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Blake KS, Schwartz DJ, Paruthiyil S, Wang B, Ning J, Isidean SD, Burns DS, Whiteson H, Lalani T, Fraser JA, Connor P, Troth T, Porter CK, Tribble DR, Riddle MS, Gutiérrez RL, Simons MP, Dantas G. Gut microbiome and antibiotic resistance effects during travelers' diarrhea treatment and prevention. mBio 2024; 15:e0279023. [PMID: 38085102 PMCID: PMC10790752 DOI: 10.1128/mbio.02790-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 01/17/2024] Open
Abstract
IMPORTANCE The travelers' gut microbiome is potentially assaulted by acute and chronic perturbations (e.g., diarrhea, antibiotic use, and different environments). Prior studies of the impact of travel and travelers' diarrhea (TD) on the microbiome have not directly compared antibiotic regimens, and studies of different antibiotic regimens have not considered travelers' microbiomes. This gap is important to be addressed as the use of antibiotics to treat or prevent TD-even in moderate to severe cases or in regions with high infectious disease burden-is controversial based on the concerns for unintended consequences to the gut microbiome and antimicrobial resistance (AMR) emergence. Our study addresses this by evaluating the impact of defined antibiotic regimens (single-dose treatment or daily prophylaxis) on the gut microbiome and resistomes of deployed servicemembers, using samples collected during clinical trials. Our findings indicate that the antibiotic treatment regimens that were studied generally do not lead to adverse effects on the gut microbiome and resistome and identify the relative risks associated with prophylaxis. These results can be used to inform therapeutic guidelines for the prevention and treatment of TD and make progress toward using microbiome information in personalized medical care.
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Affiliation(s)
- Kevin S. Blake
- The Edison Family Center for Genome Sciences & Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Drew J. Schwartz
- The Edison Family Center for Genome Sciences & Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA
- Center for Women’s Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Srinand Paruthiyil
- The Edison Family Center for Genome Sciences & Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bin Wang
- The Edison Family Center for Genome Sciences & Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jie Ning
- The Edison Family Center for Genome Sciences & Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sandra D. Isidean
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland, USA
- Naval Medical Research Command, Silver Spring, Maryland, USA
| | - Daniel S. Burns
- Academic Department of Military Medicine, UK Defence Medical Directorate, Birmingham, United Kingdom
| | - Harris Whiteson
- The Edison Family Center for Genome Sciences & Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Tahaniyat Lalani
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland, USA
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Jamie A. Fraser
- Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland, USA
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Patrick Connor
- Academic Department of Military Medicine, UK Defence Medical Directorate, Birmingham, United Kingdom
| | - Tom Troth
- Academic Department of Military Medicine, UK Defence Medical Directorate, Birmingham, United Kingdom
| | - Chad K. Porter
- Naval Medical Research Command, Silver Spring, Maryland, USA
| | - David R. Tribble
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Mark S. Riddle
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | | - Mark P. Simons
- Naval Medical Research Command, Silver Spring, Maryland, USA
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Gautam Dantas
- The Edison Family Center for Genome Sciences & Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
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Fagnant HS, Isidean SD, Wilson L, Bukhari AS, Allen JT, Agans RT, Lee DM, Hatch-McChesney A, Whitney CC, Sullo E, Porter CK, Karl JP. Orally Ingested Probiotic, Prebiotic, and Synbiotic Interventions as Countermeasures for Gastrointestinal Tract Infections in Nonelderly Adults: A Systematic Review and Meta-Analysis. Adv Nutr 2023; 14:539-554. [PMID: 36822240 DOI: 10.1016/j.advnut.2023.02.002] [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: 12/01/2022] [Revised: 01/26/2023] [Accepted: 02/15/2023] [Indexed: 02/24/2023] Open
Abstract
Meta-analyses have not examined the prophylactic use of orally ingested probiotics, prebiotics, and synbiotics for preventing gastrointestinal tract infections (GTIs) of various etiologies in adult populations, despite evidence that these gut microbiota-targeted interventions can be effective in treating certain GTIs. This systematic review and meta-analysis aimed to estimate the effects of prophylactic use of orally ingested probiotics, prebiotics, and synbiotics on GTI incidence, duration, and severity in nonelderly, nonhospitalized adults. CENTRAL, PubMed, Scopus, and Web of Science were searched through January 2022. English-language, peer-reviewed publications of randomized, placebo-controlled studies testing an orally ingested probiotic, prebiotic, or synbiotic intervention of any dose for ≥1 wk in adults who were not hospitalized, immunosuppressed, or taking antibiotics were included. Results were analyzed using random-effects meta-analyses of intention-to-treat (ITT) and complete case (CC) cohorts. Heterogeneity was explored by subgroup meta-analysis and meta-regression. The risk of bias was assessed using the Cochrane risk-of-bias 2 tool. Seventeen publications reporting 20 studies of probiotics (n = 16), prebiotics (n = 3), and synbiotics (n = 1) were identified (n > 6994 subjects). In CC and ITT analyses, risk of experiencing ≥1 GTI was reduced with probiotics (CC analysis-risk ratio: 0.86; 95% CI: 0.73, 1.01) and prebiotics (risk ratio: 0.80; 95% CI: 0.66, 0.98). No effects on GTI duration or severity were observed. Sources of heterogeneity included the study population and number of probiotic strains administered but were often unexplained, and a high risk of bias was observed for most studies. The specific effects of individual probiotic strains and prebiotic types could not be assessed owing to a lack of confirmatory studies. Findings indicated that both orally ingested probiotics and prebiotics, relative to placebo, demonstrated modest benefit for reducing GTI risk in nonelderly adults. However, results should be interpreted cautiously owing to the low number of studies, high risk of bias, and unexplained heterogeneity that may include probiotic strain-specific or prebiotic-specific effects. This review was registered at PROSPERO as CRD42020200670.
