equivalent characterization on γδ T cells and associations with disease outcomes is limited. This study investigated the functional capacity of TIM3+ γδ T cells and the underlying mechanisms contributing to TIM3 upregulation and established an association with malaria disease outcomes. METHODS We analyzed TIM3 expression on γδ T cells in 132 children aged 5-10 years living in malaria endemic areas of Papua New Guinea. TIM3 upregulation and effector functions of TIM3+ γδ T cells were assessed following in vitro stimulation with parasite-infected erythrocytes, phosphoantigen and/or cytokines. Associations between the proportion of TIM3-expressing cells and the molecular force of infection were tested using negative binomial regression and in a Cox proportional hazards model for time to first clinical episode. Multivariable analyses to determine the association of TIM3 and IL-18 levels were conducted using general linear models. Malaria infection mouse models were utilized to experimentally investigate the relationship between repeated exposure and TIM3 upregulation. RESULTS This study demonstrates that even in the absence of an active malaria infection, children of malaria endemic areas have an atypical population of TIM3-expressing γδ T cells (mean frequency TIM3+ of total γδ T cells 15.2% ± 12). Crucial factors required for γδ T cell TIM3 upregulation include IL-12/IL-18, and plasma IL-18 was associated with TIM3 expression (P = 0.002). Additionally, we show a relationship between TIM3 expression and infection with distinct parasite clones during repeated exposure. TIM3+ γδ T cells were functionally impaired and were associated with asymptomatic malaria infection (hazard ratio 0.54, P = 0.032). CONCLUSIONS Collectively our data demonstrate a novel role for IL-12/IL-18 in shaping the innate immune response and provide fundamental insight into aspects of γδ T cell immunoregulation. Furthermore, we show that TIM3 represents an important γδ T cell regulatory component involved in minimizing malaria symptoms.
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Affiliation(s)
- Louis Schofield
- Walter and Eliza Hall Institute of Medical Research, Division of Population Health and Immunity, Melbourne, VIC, 3052, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, 4811, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, 3052, Australia
| | - Lisa J Ioannidis
- Walter and Eliza Hall Institute of Medical Research, Division of Population Health and Immunity, Melbourne, VIC, 3052, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, 3052, Australia
| | - Stephan Karl
- Walter and Eliza Hall Institute of Medical Research, Division of Population Health and Immunity, Melbourne, VIC, 3052, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, 3052, Australia
| | - Leanne J Robinson
- Walter and Eliza Hall Institute of Medical Research, Division of Population Health and Immunity, Melbourne, VIC, 3052, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, 3052, Australia.,Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea.,Burnet Institute, Melbourne, VIC, 3004, Australia
| | - Qiao Y Tan
- Walter and Eliza Hall Institute of Medical Research, Division of Population Health and Immunity, Melbourne, VIC, 3052, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, 3052, Australia
| | - Daniel P Poole
- Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, VIC, 3052, Australia.,Department of Anatomy and Neuroscience, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Inoni Betuela
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Danika L Hill
- Walter and Eliza Hall Institute of Medical Research, Division of Population Health and Immunity, Melbourne, VIC, 3052, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, 3052, Australia
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea.,School of Veterinary and Biomedical Sciences, James Cook University, Townsville, QLD, 4811, Australia
| | - Diana S Hansen
- Walter and Eliza Hall Institute of Medical Research, Division of Population Health and Immunity, Melbourne, VIC, 3052, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, 3052, Australia
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Division of Population Health and Immunity, Melbourne, VIC, 3052, Australia.,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, 3052, Australia
| | - Emily M Eriksson
- Walter and Eliza Hall Institute of Medical Research, Division of Population Health and Immunity, Melbourne, VIC, 3052, Australia. .,Department of Medical Biology, The University of Melbourne, Melbourne, VIC, 3052, Australia. .,The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Melbourne, VIC, 3052, Australia.
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20
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Thomsen EK, Koimbu G, Pulford J, Jamea-Maiasa S, Ura Y, Keven JB, Siba PM, Mueller I, Hetzel MW, Reimer LJ. Mosquito Behavior Change After Distribution of Bednets Results in Decreased Protection Against Malaria Exposure. J Infect Dis 2017; 215:790-797. [PMID: 28007921 PMCID: PMC5388271 DOI: 10.1093/infdis/jiw615] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 12/07/2016] [Indexed: 11/21/2022] Open
Abstract
Background. Behavioral resilience in mosquitoes poses a significant challenge to mosquito control. Although behavior changes in anopheline vectors have been reported over the last decade, there are no empirical data to suggest they compromise the efficacy of vector control in reducing malaria transmission. Methods. In this study, we quantified human exposure to both bites and infective bites of a major malaria vector in Papua New Guinea over the course of 4 years surrounding nationwide bednet distribution. We also quantified malaria infection prevalence in the human population during the same time period. Results. We observed a shift in mosquito biting to earlier hours of the evening, before individuals are indoors and protected by bednets, followed by a return to preintervention biting rates. As a result, net users and non–net users experienced higher levels of transmission than before the intervention. The personal protection provided by a bednet decreased over the study period and was lowest in the adult population, who may be an important reservoir for transmission. Malaria prevalence decreased in only 1 of 3 study villages after the distribution. Discussion. This study highlights the necessity of validating and deploying vector control measures targeting outdoor exposure to control and eliminate malaria.
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Affiliation(s)
| | - Gussy Koimbu
- Papua New Guinea Institute of Medical Research, Vector Borne Diseases Unit, Madang, 511, Madang, Papua New Guinea
| | | | | | - Yangta Ura
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - John B Keven
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI, USA
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Ivo Mueller
- Walter and Eliza Hall Institute, Parkville, Victoria, Australia
| | - Manuel W Hetzel
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Switzerland
| | - Lisa J Reimer
- Liverpool School of Tropical Medicine, United Kingdom
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21
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Fola AA, Harrison GLA, Hazairin MH, Barnadas C, Hetzel MW, Iga J, Siba PM, Mueller I, Barry AE. Higher Complexity of Infection and Genetic Diversity of Plasmodium vivax Than Plasmodium falciparum Across All Malaria Transmission Zones of Papua New Guinea. Am J Trop Med Hyg 2017; 96:630-641. [PMID: 28070005 DOI: 10.4269/ajtmh.16-0716] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Plasmodium falciparum and Plasmodium vivax have varying transmission dynamics that are informed by molecular epidemiology. This study aimed to determine the complexity of infection and genetic diversity of P. vivax and P. falciparum throughout Papua New Guinea (PNG) to evaluate transmission dynamics across the country. In 2008-2009, a nationwide malaria indicator survey collected 8,936 samples from all 16 endemic provinces of PNG. Of these, 892 positive P. vivax samples were genotyped at PvMS16 and PvmspF3, and 758 positive P. falciparum samples were genotyped at Pfmsp2. The data were analyzed for multiplicity of infection (MOI) and genetic diversity. Overall, P. vivax had higher polyclonality (71%) and mean MOI (2.32) than P. falciparum (20%, 1.39). These measures were significantly associated with prevalence for P. falciparum but not for P. vivax. The genetic diversity of P. vivax (PvMS16: expected heterozygosity = 0.95, 0.85-0.98; PvMsp1F3: 0.78, 0.66-0.89) was higher and less variable than that of P. falciparum (Pfmsp2: 0.89, 0.65-0.97). Significant associations of MOI with allelic richness (rho = 0.69, P = 0.009) and expected heterozygosity (rho = 0.87, P < 0.001) were observed for P. falciparum. Conversely, genetic diversity was not correlated with polyclonality nor mean MOI for P. vivax. The results demonstrate higher complexity of infection and genetic diversity of P. vivax across the country. Although P. falciparum shows a strong association of these parameters with prevalence, a lack of association was observed for P. vivax and is consistent with higher potential for outcrossing of this species.
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Affiliation(s)
- Abebe A Fola
- Department of Medical Biology, University of Melbourne, Parkville, Australia.,Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - G L Abby Harrison
- Department of Medical Biology, University of Melbourne, Parkville, Australia.,Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Mita Hapsari Hazairin
- Department of Epidemiology and Preventative Medicine, Monash University, Clayton, Australia.,Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Céline Barnadas
- Statens Serum Institut, Copenhagen, Denmark.,European Public Health Microbiology (EUPHEM) Training Programme, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Manuel W Hetzel
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Jonah Iga
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Ivo Mueller
- Institut Pasteur, Paris, France.,Department of Medical Biology, University of Melbourne, Parkville, Australia.,Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Alyssa E Barry
- Department of Medical Biology, University of Melbourne, Parkville, Australia.,Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
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22
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Saweri OPM, Hetzel MW, Mueller I, Siba PM, Pulford J. The treatment of non-malarial febrile illness in Papua New Guinea: findings from cross sectional and longitudinal studies of health worker practice. BMC Health Serv Res 2017; 17:10. [PMID: 28056949 PMCID: PMC5217620 DOI: 10.1186/s12913-016-1965-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 09/04/2015] [Accepted: 12/20/2016] [Indexed: 11/17/2022] Open
Abstract
Background The Papua New Guinea Department of Health recently shifted from a presumptive to a ‘test and treat’ malaria case management policy. This shift was supported by the widespread introduction of malaria rapid diagnostic tests in health facilities across the country. Health workers received training and job-aids detailing how to conduct and interpret a malaria rapid diagnostic test and how to treat test positive cases; however, little instruction on treating non-malaria febrile cases was provided. Accordingly, this study examined health worker case management of non-malarial febrile patients in the 12-month period immediately following the introduction of the revised malaria case management policy. Methods Data were collected from a country-wide cross-sectional survey of febrile case management at randomly selected health facilities and from longitudinal surveillance at sentinel health facilities. Analysis was restricted to febrile patients who tested negative for malaria infection by rapid diagnostic test (N=303 and 5705 outpatients, respectively). Results and Discussion 96.8% of non-malarial febrile patients received a diagnosis in the longitudinal sample, compared to 52.4% of the cross-sectional sample. Respiratory tract infections were the most commonly reported diagnoses. Over 90% of patients in both samples were prescribed one or more medications, most commonly an analgesic (71.3 & 72.9% of the longitudinal and cross-sectional samples, respectively), some form of antibiotic (72.7 & 73.4%, respectively) and/or an anthelminthic (17.9 & 16.5%, respectively). Prescribing behaviour was adherent with the recommendations in the standard treatment guidelines in fewer than 20% of cases (longitudinal sample only). Conclusion Many non-malarial febrile patients are not provided with a diagnosis. When diagnoses are provided they are typically some form of respiratory tract infection. Antibiotics and analgesics are widely prescribed, although medications prescribed rarely adhere to the Papua New Guinea standard treatment guidelines. These findings indicate that Papua New Guinea health workers require support for non-malarial febrile illness case management. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1965-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Olga P M Saweri
- Papua New Guinea Institute of Medical Research (PNGIMR), PO Box 60, Goroka, EHP 441, Papua New Guinea
| | - Manuel W Hetzel
- Swiss Tropical and Public Health Institute, PO Box, 4002, Basel, Switzerland.,University of Basel, Petersplatz 1, 4003, Basel, Switzerland
| | - Ivo Mueller
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain.,Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research (PNGIMR), PO Box 60, Goroka, EHP 441, Papua New Guinea
| | - Justin Pulford
- Papua New Guinea Institute of Medical Research (PNGIMR), PO Box 60, Goroka, EHP 441, Papua New Guinea. .,Liverpool School of Tropical Medicine, Liverpool, UK.
