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Hossain MJ, Svennerholm AM, Carlin N, D’Alessandro U, Wierzba TF. A Perspective on the Strategy for Advancing ETVAX ®, An Anti-ETEC Diarrheal Disease Vaccine, into a Field Efficacy Trial in Gambian Children: Rationale, Challenges, Lessons Learned, and Future Directions. Microorganisms 2023; 12:90. [PMID: 38257916 PMCID: PMC10819518 DOI: 10.3390/microorganisms12010090] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/24/2024] Open
Abstract
For the first time in over 20 years, an Enterotoxigenic Escherichia coli (ETEC) vaccine candidate, ETVAX®, has advanced into a phase 2b field efficacy trial for children 6-18 months of age in a low-income country. ETVAX® is an inactivated whole cell vaccine that has gone through a series of clinical trials to provide a rationale for the design elements of the Phase 2b trial. This trial is now underway in The Gambia and will be a precursor to an upcoming pivotal phase 3 trial. To reach this point, numerous findings were brought together to define factors such as safe and immunogenic doses for children, and the possible benefit of a mucosal adjuvant, double mutant labile toxin (dmLT). Considering the promising but still underexplored potential of inactivated whole cells in oral vaccination, we present a perspective compiling key observations from past ETVAX® trials that informed The Gambian trial design. This report will update the trial's status and explore future directions for ETEC vaccine trials. Our aim is to provide not only an update on the most advanced ETEC vaccine candidate but also to offer insights beneficial for the development of other much-needed oral whole-cell vaccines against enteric and other pathogens.
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Affiliation(s)
- M. Jahangir Hossain
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Banjul P.O. Box 273, The Gambia
| | - Ann-Mari Svennerholm
- Department of Microbiology and Immunology, Gothenburg University Research Institute (GUVAX), Gothenburg University, 40530 Gothenburg, Sweden
| | - Nils Carlin
- Scandinavian Biopharma, Industrivägen 1, 17148 Solna, Sweden
| | - Umberto D’Alessandro
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Banjul P.O. Box 273, The Gambia
| | - Thomas F. Wierzba
- Section on Infectious Diseases, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC 27157, USA
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Berry AA, Tjaden AH, Renteria J, Friedman-Klabanoff D, Hinkelman AN, Gibbs MA, Ahmed A, Runyon MS, Schieffelin J, Santos RP, Oberhelman R, Bott M, Correa A, Edelstein SL, Uschner D, Wierzba TF. Persistence of antibody responses to COVID-19 vaccines among participants in the COVID-19 Community Research Partnership. Vaccine X 2023; 15:100371. [PMID: 37649617 PMCID: PMC10462856 DOI: 10.1016/j.jvacx.2023.100371] [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: 08/07/2023] [Accepted: 08/10/2023] [Indexed: 09/01/2023] Open
Abstract
Introduction High levels of immunity to SARS-CoV-2 in the community correlate with protection from COVID-19 illness. Measuring COVID-19 antibody seroprevalence and persistence may elucidate the level and length of protection afforded by vaccination and infection within a population. Methods We measured the duration of detectable anti-spike antibodies following COVID-19 vaccination in a multistate, longitudinal cohort study of almost 13,000 adults who completed daily surveys and submitted monthly dried blood spots collected at home. Results Overall, anti-spike antibodies persisted up to 284 days of follow-up with seroreversion occurring in only 2.4% of the study population. In adjusted analyses, risk of seroreversion increased with age (adults aged 55-64: adjusted hazard ratio [aHR] 2.19 [95% confidence interval (CI): 1.22, 3.92] and adults aged > 65: aHR 3.59 [95% CI: 2.07, 6.20] compared to adults aged 18-39). Adults with diabetes had a higher risk of seroreversion versus nondiabetics (aHR 1.77 [95% CI: 1.29, 2.44]). Decreased risk of seroreversion was shown for non-Hispanic Black versus non-Hispanic White (aHR 0.32 [95% CI: 0.13, 0.79]); college degree earners versus no college degree (aHR 0.61 [95% CI: 0.46, 0.81]); and those who received Moderna mRNA-1273 vaccine versus Pfizer-BioNTech BNT162b2 (aHR 0.35 [95% CI: 0.26, 0.47]). An interaction between healthcare worker occupation and sex was detected, with seroreversion increased among male, non-healthcare workers. Conclusion We established that a remote, longitudinal, multi-site study can reliably detect antibody durability following COVID-19 vaccination. The survey platform and measurement of antibody response using at-home collection at convenient intervals allowed us to explore sociodemographic factors and comorbidities and identify predictors of antibody persistence, which has been demonstrated to correlate with protection against disease. Our findings may help inform public health interventions and policies to protect those at highest risk for severe illness and assist in determining the optimal timing of booster doses.Clinical trials registry: NCT04342884.
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Affiliation(s)
- Andrea A. Berry
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ashley H. Tjaden
- The Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, MD, USA
| | - Jone Renteria
- The Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, MD, USA
| | - DeAnna Friedman-Klabanoff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amy N. Hinkelman
- Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Lillington, NC, USA
| | | | | | | | - John Schieffelin
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Richard Oberhelman
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | - Matthew Bott
- The Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, MD, USA
| | - Adolfo Correa
- University of Mississippi Medical Center, Jackson, MS, USA
| | - Sharon L. Edelstein
- The Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, MD, USA
| | - Diane Uschner
- The Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, MD, USA
| | - Thomas F. Wierzba
- Section on Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
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Westcott MM, Blevins M, Wierzba TF, Morse AE, White KR, Sanders LA, Sanders JW. The Immunogenicity and Properties of a Whole-Cell ETEC Vaccine Inactivated with Psoralen and UVA Light in Comparison to Formalin. Microorganisms 2023; 11:2040. [PMID: 37630600 PMCID: PMC10458022 DOI: 10.3390/microorganisms11082040] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/26/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
Inactivated whole-cell vaccines present a full repertoire of antigens to the immune system. Formalin treatment, a standard method for microbial inactivation, can modify or destroy protein antigenic epitopes. We tested the hypothesis that photochemical inactivation with psoralen and UVA light (PUVA), which targets nucleic acid, would improve the immunogenicity of an Enterotoxigenic E. coli (ETEC) vaccine relative to a formalin-inactivated counterpart. Exposure of ETEC H10407 to PUVA using the psoralen drug 4'-Aminomethyltrioxsalen hydrochloride (AMT) yielded replication-incompetent bacteria that retained their metabolic activity. CFA/I-mediated mannose-resistant hemagglutination (MRHA) was equivalent for PUVA-inactivated and live ETEC, but was severely reduced for formalin-ETEC, indicating that PUVA preserved fimbrial protein functional integrity. The immunogenicity of PUVA-ETEC and formalin-ETEC was compared in mice ± double mutant heat-labile enterotoxin (dmLT) adjuvant. Two weeks after an intramuscular prime/boost, serum anti-ETEC IgG titers were similar for the two vaccines and were increased by dmLT. However, the IgG responses raised against several conserved ETEC proteins were greater after vaccination with PUVA-ETEC. In addition, PUVA-ETEC generated IgG specific for heat-labile toxin (LT) in the absence of dmLT, which was not a property of formalin-ETEC. These data are consistent with PUVA preserving ETEC protein antigens in their native-like form and justify the further testing of PUVA as a vaccine platform for ETEC using murine challenge models.
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Affiliation(s)
- Marlena M. Westcott
- Department of Microbiology and Immunology, Wake Forest University School of Medicine, 575 Patterson Ave, Winston Salem, NC 27101, USA; (A.E.M.); (K.R.W.)
| | - Maria Blevins
- Infectious Diseases Section, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC 27157, USA; (M.B.); (T.F.W.); (L.A.S.); (J.W.S.)
| | - Thomas F. Wierzba
- Infectious Diseases Section, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC 27157, USA; (M.B.); (T.F.W.); (L.A.S.); (J.W.S.)
| | - Alexis E. Morse
- Department of Microbiology and Immunology, Wake Forest University School of Medicine, 575 Patterson Ave, Winston Salem, NC 27101, USA; (A.E.M.); (K.R.W.)
| | - Kinnede R. White
- Department of Microbiology and Immunology, Wake Forest University School of Medicine, 575 Patterson Ave, Winston Salem, NC 27101, USA; (A.E.M.); (K.R.W.)
| | - Leigh Ann Sanders
- Infectious Diseases Section, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC 27157, USA; (M.B.); (T.F.W.); (L.A.S.); (J.W.S.)
| | - John W. Sanders
- Infectious Diseases Section, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC 27157, USA; (M.B.); (T.F.W.); (L.A.S.); (J.W.S.)
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4
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DeWitt M, Wierzba TF. Automatic Case Cluster Detection Using Hospital Electronic Health Record Data. Biol Methods Protoc 2023; 8:bpad004. [PMID: 37016667 PMCID: PMC10067150 DOI: 10.1093/biomethods/bpad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/05/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Abstract
Case detection through contact tracing is a key intervention during an infectious disease outbreak. However, contact tracing is an intensive process where a given contact tracer must locate not only confirmed cases, but identify and interview known contacts. Often these data are manually recorded. During emerging outbreaks, the numbers of contacts could expand rapidly and beyond this, when focused on individual transmission chains, larger patterns may not be identified.
Understanding if particular cases can be clustered and linked to a common source can help to prioritize contact tracing effects and understand underlying risk factors for large spreading events. Electronic health records systems are used by the vast majority of private health care systems across the United States, providing a potential way to automatically detect outbreaks and connect cases through already collected data. In this analysis we propose an algorithm to identify case clusters within a community during an infectious disease outbreak using Bayesian probabilistic case linking and explore how this approach could supplement outbreak responses; especially when human contact tracing resources are limited.
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Affiliation(s)
- Michael DeWitt
- Wake Forest University School of Medicine Section on Infectious Disease, Department of Internal Medicine
| | - Thomas F Wierzba
- Wake Forest University School of Medicine Section on Infectious Disease, Department of Internal Medicine
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5
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Plumb ID, Fette LM, Tjaden AH, Feldstein L, Saydah S, Ahmed A, Link-Gelles R, Wierzba TF, Berry AA, Friedman-Klabanoff D, Larsen MP, Runyon MS, Ward LM, Santos RP, Ward J, Weintraub WS, Edelstein S, Uschner D. Estimated COVID-19 vaccine effectiveness against seroconversion from SARS-CoV-2 Infection, March-October, 2021. Vaccine 2023; 41:2596-2604. [PMID: 36932031 PMCID: PMC9995303 DOI: 10.1016/j.vaccine.2023.03.006] [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: 12/12/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Monitoring the effectiveness of COVID-19 vaccines against SARS-CoV-2 infections remains important to inform public health responses. Estimation of vaccine effectiveness (VE) against serological evidence of SARS-CoV-2 infection might provide an alternative measure of the benefit of vaccination against infection. METHODS We estimated mRNA COVID-19 vaccine effectiveness (VE) against development of SARS-CoV-2 anti-nucleocapsid antibodies in March-October 2021, during which the Delta variant became predominant. Participants were enrolled from four participating healthcare systems in the United States, and completed electronic surveys that included vaccination history. Dried blood spot specimens collected on a monthly basis were analyzed for anti-spike antibodies, and, if positive, anti-nucleocapsid antibodies. We used detection of new anti-nucleocapsid antibodies to indicate SARS-CoV-2 infection, and estimated VE by comparing 154 case-participants with new detection of anti-nucleocapsid antibodies to 1,540 seronegative control-participants matched by calendar period. Using conditional logistic regression, we estimated VE ≥ 14 days after the 2nd dose of an mRNA vaccine compared with no receipt of a COVID-19 vaccine dose, adjusting for age group, healthcare worker occupation, urban/suburban/rural residence, healthcare system region, and reported contact with a person testing positive for SARS-CoV-2. RESULTS Among individuals who completed a primary series, estimated VE against seroconversion from SARS-CoV-2 infection was 88.8% (95% confidence interval [CI], 79.6%-93.9%) after any mRNA vaccine, 87.8% (95% CI, 75.9%-93.8%) after BioNTech vaccine and 91.7% (95% CI, 75.7%-97.2%) after Moderna vaccine. VE was estimated to be lower ≥ 3 months after dose 2 compared with < 3 months after dose 2, and among participants who were older or had underlying health conditions, although confidence intervals overlapped between subgroups. CONCLUSIONS VE estimates generated using infection-induced antibodies were consistent with published estimates from clinical trials and observational studies that used virologic tests to confirm infection during the same period. Our findings support recommendations for eligible adults to remain up to date with COVID-19 vaccination.
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Affiliation(s)
- Ian D Plumb
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
| | - Lida M Fette
- Biostatistics Center, Milken Institute School of Public Health, The George Washington University, 6110 Executive Blvd., Suite 750, Rockville, MD 20852, USA
| | - Ashley H Tjaden
- Biostatistics Center, Milken Institute School of Public Health, The George Washington University, 6110 Executive Blvd., Suite 750, Rockville, MD 20852, USA
| | - Leora Feldstein
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA
| | - Sharon Saydah
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA
| | - Amina Ahmed
- Atrium Health Levine Children's Hospital, 1000 Blythe Blvd, Charlotte, NC 28203, USA
| | - Ruth Link-Gelles
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA
| | - Thomas F Wierzba
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Andrea A Berry
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W. Baltimore Street, Room 480, Baltimore, MD 21201, USA
| | - DeAnna Friedman-Klabanoff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, 685 W. Baltimore Street, Room 480, Baltimore, MD 21201, USA
| | - Moira P Larsen
- Medstar Health Research Institute, 6525 Belcrest Road, Suite 700, Hyattsville, MD 20782, USA
| | - Michael S Runyon
- Department of Emergency Medicine, Atrium Health Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC 28203, USA
| | - Lori M Ward
- University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
| | - Roberto P Santos
- University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
| | - Johnathan Ward
- Vysnova Partners, 8400 Corporate Drive Suite 130, Landover, MD 20785, USA
| | - William S Weintraub
- Medstar Health Research Institute, 6525 Belcrest Road, Suite 700, Hyattsville, MD 20782, USA
| | - Sharon Edelstein
- Biostatistics Center, Milken Institute School of Public Health, The George Washington University, 6110 Executive Blvd., Suite 750, Rockville, MD 20852, USA
| | - Diane Uschner
- Biostatistics Center, Milken Institute School of Public Health, The George Washington University, 6110 Executive Blvd., Suite 750, Rockville, MD 20852, USA
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DeWitt ME, Herrington DM, Williamson JC, Seals AL, Wierzba TF, Binek A, Van Eyk J, Sanders JW. 530. Characterization of the Proteomic Changes via SARS-CoV-2 Infection or Vaccination in the COVID-19 Community Research Partnership (CCRP). Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.585] [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: 12/23/2022] Open
Abstract
Abstract
Background
There remain important gaps in knowledge concerning the effects of SARS-CoV-2 infection or vaccination on the human blood proteome.
Methods
The CCRP is a longitudinal surveillance study with information on SARS-CoV-2 infections, vaccinations and associated humoral immune responses in over 37,000 individuals. We selected a sample of blood spots cards (n=510) from serum antibody studies obtained between October 2020 and April 2021 for mass spectrometry proteomics analysis covering 540 unique plasma proteins. We analyzed the quantified protein differences based on dried blood samples obtained before and after infection or vaccination among previously non-infected individuals (immune naïve) after adjustment for batch effects, age, sex, or prior diagnosis of cancer, cardiovascular or autoimmune disease, or diabetes. The majority of infected individuals were minimally symptomatic. Differentially expressed proteins were considered significant with an FDR adjusted p-value of < 0.05 and log2 fold change (L2FC) >0.2.
Results
We found 11 and 12 proteins differentially expressed proteins in the naïve/infected and naïve/vaccinated people respectively, of which 10 were shared. Hepatocyte growth factor receptor (HGF) was upregulated (L2FC 0.24; p < 0.001) only in those who were infected while fibrillarin (L2FC -0.24; p< 0.001) and lambda-crystallin homolog (L2FC -0.29, p < 0.001) were downregulated only in the vaccinated samples (Fig 1). The remaining DE protein were associated with a wide array of functions including metabolic, cytostructural, extracellular matrix and DNA regulatory processes.