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Affiliation(s)
- Heather S Fagnant
- US Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Sandra D Isidean
- Naval Medical Research Center, Silver Spring, MD, United States; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Lydia Wilson
- The George Washington University, Washington, DC, United States
| | - Asma S Bukhari
- US Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Jillian T Allen
- US Army Research Institute of Environmental Medicine, Natick, MA, United States; Oak Ridge Institute of Science and Education, Belcamp, MD, United States
| | - Richard T Agans
- U.S. Air Force School of Aerospace Medicine, Dayton, OH, United States
| | - Dustin M Lee
- Brooke Army Medical Center, Fort Sam Houston, TX, United States
| | | | - Claire C Whitney
- US Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Elaine Sullo
- The George Washington University, Washington, DC, United States
| | - Chad K Porter
- Naval Medical Research Center, Silver Spring, MD, United States
| | - J Philip Karl
- US Army Research Institute of Environmental Medicine, Natick, MA, United States.
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3
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Mantua J, Gutierrez RL, Isidean SD, Alcala AN, Testa KJ, Talaat KR, Doty TJ, Porter CK. Sleep duration prior to an enterotoxigenic Escherichia coli challenge predicts diarrhea severity during infection. Sleep Med 2022; 100:404-409. [PMID: 36240601 DOI: 10.1016/j.sleep.2022.09.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Acute diarrhea is the most frequent diagnosis among ill travelers. Sleep loss may weaken the body's defense against pathogens and increase susceptibility to infection. The relationship between sleep and infectious diarrhea has not been studied and was assessed utilizing data from a controlled human infection model (CHIM) for enterotoxigenic Escherichia coli (ETEC). METHODS During a CHIM assessing the efficacy of an immunoprophylactic targeting ETEC against moderate-to-severe diarrhea (MSD) following challenge, we measured sleep via actigraphy over an 8-day inpatient period. We hypothesized better sleep pre-challenge would predict illness symptomatology following challenge. RESULTS Among 57 participants (aged 34.4 ± 8.1 years, 64% male), there was no relationship between sleep metrics and incidence of MSD. However, longer total sleep time the night preceding ETEC challenge was associated with lower maximum 24 h diarrhea volume (B = -1.80, p = 0.01) and total diarrhea volume (B = -2.45, p = 0.01). CONCLUSIONS This novel study showed that shorter sleep duration predicted diarrhea severity over the course of an ETEC infection. Future work should experimentally manipulate sleep to further clarify its impact on diarrhea-related outcomes for ETEC and other important enteric pathogens.
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Affiliation(s)
- Janna Mantua
- Walter Reed Army Institute of Research, Behavioral Biology Branch, Silver Spring, MD, 20910, USA.
| | - Ramiro L Gutierrez
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, 20910, USA
| | - Sandra D Isidean
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, 20910, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA
| | - Ashley N Alcala
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, 20910, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA
| | - Kayla J Testa
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, 20910, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA
| | - Kawsar R Talaat
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Tracy Jill Doty
- Walter Reed Army Institute of Research, Behavioral Biology Branch, Silver Spring, MD, 20910, USA
| | - Chad K Porter
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, 20910, USA
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4
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Volesky KD, Magnan S, Mayrand MH, Isidean SD, El-Zein M, Comète E, Franco EL, Coutlée F. Clinical performance of the BD Onclarity extended genotyping assay for the management of women positive for human papillomavirus in cervical cancer screening. Cancer Epidemiol Biomarkers Prev 2022; 31:851-857. [DOI: 10.1158/1055-9965.epi-21-1082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/17/2021] [Accepted: 01/28/2022] [Indexed: 11/16/2022] Open
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5
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Porter CK, Detizio KJ, Maier N, Testa KJ, Talaat KR, Chen WH, Lyon CE, Gutierrez RL, Frenck R, Isidean SD, Kaminski RW, Alcala AN, Hanevik K, Sawe F, Kirkpatrick BD, Louis Bourgeois A. A site assessment tool for inpatient controlled human infection models for enteric disease pathogens. Clin Trials 2021; 19:116-118. [PMID: 34708664 DOI: 10.1177/17407745211052473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of the controlled human infection model to facilitate product development and to advance understanding of host-pathogen interactions is of increasing interest. While administering a virulent (or infective) organism to a susceptible host necessitates an ongoing evaluation of safety and ethical considerations, a central theme in conducting these studies in a safe and ethical manner that yields actionable data is their conduct in facilities well-suited to address their unique attributes. To that end, we have developed a framework for evaluating potential sites in which to conduct inpatient enteric controlled human infection model to ensure consistency and increase the likelihood of success.