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23
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Drew DR, Wilson DW, Elliott SR, Cross N, Terheggen U, Hodder AN, Siba PM, Chelimo K, Dent AE, Kazura JW, Mueller I, Beeson JG. A novel approach to identifying patterns of human invasion-inhibitory antibodies guides the design of malaria vaccines incorporating polymorphic antigens. BMC Med 2016; 14:144. [PMID: 27658419 PMCID: PMC5034621 DOI: 10.1186/s12916-016-0691-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/08/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The polymorphic nature of many malaria vaccine candidates presents major challenges to achieving highly efficacious vaccines. Presently, there is very little knowledge on the prevalence and patterns of functional immune responses to polymorphic vaccine candidates in populations to guide vaccine design. A leading polymorphic vaccine candidate against blood-stage Plasmodium falciparum is apical membrane antigen 1 (AMA1), which is essential for erythrocyte invasion. The importance of AMA1 as a target of acquired human inhibitory antibodies, their allele specificity and prevalence in populations is unknown, but crucial for vaccine design. METHODS P. falciparum lines expressing different AMA1 alleles were genetically engineered and used to quantify functional antibodies from two malaria-exposed populations of adults and children. The acquisition of AMA1 antibodies was also detected using enzyme-linked immunosorbent assay (ELISA) and competition ELISA (using different AMA1 alleles) from the same populations. RESULTS We found that AMA1 was a major target of naturally acquired invasion-inhibitory antibodies that were highly prevalent in malaria-endemic populations and showed a high degree of allele specificity. Significantly, the prevalence of inhibitory antibodies to different alleles varied substantially within populations and between geographic locations. Inhibitory antibodies to three specific alleles were highly prevalent (FVO and W2mef in Papua New Guinea; FVO and XIE in Kenya), identifying them for potential vaccine inclusion. Measurement of antibodies by standard or competition ELISA was not strongly predictive of allele-specific inhibitory antibodies. The patterns of allele-specific functional antibody responses detected with our novel assays may indicate that acquired immunity is elicited towards serotypes that are prevalent in each geographic location. CONCLUSIONS These findings provide new insights into the nature and acquisition of functional immunity to a polymorphic vaccine candidate and strategies to quantify functional immunity in populations to guide rational vaccine design.
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Affiliation(s)
- Damien R Drew
- The Burnet Institute of Medical Research and Public Health, 85 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Danny W Wilson
- The Burnet Institute of Medical Research and Public Health, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.,Research Centre for Infectious Diseases, School of Molecular and Biomedical Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Salenna R Elliott
- The Burnet Institute of Medical Research and Public Health, 85 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Nadia Cross
- The Burnet Institute of Medical Research and Public Health, 85 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Ulrich Terheggen
- The Burnet Institute of Medical Research and Public Health, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Anthony N Hodder
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | | | - Arlene E Dent
- Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - James G Beeson
- The Burnet Institute of Medical Research and Public Health, 85 Commercial Road, Melbourne, Victoria, 3004, Australia. .,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia. .,Department of Microbiology, Monash University, Clayton, Victoria, Australia.
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24
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Igai K, Itakura M, Nishijima S, Tsurumaru H, Suda W, Tsutaya T, Tomitsuka E, Tadokoro K, Baba J, Odani S, Natsuhara K, Morita A, Yoneda M, Greenhill AR, Horwood PF, Inoue JI, Ohkuma M, Hongoh Y, Yamamoto T, Siba PM, Hattori M, Minamisawa K, Umezaki M. Nitrogen fixation and nifH diversity in human gut microbiota. Sci Rep 2016; 6:31942. [PMID: 27554344 PMCID: PMC4995403 DOI: 10.1038/srep31942] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 07/27/2016] [Indexed: 12/04/2022] Open
Abstract
It has been hypothesized that nitrogen fixation occurs in the human gut. However, whether the gut microbiota truly has this potential remains unclear. We investigated the nitrogen-fixing activity and diversity of the nitrogenase reductase (NifH) genes in the faecal microbiota of humans, focusing on Papua New Guinean and Japanese individuals with low to high habitual nitrogen intake. A 15N2 incorporation assay showed significant enrichment of 15N in all faecal samples, irrespective of the host nitrogen intake, which was also supported by an acetylene reduction assay. The fixed nitrogen corresponded to 0.01% of the standard nitrogen requirement for humans, although our data implied that the contribution in the gut in vivo might be higher than this value. The nifH genes recovered in cloning and metagenomic analyses were classified in two clusters: one comprising sequences almost identical to Klebsiella sequences and the other related to sequences of Clostridiales members. These results are consistent with an analysis of databases of faecal metagenomes from other human populations. Collectively, the human gut microbiota has a potential for nitrogen fixation, which may be attributable to Klebsiella and Clostridiales strains, although no evidence was found that the nitrogen-fixing activity substantially contributes to the host nitrogen balance.
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Affiliation(s)
- Katsura Igai
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.,Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of International Health, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Manabu Itakura
- Department of Environmental Life Sciences, Graduate School of Life Sciences, Tohoku University, Miyagi, Japan
| | - Suguru Nishijima
- Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan
| | - Hirohito Tsurumaru
- Department of Environmental Life Sciences, Graduate School of Life Sciences, Tohoku University, Miyagi, Japan
| | - Wataru Suda
- Center for Omics and Bioinformatics, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan
| | - Takumi Tsutaya
- Department of Integrated Biosciences, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan
| | - Eriko Tomitsuka
- Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoshi Tadokoro
- Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jun Baba
- Department of Sociological Studies, Faculty of Human Sciences, Wako University, Tokyo, Japan
| | - Shingo Odani
- Faculty of Letters, Chiba University, Chiba, Japan
| | | | - Ayako Morita
- Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Minoru Yoneda
- Department of Integrated Biosciences, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan
| | - Andrew R Greenhill
- Papua New Guinea Institute of Medical Research, Eastern Highlands Province, Papua New Guinea.,School of Applied and Biomedical Sciences, Federation University Australia, Victoria, Australia
| | - Paul F Horwood
- Papua New Guinea Institute of Medical Research, Eastern Highlands Province, Papua New Guinea
| | - Jun-Ichi Inoue
- Japan Collection of Microorganisms, RIKEN BioResource Center, Ibaraki, Japan
| | - Moriya Ohkuma
- Japan Collection of Microorganisms, RIKEN BioResource Center, Ibaraki, Japan
| | - Yuichi Hongoh
- Department of Life Science and Technology, Tokyo Institute of Technology, Tokyo, Japan
| | - Taro Yamamoto
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.,Department of International Health, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Eastern Highlands Province, Papua New Guinea
| | - Masahira Hattori
- Center for Omics and Bioinformatics, Graduate School of Frontier Sciences, The University of Tokyo, Chiba, Japan
| | - Kiwamu Minamisawa
- Department of Environmental Life Sciences, Graduate School of Life Sciences, Tohoku University, Miyagi, Japan
| | - Masahiro Umezaki
- Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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25
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Francis JP, Richmond PC, Michael A, Siba PM, Jacoby P, Hales BJ, Thomas WR, Lehmann D, Pomat WS, van den Biggelaar AHJ. A longitudinal study of natural antibody development to pneumococcal surface protein A families 1 and 2 in Papua New Guinean Highland children: a cohort study. Pneumonia (Nathan) 2016; 8:12. [PMID: 28702291 PMCID: PMC5471893 DOI: 10.1186/s41479-016-0014-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 08/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pneumococcal surface protein A (PspA), a conserved virulence factor essential for Streptococcus pneumoniae attachment to upper respiratory tract (URT) epithelia, is a potential vaccine candidate for preventing colonisation. METHODS This cohort study was conducted in the Asaro Valley in the Eastern Highlands Province of Papua New Guinea, of which Goroka town is the provincial capital. The children included in the analysis were participants in a neonatal pneumococcal conjugate vaccine trial (ClinicalTrials.gov NCT00219401) that was conducted between 2005 and 2009. We investigated the development of anti-PspA antibodies in the first 18 months of life relative to URT pneumococcal carriage in Papua New Guinean infants who experience one of the earliest and highest colonisation rates in the world. Blood samples and nasopharyngeal swabs were collected from a cohort of 88 children at ages 3, 9, and 18 months to quantify immunoglobulin G (IgG) levels to PspA families 1 and 2 using an enzyme-linked immunosorbent assay and to determine URT carriage. RESULTS Seventy-three per cent (64/88) of infants carried S. pneumoniae at age 3 months; 85 % (75/88) at 9 months, and 83 % (73/88) at 18 months. PspA-IgG levels declined between ages 3 and 9 months (p < 0.001), then increased between 9 and 18 months (p < 0.001). At age 3 months, pneumococcal carriers showed lower PspA1-IgG levels (geometric mean concentration [GMC] 602 arbitrary units [AU]/ml, 95 % confidence interval [CI] 497-728) than non-carriers (GMC 1058 AU/ml [95 % CI 732-1530]; p = 0.008), while at 9 months, PspA1- and PspA2-IgG levels were significantly higher in carriers (PspA1: 186 AU/ml, 95 % CI 136-256; PspA2: 284 AU/ml, 95 % CI 192-421) than in non-carriers (PspA1 87 AU/ml, 95 % CI 45-169; PspA2 74 AU/ml, 95 % CI 34-159) (PspA1: p = 0.037, PspA2: p = 0.003). CONCLUSION Our findings confirm that PspA is immunogenic and indicate that natural anti-PspA immune responses are acquired through exposure and develop with age. PspA may be a useful candidate in an infant pneumococcal vaccine to prevent early URT colonisation.
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Affiliation(s)
- Jacinta P Francis
- Papua New Guinea Institute of Medical Research, Goroka, EHP Papua New Guinea
| | - Peter C Richmond
- School of Paediatrics and Child Health, The University of Western Australia, Perth, WA Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA Australia
| | - Audrey Michael
- Papua New Guinea Institute of Medical Research, Goroka, EHP Papua New Guinea
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, EHP Papua New Guinea
| | - Peter Jacoby
- Centre for Biostatistics, Telethon Kids Institute, The University of Western Australia, Perth, WA Australia
| | - Belinda J Hales
- Division of Molecular Biotechnology, Telethon Kids Institute, The University of Western Australia, Perth, WA Australia
| | - Wayne R Thomas
- Division of Molecular Biotechnology, Telethon Kids Institute, The University of Western Australia, Perth, WA Australia
| | - Deborah Lehmann
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA Australia
| | - William S Pomat
- Papua New Guinea Institute of Medical Research, Goroka, EHP Papua New Guinea
| | - Anita H J van den Biggelaar
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA Australia
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26
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Pulford J, Smith I, Mueller I, Siba PM, Hetzel MW. Health Worker Compliance with a 'Test And Treat' Malaria Case Management Protocol in Papua New Guinea. PLoS One 2016; 11:e0158780. [PMID: 27391594 PMCID: PMC4938505 DOI: 10.1371/journal.pone.0158780] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/21/2016] [Indexed: 12/05/2022] Open
Abstract
The Papua New Guinea (PNG) Department of Health introduced a ‘test and treat’ malaria case management protocol in 2011. This study assesses health worker compliance with the test and treat protocol on a wide range of measures, examines self-reported barriers to health worker compliance as well as health worker attitudes towards the test and treat protocol. Data were collected by cross-sectional survey conducted in randomly selected primary health care facilities in 2012 and repeated in 2014. The combined survey data included passive observation of current or recently febrile patients (N = 771) and interviewer administered questionnaires completed with health workers (N = 265). Across the two surveys, 77.6% of patients were tested for malaria infection by rapid diagnostic test (RDT) or microscopy, 65.6% of confirmed malaria cases were prescribed the correct antimalarials and 15.3% of febrile patients who tested negative for malaria infection were incorrectly prescribed an antimalarial. Overall compliance with a strictly defined test and treat protocol was 62.8%. A reluctance to test current/recently febrile patients for malaria infection by RDT or microscopy in the absence of acute malaria symptoms, reserving recommended antimalarials for confirmed malaria cases only and choosing to clinically diagnose a malaria infection, despite a negative RDT result were the most frequently reported barriers to protocol compliance. Attitudinal support for the test and treat protocol, as assessed by a nine-item measure, improved across time. In conclusion, health worker compliance with the full test and treat malaria protocol requires improvement in PNG and additional health worker support will likely be required to achieve this. The broader evidence base would suggest any such support should be delivered over a longer period of time, be multi-dimensional and multi-modal.