Conclusion
We found changes in the proteome both from infection and vaccination. HGF, elevated in the infected, has been associated with endothelial inflammation, upregulation of pro-inflammatory cytokines to reduce lung fibrosis and is known to promote tissue repair. Fibrillarin, downregulated in the vaccinated, has been associated with higher rates of bacterial and viral clearance, inflammation reduction, and increased cell survival. These findings suggest detectable complex inflammation from mild to moderate infections. Further investigation is required to understand the mechanism of action and clinical implication of these findings.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
- Michael E DeWitt
- Atrium Wake Forest Baptist Health/ Wake Forest University School of Medicine , Winston-Salem, North Carolina
| | - David M Herrington
- Wake Forest university School of Medicne , Winston Salem, North Carolina
| | | | | | - Thomas F Wierzba
- Wake Forest University School of Medicine , Winston-Salem, North Carolina
| | | | | | - John W Sanders
- Wake Forest University School of Medicine , Winston-Salem, North Carolina
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Wierzba TF, Sanders JW, Herrington D, Espeland MA, Williamson J, Mongraw-Chaffin M, Bertoni A, Alexander-Miller MA, Castri P, Mathews A, Munawar I, Seals AL, Ostasiewski B, Ballard CAP, Gurcan M, Ivanov A, Zapata GM, Westcott M, Blinson K, Blinson L, Mistysyn M, Davis D, Doomy L, Henderson P, Jessup A, Lane K, Levine B, McCanless J, McDaniel S, Melius K, O’Neill C, Pack A, Rathee R, Rushing S, Sheets J, Soots S, Wall M, Wheeler S, White J, Wilkerson L, Wilson R, Wilson K, Burcombe D, Saylor G, Lunn M, Ordonez K, O’Steen A, Wagner L, Runyon MS, McCurdy LH, Gibbs MA, Taylor YJ, Calamari L, Tapp H, Ahmed A, Brennan M, Munn L, Dantuluri KL, Hetherington T, Lu LC, Dunn C, Hogg M, Price A, Leonidas M, Manning M, Rossman W, Gohs FX, Harris A, Priem JS, Tochiki P, Wellinsky N, Silva C, Ludden T, Hernandez J, Spencer K, McAlister L, Weintraub W, Miller K, Washington C, Moses A, Dolman S, Zelaya-Portillo J, Erkus J, Blumenthal J, Barrientos RER, Bennett S, Shah S, Mathur S, Boxley C, Kolm P, Franklin E, Ahmed N, Larsen M, Oberhelman R, Keating J, Kissinger P, Schieffelin J, Yukich J, Beron A, Teigen J, Kotloff K, Chen WH, Friedman-Klabanoff D, Berry AA, Powell H, Roane L, Datar R, Reilly C, Correa A, Navalkele B, Min YI, Castillo A, Ward L, Santos RP, Anugu P, Gao Y, Green J, Sandlin R, Moore D, Drake L, Horton D, Johnson KL, Stover M, Lagarde WH, Daniel L, Maguire PD, Hanlon CL, McFayden L, Rigo I, Hines K, Smith L, Harris M, Lissor B, Cook V, Eversole M, Herrin T, Murphy D, Kinney L, Diehl P, Abromitis N, Pierre TS, Heckman B, Evans D, March J, Whitlock B, Moore W, Arthur S, Conway J, Gallaher TR, Johanson M, Brown S, Dixon T, Reavis M, Henderson S, Zimmer M, Oliver D, Jackson K, Menon M, Bishop B, Roeth R, King-Thiele R, Hamrick TS, Ihmeidan A, Hinkelman A, Okafor C, Bray Brown RB, Brewster A, Bouyi D, Lamont K, Yoshinaga K, Vinod P, Peela AS, Denbel G, Lo J, Mayet-Khan M, Mittal A, Motwani R, Raafat M, Schultz E, Joseph A, Parkeh A, Patel D, Afridi B, Uschner D, Edelstein SL, Santacatterina M, Strylewicz G, Burke B, Gunaratne M, Turney M, Zhou SQ, Tjaden AH, Fette L, Buahin A, Bott M, Graziani S, Soni A, Diao G, Renteria J, Mores C, Porzucek A, Laborde R, Acharya P, Guill L, Lamphier D, Schaefer A, Satterwhite WM, McKeague A, Ward J, Naranjo DP, Darko N, Castellon K, Brink R, Shehzad H, Kuprianov D, McGlasson D, Hayes D, Edwards S, Daphnis S, Todd B, Goodwin A, Berkelman R, Hanson K, Zeger S, Hopkins J, Reilly C, Minnesota UO, Edwards K, Gayle H, Redd S. The COVID-19 Community Research Partnership: a multistate surveillance platform for characterizing the epidemiology of the SARS-CoV-2 pandemic. Biol Methods Protoc 2022; 7:bpac033. [PMID: 36589317 PMCID: PMC9789889 DOI: 10.1093/biomethods/bpac033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Abstract
The COVID-19 Community Research Partnership (CCRP) is a multisite surveillance platform designed to characterize the epidemiology of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-COV-2) pandemic. This article describes the CCRP study design and methodology. The CCRP includes two prospective cohorts, one with six health systems in the mid-Atlantic and southern USA, and the other with six health systems in North Carolina. With enrollment beginning in April 2020, sites invited persons within their healthcare systems as well as community members to participate in daily surveillance for symptoms of COVID-like illnesses, testing, and risk behaviors. Participants with electronic health records (EHRs) were also asked to volunteer data access. Subsets of participants, representative of the general population and including oversampling of populations of interest, were selected for repeated at-home serology testing. By October 2021, 65 739 participants (62 261 adult and 3478 pediatric) were enrolled, with 89% providing syndromic data, 74% providing EHR data, and 70% participating in one of the two serology sub-studies. An average of 62% of the participants completed a daily survey at least once a week, and 55% of the serology kits were returned. The CCRP provides rich regional epidemiologic data and the opportunity to more fully characterize the risks and sequelae of SARS-CoV-2 infection.
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Friedman-Klabanoff DJ, Tjaden AH, Santacatterina M, Munawar I, Sanders JW, Herrington DM, Wierzba TF, Berry AA. Vaccine-induced seroconversion in participants in the North Carolina COVID-19 community Research Partnership. Vaccine 2022; 40:6133-6140. [PMID: 36117003 PMCID: PMC9464595 DOI: 10.1016/j.vaccine.2022.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 11/01/2022]
Abstract
Well-regulated clinical trials have shown FDA-approved COVID-19 vaccines to be immunogenic and highly efficacious. We evaluated seroconversion rates in adults reporting ≥ 1 dose of an mRNA COVID-19 vaccine in a cohort study of nearly 8000 adults residing in North Carolina to validate immunogenicity using a novel approach: at-home, participant administered point-of-care testing. Overall, 91.4% had documented seroconversion within 75 days of first vaccination (median: 31 days). Participants who were older and male participants were less likely to seroconvert (adults aged 41-65: adjusted hazard ratio [aHR] 0.69 [95% confidence interval (CI): 0.64, 0.73], adults aged 66-95: aHR 0.55 [95% CI: 0.50, 0.60], compared to those 18-40; males: aHR 0.92 [95% CI: 0.87, 0.98], compared to females). Participants with evidence of prior infection were more likely to seroconvert than those without (aHR 1.50 [95% CI: 1.19, 1.88]) and those receiving BNT162b2 were less likely to seroconvert compared to those receiving mRNA-1273 (aHR 0.84 [95% CI: 0.79, 0.90]). Reporting at least one new symptom after first vaccination did not affect time to seroconversion, but participants reporting at least one new symptom after second vaccination were more likely to seroconvert (aHR 1.11 [95% CI: 1.05, 1.17]). This data demonstrates the high community-level immunogenicity of COVID-19 vaccines, albeit with notable differences in older adults, and feasibility of using at-home, participant administered point-of-care testing for community cohort monitoring. Trial registration: ClinicalTrials.gov NCT04342884.
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Affiliation(s)
- DeAnna J. Friedman-Klabanoff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA,Corresponding author at: University of Maryland School of Medicine, Center for Vaccine Development and Global Health, 685 W. Baltimore St, Rm 480, Baltimore, MD, 21201
| | - Ashley H. Tjaden
- Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, MD, USA
| | | | - Iqra Munawar
- Section on Infectious Diseases, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - John W. Sanders
- Section on Infectious Diseases, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - David M. Herrington
- Section on Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Thomas F. Wierzba
- Section on Infectious Diseases, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Andrea A. Berry
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
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Connor S, Velagic M, Zhang X, Johura FT, Chowdhury G, Mukhopadhyay AK, Dutta S, Alam M, Sack DA, Wierzba TF, Chakraborty S. Evaluation of a simple, rapid and field-adapted diagnostic assay for enterotoxigenic E. coli and Shigella. PLoS Negl Trop Dis 2022; 16:e0010192. [PMID: 35130310 PMCID: PMC8853640 DOI: 10.1371/journal.pntd.0010192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 02/17/2022] [Accepted: 01/21/2022] [Indexed: 11/19/2022] Open
Abstract
Understanding the global burden of enterotoxigenic E. coli (ETEC) and Shigella diarrhea as well as estimating the cost effectiveness of vaccines to control these two significant pathogens have been hindered by the lack of a diagnostic test that is rapid, simple, sensitive, and can be applied to the endemic countries. We previously developed a simple and rapid assay, Rapid Loop mediated isothermal amplification based Diagnostic Test (RLDT) for the detection of ETEC and Shigella spp. (Shigella). In this study, the RLDT assay was evaluated in comparison with quantitative PCR (qPCR), culture and conventional PCR for the detection of ETEC and Shigella. This validation was performed using previously collected stool samples from endemic countries, from the travelers to the endemic countries, as well as samples from a controlled human infection model study of ETEC. The performance of RLDT from dried stool spots was also validated. RLDT resulted in excellent sensitivity and specificity compared to qPCR (99% and 99.2% respectively) ranging from 92.3 to 100% for the individual toxin genes of ETEC and 100% for Shigella. Culture was less sensitive compared to RLDT. No significant differences were noted in the performance of RLDT using samples from various sources or stool samples from moderate to severe diarrhea or asymptomatic infections. RLDT performed equally well in detection of ETEC and Shigella from the dried stool samples on filter papers. This study established that RLDT is sufficiently sensitive and specific to be used as a simple and rapid diagnostic assay to detect ETEC and Shigella in endemic countries to determine disease burden of these pathogens in the national and subnational levels. This information will be important to guide public health and policy makers to prioritize resources for accelerating the development and introduction of effective preventative and/or treatment interventions against these enteric infections. Enterotoxigenic E. coli (ETEC) and Shigella spp (Shigella) causes significant global morbidity and mortality, especially in low-and middle-income countries (LMICs). Since culture methods to detect Shigella are not sensitive, and the methods used to detect ETEC have not been feasible outside of specialized, well-equipped laboratories, the true burden of these pathogens at national and sub-national levels are mostly not available. Morbidity and mortality estimates, for these two pathogens are crucial to assess their relative public health importance in LMICs. We developed a simple and rapid diagnostic assay called the RLDT (Rapid Loop-mediated isothermal amplification based Diagnostic Test) for detection of ETEC and Shigella. In this study we evaluated RLDT compared to other currently available assays using previously collected stool samples. Our data showed that the RLDT assay exhibited high sensitivity and specificity for detection of ETEC and Shigella, with its result available within 50 minutes. The sensitivity of RLDT was higher than culture for these pathogens. We conclude that RLDT could be used as a rapid and simple diagnostic test to determine the burden of ETEC and Shigella in LMICs as well as in clinical vaccine trials of these pathogens.
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Affiliation(s)
- Sean Connor
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Mirza Velagic
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Xueyan Zhang
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Fatema-Tuz Johura
- icddr,b, Formerly International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Goutam Chowdhury
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Shanta Dutta
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Munirul Alam
- icddr,b, Formerly International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - David A. Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Thomas F. Wierzba
- Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
| | - Subhra Chakraborty
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
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10
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Munawar I, Seals AL, Sanders JW, Herrington DM, Wierzba TF. 1213. Vaccine Uptake Amongst Participants in the North Carolina COVID-19 Community Research Partnership Who Were Initially Receptive or Hesitant to Receive a COVID-19 Vaccine. Open Forum Infect Dis 2021. [PMCID: PMC8643983 DOI: 10.1093/ofid/ofab466.1405] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Public health officials are concerned that adults may refuse to be vaccinated with an approved COVID-19 vaccine thereby limiting the community health benefit. Here, we studied the self-reported intent to be vaccinated of persons in North Carolina (NC) and then measured whether they did or did not get vaccinated. Methods The Community COVID-19 Research Partnership (CCRP) is a large prospective study exploring COVID-19 epidemiology and sequelae in participants of several mid-Atlantic and Southern States. All participants complete an online daily survey where they are asked questions about COVID-like symptoms, infections, and their vaccination status. In addition to the daily survey, in December 2020, we implemented a short online cross-sectional survey questioning NC participants on whether they intended to be vaccinated. After completing the cross-sectional survey, we used daily survey data through 15 May 2021 to see if participants reported receiving vaccine. Unvaccinated participants who did not complete the daily survey 30 days or more prior to 15 May 2021 were excluded. Results 18,874 participants completed the cross-sectional survey and reported vaccination status. Of these participants, 90% were white, 68% were female, 26% were healthcare workers, and 2% self-reported COVID-19 diagnosis The median age was 54 years (IQR: 41 – 65). 79%, 13%, 9%, and 2% answered yes, unsure, no, and prefer not to answer, respectively, about intention to be vaccinated (Table). 99% of the participants who intended to receive the COVID-19 vaccine reporting being vaccinated. Those who were unsure or intended not to get vaccinated had vaccination rates of 80% and 53%, respectively. 78% of the participants who preferred not to answer were vaccinated. Table Vaccine intent versus vaccine status – COVID-19 Community Research Partnership, North Carolina, December 2020 – May 2021 ![]()
Conclusion More than three-quarters of NC participants intended to get vaccinated and by mid-May 2021, the vast majority had received at least one dose. Similarly, those who were unsure or preferred not to say were mostly vaccinated. Even among those who reported they would not get vaccine in January, more than half had received vaccine by May. The nature of our sample makes it difficult to generalize results to the population of NC; nevertheless, further investigation as to the causes of the shift in attitudes is warranted. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Iqra Munawar
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Austin L Seals
- Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - John W Sanders
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David M Herrington
- Wake Forest University School of Medicine, Winston Salem, North Carolina
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11
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Friedman-Klabanoff DJ, Tjaden A, Santacatterina M, Munawar I, Sanders JW, Herrington DM, Wierzba TF, Berry A. 588. Seroconversion Among Adults After Receiving At Least One Dose of a COVID-19 Vaccine: COVID-19 Community Research Partnership, Mid-Atlantic, Southeast and Southern United States, December 2020-May 2021. Open Forum Infect Dis 2021. [PMCID: PMC8644496 DOI: 10.1093/ofid/ofab466.786] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Well-regulated clinical trials have shown authorized COVID-19 vaccines to be immunogenic and highly efficacious. Information about antibody responses after vaccination in real-world settings is needed. Methods We evaluated seroconversion rates in adults reporting ≥ 1 dose of an authorized COVID-19 vaccine in a U.S. multistate longitudinal cohort study, the COVID-19 Community Research Partnership. Participants were recruited through 12 participating healthcare systems and community outreach. Participants had periodic home-based serologic testing using either a SARS-CoV-2 nucleocapsid and spike IgM/IgG lateral flow assay (63% of participants) or a SARS-CoV-2 spike IgG enzyme-linked immunosorbent assay (37% of participants). The timing and number of tests before and after vaccination varied based on participant time in study. Participants were included if they were seronegative on the last test before and had >1 test result after vaccination (some had previously been seropositive, but seroreverted). A weighted Cox regression model with right censoring was used to obtain adjusted hazard ratios for sex, age, race/ethnicity, and prior seropositivity. Time-to-event (seroconversion) was defined as time to first positive test > 4 days after vaccination; participants were censored at the date of their last available test result. Results 13,459 participants were included and 11,722 seroconverted (Table). Median time in study was 272 days (range 31–395). Median follow-up time from vaccine to last available test was 56 days (range 1–147). Participants had a median of 3 tests (range 1–12) before and 2 tests (range 1–8) after vaccination. Based on the Kaplan-Meier method, median time to seroconversion after first COVID-19 vaccination was 35 days (interquartile range: 25–45). Likelihood of seroconversion decreased with older age (Table). Female participants, non-Hispanic Black participants, and participants who were previously seropositive were more likely to seroconvert (Table). ![]()
Conclusion All subgroups had high rates of seroconversion, with some small differences in likelihood of seroconversion between subgroups. These data demonstrate the excellent immunogenicity of COVID-19 vaccines in real-world settings in the US. Disclosures All Authors: No reported disclosures
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Affiliation(s)
| | | | | | - Iqra Munawar
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John W Sanders
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David M Herrington
- Wake Forest University School of Medicine, Winston Salem, North Carolina
| | | | - Andrea Berry
- University of Maryland School of Medicine, Baltimore, Maryland
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12
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Wierzba TF, Shetty AK. Vi-TT-a typhoid conjugate vaccine for infants and young children. Lancet Glob Health 2021; 9:e1483-e1484. [PMID: 34678183 DOI: 10.1016/s2214-109x(21)00470-8] [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] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas F Wierzba
- Section on Infectious Diseases, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA.
| | - Avinash K Shetty
- Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, NC, USA
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13
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Herrington DM, Sanders JW, Wierzba TF, Alexander-Miller M, Espeland M, Bertoni AG, Mathews A, Seals AL, Munawar I, Runyon MS, McCurdy LH, Gibbs MA, Kotloff K, Friedman-Klabanoff D, Weintraub W, Correa A, Uschner D, Edelstein S, Santacatterina M. Duration of SARS-CoV-2 sero-positivity in a large longitudinal sero-surveillance cohort: the COVID-19 Community Research Partnership. BMC Infect Dis 2021; 21:889. [PMID: 34461847 PMCID: PMC8404407 DOI: 10.1186/s12879-021-06517-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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] [Received: 02/12/2021] [Accepted: 07/30/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Estimating population prevalence and incidence of prior SARS-CoV-2 infection is essential to formulate public health recommendations concerning the COVID-19 pandemic. However, interpreting estimates based on sero-surveillance requires an understanding of the duration of elevated antibodies following SARS-CoV-2 infection, especially in the large number of people with pauci-symptomatic or asymptomatic disease. METHODS We examined > 30,000 serology assays for SARS-CoV-2 specific IgG and IgM assays acquired longitudinally in 11,468 adults between April and November 2020 in the COVID-19 Community Research Partnership. RESULTS Among participants with serologic evidence for infection but few or no symptoms or clinical disease, roughly 50% sero-reverted in 30 days of their initial positive test. Sero-reversion occurred more quickly for IgM than IgG and for antibodies targeting nucleocapsid protein compared with spike proteins, but was not associated with age, sex, race/ethnicity, or healthcare worker status. CONCLUSIONS The short duration of antibody response suggests that the true population prevalence of prior SARS-CoV-2 infection may be significantly higher than presumed based on earlier sero-surveillance studies. The impact of the large number of minimally symptomatic COVID-19 cases with only a brief antibody response on population immunity remains to be determined.
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14
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Sarker P, Mily A, Ara A, Haque F, Maier N, Wierzba TF, Walker RI, Venkatesan MM, Raqib R. Functional antibodies and innate immune responses to WRSS1, a live oral Shigella sonnei vaccine candidate in Bangladeshi adults and children. J Infect Dis 2021; 224:S829-S839. [PMID: 34374425 PMCID: PMC8687094 DOI: 10.1093/infdis/jiab395] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 11/12/2022] Open
Abstract
Background We demonstrated in a randomized placebo-controlled trial that WRSS1, a live oral Shigella sonnei vaccine candidate, is safe in Bangladeshi adults and children, and elicits antigen-specific antibodies. Here, we describe functional antibody and innate immune responses to WRSS1. Methods Adults (18–39 years) and children (5–9 years) received 3 doses of 3 × 105 or 3 × 106 colony forming units (CFU) of WRSS1 or placebo, 4 weeks apart; children additionally received 3 × 104 CFU. Blood and stool were collected at baseline and 7 days after each dose. Functional antibodies were measured using serum bactericidal antibody (SBA) assay. Cytokine/chemokine concentrations were measured in lymphocyte cultures. Host defense peptides LL-37, HBD-1, and HD-5 were analyzed in plasma and stool. Results Children showed increased SBA titers over baseline after the third dose of 3 × 106 CFU (P = .048). Significant increases of Th-17 and proinflammatory cytokines (TNF-α, G-CSF, MIP-1β), and reduction of anti-inflammatory and Th2 cytokines (IL-10, IL-13, GM-CSF) were observed in children. Plasma HBD-1 and LL-37 decreased in children after vaccination but were increased/unchanged in adults. Conclusions Functional antibodies and Th1/Th17 cytokine responses in children may serve as important indicators of immunogenicity and protective potential of WRSS1. Clinical Trials Registration: NCT01813071.