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Affiliation(s)
- Chad K Porter
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, USA
| | - Katherine J Detizio
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | | | - Kayla J Testa
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Kawsar R Talaat
- Center for Immunization Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Wilbur H Chen
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Caroline E Lyon
- Vaccine Testing Center, Larner College of Medicine, The University of Vermont, Burlington, VT, USA
| | - Ramiro L Gutierrez
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, USA
| | - Robert Frenck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sandra D Isidean
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Robert W Kaminski
- Bacterial Disease Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Ashley N Alcala
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Kurt Hanevik
- Norwegian National Advisory Unit on Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Frederick Sawe
- Kenya Medical Research Institute and United States Army Medical Research Directorate-Africa, Kericho, Kenya.,Henry M. Jackson Foundation Medical Research International, Bethesda, MD, USA
| | - Beth D Kirkpatrick
- Vaccine Testing Center, Larner College of Medicine, The University of Vermont, Burlington, VT, USA
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6
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Porter CK, Talaat KR, Isidean SD, Kardinaal A, Chakraborty S, Gutiérrez RL, Sack DA, Bourgeois AL. The Controlled Human Infection Model for Enterotoxigenic Escherichia coli. Curr Top Microbiol Immunol 2021. [PMID: 34669040 DOI: 10.1007/82_2021_242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The controlled human infection model (CHIM) for enterotoxigenic Escherichia coli (ETEC) has been instrumental in defining ETEC as a causative agent of acute watery diarrhea, providing insights into disease pathogenesis and resistance to illness, and enabling preliminary efficacy evaluations for numerous products including vaccines, immunoprophylactics, and drugs. Over a dozen strains have been evaluated to date, with a spectrum of clinical signs and symptoms that appear to replicate the clinical illness seen with naturally occurring ETEC. Recent advancements in the ETEC CHIM have enhanced the characterization of clinical, immunological, and microbiological outcomes. It is anticipated that omics-based technologies applied to ETEC CHIMs will continue to broaden our understanding of host-pathogen interactions and facilitate the development of primary and secondary prevention strategies.
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Affiliation(s)
- Chad K Porter
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, 20910, USA.
| | - Kawsar R Talaat
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Sandra D Isidean
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, 20910, USA
- Henry M. Jackson Foundation, Bethesda, MD, 20817, USA
| | - Alwine Kardinaal
- NIZO Food Research, Ede, P.O. Box 20, 6710 BA EDE, Kernhemseweg 2, 6718 ZB EDE, The Netherlands
| | - Subhra Chakraborty
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Ramiro L Gutiérrez
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, 20910, USA
| | - David A Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - A Louis Bourgeois
- PATH|Center for Vaccine Innovation and Access, 455 Massachusetts Avenue NW, Suite 1000, Washington, DC, 20001, USA
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Stamps BW, Kuroiwa J, Isidean SD, Schilling MA, Harro C, Talaat KR, Sack DA, Tribble DR, Maue AC, Rimmer JE, Laird RM, Porter CK, Goodson MS, Poly F. Exploring Changes in the Host Gut Microbiota During a Controlled Human Infection Model for Campylobacter jejuni. Front Cell Infect Microbiol 2021; 11:702047. [PMID: 34532299 PMCID: PMC8439579 DOI: 10.3389/fcimb.2021.702047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/13/2021] [Indexed: 01/02/2023] Open
Abstract
Campylobacter jejuni infection is a leading cause of foodborne disease, common to children, adult travelers, and military populations in low- to middle-income countries. In the absence of a licensed vaccine, efforts to evaluate prophylactic agents are underway. The prophylactic efficacy of a twice-daily, 550 mg dose of the antibiotic rifaximin demonstrated no efficacy against campylobacteriosis in a controlled human infection model (CHIM); however, samples from the CHIM study were utilized to assess how the human gut microbiome responds to C. jejuni infection, and if a ‘protective’ microbiota exists in study participants not developing campylobacteriosis. Statistically significant, but minor, differences in study participant beta diversity were identified during the challenge period (p = 0.002, R2 = 0.042), but no significant differences were otherwise observed. Pre-challenge alpha diversity was elevated in study participants who did not develop campylobacteriosis compared to those who did (p < 0.001), but alpha diversity declined in all study participants from the pre-challenge period to post-discharge. Our work provides insight into gut microbiome shifts observed during a C. jejuni CHIM and following antibiotic treatment. This study utilized a high dose of 1.7 x 105 colony-forming units of C. jejuni; future work could include CHIM studies performed with inocula more closely mimicking natural exposure as well as field studies involving naturally-occurring enteric infections.
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Affiliation(s)
- Blake W Stamps
- 711th Human Performance Wing, Air Force Research Laboratory, Wright-Patterson Air Force Base, Dayton, OH, United States.,Integrative Health and Performance Sciences Division, UES, Inc., Dayton, OH, United States
| | - Janelle Kuroiwa
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, United States.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Sandra D Isidean
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, United States.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Megan A Schilling
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, United States
| | - Clayton Harro
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kawsar R Talaat
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - David A Sack
- Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - David R Tribble
- Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Alexander C Maue
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, United States.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Joanna E Rimmer
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, United States.,Academic Department of Military Medicine, Royal Centre for Defence Medicine, Medical Directorate, Joint Medical Command, Information and Communications Technology Centre, Birmingham, United Kingdom
| | - Renee M Laird
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, United States.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
| | - Chad K Porter
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, United States
| | - Michael S Goodson
- 711th Human Performance Wing, Air Force Research Laboratory, Wright-Patterson Air Force Base, Dayton, OH, United States
| | - Frédéric Poly
- Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, United States
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8
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Clarke TN, Schilling MA, Melendez LA, Isidean SD, Porter CK, Poly FM. A systematic review and meta-analysis of Penner serotype prevalence of Campylobacter jejuni in low- and middle-income countries. PLoS One 2021; 16:e0251039. [PMID: 33951106 PMCID: PMC8099051 DOI: 10.1371/journal.pone.0251039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/17/2021] [Indexed: 01/18/2023] Open
Abstract
Introduction While Campylobacter jejuni is a leading foodborne bacterial pathogen worldwide, it poses a particular risk to susceptible populations in low- and middle-income countries (LMICs). A capsule-conjugate vaccine approach has been proposed as a potential solution, but little information exists on circulating C. jejuni capsule types in LMICs. The capsule is the major serodeterminant of the Penner typing scheme, which is based on serum recognition of Campylobacter heat-stable antigens. We conducted a systematic review and meta-analysis to estimate the distribution of Penner serotypes associated with C. jejuni enteritis in LMICs. Vaccine coverage assessments for hypothetical regional and global C. jejuni vaccines were also estimated. Methods A systematic review of the literature published from 1980 to 2019 was performed using PubMed, Scopus, and Web of Science databases. Articles were assessed for eligibility and data were abstracted. Pooled C. jejuni serotype prevalence in LMICs was estimated by region and globally using random-effects models. Results A total of 36 studies were included, capturing 4,434 isolates from LMICs. Fifteen serotypes were present in a sufficient number of studies to be included in analyses. Among these, HS4c was the most common serotype globally (12.6%), though leading capsule types varied among regions. HS2, HS3c, HS4c, HS5/31, HS8/17, and HS10 were all among the 10 most common region-specific serotypes. Conclusions The results of this review suggest that an octavalent vaccine could provide up to 66.9% coverage of typable strains worldwide, and 56.8–69.0% regionally. This review also highlights the paucity of available data on capsules in LMICs; more testing is needed to inform vaccine development efforts.