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Affiliation(s)
- Justin Pulford
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
| | - Iso Smith
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Barcelona Centre for International Health Research, Barcelona, Spain
| | - Peter M. Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Manuel W. Hetzel
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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27
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Hetzel MW, Reimer LJ, Gideon G, Koimbu G, Barnadas C, Makita L, Siba PM, Mueller I. Changes in malaria burden and transmission in sentinel sites after the roll-out of long-lasting insecticidal nets in Papua New Guinea. Parasit Vectors 2016; 9:340. [PMID: 27301964 PMCID: PMC4908799 DOI: 10.1186/s13071-016-1635-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 03/29/2016] [Accepted: 06/08/2016] [Indexed: 12/25/2022] Open
Abstract
Background Papua New Guinea exhibits a complex malaria epidemiology due to diversity in malaria parasites, mosquito vectors, human hosts, and their natural environment. Heterogeneities in transmission and burden of malaria at various scales are likely to affect the success of malaria control interventions, and vice-versa. This manuscript assesses changes in malaria prevalence, incidence and transmission in sentinel sites following the first national distribution of long-lasting insecticidal nets (LLINs). Methods Before and after the distribution of LLINs, data collection in six purposively selected sentinel sites included clinical surveillance in the local health facility, household surveys and entomological surveys. Not all activities were carried out in all sites. Mosquitoes were collected by human landing catches. Diagnosis of malaria infection in humans was done by rapid diagnostic test, light microscopy and PCR for species confirmation. Results Following the roll-out of LLINs, the average monthly malaria incidence rate dropped from 13/1,000 population to 2/1,000 (incidence rate ratio = 0.12; 95 % CI: 0.09–0.17; P < 0.001). The average population prevalence of malaria decreased from 15.7 % pre-LLIN to 4.8 % post-LLIN (adjusted odds ratio = 0.26; 95 % CI: 0.20–0.33; P < 0.001). In general, reductions in incidence and prevalence were more pronounced in infections with P. falciparum than with P. vivax. Additional morbidity indicators (anaemia, splenomegaly, self-reported fever) showed a decreasing trend in most sites. Mean Anopheles man biting rates decreased from 83 bites/person/night pre-LLIN to 31 post-LLIN (P = 0.008). Anopheles species composition differed between sites but everywhere diversity was lower post-LLIN. In two sites, post-LLIN P. vivax infections in anophelines had decreased but P. falciparum infections had increased despite the opposite observation in humans. Conclusions LLIN distribution had distinct effects on P. falciparum and P. vivax. Higher resilience of P. vivax may be attributed to relapses from hypnozoites and other biological characteristics favouring the transmission of P. vivax. The effect on vector species composition varied by location which is likely to impact on the effectiveness of LLINs. In-depth and longer-term epidemiological and entomological investigations are required to understand when and where residual transmission occurs and whether observed changes are sustained. Electronic supplementary material The online version of this article (doi:10.1186/s13071-016-1635-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Manuel W Hetzel
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea. .,Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Lisa J Reimer
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea.,Case Western Reserve University, Cleveland, OH, USA.,Present address: Liverpool School of Tropical Medicine, Liverpool, UK
| | - Gibson Gideon
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Gussy Koimbu
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Céline Barnadas
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea.,Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Vic, Australia.,Department of Medical Biology, University of Melbourne, Parkville, Vic, Australia.,Present address: European Public Health Microbiology (EUPHEM) training programme, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Present address: Statens Serum Institut, Copenhagen, Denmark
| | - Leo Makita
- National Department of Health, Waigani, Papua New Guinea
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka and Madang, Papua New Guinea
| | - Ivo Mueller
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Vic, Australia.,Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
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28
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Chan JA, Howell KB, Langer C, Maier AG, Hasang W, Rogerson SJ, Petter M, Chesson J, Stanisic DI, Duffy MF, Cooke BM, Siba PM, Mueller I, Bull PC, Marsh K, Fowkes FJI, Beeson JG. A single point in protein trafficking by Plasmodium falciparum determines the expression of major antigens on the surface of infected erythrocytes targeted by human antibodies. Cell Mol Life Sci 2016; 73:4141-58. [PMID: 27193441 PMCID: PMC5042999 DOI: 10.1007/s00018-016-2267-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/22/2016] [Accepted: 05/06/2016] [Indexed: 11/30/2022]
Abstract
Antibodies to blood-stage antigens of Plasmodium falciparum play a pivotal role in human immunity to malaria. During parasite development, multiple proteins are trafficked from the intracellular parasite to the surface of P. falciparum-infected erythrocytes (IEs). However, the relative importance of different proteins as targets of acquired antibodies, and key pathways involved in trafficking major antigens remain to be clearly defined. We quantified antibodies to surface antigens among children, adults, and pregnant women from different malaria-exposed regions. We quantified the importance of antigens as antibody targets using genetically engineered P. falciparum with modified surface antigen expression. Genetic deletion of the trafficking protein skeleton-binding protein-1 (SBP1), which is involved in trafficking the surface antigen PfEMP1, led to a dramatic reduction in antibody recognition of IEs and the ability of human antibodies to promote opsonic phagocytosis of IEs, a key mechanism of parasite clearance. The great majority of antibody epitopes on the IE surface were SBP1-dependent. This was demonstrated using parasite isolates with different genetic or phenotypic backgrounds, and among antibodies from children, adults, and pregnant women in different populations. Comparisons of antibody reactivity to parasite isolates with SBP1 deletion or inhibited PfEMP1 expression suggest that PfEMP1 is the dominant target of acquired human antibodies, and that other P. falciparum IE surface proteins are minor targets. These results establish SBP1 as part of a critical pathway for the trafficking of major surface antigens targeted by human immunity, and have key implications for vaccine development, and quantifying immunity in populations.
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Affiliation(s)
- Jo-Anne Chan
- Burnet Institute for Medical Research and Public Health, 85 Commercial Road, Melbourne, VIC, 3001, Australia
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Katherine B Howell
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Christine Langer
- Burnet Institute for Medical Research and Public Health, 85 Commercial Road, Melbourne, VIC, 3001, Australia
| | - Alexander G Maier
- Research School of Biology, Australian National University, Canberra, ACT, Australia
| | - Wina Hasang
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Stephen J Rogerson
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Michaela Petter
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Joanne Chesson
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | | | - Michael F Duffy
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Brian M Cooke
- Programs in Infection and Immunity and Cardiovascular Disease, Monash Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
- Department of Microbiology, Monash University, Melbourne, VIC, Australia
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Peter C Bull
- Centre for Geographic Medicine Research, Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | - Kevin Marsh
- Centre for Geographic Medicine Research, Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | - Freya J I Fowkes
- Burnet Institute for Medical Research and Public Health, 85 Commercial Road, Melbourne, VIC, 3001, Australia
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
- Melbourne School of Public Health, University of Melbourne, Parkville, VIC, Australia
- Department of Epidemiology and Preventive Medicine and Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia
| | - James G Beeson
- Burnet Institute for Medical Research and Public Health, 85 Commercial Road, Melbourne, VIC, 3001, Australia.
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia.
- Department of Microbiology, Monash University, Melbourne, VIC, Australia.
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29
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Small ST, Reimer LJ, Tisch DJ, King CL, Christensen BM, Siba PM, Kazura JW, Serre D, Zimmerman PA. Population genomics of the filarial nematode parasite Wuchereria bancrofti from mosquitoes. Mol Ecol 2016; 25:1465-77. [PMID: 26850696 PMCID: PMC4808423 DOI: 10.1111/mec.13574] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 01/19/2016] [Accepted: 01/26/2016] [Indexed: 02/01/2023]
Abstract
Wuchereria bancrofti is a parasitic nematode and the primary cause of lymphatic filariasis--a disease specific to humans. W. bancrofti currently infects over 90 million people throughout the tropics and has been acknowledged by the world health organization as a vulnerable parasite. Current research has focused primarily on the clinical manifestations of disease and little is known about the evolutionary history of W. bancrofti. To improve upon knowledge of the evolutionary history of W. bancrofti, we whole genome sequenced 13 W. bancrofti larvae. We circumvent many of the difficulties of multiple infections by sampling larvae directly from mosquitoes that were experimentally inoculated with infected blood. To begin, we used whole genome data to reconstruct the historical population size. Our results support a history of fluctuating population sizes that can be correlated with human migration and fluctuating mosquito abundances. Next, we reconstructed the putative pedigree of W. bancrofti worms within an infection using the kinship coefficient. We deduced that there are full-sib and half-sib relationships residing within the same larval cohort. Through combined analysis of the mitochondrial and nuclear genomes we concluded that this is likely a results of polyandrous mating, the first time reported for W. bancrofti. Lastly, we scanned the genomes for signatures of natural selection. Annotation of putative selected regions identified proteins that may have aided in a parasitic life style or may have evolved to protect against current drug treatments. We discuss our results in the greater context of understanding the biology of an animal with a unique life history and ecology.
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Chiu CY, White MT, Healer J, Thompson JK, Siba PM, Mueller I, Cowman AF, Hansen DS. Different Regions of Plasmodium falciparum Erythrocyte-Binding Antigen 175 Induce Antibody Responses to Infection of Varied Efficacy. J Infect Dis 2016; 214:96-104. [PMID: 27020092 DOI: 10.1093/infdis/jiw119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/18/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Increasing evidence suggests that antibodies against merozoite proteins involved in Plasmodium falciparum invasion into the red blood cell play an important role in clinical immunity to malaria. Erythrocyte-binding antigen 175 (EBA-175) is the best-characterized P. falciparum invasion ligand, reported to recognize glycophorin A on the surface of erythrocytes. Its protein structure comprises 6 extracellular regions. Whereas region II contains Duffy binding-like domains involved in the binding to glycophorin A, the functional role of regions III-V is less clear. METHODS We developed a novel cytometric bead array for assessment of antigen-specific antibody concentration in plasma to evaluate the efficacy of immune responses to different regions of EBA-175 and associations between antibody levels with protection from symptomatic malaria in a treatment-reinfection cohort study. RESULTS We found that while antibodies to region II are highly abundant, circulating levels as low as 5-10 µg/mL of antibodies specific for region III or the highly conserved regions IV-V predict strong protection from clinical malaria. CONCLUSIONS These results lend support for the development of conserved regions of EBA-175 as components in a combination of a malaria vaccine.
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Affiliation(s)
- Chris Y Chiu
- The Walter and Eliza Hall Institute of Medical Research Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
| | - Michael T White
- The Walter and Eliza Hall Institute of Medical Research MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom
| | - Julie Healer
- The Walter and Eliza Hall Institute of Medical Research Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
| | - Jenny K Thompson
- The Walter and Eliza Hall Institute of Medical Research Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
| | - Peter M Siba
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province
| | - Ivo Mueller
- The Walter and Eliza Hall Institute of Medical Research Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
| | - Alan F Cowman
- The Walter and Eliza Hall Institute of Medical Research Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
| | - Diana S Hansen
- The Walter and Eliza Hall Institute of Medical Research Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
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Moore BR, Benjamin JM, Auyeung SO, Salman S, Yadi G, Griffin S, Page-Sharp M, Batty KT, Siba PM, Mueller I, Rogerson SJ, Davis TM. Safety, tolerability and pharmacokinetic properties of coadministered azithromycin and piperaquine in pregnant Papua New Guinean women. Br J Clin Pharmacol 2016; 82:199-212. [PMID: 26889763 DOI: 10.1111/bcp.12910] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/09/2016] [Accepted: 02/14/2016] [Indexed: 12/14/2022] Open
Abstract
AIMS The aim of the present study was to investigate the safety, tolerability and pharmacokinetics of coadministered azithromycin (AZI) and piperaquine (PQ) for treating malaria in pregnant Papua New Guinean women. METHODS Thirty pregnant women (median age 22 years; 16-32 weeks' gestation) were given three daily doses of 1 g AZI plus 960 mg PQ tetraphosphate with detailed monitoring/blood sampling over 42 days. Plasma AZI and PQ were assayed using liquid chromatography-mass spectrometry and high-performance liquid chromatography, respectively. Pharmacokinetic analysis was by population-based compartmental models. RESULTS The treatment was well tolerated. The median (interquartile range) increase in the rate-corrected electrocardiographic QT interval 4 h postdose [12 (6-26) ms(0) (.5) ] was similar to that found in previous studies of AZI given in pregnancy with other partner drugs. Six women with asymptomatic malaria cleared their parasitaemias within 72 h. Two apararasitaemic women developed late uncomplicated Plasmodium falciparum infections on Days 42 and 83. Compared with previous pregnancy studies, the area under the concentration-time curve (AUC0-∞ ) for PQ [38818 (24354-52299) μg h l(-1) ] was similar to published values but there was a 52% increase in relative bioavailability with each dose. The AUC0-∞ for AZI [46799 (43526-49462) μg h l(-1) ] was at least as high as reported for higher-dose regimens, suggesting saturable absorption and/or concentration-dependent tissue uptake and clearance from the central compartment. CONCLUSIONS AZI-PQ appears to be well tolerated and safe in pregnancy. Based on the present/other data, total AZI doses higher than 3 g for the treatment and prevention of malaria may be unnecessary in pregnant women, while clearance of parasitaemia could improve the relative bioavailability of PQ.