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Affiliation(s)
- Protim Sarker
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | | | - Anjuman Ara
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Farjana Haque
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Nicole Maier
- Center for Vaccine Innovation and Access, PATH, Washington DC, USA
| | - Thomas F Wierzba
- Center for Vaccine Innovation and Access, PATH, Washington DC, USA
| | - Richard I Walker
- Center for Vaccine Innovation and Access, PATH, Washington DC, USA
| | - Malabi M Venkatesan
- Bacterial Diseases Branch, Walter Reed Army Institute of Research (WRAIR), Maryland, USA
| | - Rubhana Raqib
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
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15
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16
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Toy T, Pak GD, Duc TP, Campbell JI, El Tayeb MA, Von Kalckreuth V, Im J, Panzner U, Cruz Espinoza LM, Eibach D, Dekker DM, Park SE, Jeon HJ, Konings F, Mogeni OD, Cosmas L, Bjerregaard-Andersen M, Gasmelseed N, Hertz JT, Jaeger A, Krumkamp R, Ley B, Thriemer K, Kabore LP, Niang A, Raminosoa TM, Sampo E, Sarpong N, Soura A, Owusu-Dabo E, Teferi M, Yeshitela B, Poppert S, May J, Kim JH, Chon Y, Park JK, Aseffa A, Breiman RF, Schütt-Gerowitt H, Aaby P, Adu-Sarkodie Y, Crump JA, Rakotozandrindrainy R, Meyer CG, Sow AG, Clemens JD, Wierzba TF, Baker S, Marks F. Multicountry Distribution and Characterization of Extended-spectrum β-Lactamase-associated Gram-negative Bacteria From Bloodstream Infections in Sub-Saharan Africa. Clin Infect Dis 2020; 69:S449-S458. [PMID: 31665776 PMCID: PMC6821266 DOI: 10.1093/cid/ciz450] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Indexed: 12/20/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is a major global health concern, yet, there are noticeable gaps in AMR surveillance data in regions such as sub-Saharan Africa. We aimed to measure the prevalence of extended-spectrum β-lactamase (ESBL) producing Gram-negative bacteria in bloodstream infections from 12 sentinel sites in sub-Saharan Africa. Methods Data were generated during the Typhoid Fever Surveillance in Africa Program (TSAP), in which standardized blood cultures were performed on febrile patients attending 12 health facilities in 9 sub-Saharan African countries between 2010 and 2014. Pathogenic bloodstream isolates were identified at the sites and then subsequently confirmed at a central reference laboratory. Antimicrobial susceptibility testing, detection of ESBL production, and conventional multiplex polymerase chain reaction (PCR) testing for genes encoding for β-lactamase were performed on all pathogens. Results Five hundred and five pathogenic Gram-negative bloodstream isolates were isolated during the study period and available for further characterization. This included 423 Enterobacteriaceae. Phenotypically, 61 (12.1%) isolates exhibited ESBL activity, and genotypically, 47 (9.3%) yielded a PCR amplicon for at least one of the screened ESBL genes. Among specific Gram-negative isolates, 40 (45.5%) of 88 Klebsiella spp., 7 (5.7%) of 122 Escherichia coli, 6 (16.2%) of 37 Acinetobacter spp., and 2 (1.3%) of 159 of nontyphoidal Salmonella (NTS) showed phenotypic ESBL activity. Conclusions Our findings confirm the presence of ESBL production among pathogens causing bloodstream infections in sub-Saharan Africa. With few alternatives for managing ESBL-producing pathogens in the African setting, measures to control the development and proliferation of AMR organisms are urgently needed.
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Affiliation(s)
- Trevor Toy
- International Vaccine Institute, Seoul, South Korea
| | - Gi Deok Pak
- International Vaccine Institute, Seoul, South Korea
| | - Trung Pham Duc
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - James I Campbell
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Justin Im
- International Vaccine Institute, Seoul, South Korea
| | | | | | - Daniel Eibach
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Denise Myriam Dekker
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany
| | - Se Eun Park
- International Vaccine Institute, Seoul, South Korea
| | - Hyon Jin Jeon
- International Vaccine Institute, Seoul, South Korea.,Department of Medicine, Cambridge University, United Kingdom
| | | | - Ondari D Mogeni
- International Vaccine Institute, Seoul, South Korea.,Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Nairobi
| | - Leonard Cosmas
- Centers for Disease Control and Prevention, KEMRI Complex, Nairobi, Kenya
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | - Nagla Gasmelseed
- Faculty of Medicine, University of Gezira, Wad Medani, Sudan.,Faculty of Science, University of Hafr Al Batin, Saudi Arabia
| | - Julian T Hertz
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina
| | - Anna Jaeger
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Ralf Krumkamp
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Benedikt Ley
- International Vaccine Institute, Seoul, South Korea.,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia
| | - Kamala Thriemer
- International Vaccine Institute, Seoul, South Korea.,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia
| | | | | | | | - Emmanuel Sampo
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Burkina Faso
| | - Nimako Sarpong
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Ghana
| | - Abdramane Soura
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Burkina Faso
| | - Ellis Owusu-Dabo
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Ghana.,Department of Global and International Health, School of Public Health, KNUST, Kumasi, Ghana
| | | | | | - Sven Poppert
- Infectious Diseases Department, University Hospital Eppendorf, Hamburg, Germany
| | - Jürgen May
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany
| | - Jerome H Kim
- International Vaccine Institute, Seoul, South Korea
| | - Yun Chon
- International Vaccine Institute, Seoul, South Korea
| | | | | | - Robert F Breiman
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Nairobi.,Global Health Institute, Emory University, Atlanta, Georgia
| | - Heidi Schütt-Gerowitt
- International Vaccine Institute, Seoul, South Korea.,Institute of Medical Microbiology, University of Cologne, Germany
| | - Peter Aaby
- Bandim Health Project, Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | - Yaw Adu-Sarkodie
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology (KNUST), Ghana.,Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - John A Crump
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina.,Duke Global Health Institute, Duke University, Durham, North Carolina.,Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | - Christian G Meyer
- Institute of Tropical Medicine, Eberhard-Karls University Tübingen, Germany.,Duy Tan University, Da Nang, Vietnam
| | - Amy Gassama Sow
- Institute Pasteur de Dakar, Senegal.,Université Cheikh Anta Diop de Dakar, Senegal
| | - John D Clemens
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.,University of California, Fielding School of Public Health, Los Angeles.,School of Medicine, Korea University, Seoul, South Korea
| | | | - Stephen Baker
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Department of Medicine, Cambridge University, United Kingdom
| | - Florian Marks
- International Vaccine Institute, Seoul, South Korea.,Department of Medicine, Cambridge University, United Kingdom
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17
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Wierzba TF. Implications and measurement of herd protection (indirect effects) for enteric vaccine development. Vaccine 2020; 37:4775-4777. [PMID: 31358237 DOI: 10.1016/j.vaccine.2019.02.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/10/2019] [Accepted: 02/25/2019] [Indexed: 12/11/2022]
Abstract
Diarrhea remains one of the top five causes of disease and death among young children in developing nations. Fortunately, scientists are making progress developing vaccines against enterotoxigenic E. coli (ETEC) and Shigella, two of the leading diarrhea pathogens. As vaccine developers start to consider field efficacy trials of these vaccines, they should be aware of the importance of evaluating not only vaccine direct effects on the immunized, but also the herd effects that vaccination can afford to the unimmunized in a community. In a workshop held at the conference titled "Vaccines against Shigella and ETEC (VASE)", we described to participants what herd effects are and we presented on methods used in cholera and rotavirus studies that could be useful for future ETEC and Shigella vaccine trials conducted in low and middle-income nations. We also presented evidence on the effects of vaccine herd effects for estimates of vaccine cost-effectiveness.
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Affiliation(s)
- Thomas F Wierzba
- Wake Forest School of Medicine, Department of Internal Medicine, Section on Infectious Diseases, 1 Medical Center Blvd., Winston Salem, VA 27157-1024, United States; PATH, Enteric Vaccines Initiative, 455 Massachusetts Ave NW, Washington, DC 20001-2785, United States.
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18
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Bagamian KH, Anderson JD, Muhib F, Cumming O, Laytner LA, Wierzba TF, Rheingans R. Heterogeneity in enterotoxigenic Escherichia coli and shigella infections in children under 5 years of age from 11 African countries: a subnational approach quantifying risk, mortality, morbidity, and stunting. Lancet Glob Health 2019; 8:e101-e112. [PMID: 31734154 PMCID: PMC7024994 DOI: 10.1016/s2214-109x(19)30456-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 10/07/2019] [Accepted: 10/10/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Diarrhoea, a global cause of child mortality and morbidity, is linked to adverse consequences including childhood stunting and death from other diseases. Few studies explore how diarrhoeal mortality varies subnationally, especially by cause, which is important for targeting investments. Even fewer examine indirect effects of diarrhoeal morbidity on child mortality. We estimated the subnational distribution of mortality, morbidity, and childhood stunting attributable to enterotoxigenic Escherichia coli (ETEC) and shigella infection in children younger than 5 years from 11 eastern and central African countries. These pathogens are leading causes of diarrhoea in young children and have been linked to increased childhood stunting. METHODS We combined proxy indicators of morbidity and mortality risk from the most recent Demographic and Health Surveys with published relative risks to estimate the potential distribution of diarrhoeal disease risk. To estimate subnational burden, we used country-specific or WHO region-specific morbidity and mortality estimates and distributed them subnationally by three indices that integrate relevant individual characteristics (ie, underweight, probability of receiving oral rehydration treatment of diarrhoea, and receiving vitamin A supplementation) and household characteristics (ie, type of drinking water and sanitation facilities). FINDINGS Characterising ETEC and shigella subnational estimates of indirect morbidity (infection-attributable stunting) and indirect mortality (stunting-related deaths from other infectious diseases) identified high-risk areas that could be missed by traditional metrics. Burundi and Democratic Republic of the Congo had the highest ETEC-associated and shigella-associated mortality and stunting rates. Mozambique, Democratic Republic of the Congo, and Zimbabwe had the greatest subnational heterogeneity in most ETEC and shigella mortality measures. Inclusion of indirect ETEC and shigella mortality in burden estimates resulted in a 20-30% increase in total ETEC and shigella mortality rates in some subnational areas. INTERPRETATION Understanding the indirect mortality and morbidity of diarrhoeal pathogens on a subnational level will strengthen disease control strategies and could have important implications for the relative impact and cost-effectiveness of new enteric vaccines. Because our methods rely on publicly available data, they could be employed for national planning. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Karoun H Bagamian
- Department of Environmental & Global Health, University of Florida, FL, USA; Bagamian Scientific Consulting, Gainesville, FL, USA.
| | - John D Anderson
- Department of Environmental & Global Health, University of Florida, FL, USA; Goodnight Family Department of Sustainable Development, Appalachian State University, Boone, NC, USA
| | | | - Oliver Cumming
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Lindsey A Laytner
- Department of Environmental & Global Health, University of Florida, FL, USA
| | - Thomas F Wierzba
- PATH, Washington, DC, USA; Department of Internal Medicine, Section on Infectious Diseases, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Richard Rheingans
- Goodnight Family Department of Sustainable Development, Appalachian State University, Boone, NC, USA
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Jeon HJ, Pak GD, Im J, Owusu-Dabo E, Adu-Sarkodie Y, Gassama Sow A, Bassiahi Soura A, Gasmelseed N, Keddy KH, Bjerregaard-Andersen M, Konings F, Aseffa A, Crump JA, Chon Y, Breiman RF, Park SE, Cruz Espinoza LM, Seo HJ, May J, Meyer CG, Andrews JR, Panzner U, von Kalckreuth V, Wierzba TF, Rakotozandrindrainy R, Dougan G, Levine MM, Hombach J, Kim JH, Clemens JD, Baker S, Marks F. Determining the Best Immunization Strategy for Protecting African Children Against Invasive Salmonella Disease. Clin Infect Dis 2019; 67:1824-1830. [PMID: 29746615 PMCID: PMC6260167 DOI: 10.1093/cid/ciy386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 03/01/2018] [Accepted: 04/27/2018] [Indexed: 12/26/2022] Open
Abstract
Background The World Health Organization recently prequalified a typhoid conjugate vaccine (TCV), recommending its use in persons ≥6 months to 45 years residing in typhoid fever (TF)-endemic areas. We now need to consider how TCVs can have the greatest impact in the most vulnerable populations. Methods The Typhoid Fever Surveillance in Africa Program (TSAP) was a blood culture-based surveillance of febrile patients from defined populations presenting at healthcare facilities in 10 African countries. TF and invasive non-typhoidal Salmonella (iNTS) disease incidences were estimated for 0-10 year-olds in one-year age increments. Results Salmonella Typhi and iNTS were the most frequently isolated pathogens; 135 and 94 cases were identified, respectively. Analysis from three countries was excluded (incomplete person-years of observation (PYO) data). Thirty-seven of 123 TF cases (30.1%) and 71/90 iNTS disease cases (78.9%) occurred in children aged <5 years. No TF and 8/90 iNTS infections (8.9%) were observed in infants aged <9 months. The TF incidences (/100 000 PYO) for children aged <1 year and 1 to <2 years were 5 and 39, respectively; the highest incidence was 304 per 100 000 PYO in 4 to <5 year-olds. The iNTS disease incidence in the defined age groups ranged between 81 and 233 per 100 000 PYO, highest in 1 to <2 year-olds. TF and iNTS disease incidences were higher in West Africa. Conclusions High burden of TF detected in young children strengthens the need for TCV introduction. Given the concurrent iNTS disease burden, development of a trivalent vaccine against S. Typhi, S. Typhimurium, and S. Enteritidis may be timely in this region.
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Affiliation(s)
- Hyon Jin Jeon
- International Vaccine Institute, Seoul, Republic of Korea
| | - Gi Deok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | - Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | - Ellis Owusu-Dabo
- Kumasi Center for Collaborative Research in Tropical Medicine, Kumasi, Ghana.,Departments of Global and International Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yaw Adu-Sarkodie
- Departments of Clinical Microbiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Amy Gassama Sow
- Institute Pasteur de Dakar.,Université Cheikh Anta Diop de Dakar, Senegal
| | | | - Nagla Gasmelseed
- Faculty of Medicine, University of Gezira, Wad Medani, Sudan.,Faculty of Science, University of Hafr Al Batin, Saudi Arabia
| | - Karen H Keddy
- National Institute for Communicable Diseases, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | - Frank Konings
- International Vaccine Institute, Seoul, Republic of Korea
| | - Abraham Aseffa
- Armauer Hansen Research Institute, ALERT Campus, Addis Ababa, Ethiopia
| | - John A Crump
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Division of Infectious Diseases and International Health, Duke University Medical Center.,Duke Global Health Institute, Duke University, Durham, North Carolina.,Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Yun Chon
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Se Eun Park
- International Vaccine Institute, Seoul, Republic of Korea.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Hye Jin Seo
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jürgen May
- Bernhard Nocht Institute for Tropical Medicine, Hamburg
| | - Christian G Meyer
- Institute of Tropical Medicine, Eberhard-Karls University Tübingen, Germany.,Duy Tan University, Da Nang, Vietnam
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University, California
| | - Ursula Panzner
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | - Gordon Dougan
- Department of Medicine, University of Cambridge, United Kingdom
| | - Myron M Levine
- Department of Medicine, University of Maryland School of Medicine, Baltimore
| | | | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - John D Clemens
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka.,Fielding School of Public Health, University of California, Los Angeles.,Korea University School of Medicine, Seoul, Republic of Korea
| | - Stephen Baker
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Department of Medicine, University of Cambridge, United Kingdom
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea.,Department of Medicine, University of Cambridge, United Kingdom
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20
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Gupta S, Wierzba TF, Peacock JE, Baddour LM, Sohail MR, Le KY, Vikram HR, Miró JM, Prutkin JM, Greenspon AJ, Carrillo R, Danik SB, Naber CK, Blank E, Tseng CH, Uslan D. 121. Cardiac Implantable Electronic Device-Related Infective Endocarditis (CIED-IE): Clinical Features and Outcomes of Patients with Definite IE Who Fulfill Both Major Duke Criteria. Open Forum Infect Dis 2019. [PMCID: PMC6810658 DOI: 10.1093/ofid/ofz360.196] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Cardiac implantable electronic device-related infective endocarditis (CIED-IE) comprises 10–57% of total CIED infections. Patients with definite CIED-IE who fulfill both major modified Duke criteria have not been well characterized. Methods Data from the Multicenter Electrophysiologic Device Infection Cohort, a prospective, multinational study of CIED infections were used to describe a subset of patients with CIED-IE who met both major Duke criteria for definite IE (bloodstream infection and intracardiac vegetations [VEG]). Results Of 433 patients with CIED infection, 144 (33.3%) had definite CIED-IE. The median age was 68 years and 77.1% were male. Twelve (8.3%) had past CIED infection. Seventy-seven patients (53.5%) had permanent pacemakers, 38 (26.4%) had implantable cardioverter defibrillators, and 29 (20.1%) had combination devices. The median time following the last device procedure was 550 days. CIED-IE was early in 60 patients (41.7%) and late in 84 (58.3%). Most patients presented with fever (77.8%) and sepsis (44.4%) with a median symptom duration of 7 days. On echocardiography, lead VEG was noted in 125 patients (86.8%) and valvular VEG in 54 patients (37.5%) with the tricuspid valve involved in 56.5%. On the basis of VEG location, there were 90 patients (62.5%) with isolated lead-associated IE (LAE), 19 patients (13.2%) with isolated valve-associated IE (VAE), and 35 patients (24.3%) with both (LVAE). All patients had positive blood cultures and 63/119 (52.9%) had positive lead cultures. The predominant organism in blood was Staphylococcus aureus (42.4%), followed by coagulase-negative staphylococci (20.1%). CIED removal occurred in 131 patients (91%). There were 25 deaths during the index hospitalization and 34 total deaths (24.3%) by 6 months. Mortality correlated with age >75 (P = 0.023) and sepsis on presentation (P = 0.052). Infecting organism, site of VEG, and device removal did not impact the risk of death. Conclusion Definite CIED-IE is relatively common. The majority of patients tend to have late-onset infection and often present with sepsis. S. aureus is the dominant organism causing definite CIED-IE. Isolated LAE occurs in 63% of patients. Older age and sepsis on admission are associated with higher mortality. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Siddhi Gupta
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | | | - James E Peacock
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | | | | | | | | | - José M Miró
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Jordan M Prutkin
- University of Washington School of Medicine, Seattle, Washington
| | | | - Roger Carrillo
- Miller School of Medicine, University of Miami, Miami, Florida
| | | | | | - Elisabeth Blank
- Contilia Heart and Vascular Centre, Essen, Nordrhein-Westfalen, Germany
| | - Chi-Hong Tseng
- David Geffen School of Medicine, UCLA, Los Angeles, California
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21
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Raqib R, Sarker P, Zaman K, Alam NH, Wierzba TF, Maier N, Talukder K, Baqui AH, Suvarnapunya AE, Qadri F, Walker RI, Fix A, Venkatesan MM. A phase I trial of WRSS1, a Shigella sonnei live oral vaccine in Bangladeshi adults and children. Hum Vaccin Immunother 2019; 15:1326-1337. [PMID: 30794051 DOI: 10.1080/21645515.2019.1575165] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Shigella sonnei live vaccine candidate, WRSS1, which was previously evaluated in US, Israeli and Thai volunteers, was administered orally to Bangladeshi adults and children to assess its safety, clinical tolerability and immunogenicity. In a randomized, placebo-controlled, dose-escalation, age-descending study, 39 adults (18-39 years) and 64 children (5-9 years) were enrolled. Each adult cohort (n = 13) received one dose of 3x104, or three doses of 3 × 105 or 3 × 106 colony forming unit (CFU) of WRSS1 (n = 10) or placebo (n = 3). Each child cohort (n = 16) received one dose of 3x103, or three doses of 3x104, 3x105, or 3 × 106 CFU WRSS1 (n = 12) or placebo (n = 4). WRSS1 elicited mostly mild and transient reactogenicity events in adults and children. In the 3 × 106 dose group, 50% of the adults shed the vaccine; no shedding was seen in children. At the highest dose, 100% of adults and 40% of children responded with a ≥ 4-fold increase of S. sonnei LPS-specific IgA antibody in lymphocyte supernatant (ALS). At the same dose, 63% of adults and 70% of children seroconverted with IgA to LPS, while in placebo, 33% of adults and 18% of children seroconverted. Both the vaccinees and placebos responded with fecal IgA to LPS, indicating persistent exposure to Shigella infections. In conclusion, WRSS1 was found safe up to 106 CFU dose and immunogenic in adults and children in Bangladesh. These data indicate that live, oral Shigella vaccine candidates, including WRSS1 can potentially be evaluated in toddlers and infants (<2 years of age), who comprise the target population in an endemic environment.