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Affiliation(s)
- Tegan N. Clarke
- General Dynamics Information Technology, Silver Spring, MD, United States of America
- Enteric Diseases Department, Infectious Diseases Directorate, Naval Medical Research Center, Silver Spring, MD, United States of America
| | - Megan A. Schilling
- Enteric Diseases Department, Infectious Diseases Directorate, Naval Medical Research Center, Silver Spring, MD, United States of America
| | - Luca A. Melendez
- George Washington University School of Public Health, Washington, DC, United States of America
| | - Sandra D. Isidean
- Enteric Diseases Department, Infectious Diseases Directorate, Naval Medical Research Center, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation, Bethesda, MD, United States of America
| | - Chad K. Porter
- Enteric Diseases Department, Infectious Diseases Directorate, Naval Medical Research Center, Silver Spring, MD, United States of America
| | - Frédéric M. Poly
- Enteric Diseases Department, Infectious Diseases Directorate, Naval Medical Research Center, Silver Spring, MD, United States of America
- * E-mail:
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9
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Castle PE, Pierz AJ, Adcock R, Aslam S, Basu PS, Belinson JL, Cuzick J, El-Zein M, Ferreccio C, Firnhaber C, Franco EL, Gravitt PE, Isidean SD, Lin J, Mahmud SM, Monsonego J, Muwonge R, Ratnam S, Safaeian M, Schiffman M, Smith JS, Swarts A, Wright TC, Van De Wyngard V, Xi LF. A Pooled Analysis to Compare the Clinical Characteristics of Human Papillomavirus-positive and -Negative Cervical Precancers. Cancer Prev Res (Phila) 2020; 13:829-840. [PMID: 32655005 DOI: 10.1158/1940-6207.capr-20-0182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/16/2020] [Accepted: 07/02/2020] [Indexed: 11/16/2022]
Abstract
Given that high-risk human papillomavirus (HPV) is the necessary cause of virtually all cervical cancer, the clinical meaning of HPV-negative cervical precancer is unknown. We, therefore, conducted a literature search in Ovid MEDLINE, PubMed Central, and Google Scholar to identify English-language studies in which (i) HPV-negative and -positive, histologically confirmed cervical intraepithelial neoplasia grade 2 or more severe diagnoses (CIN2+) were detected and (ii) summarized statistics or deidentified individual data were available to summarize proportions of biomarkers indicating risk of cancer. Nineteen studies including 3,089 (91.0%) HPV-positive and 307 (9.0%) HPV-negative CIN2+ were analyzed. HPV-positive CIN2+ (vs. HPV-negative CIN2+) was more likely to test positive for biomarkers linked to cancer risk: a study diagnosis of CIN3+ (vs. CIN2; 18 studies; 0.56 vs. 0.24; P < 0.001) preceding high-grade squamous intraepithelial lesion cytology (15 studies; 0.54 vs. 0.10; P < 0.001); and high-grade colposcopic impression (13 studies; 0.30 vs. 0.18; P = 0.03). HPV-negative CIN2+ was more likely to test positive for low-risk HPV genotypes than HPV-positive CIN2+ (P < 0.001). HPV-negative CIN2+ appears to have lower cancer risk than HPV-positive CIN2+. Clinical studies of human high-risk HPV testing for screening to prevent cervical cancer may refer samples of HPV test-negative women for disease ascertainment to correct verification bias in the estimates of clinical performance. However, verification bias adjustment of the clinical performance of HPV testing may overcorrect/underestimate its clinical performance to detect truly precancerous abnormalities.
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Affiliation(s)
- Philip E Castle
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New York.