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Affiliation(s)
- Brioni R Moore
- School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia.,Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea
| | - John M Benjamin
- Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea
| | - Siu On Auyeung
- School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia
| | - Sam Salman
- School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia
| | - Gumul Yadi
- Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea
| | - Suzanne Griffin
- Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea
| | - Madhu Page-Sharp
- School of Pharmacy, Curtin University of Technology, Bentley, Western Australia, Australia
| | - Kevin T Batty
- School of Pharmacy, Curtin University of Technology, Bentley, Western Australia, Australia
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Madang, Madang Province, Papua New Guinea
| | - Ivo Mueller
- Infection and Immunity, Walter and Eliza Hall Institute, Melbourne, Victoria, Australia.,Barcelona Institute for Global Health (ISGLOBAL), Barcelona, Spain
| | - Stephen J Rogerson
- Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia
| | - Timothy Me Davis
- School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia
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Reimer LJ, Thomsen EK, Koimbu G, Keven JB, Mueller I, Siba PM, Kazura JW, Hetzel MW, Zimmerman PA. Malaria transmission dynamics surrounding the first nationwide long-lasting insecticidal net distribution in Papua New Guinea. Malar J 2016; 15:25. [PMID: 26753618 PMCID: PMC4709896 DOI: 10.1186/s12936-015-1067-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 12/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The major malaria vectors of Papua New Guinea exhibit heterogeneities in distribution, biting behaviour and malaria infection levels. Long-lasting, insecticide-treated nets (LLINs), distributed as part of the National Malaria Control Programme, are the primary intervention targeting malaria transmission. This study evaluated the impact of LLINs on anopheline density, species composition, feeding behaviour, and malaria transmission. METHODS Mosquitoes were collected by human landing catch in 11 villages from East Sepik Province and Madang Province. Mosquitoes were collected for 3 years (1 year before distribution and 2 years after), and assayed to determine mosquito species and Plasmodium spp. infection prevalence. The influence of weather conditions and the presence of people and animals on biting density was determined. Determinants of biting density and sporozoite prevalence were analysed by generalized estimating equations (GEE). RESULTS Mosquito biting rates and entomological inoculation rates decreased significantly after the distribution. Plasmodium falciparum and P. vivax sporozoite prevalence decreased in year 2, but increased in year 3, suggesting the likelihood of resurgence in transmission if low biting rates are not maintained. An earlier shift in the median biting time of Anopheles punctulatus and An. farauti s.s. was observed. However, this was not accompanied by an increase in the proportion of infective bites occurring before 2200 hours. A change in species composition was observed, which resulted in dominance of An. punctulatus in Dreikikir region, but a decrease in An. punctulatus in the Madang region. When controlling for village and study year, An. farauti s.s., An. koliensis and An. punctulatus were equally likely to carry P. vivax sporozoites. However, An. punctulatus was significantly more likely than An. farauti s.s. (OR 0.14; p = 0.007) or An. koliensis (OR 0.27; p < 0.001) to carry P. falciparum sporozoites. CONCLUSIONS LLINs had a significant impact on malaria transmission, despite exophagic and crepuscular feeding behaviours of dominant vectors. Changes in species composition and feeding behaviour were observed, but their epidemiological significance will depend on their durability over time.
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Affiliation(s)
- Lisa J Reimer
- Case Western Reserve University, Cleveland, OH, USA. .,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. .,Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Edward K Thomsen
- Case Western Reserve University, Cleveland, OH, USA. .,Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. .,Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Gussy Koimbu
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - John B Keven
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. .,Michigan State University, East Lansing, MI, USA.
| | - Ivo Mueller
- Walter and Eliza Hall Institute, Parkville, VIC, Australia.
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | | | - Manuel W Hetzel
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. .,Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
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Hetzel MW, Morris H, Tarongka N, Barnadas C, Pulford J, Makita L, Siba PM, Mueller I. Prevalence of malaria across Papua New Guinea after initial roll-out of insecticide-treated mosquito nets. Trop Med Int Health 2015; 20:1745-55. [PMID: 26427024 DOI: 10.1111/tmi.12616] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To assess the population prevalence of malaria in villages across Papua New Guinea (PNG) following the first roll-out of free long-lasting insecticidal nets (LLIN). METHODS Between October 2008 and August 2009, a household survey was conducted in 49 random villages in districts covered by the LLIN distribution campaign. The survey extended to 19 villages in sentinel sites that had not yet been covered by the campaign. In each village, 30 households were randomly sampled, household heads were interviewed and capillary blood samples were collected from all consenting household members for microscopic diagnosis of malaria. RESULTS Malaria prevalence ranged from 0% to 49.7% with a weighted average of 12.1% (95% CI 9.5, 15.3) in the national sample. More people were infected with Plasmodium falciparum (7.0%; 95% CI 5.4, 9.1) than with P. vivax (3.8%; 95% CI 2.4, 5.7) or P. malariae (0.3%; 95% CI 0.1, 0.6). Parasitaemia was strongly age-dependent with a P. falciparum peak at age 5-9 years and a P. vivax peak at age 1-4 years, yet with differences between geographical regions. Individual LLIN use and high community coverage were associated with reduced odds of infection (OR = 0.64 and 0.07, respectively; both P < 0.001). Splenomegaly in children and anaemia were common morbidities attributable to malaria. CONCLUSIONS Malaria prevalence across PNG is again at levels comparable to the 1970s. The strong association of LLIN use with reduced parasitaemia supports efforts to achieve and maintain high country-wide coverage. P. vivax infections will require special targeted approaches across PNG.
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Affiliation(s)
- Manuel W Hetzel
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Hector Morris
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Nandao Tarongka
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Céline Barnadas
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.,Walter and Eliza Hall Institute of Medical Research, Parkville, Vic., Australia.,Department of Medical Biology, University of Melbourne, Parkville, Vic., Australia
| | - Justin Pulford
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.,School of Public Health, The University of Queensland, Herston, Qld, Australia
| | - Leo Makita
- National Department of Health, Waigani, Papua New Guinea
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Parkville, Vic., Australia.,Department of Medical Biology, University of Melbourne, Parkville, Vic., Australia.,Barcelona Centre for International Health Research, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
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Thomsen EK, Sanuku N, Baea M, Satofan S, Maki E, Lombore B, Schmidt MS, Siba PM, Weil GJ, Kazura JW, Fleckenstein LL, King CL. Efficacy, Safety, and Pharmacokinetics of Coadministered Diethylcarbamazine, Albendazole, and Ivermectin for Treatment of Bancroftian Filariasis. Clin Infect Dis 2015; 62:334-341. [PMID: 26486704 DOI: 10.1093/cid/civ882] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 10/07/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Available treatments for lymphatic filariasis (LF) are limited in their longterm clearance of microfilaria from the blood. The safety and efficacy of a single-dose triple-drug therapy of the antifilarial drugs diethylcarbamazine (DEC), ivermectin (IVM), and albendazole (ALB) for LF are unknown. METHODS We performed a pilot study to test the efficacy, safety, and pharmacokinetics of single-dose DEC, IVM, and ALB in Wuchereria bancrofti-infected Papua New Guineans. Adults were randomized into 2 treatment arms, DEC 6 mg/kg + ALB 400 mg (N = 12) or DEC 6 mg/kg + ALB 400 mg + IVM 200 μg/kg (N = 12), and monitored for microfilaria, parasite antigenemia, adverse events (AEs), and serum drug levels. RESULTS Triple-drug therapy induced >2-log reductions in microfilaria levels at 36 and 168 hours after treatment compared with approximately 1-log reduction with 2 drugs. All 12 individuals who received 3 drugs were microfilaria negative 1 year after treatment, whereas 11 of 12 individuals in the 2-drug regimen were microfilaria positive. In 6 participants followed 2 years after treatment, those who received 3 drugs remained microfilaria negative. AEs, particularly fever, myalgias, pruritus, and proteinuria/hematuria, occurred in 83% vs 50% of those receiving triple-drug compared to 2-drug treatment respectively (P = .021); all resolved within 7 days after treatment. No serious AEs were observed in either group. There was no significant effect of IVM on DEC or ALB drug levels. CONCLUSIONS Triple-drug therapy is safe and more effective than DEC + ALB for Bancroftian filariasis and has the potential to accelerate elimination of lymphatic filariasis. CLINICAL TRIALS REGISTRATION NCT01975441.
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Affiliation(s)
- Edward K Thomsen
- Papua New Guinea Institute of Medical Research, Papua New Guinea.,Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Nelly Sanuku
- Papua New Guinea Institute of Medical Research, Papua New Guinea
| | - Manasseh Baea
- Papua New Guinea Institute of Medical Research, Papua New Guinea
| | - Samson Satofan
- Papua New Guinea Institute of Medical Research, Papua New Guinea
| | - Elit Maki
- Papua New Guinea Institute of Medical Research, Papua New Guinea
| | - Bart Lombore
- Papua New Guinea Institute of Medical Research, Papua New Guinea
| | - Mark S Schmidt
- Department of Pharmaceutical Sciences & Experimental Therapeutics, University of Iowa, Iowa City
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Papua New Guinea
| | - Gary J Weil
- Department of Medicine, Infectious Diseases Division, Washington University School of Medicine, St. Louis, Missouri
| | - James W Kazura
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Lawrence L Fleckenstein
- Department of Pharmaceutical Sciences & Experimental Therapeutics, University of Iowa, Iowa City
| | - Christopher L King
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio.,Veterans Affairs Medical Center, Cleveland, Ohio
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Barnadas C, Timinao L, Javati S, Iga J, Malau E, Koepfli C, Robinson LJ, Senn N, Kiniboro B, Rare L, Reeder JC, Siba PM, Zimmerman PA, Karunajeewa H, Davis TM, Mueller I. Significant geographical differences in prevalence of mutations associated with Plasmodium falciparum and Plasmodium vivax drug resistance in two regions from Papua New Guinea. Malar J 2015; 14:399. [PMID: 26452541 PMCID: PMC4600278 DOI: 10.1186/s12936-015-0879-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/31/2015] [Indexed: 12/22/2022] Open
Abstract
Background Drug resistance remains a major obstacle to malaria treatment and control. It can arise and spread rapidly, and vary substantially even at sub-national level. National malaria programmes require cost-effective and timely ways of characterizing drug-resistance at multiple sites within their countries. Methods An improved multiplexed post-PCR ligase detection reaction—fluorescent microsphere assay (LDR-FMA) was used to simultaneously determine the presence of mutations in chloroquine resistance transporter (crt), multidrug resistance 1 (mdr1), dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) genes in Plasmodium falciparum (n = 727) and Plasmodium vivax (n = 574) isolates collected in 2006 from cross-sectional community population surveys in two geographically distinct regions (Madang and East Sepik) of Papua New Guinea (PNG) where strong regional differences in in vivo aminoquinoline and antifolate therapeutic efficacy had previously been observed. Data were compared to those of a follow-up survey conducted in 2010. Results Despite some very low parasite densities, the assay successfully amplified all P. falciparum and P. vivax loci in 77 and 69 % of samples, respectively. In 2006, prevalences of pfdhfr (59R-108 N) double mutation/wild type pfdhps haplotype, pfcrt SVMNT haplotype (72S-76T double mutation), and 86Y pfmdr1 mutation all exceeded 90 %. For P. vivax, 65 % carried at least two pvdhfr mutations, 97 % the 647P pvdhps mutation and 54 % the 976F pvmdr1 mutation. Prevalence of mutant haplotypes was higher in Madang than East Sepik for pfcrt SVMNT (97.4 vs 83.3 %, p = 0.001), pfdhfr (59R-108 N) (100 vs 90.6 %, p = 0.001), pvdhfr haplotypes (75.8 vs 47.6 %, p = 0.001) and pvmdr1 976F (71.2 vs 26.2 %, p < 0.001). Data from a subsequent Madang survey in 2010 showed that the prevalence of pfdhps mutations increased significantly from <5 % to >30 % (p < 0.001) as did the prevalence of pvdhfr mutant haplotypes (from 75.8 to 97.4 %, p = 0.012). Conclusions This LDR-FMA multiplex platform shows feasibility for low-cost, high-throughput, rapid characterization of a broad range of drug-resistance markers in low parasitaemia infections. Significant geographical differences in mutation prevalence correlate with previous genotyping surveys and in vivo trials and may reflect variable drug pressure and differences in health-care access in these two PNG populations. Electronic supplementary material The online version of this article (doi:10.1186/s12936-015-0879-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Céline Barnadas
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. .,Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia. .,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.