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Affiliation(s)
- Rubhana Raqib
- a Infectious Diseases Division , icddr,b , Dhaka , Bangladesh
| | - Protim Sarker
- a Infectious Diseases Division , icddr,b , Dhaka , Bangladesh
| | - K Zaman
- a Infectious Diseases Division , icddr,b , Dhaka , Bangladesh
| | - Nur Haque Alam
- b Nutrition and Clinical Services Division , icddr,b , Dhaka , Bangladesh
| | - Thomas F Wierzba
- c Center for Vaccine Innovation and Access , PATH , Washington , DC , USA
| | - Nicole Maier
- c Center for Vaccine Innovation and Access , PATH , Washington , DC , USA
| | - Kaisar Talukder
- d Laboratory Sciences and Services Division , icddr,b , Dhaka , Bangladesh
| | - Abdullah Hel Baqui
- e Johns Hopkins Bloomberg School of Public Health , Johns Hopkins University , Baltimore , MD , USA
| | - Akamol E Suvarnapunya
- f Bacterial Diseases Branch , Walter Reed Army Institute of Research , Silver Spring , MD , USA
| | - Firdausi Qadri
- a Infectious Diseases Division , icddr,b , Dhaka , Bangladesh
| | - Richard I Walker
- c Center for Vaccine Innovation and Access , PATH , Washington , DC , USA
| | - Alan Fix
- c Center for Vaccine Innovation and Access , PATH , Washington , DC , USA
| | - Malabi M Venkatesan
- f Bacterial Diseases Branch , Walter Reed Army Institute of Research , Silver Spring , MD , USA
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22
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Akhtar M, Chowdhury MI, Bhuiyan TR, Kaim J, Ahmed T, Rafique TA, Khan A, Rahman SIA, Khanam F, Begum YA, Sharif MZ, Islam LN, Carlin N, Maier N, Fix A, Wierzba TF, Walker RI, Bourgeois AL, Svennerholm AM, Qadri F, Lundgren A. Evaluation of the safety and immunogenicity of the oral inactivated multivalent enterotoxigenic Escherichia coli vaccine ETVAX in Bangladeshi adults in a double-blind, randomized, placebo-controlled Phase I trial using electrochemiluminescence and ELISA assays for immunogenicity analyses. Vaccine 2018; 37:5645-5656. [PMID: 30473185 PMCID: PMC6717083 DOI: 10.1016/j.vaccine.2018.11.040] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [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: 08/20/2018] [Revised: 10/25/2018] [Accepted: 11/14/2018] [Indexed: 12/22/2022]
Abstract
The safety and immunogenicity of the second generation oral enterotoxigenic Escherichia coli (ETEC) vaccine ETVAX, consisting of inactivated recombinant E. coli strains over-expressing the colonization factors (CFs) CFA/I, CS3, CS5 and CS6 and the heat labile toxoid LCTBA, were evaluated in Bangladeshi volunteers. To enable analysis of antibody responses against multiple vaccine antigens for subsequent use in small sample volumes from children, a sensitive electrochemiluminescence (ECL) assay for analysis of intestine-derived antibody-secreting cell responses using the antibodies in lymphocyte secretions (ALS) assay was established using Meso Scale Discovery technology. Three groups of Bangladeshi adults (n = 15 per group) received two oral doses of ETVAX with or without double mutant LT (dmLT) adjuvant or placebo in the initial part of a randomized, double-blind, placebo-controlled, age-descending, dose-escalation trial. CF- and LTB-specific ALS and plasma IgA responses were analyzed by ECL and/or ELISA. ETVAX was safe and well tolerated in the adults. Magnitudes of IgA ALS responses determined by ECL and ELISA correlated well (r = 0.85 to 0.98 for the five primary antigens, P < 0.001) and ECL was selected as the ALS readout method. ALS IgA responses against each of the primary antigens were detected in 87-100% of vaccinees after the first and in 100% after the second vaccine dose. Plasma IgA responses against different CFs and LTB were observed in 62-93% and 100% of vaccinees, respectively. No statistically significant adjuvant effect of dmLT on antibody responses to any antigen was detected, but the overall antigenic breadth of the plasma IgA response tended to favor the adjuvanted vaccine when responses to 4 or more or 5 vaccine antigens were considered. Responses in placebo recipients were infrequent and mainly detected against single antigens. The promising results in adults supported testing ETVAX in descending age groups of children. ClinicalTrials.gov Identifier: NCT02531802.
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Affiliation(s)
- Marjahan Akhtar
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Mohiul I Chowdhury
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Taufiqur R Bhuiyan
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Joanna Kaim
- GUVAX (Gothenburg University Vaccine Research Institute), Dept. of Microbiology and Immunology, Inst. of Biomedicine, University of Gothenburg, Sweden
| | - Tasnuva Ahmed
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Tanzeem A Rafique
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Arifuzzaman Khan
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Sadia I A Rahman
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Farhana Khanam
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Yasmin A Begum
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Mir Z Sharif
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Laila N Islam
- Dept. of Biochemistry and Molecular Biology, University of Dhaka, Bangladesh
| | | | | | | | | | | | | | - Ann-Mari Svennerholm
- GUVAX (Gothenburg University Vaccine Research Institute), Dept. of Microbiology and Immunology, Inst. of Biomedicine, University of Gothenburg, Sweden
| | - Firdausi Qadri
- icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Anna Lundgren
- GUVAX (Gothenburg University Vaccine Research Institute), Dept. of Microbiology and Immunology, Inst. of Biomedicine, University of Gothenburg, Sweden.
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23
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Abstract
With one-third of nations at risk of cholera, we can expect to experience massive, rapidly disseminated, and prolonged cholera outbreaks such as those recently experienced in Yemen and Haiti. The prevention of cholera outbreaks like these includes the provision of potable water, sanitation, and hygiene (WASH). This approach has been known for generations. However, it will be many years before universal global access to WASH is achieved. While working toward universal WASH, study data has shown that licensed and WHO prequalified cholera vaccines are important tools for cholera prevention. Oral inactivated whole-cell vaccines such as Shanchol and Euvichol-plus provide well-documented direct benefits to vaccine recipients and to the unimmunized through herd protection. Manufacturers have now increased the cholera vaccine supply, and since 2013 vaccine doses have been available for emergency and endemic control through a global stockpile. Advances in packaging and vaccine temperature control, reduced vaccine costs, the inclusion of pregnant women in vaccine campaigns, and a targeted approach to high incidence endemic areas are further increasing the usefulness of these vaccines for reducing the global cholera burden.
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24
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Qadri F, Ali M, Lynch J, Chowdhury F, Khan AI, Wierzba TF, Excler JL, Saha A, Islam MT, Begum YA, Bhuiyan TR, Khanam F, Chowdhury MI, Khan IA, Kabir A, Riaz BK, Akter A, Khan A, Asaduzzaman M, Kim DR, Siddik AU, Saha NC, Cravioto A, Singh AP, Clemens JD. Efficacy of a single-dose regimen of inactivated whole-cell oral cholera vaccine: results from 2 years of follow-up of a randomised trial. Lancet Infect Dis 2018; 18:666-674. [PMID: 29550406 DOI: 10.1016/s1473-3099(18)30108-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/12/2018] [Accepted: 01/15/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND A single-dose regimen of inactivated whole-cell oral cholera vaccine (OCV) is attractive because it reduces logistical challenges for vaccination and could enable more people to be vaccinated. Previously, we reported the efficacy of a single dose of an OCV vaccine during the 6 months following dosing. Herein, we report the results of 2 years of follow-up. METHODS In this placebo-controlled, double-blind trial done in Dhaka, Bangladesh, individuals aged 1 year or older with no history of receipt of OCV were randomly assigned to receive a single dose of inactivated OCV or oral placebo. The primary endpoint was a confirmed episode of non-bloody diarrhoea for which the onset was at least 7 days after dosing and a faecal culture was positive for Vibrio cholerae O1 or O139. Passive surveillance for diarrhoea was done in 13 hospitals or major clinics located in or near the study area for 2 years after the last administered dose. We assessed the protective efficacy of the OCV against culture-confirmed cholera occurring 7-730 days after dosing with both crude and multivariable per-protocol analyses. This trial is registered at ClinicalTrials.gov, number NCT02027207. FINDINGS Between Jan 10, 2014, and Feb 4, 2014, 205 513 people were randomly assigned to receive either vaccine or placebo, of whom 204 700 (102 552 vaccine recipients and 102 148 placebo recipients) were included in the per-protocol analysis. 287 first episodes of cholera (109 among vaccine recipients and 178 among placebo recipients) were detected during the 2-year follow-up; 138 of these episodes (46 in vaccine recipients and 92 in placebo recipients) were associated with severe dehydration. The overall incidence rates of initial cholera episodes were 0·22 (95% CI 0·18 to 0·27) per 100 000 person-days in vaccine recipients versus 0·36 (0·31 to 0·42) per 100 000 person-days in placebo recipients (adjusted protective efficacy 39%, 95% CI 23 to 52). The overall incidence of severe cholera was 0·09 (0·07 to 0·12) per 100 000 person-days versus 0·19 (0·15 to 0·23; adjusted protective efficacy 50%, 29 to 65). Vaccine protective efficacy was 52% (8 to 75) against all cholera episodes and 71% (27 to 88) against severe cholera episodes in participants aged 5 years to younger than 15 years. For participants aged 15 years or older, vaccine protective efficacy was 59% (42 to 71) against all cholera episodes and 59% (35 to 74) against severe cholera. The protection in the older age groups was sustained throughout the 2-year follow-up. In participants younger than 5 years, the vaccine did not show protection against either all cholera episodes (protective efficacy -13%, -68 to 25) or severe cholera episodes (-44%, -220 to 35). INTERPRETATION A single dose of the inactivated whole-cell OCV offered protection to older children and adults that was sustained for at least 2 years. The absence of protection of young children might reflect a lesser degree of pre-existing natural immunity in this age group. FUNDING Bill & Melinda Gates Foundation to the International Vaccine Institute.
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Affiliation(s)
- Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh.
| | - Mohammad Ali
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Julia Lynch
- International Vaccine Institute, Seoul, South Korea
| | - Fahima Chowdhury
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Ashraful Islam Khan
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | | | | | - Amit Saha
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Md Taufiqul Islam
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Yasmin A Begum
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Taufiqur R Bhuiyan
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Farhana Khanam
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Mohiul I Chowdhury
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Iqbal Ansary Khan
- The Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Alamgir Kabir
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Baizid Khoorshid Riaz
- Department of Public Health and Hospital Administration, National Institute of Preventive and Social Medicine, Dhaka, Bangladesh
| | - Afroza Akter
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Arifuzzaman Khan
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Muhammad Asaduzzaman
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | | | - Ashraf U Siddik
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Nirod C Saha
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Alejandro Cravioto
- Department of Public Health, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Ajit P Singh
- MSD Wellcome Trust Hilleman Laboratories, New Delhi, India
| | - John D Clemens
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh; Department of Epidemiology of the Center for Global Infectious Diseases, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Medicine, Korea University School of Medicine, Seoul, South Korea
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25
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Wierzba TF, Muhib F. Exploring the broader consequences of diarrhoeal diseases on child health. Lancet Glob Health 2018; 6:e230-e231. [PMID: 29433653 DOI: 10.1016/s2214-109x(18)30047-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 01/26/2018] [Indexed: 12/12/2022]
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26
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Sinha A, Kanungo S, Kim DR, Manna B, Song M, Park JY, Haldar B, Sharma P, Mallick AH, Kim SA, Babji S, Sur D, Kang G, Ali M, Petri WA, Wierzba TF, Czerkinsky C, Nandy RK, Dey A. Antibody secreting B cells and plasma antibody response to rotavirus vaccination in infants from Kolkata India. Heliyon 2018; 4:e00519. [PMID: 29560435 PMCID: PMC5857522 DOI: 10.1016/j.heliyon.2018.e00519] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/09/2018] [Accepted: 01/16/2018] [Indexed: 01/28/2023] Open
Abstract
Background Assessing immune response after rotavirus vaccination consists in measuring serum or plasma IgA and IgG antibodies, but these assays provide very little information about the mucosal immune response. Thus the development of assays for detection of mucosal immune response following rotavirus vaccination is essential. We evaluate to assess circulating antibody-secreting cells (ASCs) as a potential means to evaluate mucosal immune responses to rotavirus vaccine. Methods 372 subjects, aged 6 weeks, were enrolled in the study. All the subjects were assigned to receive two doses of Rotarix® vaccine. Using a micro-modified whole blood-based ELISPOT assay, circulating rotavirus type-specific IgA- and IgG-ASCs, including gut homing β7+ ASCs, were enumerated on week 6 before the first dose of Rotarix vaccination at 7 weeks of age and week 18 after the second vaccination at 17 weeks of age. Plasma samples collected before vaccination, and after two doses of Rotarix® vaccination were tested for plasma rotavirus IgA titers. Results Two doses of Rotarix® provided to induce sero-protective titer of ≥ 20 Units in 35% of subjects. Total blood IgA- ASC responses were detected in 26.4% of subjects who were non-responder before vaccination. Among responders, 47% of the subjects also have sero-protective plasma IgA titers. Discussion Our results suggest that virus-specific blood gut homing ASCs were detected and provide insight into mucosal immune response after rotavirus vaccination. Further studies are needed to evaluate the duration of such immune responses and to assess the programmatic utility of this whole blood-based mucosal ASC testing for the rotavirus immunization program.
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Affiliation(s)
- Anuradha Sinha
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Suman Kanungo
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Byomkesh Manna
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Manki Song
- International Vaccine Institute, Seoul, South Korea
| | - Ju Yeon Park
- International Vaccine Institute, Seoul, South Korea
| | - Bisakha Haldar
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Prashant Sharma
- Department of Microbiology and Immunology, Seoul National University
| | | | - Soon Ae Kim
- International Vaccine Institute, Seoul, South Korea
| | - Sudhir Babji
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Dipika Sur
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Mohammad Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | | | - Cecil Czerkinsky
- Institut de Pharmacologie Moleculaire & Cellulaire, CNRS-INSERM-University of Nice-Sophia Antipolis, Valbonne, France
| | | | - Ayan Dey
- International Vaccine Institute, Seoul, South Korea
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Walker RI, Wierzba TF, Mani S, Bourgeois AL. Vaccines against Shigella and enterotoxigenic Escherichia coli: A summary of the 2016 VASE Conference. Vaccine 2017; 35:6775-6782. [PMID: 28987444 DOI: 10.1016/j.vaccine.2017.09.045] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 05/09/2017] [Revised: 09/05/2017] [Accepted: 09/13/2017] [Indexed: 11/25/2022]
Abstract
PATH hosted the inaugural Vaccines Against Shigella and Enterotoxigenic Escherichia coli (VASE) Conference in Washington, DC in June 2016, bringing together experts from around the world for a highly collaborative forum to discuss progress in the development of new enteric vaccines. Diarrheal disease and long-term sequelae caused by infections with the bacterial pathogens Shigella and enterotoxigenic E. coli (ETEC) pose a significant public health burden in low-income communities. There are currently no licensed vaccines against these pathogens, and the global health community has recently prioritized their development. The 2016 VASE Conference aimed to accelerate communication and progress among those working in the enteric vaccine field to make Shigella and ETEC vaccines a reality as quickly as possible. Research presented in oral and poster presentations at the VASE Conference covered a range of topics, including: the global burden of disease and public health case for Shigella and ETEC vaccines; current vaccine candidates in development; immunology and host responses to the pathogens; and the rationale for and status of combined Shigella-ETEC vaccine candidates. This article reviews key points and highlighted research presented in each of the plenary conference sessions and poster presentations at the 2016 conference. Planning for the 2018 VASE Conference is underway and will likely provide an important platform for sharing the latest updates on Shigella and ETEC vaccine research efforts and maintaining the momentum for accelerating this work. It is also expected that the VASE Conference will continue to provide a unique opportunity for those in the enteric vaccine field to share ideas, make connections, and create workable plans to make Shigella and ETEC vaccines a reality. (Updates available at: www.vaseconference.org.).