| | - Amanda J Pierz
- Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, New York
| | - Rachael Adcock
- Queen Mary University of London, Centre for Cancer Prevention, London, United Kingdom
| | | | - Partha S Basu
- International Agency for Research on Cancer, Screening Group, Lyon, France
| | - Jerome L Belinson
- Preventive Oncology International and the Cleveland Clinic, Cleveland, Ohio
| | - Jack Cuzick
- Queen Mary University of London, Centre for Cancer Prevention, London, United Kingdom
| | - Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montréal, Quebec, Canada
| | - Catterina Ferreccio
- Advanced Center for Chronic Diseases, ACCDiS, Santiago, Chile
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montréal, Quebec, Canada
| | - Patti E Gravitt
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Sandra D Isidean
- Division of Cancer Epidemiology, McGill University, Montréal, Quebec, Canada
| | - John Lin
- HPV Research Group, University of Washington, Seattle, Washington
| | - Salaheddin M Mahmud
- Rady Faculty of Health Sciences, Department of Community Health, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Joseph Monsonego
- Institute of the Cervix, Federation Mutualiste Parisienne, Paris, France
| | - Richard Muwonge
- International Agency for Research on Cancer, Screening Group, Lyon, France
| | - Samuel Ratnam
- Division of Cancer Epidemiology, McGill University, Montréal, Quebec, Canada
| | | | - Mark Schiffman
- Division of Cancer Epidemiology & Genetics, NIH, NCI, Bethesda, Maryland
| | - Jennifer S Smith
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Avril Swarts
- Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Thomas C Wright
- Department of Pathology and Cell Biology, Columbia University, New York, New York
| | - Vanessa Van De Wyngard
- Advanced Center for Chronic Diseases, ACCDiS, Santiago, Chile
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Long Fu Xi
- HPV Research Group, University of Washington, Seattle, Washington
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10
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Tota JE, Isidean SD, Franco EL. Defining benchmarks for tolerable risk thresholds in cancer screening: Impact of HPV vaccination on the future of cervical cancer screening. Int J Cancer 2020; 147:3305-3312. [PMID: 32588426 PMCID: PMC7689748 DOI: 10.1002/ijc.33178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 12/17/2022]
Abstract
The performance of cervical cancer screening will decline as a function of lower disease prevalence—a consequence of successful human papillomavirus (HPV) vaccination. Replacement of cytology with molecular HPV testing as the primary screening test and adoption of risk‐based screening, with less intense screening of vaccinated individuals and initiated at older ages is expected to improve efficiency. However, policy officials may decide to further reduce or eliminate screening as the ratio of benefits to harms continues to decline. To evaluate the level of risk currently tolerated for different cancers in the United States (ie, for which clinical guidelines do not recommend secondary prevention though effective screening methods exist), we used US cancer registry data to compare incidence (2008‐2012) and survival (1988‐2011) associated with different cancers for which organized screening is recommended and not recommended. The most common cancer at ages 70 to 74 years (ie, age group with highest cancer incidence and reasonable life expectancy to consider screening in the US) satisfying Wilson and Jungner's classic screening criteria was vulvar cancer (incidence = 9/100 000 females). In comparison, the incidence of cervical cancer among females 65 years of age (the upper recommended age limit for screening) was 13 cases per 100 000 females (low as a reflection of effective screening), whereas 10‐year survival was 66% (similar to vulvar cancer at 67%). Our approach of defining tolerable risk in cancer screening could help guide future decisions to modify cervical screening programs.
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Affiliation(s)
- Joseph E Tota
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.,Department of Oncology, McGill University, Montreal, Quebec, Canada.,Department of Pharmacoepidemiology, Merck Research Laboratories, West Point, Pennsylvania, USA
| | - Sandra D Isidean
- Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Eduardo L Franco
- Department of Oncology, McGill University, Montreal, Quebec, Canada
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11
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Mantua J, Gutierrez RL, Isidean SD, Alaca AN, Testa KJ, Talaat K, Doty TJ, Capaldi VF, Porter C. 1028 Sleep and Enteric Disease: Sleep Now for Less Diarrhea Later. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The bi-directional relationship between sleep and immune function is well-established. Sufficient sleep supports immune health and can increase vaccine efficacy. Conversely, sickness can disturb sleep quality, which can delay recovery and waking functioning. However, the bidirectional relationship between sleep and infectious diarrhea, the leading infectious disease threat to deployed military populations, has not been studied. We assessed the bi-directional relationship between sleep and enteric disease utilizing data from a recently-completed controlled human infection model (CHIM) with enterotoxigenic Escherichia coli (ETEC).
Methods
During a CHIM to assess the efficacy of an immunoprophylactic targeting ETEC (NCT03040687), we measured sleep via actigraphy over an 8-day inpatient period. Participants ingested prophylaxis 3 times/day during days -2 and -1 and ingested ETEC on day 0. The primary outcome was moderate-severe diarrhea following the ETEC challenge. We hypothesized better sleep pre-challenge would reduce risk of disease after the challenge (assessed using linear regression). We also hypothesized total sleep time (TST) and sleep efficiency (SE) after the challenge would be lower/poorer than baseline (assessed using paired t-test).
Results
Among 59 participants (aged 34.4±8.1yrs, 64% female), longer TST the night preceding ETEC challenge was associated with lower total diarrhea volume (B=-3.13,p=.001). SE was slightly but significantly poorer after the challenge (78 vs. 76%; t(55)=2.2,p=.03), but there was no significant change in TST, potentially due to low TST pre-challenge (316 vs. 329 minutes; p=0.12).
Conclusion
These results - in aggregation with previous work on sleep and vaccines - suggest military sleep regulations should be put in place to increase sleep prior to traveling to an area of responsibility with high risk for enteric disease. These minor behavioral changes could provide lasting benefits to readiness of military servicemembers.
Support
This work was supported by Joint Warfighter Medical Research Program (JWMRP) and the Military Operational Medicine Research Program (MOMRP). The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the US Army or of the US Department of Defense. This abstract has been approved for public release with unlimited distribution.