| | - Lincoln Timinao
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Sarah Javati
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Jonah Iga
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Elisheba Malau
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia. .,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.
| | - Cristian Koepfli
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia. .,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.
| | - Leanne J Robinson
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. .,Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia. .,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.
| | - Nicolas Senn
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. .,Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - Benson Kiniboro
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Lawrence Rare
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | | | - Peter M Siba
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Peter A Zimmerman
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, USA.
| | - Harin Karunajeewa
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia. .,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia.
| | - Timothy M Davis
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
| | - Ivo Mueller
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia. .,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia. .,Centre de Recerca en Salut Internacional de Barcelona, Barcelona, Spain.
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Robinson LJ, Wampfler R, Betuela I, Karl S, White MT, Li Wai Suen CSN, Hofmann NE, Kinboro B, Waltmann A, Brewster J, Lorry L, Tarongka N, Samol L, Silkey M, Bassat Q, Siba PM, Schofield L, Felger I, Mueller I. Strategies for understanding and reducing the Plasmodium vivax and Plasmodium ovale hypnozoite reservoir in Papua New Guinean children: a randomised placebo-controlled trial and mathematical model. PLoS Med 2015; 12:e1001891. [PMID: 26505753 PMCID: PMC4624431 DOI: 10.1371/journal.pmed.1001891] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 09/17/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The undetectable hypnozoite reservoir for relapsing Plasmodium vivax and P. ovale malarias presents a major challenge for malaria control and elimination in endemic countries. This study aims to directly determine the contribution of relapses to the burden of P. vivax and P. ovale infection, illness, and transmission in Papua New Guinean children. METHODS AND FINDINGS From 17 August 2009 to 20 May 2010, 524 children aged 5-10 y from East Sepik Province in Papua New Guinea (PNG) participated in a randomised double-blind placebo-controlled trial of blood- plus liver-stage drugs (chloroquine [CQ], 3 d; artemether-lumefantrine [AL], 3 d; and primaquine [PQ], 20 d, 10 mg/kg total dose) (261 children) or blood-stage drugs only (CQ, 3 d; AL, 3 d; and placebo [PL], 20 d) (263 children). Participants, study staff, and investigators were blinded to the treatment allocation. Twenty children were excluded during the treatment phase (PQ arm: 14, PL arm: 6), and 504 were followed actively for 9 mo. During the follow-up time, 18 children (PQ arm: 7, PL arm: 11) were lost to follow-up. Main primary and secondary outcome measures were time to first P. vivax infection (by qPCR), time to first clinical episode, force of infection, gametocyte positivity, and time to first P. ovale infection (by PCR). A basic stochastic transmission model was developed to estimate the potential effect of mass drug administration (MDA) for the prevention of recurrent P. vivax infections. Targeting hypnozoites through PQ treatment reduced the risk of having at least one qPCR-detectable P. vivax or P. ovale infection during 8 mo of follow-up (P. vivax: PQ arm 0.63/y versus PL arm 2.62/y, HR = 0.18 [95% CI 0.14, 0.25], p < 0.001; P. ovale: 0.06 versus 0.14, HR = 0.31 [95% CI 0.13, 0.77], p = 0.011) and the risk of having at least one clinical P. vivax episode (HR = 0.25 [95% CI 0.11, 0.61], p = 0.002). PQ also reduced the molecular force of P. vivax blood-stage infection in the first 3 mo of follow-up (PQ arm 1.90/y versus PL arm 7.75/y, incidence rate ratio [IRR] = 0.21 [95% CI 0.15, 0.28], p < 0.001). Children who received PQ were less likely to carry P. vivax gametocytes (IRR = 0.27 [95% CI 0.19, 0.38], p < 0.001). PQ had a comparable effect irrespective of the presence of P. vivax blood-stage infection at the time of treatment (p = 0.14). Modelling revealed that mass screening and treatment with highly sensitive quantitative real-time PCR, or MDA with blood-stage treatment alone, would have only a transient effect on P. vivax transmission levels, while MDA that includes liver-stage treatment is predicted to be a highly effective strategy for P. vivax elimination. The inclusion of a directly observed 20-d treatment regime maximises the efficiency of hypnozoite clearance but limits the generalisability of results to real-world MDA programmes. CONCLUSIONS These results suggest that relapses cause approximately four of every five P. vivax infections and at least three of every five P. ovale infections in PNG children and are important in sustaining transmission. MDA campaigns combining blood- and liver-stage treatment are predicted to be a highly efficacious intervention for reducing P. vivax and P. ovale transmission. TRIAL REGISTRATION ClinicalTrials.gov NCT02143934.
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Affiliation(s)
- Leanne J. Robinson
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang and Maprik, Papua New Guinea
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Rahel Wampfler
- Molecular Diagnostics Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Inoni Betuela
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang and Maprik, Papua New Guinea
| | - Stephan Karl
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael T. White
- MRC Centre for Outbreak Analysis and Modelling, Imperial College London, London, United Kingdom
| | - Connie S. N. Li Wai Suen
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Natalie E. Hofmann
- Molecular Diagnostics Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Benson Kinboro
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang and Maprik, Papua New Guinea
| | - Andreea Waltmann
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jessica Brewster
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Lina Lorry
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang and Maprik, Papua New Guinea
| | - Nandao Tarongka
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang and Maprik, Papua New Guinea
| | - Lornah Samol
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang and Maprik, Papua New Guinea
| | - Mariabeth Silkey
- Molecular Diagnostics Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Quique Bassat
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Peter M. Siba
- Vector Borne Diseases Unit, Papua New Guinea Institute of Medical Research, Madang and Maprik, Papua New Guinea
- School of Veterinary and Biomedical Sciences, James Cook University, Townsville, Queensland, Australia
| | - Louis Schofield
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Ingrid Felger
- Molecular Diagnostics Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Ivo Mueller
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Victoria, Australia
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic–University of Barcelona, Barcelona, Spain
- * E-mail:
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37
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Mehlotra RK, Hall NB, Bruse SE, John B, Zikursh MJB, Stein CM, Siba PM, Zimmerman PA. CCR2, CCR5, and CXCL12 variation and HIV/AIDS in Papua New Guinea. Infect Genet Evol 2015; 36:165-173. [PMID: 26397046 DOI: 10.1016/j.meegid.2015.09.014] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/28/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
Abstract
Polymorphisms in chemokine receptors, serving as HIV co-receptors, and their ligands are among the well-known host genetic factors associated with susceptibility to HIV infection and/or disease progression. Papua New Guinea (PNG) has one of the highest adult HIV prevalences in the Asia-Pacific region. However, information regarding the distribution of polymorphisms in chemokine receptor (CCR5, CCR2) and chemokine (CXCL12) genes in PNG is very limited. In this study, we genotyped a total of nine CCR2-CCR5 polymorphisms, including CCR2 190G >A, CCR5 -2459G >A and Δ32, and CXCL12 801G >A in PNG (n=258), North America (n=184), and five countries in West Africa (n=178). Using this data, we determined previously characterized CCR5 haplotypes. In addition, based on the previously reported associations of CCR2 190, CCR5 -2459, CCR5 open reading frame, and CXCL12 801 genotypes with HIV acquisition and/or disease progression, we calculated composite full risk scores, considering both protective as well as susceptibility effects of the CXCL12 801 AA genotype. We observed a very high frequency of the CCR5 -2459A allele (0.98) in the PNG population, which together with the absence of Δ32 resulted in a very high frequency of the HHE haplotype (0.92). These frequencies were significantly higher than in any other population (all P-values<0.001). Regardless of whether we considered the CXCL12 801 AA genotype protective or susceptible, the risk scores were significantly higher in the PNG population compared with any other population (all P-values<0.001). The results of this study provide new insights regarding CCR5 variation in the PNG population, and suggest that the collective variation in CCR2, CCR5, and CXCL12 may increase the risk of HIV/AIDS in a large majority of Papua New Guineans.
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Affiliation(s)
- Rajeev K Mehlotra
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Noemi B Hall
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA
| | - Shannon E Bruse
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Bangan John
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Melinda J Blood Zikursh
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Catherine M Stein
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA.,Center for Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea
| | - Peter A Zimmerman
- Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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38
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Umezaki M, Naito YI, Tsutaya T, Baba J, Tadokoro K, Odani S, Morita A, Natsuhara K, Phuanukoonnon S, Vengiau G, Siba PM, Yoneda M. Association between sex inequality in animal protein intake and economic development in the Papua New Guinea highlands: The carbon and nitrogen isotopic composition of scalp hair and fingernail. Am J Phys Anthropol 2015; 159:164-73. [DOI: 10.1002/ajpa.22844] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 08/09/2015] [Accepted: 08/11/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Masahiro Umezaki
- Department of Human Ecology; Graduate School of Medicine, The University of Tokyo; Hongo Tokyo 113-0033 Japan
| | - Yuichi I. Naito
- Department of Integrated Biosciences; Graduate School of Frontier Sciences, The University of Tokyo; Japan
| | - Takumi Tsutaya
- Department of Integrated Biosciences; Graduate School of Frontier Sciences, The University of Tokyo; Japan
| | - Jun Baba
- Faculty of Urban Liberal Arts; Tokyo Metropolitan University; Tokyo Japan
| | - Kiyoshi Tadokoro
- Department of Human Ecology; Graduate School of Medicine, The University of Tokyo; Hongo Tokyo 113-0033 Japan
- Faculty of International Resource Sciences; Akita University; Akita Japan
| | - Shingo Odani
- Faculty of Letters; Chiba University; Chiba Japan
| | - Ayako Morita
- Department of Human Ecology; Graduate School of Medicine, The University of Tokyo; Hongo Tokyo 113-0033 Japan
- Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - Kazumi Natsuhara
- Faculty of Nursing; The Japanese Red Cross Akita College of Nursing; Akita Japan
| | | | - Gwendalyn Vengiau
- Papua New Guinea Institute of Medical Research; Goroka Papua New Guinea
| | - Peter M. Siba
- Papua New Guinea Institute of Medical Research; Goroka Papua New Guinea
| | - Minoru Yoneda
- Department of Integrated Biosciences; Graduate School of Frontier Sciences, The University of Tokyo; Japan
- The University Museum, The University of Tokyo; Japan
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39
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Atwell JE, Thumar B, Robinson LJ, Tobby R, Yambo P, Ome-Kaius M, Siba PM, Unger HW, Rogerson SJ, King CL, Karron RA. Impact of Placental Malaria and Hypergammaglobulinemia on Transplacental Transfer of Respiratory Syncytial Virus Antibody in Papua New Guinea. J Infect Dis 2015; 213:423-31. [PMID: 26238686 DOI: 10.1093/infdis/jiv401] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/20/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Passively acquired respiratory syncytial virus (RSV) neutralizing antibody protects against RSV-associated lower respiratory infections, but placental malaria (PM) and maternal hypergammaglobulinemia might interfere with transplacental immunoglobulin transport. METHODS We measured RSV plaque-reduction neutralization (PRN) antibody in 300 full-term maternal/cord serum pairs in 2 cohorts in malaria-endemic Papua New Guinea: Alexishafen (2005-2008) and the Fetal Immunity Study (FIS) (2011-2013). We defined impaired transport as a cord-to-maternal titer ratio <1.0 and a protective RSV PRN titer (PRNT) ≥1:200. RESULTS PM and hypergammaglobulinemia occurred in 60% and 54% of Alexishafen mothers versus 8% and 9% of FIS mothers, respectively. 34% of Alexishafen and 32% of FIS pairs demonstrated impaired transport. Multivariate modeling revealed significant associations between increasing maternal IgG (log2) and impaired transport (adjusted OR, Alexishafen: 2.68 [1.17-6.14], FIS: 6.94 [1.94-24.8]) but no association with PM. 34% of Alexishafen and 31% of FIS cord PRNTs were <1:200. CONCLUSIONS Impaired RSV antibody transport was observed in approximately one-third of maternal/cord pairs. Hypergammaglobulinemia, but not PM, was associated with impaired transport, particularly among women with low RSV PRNT. Detection of RSV PRNT <1:200 in one-third of cord sera confirms the need to increase levels of RSV neutralizing antibody in pregnant women through maternal immunization.