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Affiliation(s)
| | | | | | - A Louis Bourgeois
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Kim JH, Nelson KE, Panzner U, Kasture Y, Labrique AB, Wierzba TF. Erratum to: A systematic review of the epidemiology of hepatitis E virus in Africa. BMC Infect Dis 2017; 17:187. [PMID: 28257623 PMCID: PMC5335775 DOI: 10.1186/s12879-017-2274-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 02/21/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jong-Hoon Kim
- International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Korea.
| | - Kenrad E Nelson
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, Maryland, 21205, USA
| | - Ursula Panzner
- International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Korea
| | - Yogita Kasture
- International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Korea
| | - Alain B Labrique
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, Maryland, 21205, USA
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Nayak U, Kanungo S, Zhang D, Ross Colgate E, Carmolli MP, Dey A, Alam M, Manna B, Nandy RK, Kim DR, Paul DK, Choudhury S, Sahoo S, Harris WS, Wierzba TF, Ahmed T, Kirkpatrick BD, Haque R, Petri WA, Mychaleckyj JC. Influence of maternal and socioeconomic factors on breast milk fatty acid composition in urban, low-income families. Matern Child Nutr 2017; 13. [PMID: 28198164 PMCID: PMC5638057 DOI: 10.1111/mcn.12423] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 11/18/2016] [Accepted: 11/22/2016] [Indexed: 11/28/2022]
Abstract
The lipid composition of breast milk may have a significant impact on early infant growth and cognitive development. Comprehensive breast milk data is lacking from low‐income populations in the Indian subcontinent impeding assessment of deficiencies and limiting development of maternal nutritional interventions. A single breast milk specimen was collected within 6 weeks postpartum from two low‐income maternal cohorts of exclusively breastfed infants, from Dhaka, Bangladesh (n = 683) and Kolkata, India (n = 372) and assayed for percentage composition of 26 fatty acids. Mature milk (>15 days) in Dhaka (n = 99) compared to Kolkata (n = 372) was higher in total saturated fatty acid (SFA; mean 48% vs. 44%) and disproportionately lower in ω3‐polyunsaturated fatty acid (PUFA), hence the ω6‐ and ω3‐PUFA ratio in Dhaka were almost double the value in Kolkata. In both sites, after adjusting for days of lactation, increased maternal education was associated with decreased SFA and PUFA, and increasing birth order or total pregnancies was associated with decreasing ω6‐PUFA or ω3‐PUFA by a factor of 0.95 for each birth and pregnancy. In Dhaka, household prosperity was associated with decreased SFA and PUFA and increased ω6‐ and ω3‐PUFA. Maternal height was associated with increased SFA and PUFA in Kolkata (1% increase per 1 cm), but body mass index showed no independent association with either ratio in either cohort. In summary, the socioeconomic factors of maternal education and household prosperity were associated with breast milk composition, although prosperity may only be important in higher cost of living communities. Associated maternal biological factors were height and infant birth order, but not adiposity. Further study is needed to elucidate the underlying mechanisms of these effects.
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Affiliation(s)
- Uma Nayak
- Center for Public Health Genomics, University of Virginia, Charlottesville, 22908, Virginia, USA
| | - Suman Kanungo
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Dadong Zhang
- Center for Public Health Genomics, University of Virginia, Charlottesville, 22908, Virginia, USA
| | - E Ross Colgate
- Department of Medicine and Vaccine Testing Center, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Marya P Carmolli
- Department of Medicine and Vaccine Testing Center, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Ayan Dey
- International Vaccine Institute, Seoul, South Korea
| | - Masud Alam
- International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Byomkesh Manna
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | | | - Dilip Kumar Paul
- Dr. B.C. Roy Post Graduate Institute of Paediatric Sciences, Kolkata, India
| | - Saugato Choudhury
- Dr. B.C. Roy Post Graduate Institute of Paediatric Sciences, Kolkata, India
| | - Sushama Sahoo
- Dr. B.C. Roy Post Graduate Institute of Paediatric Sciences, Kolkata, India
| | | | | | - Tahmeed Ahmed
- International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Beth D Kirkpatrick
- Department of Medicine and Vaccine Testing Center, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Rashidul Haque
- International Center for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - William A Petri
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, 22908, Virginia, USA.,Department of Pathology, University of Virginia, Charlottesville, Virginia, USA, 22908
| | - Josyf C Mychaleckyj
- Center for Public Health Genomics, University of Virginia, Charlottesville, 22908, Virginia, USA.,Department of Public Health Sciences, University of Virginia, Charlottesville, 22908, Virginia, USA
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Marks F, von Kalckreuth V, Aaby P, Adu-Sarkodie Y, El Tayeb MA, Ali M, Aseffa A, Baker S, Biggs HM, Bjerregaard-Andersen M, Breiman RF, Campbell JI, Cosmas L, Crump JA, Espinoza LMC, Deerin JF, Dekker DM, Fields BS, Gasmelseed N, Hertz JT, Van Minh Hoang N, Im J, Jaeger A, Jeon HJ, Kabore LP, Keddy KH, Konings F, Krumkamp R, Ley B, Løfberg SV, May J, Meyer CG, Mintz ED, Montgomery JM, Niang AA, Nichols C, Olack B, Pak GD, Panzner U, Park JK, Park SE, Rabezanahary H, Rakotozandrindrainy R, Raminosoa TM, Razafindrabe TJL, Sampo E, Schütt-Gerowitt H, Sow AG, Sarpong N, Seo HJ, Sooka A, Soura AB, Tall A, Teferi M, Thriemer K, Warren MR, Yeshitela B, Clemens JD, Wierzba TF. Incidence of invasive salmonella disease in sub-Saharan Africa: a multicentre population-based surveillance study. Lancet Glob Health 2017; 5:e310-e323. [PMID: 28193398 PMCID: PMC5316558 DOI: 10.1016/s2214-109x(17)30022-0] [Citation(s) in RCA: 175] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/17/2016] [Accepted: 11/23/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Available incidence data for invasive salmonella disease in sub-Saharan Africa are scarce. Standardised, multicountry data are required to better understand the nature and burden of disease in Africa. We aimed to measure the adjusted incidence estimates of typhoid fever and invasive non-typhoidal salmonella (iNTS) disease in sub-Saharan Africa, and the antimicrobial susceptibility profiles of the causative agents. METHODS We established a systematic, standardised surveillance of blood culture-based febrile illness in 13 African sentinel sites with previous reports of typhoid fever: Burkina Faso (two sites), Ethiopia, Ghana, Guinea-Bissau, Kenya, Madagascar (two sites), Senegal, South Africa, Sudan, and Tanzania (two sites). We used census data and health-care records to define study catchment areas and populations. Eligible participants were either inpatients or outpatients who resided within the catchment area and presented with tympanic (≥38·0°C) or axillary temperature (≥37·5°C). Inpatients with a reported history of fever for 72 h or longer were excluded. We also implemented a health-care utilisation survey in a sample of households randomly selected from each study area to investigate health-seeking behaviour in cases of self-reported fever lasting less than 3 days. Typhoid fever and iNTS disease incidences were corrected for health-care-seeking behaviour and recruitment. FINDINGS Between March 1, 2010, and Jan 31, 2014, 135 Salmonella enterica serotype Typhi (S Typhi) and 94 iNTS isolates were cultured from the blood of 13 431 febrile patients. Salmonella spp accounted for 33% or more of all bacterial pathogens at nine sites. The adjusted incidence rate (AIR) of S Typhi per 100 000 person-years of observation ranged from 0 (95% CI 0-0) in Sudan to 383 (274-535) at one site in Burkina Faso; the AIR of iNTS ranged from 0 in Sudan, Ethiopia, Madagascar (Isotry site), and South Africa to 237 (178-316) at the second site in Burkina Faso. The AIR of iNTS and typhoid fever in individuals younger than 15 years old was typically higher than in those aged 15 years or older. Multidrug-resistant S Typhi was isolated in Ghana, Kenya, and Tanzania (both sites combined), and multidrug-resistant iNTS was isolated in Burkina Faso (both sites combined), Ghana, Kenya, and Guinea-Bissau. INTERPRETATION Typhoid fever and iNTS disease are major causes of invasive bacterial febrile illness in the sampled locations, most commonly affecting children in both low and high population density settings. The development of iNTS vaccines and the introduction of S Typhi conjugate vaccines should be considered for high-incidence settings, such as those identified in this study. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Florian Marks
- International Vaccine Institute, SNU Research Park, Seoul, South Korea.
| | | | - Peter Aaby
- Bandim Health Project, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | - Yaw Adu-Sarkodie
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Mohammad Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Stephen Baker
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Holly M Biggs
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | - Robert F Breiman
- Centers for Disease Control and Prevention, Nairobi, Kenya; Global Health Institute, Emory University, Atlanta, GA, USA
| | - James I Campbell
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Leonard Cosmas
- Centers for Disease Control and Prevention, Nairobi, Kenya; WHO-Kenya Country Office, Nairobi, Kenya
| | - John A Crump
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA; Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | | | - Denise Myriam Dekker
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany
| | - Barry S Fields
- Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Nagla Gasmelseed
- Faculty of Medicine, University of Gezira, Wad Medani, Sudan; Faculty of Science, University of Hafr Al Batin, Hafr Al Batin, Saudi Arabia
| | - Julian T Hertz
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | | | - Justin Im
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Anna Jaeger
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Hyon Jin Jeon
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | | | - Karen H Keddy
- National Institute for Communicable Diseases, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frank Konings
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Ralf Krumkamp
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany
| | - Benedikt Ley
- International Vaccine Institute, SNU Research Park, Seoul, South Korea; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia
| | - Sandra Valborg Løfberg
- Bandim Health Project, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | - Jürgen May
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany
| | - Christian G Meyer
- Institute of Tropical Medicine, Eberhard-Karls University Tübingen, Tübingen, Germany; Duy Tan University, Da Nang, Vietnam
| | - Eric D Mintz
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Chelsea Nichols
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Beatrice Olack
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Gi Deok Pak
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Ursula Panzner
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Jin Kyung Park
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Se Eun Park
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | | | | | | | | | | | - Heidi Schütt-Gerowitt
- International Vaccine Institute, SNU Research Park, Seoul, South Korea; Institute of Medical Microbiology, University of Cologne, Cologne, Germany
| | - Amy Gassama Sow
- Institute Pasteur de Dakar, Dakar, Senegal; University Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Nimako Sarpong
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; German Center for Infection Research, Hamburg-Borstel-Lübeck, Germany
| | - Hye Jin Seo
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | - Arvinda Sooka
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Abdramane Bassiahi Soura
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Adama Tall
- Institute Pasteur de Dakar, Dakar, Senegal
| | | | - Kamala Thriemer
- International Vaccine Institute, SNU Research Park, Seoul, South Korea; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Australia
| | - Michelle R Warren
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
| | | | - John D Clemens
- International Vaccine Institute, SNU Research Park, Seoul, South Korea; International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh; University of California Fielding School of Public Health, Los Angeles, CA, USA
| | - Thomas F Wierzba
- International Vaccine Institute, SNU Research Park, Seoul, South Korea
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Kanungo S, Kim DR, Haldar B, Snider C, Nalavade U, Kim SA, Park JY, Sinha A, Mallick AH, Manna B, Sur D, Nandy RK, Deshpande JM, Czerkinsky C, Wierzba TF, Petri WA, Ali M, Dey A. Comparison of IPV to tOPV week 39 boost of primary OPV vaccination in Indian infants: an open labelled randomized controlled trial. Heliyon 2017; 3:e00223. [PMID: 28194449 PMCID: PMC5289926 DOI: 10.1016/j.heliyon.2016.e00223] [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: 11/16/2016] [Accepted: 12/20/2016] [Indexed: 11/22/2022] Open
Abstract
Background The final endgame strategy of global polio eradication initiative includes switching from trivalent oral poliovirus vaccines (tOPV) to bivalent oral polio vaccine (bOPV), and introduction of inactivated poliovirus vaccine (IPV). This study compares IPV with tOPV week 39 boost in Indian infants. Methods Starting 28 March 2012, we enrolled 372 Indian infant-mother pairs from Kolkata, India in an open-label, block-randomized, controlled trial comparing a 39 week tOPV to an IPV boost among infants immunized with three doses of tOPV. The primary outcome was mucosal immunity to poliovirus as measured by fecal polio virus shedding after OPV challenge. The secondary outcome was humoral response as defined by >1:8 titers for neutralizing antibodies at week 40. Seroconversion was measured by change in level of antibody titers from week 18 to week 40. The analyses were performed by both intention-to-treat (ITT) and per-protocol (PP) comparing the occurrences of outcomes between the arms of the study. Findings Both the study arms provided equivalent mucosal immunity at 52 weeks with a total shedding prevalence of 28%. Vaccination with IPV resulted in significantly higher seroconversion rates for Polio type 2 (p = 0.03) and Polio type 3 (p < 0.01). Conclusions This study indicates that an IPV boost at week 39 is equivalent to tOPV in intestinal immunity, and provides higher seroconversion compared to tOPV. The major limitation of the study was the additional OPV doses receive by infants during pulse polio immunization resulted in additional mucosal boosting, diminishing the impact of IPV or tOPV boost at week 39. However, IPV for OPV boost should prove to be a step forward in the global polio eradication initiative to reduce the problem of circulating vaccine-derived poliovirus (cVDPV).
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Affiliation(s)
- Suman Kanungo
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Bisakha Haldar
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | | | - Soon Ae Kim
- International Vaccine Institute, Seoul, South Korea
| | - Ju Yeon Park
- International Vaccine Institute, Seoul, South Korea
| | - Anuradha Sinha
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Byomkesh Manna
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Dipika Sur
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | | | - Cecil Czerkinsky
- Institut de Pharmacologie Moleculaire & Cellulaire, CNRS-INSERM-University of Nice-Sophia Antipolis, Valbonne, France
| | | | - William A Petri
- Division of Infectious Diseases and International Health, The University of Virginia, Charlottesville, VA, USA
| | - Mohammad Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ayan Dey
- International Vaccine Institute, Seoul, South Korea
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von Kalckreuth V, Konings F, Aaby P, Adu-Sarkodie Y, Ali M, Aseffa A, Baker S, Breiman RF, Bjerregaard-Andersen M, Clemens JD, Crump JA, Cruz Espinoza LM, Deerin JF, Gasmelseed N, Sow AG, Im J, Keddy KH, Cosmas L, May J, Meyer CG, Mintz ED, Montgomery JM, Olack B, Pak GD, Panzner U, Park SE, Rakotozandrindrainy R, Schütt-Gerowitt H, Soura AB, Warren MR, Wierzba TF, Marks F. The Typhoid Fever Surveillance in Africa Program (TSAP): Clinical, Diagnostic, and Epidemiological Methodologies. Clin Infect Dis 2016; 62 Suppl 1:S9-S16. [PMID: 26933028 DOI: 10.1093/cid/civ693] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [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: 01/09/2023] Open
Abstract
BACKGROUND New immunization programs are dependent on data from surveillance networks and disease burden estimates to prioritize target areas and risk groups. Data regarding invasive Salmonella disease in sub-Saharan Africa are currently limited, thus hindering the implementation of preventive measures. The Typhoid Fever Surveillance in Africa Program (TSAP) was established by the International Vaccine Institute to obtain comparable incidence data on typhoid fever and invasive nontyphoidal Salmonella (iNTS) disease in sub-Saharan Africa through standardized surveillance in multiple countries. METHODS Standardized procedures were developed and deployed across sites for study site selection, patient enrolment, laboratory procedures, quality control and quality assurance, assessment of healthcare utilization and incidence calculations. RESULTS Passive surveillance for bloodstream infections among febrile patients was initiated at thirteen sentinel sites in ten countries (Burkina Faso, Ethiopia, Ghana, Guinea-Bissau, Kenya, Madagascar, Senegal, South Africa, Sudan, and Tanzania). Each TSAP site conducted case detection using these standardized methods to isolate and identify aerobic bacteria from the bloodstream of febrile patients. Healthcare utilization surveys were conducted to adjust population denominators in incidence calculations for differing healthcare utilization patterns and improve comparability of incidence rates across sites. CONCLUSIONS By providing standardized data on the incidence of typhoid fever and iNTS disease in sub-Saharan Africa, TSAP will provide vital input for targeted typhoid fever prevention programs.