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Affiliation(s)
- J Mantua
- Walter Reed Army Institute of Research, Silver Spring, MD
| | | | - S D Isidean
- Naval Medical Research Center, Silver Spring, MD
| | - A N Alaca
- Naval Medical Research Center, Silver Spring, MD
| | - K J Testa
- Naval Medical Research Center, Silver Spring, MD
| | - K Talaat
- Johns Hopkins Medicine, Baltimore, MD
| | - T J Doty
- Walter Reed Army Institute of Research, Silver Spring, MD
| | - V F Capaldi
- Walter Reed Army Institute of Research, Silver Spring, MD
| | - C Porter
- Naval Medical Research Center, Silver Spring, MD
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12
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Isidean SD, Wang Y, Mayrand MH, Ratnam S, Coutlée F, Franco EL, Abrahamowicz M. Assessing the time dependence of prognostic values of cytology and human papillomavirus testing in cervical cancer screening. Int J Cancer 2019; 144:2408-2418. [PMID: 30411802 DOI: 10.1002/ijc.31970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/06/2018] [Revised: 10/04/2018] [Accepted: 10/16/2018] [Indexed: 11/11/2022]
Abstract
Accurate assessment of risks for developing cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) after a given set of screening test results is instrumental to reaching valid conclusions and informing cervical cancer screening recommendations. Using data from the Canadian Cervical Cancer Screening Trial (CCCaST), we assessed prognostic values of enrollment screening test results to predict CIN2+ among women attending routine cervical screening using multivariable Cox proportional hazards (PH) regression and its flexible extension during each of two follow-up periods (protocol-defined and extended). Nonproportional (time-dependent (TD)) and/or nonlinear effects were modeled, as appropriate. Women with abnormal cytology had hazard ratios (HRs) for CIN2+ detection of 17.61 (95% CI: 11.25-27.57) and 10.46 (95% CI: 5.41-20.24) relative to women with normal cytology during the protocol-defined and extended follow-up periods, respectively. High-risk human papillomavirus (HR-HPV) positivity was an even stronger predictor of CIN2+ risk, with significant TD effects during both follow-up periods (p <0.001 for both TD effects). Risks among women co-testing HR-HPV+ with and without abnormal cytology (relative to women co-testing negative) were highest immediately after baseline, and decreased significantly thereafter (p <0.001 for both TD effects). HRs for HPV16+ and HPV18+ women (relative to those testing HR-HPV-) did not vary significantly over time (HR = 182.96; 95% CI: 95.16-351.77 and HR = 111.81; 95% CI: 44.60-280.31, respectively). Due to TD effects, conventional Cox model estimates considerably underestimated adjusted HRs associated with positive HR-HPV testing results early on in the follow-up periods.
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Affiliation(s)
- Sandra D Isidean
- Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Yishu Wang
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Marie-Hélène Mayrand
- Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada.,Départements d'Obstétrique-Gynécologie et de Médecine Sociale et Préventive, Université de Montréal et CRCHUM, Montréal, QC, Canada
| | - Sam Ratnam
- Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada.,Division of Community Health and Humanities, Memorial University, St. John's, NL, Canada
| | - François Coutlée
- Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada.,Département de Microbiologie-Infectiologie, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
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13
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Affiliation(s)
- Eduardo L Franco
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
| | - Gayle A Shinder
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada
| | - Joseph E Tota
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, USA
| | - Karena Volesky
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Sandra D Isidean
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
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14
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Isidean SD, Tota JE, Shinder GA, Franco EL. Population health intervention research: A renewed commitment to promoting a science of solutions. Prev Med 2017; 100:1-2. [PMID: 28322878 DOI: 10.1016/j.ypmed.2017.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Sandra D Isidean
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
| | - Joseph E Tota
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Gayle A Shinder
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada
| | - Eduardo L Franco
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
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15
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Affiliation(s)
- Sandra D Isidean
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada; Department of Epidemiology & Biostatistics, McGill University, Montreal, QC, Canada.
| | - Gayle A Shinder
- Gerald Bronfman Department of Oncology, McGill University, Montreal, QC, Canada
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16
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Isidean SD, Mayrand MH, Ramanakumar AV, Rodrigues I, Ferenczy A, Ratnam S, Coutlée F, Franco EL. Comparison of Triage Strategies for HPV-Positive Women: Canadian Cervical Cancer Screening Trial Results. Cancer Epidemiol Biomarkers Prev 2017; 26:923-929. [PMID: 28096198 DOI: 10.1158/1055-9965.epi-16-0705] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/14/2016] [Accepted: 01/07/2017] [Indexed: 11/16/2022] Open
Abstract
Background: High-risk human papillomavirus (HR-HPV) testing has become a preferred cervical cancer screening strategy in some countries due to its superior sensitivity over cytology-based methods for identifying cervical intraepithelial neoplasia of grade 2 or worse (CIN2+). Improved sensitivity has been accompanied by reductions in specificity and concerns regarding overscreening and overtreatment of women with transient or nonprogressing HR-HPV infections. Triage of HR-HPV+ women to colposcopy is, thus, warranted for appropriate management and treatment.Methods: Using data from the Canadian Cervical Cancer Screening Trial (CCCaST), we compared the performance of cytology and HR-HPV strategies to detect CIN2+ among HR-HPV+ women (age, 30-69 years). Colposcopy referral rates and performance gains from adding other HR-HPV genotypes to HPV16/18+ triage were also evaluated.Results: A strategy referring all women HPV16/18+ and HPV16/18-, but with atypical squamous cells of undetermined significance or worse cytology (ASC-US+) had the highest sensitivity [82.5%; 95% confidence interval (CI), 70.9%-91.0%] but yielded the highest colposcopy referral rate. HPV16/18+ triage was the next most sensitive strategy (64.1%; 95% CI, 51.1%-75.7%). Low-grade squamous intraepithelial lesion or worse cytology (LSIL+) triage yielded a low sensitivity (32.8%; 95% CI, 21.9%-45.4%) but had the most favorable specificity (93.6%; 95% CI, 91.0%-95.6%), positive predictive value (41.5%; 95% CI, 28.1%-55.9%), and colposcopy referral rate of strategies examined. HPV viral load triage strategies did not perform optimally overall. Inclusion of HR-HPV genotypes 31 and 52 to HPV16/18+ triage provided the highest sensitivities.Conclusion: Concerns surrounding HPV-based screening can be effectively mitigated via triage.Impact: Balancing the benefits of HPV-based primary cervical screening with informed management recommendations for HR-HPV+ women may decide the success of its widening utilization. Cancer Epidemiol Biomarkers Prev; 26(6); 923-9. ©2017 AACR.