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Affiliation(s)
- Jessica E Atwell
- Department of International Health, Center for Immunization Research, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Bhagvanji Thumar
- Department of International Health, Center for Immunization Research, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Leanne J Robinson
- Papua New Guinea Institute of Medical Research, Madang & Goroka Walter and Eliza Hall Institute Department of Medical Biology, The University of Melbourne, Parkville, Victoria
| | - Roselyn Tobby
- Papua New Guinea Institute of Medical Research, Madang & Goroka
| | - Phantica Yambo
- Papua New Guinea Institute of Medical Research, Madang & Goroka
| | - Maria Ome-Kaius
- Papua New Guinea Institute of Medical Research, Madang & Goroka
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Madang & Goroka Division of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville City, Queensland
| | - Holger W Unger
- Department of Medicine, The University of Melbourne, Australia
| | | | - Christopher L King
- Center for Global Health and Disease, Case Western Reserve University and Veterans Affairs Medical Center, Cleveland, Ohio
| | - Ruth A Karron
- Department of International Health, Center for Immunization Research, Johns Hopkins School of Public Health, Baltimore, Maryland
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Naito YI, Morita A, Natsuhara K, Tadokoro K, Baba J, Odani S, Tomitsuka E, Igai K, Tsutaya T, Yoneda M, Greenhill AR, Horwood PF, Soli KW, Phuanukoonnon S, Siba PM, Umezaki M. Association of protein intakes and variation of diet-scalp hair nitrogen isotopic discrimination factor in Papua New Guinea highlanders. Am J Phys Anthropol 2015; 158:359-70. [DOI: 10.1002/ajpa.22798] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 06/09/2015] [Accepted: 06/09/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Yuichi I. Naito
- Department of Integrated Biosciences; Graduate School of Frontier Sciences, The University of Tokyo; Kashiwanoha 5-1-5 Kashiwa Chiba 277-8562 Japan
| | - Ayako Morita
- Department of Human Ecology; Graduate School of Medicine, The University of Tokyo; 7-3-1 Hongo Bunkyo Tokyo 113-0033 Japan
- Tokyo Medical and Dental University; Yushima 1-5-45 Bunkyo-ku Tokyo 113-8519 Japan
| | - Kazumi Natsuhara
- The Japanese Red Cross Akita College of Nursing; Nawashirosawa 17-3, Saruta, Kamikitate Akita Akita 010-1493 Japan
| | - Kiyoshi Tadokoro
- Department of Human Ecology; Graduate School of Medicine, The University of Tokyo; 7-3-1 Hongo Bunkyo Tokyo 113-0033 Japan
| | - Jun Baba
- The Research Institute for Languages and Cultures of Asia and Africa, Tokyo University of Foreign Studies; 3-11-1 Asahi-cho Fuchu Tokyo 183-8534 Japan
| | - Shingo Odani
- Faculty of Letters, Chiba University; 1-33 Yayoicho, Inage Chiba 263-8522 Japan
| | - Eriko Tomitsuka
- Department of Human Ecology; Graduate School of Medicine, The University of Tokyo; 7-3-1 Hongo Bunkyo Tokyo 113-0033 Japan
| | - Katsura Igai
- Graduate School of Biomedical Science, Nagasaki University; 1-12-4 Sakamoto Nagasaki 852-8523 Japan
| | - Takumi Tsutaya
- Department of Integrated Biosciences; Graduate School of Frontier Sciences, The University of Tokyo; Kashiwanoha 5-1-5 Kashiwa Chiba 277-8562 Japan
| | - Minoru Yoneda
- Department of Integrated Biosciences; Graduate School of Frontier Sciences, The University of Tokyo; Kashiwanoha 5-1-5 Kashiwa Chiba 277-8562 Japan
- The University Museum, The University of Tokyo; Hongo 7-3-1 Bunkyo Tokyo 113-0033 Japan
| | - Andrew R. Greenhill
- Papua New Guinea Institute of Medical Research, PO Box 60, Goroka, Eastern Highlands Province 441; Papua New Guinea
- Federation University; Gippsland Campus Northways Road, Churchill Victoria 3842 Australia
| | - Paul F. Horwood
- Papua New Guinea Institute of Medical Research, PO Box 60, Goroka, Eastern Highlands Province 441; Papua New Guinea
| | - Kevin W. Soli
- Papua New Guinea Institute of Medical Research, PO Box 60, Goroka, Eastern Highlands Province 441; Papua New Guinea
| | - Suparat Phuanukoonnon
- Papua New Guinea Institute of Medical Research, PO Box 60, Goroka, Eastern Highlands Province 441; Papua New Guinea
| | - Peter M. Siba
- Papua New Guinea Institute of Medical Research, PO Box 60, Goroka, Eastern Highlands Province 441; Papua New Guinea
| | - Masahiro Umezaki
- Department of Human Ecology; Graduate School of Medicine, The University of Tokyo; 7-3-1 Hongo Bunkyo Tokyo 113-0033 Japan
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41
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Reddy SB, Anders RF, Cross N, Mueller I, Senn N, Stanisic DI, Siba PM, Wahlgren M, Kironde F, Beeson JG, Persson KEM. Differences in affinity of monoclonal and naturally acquired polyclonal antibodies against Plasmodium falciparum merozoite antigens. BMC Microbiol 2015; 15:133. [PMID: 26149471 PMCID: PMC4491891 DOI: 10.1186/s12866-015-0461-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 06/03/2015] [Indexed: 11/10/2022] Open
Abstract
Background Malaria is a major global cause of deaths and a vaccine is urgently needed. Results We have employed the P. falciparum merozoite antigens MSP2-3D7/FC27 and AMA1, used them in ELISA, and coupled them in different ways using surface plasmon resonance (SPR) and estimated affinity (measured as kd) of monoclonal as well as naturally-acquired polyclonal antibodies in human plasma. There were major differences in kd depending on how the antigens were immobilized and where the His-tag was placed. For AMA1 we could see correlations with invasion inhibition. Using different immobilizations of proteins in SPR, we could see only moderate correlations with levels of antibodies in ELISA, indicating that in ELISA the proteins were not uniformly bound and that antibodies with many specificities exist in natural immunisation. The correlations between ELISA and SPR were enhanced when only parasite positive samples were included, which may indicate that high affinity antibodies are difficult to maintain over long periods of time. We found higher kd values for MSP2 (indicating lower affinity) compared to AMA1, which might be partly explained by MSP2 being an intrinsically disordered protein, while AMA1 is globular. Conclusions For future vaccine studies and for understanding immunity, it is important to consider how to present proteins to the immune system to achieve highest antibody affinities. Electronic supplementary material The online version of this article (doi:10.1186/s12866-015-0461-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sreenivasulu B Reddy
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Robin F Anders
- Department of Biochemistry, La Trobe University, Vic, 3086, Australia
| | - Nadia Cross
- The Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia
| | - Ivo Mueller
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.,Papua New Guinea Institute of Medical Research, Goroka, 441, Papua New Guinea
| | - Nicolas Senn
- Papua New Guinea Institute of Medical Research, Goroka, 441, Papua New Guinea.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Danielle I Stanisic
- Papua New Guinea Institute of Medical Research, Goroka, 441, Papua New Guinea.,Institute for Glycomics, Griffith University, Queensland, Australia
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, 441, Papua New Guinea
| | - Mats Wahlgren
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Fred Kironde
- Department of Biochemistry, Makerere University, Kampala, Uganda.,Habib Medical School, IUIU, Kampala, Uganda
| | - James G Beeson
- The Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Victoria, Australia.,The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Kristina E M Persson
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 77, Stockholm, Sweden. .,Department of Laboratory Medicine, Lund University, 22185, Lund, Sweden.
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42
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Irani V, Ramsland PA, Guy AJ, Siba PM, Mueller I, Richards JS, Beeson JG. Acquisition of Functional Antibodies That Block the Binding of Erythrocyte-Binding Antigen 175 and Protection Against Plasmodium falciparum Malaria in Children. Clin Infect Dis 2015; 61:1244-52. [PMID: 26136391 DOI: 10.1093/cid/civ525] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 05/22/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The targets and mechanisms of human immunity to malaria are poorly understood, which poses a major barrier to malaria vaccine development. Antibodies play a key role in human immunity and may act by inhibiting receptor-binding functions of key merozoite invasion ligands. Antibodies to the major invasion ligand and vaccine candidate, erythrocyte-binding antigen 175 (EBA-175), have been linked with protection, but how these antibodies function has not been established. METHODS We developed 2 new assays that quantify the ability of antibodies to inhibit binding of EBA-175 to its erythrocyte receptor, glycophorin A, using either native or recombinant EBA-175. Binding-inhibitory antibodies were evaluated in a longitudinal cohort study of Papua New Guinean children and related to risk of malaria, age, infection status, and markers of parasite exposure. RESULTS Binding-inhibition assays (BIAs) were reproducible, and the 2 assays had a high level of agreement. Inhibitory antibodies were common among children, acquired in association with markers of increasing parasite exposure, and high in those children with active infection. Inhibitory antibodies correlated with total immunoglobulin G levels to the EBA-175 binding domain (region II). Importantly, binding-inhibitory antibodies were significantly associated with protection from symptomatic malaria when measured using either BIA. CONCLUSIONS Findings suggest that naturally acquired binding-inhibitory antibodies are an important functional mechanism that contributes to protection against malaria and further supports the potential of EBA-175 as a vaccine candidate. Identifying vaccines and approaches that induce potent binding-inhibitory antibodies may be a valuable strategy in the development of highly efficacious malaria vaccines.