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Affiliation(s)
| | - Frank Konings
- International Vaccine Institute, Seoul, Republic of Korea
| | - Peter Aaby
- Bandim Health Project, Bissau, Guinea-Bissau
| | - Yaw Adu-Sarkodie
- Kumasi Centre for Collaborative Research in Tropical Medicine School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Mohammad Ali
- International Vaccine Institute, Seoul, Republic of Korea Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Stephen Baker
- Oxford University Clinical Resarch Unit, Ho Chi Minh City, Vietnam
| | - Robert F Breiman
- Centers for Disease Control and Prevention, Nairobi, Kenya Global Health Institute, Emory University, Atlanta, Georgia
| | | | - John D Clemens
- International Vaccine Institute, Seoul, Republic of Korea International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - John A Crump
- Division of Infectious Diseases and International Health, Duke University Medical Center Duke Global Health Institute, Duke University, Durham, North Carolina Kilimanjaro Christian Medical Centre, Moshi, Tanzania Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | | | | | - Amy Gassama Sow
- Institute Pasteur Senegal Université Cheikh Anta Diop de Dakar, Senegal
| | - Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | - Karen H Keddy
- National Institute for Communicable Diseases School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Leonard Cosmas
- Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Jürgen May
- Department of Infection Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg
| | - Christian G Meyer
- Institute of Tropical Medicine, Eberhard-Karls University Tübingen, Germany
| | - Eric D Mintz
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Gi Deok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | - Ursula Panzner
- International Vaccine Institute, Seoul, Republic of Korea
| | - Se Eun Park
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | | | | | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
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Al-Emran HM, Krumkamp R, Dekker DM, Eibach D, Aaby P, Adu-Sarkodie Y, Ali M, Rubach MP, Bjerregaard-Andersen M, Crump JA, Cruz Espinoza LM, Løfberg SV, Gassama Sow A, Hertz JT, Im J, Jaeger A, Kabore LP, Konings F, Meyer CG, Niang A, Pak GD, Panzner U, Park SE, Rabezanahary H, Rakotozandrindrainy R, Raminosoa TM, Razafindrabe TJL, Sampo E, Schütt-Gerowitt H, Sarpong N, Soura AB, Tall A, von Kalckreuth V, Wierzba TF, May J, Marks F. Validation and Identification of Invasive Salmonella Serotypes in Sub-Saharan Africa by Multiplex Polymerase Chain Reaction. Clin Infect Dis 2016; 62 Suppl 1:S80-2. [PMID: 26933026 DOI: 10.1093/cid/civ782] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Salmonella enterica serovar Typhi and nontyphoidal Salmonella (NTS) cause the majority of bloodstream infections in sub-Saharan Africa; however, serotyping is rarely performed. We validated a multiplex polymerase chain reaction (PCR) assay with the White-Kauffmann-Le Minor (WKLM) scheme of serotyping using 110 Salmonella isolates from blood cultures of febrile children in Ghana and applied the method in other Typhoid Fever Surveillance in Africa Program study sites. In Ghana, 47 (43%) S. Typhi, 36 (33%) Salmonella enterica serovar Typhimurium, 14 (13%) Salmonella enterica serovar Dublin, and 13 (12%) Salmonella enterica serovar Enteritidis were identified by both multiplex PCR and the WKLM scheme separately. Using the validated multiplex PCR assay, we identified 42 (66%) S. Typhi, 14 (22%) S. Typhimurium, 2 (3%) S. Dublin, 2 (3%) S. Enteritidis, and 4 (6%) other Salmonella species from the febrile patients in Burkina Faso, Guinea-Bissau, Madagascar, Senegal, and Tanzania. Application of this multiplex PCR assay in sub-Saharan Africa could advance the knowledge of serotype distribution of Salmonella.
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Affiliation(s)
| | - Ralf Krumkamp
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | - Daniel Eibach
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Peter Aaby
- Bandim Health Project, Bissau, Guinea-Bissau Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | - Yaw Adu-Sarkodie
- Kwame Nkrumah University of Science and Technology Kumasi Centre for Collaborative Research in Tropical Medicine, Ghana
| | - Mohammad Ali
- International Vaccine Institute, Seoul, Republic of Korea Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mathew P Rubach
- Division of Infectious Diseases and International Health, Duke University Medical Center
| | | | - John A Crump
- Division of Infectious Diseases and International Health, Duke University Medical Center Duke Global Health Institute, Duke University, Durham, North Carolina Kilimanjaro Christian Medical Centre, Moshi, Tanzania Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | - Sandra Valborg Løfberg
- Bandim Health Project, Bissau, Guinea-Bissau Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | - Amy Gassama Sow
- Institute Pasteur Senegal Université Cheikh Anta Diop de Dakar, Senegal
| | - Julian T Hertz
- Division of Infectious Diseases and International Health, Duke University Medical Center Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | - Anna Jaeger
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | - Frank Konings
- International Vaccine Institute, Seoul, Republic of Korea
| | - Christian G Meyer
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany Institute of Tropical Medicine, Eberhard-Karls University Tübingen, Germany
| | | | - Gi Deok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | - Ursula Panzner
- International Vaccine Institute, Seoul, Republic of Korea
| | - Se Eun Park
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | | | - Emmanuel Sampo
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Burkina Faso
| | - Heidi Schütt-Gerowitt
- International Vaccine Institute, Seoul, Republic of Korea Institute of Medical Microbiology, University of Cologne, Germany
| | - Nimako Sarpong
- Kumasi Centre for Collaborative Research in Tropical Medicine, Ghana
| | | | | | | | | | - Jürgen May
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
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Im J, Nichols C, Bjerregaard-Andersen M, Sow AG, Løfberg S, Tall A, Pak GD, Aaby P, Baker S, Clemens JD, Espinoza LMC, Konings F, May J, Monteiro M, Niang A, Panzner U, Park SE, Schütt-Gerowitt H, Wierzba TF, Marks F, von Kalckreuth V. Prevalence of Salmonella Excretion in Stool: A Community Survey in 2 Sites, Guinea-Bissau and Senegal. Clin Infect Dis 2016; 62 Suppl 1:S50-5. [PMID: 26933022 DOI: 10.1093/cid/civ789] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic and convalescent carriers play an important role in the transmission and endemicity of many communicable diseases. A high incidence of Salmonella enterica serovar Typhi and invasive nontyphoidal Salmonella (NTS) infection has been reported in parts of sub-Saharan Africa, yet the prevalence of Salmonella excretion in the general population is unknown. METHODS Stool specimens were collected from a random sample of households in 2 populations in West Africa: Bissau, Guinea-Bissau, and Dakar, Senegal. Stool was cultured to detect presence of Salmonella, and antimicrobial susceptibility testing was performed on the isolated organisms. RESULTS Stool was cultured from 1077 and 1359 individuals from Guinea-Bissau and Senegal, respectively. Salmonella Typhi was not isolated from stool samples at either site. Prevalence of NTS in stool samples was 24.1 (95% confidence interval [CI], 16.5-35.1; n = 26/1077) per 1000 population in Guinea-Bissau and 10.3 (95% CI, 6.1-17.2; n = 14/1359) per 1000 population in Senegal. CONCLUSIONS Evidence of NTS excretion in stool in both study populations indicates a possible NTS transmission route in these settings.
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Affiliation(s)
- Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | - Amy Gassama Sow
- Institut Pasteur de Dakar Université Cheikh Anta Diop de Dakar, Senegal
| | - Sandra Løfberg
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | | | - Gi Deok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | - Peter Aaby
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | - Stephen Baker
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University London School of Hygiene and Tropical Medicine, United Kingdom
| | - John D Clemens
- International Vaccine Institute, Seoul, Republic of Korea International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka Fielding School of Public Health, University of California, Los Angeles
| | | | - Frank Konings
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jürgen May
- Bernhard Nocht Institute for Tropical Medicine, and German Center for Infection Research, partner site Hamburg-Borstel-Lübeck, Hamburg
| | - Mario Monteiro
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau
| | | | - Ursula Panzner
- International Vaccine Institute, Seoul, Republic of Korea
| | - Se Eun Park
- International Vaccine Institute, Seoul, Republic of Korea
| | - Heidi Schütt-Gerowitt
- International Vaccine Institute, Seoul, Republic of Korea Institute of Medical Microbiology, University of Cologne, Germany
| | | | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
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Park SE, Pak GD, Aaby P, Adu-Sarkodie Y, Ali M, Aseffa A, Biggs HM, Bjerregaard-Andersen M, Breiman RF, Crump JA, Cruz Espinoza LM, Eltayeb MA, Gasmelseed N, Hertz JT, Im J, Jaeger A, Parfait Kabore L, von Kalckreuth V, Keddy KH, Konings F, Krumkamp R, MacLennan CA, Meyer CG, Montgomery JM, Ahmet Niang A, Nichols C, Olack B, Panzner U, Park JK, Rabezanahary H, Rakotozandrindrainy R, Sampo E, Sarpong N, Schütt-Gerowitt H, Sooka A, Soura AB, Sow AG, Tall A, Teferi M, Yeshitela B, May J, Wierzba TF, Clemens JD, Baker S, Marks F. The Relationship Between Invasive Nontyphoidal Salmonella Disease, Other Bacterial Bloodstream Infections, and Malaria in Sub-Saharan Africa. Clin Infect Dis 2016; 62 Suppl 1:S23-31. [PMID: 26933016 DOI: 10.1093/cid/civ893] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Country-specific studies in Africa have indicated that Plasmodium falciparum is associated with invasive nontyphoidal Salmonella (iNTS) disease. We conducted a multicenter study in 13 sites in Burkina Faso, Ethiopia, Ghana, Guinea-Bissau, Kenya, Madagascar, Senegal, South Africa, Sudan, and Tanzania to investigate the relationship between the occurrence of iNTS disease, other systemic bacterial infections, and malaria. METHODS Febrile patients received a blood culture and a malaria test. Isolated bacteria underwent antimicrobial susceptibility testing, and the association between iNTS disease and malaria was assessed. RESULTS A positive correlation between frequency proportions of malaria and iNTS was observed (P = .01; r = 0.70). Areas with higher burden of malaria exhibited higher odds of iNTS disease compared to other bacterial infections (odds ratio [OR], 4.89; 95% CI, 1.61-14.90; P = .005) than areas with lower malaria burden. Malaria parasite positivity was associated with iNTS disease (OR, 2.44; P = .031) and gram-positive bacteremias, particularly Staphylococcus aureus, exhibited a high proportion of coinfection with Plasmodium malaria. Salmonella Typhimurium and Salmonella Enteritidis were the predominant NTS serovars (53/73; 73%). Both moderate (OR, 6.05; P = .0001) and severe (OR, 14.62; P < .0001) anemia were associated with iNTS disease. CONCLUSIONS A positive correlation between iNTS disease and malaria endemicity, and the association between Plasmodium parasite positivity and iNTS disease across sub-Saharan Africa, indicates the necessity to consider iNTS as a major cause of febrile illness in malaria-holoendemic areas. Prevention of iNTS disease through iNTS vaccines for areas of high malaria endemicity, targeting high-risk groups for Plasmodium parasitic infection, should be considered.
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Affiliation(s)
- Se Eun Park
- International Vaccine Institute, Seoul, Republic of Korea
| | - Gi Deok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | - Peter Aaby
- Bandim Health Project, Bissau, Guinea-Bissau Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | - Yaw Adu-Sarkodie
- Kumasi Centre for Collaborative Research in Tropical Medicine School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Mohammad Ali
- International Vaccine Institute, Seoul, Republic of Korea Johns Hopkins University, Baltimore, Maryland
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Holly M Biggs
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Robert F Breiman
- Centers for Disease Control and Prevention, Nairobi, Kenya Emory Global Health Institute, Emory University, Atlanta, Georgia
| | - John A Crump
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina Kilimanjaro Christian Medical Centre, Moshi, Tanzania Duke Global Health Institute, Duke University, Durham, North Carolina Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | | | | | - Julian T Hertz
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | - Anna Jaeger
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | | | - Karen H Keddy
- National Institute for Communicable Diseases Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frank Konings
- International Vaccine Institute, Seoul, Republic of Korea
| | - Ralf Krumkamp
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Calman A MacLennan
- Jenner Institute, Nuffield Department of Medicine, University of Oxford Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, United Kingdom
| | - Christian G Meyer
- Institute of Tropical Medicine, Eberhard-Karls University Tübingen, Germany
| | | | | | | | | | - Ursula Panzner
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jin Kyung Park
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | - Emmanuel Sampo
- Schiphra Hospital, Ouagadougou, Burkina Faso Institut Supérieur des Sciences de la Population, University of Ouagadougou, Burkina Faso
| | - Nimako Sarpong
- Kumasi Centre for Collaborative Research in Tropical Medicine
| | - Heidi Schütt-Gerowitt
- International Vaccine Institute, Seoul, Republic of Korea Institute of Medical Microbiology, University of Cologne, Germany
| | | | | | - Amy Gassama Sow
- Institute Pasteur Senegal, Dakar Université Cheikh Anta Diop de Dakar, Senegal
| | | | | | | | - Jürgen May
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | - John D Clemens
- International Vaccine Institute, Seoul, Republic of Korea International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka Fielding School of Public Health, University of California, Los Angeles
| | - Stephen Baker
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
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Nichols C, Cruz Espinoza LM, von Kalckreuth V, Aaby P, Ahmed El Tayeb M, Ali M, Aseffa A, Bjerregaard-Andersen M, Breiman RF, Cosmas L, Crump JA, Dekker DM, Gassama Sow A, Gasmelseed N, Hertz JT, Im J, Kabore LP, Keddy KH, Konings F, Valborg Løfberg S, Meyer CG, Montgomery JM, Niang A, Njariharinjakamampionona A, Olack B, Pak GD, Panzner U, Park JK, Park SE, Rabezanahary H, Rakotondrainiarivelo JP, Rakotozandrindrainy R, Raminosoa TM, Rubach MP, Teferi M, Seo HJ, Sooka A, Soura A, Tall A, Toy T, Yeshitela B, Clemens JD, Wierzba TF, Baker S, Marks F. Bloodstream Infections and Frequency of Pretreatment Associated With Age and Hospitalization Status in Sub-Saharan Africa. Clin Infect Dis 2016; 61 Suppl 4:S372-9. [PMID: 26449954 DOI: 10.1093/cid/civ730] [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] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The clinical diagnosis of bacterial bloodstream infections (BSIs) in sub-Saharan Africa is routinely confused with malaria due to overlapping symptoms. The Typhoid Surveillance in Africa Program (TSAP) recruited febrile inpatients and outpatients of all ages using identical study procedures and enrollment criteria, thus providing an opportunity to assess disease etiology and pretreatment patterns among children and adults. METHODS Inpatients and outpatients of all ages with tympanic or axillary temperatures of ≥38.0 or ≥37.5°C, respectively, and inpatients only reporting fever within the previous 72 hours were eligible for recruitment. All recruited patients had one blood sample drawn and cultured for microorganisms. Data from 11 TSAP surveillance sites in nine different countries were used in the analysis. Bivariate analysis was used to compare frequencies of pretreatment and BSIs in febrile children (<15 years old) and adults (≥15 years old) in each country. Pooled Cochran Mantel-Haenszel odds ratios (ORs) were calculated for overall trends. RESULTS There was no significant difference in the odds of a culture-proven BSI between children and adults among inpatients or outpatients. Among both inpatients and outpatients, children had significantly higher odds of having a contaminated blood culture compared with adults. Using country-pooled data, child outpatients had 66% higher odds of having Salmonella Typhi in their bloodstream than adults (OR, 1.66; 95% confidence interval [CI], 1.01-2.73). Overall, inpatient children had 59% higher odds of pretreatment with analgesics in comparison to inpatient adults (OR, 1.59; 95% CI, 1.28-1.97). CONCLUSIONS The proportion of patients with culture-proven BSIs in children compared with adults was similar across the TSAP study population; however, outpatient children were more likely to have Salmonella Typhi infections than outpatient adults. This finding points to the importance of including outpatient facilities in surveillance efforts, particularly for the surveillance of typhoid fever. Strategies to reduce contamination among pediatric blood cultures are needed across the continent to prevent the misdiagnosis of BSI cases in children.
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Affiliation(s)
| | | | | | - Peter Aaby
- Bandim Health Project, Bissau, Guinea-Bissau Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | | | - Mohammad Ali
- International Vaccine Institute, Seoul, Republic of Korea Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | - Robert F Breiman
- Kenya Medical Research Institute-Center for Global Health Research, Nairobi Global Health Institute, Emory University, Atlanta, Georgia
| | - Leonard Cosmas
- Kenya Medical Research Institute-Center for Global Health Research, Nairobi Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention-Kenya, Nairobi
| | - John A Crump
- Division of Infectious Diseases and International Health, Duke University Medical Center Duke Global Health Institute, Duke University, Durham, North Carolina Centre for International Health, University of Otago, Dunedin, New Zealand Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Amy Gassama Sow
- Université Cheikh Anta Diop de Dakar Institut Pasteur de Dakar, Senegal
| | | | - Julian T Hertz
- Division of Infectious Diseases and International Health, Duke University Medical Center Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Karen H Keddy
- National Institute for Communicable Diseases Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Frank Konings
- International Vaccine Institute, Seoul, Republic of Korea
| | - Sandra Valborg Løfberg
- Bandim Health Project, Bissau, Guinea-Bissau Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | - Christian G Meyer
- Institute of Tropical Medicine, Eberhard-Karls University Tübingen, Germany
| | - Joel M Montgomery
- Kenya Medical Research Institute-Center for Global Health Research, Nairobi Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention-Kenya, Nairobi
| | | | | | - Beatrice Olack
- Kenya Medical Research Institute-Center for Global Health Research, Nairobi
| | - Gi Deok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | - Ursula Panzner
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jin Kyung Park
- International Vaccine Institute, Seoul, Republic of Korea
| | - Se Eun Park
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | | | - Matthew P Rubach
- Division of Infectious Diseases and International Health, Duke University Medical Center
| | | | - Hye Jin Seo
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Abdramane Soura
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Burkina Faso
| | | | - Trevor Toy
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - John D Clemens
- International Centre for Diarrheal Disease Research, Bangladesh, Dhaka UCLA Fielding School of Public Health
| | | | - Stephen Baker
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
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Qadri F, Wierzba TF, Ali M, Chowdhury F, Khan AI, Saha A, Khan IA, Asaduzzaman M, Akter A, Khan A, Begum YA, Bhuiyan TR, Khanam F, Chowdhury MI, Islam T, Chowdhury AI, Rahman A, Siddique SA, You YA, Kim DR, Siddik AU, Saha NC, Kabir A, Cravioto A, Desai SN, Singh AP, Clemens JD. Efficacy of a Single-Dose, Inactivated Oral Cholera Vaccine in Bangladesh. N Engl J Med 2016; 374:1723-32. [PMID: 27144848 DOI: 10.1056/nejmoa1510330] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND A single-dose regimen of the current killed oral cholera vaccines that have been prequalified by the World Health Organization would make them more attractive for use against endemic and epidemic cholera. We conducted an efficacy trial of a single dose of the killed oral cholera vaccine Shanchol, which is currently given in a two-dose schedule, in an urban area in which cholera is highly endemic. METHODS Nonpregnant residents of Dhaka, Bangladesh, who were 1 year of age or older were randomly assigned to receive a single dose of oral cholera vaccine or oral placebo. The primary outcome was vaccine protective efficacy against culture-confirmed cholera occurring 7 to 180 days after dosing. Prespecified secondary outcomes included protective efficacy against severely dehydrating culture-confirmed cholera during the same interval, against cholera and severe cholera occurring 7 to 90 versus 91 to 180 days after dosing, and against cholera and severe cholera according to age at baseline. RESULTS A total of 101 episodes of cholera, 37 associated with severe dehydration, were detected among the 204,700 persons who received one dose of vaccine or placebo. The vaccine protective efficacy was 40% (95% confidence interval [CI], 11 to 60%; 0.37 cases per 1000 vaccine recipients vs. 0.62 cases per 1000 placebo recipients) against all cholera episodes, 63% (95% CI, 24 to 82%; 0.10 vs. 0.26 cases per 1000 recipients) against severely dehydrating cholera episodes, and 63% (95% CI, -39 to 90%), 56% (95% CI, 16 to 77%), and 16% (95% CI, -49% to 53%) against all cholera episodes among persons vaccinated at the age of 5 to 14 years, 15 or more years, and 1 to 4 years, respectively, although the differences according to age were not significant (P=0.25). Adverse events occurred at similar frequencies in the two groups. CONCLUSIONS A single dose of the oral cholera vaccine was efficacious in older children (≥5 years of age) and in adults in a setting with a high level of cholera endemicity. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov number, NCT02027207.).