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Affiliation(s)
- Sandra D Isidean
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Marie-Hélène Mayrand
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada.,Départements d'Obstétrique-Gynécologie et de Médecine Sociale et Préventive, Université de Montréal et CRCHUM, Montréal, Québec, Canada
| | | | - Isabel Rodrigues
- Département de Médecine Familiale, Université de Montréal, Montréal, Québec, Canada
| | - Alex Ferenczy
- Department of Pathology, McGill University and Jewish General Hospital, Montreal, Quebec, Canada
| | - Sam Ratnam
- Division of Community Health and Humanities, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - François Coutlée
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada.,Département de Microbiologie-Infectiologie, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada.
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17
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Isidean SD, Mayrand MH, Ramanakumar AV, Gilbert L, Reid SL, Rodrigues I, Ferenczy A, Ratnam S, Coutlée F, Franco EL. Human papillomavirus testing versus cytology in primary cervical cancer screening: End-of-study and extended follow-up results from the Canadian cervical cancer screening trial. Int J Cancer 2016; 139:2456-66. [PMID: 27538188 DOI: 10.1002/ijc.30385] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/22/2016] [Accepted: 08/01/2016] [Indexed: 11/09/2022]
Abstract
The Canadian Cervical Cancer Screening Trial was a randomized controlled trial comparing the performance of human papillomavirus (HPV) testing and Papanicolaou cytology to detect cervical intraepithelial neoplasia of grades 2 or worse (CIN2+) among women aged 30-69 years attending routine cervical cancer screening in Montreal and St. John's, Canada (n = 10,154). We examined screening and prognostic values of enrollment cytologic and HPV testing results. Extended follow-up data were available for St. John's participants (n = 5,754; 501,682.6 person-months). HPV testing detected more CIN2+ than cytology during protocol-defined (82.9 vs. 44.4%) and extended (54.2 vs. 19.3%) follow-up periods, respectively. Three-year risks ranged from 0.87% (95% CI: 0.37-2.05) for HPV-/Pap- women to 35.77% (95% CI: 25.88-48.04) for HPV+/Pap+ women. Genotype-specific risks ranged from 0.90% (95% CI: 0.40-2.01) to 43.84% (95% CI: 32.42-57.24) among HPV- and HPV16+ women, respectively, exceeding those associated with Pap+ or HPV+ results taken individually or jointly. Ten-year risks ranged from 1.15% (95% CI: 0.60-2.19) for HPV-/Pap- women to 26.05% (95% CI: 15.34-42.13) for HPV+/Pap+ women and genotype-specific risks ranged from 1.13% (95% CI: 0.59-2.14) to 32.78% (95% CI: 21.15-48.51) among women testing HPV- and HPV16+, respectively. Abnormal cytology stratified risks most meaningfully for HPV+ women. Primary HPV testing every 3 years provided a similar or greater level of reassurance against disease risks as currently recommended screening strategies. HPV-based cervical screening may allow for greater disease detection than cytology-based screening and permit safe extensions of screening intervals; genotype-specific testing could provide further improvement in the positive predictive value of such screening.
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Affiliation(s)
- Sandra D Isidean
- Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada
| | - Marie-Hélène Mayrand
- Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada.,Départements d'Obstétrique-Gynécologie et de Médecine Sociale et Préventive, Université de Montréal et CRCHUM, Montréal, QC, Canada
| | | | - Laura Gilbert
- Newfoundland and Labrador Public Health Laboratory, St. John's, NL, Canada
| | - Stephanie L Reid
- Newfoundland and Labrador Public Health Laboratory, St. John's, NL, Canada
| | - Isabel Rodrigues
- Département de Médecine Familiale, Université de Montréal, Montréal, QC, Canada
| | - Alex Ferenczy
- Department of Pathology, McGill University and Jewish General Hospital, Montreal, QC, Canada
| | - Sam Ratnam
- Division of Community Health and Humanities, Memorial University, St. John's, NL, Canada
| | - François Coutlée
- Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada.,Département de Microbiologie-Infectiologie, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada.
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18
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Affiliation(s)
- Eduardo L Franco
- Department of Oncology, McGill University, Montreal, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | | | - Joseph E Tota
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, USA
| | - Sandra D Isidean
- Department of Oncology, McGill University, Montreal, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
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19
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Franco EL, Shinder GA, Tota JE, Isidean SD. Sobering realizations in cancer prevention and screening and their lessons. Prev Med 2015; 76:129-31. [PMID: 25933986 DOI: 10.1016/j.ypmed.2015.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Eduardo L Franco
- Department of Oncology, McGill University, Montreal, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.
| | | | - Joseph E Tota
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, USA
| | - Sandra D Isidean
- Department of Oncology, McGill University, Montreal, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
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20
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Affiliation(s)
- Eduardo L Franco
- Preventive Medicine Editorial Office, Department of Oncology, McGill University, Montreal H2W1S6, Canada.