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Affiliation(s)
- Vashti Irani
- Centre for Biomedical Research, Burnet Institute, Melbourne Department of Medicine, University of Melbourne, Parkville Department of Immunology, Monash University, Melbourne
| | - Paul A Ramsland
- Centre for Biomedical Research, Burnet Institute, Melbourne Department of Immunology, Monash University, Melbourne Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Victoria School of Biomedical Sciences, Curtin Health Innovation Research Institute-Biosciences, Curtin University, Perth, Western Australia, Australia
| | - Andrew J Guy
- Centre for Biomedical Research, Burnet Institute, Melbourne Department of Immunology, Monash University, Melbourne
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka
| | - Ivo Mueller
- Infection and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia Barcelona Centre for International Health Research, Spain
| | - Jack S Richards
- Centre for Biomedical Research, Burnet Institute, Melbourne Department of Medicine, University of Melbourne, Parkville Department of Microbiology, Monash University, Clayton, Victoria, Australia
| | - James G Beeson
- Centre for Biomedical Research, Burnet Institute, Melbourne Department of Medicine, University of Melbourne, Parkville Department of Microbiology, Monash University, Clayton, Victoria, Australia
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43
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Laman M, Aipit S, Bona C, Siba PM, Robinson LJ, Manning L, Davis TME. Ultrasonographic assessment of splenic volume at presentation and after anti-malarial therapy in children with malarial anaemia. Malar J 2015; 14:219. [PMID: 26017395 PMCID: PMC4448319 DOI: 10.1186/s12936-015-0741-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/20/2015] [Indexed: 11/20/2022] Open
Abstract
Background Splenic enlargement is a component of the host response to malaria and may also influence the genesis and progression of malarial anaemia. Few cross-sectional and no longitudinal studies have assessed the relationship between splenic volume measured ultrasonographically and haemoglobin concentrations in children with malaria. Methods Fifteen Papua New Guinean children with severe malarial anaemia (SMA; haemoglobin <50 g/L) and ten with moderate malarial anaemia (MMA; 51–99 g/L) were recruited. The SMA patients were given intramuscular artemether followed by oral artemisinin combination therapy (ACT), and were transfused one unit of packed cells 0.3-4.0 days post-admission. The MMA patients were treated with ACT. Splenic enlargement (Hackett’s grade, subcostal distance and ultrasonographically determined volume) and haemoglobin concentrations were measured on days 0, 1, 2, 3, 7, 14, 28, and 42. Results Associations between Hackett’s grade, subcostal distance and splenic volume were modest (rs ≤ 0.62, P <0.001). Baseline splenic volume was not associated with age or haemoglobin (P ≥0.90). Mean splenic volume had fallen by approximately 50 % at day 14 in children with MMA (P ≤0.011 vs days 0, 1 and 2), but there was no change in the SMA group (P ≥0.30). There was no change in haemoglobin in the MMA group during follow-up but a rise in the SMA group to day 7 (P ≤0.05 vs days 0, 1, 2, and 3) which paralleled the packed cell volume transfused. Conclusions Clinical assessment of splenomegaly is imprecise compared with ultrasonography. Serial splenic volumes and haemoglobin concentrations suggest that the spleen does not influence post-treatment haemoglobin, including after transfusion.
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Affiliation(s)
- Moses Laman
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, PO Box 480, Fremantle, 6959, WA, Australia. .,Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.
| | - Susan Aipit
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.
| | - Cathy Bona
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea. .,Department of Microbiology, Division of Veterinary and Biomedical Sciences, James Cook University, Townsville, Australia.
| | - Leanne J Robinson
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea. .,Infection and Immunity Division, Walter and Eliza Hall Institute, Parkville, VIC, Australia. .,Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia.
| | - Laurens Manning
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, PO Box 480, Fremantle, 6959, WA, Australia.
| | - Timothy M E Davis
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, PO Box 480, Fremantle, 6959, WA, Australia.
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44
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Teo A, Hasang W, Randall LM, Unger HW, Siba PM, Mueller I, Brown GV, Rogerson SJ. Malaria preventive therapy in pregnancy and its potential impact on immunity to malaria in an area of declining transmission. Malar J 2015; 14:215. [PMID: 26006260 PMCID: PMC4449596 DOI: 10.1186/s12936-015-0736-x] [Citation(s) in RCA: 9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 05/20/2015] [Indexed: 11/23/2022] Open
Abstract
Background Regular anti-malarial therapy in pregnancy, a pillar of malaria control, may affect malaria immunity, with therapeutic implications in regions of reducing transmission. Methods Plasma antibodies to leading vaccine candidate merozoite antigens and opsonizing antibodies to endothelial-binding and placental-binding infected erythrocytes were quantified in pregnant Melanesian women receiving sulfadoxine-pyrimethamine (SP) with chloroquine taken once, or three courses of SP with azithromycin. Results Malaria prevalence was low. Between enrolment and delivery, antibodies to recombinant antigens declined in both groups (p < 0.0001). In contrast, median levels of opsonizing antibodies did not change, although levels for some individuals changed significantly. In multivariate analysis, the malaria prevention regimen did not influence antibody levels. Conclusion Different preventive anti-malarial chemotherapy regimens used during pregnancy had limited impact on malarial-immunity in a low-transmission region of Papua New Guinea. Trial registrations NCT01136850
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Affiliation(s)
- Andrew Teo
- University of Melbourne, Department of Medicine (Royal Melbourne Hospital), Melbourne, VIC, Australia.
| | - Wina Hasang
- University of Melbourne, Department of Medicine (Royal Melbourne Hospital), Melbourne, VIC, Australia. .,Victorian Infectious Diseases Service, The Doherty Institute, Melbourne, VIC, Australia.
| | - Louise M Randall
- University of Melbourne, Department of Medicine (Royal Melbourne Hospital), Melbourne, VIC, Australia. .,Victorian Infectious Diseases Service, The Doherty Institute, Melbourne, VIC, Australia.
| | - Holger W Unger
- University of Melbourne, Department of Medicine (Royal Melbourne Hospital), Melbourne, VIC, Australia.
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Ivo Mueller
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia. .,Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain.
| | - Graham V Brown
- University of Melbourne, Department of Medicine (Royal Melbourne Hospital), Melbourne, VIC, Australia. .,Victorian Infectious Diseases Service, The Doherty Institute, Melbourne, VIC, Australia. .,The Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Stephen J Rogerson
- University of Melbourne, Department of Medicine (Royal Melbourne Hospital), Melbourne, VIC, Australia. .,Victorian Infectious Diseases Service, The Doherty Institute, Melbourne, VIC, Australia.
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Martínez I, Stegen JC, Maldonado-Gómez MX, Eren AM, Siba PM, Greenhill AR, Walter J. The gut microbiota of rural papua new guineans: composition, diversity patterns, and ecological processes. Cell Rep 2015; 11:527-38. [PMID: 25892234 DOI: 10.1016/j.celrep.2015.03.049] [Citation(s) in RCA: 366] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/07/2015] [Accepted: 03/22/2015] [Indexed: 12/17/2022] Open
Abstract
Although recent research revealed an impact of westernization on diversity and composition of the human gut microbiota, the exact consequences on metacommunity characteristics are insufficiently understood, and the underlying ecological mechanisms have not been elucidated. Here, we have compared the fecal microbiota of adults from two non-industrialized regions in Papua New Guinea (PNG) with that of United States (US) residents. Papua New Guineans harbor communities with greater bacterial diversity, lower inter-individual variation, vastly different abundance profiles, and bacterial lineages undetectable in US residents. A quantification of the ecological processes that govern community assembly identified bacterial dispersal as the dominant process that shapes the microbiome in PNG but not in the US. These findings suggest that the microbiome alterations detected in industrialized societies might arise from modern lifestyle factors limiting bacterial dispersal, which has implications for human health and the development of strategies aimed to redress the impact of westernization.
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Affiliation(s)
- Inés Martínez
- Department of Agriculture, Food, and Nutritional Science, University of Alberta, Edmonton, AB T6G 2E1, Canada; Department of Food Science and Technology, University of Nebraska, Lincoln, NE 68583, USA
| | - James C Stegen
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99352, USA
| | | | - A Murat Eren
- Josephine Bay Paul Center for Comparative Molecular Biology and Evolution, Marine Biological Laboratory, Woods Hole, MA 02543, USA
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province 441, Papua New Guinea
| | - Andrew R Greenhill
- Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province 441, Papua New Guinea; School of Applied and Biomedical Sciences, Federation University Australia, Churchill, VIC 3842, Australia.
| | - Jens Walter
- Department of Agriculture, Food, and Nutritional Science, University of Alberta, Edmonton, AB T6G 2E1, Canada; Department of Food Science and Technology, University of Nebraska, Lincoln, NE 68583, USA; Department of Biological Sciences, University of Alberta, Edmonton, AB T6G 2E1, Canada.
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Laman M, Benjamin JM, Moore BR, Salib M, Tawat S, Davis WA, Siba PM, Robinson LJ, Davis TME. Artemether-lumefantrine versus artemisinin-naphthoquine in Papua New Guinean children with uncomplicated malaria: a six months post-treatment follow-up study. Malar J 2015; 14:121. [PMID: 25889150 PMCID: PMC4374335 DOI: 10.1186/s12936-015-0624-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In a recent trial of artemisinin-naphthoquine (artemisinin-NQ) and artemether-lumefantrine (AM-LM) therapy in young children from Papua New Guinea (PNG), there were no treatment failures in artemisinin-NQ-treated children with Plasmodium falciparum or Plasmodium vivax compared with 2.2% and 30.0%, respectively, in AM-LM-treated children during 42 days of follow-up. To determine whether, consistent with the long elimination half-life of NQ, this difference in efficacy would be more durable, clinical episodes of malaria were assessed in a subset of trial patients followed for six months post-treatment. METHODS For children completing trial procedures and who were assessable at six months, all within-trial and subsequent clinical malaria episodes were ascertained, the latter by clinic attendances and/or review of hand-held health records. Presentations with non-malarial illness were also recorded. Differences between allocated treatments for pre-specified endpoints were determined using Kaplan-Meier survival analysis. RESULTS Of 247 children who were followed to Day 42, 176 (71.3%) were included in the present sub-study, 87 allocated to AM-LM and 89 to artemisinin-NQ. Twenty children in the AM-LM group (32.8%) had a first episode of clinical malaria within six months compared with 10 (16.4%) in the artemisinin-NQ group (P = 0.033, log rank test). The median (interquartile range) time to first episode of clinical malaria was 64 (50-146) vs 116 (77-130) days, respectively (P = 0.20). There were no between-group differences in the incidence of first presentation with non-malarial illness (P = 0.31). CONCLUSIONS The greater effectiveness of artemisinin-NQ over conventional AM-LM extends to at least six months post-treatment for clinical malaria but not non-malarial illness. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12610000913077 .
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Affiliation(s)
- Moses Laman
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, PO Box 480, Fremantle, 6959, WA, Australia. .,Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.
| | - John M Benjamin
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.
| | - Brioni R Moore
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, PO Box 480, Fremantle, 6959, WA, Australia. .,Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.
| | - Mary Salib
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.
| | - Somoyang Tawat
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.
| | - Wendy A Davis
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, PO Box 480, Fremantle, 6959, WA, Australia.
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.
| | - Leanne J Robinson
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea. .,Infection and Immunity Division, Walter and Eliza Hall Institute, Parkville, VIC, Australia. .,Department of Medical Biology, University of Melbourne, Melbourne, VIC, Australia.
| | - Timothy M E Davis
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, PO Box 480, Fremantle, 6959, WA, Australia.