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Affiliation(s)
- Firdausi Qadri
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Thomas F Wierzba
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Mohammad Ali
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Fahima Chowdhury
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Ashraful I Khan
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Amit Saha
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Iqbal A Khan
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Muhammad Asaduzzaman
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Afroza Akter
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Arifuzzaman Khan
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Yasmin A Begum
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Taufiqur R Bhuiyan
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Farhana Khanam
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Mohiul I Chowdhury
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Taufiqul Islam
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Atique I Chowdhury
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Anisur Rahman
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Shah A Siddique
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Young A You
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Deok R Kim
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Ashraf U Siddik
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Nirod C Saha
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Alamgir Kabir
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Alejandro Cravioto
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Sachin N Desai
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - Ajit P Singh
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
| | - John D Clemens
- From the icddr,b, formerly known as the International Centre for Diarrhoeal Disease Research, Bangladesh (F.Q., F.C., A.I.K., A.S., M. Asaduzzaman, A.A., A. Khan, Y.A.B., T.R.B., F.K., M.I.C., T.I., A.I.C., A.R., S.A.S., A.U.S., N.C.S., A. Kabir, J.D.C.), and the Institute of Epidemiology, Disease Control and Research (I.A.K.) - both in Dhaka, Bangladesh; the International Vaccine Institute, Seoul, South Korea (T.F.W., M. Ali, Y.A.Y., D.R.K., A.C., S.N.D., A.P.S.); Johns Hopkins School of Public Health, Baltimore (M. Ali); and UCLA Fielding School of Public Health, Los Angeles (J.D.C.)
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Kim JH, Mogasale V, Burgess C, Wierzba TF. Impact of oral cholera vaccines in cholera-endemic countries: A mathematical modeling study. Vaccine 2016; 34:2113-20. [DOI: 10.1016/j.vaccine.2016.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/11/2016] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
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Al-Emran HM, Eibach D, Krumkamp R, Ali M, Baker S, Biggs HM, Bjerregaard-Andersen M, Breiman RF, Clemens JD, Crump JA, Cruz Espinoza LM, Deerin J, Dekker DM, Gassama Sow A, Hertz JT, Im J, Ibrango S, von Kalckreuth V, Kabore LP, Konings F, Løfberg SV, Meyer CG, Mintz ED, Montgomery JM, Olack B, Pak GD, Panzner U, Park SE, Razafindrabe JLT, Rabezanahary H, Rakotondrainiarivelo JP, Rakotozandrindrainy R, Raminosoa TM, Schütt-Gerowitt H, Sampo E, Soura AB, Tall A, Warren M, Wierzba TF, May J, Marks F. A Multicountry Molecular Analysis of Salmonella enterica Serovar Typhi With Reduced Susceptibility to Ciprofloxacin in Sub-Saharan Africa. Clin Infect Dis 2016; 62 Suppl 1:S42-6. [PMID: 26933020 PMCID: PMC4772832 DOI: 10.1093/cid/civ788] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Salmonella enterica serovar Typhi is a predominant cause of bloodstream infections in sub-Saharan Africa (SSA). Increasing numbers of S. Typhi with resistance to ciprofloxacin have been reported from different parts of the world. However, data from SSA are limited. In this study, we aimed to measure the ciprofloxacin susceptibility of S. Typhi isolated from patients with febrile illness in SSA. METHODS Febrile patients from 9 sites within 6 countries in SSA with a body temperature of ≥38.0°C were enrolled in this study. Blood samples were obtained for bacterial culture, and Salmonella isolates were identified biochemically and confirmed by multiplex polymerase chain reaction (PCR). Antimicrobial susceptibility of all Salmonella isolates was performed by disk diffusion test, and minimum inhibitory concentrations (MICs) against ciprofloxacin were measured by Etest. All Salmonella isolates with reduced susceptibility to ciprofloxacin (MIC > 0.06 µg/mL) were screened for mutations in quinolone resistance-determining regions in target genes, and the presence of plasmid-mediated quinolone resistance (PMQR) genes was assessed by PCR. RESULTS A total of 8161 blood cultures were performed, and 100 (1.2%) S. Typhi, 2 (<0.1%) Salmonella enterica serovar Paratyphi A, and 27 (0.3%) nontyphoid Salmonella (NTS) were isolated. Multidrug-resistant S. Typhi were isolated in Kenya (79% [n = 38]) and Tanzania (89% [n = 8]) only. Reduced ciprofloxacin-susceptible (22% [n = 11]) S. Typhi were isolated only in Kenya. Among those 11 isolates, all had a Glu133Gly mutation in the gyrA gene combined with either a gyrA (Ser83Phe) or gyrB mutation (Ser464Phe). One Salmonella Paratyphi A isolate with reduced susceptibility to ciprofloxacin was found in Senegal, with 1 mutation in gyrA (Ser83Phe) and a second mutation in parC (Ser57Phe). Mutations in the parE gene and PMQR genes were not detected in any isolate. CONCLUSIONS Salmonella Typhi with reduced susceptibility to ciprofloxacin was not distributed homogenously throughout SSA. Its prevalence was very high in Kenya, and was not observed in other study countries. Continuous monitoring of antimicrobial susceptibility is required to follow the potential spread of antimicrobial-resistant isolates throughout SSA.
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Affiliation(s)
- Hassan M Al-Emran
- Bernhard Nocht Institute for Tropical Medicine German Center for Infection Research, partner site Hamburg-Borstel-Lübeck, Hamburg, Germany
| | - Daniel Eibach
- Bernhard Nocht Institute for Tropical Medicine German Center for Infection Research, partner site Hamburg-Borstel-Lübeck, Hamburg, Germany
| | - Ralf Krumkamp
- Bernhard Nocht Institute for Tropical Medicine German Center for Infection Research, partner site Hamburg-Borstel-Lübeck, Hamburg, Germany
| | - Mohammad Ali
- International Vaccine Institute, Seoul, Republic of Korea Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Stephen Baker
- Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Holly M Biggs
- Division of Infectious Diseases and International Health, Duke University Medical Center Duke Global Health Institute, Duke University, Durham, North Carolina
| | | | - Robert F Breiman
- Kenya Medical Research Institute-Centers for Disease Control and Prevention Kenya Collaboration, Nairobi Global Health Institute, Emory University, Atlanta, Georgia
| | - John D Clemens
- International Vaccine Institute, Seoul, Republic of Korea International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | - John A Crump
- Division of Infectious Diseases and International Health, Duke University Medical Center Duke Global Health Institute, Duke University, Durham, North Carolina Kilimanjaro Christian Medical Centre, Moshi, Tanzania Centre for International Health, University of Otago, Dunedin, New Zealand
| | | | - Jessica Deerin
- International Vaccine Institute, Seoul, Republic of Korea
| | - Denise Myriam Dekker
- Bernhard Nocht Institute for Tropical Medicine German Center for Infection Research, partner site Hamburg-Borstel-Lübeck, Hamburg, Germany
| | - Amy Gassama Sow
- Institut Pasteur de Dakar, Université Cheikh Anta Diop de Dakar, Senegal
| | - Julian T Hertz
- Division of Infectious Diseases and International Health, Duke University Medical Center Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | - Frank Konings
- International Vaccine Institute, Seoul, Republic of Korea
| | - Sandra Valborg Løfberg
- Bandim Health Project, Bissau, Guinea-Bissau Research Center for Vitamins and Vaccines, Copenhagen, Denmark
| | - Christian G Meyer
- Bernhard Nocht Institute for Tropical Medicine Institute of Tropical Medicine, Eberhard-Karls University Tübingen, Germany
| | - Eric D Mintz
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joel M Montgomery
- Kenya Medical Research Institute-Centers for Disease Control and Prevention Kenya Collaboration, Nairobi
| | - Beatrice Olack
- Kenya Medical Research Institute-Centers for Disease Control and Prevention Kenya Collaboration, Nairobi
| | - Gi Deok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | - Ursula Panzner
- International Vaccine Institute, Seoul, Republic of Korea
| | - Se Eun Park
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | | | | | - Heidi Schütt-Gerowitt
- International Vaccine Institute, Seoul, Republic of Korea Institute of Medical Microbiology, University of Cologne, Germany
| | - Emmanuel Sampo
- Institute of Medical Microbiology, University of Cologne, Germany
| | | | - Adama Tall
- Institut Pasteur de Dakar, Université Cheikh Anta Diop de Dakar, Senegal
| | | | | | - Jürgen May
- Bernhard Nocht Institute for Tropical Medicine German Center for Infection Research, partner site Hamburg-Borstel-Lübeck, Hamburg, Germany
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
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Panzner U, Pak GD, Aaby P, Adu-Sarkodie Y, Ali M, Aseffa A, Baker S, Bjerregaard-Andersen M, Crump JA, Deerin J, Cruz Espinoza LM, Gasmelseed N, Heriniaina JN, Hertz JT, Im J, von Kalckreuth V, Keddy KH, Lankoande B, Løfberg S, Meyer CG, Oresto MM, Park JK, Park SE, Rakotozandrindrainy R, Sarpong N, Soura AB, Gassama Sow A, Tall A, Teferi M, Worku A, Yeshitela B, Wierzba TF, Marks F. Utilization of Healthcare in the Typhoid Fever Surveillance in Africa Program. Clin Infect Dis 2016; 62 Suppl 1:S56-68. [PMID: 26933023 PMCID: PMC4772834 DOI: 10.1093/cid/civ891] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Assessing healthcare utilization is important to identify weaknesses of healthcare systems, to outline action points for preventive measures and interventions, and to more accurately estimate the disease burden in a population. METHODS A healthcare utilization survey was developed for the Typhoid Fever Surveillance in Africa Program (TSAP) to adjust incidences of salmonellosis determined through passive, healthcare facility-based surveillance. This cross-sectional survey was conducted at 11 sites in 9 sub-Saharan African countries. Demographic data and healthcare-seeking behavior were assessed at selected households. Overall and age-stratified percentages of each study population that sought healthcare at a TSAP healthcare facility and elsewhere were determined. RESULTS Overall, 88% (1007/1145) and 81% (1811/2238) of the population in Polesgo and Nioko 2, Burkina Faso, respectively, and 63% (1636/2590) in Butajira, Ethiopia, sought healthcare for fever at any TSAP healthcare facility. A far smaller proportion-namely, 20%-45% of the population in Bissau, Guinea-Bissau (1743/3885), Pikine, Senegal (1473/4659), Wad-Medani, Sudan (861/3169), and Pietermaritzburg, South Africa (667/2819); 18% (483/2622) and 9% (197/2293) in Imerintsiatosika and Isotry, Madagascar, respectively; and 4% (127/3089) in Moshi, Tanzania-sought healthcare at a TSAP healthcare facility. Patients with fever preferred to visit pharmacies in Imerintsiatosika and Isotry, and favored self-management of fever in Moshi. Age-dependent differences in healthcare utilization were also observed within and across sites. CONCLUSIONS Healthcare utilization for fever varied greatly across sites, and revealed that not all studied populations were under optimal surveillance. This demonstrates the importance of assessing healthcare utilization. Survey data were pivotal for the adjustment of the program's estimates of salmonellosis and other conditions associated with fever.
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Affiliation(s)
- Ursula Panzner
- International Vaccine Institute, Seoul, Republic of Korea
| | - Gi Deok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | - Peter Aaby
- Bandim Health Project, Bissau, Guinea-Bissau
| | - Yaw Adu-Sarkodie
- Kumasi Centre for Collaborative Research in Tropical Medicine School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Mohammad Ali
- International Vaccine Institute, Seoul, Republic of Korea Johns Hopkins University, Baltimore, Maryland
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Stephen Baker
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Morten Bjerregaard-Andersen
- Bandim Health Project, Bissau, Guinea-Bissau Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
| | - John A Crump
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania Centre for International Health, University of Otago, Dunedin, New Zealand Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina
| | - Jessica Deerin
- International Vaccine Institute, Seoul, Republic of Korea
| | | | | | | | - Julian T Hertz
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina
| | - Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Karen H Keddy
- National Institute for Communicable Diseases Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Christian G Meyer
- Institute of Tropical Medicine, Eberhard-Karls University, Tübingen, Germany
| | | | - Jin Kyung Park
- International Vaccine Institute, Seoul, Republic of Korea
| | - Se Eun Park
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Nimako Sarpong
- Kumasi Centre for Collaborative Research in Tropical Medicine
| | | | - Amy Gassama Sow
- Institute Pasteur de Dakar Université Cheikh Anta Diop de Dakar, Senegal
| | | | | | | | | | | | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
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Eibach D, Al-Emran HM, Dekker DM, Krumkamp R, Adu-Sarkodie Y, Cruz Espinoza LM, Ehmen C, Boahen K, Heisig P, Im J, Jaeger A, von Kalckreuth V, Pak GD, Panzner U, Park SE, Reinhardt A, Sarpong N, Schütt-Gerowitt H, Wierzba TF, Marks F, May J. The Emergence of Reduced Ciprofloxacin Susceptibility inSalmonella entericaCausing Bloodstream Infections in Rural Ghana. Clin Infect Dis 2016; 62 Suppl 1:S32-6. [DOI: 10.1093/cid/civ757] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cruz Espinoza LM, Nichols C, Adu-Sarkodie Y, Al-Emran HM, Baker S, Clemens JD, Dekker DM, Eibach D, Krumkamp R, Boahen K, Im J, Jaeger A, von Kalckreuth V, Pak GD, Panzner U, Park SE, Park JK, Sarpong N, Schütt-Gerowitt H, Toy T, Wierzba TF, Marks F, May J. Variations of InvasiveSalmonellaInfections by Population Size in Asante Akim North Municipal, Ghana. Clin Infect Dis 2016; 62 Suppl 1:S17-22. [DOI: 10.1093/cid/civ787] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mogasale V, Mogasale VV, Ramani E, Lee JS, Park JY, Lee KS, Wierzba TF. Revisiting typhoid fever surveillance in low and middle income countries: lessons from systematic literature review of population-based longitudinal studies. BMC Infect Dis 2016; 16:35. [PMID: 26822522 PMCID: PMC4731936 DOI: 10.1186/s12879-016-1351-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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: 06/24/2015] [Accepted: 01/15/2016] [Indexed: 11/10/2022] Open
Abstract
Background The control of typhoid fever being an important public health concern in low and middle income countries, improving typhoid surveillance will help in planning and implementing typhoid control activities such as deployment of new generation Vi conjugate typhoid vaccines. Methods We conducted a systematic literature review of longitudinal population-based blood culture-confirmed typhoid fever studies from low and middle income countries published from 1st January 1990 to 31st December 2013. We quantitatively summarized typhoid fever incidence rates and qualitatively reviewed study methodology that could have influenced rate estimates. We used meta-analysis approach based on random effects model in summarizing the hospitalization rates. Results Twenty-two papers presented longitudinal population-based and blood culture-confirmed typhoid fever incidence estimates from 20 distinct sites in low and middle income countries. The reported incidence and hospitalizations rates were heterogeneous as well as the study methodology across the sites. We elucidated how the incidence rates were underestimated in published studies. We summarized six categories of under-estimation biases observed in these studies and presented potential solutions. Conclusions Published longitudinal typhoid fever studies in low and middle income countries are geographically clustered and the methodology employed has a potential for underestimation. Future studies should account for these limitations. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1351-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vittal Mogasale
- Policy and Economic Research Department, International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, South Korea.
| | | | - Enusa Ramani
- Policy and Economic Research Department, International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, South Korea.
| | - Jung Seok Lee
- Policy and Economic Research Department, International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, South Korea.
| | - Ju Yeon Park
- Biostatistics and Data Management Department, International Vaccine Institute, Seoul, South Korea.
| | - Kang Sung Lee
- Biostatistics and Data Management Department, International Vaccine Institute, Seoul, South Korea.
| | - Thomas F Wierzba
- Development and Delivery Unit, International Vaccine Institute, Seoul, South Korea. .,PATH, 455 Massachusetts Avenue NW, Suite 1000, Washington, DC, USA.