| | - Gayle A Shinder
- Preventive Medicine Editorial Office, Department of Oncology, McGill University, Montreal H2W1S6, Canada
| | - Joseph E Tota
- Preventive Medicine Editorial Office, Department of Oncology, McGill University, Montreal H2W1S6, Canada
| | - Sandra D Isidean
- Preventive Medicine Editorial Office, Department of Oncology, McGill University, Montreal H2W1S6, Canada
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21
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Abstract
Prophylactic HPV vaccines hold tremendous potential for reducing cervical and non-cervical HPV-related disease burden worldwide. To maximize on this potential, policy officials will need to carefully consider available evidence, existing uncertainties and the cost-effectiveness of mass HPV vaccination programs in the context of their respective nations and/or regions. Proper harmonization of primary prevention strategies with secondary prevention efforts will also be important. Decisions following such considerations may ultimately depend on programmatic objectives, infrastructure and available resources. Continued research and surveillance surrounding HPV vaccination will be essential for filling current knowledge gaps, and forcing ongoing reconsiderations of selected immunization strategies.
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Affiliation(s)
- Sandra D Isidean
- Department of Epidemiology, Biostatistics, and Occupational Health, Division of Cancer Epidemiology, McGill University, 546 Pine Avenue West, Montreal, QC H2W1S6, Canada
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22
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Affiliation(s)
- Sandra D Isidean
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada H3A 1A2; Department of Oncology, McGill University, Montreal, QC, Canada H2W 1S6
| | - Eduardo L Franco
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada H3A 1A2; Department of Oncology, McGill University, Montreal, QC, Canada H2W 1S6.
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23
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Isidean SD, Coutlée F, Franco EL. cobas®4800 HPV Test, a real-time polymerase chain reaction assay for the detection of human papillomavirus in cervical specimens. Expert Rev Mol Diagn 2013; 14:5-16. [DOI: 10.1586/14737159.2014.865521] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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24
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Franco EL, de Sanjosé S, Broker TR, Stanley MA, Chevarie-Davis M, Isidean SD, Schiffman M. Human papillomavirus and cancer prevention: gaps in knowledge and prospects for research, policy, and advocacy. Vaccine 2013. [PMID: 23199961 DOI: 10.1016/j.vaccine.2012.06.092] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The recognition that human papillomavirus (HPV) infection is the central, necessary cause of cervical cancer paved the way to new fronts of prevention via improved screening methods and HPV vaccination. Much has been learned in all fronts, from the molecular basis of our understanding of how HPV causes disease to the health economics of preventive strategies at the individual and population levels. Progress in other areas of cancer control has yet to show the same multi- and trans-disciplinary gains seen in research on HPV-associated malignancies, which is one of the unequivocal success stories in disease prevention. Yet, as an embarrassment of riches, much more research is needed to fill the gaps in knowledge that remain before we are able to reap the benefits from the knowledge translation from all fronts. Public health research on setting-specific implementation of HPV-based preventive strategies and more concerted advocacy to counter barriers facing the adoption of these strategies are likely to yield major dividends in reducing the burden of HPV-associated diseases. This article forms part of a special supplement entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.
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Affiliation(s)
- Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, Canada.
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25
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Isidean SD, Riddle MS, Savarino SJ, Porter CK. A systematic review of ETEC epidemiology focusing on colonization factor and toxin expression. Vaccine 2011; 29:6167-78. [PMID: 21723899 DOI: 10.1016/j.vaccine.2011.06.084] [Citation(s) in RCA: 179] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 06/15/2011] [Accepted: 06/22/2011] [Indexed: 11/29/2022]
Affiliation(s)
- S D Isidean
- Enteric Diseases Department, Infectious Disease Directorate, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD 20910-7500, USA
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26
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Porter CK, Riddle MS, Tribble DR, Louis Bougeois A, McKenzie R, Isidean SD, Sebeny P, Savarino SJ. A systematic review of experimental infections with enterotoxigenic Escherichia coli (ETEC). Vaccine 2011; 29:5869-85. [PMID: 21616116 DOI: 10.1016/j.vaccine.2011.05.021] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 05/04/2011] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
Abstract
Volunteer challenge with enterotoxigenic Escherichia coli (ETEC) has been used for four decades to elucidate the pathogenesis and immune responses and assess efficacy of various interventions. We performed a systematic review of these studies and a meta-analysis of individual patient-level data (IPD) from a subset of studies using standard methodology. We identified 27 studies of 11 ETEC strains administered to 443 naive subjects at doses from 1×10(6) to 1×10(10) colony forming units (cfu). Diarrhea attack rates varied by strain, dose and enterotoxin. Similar rates were seen at doses of 5×10(8) to 1×10(10)cfu with the three most commonly used strains B7A, E24377A, H10407. In IPD analysis, the highest diarrhea attack rates were seen with strains B7A, H10407 and E24377A. The H10407 induced significantly higher stool output than the other strains. Additionally, the rate of output was different across strains. The risk of diarrhea, abdominal cramps, nausea and headaches differed significantly by ETEC strain. An increased risk of nausea, abdominal cramps and headaches was seen for females. Baseline anti-LT IgG titers appeared to be associated with a decrease risk of diarrhea outcomes, a trend not seen with anti-LT IgA or seen consistently with anti-colonization factor antibodies. Neither early antibiotic treatment nor diarrhea duration significantly affected the frequency or magnitude of serologic responses. These studies have served as an invaluable tool in understanding disease course, pathogenicity, innate immune responses and an early assessment of product efficacy. When designing and planning experimental ETEC infection studies in this age of increased ethical scrutiny and growing appreciation of post-infectious sequelae, better understanding of available data is essential.
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Affiliation(s)
- Chad K Porter
- Naval Medical Research Center, Enteric Diseases Department, Silver Spring, MD, United States.
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