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Stanisic DI, Moore KA, Baiwog F, Ura A, Clapham C, King CL, Siba PM, Beeson JG, Mueller I, Fowkes FJ, Rogerson SJ. Risk factors for malaria and adverse birth outcomes in a prospective cohort of pregnant women resident in a high malaria transmission area of Papua New Guinea. Trans R Soc Trop Med Hyg 2015; 109:313-24. [PMID: 25758854 DOI: 10.1093/trstmh/trv019] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 11/09/2014] [Accepted: 02/13/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Low birth weight (LBW), anaemia and malaria are common in Papua New Guinean women. METHODS To identify risk factors for LBW, anaemia and preterm delivery (PTD), pregnant women recruited into a cohort study in Madang, Papua New Guinea, were followed to delivery. RESULTS Of 470 women enrolled, delivery data were available for 328 (69.7%). By microscopy, 34.4% (113/328) of women had malaria parasitaemia at enrolment and 12.5% (41/328) at delivery; at each time point, PCR detected sub-microscopic parasitaemia in substantially more. Most infections were with Plasmodium falciparum; the remainder being predominantly P. vivax. Anaemia and smoking were associated with lower birth weight, and LBW (16.7%; 51/305) and PTD (21.8%; 63/290) were common. Histopathologically diagnosed chronic placental malaria was associated with LBW (adjusted odds ratio [aOR] 3.3; p=0.048) and PTD (aOR 4.2; p=0.01). Lack of maternal education predisposed to PTD. Sub-microscopic parasitaemia at delivery appeared to increase the risk of LBW. Of the genetic polymorphisms, Southeast Asian ovalocytosis, α(+)-thalassaemia and complement receptor 1 (CR1) deficiency, a CR1 heterozygous genotype was associated with decreased risk of anaemia and substantial but non-significant effects were noted in other comparisons. CONCLUSIONS In coastal Papua New Guinea, malaria and anaemia are important causes of adverse pregnancy outcomes.
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Affiliation(s)
- Danielle I Stanisic
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3050, Australia Institute of Glycomics, Griffith University, Southport, Queensland 4215, Australia
| | - Kerryn A Moore
- Burnet Institute, Melbourne, Victoria, Australia Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Victoria, Australia
| | - Francesca Baiwog
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Alice Ura
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Caroline Clapham
- Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Christopher L King
- Case Western Reserve University, Cleveland Ohio, USA Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - James G Beeson
- Burnet Institute, Melbourne, Victoria, Australia Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria 3010, Australia Department of Microbiology, Monash University, Victoria, Australia
| | - Ivo Mueller
- Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3050, Australia CRESIB, University of Barcelona, Barcelona, Spain
| | - Freya J Fowkes
- Burnet Institute, Melbourne, Victoria, Australia Department of Epidemiology and Preventive Medicine and Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia
| | - Stephen J Rogerson
- Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria 3010, Australia
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Logue K, Small ST, Chan ER, Reimer L, Siba PM, Zimmerman PA, Serre D. Whole-genome sequencing reveals absence of recent gene flow and separate demographic histories for Anopheles punctulatus mosquitoes in Papua New Guinea. Mol Ecol 2015; 24:1263-74. [PMID: 25677924 DOI: 10.1111/mec.13107] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 02/03/2015] [Accepted: 02/04/2015] [Indexed: 02/01/2023]
Abstract
Anopheles mosquitoes are the vectors of several human diseases including malaria. In many malaria endemic areas, several species of Anopheles coexist, sometimes in the form of related sibling species that are morphologically indistinguishable. Determining the size and organization of Anopheles populations, and possible ongoing gene flow among them is important for malaria control and, in particular, for monitoring the spread of insecticide resistance alleles. However, these parameters have been difficult to evaluate in most Anopheles species due to the paucity of genetic data available. Here, we assess the extent of contemporary gene flow and historical variations in population size by sequencing and de novo assembling the genomes of wild-caught mosquitoes from four species of the Anopheles punctulatus group of Papua New Guinea. Our analysis of more than 50 Mb of orthologous DNA sequences revealed no evidence of contemporary gene flow among these mosquitoes. In addition, investigation of the demography of two of the An. punctulatus species revealed distinct population histories. Overall, our analyses suggest that, despite their similarities in morphology, behaviour and ecology, contemporary sympatric populations of An. punctulatus are evolving independently.
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Affiliation(s)
- Kyle Logue
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH, 44195, USA; Department of Biology, Case Western Reserve University, Cleveland, OH, 44106, USA; Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, 44106, USA
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Requena P, Barrios D, Robinson LJ, Samol P, Umbers AJ, Wangnapi R, Ome-Kaius M, Rosanas-Urgell A, Mayor A, López M, de Lazzari E, Arévalo-Herrera M, Fernández-Becerra C, del Portillo H, Chitnis CE, Siba PM, Rogerson S, Mueller I, Bardají A, Menéndez C, Dobaño C. Proinflammatory responses and higher IL-10 production by T cells correlate with protection against malaria during pregnancy and delivery outcomes. J Immunol 2015; 194:3275-85. [PMID: 25725110 DOI: 10.4049/jimmunol.1401038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Pregnancy triggers immunological changes aimed to tolerate the fetus. However, it has not been properly addressed whether similar changes occur in tropical areas with high infection pressure and whether these changes render women more susceptible to infectious diseases. We compared the frequencies of T cell subsets, including regulatory T cells, in pregnant and nonpregnant women from Papua New Guinea, a high malaria transmission area, and from Spain, a malaria-free country. We also assessed the relationship among these cellular subsets, malaria infection, and delivery outcomes. CD4(+)FOXP3(+)CD127(low) T cells (Tregs) were decreased in pregnant women in both countries but were not associated with malaria infection or poor delivery outcomes. An expansion of IFN-γ-producing cells and intracytoplasmic IFN-γ levels was found in pregnant compared with nonpregnant women only in Papua New Guinea. Increased CD4(+)IL-10(+)IFN-γ(+) frequencies and Treg-IFN-γ production were found in women with current Plasmodium falciparum infection. Higher CD4(+)IL-10(-)IFN-γ(+) T cells frequencies and production of proinflammatory cytokines (including TNF and IL-2) at recruitment (first antenatal visit) had a protective association with birth weight and future (delivery) P. falciparum infection, respectively. Higher intracellular IL-10 levels in T cells had a protective association with future P. falciparum infection and hemoglobin levels at delivery. The protective associations were found also with nonmalaria-specific T cell responses. Treg frequencies positively correlated with plasma eotaxin concentrations, but this subset did not express eotaxin receptor CCR3. Thus, an activated immune system during pregnancy might contribute to protection against malaria during pregnancy and poor delivery outcomes.
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Affiliation(s)
- Pilar Requena
- Malaria Program, Barcelona Centre for International Health Research, Hospital Clínic-University of Barcelona, 08036 Barcelona, Spain; Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, United Kingdom;
| | - Diana Barrios
- Malaria Program, Barcelona Centre for International Health Research, Hospital Clínic-University of Barcelona, 08036 Barcelona, Spain
| | - Leanne J Robinson
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, Madang 511, Papua New Guinea; Infection and Immunity Division, Walter and Eliza Hall Institute, Parkville, Victoria 3050, Australia
| | - Paula Samol
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, Madang 511, Papua New Guinea
| | - Alexandra J Umbers
- Department of Medicine, University of Melbourne, Parkville, Victoria 3050, Australia
| | - Regina Wangnapi
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, Madang 511, Papua New Guinea
| | - Maria Ome-Kaius
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, Madang 511, Papua New Guinea
| | - Anna Rosanas-Urgell
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, Madang 511, Papua New Guinea
| | - Alfredo Mayor
- Malaria Program, Barcelona Centre for International Health Research, Hospital Clínic-University of Barcelona, 08036 Barcelona, Spain
| | - Marta López
- Department of Maternal-Fetal Medicine, Hospital Clinic-August Pi i Sunyer Biomedical Research Institute, Centre for Biomedical Network Research in Rare Diseases, 08028 Barcelona, Spain
| | - Elisa de Lazzari
- Malaria Program, Barcelona Centre for International Health Research, Hospital Clínic-University of Barcelona, 08036 Barcelona, Spain
| | | | - Carmen Fernández-Becerra
- Malaria Program, Barcelona Centre for International Health Research, Hospital Clínic-University of Barcelona, 08036 Barcelona, Spain
| | - Hernando del Portillo
- Malaria Program, Barcelona Centre for International Health Research, Hospital Clínic-University of Barcelona, 08036 Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats, 08010 Barcelona, Spain; and
| | - Chetan E Chitnis
- Malaria Program, International Center for Genetic Engineering and Biotechnology, Delhi 110 067, India
| | - Peter M Siba
- Vector Borne Disease Unit, Papua New Guinea Institute of Medical Research, Madang 511, Papua New Guinea
| | - Stephen Rogerson
- Department of Medicine, University of Melbourne, Parkville, Victoria 3050, Australia
| | - Ivo Mueller
- Malaria Program, Barcelona Centre for International Health Research, Hospital Clínic-University of Barcelona, 08036 Barcelona, Spain; Infection and Immunity Division, Walter and Eliza Hall Institute, Parkville, Victoria 3050, Australia
| | - Azucena Bardají
- Malaria Program, Barcelona Centre for International Health Research, Hospital Clínic-University of Barcelona, 08036 Barcelona, Spain
| | - Clara Menéndez
- Malaria Program, Barcelona Centre for International Health Research, Hospital Clínic-University of Barcelona, 08036 Barcelona, Spain
| | - Carlota Dobaño
- Malaria Program, Barcelona Centre for International Health Research, Hospital Clínic-University of Barcelona, 08036 Barcelona, Spain
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50
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Greenhill AR, Tsuji H, Ogata K, Natsuhara K, Morita A, Soli K, Larkins JA, Tadokoro K, Odani S, Baba J, Naito Y, Tomitsuka E, Nomoto K, Siba PM, Horwood PF, Umezaki M. Characterization of the gut microbiota of Papua New Guineans using reverse transcription quantitative PCR. PLoS One 2015; 10:e0117427. [PMID: 25658868 PMCID: PMC4319852 DOI: 10.1371/journal.pone.0117427] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 12/23/2014] [Indexed: 12/17/2022] Open
Abstract
There has been considerable interest in composition of gut microbiota in recent years, leading to a better understanding of the role the gut microbiota plays in health and disease. Most studies have been limited in their geographical and socioeconomic diversity to high-income settings, and have been conducted using small sample sizes. To date, few analyses have been conducted in low-income settings, where a better understanding of the gut microbiome could lead to the greatest return in terms of health benefits. Here, we have used quantitative real-time polymerase chain reaction targeting dominant and sub-dominant groups of microorganisms associated with human gut microbiome in 115 people living a subsistence lifestyle in rural areas of Papua New Guinea. Quantification of Clostridium coccoides group, C. leptum subgroup, C. perfringens, Bacteroides fragilis group, Bifidobacterium, Atopobium cluster, Prevotella, Enterobacteriaceae, Enterococcus, Staphylococcus, and Lactobacillus spp. was conducted. Principle coordinates analysis (PCoA) revealed two dimensions with Prevotella, clostridia, Atopobium, Enterobacteriaceae, Enterococcus and Staphylococcus grouping in one dimension, while B. fragilis, Bifidobacterium and Lactobacillus grouping in the second dimension. Highland people had higher numbers of most groups of bacteria detected, and this is likely a key factor for the differences revealed by PCoA between highland and lowland study participants. Age and sex were not major determinants in microbial population composition. The study demonstrates a gut microbial composition with some similarities to those observed in other low-income settings where traditional diets are consumed, which have previously been suggested to favor energy extraction from a carbohydrate rich diet.
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Affiliation(s)
- Andrew R. Greenhill
- School of Applied and Biomedical Sciences, Federation University, Churchill, Australia
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
- * E-mail:
| | | | | | - Kazumi Natsuhara
- Faculty of Nursing, The Japanese Red Cross Akita College of Nursing, Akita, Japan
| | - Ayako Morita
- Department of Human Ecology, The University of Tokyo, Tokyo, Japan
| | - Kevin Soli
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Jo-Ann Larkins
- School of Applied and Biomedical Sciences, Federation University, Churchill, Australia
| | - Kiyoshi Tadokoro
- Department of Human Ecology, The University of Tokyo, Tokyo, Japan
| | - Shingo Odani
- Faculty of Letter, Chiba University, Chiba, Japan
| | - Jun Baba
- Research Institute for Languages and Cultures of Asia and Africa, Tokyo University of Foreign Studies, Tokyo, Japan
| | | | - Eriko Tomitsuka
- Department of Human Ecology, The University of Tokyo, Tokyo, Japan
| | | | - Peter M. Siba
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Paul F. Horwood
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Masahiro Umezaki
- Department of Human Ecology, The University of Tokyo, Tokyo, Japan
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