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Park JY, Kim DR, Haldar B, Mallick AH, Kim SA, Dey A, Nandy RK, Paul DK, Choudhury S, Sahoo S, Wierzba TF, Sur D, Kanungo S, Ali M, Manna B. Use of the data system for field management of a clinical study conducted in Kolkata, India. BMC Res Notes 2016; 9:20. [PMID: 26749186 PMCID: PMC4706999 DOI: 10.1186/s13104-015-1767-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 05/22/2015] [Accepted: 11/30/2015] [Indexed: 11/26/2022] Open
Abstract
Background
Designing an appropriate data system is important to the success of a clinical study. However, little information is available on this topic. We share our experiences on designing, developing, and implementation of a data system for management of data and field activities of a complex clinical study. Methods The data system was implemented aiming at determining the biological basis for the underperformance of oral vaccines, such as polio and rotavirus vaccines in children at a site in Kolkata, India. The system included several functionalities to control data and field activities. It was restricted to authorized users based on their access privileges. A relational database platform was chosen, and Microsoft Visual FoxPro 7.0 (Microsoft Corporation, Seattle, WA, USA) was used to develop the system. The system was installed at the clinic and data office to facilitate both the field and data management activities. Results Data were doubly entered by two different data operators to identify keypunching errors in the data. Outliers, duplication, inconsistencies, missing entries, and linkage were also checked. Every modification and users log-in/log-out information was auto-recorded in an audit trail. The system offered tools for preparation of visit schedule of the participants. A visit considered as protocol deviation was documented by the system. The system alerted field staff to every upcoming visit date to organize the field activities and to inform participants which day to come. The system also produced a growth chart for evaluating nutritional status and referring the child to a specialized clinic if found to be severely malnourished. Conclusion The data system offered unique features for controlling for both data and field activities, which led to minimize drop-out rates as well as protocol deviations. Such system is warranted for a successful clinical study.
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Affiliation(s)
- Ju Yeon Park
- International Vaccine Institute, Seoul, South Korea.
| | - Deok Ryun Kim
- International Vaccine Institute, Seoul, South Korea.
| | - Bisakha Haldar
- National Institute of Cholera and Enteric Diseases, Kolkata, India.
| | | | - Soon Ae Kim
- International Vaccine Institute, Seoul, South Korea.
| | - Ayan Dey
- International Vaccine Institute, Seoul, South Korea.
| | | | - Dilip Kumar Paul
- B.C. Roy Post Graduate Institute of Pediatric Sciences, Kolkata, India.
| | - Saugata Choudhury
- B.C. Roy Post Graduate Institute of Pediatric Sciences, Kolkata, India.
| | - Shushama Sahoo
- B.C. Roy Post Graduate Institute of Pediatric Sciences, Kolkata, India.
| | - Thomas F Wierzba
- International Vaccine Institute, Seoul, South Korea. .,PATH, Washington, DC, USA.
| | - Dipika Sur
- National Institute of Cholera and Enteric Diseases, Kolkata, India.
| | - Suman Kanungo
- National Institute of Cholera and Enteric Diseases, Kolkata, India.
| | - Mohammad Ali
- International Vaccine Institute, Seoul, South Korea. .,Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Byomkesh Manna
- National Institute of Cholera and Enteric Diseases, Kolkata, India.
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Dey A, Molodecky NA, Verma H, Sharma P, Yang JS, Saletti G, Ahmad M, Bahl SK, Wierzba TF, Nandy RK, Deshpande JM, Sutter RW, Czerkinsky C. Human Circulating Antibody-Producing B Cell as a Predictive Measure of Mucosal Immunity to Poliovirus. PLoS One 2016; 11:e0146010. [PMID: 26730586 PMCID: PMC4701219 DOI: 10.1371/journal.pone.0146010] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 12/12/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The "gold standard" for assessing mucosal immunity after vaccination with poliovirus vaccines consists in measuring virus excretion in stool after challenge with oral poliovirus vaccine (OPV). This testing is time and resource intensive, and development of alternative methods is a priority for accelerating polio eradication. We therefore evaluated circulating antibody-secreting cells (ASCs) as a potential means to evaluate mucosal immunity to poliovirus vaccine. METHODS 199 subjects, aged 10 years, and previously immunized repeatedly with OPV, were selected. Subjects were assigned to receive either a booster dose of inactivated poliovirus vaccine (IPV), bivalent OPV (bOPV), or no vaccine. Using a micro-modified whole blood-based ELISPOT assay designed for field setting, circulating poliovirus type-specific IgA- and IgG-ASCs, including gut homing α4β7+ ASCs, were enumerated on days 0 and 7 after booster immunization. In addition, serum samples collected on days 0, 28 and 56 were tested for neutralizing antibody titers against poliovirus types 1, 2, and 3. Stool specimens were collected on day 28 (day of bOPV challenge), and on days 31, 35 and 42 and processed for poliovirus isolation. RESULTS An IPV dose elicited blood IgA- and IgG-ASC responses in 84.8 to 94.9% of subjects, respectively. In comparison, a bOPV dose evoked corresponding blood ASC responses in 20.0 to 48.6% of subjects. A significant association was found between IgA- and IgG-ASC responses and serum neutralizing antibody titers for poliovirus type 1, 2, 3 (p<0.001). In the IPV group, α4β7+ ASCs accounted for a substantial proportion of IgA-ASCs and the proportion of subjects with a positive α4β7+ IgA-ASC response to poliovirus types 1, 2 and 3 was 62.7%, 89.8% and 45.8%, respectively. A significant association was observed between virus excretion and α4β7+ IgA- and/or IgG-ASC responses to poliovirus type 3 among immunized children; however, only a weak association was found for type 1 poliovirus. DISCUSSION Our results suggest that virus-specific blood ASCs, especially for type 3 poliovirus, can serve as surrogate of mucosal immunity after vaccination. Further studies are needed to evaluate the duration of such memory responses and to assess the programmatic utility of this whole blood-based mucosal ASC testing for the polio eradication program.
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MESH Headings
- Antibodies, Neutralizing/blood
- Antibodies, Neutralizing/immunology
- Antibodies, Viral/blood
- Antibodies, Viral/immunology
- Antibody-Producing Cells/immunology
- Antibody-Producing Cells/metabolism
- B-Lymphocytes/immunology
- B-Lymphocytes/metabolism
- Child
- Child, Preschool
- Feces/virology
- Humans
- Immunity, Mucosal/immunology
- Immunization, Secondary
- Immunoglobulin A/blood
- Immunoglobulin A/immunology
- Immunoglobulin G/blood
- Immunoglobulin G/immunology
- Infant
- Outcome Assessment, Health Care/methods
- Poliomyelitis/immunology
- Poliomyelitis/prevention & control
- Poliomyelitis/virology
- Poliovirus/classification
- Poliovirus/immunology
- Poliovirus Vaccine, Inactivated/administration & dosage
- Poliovirus Vaccine, Inactivated/immunology
- Poliovirus Vaccine, Oral/administration & dosage
- Poliovirus Vaccine, Oral/immunology
- Prognosis
- Reproducibility of Results
- Vaccination
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Affiliation(s)
- Ayan Dey
- International Vaccine Institute, Seoul, South Korea
| | | | | | - Prashant Sharma
- International Vaccine Institute, Seoul, South Korea
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | - Mohammad Ahmad
- World Health Organization- National Polio Surveillance Project, New Dehli, India
| | - Sunil K. Bahl
- World Health Organization- National Polio Surveillance Project, New Dehli, India
| | - Thomas F. Wierzba
- International Vaccine Institute, Seoul, South Korea
- Vaccine Development Global Program, PATH, Washington, DC, United States of America
| | - Ranjan K. Nandy
- National institute of Cholera and Enteric Diseases, Kolkata, India
| | | | | | - Cecil Czerkinsky
- International Vaccine Institute, Seoul, South Korea
- Institut de Pharmacologie Moleculaire et Cellulaire, CNRS-INSERM-University of Nice-Sophia Antipolis, Valbonne, France
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Ali M, You YA, Sur D, Kanungo S, Kim DR, Deen J, Lopez AL, Wierzba TF, Bhattacharya SK, Clemens JD. Validity of the estimates of oral cholera vaccine effectiveness derived from the test-negative design. Vaccine 2015; 34:479-485. [PMID: 26707378 DOI: 10.1016/j.vaccine.2015.12.004] [Citation(s) in RCA: 14] [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: 10/06/2015] [Revised: 11/28/2015] [Accepted: 12/01/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The test-negative design (TND) has emerged as a simple method for evaluating vaccine effectiveness (VE). Its utility for evaluating oral cholera vaccine (OCV) effectiveness is unknown. We examined this method's validity in assessing OCV effectiveness by comparing the results of TND analyses with those of conventional cohort analyses. METHODS Randomized controlled trials of OCV were conducted in Matlab (Bangladesh) and Kolkata (India), and an observational cohort design was used in Zanzibar (Tanzania). For all three studies, VE using the TND was estimated from the odds ratio (OR) relating vaccination status to fecal test status (Vibrio cholerae O1 positive or negative) among diarrheal patients enrolled during surveillance (VE= (1-OR)×100%). In cohort analyses of these studies, we employed the Cox proportional hazard model for estimating VE (=1-hazard ratio)×100%). RESULTS OCV effectiveness estimates obtained using the TND (Matlab: 51%, 95% CI:37-62%; Kolkata: 67%, 95% CI:57-75%) were similar to the cohort analyses of these RCTs (Matlab: 52%, 95% CI:43-60% and Kolkata: 66%, 95% CI:55-74%). The TND VE estimate for the Zanzibar data was 94% (95% CI:84-98%) compared with 82% (95% CI:58-93%) in the cohort analysis. After adjusting for residual confounding in the cohort analysis of the Zanzibar study, using a bias indicator condition, we observed almost no difference in the two estimates. CONCLUSION Our findings suggest that the TND is a valid approach for evaluating OCV effectiveness in routine vaccination programs.
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Affiliation(s)
- Mohammad Ali
- International Vaccine Institute, Seoul, Republic of Korea; Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Young Ae You
- International Vaccine Institute, Seoul, Republic of Korea
| | - Dipika Sur
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Suman Kanungo
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Deok Ryun Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Jacqueline Deen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Anna Lena Lopez
- University of the Philippines Manila-National Institutes of Health, Manila, Philippines
| | | | | | - John D Clemens
- icddr,b, Dhaka, Bangladesh; UCLA Fielding School of Public Health, Los Angeles, USA
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Mogasale V, Maskery B, Ochiai RL, Lee JS, Mogasale VV, Ramani E, Kim YE, Park JK, Wierzba TF. Burden of typhoid fever in low-income and middle-income countries: a systematic, literature-based update with risk-factor adjustment. Lancet Glob Health 2015; 2:e570-80. [PMID: 25304633 DOI: 10.1016/s2214-109x(14)70301-8] [Citation(s) in RCA: 336] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND No access to safe water is an important risk factor for typhoid fever, yet risk-level heterogeneity is unaccounted for in previous global burden estimates. Since WHO has recommended risk-based use of typhoid polysaccharide vaccine, we revisited the burden of typhoid fever in low-income and middle-income countries (LMICs) after adjusting for water-related risk. METHODS We estimated the typhoid disease burden from studies done in LMICs based on blood-culture-confirmed incidence rates applied to the 2010 population, after correcting for operational issues related to surveillance, limitations of diagnostic tests, and water-related risk. We derived incidence estimates, correction factors, and mortality estimates from systematic literature reviews. We did scenario analyses for risk factors, diagnostic sensitivity, and case fatality rates, accounting for the uncertainty in these estimates and we compared them with previous disease burden estimates. FINDINGS The estimated number of typhoid fever cases in LMICs in 2010 after adjusting for water-related risk was 11·9 million (95% CI 9·9-14·7) cases with 129 000 (75 000-208 000) deaths. By comparison, the estimated risk-unadjusted burden was 20·6 million (17·5-24·2) cases and 223 000 (131 000-344 000) deaths. Scenario analyses indicated that the risk-factor adjustment and updated diagnostic test correction factor derived from systematic literature reviews were the drivers of differences between the current estimate and past estimates. INTERPRETATION The risk-adjusted typhoid fever burden estimate was more conservative than previous estimates. However, by distinguishing the risk differences, it will allow assessment of the effect at the population level and will facilitate cost-effectiveness calculations for risk-based vaccination strategies for future typhoid conjugate vaccine.
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Affiliation(s)
| | | | | | | | | | - Enusa Ramani
- International Vaccine Institute, Seoul, South Korea
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48
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Kar SK, Pach A, Sah B, Kerketta AS, Patnaik B, Mogasale V, Kim YH, Rath SB, Shin S, Khuntia HK, Bhattachan A, Puri MK, Wierzba TF, Kaljee LM. Uptake during an oral cholera vaccine pilot demonstration program, Odisha, India. Hum Vaccin Immunother 2015; 10:2834-42. [PMID: 25483631 DOI: 10.4161/21645515.2014.971655] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Approximately 30% of reported global cholera cases occur in India. In 2011, a household survey was conducted 4 months after an oral cholera vaccine pilot demonstration project in Odisha India to assess factors associated with vaccine up-take and exposure to a communication and social mobilization campaign. Nine villages were purposefully selected based on socio-demographics and demonstration participation rates. Households were stratified by level of participation and randomly selected. Bivariate and ordered logistic regression analyses were conducted. 517/600 (86%) selected households were surveyed. At the household level, participant compared to non-participant households were more likely to use the local primary health centers for general healthcare (P < 0.001). Similarly, at the village level, higher participation was associated with use of the primary health centers (P < 0.001) and private clinics (p = 0.032). Also at the village level, lower participation was associated with greater perceived availability of effective treatment for cholera (p = 0.013) and higher participation was associated with respondents reporting spouse as the sole decision-maker for household participation in the study. In terms of pre-vaccination communication, at the household level verbal communication was reported to be more useful than written communication. However written communication was perceived to be more useful by respondents in low-participating villages compared to average-participating villages (p = 0.007) These data on participation in an oral cholera vaccine demonstration program are important in light of the World Health Organization's (WHO) recommendations for pre-emptive use of cholera vaccine among vulnerable populations in endemic settings. Continued research is needed to further delineate barriers to vaccine up-take within and across targeted communities in low- and middle-income countries.
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Affiliation(s)
- Shantanu K Kar
- a Regional Medical Research Center (RMRC) ; Bhubaneswar , India
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49
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Ali M, You YA, Kanungo S, Manna B, Deen JL, Lopez AL, Wierzba TF, Bhattacharya SK, Sur D, Clemens JD. Assessing different measures of population-level vaccine protection using a case-control study. Vaccine 2015; 33:6878-83. [PMID: 26364121 DOI: 10.1016/j.vaccine.2015.07.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 07/13/2015] [Accepted: 07/16/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Case-control studies have not been examined for their utility in assessing population-level vaccine protection in individually randomized trials. METHODS We used the data of a randomized, placebo-controlled trial of a cholera vaccine to compare the results of case-control analyses with those of cohort analyses. Cases of cholera were selected from the trial population followed for three years following dosing. For each case, we selected 4 age-matched controls who had not developed cholera. For each case and control, GIS was used to calculate vaccine coverage of individuals in a surrounding "virtual" cluster. Specific selection strategies were used to evaluate the vaccine protective effects. RESULTS 66,900 out of 108,389 individuals received two doses of the assigned regimen. For direct protection among subjects in low vaccine coverage clusters, we observed 78% (95% CI: 47-91%) protection in a cohort analysis and 84% (95% CI: 60-94%) in case-control analysis after adjusting for confounding factors. Using our GIS-based approach, estimated indirect protection was 52% (95% CI: 10-74%) in cohort and 76% (95% CI: 47-89%) in case control analysis. Estimates of total and overall effectiveness were similar for cohort and case-control analyses. CONCLUSION The findings show that case-control analyses of individually randomized vaccine trials may be used to evaluate direct as well as population-level vaccine protection.
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Affiliation(s)
- Mohammad Ali
- International Vaccine Institute, Seoul, Republic of Korea; Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Young Ae You
- International Vaccine Institute, Seoul, Republic of Korea
| | - Suman Kanungo
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Byomkesh Manna
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Anna Lena Lopez
- University of the Philippines Manila, National Institutes of Health, Philippines
| | | | | | - Dipika Sur
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - John D Clemens
- icddr,b, Dhaka, Bangladesh; UCLA Fielding School of Public Health, Los Angeles, USA
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50
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Mogasale V, Kar SK, Kim JH, Mogasale VV, Kerketta AS, Patnaik B, Rath SB, Puri MK, You YA, Khuntia HK, Maskery B, Wierzba TF, Sah B. An Estimation of Private Household Costs to Receive Free Oral Cholera Vaccine in Odisha, India. PLoS Negl Trop Dis 2015; 9:e0004072. [PMID: 26352143 PMCID: PMC4564266 DOI: 10.1371/journal.pntd.0004072] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/19/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Service provider costs for vaccine delivery have been well documented; however, vaccine recipients' costs have drawn less attention. This research explores the private household out-of-pocket and opportunity costs incurred to receive free oral cholera vaccine during a mass vaccination campaign in rural Odisha, India. METHODS Following a government-driven oral cholera mass vaccination campaign targeting population over one year of age, a questionnaire-based cross-sectional survey was conducted to estimate private household costs among vaccine recipients. The questionnaire captured travel costs as well as time and wage loss for self and accompanying persons. The productivity loss was estimated using three methods: self-reported, government defined minimum daily wages and gross domestic product per capita in Odisha. FINDINGS On average, families were located 282.7 (SD = 254.5) meters from the nearest vaccination booths. Most family members either walked or bicycled to the vaccination sites and spent on average 26.5 minutes on travel and 15.7 minutes on waiting. Depending upon the methodology, the estimated productivity loss due to potential foregone income ranged from $0.15 to $0.29 per dose of cholera vaccine received. The private household cost of receiving oral cholera vaccine constituted 24.6% to 38.0% of overall vaccine delivery costs. INTERPRETATION The private household costs resulting from productivity loss for receiving a free oral cholera vaccine is a substantial proportion of overall vaccine delivery cost and may influence vaccine uptake. Policy makers and program managers need to recognize the importance of private costs and consider how to balance programmatic delivery costs with private household costs to receive vaccines.
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Affiliation(s)
- Vittal Mogasale
- International Vaccine Institute (IVI), Seoul, Republic of Korea
- * E-mail:
| | - Shantanu K. Kar
- Regional Medical Research Center (RMRC), Bhubaneswar, Odisha, India
| | - Jong-Hoon Kim
- International Vaccine Institute (IVI), Seoul, Republic of Korea
| | | | - Anna S. Kerketta
- Regional Medical Research Center (RMRC), Bhubaneswar, Odisha, India
| | | | | | - Mahesh K. Puri
- International Vaccine Institute (IVI), Seoul, Republic of Korea
| | - Young Ae You
- International Vaccine Institute (IVI), Seoul, Republic of Korea
| | | | - Brian Maskery
- International Vaccine Institute (IVI), Seoul, Republic of Korea
| | | | - Binod Sah
- International Vaccine Institute (IVI), Seoul, Republic of Korea
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